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1.
Nutr Cancer ; 75(1): 219-227, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35930377

RESUMO

Dietary factors show different effects on genetically diverse populations. Scientific research uses gene-environment interaction models to study the effects of dietary factors on genetically diverse populations for lung cancer risk. However, previous study designs have not investigated the degree of type I error inflation and, in some instances, have not corrected for multiple testing. Using a motivating investigation of diet-gene interaction and lung cancer risk, we propose a training and testing strategy and perform real-world simulations to select the appropriate statistical methods to reduce false-positive discoveries. The simulation results show that the unconstrained maximum likelihood (UML) method controls the type I error better than the constrained maximum likelihood (CML). The empirical Bayesian (EB) method can compete with the UML method in achieving statistical power and controlling type I error. We observed a significant interaction between SNP rs7175421 with dietary whole grain in lung cancer prevention, with an effect size (standard error) of -0.312 (0.112) for EB estimate. SNP rs7175421 may interact with dietary whole grains in modulating lung cancer risk. Evaluating statistical methods for gene-diet interaction analysis can help balance the statistical power and type I error.


Assuntos
Neoplasias Pulmonares , Grãos Integrais , Humanos , Teorema de Bayes , Dieta , Interação Gene-Ambiente , Neoplasias Pulmonares/genética
2.
Ophthalmic Res ; 66(1): 846-853, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36893745

RESUMO

INTRODUCTION: Patient decision aid (PDA) is a tool to prompt shared decision-making. The aim of this study was to evaluate the impact of a PDA on Chinese primary open-angle glaucoma patients. METHODS: All subjects were randomized into control and PDA group. The questionnaires, including 1) glaucoma knowledge; 2) 8-item Morisky medication adherence scale (MMAS-8); 3) 10-item glaucoma medication adherence self-efficacy scale (GMASES-10); and 4) 16-item decision conflict scale (DCS), were evaluated at baseline, 3- and 6-month follow-up. RESULTS: Totally, 156 subjects participated in this study, including 77 in the control group and 79 in the PDA group. Compared to the control group, PDA group showed around 1 point more improvement in disease knowledge at both 3 and 6 months (both p < 0.05), 2.5 (95% CI: [1.0, 4.1]) and 1.9 (95% CI: [0.2, 3.7]) points more improvement in GMASES-10 at 3 and 6 months, respectively, and reduction in DCS by 8.8 (95% CI: [4.6, 12.9]) points more at 3 months and 13.5 (95% CI: [8.9, 18.0]) points more at 6 months. No difference was detected in MMAS-8. CONCLUSION: PDA led to improvement in disease knowledge and self-confidence in medication adherence and reduced decision conflict compared to control group for at least 6 months.


Assuntos
Glaucoma de Ângulo Aberto , Humanos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Adesão à Medicação , Inquéritos e Questionários , Técnicas de Apoio para a Decisão , China
3.
Psychooncology ; 31(1): 46-53, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34314560

RESUMO

OBJECTIVE: To explore the role of personality traits in moderating the relation between COVID-19 risk perception and treatment adherence, and between risk perception and psychosocial distress in patients diagnosed with cancer. METHODS: An online survey (n = 1281) was conducted worldwide in seven countries (Austria, Germany, Hong Kong, Italy, Spain, Sweden, and Turkey). Inclusion criteria were to be 18 years of age or older, have received a cancer diagnosis, and be in treatment or follow-up. A few moderated regression models were performed with both personality traits and Hierarchical Taxonomy of Psychopathology super-spectra as moderators. RESULTS: Detachment, negative affectivity, psychoticism and all the super-spectra significantly moderated the relation between coronavirus risk perception and psychosocial distress, after the adjusting effect of confidence in safeguards. Only negative affectivity moderated the association between coronavirus risk perception and treatment adherence. CONCLUSIONS: Personality traits may foster the understanding of how a patient might adjust to cancer treatment and, more generically, to highly stressful events such as the COVID-19 pandemic. Further research is needed to confirm the results in different cancer stages and types.


