Publications by authors named "Joanne Chan"

55 Publications

Prediction of labour onset in women who present with symptoms of preterm labour using cervical length.

BMC Pregnancy Childbirth 2021 May 5;21(1):359. Epub 2021 May 5.

Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore.

Background: Diagnosis of preterm labour is difficult because initial symptoms and signs are often mild and may occur in continuing pregnancies. This study aims to investigate the utility of measuring cervical length, using transvaginal ultrasound, in women presenting to the delivery suite with symptoms of preterm labour.

Methods: This was a prospective cohort study performed in KK Women's and Children's Hospital, Singapore from September 2017 to July 2018. Women with singleton pregnancies, presenting with symptoms of contraction pain, between 24 to 36 weeks gestation, were included. Transvaginal ultrasound cervical length measurements were done at presentation to the labour ward, after four hours and in the following morning. The primary outcome of the study was delivery within 1 week. All statistical analyses were conducted with Microsoft Excel and Statistical Package for the Social Sciences.

Results: A total of 95 subjects were included. A one-millimeter increase in the 1st cervical length increases scan-to-delivery time by 0.802 days (p-value 0.003, CI 0.280-1.323). Receiver Operator Characteristic (ROC) curve analysis for prediction of delivery within 1 week showed an Area Under Curve (AUC) of 0.667, optimal cut-off value of 27.5mm (sensitivity 77.8 %, specificity 61.6 %). A one-millimetre increase in the 3rd cervical length increases scan-to-delivery time by 0.770 days (p-value 0.023, CI 0.108-1.432). ROC curve analysis for prediction of delivery within 1 week showed an AUC of 0.915, optimal cut-off value of 25.5mm (sensitivity 100 %, specificity 73.6 %). However, the change in cervical length over a period of 1 day was not significant in predicting delivery within 1 week.

Conclusions: Our results indicate that by using a cervical length cut off of 27.5mm at presentation, we would have predicted 77.8 % of deliveries within 1 week. If we were to repeat the cervical length scan the next day, with the same cut-off of 27.5mm, we would have predicted 100 % of deliveries within 1 week. In our study, measuring the transvaginal ultrasound cervical length is a reliable diagnostic test for delivery within 1 week. However, the results are limited by the small sample size. Further studies should be conducted with a larger sample size.
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http://dx.doi.org/10.1186/s12884-021-03828-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097783PMC
May 2021

A genome-wide atlas of co-essential modules assigns function to uncharacterized genes.

Nat Genet 2021 05 15;53(5):638-649. Epub 2021 Apr 15.

Department of Genetics, Stanford University, Stanford, CA, USA.

A central question in the post-genomic era is how genes interact to form biological pathways. Measurements of gene dependency across hundreds of cell lines have been used to cluster genes into 'co-essential' pathways, but this approach has been limited by ubiquitous false positives. In the present study, we develop a statistical method that enables robust identification of gene co-essentiality and yields a genome-wide set of functional modules. This atlas recapitulates diverse pathways and protein complexes, and predicts the functions of 108 uncharacterized genes. Validating top predictions, we show that TMEM189 encodes plasmanylethanolamine desaturase, a key enzyme for plasmalogen synthesis. We also show that C15orf57 encodes a protein that binds the AP2 complex, localizes to clathrin-coated pits and enables efficient transferrin uptake. Finally, we provide an interactive webtool for the community to explore our results, which establish co-essentiality profiling as a powerful resource for biological pathway identification and discovery of new gene functions.
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http://dx.doi.org/10.1038/s41588-021-00840-zDOI Listing
May 2021

Exposure to DMSO during infancy alters neurochemistry, social interactions, and brain morphology in long-evans rats.

Brain Behav 2021 05 10;11(5):e02146. Epub 2021 Apr 10.

Department of Pathology and Laboratory Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA.

Introduction: Dimethyl sulfoxide (DMSO) is a widely used solvent to dissolve hydrophobic substances for clinical uses and experimental in vivo purposes. While usually regarded safe, our prior studies suggest changes to behavior following DMSO exposure. We therefore evaluated the effects of a five-day, short-term exposure to DMSO on postnatal infant rats (P6-10).

Methods: DMSO was intraperitoneally injected for five days at 0.2, 2.0, and 4.0 ml/kg body mass. One cohort of animals was sacrificed 24 hr after DMSO exposure to analyze the neurometabolic changes in four brain regions (cortex, hippocampus, basal ganglia, and cerebellum) by hydrophilic interaction liquid chromatography. A second cohort of animals was used to analyze chronic alterations to behavior and pathological changes to glia and neuronal cells later in life (P21-P40).

Results: 164 metabolites, including key regulatory molecules (retinoic acid, orotic acid, adrenic acid, and hypotaurine), were found significantly altered by DMSO exposure in at least one of the brain regions at P11 (p < .05). Behavioral tests showed significant hypoactive behavior and decreased social habits to the 2.0 and 4.0 ml DMSO/kg groups (p < .01). Significant increases in number of microglia and astrocytes at P40 were observed in the 4.0 ml DMSO/kg group (at p < .015.) CONCLUSIONS: Despite short-term exposure at low, putatively nontoxic concentrations, DMSO led to changes in behavior and social preferences, chronic alterations in glial cells, and changes in essential regulatory brain metabolites. The chronic neurological effects of DMSO exposure reported here raise concerns about its neurotoxicity and consequent safety in human medical applications and clinical trials.
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http://dx.doi.org/10.1002/brb3.2146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119844PMC
May 2021

RobNorm: model-based robust normalization method for labeled quantitative mass spectrometry proteomics data.

Bioinformatics 2021 05;37(6):815-821

Department of Genetics, Stanford University, Stanford, CA 94305, USA.

