Publications by authors named "Michelle Pang"

12 Publications

  • Page 1 of 1

Variables Associated with Coronavirus Disease 2019 Vaccine Hesitancy Amongst Patients with Neurological Disorders.

Infect Dis Rep 2021 Aug 30;13(3):763-810. Epub 2021 Aug 30.

John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI 96813, USA.

Introduction: Given that the success of vaccines against coronavirus disease 2019 (COVID-19) relies on herd immunity, identifying patients at risk for vaccine hesitancy is imperative-particularly for those at high risk for severe COVID-19 (i.e., minorities and patients with neurological disorders).

Methods: Among patients from a large neuroscience institute in Hawaii, vaccine hesitancy was investigated in relation to over 30 sociodemographic variables and medical comorbidities, via a telephone quality improvement survey conducted between 23 January 2021 and 13 February 2021.

Results: Vaccine willingness ( = 363) was 81.3%. Univariate analysis identified that the odds of vaccine acceptance reduced for patients who do not regard COVID-19 as a severe illness, are of younger age, have a lower Charlson Comorbidity Index, use illicit drugs, or carry Medicaid insurance. Multivariable logistic regression identified the best predictors of vaccine hesitancy to be: social media use to obtain COVID-19 information, concerns regarding vaccine safety, self-perception of a preexisting medical condition contraindicated with vaccination, not having received the annual influenza vaccine, having some high school education only, being a current smoker, and not having a prior cerebrovascular accident. Unique amongst males, a conservative political view strongly predicted vaccine hesitancy. Specifically for Asians, a higher body mass index, while for Native Hawaiians and other Pacific Islanders (NHPI), a positive depression screen, both reduced the odds of vaccine acceptance.

Conclusion: Upon identifying the variables associated with vaccine hesitancy amongst patients with neurological disorders, our clinic is now able to efficiently provide ancillary COVID-19 education to sub-populations at risk for vaccine hesitancy. While our results may be limited to the sub-population of patients with neurological disorders, the findings nonetheless provide valuable insight to understanding vaccine hesitancy.
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http://dx.doi.org/10.3390/idr13030072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482072PMC
August 2021

Evaluation of students' perceived clinical competence and learning needs following an online virtual simulation education programme with debriefing during the COVID-19 pandemic.

Nurs Open 2021 11 31;8(6):3045-3054. Epub 2021 Jul 31.

School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.

Aims And Objectives: This study aimed to evaluate the effect of a virtual simulation education programme with debriefing in undergraduate nursing students. Perceived clinical competence and learning needs of students in a simulation environment were also measured.

Background: Evidence showed virtual simulation education programmes provided better knowledge acquisition. However, these studies to date did not incorporate virtual simulation in the combination of a debriefing model in nursing students.

Design: A one-group pre-test and post-test design.

Methods: 188 final year undergraduate nursing students participated in the study. Linear mixed model analysis was conducted to evaluate the effect of the programme.

Results: Students have perceived a significant improvement in clinical competence and nursing process. Self-efficacy has also boosted. Communication and critical thinking were applied better in the traditional clinical environment.

Conclusion: Perceived clinical competence of Chinese nursing students has significant improvements by using virtual simulation combining a debriefing model during the COVID-19 period. Virtual simulation met students' learning needs. Future studies should include a control group for comparison and long-term measurement.

Relevance To Clinical Practice: The study provided an innovative clinical learning pedagogy to serve as a potential alternative with traditional clinical practicum during the COVID-19 period as this is substantially limited.
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http://dx.doi.org/10.1002/nop2.1017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441701PMC
November 2021

The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis.

Front Nutr 2020 7;7:598340. Epub 2021 Jan 7.

Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands.