Assuntos
COVID-19 , Neoplasias , Adolescente , Adulto , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Pandemias , Percepção , Personalidade , SARS-CoV-2 , Cooperação e Adesão ao Tratamento
4.
Psychooncology ; 31(6): 879-892, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35388525

RESUMO

OBJECTIVE: Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI-SF). We also report on associations between FCR and clinical and demographic characteristics. METHODS: This is a systematic review and individual participant data (IPD) meta-analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI-SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI-SF (range 0-36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. CONCLUSIONS: FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185).


Assuntos
Sobreviventes de Câncer , Adulto , Medo , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Transtornos Fóbicos , Prevalência
5.
Psychooncology ; 29(2): 271-279, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31663187

RESUMO

OBJECTIVE: This longitudinal study mapped distinct trajectories of fear of cancer recurrence (FCR) over 12 months among patients with breast (BC) or colorectal (CRC) cancer, and examined if metacognition, indirectly via attentional bias, intrusive thoughts and avoidance (hallmarks of cognitive attentional syndrome; CAS) predicted FCR trajectory membership. METHODS: Two hundred and seventy BC (n = 163) or CRC (n = 107) patients were assessed at 8-weeks, 3-, 6-, and 12-months postsurgery on a measure of FCR (FCRI-SF). Metacognition (MCQ-30), Intrusive and Avoidant Thoughts (CIES-R) and attentional bias (dot-probe tasks) were assessed at baseline. Latent growth mixture modeling identified FCR trajectories. Fully-adjusted Multinomial Logistic Regression identified whether direct and indirect effects of metacognition through CAS determined FCR trajectory membership. RESULTS: Three distinct FCR trajectories were identified, namely, low-stable (62.4%), high-stable (29.2%), and recovery (8.3%). Negative beliefs about worry, cognitive confidence, and age predicted FCR trajectories (χ2 (6) = 38.31, P<.001). Compared with Low-stable group, Recovery FCR patients held greater Negative beliefs about worry (OR = 1.13, P = .035) and High-stable FCR patients reported poorer Cognitive confidence (OR = 1.12, P = .004). The effect of Negative beliefs about worry was partially mediated by avoidance (ß = .06, 95% CIs 0.03-0.12) and fully mediated by intrusive thoughts (ß = .14, 95% CIs 0.08-0.20). Attentional bias did not predict FCR trajectories. CONCLUSIONS: While most patients experienced low level of FCR, 3 in 10 persistently worried about cancer returning over the first 12-months postsurgery. Modifying metacognitive knowledge to interrupt maladaptive cognitive processing including intrusion and avoidance may be an effective therapeutic intervention for patients at risk of persistent FCR.


Assuntos
Ansiedade/psicologia , Atenção , Neoplasias da Mama/psicologia , Neoplasias Colorretais/psicologia , Metacognição , Recidiva Local de Neoplasia/psicologia , Transtornos Fóbicos/psicologia , Adulto , Idoso , Atenção/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Metacognição/fisiologia , Pessoa de Meia-Idade
6.
Psychooncology ; 28(6): 1243-1251, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30932279

RESUMO

OBJECTIVE: Fear of cancer recurrence (FCR) represents a chronic burden for many cancer survivors. We determined FCR prevalence and potential correlates, specifically metacognitive styles and neuroticism among Chinese cancer survivors with breast or colorectal cancer. METHODS: This study included 285 Chinese patients with breast (N = 173) and colorectal (N = 112) cancers at 8-week postsurgery. Participants completed a set of baseline questionnaires evaluating FCR (Fear of Cancer Recurrence Inventory-Short Form [FCRI-SF]), metacognition (Metacognitions Questionnaire-30), and neuroticism (Eysenck Personality Questionnaire). Scores of 13 to 21 were indicative of subclinical FCR on the FCRI-SF. Scores greater than or equal to 22 indicated clinically significant levels of FCR. Fully adjusted multinomial logistic regressions identified correlates of subclinical and clinically significant FCR. RESULTS: Respectively, 26.0% (n = 74) and 11.2% (n = 32) achieved scores indicating subclinical and clinically significant FCR. Expressing significantly more positive (OR = 1.21, P = .003) and negative (OR = 1.19, P = .005) beliefs about worry was associated with a higher likelihood of reporting subclinical FCR. Both higher neuroticism (OR = 1.28, P = .003) and more negative beliefs about worry (OR = 1.19, P = 0.035) were associated with an increased likelihood of experiencing clinically significant FCR. CONCLUSIONS: Positive and negative metacognitions may play an important role in the development of subclinical FCR. In particular, negative metacognition and neuroticism may elevate FCR from subclinical to a clinical level. The findings give insight into the identification of cancer survivors with subclinical or clinical FCR and aid the development of interventions aimed at changing metacognitive beliefs in order to manage FCR.