Motivation: Data normalization is an important step in processing proteomics data generated in mass spectrometry experiments, which aims to reduce sample-level variation and facilitate comparisons of samples. Previously published methods for normalization primarily depend on the assumption that the distribution of protein expression is similar across all samples. However, this assumption fails when the protein expression data is generated from heterogenous samples, such as from various tissue types. This led us to develop a novel data-driven method for improved normalization to correct the systematic bias meanwhile maintaining underlying biological heterogeneity.

Results: To robustly correct the systematic bias, we used the density-power-weight method to down-weigh outliers and extended the one-dimensional robust fitting method described in the previous work to our structured data. We then constructed a robustness criterion and developed a new normalization algorithm, called RobNorm.In simulation studies and analysis of real data from the genotype-tissue expression project, we compared and evaluated the performance of RobNorm against other normalization methods. We found that the RobNorm approach exhibits the greatest reduction in systematic bias while maintaining across-tissue variation, especially for datasets from highly heterogeneous samples.

Availabilityand Implementation: https://github.com/mwgrassgreen/RobNorm.

Supplementary Information: Supplementary data are available at Bioinformatics online.
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http://dx.doi.org/10.1093/bioinformatics/btaa904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098025PMC
May 2021

A Quantitative Proteome Map of the Human Body.

Cell 2020 10 10;183(1):269-283.e19. Epub 2020 Sep 10.

Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address:

Determining protein levels in each tissue and how they compare with RNA levels is important for understanding human biology and disease as well as regulatory processes that control protein levels. We quantified the relative protein levels from over 12,000 genes across 32 normal human tissues. Tissue-specific or tissue-enriched proteins were identified and compared to transcriptome data. Many ubiquitous transcripts are found to encode tissue-specific proteins. Discordance of RNA and protein enrichment revealed potential sites of synthesis and action of secreted proteins. The tissue-specific distribution of proteins also provides an in-depth view of complex biological events that require the interplay of multiple tissues. Most importantly, our study demonstrated that protein tissue-enrichment information can explain phenotypes of genetic diseases, which cannot be obtained by transcript information alone. Overall, our results demonstrate how understanding protein levels can provide insights into regulation, secretome, metabolism, and human diseases.
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http://dx.doi.org/10.1016/j.cell.2020.08.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575058PMC
October 2020

Can mindfulness-based interventions benefit people with dementia? Drawing on the evidence from a systematic review in populations with cognitive impairments.

Expert Rev Neurother 2020 11 6;20(11):1143-1156. Epub 2020 Oct 6.

Department of Clinical, Educational and Health Psychology, University College London , London, UK.

Introduction: Non-pharmacological interventions that promote quality of life in people with dementia are urgently needed. To accelerate development, evidence-based psychotherapies used in other populations can be considered. Mindfulness-based interventions with standardized protocols, namely mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR), may be effective in people with dementia, although tailoring for cognitive impairment may be needed. Evidence from other cognitive disorders can inform research.

Areas Covered: The authors reviewed 12 studies of MBCT/MBSR conducted in people with cognitive impairments, including 10 in stroke, traumatic brain injury, and mild cognitive impairment; and two in dementia. Protocol modifications, outcomes, and evidence quality were analyzed. Common themes to address cognitive difficulties included: shortened session duration, use of memory aids, increase in repetition, simplified language, and omitted retreat sessions.

Expert Opinion: MBCT and MBSR can be applied without drastic modifications in people with cognitive impairment. Their effectiveness in people with dementia remains unknown: empirical studies using/adapting evidence-based MBCT/MBSR protocols in this population is seriously lacking. Studies used a diverse range of outcome measures, which made direct comparison difficult. Further research with high methodological quality, sufficient power, and longer follow-up is urgently needed. Development of manuals would enhance the replicability of future studies.
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http://dx.doi.org/10.1080/14737175.2020.1810571DOI Listing
November 2020

Visually mediated functioning improves following treatment of hoarding disorder.

J Affect Disord 2020 03 20;264:310-317. Epub 2019 Dec 20.

Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, College of Medicine, University of Florida, 100 S Newell Drive, L4-100, Gainesville FL 32610, USA. Electronic address:

Background: Hoarding disorder (HD) is a highly debilitating psychiatric disorder that affects 2-6% of adults. Neuropsychological deficits in visual memory, detection, and categorization have been reported in HD. To date, no study has examined the relationship between neurocognitive functioning and treatment for HD. We aim to determine the association between neurocognitive functioning and treatment outcomes, as well as the impact of HD-specific treatment on cognitive functioning.

Methods: 323 individuals with HD were randomized to 20 weeks of peer- or clinician-led group behavioral treatment. 242 participants completed pre- and post-treatment neuropsychological testing covering eight neurocognitive domains. Rates of cognitive impairment (CI) were assessed for each neurocognitive domain. The association of baseline neurocognitive function on treatment response was examined using multiple regression. MANOVA and post-hoc tests were used to determine neurocognitive performance change pre- to post treatment.

Results: Sixty-seven percent of participants had CI on ≥1 cognitive domain. There was no significant effect of pre-treatment neurocognitive functioning on treatment outcome. Post-treatment improvements were observed in visual memory, visual detection, decision making, information processing speed, visuospatial processing, attention/working memory (p≤.001). Declines in performance were found in visual reaction time and categorization.

Limitations: This was a non-inferiority trial to examine two treatment types with no normative comparison group. Treatment seeking individuals are more likely to be insightful, motivated, and have other features which limit generalizability.

Conclusions: Patterns of cognitive impairment in HD are similar to previous reports. Pre-treatment neurocognitive functioning did not impact treatment response. Neuropsychological functioning improved across multiple domains following targeted treatment.
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http://dx.doi.org/10.1016/j.jad.2019.12.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056607PMC
March 2020

Systematic Identification of Host Cell Regulators of Legionella pneumophila Pathogenesis Using a Genome-wide CRISPR Screen.

