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Abstract
Trust influences a range of human behaviors including health decision making. Over the past 60 years a significant industry has sprung up to influence public opinion and mobilize grassroots challenges against evidence-based threats to vested interests. Simultaneously, media reports of scientific fraud, misrepresentation, constantly changing “evidence” for health, and “hyped” predictions of disasters that were ultimately less significant amplify doubts about the reliability of scientific evidence and technology when hazards arise. This has contributed to the appearance of decay of trust in the veracity of scientific claims. Population responses during communicable disease epidemics illustrate these interacting processes that simultaneously create uncertainty and significant discomfort within communities. Research on the relative influences of formal versus informal information sources in driving protective behavior during recent influenza epidemics shows how both the uptake of everyday preventive practices such as hand hygiene, and specific health interventions, such as vaccination are affected by these processes. We review recent work on influenza-related personal preventive practices, with a particular focus on the shifting roles and utility of formal and informal sources in decision making among the public, and consider the implications within the context of prevailing levels of trust, uncertainty, and doubt surrounding health care recommendations.
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Li WWY, Lam WWT, Shun SC, Lai YH, Law WL, Poon J, Fielding R. Psychometric assessment of the Chinese version of the Supportive Care Needs Survey short-form (SCNS-SF34-C) among Hong Kong and Taiwanese Chinese colorectal cancer patients. PLoS One 2013; 8:e75755. [PMID: 24146774 PMCID: PMC3795709 DOI: 10.1371/journal.pone.0075755] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/16/2013] [Indexed: 11/21/2022] Open
Abstract
Background Accurate assessment of unmet supportive care needs is essential for optimal cancer patient care. This study used confirmatory factor analysis (CFA) to test the known factor structures of the short form of Supportive Care Need Survey (SCNS-34) in Hong Kong and Taiwan Chinese patients diagnosed with colorectal cancer (CRC). Methods 360 Hong Kong and 263 Taiwanese Chinese CRC patients completed the Chinese version of SCNS-SF34. Comparative measures (patient satisfaction, anxiety, depression, and symptom distress) tested convergent validity while known group differences were examined to test discriminant validity. Results The original 5-factor and recent 4-factor models of the SCNS demonstrated poor data fit using CFA in both Hong Kong and Taiwan samples. Subsequently a modified five-factor model with correlated residuals demonstrated acceptable fit in both samples. Correlations demonstrated convergent and divergent validity and known group differences were observed. Conclusions While the five-factor model demonstrated a better fit for data from Chinese colorectal cancer patients, some of the items within its domain overlapped, suggesting item redundancy. The five-factor model showed good psychometric properties in these samples but also suggests conceptualization of unmet supportive care needs are currently inadequate.
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Cooper C, Fielding R, Visser M, van Loon LJ, Rolland Y, Orwoll E, Reid K, Boonen S, Dere W, Epstein S, Mitlak B, Tsouderos Y, Sayer AA, Rizzoli R, Reginster JY, Kanis JA. Tools in the assessment of sarcopenia. Calcif Tissue Int 2013; 93:201-10. [PMID: 23842964 PMCID: PMC3744387 DOI: 10.1007/s00223-013-9757-z] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/15/2013] [Indexed: 12/13/2022]
Abstract
This review provides a framework for the development of an operational definition of sarcopenia and of the potential end points that might be adopted in clinical trials among older adults. While the clinical relevance of sarcopenia is widely recognized, there is currently no universally accepted definition of the disorder. The development of interventions to alter the natural history of sarcopenia also requires consensus on the most appropriate end points for determining outcomes of clinical importance which might be utilized in intervention studies. We review current approaches to the definition of sarcopenia and the methods used for the assessment of various aspects of physical function in older people. The potential end points of muscle mass, muscle strength, muscle power, and muscle fatigue, as well as the relationships between them, are explored with reference to the availability and practicality of the available methods for measuring these end points in clinical trials. Based on current evidence, none of the four potential outcomes in question is sufficiently comprehensive to recommend as a uniform single outcome in randomized clinical trials. We propose that sarcopenia may be optimally defined (for the purposes of clinical trial inclusion criteria as well as epidemiological studies) using a combination of measures of muscle mass and physical performance. The choice of outcome measures for clinical trials in sarcopenia is more difficult; co-primary outcomes, tailored to the specific intervention in question, may be the best way forward in this difficult but clinically important area.