Assuntos
Sobreviventes de Câncer/psicologia , Medo/psicologia , Metacognição , Recidiva Local de Neoplasia/psicologia , Neuroticismo , Adulto , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
7.
BMC Cancer ; 18(1): 162, 2018 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-29415669

RESUMO

BACKGROUND: The present study (1) examined patient satisfaction with care over the first year following the diagnosis of advanced breast cancer and (2) tested if unmet health system and information needs, physical symptom distress, and psychological distress predicted patient satisfaction. METHODS: Prospective study of 213 Chinese women with advanced breast cancer assessed while awaiting or receiving initial chemotherapy (baseline), then again at 1.5-, 3-, 6-, and 12-months post-baseline. Health system and information unmet (HSI) needs, psychological distress, physical symptom distress, and patient satisfaction were assessed at baseline; patient satisfaction was reassessed at each follow-up assessment. Latent growth curve analysis assessed changes in patient satisfaction over the 12 months follow-up; hierarchical multiple regression analysis tested if baseline health system information needs, physical symptom distress, anxiety and depression predicted patient satisfaction at one-year post-baseline. RESULTS: The level of patient satisfaction was high and did not change significantly over time. Only HSI needs (ß = - 0.27, p < 0.005) significantly associated with baseline patient satisfaction. Patient satisfaction at one-year post-baseline was predicted by HSI needs (ß = - 0.26, p < 0.005), Anxiety (ß = 0.23, p < 0.05) and Depression (ß = - 0.28, p < 0.005), adjusting for the effect of baseline patient satisfaction (ß = 0.22, p < 0.005). CONCLUSIONS: Unmet health information needs and greater depressive symptoms at initial treatment phased predicted subsequent poorer patient satisfaction. This highlights a need to reinforce the importance of patient-centered care model in managing advanced breast cancer.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/psicologia , Satisfação do Paciente , Estresse Psicológico/psicologia , Ansiedade/etnologia , Ansiedade/psicologia , Povo Asiático/psicologia , Neoplasias da Mama/etnologia , China , Depressão/etnologia , Depressão/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Análise de Regressão , Estresse Psicológico/etnologia , Inquéritos e Questionários
8.
Psychooncology ; 27(3): 983-989, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29274295

RESUMO

OBJECTIVE: To examine if bias in attention to and interpretation of cancer-related stimuli differentiates women with persistent psychological distress from those with low/transient distress following breast cancer. METHODS: One-hundred forty women classified in a prior longitudinal study as having low (n = 73) or persistent high (n = 67) distress completed 2 modified dot-probe tasks assessing attention bias and an ambiguous cues task assessing interpretation bias toward cancer-related vs neutral information. Psychological distress was assessed using the Hospital Anxiety Depression Scale. Four-way repeated analysis of variance was adopted. RESULTS: Participants with persistent high distress from the original study who continued to report high Hospital Anxiety Depression Scale scores (≥8) on recruitment into the present study comprised the persistent distress group (ie, 31 reporting high anxiety and 30 reporting high depression scores). Persistent distress and low distress groups did not differ in attentional bias toward negative-stimuli or cancer-related information, but a significant time-course effect in attentional bias toward negative-stimuli or cancer-related information was observed, with women in the persistent distress group showing a significant bias away from negative-stimuli or cancer-related information under supraliminal conditions. There was a borderline difference in interpretation bias scores between low anxiety and chronic anxiety groups (P = .065), with correlation suggesting a significant positive association (r = 0.20, P = .019). CONCLUSION: Women with persistent distress may adopt avoidance strategies to cope with breast cancer. Moreover, women reporting persistent anxiety may have a tendency to negatively interpret ambiguous information, leading to illness preoccupation. These findings offer critical insight for clinicians to develop tailored interventions to help women with persistent psychological distress.