Cell Host Microbe 2019 10 17;26(4):551-563.e6. Epub 2019 Sep 17.

Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address:

During infection, Legionella pneumophila translocates over 300 effector proteins into the host cytosol, allowing the pathogen to establish an endoplasmic reticulum (ER)-like Legionella-containing vacuole (LCV) that supports bacterial replication. Here, we perform a genome-wide CRISPR-Cas9 screen and secondary targeted screens in U937 human monocyte/macrophage-like cells to systematically identify host factors that regulate killing by L. pneumophila. The screens reveal known host factors hijacked by L. pneumophila, as well as genes spanning diverse trafficking and signaling pathways previously not linked to L. pneumophila pathogenesis. We further characterize C1orf43 and KIAA1109 as regulators of phagocytosis and show that RAB10 and its chaperone RABIF are required for optimal L. pneumophila replication and ER recruitment to the LCV. Finally, we show that Rab10 protein is recruited to the LCV and ubiquitinated by the effectors SidC/SdcA. Collectively, our results provide a wealth of previously undescribed insights into L. pneumophila pathogenesis and mammalian cell function.
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http://dx.doi.org/10.1016/j.chom.2019.08.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800164PMC
October 2019

Treating hoarding disorder with compassion-focused therapy: A pilot study examining treatment feasibility, acceptability, and exploring treatment effects.

Br J Clin Psychol 2020 Mar 4;59(1):1-21. Epub 2019 Jul 4.

Department of Psychiatry, University of California, San Francisco, California, USA.

Objectives: Hoarding disorder (HD) was recognized as a psychiatric disorder in 2013. Existing literature suggests room for improvement in its treatment. The current pilot study aimed to provide an initial evaluation on the potential of compassion-focused therapy (CFT) as an intervention for HD, with the primary aim being assessing its feasibility and acceptability, and the secondary being evaluating its effects.

Design: Both CFT and a second round of the current standard of treatment and cognitive behavioural therapy (CBT) were investigated in the current study as follow-up treatment options for individuals who had completed CBT but were still significantly symptomatic.

Methods: Forty eligible individuals were enrolled (20 in each treatment). Treatment feasibility and acceptability were assessed by quantitative and qualitative measures. To explore treatment effects, HD symptom severity, HD-related dysfunctions, and their underlying mechanisms were assessed pre-treatment and post-treatment.

Results: Retention rates were 72% for CFT and 37% for CBT. All participants and 79% of the participants rated CFT and CBT, respectively, as good or excellent. After receiving CFT as a follow-up treatment, HD symptom severity dropped below the cut-off point for clinically significant HD for 77% of the treatment completers, and 62% achieved clinically significant reduction in symptom severity. In contrast, after completing a second course of CBT, 23% had HD symptom severity dropped below the cut-off threshold, and 29% achieved clinically significant symptom reduction.

Conclusions: The current study showed satisfactory feasibility and acceptability of CFT. Moreover, it also found promising effects of CFT in addressing hoarding-related mechanisms that may not have been sufficiently addressed by CBT. The results suggest promising potential of CFT as a treatment for HD. Further investigation on this intervention is needed.

Practitioner Points: CFT may be a promising treatment option, particularly for those who do not respond well to CBT. Improving emotion regulation and negative self-perception by applying CFT interventions may help relieve hoarding symptoms. Generalization of the findings should be applied with caution given the small convenience sample of the current study. Statistical comparison on treatment effect measures between CFT and CBT as follow-up treatments was not available due to small sample size. Therefore, the comparative conclusions based on this pilot study should be made with caution.
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http://dx.doi.org/10.1111/bjc.12228DOI Listing
March 2020

Recruiting under-represented populations into psychiatric research: Results from the help for hoarding study.

Contemp Clin Trials Commun 2018 Dec 9;12:169-175. Epub 2018 Nov 9.

Department of Psychiatry, University of Florida, United States.

This study compares the effectiveness of approaches used to recruit a diverse sample for a randomized clinical trial for Hoarding Disorder (HD) in the San Francisco Bay Area. Of the 632 individuals who inquired about the study, 313 were randomized and 231 completed treatment. Most participants heard about the study via flyering (N = 161), followed by advocacy groups (N = 113), word of mouth (N = 84), health care professionals (N = 78), online (N = 68), and media (N = 11). However, those that heard about the study via advertising methods, such as flyers, were less likely to complete the study, p = .01, while those recruited via advocacy groups were most likely to be randomized, p = .03. No source proved more effective in recruiting underrepresented groups such as men, p = .60; non-whites, p = .49; or Hispanics, p = .97. Advertising recruited the youngest individuals, p < 0.001, and word of mouth was most likely to recruit unemployed, disabled, or retired individuals, p = .01. Thus, results suggest an ongoing multimodal approach is likely to be most effective in both soliciting and retaining a diverse sample. Future studies should compare recruitment methods across greater geographical regions too, as well as in terms of financial and human costs.
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http://dx.doi.org/10.1016/j.conctc.2018.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240798PMC
December 2018

Identification of phagocytosis regulators using magnetic genome-wide CRISPR screens.

Nat Genet 2018 12 5;50(12):1716-1727. Epub 2018 Nov 5.

Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA.