A poor diet is one of the leading causes for non-communicable diseases. Due to the increasing prevalence of overweight and obesity, there is a strong focus on dietary overconsumption and energy restriction. Many strategies focus on improving energy balance to achieve successful weight loss. One of the strategies to lower energy intake is refraining from sugars and replacing them with artificial sweeteners, which maintain the palatability without ingesting calories. Nevertheless, the safety and health benefits of artificial sweeteners consumption remain a topic of debate within the scientific community and society at large. Notably, artificial sweeteners are metabolized differently from each other due to their different properties. Therefore, the difference in metabolic fate of artificial sweeteners may underlie conflicting findings that have been reported related to their effects on body weight control, glucose homeostasis, and underlying biological mechanisms. Thus, extrapolation of the metabolic effects of a single artificial sweetener to all artificial sweeteners is not appropriate. Although many rodent studies have assessed the metabolic effects of artificial sweeteners, long-term studies in humans are scarce. The majority of clinical studies performed thus far report no significant effects or beneficial effects of artificial sweeteners on body weight and glycemic control, but it should be emphasized that the study duration of most studies was limited. Clearly, further well-controlled, long-term human studies investigating the effects of different artificial sweeteners and their impact on gut microbiota, body weight regulation and glucose homeostasis, as well as the underlying mechanisms, are warranted.
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http://dx.doi.org/10.3389/fnut.2020.598340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817779PMC
January 2021

A rational review on the effects of sweeteners and sweetness enhancers on appetite, food reward and metabolic/adiposity outcomes in adults.

Food Funct 2021 Jan 16;12(2):442-465. Epub 2020 Dec 16.

Biopsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK.

Numerous strategies have been investigated to overcome the excessive weight gain that accompanies a chronic positive energy balance. Most approaches focus on a reduction of energy intake and the improvement of lifestyle habits. The use of high intensity artificial sweeteners, also known as non-caloric sweeteners (NCS), as sugar substitutes in foods and beverages, is rapidly developing. NCS are commonly defined as molecules with a sweetness profile of 30 times higher or more that of sucrose, scarcely contributing to the individual's net energy intake as they are hardly metabolized. The purpose of this review is first, to assess the impact of NCS on eating behaviour, including subjective appetite, food intake, food reward and sensory stimulation; and secondly, to assess the metabolic impact of NCS on body weight regulation, glucose homeostasis and gut health. The evidence reviewed suggests that while some sweeteners have the potential to increase subjective appetite, these effects do not translate in changes in food intake. This is supported by a large body of empirical evidence advocating that the use of NCS facilitates weight management when used alongside other weight management strategies. On the other hand, although NCS are very unlikely to impair insulin metabolism and glycaemic control, some studies suggest that NCS could have putatively undesirable effects, through various indirect mechanisms, on body weight, glycemia, adipogenesis and the gut microbiota; however there is insufficient evidence to determine the degree of such effects. Overall, the available data suggests that NCS can be used to facilitate a reduction in dietary energy content without significant negative effects on food intake behaviour or body metabolism, which would support their potential role in the prevention of obesity as a complementary strategy to other weight management approaches. More research is needed to determine the impact of NCS on metabolic health, in particular gut microbiota.
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http://dx.doi.org/10.1039/d0fo02424dDOI Listing
January 2021

Exploring the role of simulation to foster interprofessional teamwork among medical and nursing students: A mixed-method pilot investigation in Hong Kong.

J Interprof Care 2020 Dec 8:1-9. Epub 2020 Dec 8.

School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, S.A.R., China.

Effective teamwork is a critical component of maintaining patient safety. However, there is lack of clarity on the best teaching approach to interprofessional teamwork training in medical and nursing curricula. This study aimed to compare the effects of blended classroom plus clinical simulation versus clinical simulation alone on teamwork attitudes, perceptions and performance in medical and nursing students in Hong Kong. This was a pilot study with a mixed-method research design, with both quantitative and qualitative evaluations. Students who studied medicine or nursing courses at a university in Hong Kong were invited to this study. They were assigned into two groups: clinical simulation alone versus blended classroom plus clinical simulation. The primary outcome was attitudinal change related to teamwork behaviours, which was measured using the Human Factors Attitude Survey. The secondary outcomes were perceptions of team-based learning and teamwork performance, which were accessed by the Team-Based Learning Student Assessment Instrument and Ottawa Global Rating Scale, respectively. Four focus group interviews were conducted after the training sessions. Conventional content analysis using inductive coding was performed with the qualitative data. Forty-six students participated in this study. There was a significant increase in the participants' positive attitudes on teamwork for both groups (intervention:  = 5.36 and control:  = 3.6, <.05); however, there was no significant difference on increasing positive attitudes between the groups (estimate = 1.76, 95% CI [-8.59, 5.06], = .61). Qualitative analysis identified four themes: (1) reconsidering professional roles in managing patients; (2) embodying the experience to share responsibility and complement each other's skills; (3) realizing the importance of trust and communication; and (4) engaging to achieve the mission within a limited time. This pilot study found that a blended classroom did not further improve teamwork attitudes, perceptions and performance in medical and nursing students compared with clinical simulation alone. Qualitative findings showed that students had reconsidered their professional roles in managing patients and realized the importance of teamwork in caring patients.
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http://dx.doi.org/10.1080/13561820.2020.1831451DOI Listing
December 2020