Assuntos
Ansiedade/psicologia , Viés de Atenção/fisiologia , Neoplasias da Mama/psicologia , Depressão/psicologia , Estresse Psicológico/psicologia , Pensamento/fisiologia , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade
9.
Psychooncology ; 25(5): 496-505, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26333916

RESUMO

OBJECTIVE: Our aim is to determine supportive care needs trajectories over the first year following colorectal cancer (CRC) surgery and identify factors differentiating these trajectories in a sample of Hong Kong Chinese CRC patients. METHODS: Overall, 247/274 Chinese patients diagnosed with CRC were recruited and assessed following admission for colorectal surgery, then at 1, 4, 8, and 12 months post-surgery. Supportive care needs were assessed at each assessment point. Latent growth mixture modeling identified trajectories within each of five assessed needs domains: health system and information (HSI), psychological (PSY), physical daily living (PDL), patient care and support (PCS), and sexuality (SEX) needs. RESULTS: Results indicated four needs trajectories each for HSI, PSY, and PDL domains, three for the PCS and two for the SEX domains. Most patients showed stable low levels of unmet PSY (86%), PDL (86%), PCS (81%), and SEX (98%) supportive care needs. One in seven patients showed persistent high, unmet HSI needs. The coexistence of two or more unmet need domains were found among patients in the high-decline needs group. HSI trajectories were predicted by education level and positive cancer-related rumination, PSY and PCS needs; PSY trajectories were predicted by stoma and HSI needs; PDL trajectories were predicted by physical symptom distress, stoma, PCS, and HSI needs; PCS trajectories were predicted by negative cancer-related rumination, depression, HSI, and PSY needs. CONCLUSIONS: These Chinese CRC patients showed generally low stable supportive care needs, but a minority demonstrated high persistent unmet needs. Supportive care services should target those at risk of prolonged high unmet needs.


Assuntos
Povo Asiático/psicologia , Neoplasias Colorretais/psicologia , Necessidades e Demandas de Serviços de Saúde , Avaliação das Necessidades , Apoio Social , Adulto , Idoso , Ansiedade/etnologia , Ansiedade/etiologia , Ansiedade/psicologia , Povo Asiático/estatística & dados numéricos , China/epidemiologia , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/cirurgia , Depressão/etnologia , Depressão/etiologia , Depressão/psicologia , Transtorno Depressivo , Feminino , Hong Kong , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente , Sexualidade , Fatores Socioeconômicos , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
10.
Psychooncology ; 25(1): 58-65, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26087143

RESUMO

OBJECTIVE: A diagnosis of advanced breast cancer (ABC) challenges a woman's ambitions. This longitudinal study explored (1) if goal adjustment disposition influenced psychological adjustment patterns among women with ABC and (2) if dispositional hope and optimism moderate effects of goal adjustment on psychological adjustment. METHODS: One hundred ninety three out of 225 women with ABC were assessed while they were awaiting/receiving initial chemotherapy, then again at 6 weeks, 3 months, 6 months, and 12 months post-baseline. Goal disengagement, goal reengagement, optimism, hope, and psychological adjustment (anxiety, depression, and positive affect) were assessed at baseline; psychological adjustment was reassessed at each follow-up. Latent growth curve modeling was used to examine the change of psychological adjustment and test the study objectives. RESULTS: High goal disengagement, low reengagement, and high optimism were associated with lower initial anxiety, while high goal disengagement and optimism predicted a slower rate of change in anxiety. High goal disengagement, reengagement, and optimism were associated with lower initial depression. High goal reengagement, optimism, and hope were associated with initial positive affect scores, while optimism predicted its rate of change. Optimism moderated the effect of goal disengagement on anxiety and depression, whereas hope moderated the effect of goal reengagement on positive affect. CONCLUSION: Goal disengagement and reengagement are two relatively independent processes influencing psychological well-being. These findings will help clinicians to tailor specific interventions to help women coping with the diagnosis of ABC.