Phagocytosis is required for a broad range of physiological functions, from pathogen defense to tissue homeostasis, but the mechanisms required for phagocytosis of diverse substrates remain incompletely understood. Here, we developed a rapid magnet-based phenotypic screening strategy, and performed eight genome-wide CRISPR screens in human cells to identify genes regulating phagocytosis of distinct substrates. After validating select hits in focused miniscreens, orthogonal assays and primary human macrophages, we show that (1) the previously uncharacterized gene NHLRC2 is a central player in phagocytosis, regulating RhoA-Rac1 signaling cascades that control actin polymerization and filopodia formation, (2) very-long-chain fatty acids are essential for efficient phagocytosis of certain substrates and (3) the previously uncharacterized Alzheimer's disease-associated gene TM2D3 can preferentially influence uptake of amyloid-β aggregates. These findings illuminate new regulators and core principles of phagocytosis, and more generally establish an efficient method for unbiased identification of cellular uptake mechanisms across diverse physiological and pathological contexts.
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http://dx.doi.org/10.1038/s41588-018-0254-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719718PMC
December 2018

Randomised clinical trial of community-based peer-led and psychologist-led group treatment for hoarding disorder.

BJPsych Open 2018 Jul 20;4(4):285-293. Epub 2018 Jul 20.

Professor, Department of Psychiatry, University of California, San Francisco, USA.

Background: Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.

Aims: We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive-behavioural therapy (G-CBT).

Method: We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3-25). Predictors of treatment response were examined.

Results: G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, = -1.71, d.f. = 245, = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up ( = 2.79, d.f. = 175, = 0.006; = 2.89, d.f. = 175, = 0.004).

Conclusions: Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.

Declaration Of Interest: C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers' honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
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http://dx.doi.org/10.1192/bjo.2018.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066983PMC
July 2018

Barriers and facilitators of appropriate vancomycin use: prescribing context is key.

Eur J Clin Pharmacol 2018 Nov 28;74(11):1523-1529. Epub 2018 Jul 28.

School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.

Purpose: Audit studies reveal frequent non-compliance with dosing and monitoring guidelines for vancomycin. This study aimed to qualitatively explore the barriers and facilitators of compliance with vancomycin dosing and monitoring guidelines.

Methods: Interviews were conducted with 16 prescribers in a large tertiary teaching hospital in Sydney, Australia. Questions explored knowledge, attitudes, and perceived complexities associated with vancomycin use. Interviews were analysed using thematic analysis.

Results: Prescribers reported utilising vancomycin guidelines, citing familiarity with guidelines, a positive perception of guidelines, awareness of poor guideline compliance, and assistance from specialist staff as facilitators of the uptake of guideline recommendations. Barriers existing within the prescribing environment such as the prescribing culture, a lack of time, and poor communication and coordination of therapeutic drug monitoring processes were identified as hindrances to guideline compliance.

Conclusions: The provision of guidelines may not be sufficient in ensuring appropriate prescribing and monitoring of vancomycin when barriers relating to the prescribing environment exist. Developing interventions targeted toward these barriers, such as having dedicated phlebotomists for vancomycin blood sampling, fostering better handover processes, and educating staff on poorly understood aspects of guidelines, is likely to improve the uptake of guideline recommendations for vancomycin and other medications requiring therapeutic drug monitoring.
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http://dx.doi.org/10.1007/s00228-018-2525-2DOI Listing
November 2018

Usability of Reports Generated by a Computerised Dose Prediction Software.

Stud Health Technol Inform 2018 ;252:27-32

St Vincent's Clinical School, UNSW Sydney, Australia.

Computerised dose prediction software assist clinicians in undertaking therapeutic drug monitoring by providing individualised dosing recommendations, typically communicated to prescribers in the form of a report. These software are highly sophisticated and accurate in predicting individualised dosage regimens, but if the information contained in the report is not understood by prescribers, the benefits of the software are not achieved. In this study, we set out to assess the perceived usability of a report generated from a dose prediction system. Fifteen prescribers were presented with a mock report and asked a number of questions to elicit their views of the report's content and design. Overall, we found that the mock report was effective in communicating the recommended dose of a drug, but this recommendation was presented alongside information that was not understood or was unlikely to be utilised by prescribers. In particular, the aspects of the report viewed negatively by end-users largely related to a lack of familiarity with the pharmacological terminology used in the report, which hindered understanding and caused confusion. Involving prescribers early on in the process of designing decision support systems is likely to result in systems and outputs that are more useful, usable and accessible to users.
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November 2018

A Theory-Based and Culturally Aligned Training Program on Breast and Cervical Cancer Prevention for South Asian Community Health Workers: A Feasibility Study.

Cancer Nurs 2019 Mar/Apr;42(2):E20-E30

Author Affiliations: The Nethersole School of Nursing, The Chinese University of Hong Kong (Drs So, J. Chan, Law, Sit, and C. Chan and Mss Kwong and Chen); Vocational Training Council, Institute of Vocational Education (Ms Kwong); and School of Health Sciences, Caritas Institute of Higher Education (Ms Chen), Hong Kong, China.

Background: Cancer screening uptake among South Asian ethnic minorities is reported to be relatively low. An outreach program, led by community health workers (CHWs), may increase the minority group's awareness of the importance of cancer screening.

Objective: The aim of this study was to assess the feasibility and effectiveness of a theory-based, culturally sensitive program to train South Asian women in Hong Kong as CHWs.

Methods: A CHW training program, guided by the Empowerment Model and the Health Belief Model, was developed and implemented. Its feasibility was evaluated through the recruitment of South Asian women to the program and their satisfaction with it. Its effectiveness was assessed by a test of knowledge, the participants' self-efficacy and competence, and their readiness to work as CHWs.

Results: Five South Asian women were recruited to the training program. Outcomes included increased participants' knowledge of cancer and improved self-efficacy and competence in working as CHWs. All participants were highly satisfied with the program, although the addition of practical sessions in the South Asian community was suggested as a further improvement.

Conclusion: It seems to be feasible to train South Asian CHWs to deliver interventions to promote their peers' awareness of breast and cervical cancer prevention, although challenges exist in recruitment of trainees. More hands-on practical opportunities as CHWs would likely increase their effectiveness.

