Publications by authors named "Paul H Lee"

105 Publications

Effects of Tai Chi or Exercise on Sleep in Older Adults With Insomnia: A Randomized Clinical Trial.

JAMA Netw Open 2021 Feb 1;4(2):e2037199. Epub 2021 Feb 1.

Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.

Importance: Previous studies that have shown tai chi to improve sleep were mainly based on subjective assessments, which might have produced results confounded by self-reporting bias.

Objective: To compare the effectiveness of tai chi for improving sleep in older adults with insomnia with conventional exercise and a passive control group using actigraphy-based objective measurements.

Design, Setting, And Participants: This randomized, 3-arm, parallel group, assessor-masked clinical trial was conducted at a single research unit in Hong Kong between August 2014 and August 2018. Eligible participants, aged 60 years or older and with chronic insomnia, were randomly allocated into tai chi training, exercise, and control groups.

Interventions: 12-week tai chi training, 12-week conventional exercise, and no intervention control.

Main Outcomes And Measures: Primary outcomes were measures taken from actigraphy sleep assessment. Secondary outcomes included remission of insomnia, insomnia treatment response, Pittsburgh Sleep Quality Index score, Insomnia Severity Index score, and self-reported sleep using a 7-day sleep diary. Assessments were performed at baseline, end of the intervention (postintervention), and 24 months after the intervention (follow-up). Data analysis was performed from September 2018 to August 2020.

Results: A total of 320 participants (mean [SD] age, 67.3 [6.8] years; mean [SD] insomnia duration, 124.4 [134.5] months; 256 [80.0%] women) were randomly allocated into control (110 participants), exercise (105 participants), and tai chi (105 participants) groups and included in the data analysis. Compared with the control group, the exercise and tai chi groups showed improved sleep efficiency (exercise vs control: adjusted mean difference, +3.5%; 95% CI, 1.8-5.2; P < .001; tai chi vs control: adjusted mean difference, +3.4%; 95% CI, 1.6-5.1; P < .001) and reductions of wake time after sleep onset (exercise vs control: -17.0 minutes; 95% CI, -24.9 to -9.0; P < .001; tai chi vs control: -13.3 minutes; 95% CI, -21.3 to -5.2; P = .001) and number of awakenings (exercise vs control: -2.8 times; 95% CI, -4.0 to -1.6; P < .001; tai chi vs control: -2.2 times; 95% CI, -3.5 to -1.0; P < .001) as assessed by actigraphy at postintervention; although there were no significant differences between the exercise and tai chi groups. The actigraphy-assessed beneficial effects were maintained in both intervention groups at follow-up.

Conclusions And Relevance: Conventional exercise and tai chi improved sleep and the beneficial effects sustained for 24 months, although the absolute improvements in sleep parameters were modest. Improvements in objective sleep parameters were not different between the tai chi and exercise groups, suggesting that tai chi can be an alternative approach for managing insomnia.

Trial Registration: ClinicalTrials.gov Identifier: NCT02260843.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.37199DOI Listing
February 2021

Validation of Self-Reported Smartphone Usage Against Objectively-Measured Smartphone Usage in Hong Kong Chinese Adolescents and Young Adults.

Psychiatry Investig 2021 Feb 2. Epub 2021 Feb 2.

Department of Knowledge Service Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.

Objective: This study evaluated the validity of self-reported smartphone usage data against objectively-measured smartphone usage data by directly tracking the activities in the participants' smartphone among Chinese adolescents and young adults in Hong Kong.

Methods: A total of 187 participants were recruited (mean age 19.4, 71.7% female) between 2017 and 2018. A smartphone usage tracking app was installed on all participants' smartphone for 7 consecutive days. After the 7-day monitoring period, they completed a selfadministered questionnaire on smartphone usage habits.

Results: Although the correlation between self-reported and objectively-measured total smartphone usage time was insignificant (ρ=-0.10, p=0.18), in three out of the four usage domains were positively and significantly correlated, namely social network (ρ=0.21, p=0.005), instant messaging (ρ=0.27, p<0.001), and games (ρ=0.64, p<0.001). Participants' self-report of the total time spent on smartphones exceeded the objective data by around 760 min per week (self-reported 1,930.3 min/wk vs. objectively-measured 1,170.7 min/wk, p<0.001). Most of the over-reporting was contributed by the web browsing domain (self-reported 447.8 min/wk vs. objectively-measured 33.3 min/wk, p<0.001).

Conclusion: Our results showed large discrepancies between self-reported smartphone and objectively-measured smartphone usage except for self-reported usage on game apps.
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http://dx.doi.org/10.30773/pi.2020.0197DOI Listing
February 2021

Association between Time Spent on Smart Devices and Change in Refractive Error: A 1-Year Prospective Observational Study among Hong Kong Children and Adolescents.

Int J Environ Res Public Health 2020 11 30;17(23). Epub 2020 Nov 30.

School of Nursing, Hong Kong Polytechnic University, Hong Kong, China.

This study examined the association between smart device usage and the 1-year change in refractive error among a representative sample of Hong Kong children and adolescents aged 8-14 years. A total of 1597 participants (49.9% male, mean age 10.9, SD 2.0) who completed both baseline (2017-2018) and 1-year follow-up (2018-2019) eye examinations were included in the present study. The non-cycloplegic auto-refractive error was measured and the average spherical equivalent refraction (SER) was analyzed. The participants also self-reported their smart device usage at baseline. Multivariate regression adjusted for age, sex, baseline SER, parents' short-sightedness, BMI, time spent on moderate-to-vigorous physical activity (MVPA), and caregiver-reported socio-economic status showed that, compared with the reference group (<2 h per day on both smartphone and tablet usages), those who spent ≥2 h per day using a smartphone and <2 h per day using a tablet had a significantly negative shift in refractive error (1-year change in SER -0.25 vs. -0.09 D, = 0.01) for the right eye, while the level of significance was marginal (1-year change -0.28 vs. -0.15 D, = 0.055) for the left eye. To conclude, our data suggested spending at most 2 h per day on both smartphones and tablets.
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http://dx.doi.org/10.3390/ijerph17238923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730324PMC
November 2020

Sleep pattern in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data.

Eur J Public Health 2021 02;31(1):23-30

Urbandroid Team, Prague, Czech.

Background: To stop the spread of the new coronavirus disease in 2019 (COVID-19), many countries had completely locked down. This lockdown restricted the everyday life of the affected residents and changed their mobility pattern, but its effects on sleep pattern were largely unknown.

Methods: Here, utilizing one of the largest crowdsourced database (Sleep as Android), we analyzed the sleep pattern of 25 217 users with 1 352 513 sleep records between 1 January and 29 April 2020 in the US and 16 European countries (Germany, UK, Spain, France, Italy, The Netherlands, Belgium, Hungary, Denmark, Finland, Norway, Czech, Sweden, Austria, Poland and Switzerland) with more than 100 records in all days of 2020.

Results: During the COVID-19 pandemic, the sleeping pattern before and after the country-level lockdown largely differed. The subjects increased their sleep duration by an average of 11.3 to 18.6 min on weekday nights, except Denmark (4.9 min) and Finland (7.1 min). In addition, subjects form all 16 European countries delayed their sleep onset from 10.7 min (Sweden) to 29.6 min (Austria).