Assuntos
Adaptação Psicológica , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Objetivos , Afeto , Idoso , Ansiedade/psicologia , Depressão/psicologia , Feminino , Seguimentos , Esperança , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Otimismo/psicologia , Personalidade
13.
Health Expect ; 18(2): 210-20, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23167846

RESUMO

OBJECTIVE: The decisional conflict scale (DCS) measures the perception of uncertainty in choosing options, factors contributing to decision conflict and effective decision making. This study examined the validity and reliability of the Chinese version of the DCS in Hong Kong Chinese women deciding breast cancer (BC) surgery. METHOD: A Chinese version of the 16-item DCS was administered to 471 women awaiting initial consultation for BC diagnosis. Confirmatory factor analysis (CFA) assessed the factor structure. Internal consistency, and convergent and discriminant validities of the factor structure were assessed. RESULTS: CFA revealed the original factor structure of the DCS showed poor fit to this sample. Exploratory factor analysis revealed an alternative three-factor structure, Informed and Values Clarity, Uncertainty and Effective Decision and Support, was optimal. Cronbach's alpha ranged from 0.51 to 0.87. Correlations between decision-making difficulties and satisfaction with medical consultation demonstrated acceptable convergent validity. Construct validity was supported by correlations between decision regret and psychological distress. Discriminant validity was supported by differentiation between delaying and non-delaying decision-makers. CONCLUSIONS: The three-factor DCS-14 is a valid and practical measure for assessing decisional conflict in deciding BC surgery. It shows good potential for use in assessing decision satisfaction for women diagnosed with BC.


Assuntos
Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Tomada de Decisões , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Análise Fatorial , Feminino , Hong Kong , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Percepção , Psicometria , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Incerteza
14.
Health Expect ; 18(6): 2825-40, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25200668

RESUMO

BACKGROUND: While previous studies have analysed features of interaction in cancer consultations using observational coding frames, relatively little attention is being given to how actual interactions are sequentially organized and achieved by participants in the course of talk-in-interaction. Research into the interactional practices in consultations, which involves Chinese patients, is largely absent. OBJECTIVE: To provide insight into the talk-in-interaction in surgical-oncology consultations in the context of a Chinese medical setting. METHODS: Thirty-one consultations involving 31 patients with breast cancer and eight surgeons were videotaped. The recordings were transcribed verbatim and analysed using conversation analysis. RESULTS: The manner in which surgeons delivered the diagnostic results was fairly similar across all the consultations. Most surgeons gave the diagnosis in a very straightforward and abrupt manner at the outset of the consultation with no mitigation. While patients in our study conformed to the traditional information giving and receiving roles, how information was presented by surgeons shaped the subsequent sequential organization of surgeon-patient interaction and turn-taking patterns. More importantly, there was a tendency by the surgeons to move from issues of psychosocial nature to clinical matters regardless of the topics taken up in the specific encounter. CONCLUSIONS: This study demonstrated the potential of conversation analysis as a context-sensitive method that enabled researchers to gain a more thorough understanding of dynamics of interaction in cancer consultations, thereby informing training interventions for surgeons. Our findings underscore the importance of discursive practices in shaping and encouraging (or discouraging) patient participation in oncology consultation.


Assuntos
Neoplasias da Mama/psicologia , Comunicação , Oncologia , Relações Médico-Paciente , Adulto , Idoso , Neoplasias da Mama/cirurgia , China , Feminino , Humanos , Oncologia/métodos , Pessoa de Meia-Idade , Gravação em Vídeo
15.
Hong Kong Med J ; 21(6): 518-23, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26371157

RESUMO

OBJECTIVES: To review all paediatric patients with intussusception over the last 17 years. DESIGN: Retrospective case series. SETTING: A tertiary centre in Hong Kong. PATIENTS: Children who presented with intussusception from January 1997 to December 2014 were reviewed. MAIN OUTCOME MEASURES: The duration of symptoms, successful treatment modalities, complication rate, and length of hospital stay were studied. RESULTS: A total of 173 children (108 male, 65 female) presented to our hospital with intussusception during the study period. Their median age at presentation was 12.5 months (range, 2 months to 16 years) and the mean duration of symptoms was 2.3 (standard deviation, 1.8) days. Vomiting was the most common symptom (76.3%) followed by abdominal pain (46.2%), per rectal bleeding or red currant jelly stool (40.5%), and a palpable abdominal mass (39.3%). Overall, 160 patients proceeded to pneumatic or hydrostatic reduction, among whom 127 (79.4%) were successful. Three (1.9%) patients had bowel perforation during the procedure. Early recurrence of intussusception occurred in four (3.1%) patients with non-operative reduction. No recurrence was reported in the operative group. The presence of a palpable abdominal mass was a risk factor for operative treatment (relative risk=2.0; 95% confidence interval, 1.8-2.2). Analysis of our results suggested that duration of symptoms did not affect the success rate of non-operative reduction. CONCLUSIONS: Non-operative reduction has a high success rate and low complication rate, but the presence of a palpable abdominal mass is a risk factor for failure. Operative intervention should not be delayed in those patients who encounter difficult or doubtful non-operative reduction.