Implications For Practice: The theoretical framework of our CHW training program and the incorporated cultural components could be useful for the development of future programs for training South Asian CHWs in delivering interventions on cancer prevention.
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http://dx.doi.org/10.1097/NCC.0000000000000543DOI Listing
February 2020

A Mixed-Methods Study of Unmet Supportive Care Needs Among Head and Neck Cancer Survivors.

Cancer Nurs 2019 Jan/Feb;42(1):67-78

Author Affiliations: The Nethersole School of Nursing, The Chinese University of Hong Kong (Drs So, Wong, Choi, C. Chan, J. Chan, and Law); Department of Clinical Oncology, Prince of Wales Hospital, Shatin, the New Territories (Mr Wan and Ms Mak); Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan (Mr Ling and Dr Ng); and Department of Oncology, Princess Margaret Hospital, Lai Chi Kok, Kowloon (Ms Yu), Hong Kong.

Background: Head and neck cancer (HNC) survivors face increasing challenges to adjust to the diagnosis and late effects of treatment. Identifying unmet needs among HNC survivors is therefore important to provide a comprehensive supportive care service for them.

Objective: The aim of this study was to examine the unmet supportive care needs (SCNs) of HNC survivors in the first year after treatment.

Methods: An explanatory sequential mixed-method design with 2 phases was used. In the quantitative phase, standardized questionnaires were administered to 285 Chinese HNC survivors to solicit their demographic and clinical characteristics, unmet SCNs, and access to various support services. In the qualitative phase, individual semistructured interviews were conducted with 53 participants to explore their unmet needs in more detail.

Results: The most prevalent unmet SCNs among the survivors were in the health system and information domain. Five categories of unmet needs emerged from the interview data: physical, psychological, health system and information, patient care and support, and sexuality. The findings reflect the inadequacy of the healthcare services for these survivors.

Conclusion: Chinese HNC survivors experienced a variety of unmet SCNs, particularly in the areas of symptom management and healthcare system and information provision.

Implications For Practice: The study provides insights that can (1) inform future service development, including regular symptom identification and management, improvements in communication, and counseling services and (2) identify the specific needs of these survivors as the basis for tailoring care to meet their needs.
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http://dx.doi.org/10.1097/NCC.0000000000000542DOI Listing
January 2020

Prostaglandin D2 Uses Components of ROS Signaling to Enhance Testosterone Production in Keratinocytes.

J Investig Dermatol Symp Proc 2017 10;18(2):S81-S84

Hampton University Skin of Color Research Institute (HUSCRI), Hampton, Virginia, USA; Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia, USA. Electronic address:

Elevated levels of prostaglandin D2 (PGD2) have been shown to be present in the bald scalp of androgenic alopecia (AGA) patients and to functionally inhibit hair growth. However, its precise mechanism in AGA has yet to be clearly defined. Although testosterone plays a critical role in the initiation and progression of AGA, the existence of a possible link between PGD2 and testosterone in skin has not been investigated. Here we show that human keratinocytes treated with PGD2 show enhanced capacity to convert the weak androgen, androstenedione, to testosterone. At the same time, treatment with PGD2 induced reactive oxygen species as indicated by generation of the lipid peroxidation product, 4-hydroxynonenal. To determine whether these two events are linked, we used the reactive oxygen species scavenger N-acetyl-cysteine, which blocked the enhanced testosterone production from PGD2-treated keratinocytes. Our study suggests the existence of a possible crosstalk between the PGD2-reactive oxygen species axis and testosterone metabolism in keratinocytes. Thus, we propose that AGA patients might benefit from the use of N-acetyl-cysteine or other antioxidants as a supplement to currently available or emerging AGA therapies such as finasteride, minoxidil, and PGD2 receptor blockers.
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http://dx.doi.org/10.1016/j.jisp.2017.01.003DOI Listing
October 2017

Contributions of self-criticism and shame to hoarding.

Psychiatry Res 2018 04 13;262:488-493. Epub 2017 Sep 13.

Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Psychiatry, University of Florida, Gainesville, FL, USA. Electronic address:

Pathological hoarding-related beliefs, such as need to control possessions, and inflated sense of responsibility over possessions, have been used to explain the development of symptoms of hoarding disorder (HD). While these beliefs have been the focus of the current standard treatment for HD, it is of significant clinical interest to further examine other constructs that may be linked to, or may underliethese beliefs, as well as the pathology of HD. To this end, the current study aimed to build on existing findings regarding the relationship of compromised self-identity with HD. Specifically, we investigated the relationship between self-criticism, shame, hoarding beliefs, and severity of HD symptoms among 104 treatment-seeking individuals with HD. We found that self-criticism and shame are positively associated with HD symptoms and hoarding related beliefs. Moreover, our data shed light on how these factors are connected by elucidating the indirect effects of self-criticism and shame on HD symptoms, mediated through beliefs about inflated sense of responsibility over possessions. The findings have implications for future research to examine interventions targeting compromised self-identity, including self-criticism and shame, among individuals with HD.
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http://dx.doi.org/10.1016/j.psychres.2017.09.030DOI Listing
April 2018

A Mindfulness Program Manual for People With Dementia.

Behav Modif 2017 11 8;41(6):764-787. Epub 2017 Jul 8.

1 University College London, London, UK.

This article describes a 10-session group-based Mindfulness Program for people with mild to moderate dementia. It aims to equip people with dementia with skills to manage psychological distress, with support from carers. The Mindfulness Program was developed through reviews of existing literature, consultation with experts, and a focus group with people with dementia. In a randomized controlled feasibility and pilot trial with people with mild to moderate dementia in care homes, it was found to significantly increase quality of life. The manual presented here is designed to be administered flexibly to promote participants' personhood. The protocol is designed for use by therapists with experience in practicing mindfulness meditation.
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http://dx.doi.org/10.1177/0145445517715872DOI Listing
November 2017

The Relationships Among Personality, Intercultural Communication, and Cultural Self-Efficacy in Nursing Students.