Conclusion: During the COVID-19 pandemic, residents in the US and 16 European countries delayed their bedtime and slept longer than usual.
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http://dx.doi.org/10.1093/eurpub/ckaa208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717335PMC
February 2021

Temporal association between objectively measured smartphone usage, sleep quality and physical activity among Chinese adolescents and young adults.

J Sleep Res 2020 Oct 13:e13213. Epub 2020 Oct 13.

Department of Knowledge Service Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.

We studied the association between objectively measured smartphone usage and objectively measured sleep quality and physical activity for seven consecutive days among Hong Kong adolescents and young adults aged 11-25 years (n = 357, 67% female). We installed an app that tracked the subjects' smartphone usage and had them wear an ActiGraph GT3X accelerometer on their wrist to measure their sleep quality and physical activity level. Smartphone usage data were successfully obtained from 187 participants (52.4%). The participants on average spent 2 h 46 min per day on their smartphone. Multilevel regression showed that 1 min of daytime smartphone usage was associated with 0.07 min decrease in total sleeping time that night (p = .043, 95% confidence interval [CI]: -0.14, -0.003). Broken down for different usage purposes, 1 min of daytime social network usage and games and comics was associated with a 0.28 (p = .02, 95% CI: -0.52, -0.04) min and 0.18 min (p = .01, 95% CI: -0.32, -0.04) decrease in total sleeping time that night, respectively. One minute of daytime smartphone usage was associated with an increase of 4.55 steps in the number of steps (p = .001, 95% CI: 1.77, 7.34) on the next day. To conclude, time spent on a smartphone in the daytime was associated with total sleeping time that night and number of steps the next day, but was not associated with sleep efficiency, wake after sleep onset and moderate-to-vigorous-intensity activity (MVPA) among Hong Kong adolescents and young adults.
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http://dx.doi.org/10.1111/jsr.13213DOI Listing
October 2020

Investigating the Matching Relationship between Physical Exercise and Stereotypic Behavior in Children with Autism.

Med Sci Sports Exerc 2020 Sep 25. Epub 2020 Sep 25.

School of Nursing, Hong Kong Polytechnic University, Hong Kong, China.

Purpose: Physical exercise has been shown to be effective in reducing stereotypic behaviors in children with autism spectrum disorder (ASD). One possible mechanism concerns the matching hypothesis between exercise and behavior. The present study sought to examine this matching exercise-behavior relationship.

Methods: Participants (N = 21, 17 males and 4 females, Mage = 11.07 ± 1.44 yr, Mheight = 1.46 ± 0.99 m, and Mweight = 40.60 ± 8.25 kg), with observable forms of hand-flapping and body-rocking stereotypic behaviors, underwent three separate days of conditions, one for the control condition, one for the 10-min ball-tapping exercise condition, and one for the 10-min jogging condition, in randomized order. The frequency of each type of stereotypic behavior was video-recorded from 15 min before to 60 min after the exercise.

Results: Results revealed that only hand-flapping stereotypic behaviors were significantly reduced in the ball-tapping exercise condition (p <.017), while only body-rocking stereotypic behaviors were significantly reduced in the jogging exercise condition (p <.017). However, the behavioral benefit diminished at 45 min after the respective exercise.

Conclusion: Physical exercise should be topographically-matched with stereotypic behavior in order to produce desirable behavioral benefits in children with ASD.
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http://dx.doi.org/10.1249/MSS.0000000000002525DOI Listing
September 2020

Crowdsourced smartphone data reveal altered sleep/wake pattern in quarantined Chinese during the COVID-19 outbreak.

Chronobiol Int 2020 08 5;37(8):1181-1190. Epub 2020 Aug 5.

Urbandroid Team , Prague, Czech Republic.

The Chinese Government quarantined Wuhan on 23 January 2020 and thereafter the Hubei province, affecting a total of 59 million citizens, to cease the spread of the coronavirus disease in 2019 (COVID-19). The effects of this lockdown on the psychological and mental health of both the affected and unaffected Chinese are largely unknown currently. We utilized one of the largest crowdsourced databases (Sleep as Android) that consisted of 15,681 sleep records from 563 users in China to estimate the change in the sleep pattern of Chinese users during the span of 30 December 2019 to 8 March 2020 with reference to 64,378 sleep records of 1,628 users for the same calendar period of years 2011-2019. The sleep pattern in China changed drastically after 23 January 2020 when the law of quarantine and suspension of Wuhan became effective. The two major findings are: (1) Chinese people increased their sleep duration by an average of 20 min and delayed their sleep onset by an average of 30 min at weekdays, while they maintained a similar sleep duration at weekends, and (2) larger changes were found in several subgroups, including those in Wuhan (80 sleep records from 3 users), female subjects, and those aged ≤ 24 years. Overall, Chinese people slept later and longer than usual during the COVID-19 pandemic quarantine.
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http://dx.doi.org/10.1080/07420528.2020.1792486DOI Listing
August 2020

Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial.

JMIR Mhealth Uhealth 2020 07 31;8(7):e16596. Epub 2020 Jul 31.

School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (China).

Background: Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear.

Objective: We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA.

Methods: An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ≥60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately.

Results: We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85%). The recruitment rate was 33% (33/99), the participant retention rate was 91% (30/33), and the attendance rate of all the face-to-face sessions was 100% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1%). ActiGraph (58/66 days, 88%) and smartphone (54/56 days, 97%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group.

Conclusions: Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects.

Trial Registration: HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756.
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http://dx.doi.org/10.2196/16596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428907PMC
July 2020

Comparing sleep patterns between children with autism spectrum disorder and children with typical development: A matched case-control study.

Autism 2020 11 7;24(8):2298-2303. Epub 2020 Jul 7.

The Hong Kong Polytechnic University, Hong Kong.

Lay Abstract: This study compared the sleep pattern between children with autism spectrum disorders and children with typical development using a matched case-control design (matched age, gender, and body mass index). Significant differences were found in night-time sleep duration (total amount of sleep at night), sleep efficiency (percentage of time spent asleep), sleep-onset latency (length of time that it takes to transit from awake to asleep), and wake after sleep onset (total amount of time spent awake after defined sleep onset). Findings showed that children with autism spectrum disorder had poorer sleep quality than children with typical development. Mechanisms underlying the differences should be further explored in order to develop an effective treatment intervention.
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http://dx.doi.org/10.1177/1362361320936827DOI Listing
November 2020

An Exploration of the Effectiveness of a Peer-Led Pain Management Program (PAP) for Nursing Home Residents with Chronic Pain and an Evaluation of Their Experiences: A Pilot Randomized Controlled Trial.

Int J Environ Res Public Health 2020 06 8;17(11). Epub 2020 Jun 8.

Department of Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.

80% of nursing home residents have reported chronic pain, which is often accepted by older adults as part of aging. Peer support models are being used to help individuals manage their chronic conditions and overcome the challenges of limited healthcare resources. The aims of this study were: (i) to examine the effectiveness of a 12 week peer-led pain management program (PAP) for nursing home residents and (ii) to evaluate their experiences. A cluster randomized controlled trial (RCT) was used. The 12 week pain management program was provided for the experimental group. Outcomes were measured at three time points. The participants' satisfaction and acceptance were evaluated by a semi-structured interview after the program was completed. Pain self-efficacy, pain intensity, pain interference, pain knowledge, and depression levels improved after the completion of the 12 week peer-led PAP. The pain-intensity level reported at week 12 was significantly lower in the experimental group than in the control group. Semi-structured interviews showed that the nursing home residents were satisfied with the pain education that they received. The 12 week peer-led PAP appeared to improve the pain-related and psychological outcome measures in nursing home residents, and the feedback on the peer-led PAP from the nursing home residents was positive.
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http://dx.doi.org/10.3390/ijerph17114090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312826PMC
June 2020

The quality of the reported sample size calculation in clinical trials on COVID-19 patients indexed in PubMed.