The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis?

Subst Abuse Treat Prev Policy 2020 02 17;15(1):14. Epub 2020 Feb 17.

Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.

While there has been extensive attention to the 'demand side' - or use and adverse consequences, including mortality - of the 'opioid crisis' presently unfolding across North America, few considerations have focused on the supply side. This paper examines the supply side dynamics of this unprecedented public health phenomenon. We provide evidence for several interrelated supply-side elements that have contributed to the present public health crisis. We observe that initially, persistently high levels of prescription opioid availability and use exposed large proportions of the North American population to opioids, resulting in correspondingly high levels of medical and non-medical use (e.g., involving diversion). While various intervention measures to control prescription opioid availability and use have been implemented in recent years, leading to eventual reductions in opioid dispensing levels, these occurred late in the crisis's evolution. Moreover, these supply reductions have not been met by corresponding reductions in opioid use or demand levels. These growing discrepancies between opioid demand and prescription-based sources have left major gaps in opioid supplies. In response to such supply gaps, highly potent and toxic illicit opioid products have rapidly proliferated across North America, and become a core driver of the dramatic spikes in opioid overdose fatality levels in recent years. These supply-related interrelations are corroborated by a corresponding increase in illicit opioid-related fatalities, which arose just as medical opioid supplies began to decrease in many jurisdictions. Improved analyses and understanding of the supply-side dynamics of the opioid crisis are urgently needed in order to inform future intervention and policy development. Meanwhile, the high mortality toll related to illicit, highly toxic opioid exposure requires sustained solutions, including supply-oriented measures (e.g., safer opioid distribution for at-risk users) towards improved public health protection.
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http://dx.doi.org/10.1186/s13011-020-0256-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027114PMC
February 2020

Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review.

PLoS Med 2019 12 31;16(12):e1003002. Epub 2019 Dec 31.

Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.

Background: Worldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration.

Methods And Findings: We systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273-131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27-960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15-1,557) and 44 (range 27-382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36-55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research.

Conclusions: In this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional preventive strategies such as the distribution of NLX kits to at-risk individuals upon release greatly decrease the occurrence of opioid-related overdose and mortality. In an effort to mitigate the impact of the opioid-related overdose crisis, it is crucial to scale up OAT and opioid-related overdose prevention strategies (e.g., NLX) within a continuum of treatment before, during, and after incarceration.
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http://dx.doi.org/10.1371/journal.pmed.1003002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938347PMC
December 2019

Applying principles of injury and infectious disease control to the opioid mortality epidemic in North America: critical intervention gaps.

J Public Health (Oxf) 2020 11;42(4):848-852

British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.

North America has been experiencing an acute and unprecedented public health crisis involving excessive and increasing levels of opioid-related overdose mortality. In the present commentary, we examine current interventions (as existent mainly in Canada) to date and compare them against established intervention frameworks and practices in other areas of public health, specifically injury and infectious disease control. We observe that current interventions focusing on opioid drug safety or exposure-specifically those that focus on distinctly potent and toxic opioid products driving major increases in overdose mortality-may be considered the equivalent of 'agent-' or 'vector'-based interventions. Such interventions have been largely neglected in favor of 'host' (e.g., drug user-oriented) or 'environmental' measures among strategies to reduce opioid-related overdose, likely contributing to the limited efficacy of current measures. We explore potential reasons, implications and remedies for these gaps in the overall public health strategy employed towards improved interventions to reduce opioid-related health harms.
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http://dx.doi.org/10.1093/pubmed/fdz162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685850PMC
November 2020

The opioid death crisis in Canada: crucial lessons for public health.