J Nurs Res 2016 Dec;24(4):286-290

1PhD, Assistant Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong 2BN(Hons), RN, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.

Background: The demand for nurses to provide transcultural nursing care is rising. However, little is known about the relationships among the dimensions of nurse personality, intercultural communication, and cultural self-efficacy in the provision of this care.

Purpose: The aims of this study were to examine the associations among personality, intercultural communication, and cultural self-efficacy in nursing students and to compare intercultural communication and cultural self-efficacy between first-year and third-year nursing students.

Method: One hundred twenty-six Chinese students completed a questionnaire that consisted of three scales that were designed to measure intercultural communication, cultural self-efficacy (cultural concepts, transcultural nursing functions, and cultural knowledge related to South Asians), and personality, respectively.

Results: Intercultural communication correlated positively with the three subscales of personality, agreeableness (r = .22, p < .05), openness (r = .20, p < .05), and conscientiousness (r = .18, p < .05). Self-efficacy in cultural concepts correlated positively with agreeableness (r = .18, p < .05) and intercultural communication (r = .49, p < .01). Self-efficacy in transcultural nursing functions correlated positively with intercultural communication (r = .36, p < .01), agreeableness (r = .31, p < .01), emotional stability (r = .25, p < .01), openness (r = .32, p < .01), extraversion (r = .19, p < .05), and conscientiousness (r = .20, p < .05). Self-efficacy in cultural knowledge related to South Asians correlated positively with agreeableness (r = .20, p < .05) and intercultural communication (r = .27, p < .01). No significant difference was found between first-year and third-year students in terms of intercultural communication, self-efficacy in knowledge of cultural concepts, self-efficacy in the skills needed to perform key transcultural nursing functions, or self-efficacy in the cultural knowledge related to South Asians.

Conclusions/implications For Practice: Personality assessments should be included in the nursing student recruitment process. Furthermore, nurse educators should focus greater attention on enhancing the cultural self-efficacy and intercultural communication skills of their students.
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http://dx.doi.org/10.1097/JNR.0000000000000157DOI Listing
December 2016

Comparison of a peer facilitated support group to cognitive behavior therapy: Study protocol for a randomized controlled trial for hoarding disorder.

Contemp Clin Trials 2016 09 19;50:98-105. Epub 2016 Jul 19.

Department of Psychiatry, University of California, San Francisco, California, USA; College of Medicine, University of Florida, Florida, USA. Electronic address:

Although individual and group cognitive-behavioral therapy (CBT) is the standard treatment approach for hoarding disorder (HD), it requires trained mental health professionals with specialization in HD. There is a need to offer additional options and services due to the limited number of professionals with advanced training, combined with the high prevalence rate of individuals with HD. A structured support group led by trained facilitators or lay professionals using a facilitator's manual and participant workbook (Buried in Treasures or BiT), addresses this need and increases accessibility. Prior studies of BiT groups have shown decreased hoarding symptoms. Only one retrospective study compared BiT and CBT outcomes in a naturalistic setting and showed no difference. Thus, a well-powered randomized controlled trial is needed to directly compare these forms of treatment. This paper presents a non-inferiority controlled trial protocol that compares group CBT to group BiT. Three hundred participants with HD, 18years or older, are being recruited for a 16-week treatment study. Participants are randomly assigned to either the CBT or BiT group. The primary outcome is reduction in hoarding symptom severity. Secondary outcomes include reduction in other indices of hoarding symptomology, including functional impairment, physical clutter, cognition, and changes in neuropsychological functioning.
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http://dx.doi.org/10.1016/j.cct.2016.07.018DOI Listing
September 2016

Emotional Intelligence, Pain Knowledge, and Attitudes of Nursing Students in Hong Kong.

Pain Manag Nurs 2016 04 20;17(2):159-68. Epub 2016 Apr 20.

School of Psychology and Speech Pathology, Curtin University, Perth, Australia.

Research on nursing students' pain knowledge and attitudes is limited. Although emotions play a role in pain assessment, no study has examined the associations between emotional intelligence and pain knowledge and the attitudes of nursing students. This cross-sectional quantitative study aimed to address this research gap by assessing the pain knowledge and attitudes of nursing students in Hong Kong and examining associations between emotional intelligence and the pain knowledge and attitudes of nursing students. A total of 104 postgraduate nursing students (45 Year 1 students and 59 Year 3 students) completed a questionnaire that included demographic information, the Schutte Emotional Intelligence Scale (SEIS) and the Knowledge and Attitudes Survey Regarding Pain (KASRP). Data analyses included descriptive statistics, correlational analyses, chi-square test and t-tests. The pain knowledge and attitudes of both Year 1 students (M = 20.40, SD = 3.78) and Year 3 students (M = 21.36, SD = 3.15) were suboptimal, t(102) = -1.41, p = .16. Year 1 students had higher emotional intelligence (M = 122.44, SD = 8.90) than Year 3 students (M = 117.71, SD = 14.34), t(98.35) = 2.07, p = .04. For Year 1 students, emotional intelligence was negatively correlated with pain knowledge and attitudes, but the correlation was not significant (r = -.15, p = .33). For Year 3 students, emotional intelligence, pain knowledge and attitudes were negatively correlated, but the correlation was significant (r = -.31, p = .02). These results suggest that nursing students' pain knowledge and attitudes could be improved. Implications for nurse educators to enhance emotional intelligence and pain education for nursing students are discussed.
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http://dx.doi.org/10.1016/j.pmn.2016.02.001DOI Listing
April 2016

Efficacy of a Church-Based, Culturally Tailored Program to Promote Completion of Advance Directives Among Asian Americans.