Authors:
Paul H Lee

Eur J Intern Med 2020 07 30;77:139-140. Epub 2020 Apr 30.

School of Nursing, Hong Kong Polytechnic University. Electronic address:

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http://dx.doi.org/10.1016/j.ejim.2020.04.057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190503PMC
July 2020

Sample sizes in COVID-19-related research.

Authors:
Paul H Lee

CMAJ 2020 04;192(17):E461

School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong.

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http://dx.doi.org/10.1503/cmaj.75308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207191PMC
April 2020

A cluster randomized controlled trial of a simplified 5-step handwashing technique versus a conventional 7-step handwashing technique among Chinese students with intellectual disabilities.

J Appl Res Intellect Disabil 2020 Sep 13;33(5):1090-1099. Epub 2020 Apr 13.

School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.

Objective: To compare the effects of the simplified 5-step and the conventional 7-Step hand hygiene programme in a cluster randomized controlled trial among students with intellectual disabilities.

Method: A total of 472 Chinese students with intellectual disabilities were randomized to either simplified 5-step or conventional 7-step hand hygiene programme. Assessments included handwashing technique, cleanliness and sick leave days.

Results: Handwashing technique scores (g = 0.25, 95% CI [0.18, 0.32]) and hand cleanliness scores (g = 0.33, 95% CI [0.26, 0.4]) in intervention group were significantly higher than those scores in control group at 6th month post-intervention although there were significant increases in the scores within both groups. The mean number of sick leave days decreased between baseline and 10 month in both groups according to descriptive statistics.

Conclusions: It is feasible and effective to adopt the simplified 5-step intervention as a standardized handwashing technique for the population group with intellectual disabilities.
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http://dx.doi.org/10.1111/jar.12731DOI Listing
September 2020

The effectiveness of a pressure injury prevention program for nursing assistants in private for-profit nursing homes: A cluster randomized controlled trial.

J Adv Nurs 2020 Jul 11;76(7):1780-1793. Epub 2020 May 11.

School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.

Aim: To examine the effectiveness of a pressure injury prevention program for private for-profit nursing homes.

Design: This study was a two-arm cluster randomized controlled trial. Ten private for-profit nursing homes made up the clusters.

Methods: The participants were nursing home residents who aged 60 or above regardless of whether or not having pre-existing pressure injuries and also three types of nursing home assistants who provided direct care to the residents from 10 private for-profit nursing homes. These 10 nursing homes were randomly assigned to either the experimental or the control group. There were 477 and 536 resident participants and 51 and 62 nursing assistant participants in the experimental and control groups, respectively. The residents were the study participants and the nursing assistant participants were the interveners. The experimental group had the pressure injury prevention program implemented while the control group received the usual care. The primary study outcome which was the pressure injury incidence was analysed by GEE. Significance was set at a p-value of ≤.05. The data were collected between September 2017-March 2018.

Result: There were significant interactive effects of time and group on the incidence of pressure injuries (p = .0015) and on the skill performance of the nursing assistant participants (p < .0001).

Conclusions: An evidence-based pressure injury prevention program reduced the development of the pressure injuries and improved the skill performance of the nursing assistant participants. It is highly recommended that private for-profit nursing homes with high proportion of non-professional nursing assistants and insufficient nurses adopt this program for improving the prevention care of pressure injuries.

Impact: This research has an impact on prevention care of pressure injury in private for-profit nursing homes with high proportion non-professional nursing assistants which have the similar characteristics as the nursing homes studied in various regions and countries.

Trial Registration: The Controlled Trial registration ID is NCT02270385.
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http://dx.doi.org/10.1111/jan.14391DOI Listing
July 2020

Associations Between Quality of Life, Psychosocial Well-being and Health-Related Behaviors Among Adolescents in Chinese, Japanese, Taiwanese, Thai and the Filipino Populations: A Cross-Sectional Survey.

Int J Environ Res Public Health 2020 04 1;17(7). Epub 2020 Apr 1.

School of Nursing, World Health Organization Collaborating Center for Community Health Services, The Hong Kong Polytechnic University, Hong Kong, China.

Health-related behaviors during adolescence have lifelong impacts. However, there are unclear areas regarding the associations between health-related quality of life and demographic characteristics, as well as physical and psychosocial indicators. The aim of this study was to examine the associations between quality of life and body weight, sleep outcome, social support by age, and cohabitants, given that income, self-esteem, lifestyle, emotional, social and behavioral problems were taken into account among adolescents in East and Southeast Asia. A cross-sectional survey was conducted in Zhengzhou of China, Hong Kong, Kansai region of Japan, Taipei of Taiwan, Bangkok of Thailand and Manila of the Philippines between 2016 and 2017 among 21,359 urban adolescents aged between 9 and 16. The results showed that adolescents who had better self-esteem and control of emotions and behaviors had much higher level of perceived quality of life. Those who were overweight or obese, sleepy in the daytime, and not living with parents had worse quality of life compared with those who were not. In conclusion, psychosocial well-being should have a higher priority in the promotion of quality of life among Asian adolescents. Nevertheless, further studies are required to explore the differences in perceived quality of life between genders and countries.
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http://dx.doi.org/10.3390/ijerph17072402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177547PMC
April 2020

Obestatin and growth hormone reveal the interaction of central obesity and other cardiometabolic risk factors of metabolic syndrome.

Sci Rep 2020 03 26;10(1):5495. Epub 2020 Mar 26.

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

Metabolic syndrome (MetS) is a multi-factorial disorder including central obesity (CO), insulin resistance, hyperglycemia, dyslipidemia and hypertension which increases the risk of diabetes mellitus and cardiovascular diseases. CO is considered as an essential component of MetS according to International Diabetes Federation (IDF), which may further modulate distinct signalling pathways compared with the other four MetS risk factors. Given that ghrelin signalling and the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis regulates energy balance and metabolic homeostasis, this study examined the changes in various ghrelin products and circulating hormones in response to the interaction between CO and other MetS components including blood pressure, fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol in 133 Hong Kong Chinese adults. Circulating obestatin and GH were increased and reduced, respectively, by either CO or the other 4-risk factor cluster. These changes were further augmented by the presence of all MetS risk factors. However, changes of ghrelin levels were not mediated by CO but the other MetS risk factors. Our findings suggest that CO does not predict all the dysregulation of signalling pathways in individuals with MetS. Although CO and other MetS may share common signalling targets (i.e., obestatin and GH), CO does not contribute to the perturbation of ghrelin signalling.
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http://dx.doi.org/10.1038/s41598-020-62271-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099091PMC
March 2020

Tracking development assistance for health from China, 2007-2017.

BMJ Glob Health 2019 8;4(5):e001513. Epub 2019 Oct 8.

Institute for Health Metrics and Evaluation, Seattle, Washington, USA.