Assuntos
Enteropatias/complicações , Intussuscepção/complicações , Neoplasias Abdominais/etiologia , Neoplasias Abdominais/cirurgia , Dor Abdominal/etiologia , Adolescente , Criança , Pré-Escolar , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Hemorragia Gastrointestinal/etiologia , Hong Kong , Humanos , Lactente , Enteropatias/cirurgia , Perfuração Intestinal/etiologia , Intussuscepção/cirurgia , Tempo de Internação , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Resultado do Tratamento , Vômito/etiologia
16.
BMC Infect Dis ; 14: 169, 2014 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-24674239

RESUMO

BACKGROUND: Few studies have investigated associations between psychological and behavioral indices throughout a major epidemic. This study was aimed to compare the strength of associations between different cognitive and affective measures of risk and self-reported protective behaviors in a series of ten cross-sectional surveys conducted throughout the first wave of influenza A/H1N1 pandemic. METHODS: All surveys were conducted using questionnaire-based telephone interviews, with random digit dialing to recruit adults from the general population. Measures of anxiety and worry (affective) and perceived risk (cognitive) regarding A/H1N1 were made in 10 serial surveys. Multivariate logistic regression models were used to estimate the cognitive/affective-behavioral associations in each survey while multilevel logistic models were conducted to estimate the average effects of each cognitive/affective measure on adoption of protective behaviors throughout the ten surveys. RESULTS: Excepting state anxiety, other affective measures including "anticipated worry", "experienced worry" and "current worry" specific to A/H1N1 risk were consistently and strongly associated with adoption of protective behaviors across different survey periods. However, the cognitive-behavioral associations were weaker and inconsistent across the ten surveys. Perceived A/H1N1 severity relative to SARS had stronger associations with adoption of protective behaviors in the late epidemic periods than in the early epidemic periods. CONCLUSION: Risk-specific worries appear to be significantly associated with the adoption of protective behaviors at different epidemic stages, whereas cognitive measures may become more important in understanding people's behavioral responses later in epidemics. Future epidemic-related psycho-behavioral research should include more affective-loaded measures of risk.


Assuntos
Ansiedade/epidemiologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/psicologia , Pandemias , Adulto , Estudos Transversais , Medo/psicologia , Hong Kong/epidemiologia , Humanos , Influenza Humana/epidemiologia , Entrevistas como Assunto , Percepção , Medição de Risco
17.
BMC Cardiovasc Disord ; 14: 49, 2014 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-24725620

RESUMO

BACKGROUND: Iron may damage sarcomeric proteins through oxidative stress. We explored the left ventricular (LV) torsional mechanics in patients with beta-thalassaemia major and its relationship to myocardial iron load. Using HL-1 cell and B6D2F1 mouse models, we further determined the impact of iron load on proteolysis of the giant sarcomeric protein titin. METHODS AND RESULTS: In 44 thalassaemia patients aged 25 ± 7 years and 38 healthy subjects, LV torsion and twisting velocities were determined at rest using speckle tracking echocardiography. Changes in LV torsional parameters during submaximal exercise testing were further assessed in 32 patients and 17 controls. Compared with controls, patients had significantly reduced LV apical rotation, torsion, systolic twisting velocity, and diastolic untwisting velocity. T2* cardiac magnetic resonance findings correlated with resting diastolic untwisting velocity. The increments from baseline and resultant LV torsion and systolic and diastolic untwisting velocities during exercise were significantly lower in patients than controls. Significant correlations existed between LV systolic torsion and diastolic untwisting velocities in patients and controls, both at rest and during exercise. In HL-1 cells and ventricular myocardium of B6D2F1 mice overloaded with iron, the titin-stained pattern of sarcomeric structure became disrupted. Gel electrophoresis of iron-overloaded mouse myocardial tissue further showed significant decrease in the amount of titin isoforms and increase in titin degradation products. CONCLUSIONS: Resting and dynamic LV torsional mechanics is impaired in patients with beta-thalassaemia major. Cell and animal models suggest a potential role of titin degradation in iron overload-induced alteration of LV torsional mechanics.