Lancet Public Health 2019 02 20;4(2):e81-e82. Epub 2018 Dec 20.

British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

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http://dx.doi.org/10.1016/S2468-2667(18)30232-9DOI Listing
February 2019

Developmental Biology: Neurons That Divide Together Wire Together.

Curr Biol 2018 06;28(12):R715-R717

Department of Neurobiology, Stanford University, Stanford, CA 94305, USA. Electronic address:

Retinotopic maps represent a fundamental organizing principle of visual system wiring. A recent study illustrates how careful coordination of developmental strategies can simultaneously create a diverse array of cell types and establish a complex wiring diagram.
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http://dx.doi.org/10.1016/j.cub.2018.05.007DOI Listing
June 2018

Chinese women health ambassadors programme: A process evaluation.

J Clin Nurs 2017 Oct 15;26(19-20):2976-2985. Epub 2017 Mar 15.

School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.

Aims And Objectives: The aim of this study was to assess a community-women health ambassadors programme and report the areas that were successful and those that required improvement. The objectives were to assess the feasibility, effectiveness, implementation and sustainability of the programme.

Background: Health promotion for the prevention of chronic diseases has always been the top priority in the health sector. To ensure that the relevant health messages are well received in local communities, a health promotion programme must be accessible, acceptable and culturally relevant.

Design: We conducted and evaluated a women health ambassador programme based on the lay health advisor model for health promotion in Hong Kong during November 2014 to February 2015. Health needs and the subsequent focus of the programme were determined by underprivileged Chinese women.

Methods: University health educators from different disciplines trained the women (N = 80) to be health ambassadors through mini-lectures and training workshops. The trained women raised awareness about the importance of health within their families and social networks. The programme was evaluated through attendance rates, questionnaires and quizzes, changes in knowledge and behaviour, as well as qualitative discussion.

Results: While the majority of participants found the programme valuable and useful, retention rates were unideal. A statistically significant improvement was found in eating habits, but no significant change was identified for other knowledge and behaviour assessments.

Conclusions: The programme empowered underprivileged women to reflect on the importance of health, take responsibility for their own health and actively promote health to their families and personal communities.

Relevance To Clinical Practice: Our study supports that health promotion programmes based on the lay health advisor model are effective and encourage large-scale programmes of this nature. Our results also support that future health promotion efforts should deliver brief, clear and simple content as opposed to intricate information.
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http://dx.doi.org/10.1111/jocn.13638DOI Listing
October 2017

Enhancing the management of deteriorating patients with Australian on line e-simulation software: Acceptability, transferability, and impact in Hong Kong.

Nurs Health Sci 2016 Sep 22;18(3):393-9. Epub 2016 Apr 22.

School of Nursing, The University of Hong Kong, Pok Fu Lam, Hong Kong.

International concerns relating to healthcare professionals' failure to rescue deteriorating patients exist. Web-based training programs have been developed and evaluated in Western settings but further testing is required before application in non-Western countries, as traditional modalities of learning may differ between cultures. We trialed an Australian English language online simulation program for the management of deteriorating patients, Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST(2) ACTWeb), to test cultural acceptability, transferability, and educational impact. The study was designed as a quasi-experimental evaluation of the FIRST(2) ACTWeb program with final year nursing students from a Bachelor of Nursing program at the University of Hong Kong. Participants completed pre-course and post-course tests, three interactive scenarios, and program evaluations. The program was positively evaluated, with significant improvements in knowledge, skills, self-rating of performance, confidence, and competence. Outcomes were comparable to earlier evaluations with Australian students, demonstrating that an interactive simulation-based program of patient deterioration management has cultural and language acceptability and transferability across communities with significant educational impact.
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http://dx.doi.org/10.1111/nhs.12282DOI Listing
September 2016
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