Introduction: In recent years, China has increased its international engagement in health. Nonetheless, the lack of data on contributions has limited efforts to examine contributions from China. Existing estimates that track development assistance for health (DAH) from China have relied primarily on one dataset. Furthermore, little is known about the disbursing agencies especially the multilaterals through which contributions are disbursed and how these are changing across time. In this study, we generated estimates of DAH from China from 2007 through 2017 and disaggregated those estimates by disbursing agency and health focus area.

Methods: We identified the major government agencies providing DAH. To estimate DAH provided by each agency, we leveraged publicly available development assistance data in government agencies' budgets and financial accounts, as well as revenue statements from key international development agencies such as the WHO. We reported trends in DAH from China, disaggregated contributions by disbursing bilateral and multilateral agencies, and compared DAH from China with other traditional donors. We also compared these estimates with existing estimates.

Results: DAH provided by China grew dramatically, from US$323.1 million in 2007 to $652.3 million in 2017. During this period, 91.8% of DAH from China was disbursed through its bilateral agencies, including the Ministry of Commerce ($3.7 billion, 64.1%) and the National Health Commission ($917.1 million, 16.1%); the other 8.2% was disbursed through multilateral agencies including the WHO ($236.5 million, 4.1%) and the World Bank ($123.1 million, 2.2%). Relative to its level of economic development, China provided substantially more DAH than would be expected. However, relative to population size and government spending, China's contributions are modest.

Conclusion: In the current context of plateauing in the growth rate of DAH contributions, China has the potential to contribute to future global health financing, especially financing for health system strengthening.
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http://dx.doi.org/10.1136/bmjgh-2019-001513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6782043PMC
October 2019

Psychometric Properties and Demographic Correlates of the Smartphone Addiction Scale-Short Version Among Chinese Children and Adolescents in Hong Kong.

Cyberpsychol Behav Soc Netw 2019 Nov 17;22(11):714-723. Epub 2019 Oct 17.

School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong.

Nearly all children and teens in Hong Kong own a smartphone. There is currently no validated instrument that measures whether they use their phone too much. This study tested the psychometric properties of a translated Chinese version of the Smartphone Addiction Scale-Short Version (SAS-SV) and examined the demographic correlates of smartphone addiction among Hong Kong children and adolescents. A total of 1,901 primary school children and secondary school pupils were recruited from 15 Hong Kong schools. Furthermore, 1,797 primary caregivers were asked to complete a self-administered questionnaire on their socioeconomic status and educational attainment. The study used exploratory factor analysis (EFA) to identify the factor structure of SAS-SV for half the participants ( = 951), while confirmatory factor analysis (CFA) was used to assess the goodness-of-fit of EFA models for the remaining half ( = 951). Spearman correlations were used to assess the convergent validity of the SAS-SV, taking account of time spent by subjects on phones per day, the Smart Device Addiction Screening Tool (SDAST), the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Center for Epidemiological Studies Depression Scale for Children (CES-DC). EFA generated a three-factor model (with factors labeled "dependency," the incidence of a "problem," and "time spent"). CFA confirmed this model yielded an acceptable goodness-of-fit (Comparative Fit Index = 0.96, Tucker Lewis Index = 0.95, and root-mean-square error of approximation = 0.06). SAS-SV was positively correlated with SDAST (ρ = 0.59), PSQI (ρ = 0.29), and CES-D (ρ = 0.35), and negatively correlated with MSPSS (ρ = -0.10). A linear regression model showed that female adolescents, those with highly educated caregivers and those who spent more time using smartphones on their holidays, had on average higher SAS-SV scores, meaning they showed greater vulnerability to becoming addicted. The study found that SAS-SV is a valid scale for estimating excessive smartphone use among Hong Kong children and adolescents.
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http://dx.doi.org/10.1089/cyber.2019.0325DOI Listing
November 2019