Assuntos
Ferro/metabolismo , Contração Miocárdica , Miocárdio/metabolismo , Proteínas Quinases/metabolismo , Talassemia/metabolismo , Função Ventricular Esquerda , Adolescente , Adulto , Animais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Linhagem Celular , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Camundongos , Miócitos Cardíacos/metabolismo , Estudos Prospectivos , Proteólise , Talassemia/complicações , Talassemia/diagnóstico por imagem , Talassemia/fisiopatologia , Torção Mecânica , Ultrassonografia , Adulto Jovem
18.
Support Care Cancer ; 22(3): 635-44, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24158684

RESUMO

PURPOSE: This longitudinal study examined if the evolution of supportive care needs differed over the first year following the diagnosis of advanced breast cancer and examined factors differentiating these trajectories. METHODS: Two hundred twenty-eight of 276 Chinese women with advanced breast cancer were assessed while they were awaiting or receiving initial chemotherapy, then again at 6 weeks, 3 months, 6 months, and 12 months post-baseline. Supportive care needs (SCNS-34-Ch), psychological distress (Hospital Anxiety and Depression scale), symptom distress (MSAS-Ch), and patient satisfaction (PSEQ-9) were assessed at baseline; supportive care needs were reassessed at each follow-up assessment. Latent growth mixture modeling explored if trajectories differed within each of four need domains: health system, information, and patient support (HSIPS); psychological; physical daily living (PDL); and sexuality needs. Logistic regression identified factors predicting trajectory patterns. RESULTS: Two distinct trajectories were identified for HSIPS and sexuality need domains and three distinct trajectories for psychological and physical daily living need domains. Most women showed stable low levels of HSIPS (78.9 %), psychological (82.4 %), PDL (83.7 %), and sexuality (97.4 %) supportive care needs. One in five and one in eight women showed high initial supportive care needs in HSIPS and psychological and PDL domains, respectively. With the exception of sexuality needs, trajectory patterns were predicted by physical symptom distress. Women in the high-decline group reported greater physical symptom distress. CONCLUSIONS: Most Chinese women with advanced breast cancer showed low stable supportive care needs. Physical symptom distress predicted high supportive care needs. Interventions should focus on optimizing symptom assessment and management.


Assuntos
Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Necessidades e Demandas de Serviços de Saúde , Administração dos Cuidados ao Paciente , Atividades Cotidianas/psicologia , Adulto , China , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Saúde Reprodutiva , Inquéritos e Questionários
19.
BMC Public Health ; 14: 133, 2014 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-24507384

RESUMO

BACKGROUND: While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children's vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. METHODS: Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. RESULTS: Participants' conversation revealed five underlying themes which influenced parents' vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents' vaccination decision making. Institutional factors shaped parent's perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. CONCLUSIONS: Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme.


Assuntos
Defesa da Criança e do Adolescente/estatística & dados numéricos , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Mães/psicologia , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Criança , China/etnologia , Tomada de Decisões , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Hong Kong , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Vacinas contra Papillomavirus/uso terapêutico , Normas Sociais
20.
J Clin Transl Sci ; 8(1): e9, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38384917

RESUMO

The proposal of improving reproducibility by lowering the significance threshold to 0.005 has been discussed, but the impact on conducting clinical trials has yet to be examined from a study design perspective. The impact on sample size and study duration was investigated using design setups from 125 phase II studies published between 2015 and 2022. The impact was assessed using percent increase in sample size and additional years of accrual with the medians being 110.97% higher and 2.65 years longer respectively. The results indicated that this proposal causes additional financial burdens that reduce the efficiency of conducting clinical trials.

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