J Immigr Minor Health 2017 04;19(2):381-391

Division of General Internal Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.

Having an Advance Directive (AD) can help to guide medical decision-making. Asian Americans (AA) are less likely than White Americans to complete an AD. This pilot study investigated the feasibility and efficacy of a church-based intervention to increase knowledge and behavior change related to AD among Chinese and Vietnamese Americans. This study utilized a single group pre- and post-intervention design with 174 participants from 4 churches. Domain assessed: demographics; AD-related knowledge, beliefs, attitudes, and intentions; AD completion; and conversations with a healthcare proxy. Data were analyzed using Chi square and multiple logistic regression techniques. We observed significant increases in participants' AD-related knowledge, intentions, and a gain in supportive beliefs and attitudes about AD, resulting in 71.8 % AD completion, and 25.0 % having had a proxy conversation. Providing culturally-tailored intervention and step-by-step guidance can help to achieve significant changes in AD related knowledge and behavior in AA church goers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074907PMC
http://dx.doi.org/10.1007/s10903-016-0365-7DOI Listing
April 2017

Treating Hoarding Disorder in a real-world setting: Results from the Mental Health Association of San Francisco.

Psychiatry Res 2016 Mar 21;237:331-8. Epub 2016 Jan 21.

Mental Health Association of San Francisco, San Francisco, CA, USA.

Hoarding Disorder (HD) is associated with substantial distress, impairment, and individual and societal costs. Cognitive-behavioral therapy (CBT) tailored to HD is the best-studied form of treatment and can be led by mental health professionals or by non-professionals (peers) with specific training. No previous study has directly compared outcomes for therapist-led and peer-led groups, and none have examined the effectiveness of these groups in a real-world setting. We used retrospective data to compare psychologist-led CBT groups (G-CBT) to groups led by peer facilitators using the Buried in Treasures workbooks (G-BiT) in individuals who sought treatment for HD from the Mental Health Association of San Francisco. The primary outcome was change in Hoarding Severity Scale scores. Approximate costs per participant were also examined. Both G-CBT and G-BiT showed improvement consistent with previous reports (22% improvement overall). After controlling for baseline group characteristics, there were no significant differences in outcomes between G-CBT and G-BiT. For G-CBT, where additional outcome data were available, functional impairment and severity of hoarding symptoms improved to a similar degree as compared to previous G-CBT studies, while hoarding-related cognition improved to a lesser degree (also consistent with previous studies). G-BiT cost approximately $100 less per participant than did G-CBT.
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http://dx.doi.org/10.1016/j.psychres.2016.01.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020681PMC
March 2016

Oral health knowledge and psychological determinants of oral health behavior of nursing students.

J Health Psychol 2017 01 10;22(1):79-88. Epub 2016 Jul 10.

2 Xpert Dental Group Ltd., Hong Kong.

This survey examined the oral health knowledge and psychological determinants of oral health behavior of 1019 undergraduate and postgraduate nursing students. Overall, most of the students perceived their oral health to be average, and their flossing and dental visiting frequencies were inadequate. Moreover, the students' oral health knowledge was suboptimal, regardless of the type of study, and it was not significantly associated with oral health behavior. Binary logistic regression showed that toothbrushing self-efficacy and the type of study were both significantly associated with toothbrushing behavior. Furthermore, flossing self-efficacy and dental visiting self-efficacy were both significantly associated with flossing and dental visiting behaviors, respectively.
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http://dx.doi.org/10.1177/1359105315595122DOI Listing
January 2017

A Social Network Family-Focused Intervention to Promote Smoking Cessation in Chinese and Vietnamese American Male Smokers: A Feasibility Study.

Nicotine Tob Res 2015 Aug;17(8):1029-38

Asian American Research Center for Health (ARCH), San Francisco, CA; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA;

Introduction: Smoking prevalence is high among limited English-proficient Chinese and Vietnamese American men, who are frequently unmotivated to quit and who underutilize smoking cessation resources. This study applied lay health worker outreach to leverage peer and family networks to promote smoking cessation among these men.

Methods: We integrated qualitative formative research findings and Social Network Theory to develop a social-network family-focused intervention. In a pilot single-group trial, 15 lay health workers recruited 96 dyads (N = 192, 75% Vietnamese) of Chinese or Vietnamese male daily smokers and their family members and delivered the intervention consisting of two small group education sessions and two individual telephone calls over 2 months.

Results: At baseline, 42% of smokers were at precontemplation. At 3 months following the initiation of the intervention, 7-day and 30-day point prevalence smoking abstinence rates as reported by smokers and independently corroborated by family members were 30% and 24%, respectively. Utilization of smoking cessation resources (medication, quitline, physician's advice) increased from 2% to 60% (P < .001). Findings showed high acceptability of the intervention as it facilitated learning about tobacco-related health risks and cessation resources, and communications between smokers and their families.

Conclusions: This novel social network family-focused intervention to promote smoking cessation among Chinese and Vietnamese smokers appears to be acceptable, feasible, and potentially efficacious. Findings warrant evaluation of long-term efficacy of the intervention in a larger scale randomized controlled trial.
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http://dx.doi.org/10.1093/ntr/ntv088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542845PMC
August 2015

Nursing students' assessment of pain and decision of triage for different ethnic groups: An experimental study.

Nurse Educ Today 2015 Aug 21;35(8):921-5. Epub 2015 Apr 21.

School of Psychology and Speech Pathology, Curtin University, Australia.