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Authors:
Roy Burstein Nathaniel J Henry Michael L Collison Laurie B Marczak Amber Sligar Stefanie Watson Neal Marquez Mahdieh Abbasalizad-Farhangi Masoumeh Abbasi Foad Abd-Allah Amir Abdoli Mohammad Abdollahi Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Michael R M Abrigo Dilaram Acharya Oladimeji M Adebayo Victor Adekanmbi Davoud Adham Mahdi Afshari Mohammad Aghaali Keivan Ahmadi Mehdi Ahmadi Ehsan Ahmadpour Rushdia Ahmed Chalachew Genet Akal Joshua O Akinyemi Fares Alahdab Noore Alam Genet Melak Alamene Kefyalew Addis Alene Mehran Alijanzadeh Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Mohammed J Almalki Hesham M Al-Mekhlafi Khalid Altirkawi Nelson Alvis-Guzman Adeladza Kofi Amegah Saeed Amini Arianna Maever Loreche Amit Zohreh Anbari Sofia Androudi Mina Anjomshoa Fereshteh Ansari Carl Abelardo T Antonio Jalal Arabloo Zohreh Arefi Olatunde Aremu Bahram Armoon Amit Arora Al Artaman Anvar Asadi Mehran Asadi-Aliabadi Amir Ashraf-Ganjouei Reza Assadi Bahar Ataeinia Sachin R Atre Beatriz Paulina Ayala Quintanilla Martin Amogre Ayanore Samad Azari Ebrahim Babaee Arefeh Babazadeh Alaa Badawi Soghra Bagheri Mojtaba Bagherzadeh Nafiseh Baheiraei Abbas Balouchi Aleksandra Barac Quique Bassat Bernhard T Baune Mohsen Bayati Neeraj Bedi Ettore Beghi Masoud Behzadifar Meysam Behzadifar Yared Belete Belay Brent Bell Michelle L Bell Dessalegn Ajema Berbada Robert S Bernstein Natalia V Bhattacharjee Suraj Bhattarai Zulfiqar A Bhutta Ali Bijani Somayeh Bohlouli Nicholas J K Breitborde Gabrielle Britton Annie J Browne Sharath Burugina Nagaraja Reinhard Busse Zahid A Butt Josip Car Rosario Cárdenas Carlos A Castañeda-Orjuela Ester Cerin Wagaye Fentahun Chanie Pranab Chatterjee Dinh-Toi Chu Cyrus Cooper Vera M Costa Koustuv Dalal Lalit Dandona Rakhi Dandona Farah Daoud Ahmad Daryani Rajat Das Gupta Ian Davis Nicole Davis Weaver Dragos Virgil Davitoiu Jan-Walter De Neve Feleke Mekonnen Demeke Gebre Teklemariam Demoz Kebede Deribe Rupak Desai Aniruddha Deshpande Hanna Demelash Desyibelew Sagnik Dey Samath Dhamminda Dharmaratne Meghnath Dhimal Daniel Diaz Leila Doshmangir Andre R Duraes Laura Dwyer-Lindgren Lucas Earl Roya Ebrahimi Soheil Ebrahimpour Andem Effiong Aziz Eftekhari Elham Ehsani-Chimeh Iman El Sayed Maysaa El Sayed Zaki Maha El Tantawi Ziad El-Khatib Mohammad Hassan Emamian Shymaa Enany Sharareh Eskandarieh Oghenowede Eyawo Maha Ezalarab Mahbobeh Faramarzi Mohammad Fareed Roghiyeh Faridnia Andre Faro Ali Akbar Fazaeli Mehdi Fazlzadeh Netsanet Fentahun Seyed-Mohammad Fereshtehnejad João C Fernandes Irina Filip Florian Fischer Nataliya A Foigt Masoud Foroutan Joel Msafiri Francis Takeshi Fukumoto Nancy Fullman Silvano Gallus Destallem Gebremedhin Gebre Tsegaye Tewelde Gebrehiwot Gebreamlak Gebremedhn Gebremeskel Bradford D Gessner Birhanu Geta Peter W Gething Reza Ghadimi Keyghobad Ghadiri Mahsa Ghajarzadeh Ahmad Ghashghaee Paramjit Singh Gill Tiffany K Gill Nick Golding Nelson G M Gomes Philimon N Gona Sameer Vali Gopalani Giuseppe Gorini Bárbara Niegia Garcia Goulart Nicholas Graetz Felix Greaves Manfred S Green Yuming Guo Arvin Haj-Mirzaian Arya Haj-Mirzaian Brian James Hall Samer Hamidi Hamidreza Haririan Josep Maria Haro Milad Hasankhani Edris Hasanpoor Amir Hasanzadeh Hadi Hassankhani Hamid Yimam Hassen Mohamed I Hegazy Delia Hendrie Fatemeh Heydarpour Thomas R Hird Chi Linh Hoang Gillian Hollerich Enayatollah Homaie Rad Mojtaba Hoseini-Ghahfarokhi Naznin Hossain Mostafa Hosseini Mehdi Hosseinzadeh Mihaela Hostiuc Sorin Hostiuc Mowafa Househ Mohamed Hsairi Olayinka Stephen Ilesanmi Mohammad Hasan Imani-Nasab Usman Iqbal Seyed Sina Naghibi Irvani Nazrul Islam Sheikh Mohammed Shariful Islam Mikk Jürisson Nader Jafari Balalami Amir Jalali Javad Javidnia Achala Upendra Jayatilleke Ensiyeh Jenabi John S Ji Yash B Jobanputra Kimberly Johnson Jost B Jonas Zahra Jorjoran Shushtari Jacek Jerzy Jozwiak Ali Kabir Amaha Kahsay Hamed Kalani Rohollah Kalhor Manoochehr Karami Surendra Karki Amir Kasaeian Nicholas J Kassebaum Peter Njenga Keiyoro Grant Rodgers Kemp Roghayeh Khabiri Yousef Saleh Khader Morteza Abdullatif Khafaie Ejaz Ahmad Khan Junaid Khan Muhammad Shahzeb Khan Young-Ho Khang Khaled Khatab Amir Khater Mona M Khater Alireza Khatony Mohammad Khazaei Salman Khazaei Maryam Khazaei-Pool Jagdish Khubchandani Neda Kianipour Yun Jin Kim Ruth W Kimokoti Damaris K Kinyoki Adnan Kisa Sezer Kisa Tufa Kolola Soewarta Kosen Parvaiz A Koul Ai Koyanagi Moritz U G Kraemer Kewal Krishan Kris J Krohn Nuworza Kugbey G Anil Kumar Manasi Kumar Pushpendra Kumar Desmond Kuupiel Ben Lacey Sheetal D Lad Faris Hasan Lami Anders O Larsson Paul H Lee Mostafa Leili Aubrey J Levine Shanshan Li Lee-Ling Lim Stefan Listl Joshua Longbottom Jaifred Christian F Lopez Stefan Lorkowski Sameh Magdeldin Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Azeem Majeed Afshin Maleki Reza Malekzadeh Deborah Carvalho Malta Abdullah A Mamun Navid Manafi Ana-Laura Manda Morteza Mansourian Francisco Rogerlândio Martins-Melo Anthony Masaka Benjamin Ballard Massenburg Pallab K Maulik Benjamin K Mayala Mohsen Mazidi Martin McKee Ravi Mehrotra Kala M Mehta Gebrekiros Gebremichael Meles Walter Mendoza Ritesh G Menezes Atte Meretoja Tuomo J Meretoja Tomislav Mestrovic Ted R Miller Molly K Miller-Petrie Edward J Mills George J Milne G K Mini Seyed Mostafa Mir Hamed Mirjalali Erkin M Mirrakhimov Efat Mohamadi Dara K Mohammad Aso Mohammad Darwesh Naser Mohammad Gholi Mezerji Ammas Siraj Mohammed Shafiu Mohammed Ali H Mokdad Mariam Molokhia Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Ghobad Moradi Masoud Moradi Yousef Moradi Maziar Moradi-Lakeh Mehdi Moradinazar Paula Moraga Lidia Morawska Abbas Mosapour Seyyed Meysam Mousavi Ulrich Otto Mueller Atalay Goshu Muluneh Ghulam Mustafa Behnam Nabavizadeh Mehdi Naderi Ahamarshan Jayaraman Nagarajan Azin Nahvijou Farid Najafi Vinay Nangia Duduzile Edith Ndwandwe Nahid Neamati Ionut Negoi Ruxandra Irina Negoi Josephine W Ngunjiri Huong Lan Thi Nguyen Long Hoang Nguyen Son Hoang Nguyen Katie R Nielsen Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Molly R Nixon Chukwudi A Nnaji Marzieh Nojomi Mehdi Noroozi Shirin Nosratnejad Jean Jacques Noubiap Soraya Nouraei Motlagh Richard Ofori-Asenso Felix Akpojene Ogbo Kelechi E Oladimeji Andrew T Olagunju Meysam Olfatifar Solomon Olum Bolajoko Olubukunola Olusanya Mojisola Morenike Oluwasanu Obinna E Onwujekwe Eyal Oren Doris D V Ortega-Altamirano Alberto Ortiz Osayomwanbo Osarenotor Frank B Osei Aaron E Osgood-Zimmerman Stanislav S Otstavnov Mayowa Ojo Owolabi Mahesh P A Abdol Sattar Pagheh Smita Pakhale Songhomitra Panda-Jonas Animika Pandey Eun-Kee Park Hadi Parsian Tahereh Pashaei Sangram Kishor Patel Veincent Christian Filipino Pepito Alexandre Pereira Samantha Perkins Brandon V Pickering Thomas Pilgrim Majid Pirestani Bakhtiar Piroozi Meghdad Pirsaheb Oleguer Plana-Ripoll Hadi Pourjafar Parul Puri Mostafa Qorbani Hedley Quintana Mohammad Rabiee Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Zohreh Rahimi Vafa Rahimi-Movaghar Shadi Rahimzadeh Fatemeh Rajati Sree Bhushan Raju Azra Ramezankhani Chhabi Lal Ranabhat Davide Rasella Vahid Rashedi Lal Rawal Robert C Reiner Andre M N Renzaho Satar Rezaei Aziz Rezapour Seyed Mohammad Riahi Ana Isabel Ribeiro Leonardo Roever Elias Merdassa Roro Max Roser Gholamreza Roshandel Daem Roshani Ali Rostami Enrico Rubagotti Salvatore Rubino Siamak Sabour Nafis Sadat Ehsan Sadeghi Reza Saeedi Yahya Safari Roya Safari-Faramani Mahdi Safdarian Amirhossein Sahebkar Mohammad Reza Salahshoor Nasir Salam Payman Salamati Farkhonde Salehi Saleh Salehi Zahabi Yahya Salimi Hamideh Salimzadeh Joshua A Salomon Evanson Zondani Sambala Abdallah M Samy Milena M Santric Milicevic Bruno Piassi Sao Jose Sivan Yegnanarayana Iyer Saraswathy Rodrigo Sarmiento-Suárez Benn Sartorius Brijesh Sathian Sonia Saxena Alyssa N Sbarra Lauren E Schaeffer David C Schwebel Sadaf G Sepanlou Seyedmojtaba Seyedmousavi Faramarz Shaahmadi Masood Ali Shaikh Mehran Shams-Beyranvand Amir Shamshirian Morteza Shamsizadeh Kiomars Sharafi Mehdi Sharif Mahdi Sharif-Alhoseini Hamid Sharifi Jayendra Sharma Rajesh Sharma Aziz Sheikh Chloe Shields Mika Shigematsu Rahman Shiri Ivy Shiue Kerem Shuval Tariq J Siddiqi João Pedro Silva Jasvinder A Singh Dhirendra Narain Sinha Malede Mequanent Sisay Solomon Sisay Karen Sliwa David L Smith Ranjani Somayaji Moslem Soofi Joan B Soriano Chandrashekhar T Sreeramareddy Agus Sudaryanto Mu'awiyyah Babale Sufiyan Bryan L Sykes P N Sylaja Rafael Tabarés-Seisdedos Karen M Tabb Takahiro Tabuchi Nuno Taveira Mohamad-Hani Temsah Abdullah Sulieman Terkawi Zemenu Tadesse Tessema Kavumpurathu Raman Thankappan Sathish Thirunavukkarasu Quyen G To Marcos Roberto Tovani-Palone Bach Xuan Tran Khanh Bao Tran Irfan Ullah Muhammad Shariq Usman Olalekan A Uthman Amir Vahedian-Azimi Pascual R Valdez Job F M van Boven Tommi Juhani Vasankari Yasser Vasseghian Yousef Veisani Narayanaswamy Venketasubramanian Francesco S Violante Sergey Konstantinovitch Vladimirov Vasily Vlassov Theo Vos Giang Thu Vu Isidora S Vujcic Yasir Waheed Jon Wakefield Haidong Wang Yafeng Wang Yuan-Pang Wang Joseph L Ward Robert G Weintraub Kidu Gidey Weldegwergs Girmay Teklay Weldesamuel Ronny Westerman Charles Shey Wiysonge Dawit Zewdu Wondafrash Lauren Woyczynski Ai-Min Wu Gelin Xu Abbas Yadegar Tomohide Yamada Vahid Yazdi-Feyzabadi Christopher Sabo Yilgwan Paul Yip Naohiro Yonemoto Javad Yoosefi Lebni Mustafa Z Younis Mahmoud Yousefifard Hebat-Allah Salah A Yousof Chuanhua Yu Hasan Yusefzadeh Erfan Zabeh Telma Zahirian Moghadam Sojib Bin Zaman Mohammad Zamani Hamed Zandian Alireza Zangeneh Taddese Alemu Zerfu Yunquan Zhang Arash Ziapour Sanjay Zodpey Christopher J L Murray Simon I Hay

Nature 2019 10 16;574(7778):353-358. Epub 2019 Oct 16.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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http://dx.doi.org/10.1038/s41586-019-1545-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800389PMC
October 2019

Social media use and depressive symptoms among Hong Kong young adults during the period of 2019 extradition bill controversy.

Authors:
Paul H Lee

Asian J Psychiatr 2019 Oct 28;45:38-40. Epub 2019 Aug 28.

School of Nursing, GH527, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. Electronic address:

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http://dx.doi.org/10.1016/j.ajp.2019.08.012DOI Listing
October 2019

The Association between Demographic Characteristics, Lifestyle Health Behaviours, and Quality of Life among Adolescents in Asia Pacific Region.

Int J Environ Res Public Health 2019 07 1;16(13). Epub 2019 Jul 1.

School of Nursing, World Health Organization Collaborating Center for Community Health Services, The Hong Kong Polytechnic University, Hong Kong, China.

: Given the risk of physical and psychosocial health that emerge in adolescents that are continuing into adulthood, identifying and addressing early signs of health-related quality of life (HRQoL) decline provides an opportunity to ensure that young people have a healthier progression through adolescence. : To investigate the association between demographic characteristics, lifestyle health behaviours, and HRQoL of adolescents who live in Asia Pacific region, including Hong Kong in China, Beijing in China, Akashi in Japan, Seoul in South Korea, and Bangkok in Thailand. : A cross-sectional self-reported survey carried out in a sample of 2296 adolescents that were aged 9-16 years (mean= 12.0; standard deviation [SD] = 1.63) was conducted in the five cities of the Asia Pacific region between January and August 2017. Demographic characteristics, adolescent lifestyle behaviours, and HRQoL were measured with demographic questionnaire, Adolescent Lifestyle Questionnaire's (ALQ) seven domains and Paediatric Quality of Life's (PedsQL 4.0) global score, respectively. Mixed multilevel model (MMLM) was used to fit the data. : After adjusting the demographic variables, one score increase in ALQ physical participation, nutrition, social support, and identity awareness are associated with an increase in PedsQL global score. On the contrary, one score increase in ALQ health practices is associated with a decrease in the PedsQL global score. The estimated mean of PedsQL global score of South Korea, Beijing, and Japan were better, while the score of Thailand and Hong Kong were poorer. : Differentiating the impacts of promoting health behaviours among different countries can help in better understanding the health needs of adolescents in each country, especially in the Asia Pacific region, so that adequate and relevant resources can be allocated to reduce health-risk taking behaviours among this vulnerable group for health-promoting strategies.
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http://dx.doi.org/10.3390/ijerph16132324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651512PMC
July 2019

A Brief Hope Intervention to Increase Hope Level and Improve Well-Being in Rehabilitating Cancer Patients: A Feasibility Test.

SAGE Open Nurs 2019 Jan-Dec;5:2377960819844381. Epub 2019 May 8.

School of Nursing, The Hong Kong Polytechnic University, People's Republic of China.

This article reports on the feasibility and effect of the brief hope intervention (BHI) in terms of increasing the hope level and psychological and physical health outcomes of rehabilitating cancer patients (RCP). Chinese RCP living in the community were invited to join the study. The BHI consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between. There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals. A one-group pre- and postintervention design was used. Outcome measures included the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression Scale (CES-D), and the State Hope Scale. Recruitment, attrition, and qualitative feedback were collected to understand their comments on BHI. A total of 40 participants were recruited (female 92.3%). The mean age was 57.2 years ( = 6.7). The participants had significant improvement in all aspects of the Memorial Symptom Assessment Scale, with moderate-to-large effect sizes ( = 0.49-0.74). The changes in present hope and depression scores were insignificant, with small effect sizes ( = 0.17-0.34). The BHI seemed to be promising in producing both physical and psychological benefits in RCP.
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http://dx.doi.org/10.1177/2377960819844381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774404PMC
May 2019

Smoking and Influenza-associated Morbidity and Mortality: A Systematic Review and Meta-analysis.

Epidemiology 2019 05;30(3):405-417

From the School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, People's Republic of China.

Background: Although smoking has been recognized as a risk factor for many respiratory diseases, its effects of influenza-associated morbidity and mortality remain controversial. We conducted a systematic review and meta-analysis to assess the impact of smoking on influenza-associated hospital admissions, intensive care unit (ICU) admissions, and deaths.