Background: Pain management is a priority in nursing care but little is known about the factors that affect nursing students' assessment of pain expressed by patients of different ethnic backgrounds.

Objectives: This study examined undergraduate nursing students' assessment of pain and decision of triage when pain was expressed in different languages and their relation to students' empathy and social identity. Comparison between students with and without clinical experience was also carried out.

Design: This is a cross-sectional quantitative design.

Setting: This study took place at a university in Hong Kong.

Participants: 74 female undergraduate nursing students.

Methods: Students listened to eight audio recordings in which an individual expressed pain in one of the two dialects of Chinese, either Cantonese or Putonghua. For each dialect, two recordings depicted mild pain and two depicted severe pain. After listening to each recording, students rated the pain level and indicated their decision of triage. Subsequently, students completed a questionnaire that measured their empathy and social identity and reported their demographics. The data were analyzed by descriptive statistics, correlational analyses, and t-tests.

Results: Severe pain described in Putonghua was rated as more intense than that described in Cantonese but it was not classified as more urgent. Students with clinical experience tended to perceive mild pain as less painful and less urgent than those without clinical experience. For mild pain described in Cantonese, students with clinical experience evaluated it as more urgent than those without such experience. The empathy level of students with and without clinical experience was comparable. Students with more empathy, especially those without clinical experience, reported heightened perceived intensity of severe pain described in Putonghua.

Conclusions: Nurse educators should note that empathy, social identity, and clinical experience may alter students' pain assessment of patients from different ethnicities. Pain education needs to be reinforced.
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http://dx.doi.org/10.1016/j.nedt.2015.04.004DOI Listing
August 2015

A Review of Psychoeducational Interventions to Improve Sexual Functioning, Quality of Life, and Psychological Outcomes in Gynecological Cancer Patients.

Cancer Nurs 2016 Jan-Feb;39(1):20-31

Author Affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong S.A.R.

Background: Psychoeducational interventions are recommended for use with clinical gynecological cancer patients to improve their patient care outcomes. However, the evidence of their effectiveness is far from conclusive.

Objective: The objective of this study was to identify the best available research evidence related to the effects of psychoeducational interventions on sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients.

Methods: A systematic search was conducted to identify English and Chinese articles from the inception of the databases to April 2012 and included 13 English databases and 7 Chinese databases. Gray literature or unpublished studies were also searched.

Results: A total of 11 studies involving 975 gynecological cancer patients were included in the review. Meta-analysis results for 4 comparable studies indicated that psychoeducational interventions were effective in treating depressive symptoms among gynecological cancer patients (standardized mean difference = -0.80; 95% confidence interval, -1.05 to -0.54), whereas information provision significantly improved the mental aspect of quality of life (standardized mean difference = -0.41; 95% confidence interval, -0.74 to -0.08). With regard to sexual functioning, psychoeducational interventions appeared to have benefits in improving the sexual life of patients.

Conclusions: Findings confirm the effectiveness of psychoeducational interventions on depressive symptoms and mental aspect of the quality of life in gynecological cancer patients.

Implications For Practice: The authors discuss the implications of review findings for the effective design of psychoeducational interventions including components, provider, provision time frame, and duration for clinical practice, as well as psychoeducational intervention research.
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http://dx.doi.org/10.1097/NCC.0000000000000234DOI Listing
June 2017

Using medical incidents to teach: effects of vicarious experience on nursing students' self-efficacy in performing urinary catheterization.

J Nurs Educ 2015 Feb 20;54(2):80-6. Epub 2015 Jan 20.

This study compared the effects of instruction on nursing students' self-efficacy in urinary catheterization, using positively and negatively worded examples after vicarious experience of a medical incident. Nursing students (n = 128) completed measures on urinary catheterization performance, general self-efficacy, and self-efficacy in urinary catheterization before being assigned to one of three groups: the instruction with negative examples (NE), the instruction with positive examples (PE), or the control group. Each group read the same medical incident. The instruction with NE and PE groups read negatively and positively worded examples, respectively, about urinary catheterization, and the control group read a summary of the incident. All students indicated their self-efficacy in urinary catheterization. A statistically significant increase in self-efficacy was noted in the PE and NE groups but was significantly higher in the NE group, compared with the control group. Implications for nurse educators using medical incidents to increase nursing students' self-efficacy are discussed.
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http://dx.doi.org/10.3928/01484834-20150120-01DOI Listing
February 2015

Psychological determinants of exercise behavior of nursing students.

Contemp Nurse 2014 ;49:60-7

The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong, 2. The Hong Kong Polytechnic University, Hung Hom, Hong Kong.

Background: Though expected to be role models in health promotion, research has shown that nursing students often have suboptimal exercise behavior.

Aim: This study explored the psychological factors associated with the exercise behavior of nursing students.

Methods/design: A total of 195 first-year undergraduate nursing students completed a cross-sectional quantitative survey questionnaire, which included measures of their exercise behavior, the Physical Exercise Self-efficacy Scale, and the Exercise Barriers/Benefits Scale.

Results/findings: The results showed that male students spent more time exercising and had higher exercise self-efficacy compared with female students, but there were no gender differences in the perceived barriers to or benefits of exercise. Fatigue brought on by exercising was the greatest perceived barrier to exercise, whereas increasing physical fitness and mental health were the greatest perceived benefits of exercise. Multiple linear regression showed that gender, exercise self-efficacy, perceived barriers to exercise, and perceived benefits of exercise were independent predictors of exercise behavior.

Conclusion: Nurse educators can endeavor to promote exercise behavior among nursing students by highlighting the specific benefits of exercise, empowering students to overcome their perceived barriers to exercise, and enhancing students' exercise self-efficacy.
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http://dx.doi.org/10.5172/conu.2014.49.60DOI Listing
May 2017
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