Methods: We searched the databases of PubMed, CINAHL, EMBASE, and the China National Knowledge Infrastructure for all observational studies published between 1 January 2000 and 30 November 2017 on ever-active/secondhand smoking and influenza-associated hospital admissions, ICU admissions, and deaths. We pooled data using random effect models.

Results: The initial search retrieved 7495 articles, of which 20 studies were included for systematic review, and 12 studies (eight case-control studies, two cohort studies, and two cross-sectional studies) with 18612 subjects were included in meta-analysis. The overall quality of selected studies was moderate. Ever-active smokers had higher odds of hospital admissions (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.3, 1.7) and ICU admissions (OR 2.2; 95% CI = 1.4, 3.4) after influenza infections, as compared with never smokers. No association was observed between ever-active smoking and influenza-associated deaths. We found a positive association between secondhand smoking and influenza-associated hospital admissions, but only in children below 15 years of age.

Conclusions: The literature evidence showed that smoking was consistently associated with higher risk of hospital admissions after influenza infection, but the results for ICU admissions and deaths were less conclusive because of the limited number of studies.
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http://dx.doi.org/10.1097/EDE.0000000000000984DOI Listing
May 2019

The association between workplace violence and physicians' and nurses' job satisfaction in Macau.

PLoS One 2018 5;13(12):e0207577. Epub 2018 Dec 5.

Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong SAR.

Background: This paper describes the association between workplace violence and job satisfaction among physicians and nurses in Macau. Convenience sampling was sourced from six health centers under the Macau Health Bureau.

Methods: This study uses a cross-sectional self-administrative survey. The study used case studies research instruments for workplace violence in the health sector by country (from the ILO, ICN, WHO, PSI), the Minnesota Satisfaction Questionnaire and Perceived Stress Scale. The data collection period spanned from August to December, 2014.

Data Analysis: Multiple logistic regression examines levels of intrinsic and extrinsic satisfaction in physicians and nurses and significant correlates affecting their job satisfaction.

Results: A total of 720 (14.9% physicians) participants were recruited. 57.2% of participants reported physical and psychological workplace violence in the preceding year. The most common forms of workplace violence were verbal abuse (53.4%), physical assault (16.1%), bullying / harassment (14.2%), sexual harassment (4.6%) and racial harassment (2.6%). Nurses were at a significantly higher risk of physical assault and verbal abuse compared to physicians. Patients, patients' relatives, and colleagues were the main perpetrators. Worry about WPV, on-call duty and shift work, experience of bullying and verbal abuse and employment sector emerged as significant correlates affecting the intrinsic and extrinsic job satisfaction of physicians and nurses. Frontline staff, aged 30 and 39, coming from an ethnic minority, and perceived stress were significant correlates affecting nurses' job satisfaction.

Conclusions: WPV remains a significant concern in healthcare settings in Macau. Stakeholders should legally enforce a zero-tolerance policy towards WPV within healthcare workplaces. WPV is detrimental to healthcare professionals' mental wellbeing, risking irreversible physical and psychological harm for its victims.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207577PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281202PMC
May 2019

Determining the Optimal Number of Wearing-Days Given a Fixed Number of Accelerometers in Population-Level Study.

Authors:
Paul H Lee

J Epidemiol 2019 Nov 20;29(11):432-443. Epub 2018 Oct 20.

School of Nursing, Hong Kong Polytechnic University.

Background: In research using accelerometers to measure physical activity, the number of accelerometers that can be utilized in a study and the study duration are both constrained. It means that increasing the number of accelerometer wearing days for all subjects leads to a decrease in the total number of participants the study can recruit. We used simulations to find the optimal combination of the number of wearing days and number of participant given a fixed number of accelerometer days.

Methods: Two scenarios were studied here, including estimation of population physical activity level and the association between physical activity level and a health outcome. Another similar simulation was conducted by bootstrapping the National Health and Nutrition Examination Survey (NHANES) 2003-2006 accelerometer data (n = 4,069).

Results: The simulation results of the first scenario showed that the error was minimized when the number of wearing days was 1 to 2. Simulation results of the second scenario showed that the optimal number of wearing days increased with the total number of accelerometer days and decreased with intra-class correlation (ICC).

Conclusion: We developed a tool for researchers to determine the optimal combination of the number of the accelerometer wearing days and the total number of participants and showed that 1 to 2 accelerometer wearing days is optimal for estimation of population physical activity level.
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http://dx.doi.org/10.2188/jea.JE20180095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776478PMC
November 2019

One Year of Yoga Training Alters Ghrelin Axis in Centrally Obese Adults With Metabolic Syndrome.

Front Physiol 2018 20;9:1321. Epub 2018 Sep 20.

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

Metabolic syndrome (MetS) is a multiplex cardiometabolic manifestation associated with type 2 diabetes mellitus and cardiovascular diseases. Yoga training has been shown to alleviate MetS. Recently, circulatory ghrelin profile was demonstrated to be associated with MetS. This study examined the effects of 1 year of yoga training on β-cell function and insulin resistance, and the involvement of metabolic peptides, including unacylated ghrelin (UnAG), acylated ghrelin (AG), obestatin, growth hormone (GH), and insulin, in the beneficial effects of yoga training in centrally obese adults with MetS. This was a follow up study, in which data of risk factors of MetS, physical performance tests [resting heart rate (HR), chair stand test (CS), chair sit and reach test (CSR), back scratch test (BS), and single leg stand tests (SLS)] and serum samples of 79 centrally obese MetS subjects aged 58 ± 8 years (39 subjects received 1-year yoga training and 40 subjects received no training) were retrieved for analyses. β-cell function and insulin resistance were examined by Homeostasis Model Assessment (HOMA). Circulating levels of UnAG, AG, obestatin, GH, and insulin were determined by enzyme-linked immunosorbent assay using fasting serum samples. Generalized estimating equation analysis and Mann-Whitney -test were used to detect statistically significant differences between groups. Waist circumference (WC) was significantly decreased after yoga intervention (control: +2%; yoga: -4%). Significant improvements in HR (control: +2%; yoga: -5%), CS (control: -1%; yoga: +24%), CSR left (control: worsen by 0.90 cm; yoga: improved by 4.21 cm), CSR right (control: worsen by 0.75 cm; yoga: improved by 4.28 cm), right side of BS (control: improved by 0.19 cm; yoga: improved by 4.31 cm), SLS left (control: -10%; yoga: +86%), and SLS right (control: -6%; yoga: +47%) were observed after 1-year yoga training. No significant difference was found between the two groups in insulin, HOMA indices, and disposition index. Yoga training significantly increased circulating GH (control: -3%; yoga: +22%), total circulating ghrelin (control: -26%; yoga: +13%), and UnAG (control: -27%; yoga: +14%), whereas decreased AG (control: -7%; yoga: -33%) and obestatin (control: +24%; yoga: -29%). One-year of yoga training modulated total ghrelin, UnAG, AG, obestatin, and GH while exerting beneficial effects on physical functions and central obesity in adults with MetS. The beneficial effects of yoga may be associated with the alteration of ghrelin gene product and GH.
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http://dx.doi.org/10.3389/fphys.2018.01321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158302PMC
September 2018

Ghrelin Axis Reveals the Interacting Influence of Central Obesity and Hypertension.

Front Endocrinol (Lausanne) 2018 12;9:534. Epub 2018 Sep 12.

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

This study aimed to investigate how central obesity and hypertension modulate unacylated ghrelin (UnAG), acylated ghrelin (AG), obestatin, growth hormone (GH), and the ratios of UnAG/obestatin, AG/obestatin, and total ghrelin/obestatin. Circulatory abundances of UnAG, AG, obestatin and GH were determined in 387 Hong Kong Chinese female adults with age between 24 to 86 years based on a 2 × 2 factorial design of hypertension (blood pressure ≥140/90 mmHg) and central obesity (waist circumference or WC ≥80 cm). Participants were categorized as neither hypertensive nor centrally obese (NHNO; = 105), hypertensive but not centrally obese (HNO; = 102), centrally obese but not hypertensive (NHO; = 74) and hypertensive and centrally obese (NO; = 106). Pearson's correlation analyses were performed to detect the association between the peptides examined with WC and blood pressure. The main and interaction effects of hypertension and central obesity were examined by generalized estimating equations analyses. Correlation analyses revealed that systolic blood pressure was negatively correlated with AG/obestatin, UnAG/obestatin and total ghrelin/obestatin ratios, AG, total ghrelin, and GH, while diastolic blood pressure was negatively correlated with UnAG/obestatin, total ghrelin/obestatin ratios, and GH. WC was negatively correlated with AG/obestatin, UnAG/obestatin, and total ghrelin/obestatin ratios, UnAG, AG, total ghrelin, GH, and obestatin. Interaction effects of hypertension and central obesity were observed on UnAG/obestatin, AG/obestatin and total ghrelin/obestatin ratios, and obestatin. Obestatin in NHO group was significantly higher compared to NHNO and HO groups. UnAG/obestatin, AG/obestatin, and total ghrelin/obestatin ratios were higher in NHNO group compared to HNO and HO groups. Main effects of central obesity and hypertension were observed in UnAG, total ghrelin and GH. The HO group manifested the lowest level of UnAG, total ghrelin and GH among all the groups studied. Main effect of hypertension was observed on AG, suggesting that hypertensive individuals exhibited lower levels of AG regardless of central obesity. Circulatory ghrelin gene products and GH exhibit different modes of modulation in response to the co-manifestation of multiple cardiovascular risk factors compared with a single risk factor alone.
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http://dx.doi.org/10.3389/fendo.2018.00534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145011PMC
September 2018

Effects of play activities program for nursing home residents with dementia on pain and psychological well-being: Cluster randomized controlled trial.

Geriatr Gerontol Int 2018 Oct 25;18(10):1485-1490. Epub 2018 Sep 25.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.

Aim: The prevalence of chronic pain among nursing home residents with dementia is high. This present study aimed to explore the effectiveness of a play activities program among nursing home residents with dementia.

Methods: Each nursing home was randomly assigned to an experimental group or control group. A 1-h play activities program was offered weekly for 8 weeks to the experimental group, whereas participants in the control group read books and magazines for 15 min weekly for the 8 weeks. Outcome measures were assessed at baseline, post-intervention (at week 8) and 4 weeks after the intervention.

Results: A total of 53 nursing home residents from four nursing homes were recruited. There were significant treatment effects on pain, depression and happiness level when comparing the experimental group and control group. However, there were no treatment effects on activities of daily living, social engagement, behavioral symptoms and mobility between the two groups.

Conclusion: The play activities program was useful in reducing pain and improving the psychological health of nursing home residents with dementia. Geriatr Gerontol Int 2018; 18: 1485-1490.
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http://dx.doi.org/10.1111/ggi.13509DOI Listing
October 2018

Family carers' experiences of participating in a weight management programme for overweight children and adolescents with intellectual disabilities: An exploratory study.

J Adv Nurs 2019 Feb 8;75(2):388-399. Epub 2018 Oct 8.

World Health Organization Collaboration Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.

Aim: To gain insight into the experiences of family carers participating in a weight management programme via mHealth tools for overweight children and adolescents with intellectual disabilities.

Background: Many weight reduction programs fail to show positive and sustainable impacts due to not involving parents, who are usually unavailable to attend school-based health programs. The mHealth interactive interventions were carried out in September 2015-August 2016, engaging carers to monitor and sustain their children's healthy lifestyle behaviours at home being one way to achieve this.

Design: Qualitative research design to conduct focus group discussion with family carers involved in a school-based weight management programme via the mHealth interventions.

Methods: An exploratory study was used to examine family carers' views of participating in a weight management programme. Focus group interviews examined the in-depth experiences of 20 family carers in providing social support and monitoring lifestyle behaviours via the mHealth interactive interventions.

Results: Twenty family carers were recruited and four themes emerged: (a) improving family carer-child interactions and communications; (b) gaining useful and practical health information from experts; (c) supporting each other via an mHealth platform; and (d) appreciating the collaborative effort between school personnel and family carers. Family carers stressed the usefulness of the mHealth interactive interventions in monitoring and sustaining the children's healthy lifestyle behaviours at home.

Conclusion: The mHealth interactive interventions for increasing family carers' involvement and monitoring were well received. The findings provide new insights into using mHealth interventions in future weight management programmes involving parental participation in the home environment.
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http://dx.doi.org/10.1111/jan.13845DOI Listing
February 2019

Adipokines demonstrate the interacting influence of central obesity with other cardiometabolic risk factors of metabolic syndrome in Hong Kong Chinese adults.

PLoS One 2018 16;13(8):e0201585. Epub 2018 Aug 16.

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

Objective: Metabolic syndrome (MetS) or prediabetes is a complex disorder that is defined by a clustering of cardiometabolic risk factors, including obesity, hypertriglyceridemia, reduced high-density lipoprotein (HDL) cholesterol, hypertension, and insulin resistance. Among cardiometabolic risk factors, central obesity plays a key role in the development of MetS through alterations in the secretion of adipokines and interacts with other MetS risk factors to unfavorably influence overall cardiometabolic risk. Obesity has grasped epidemic proportions in Asia, which has the highest number of people with diabetes in the world. But, the importance of central obesity in the clustering of all four MetS risk factors or vice versa in predicting severity of MetS has not yet been investigated in Asian population. Therefore, the present study examined the influence of central obesity on circulating levels of adipokines through its interaction with the clustering of cardiometabolic risk factors of MetS including hyperglycemia, hypertriglyceridemia, dyslipidemia and hypertension in Hong Kong Chinese adults.

Subjects: Blood samples from 83 Hong Kong Chinese adults, who were previously screened for MetS according to the guideline of the United States National Cholesterol Education Program Expert Panel Adult Treatment Panel III criteria were selected. Insulin and adipokines, including visfatin, chemerin, plasminogen activator inhibitor-1 (PAI-1), resistin, C-C motif chemokine ligand 2 (CCL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumour necrosis factor-α (TNF-α), leptin and adiponectin were assessed.

Results: The interacting effect of central obesity with all of the other four MetS risk factors increased the proinflammatory status of adipokines (TNF-α, leptin) and decreased the anti-inflammatory status of adipokine (adiponectin).

Conclusion: Our results indicate that the inflammatory status of MetS may be more severe in the presence of central obesity. Adipokines, as biomarkers for pathophysiological changes, may help to improve early patient identification and to predict MetS-associated morbidity and mortality.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201585PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095502PMC
February 2019