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Lam WWT, Soong I, Yau TK, Wong KY, Tsang J, Yeo W, Suen J, Ho WM, Sze WK, Ng AWY, Kwong A, Suen D, Fielding R. The evolution of psychological distress trajectories in women diagnosed with advanced breast cancer: a longitudinal study. Psychooncology 2013; 22:2831-9. [DOI: 10.1002/pon.3361] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/18/2013] [Accepted: 06/27/2013] [Indexed: 01/12/2023]
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Fielding R, Kause J, Arnell-Cullen V, Sandeman D. The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes. Clin Med (Lond) 2013; 13:344-8. [PMID: 23908501 PMCID: PMC4954298 DOI: 10.7861/clinmedicine.13-4-344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Consultant-delivered care has been shown to improve outcomes for acute medical patients. However, the ideal composition of a medical team to support consultant-delivered care is not clear and little is known about the effect of continuing consultant-delivered care until the patient is discharged. Between December 2011 and April 2012, 260 general medical patients requiring inpatient care were managed by a consultant-delivered multidisciplinary team (CD-MDT) and 150 patients by a standard consultant-led team of trainee doctors. The length of hospital stay was significantly lower for patients managed by a CD-MDT than for those managed by a standard team (4-5 days vs 7 days, p<0.001). No difference between the groups was seen for readmission rates, patient safety or mortality. In conclusion, a CD-MDT is a safe and effective model of inpatient medical care and is associated with a shorter length of hospital stay.
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Liao Q, Wong WS, Fielding R. Comparison of different risk perception measures in predicting seasonal influenza vaccination among healthy Chinese adults in Hong Kong: a prospective longitudinal study. PLoS One 2013; 8:e68019. [PMID: 23894292 PMCID: PMC3716928 DOI: 10.1371/journal.pone.0068019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/25/2013] [Indexed: 11/18/2022] Open
Abstract
Background Risk perception is a reported predictor of vaccination uptake, but which measures of risk perception best predict influenza vaccination uptake remain unclear. Methodology During the main influenza seasons (between January and March) of 2009 (Wave 1) and 2010 (Wave 2),505 Chinese students and employees from a Hong Kong university completed an online survey. Multivariate logistic regression models were conducted to assess how well different risk perceptions measures in Wave 1 predicted vaccination uptake against seasonal influenza in Wave 2. Principal Findings The results of the multivariate logistic regression models showed that feeling at risk (β = 0.25, p = 0.021) was the better predictor compared with probability judgment while probability judgment (β = 0.25, p = 0.029 ) was better than beliefs about risk in predicting subsequent influenza vaccination uptake. Beliefs about risk and feeling at risk seemed to predict the same aspect of subsequent vaccination uptake because their associations with vaccination uptake became insignificant when paired into the logistic regression model. Similarly, to compare the four scales for assessing probability judgment in predicting vaccination uptake, the 7-point verbal scale remained a significant and stronger predictor for vaccination uptake when paired with other three scales; the 6-point verbal scale was a significant and stronger predictor when paired with the percentage scale or the 2-point verbal scale; and the percentage scale was a significant and stronger predictor only when paired with the 2-point verbal scale. Conclusions/Significance Beliefs about risk and feeling at risk are not well differentiated by Hong Kong Chinese people. Feeling at risk, an affective-cognitive dimension of risk perception predicts subsequent vaccination uptake better than do probability judgments. Among the four scales for assessing risk probability judgment, the 7-point verbal scale offered the best predictive power for subsequent vaccination uptake.
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Liao Q, Wong WS, Fielding R. How do anticipated worry and regret predict seasonal influenza vaccination uptake among Chinese adults? Vaccine 2013; 31:4084-90. [PMID: 23867015 DOI: 10.1016/j.vaccine.2013.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/27/2013] [Accepted: 07/03/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test two hypothesized models of how anticipated affect, cognitive risk estimate and vaccination intention might influence vaccination uptake against seasonal influenza. METHODS The study collected baseline and follow-up data during the main influenza seasons (January-March) of 2009 and 2010, respectively, among 507 university students and staff of a university in Hong Kong. Following logistic regression to determine eligible variables, two mediation models of cognitive risk estimate, anticipated affect, vaccination intention and vaccination uptake against seasonal influenza were tested using structural equation modeling. RESULTS Mediation analyses found that anticipated worry if not vaccinated influenced seasonal influenza vaccination uptake through its effects on either perceived probability of influenza infection (β=0.45) or intention (β=0.45) while anticipated regret if not vaccinated influenced vaccination uptake through its effect on intention (β=0.45) only; anticipated regret if vaccinated impeded vaccination uptake indirectly through its effect on vaccination intention (β=-0.26) or directly (β=-0.20); perceived probability of influenza infection influenced vaccination uptake through its effect on intention (β=0.20) or directly (β=0.22); and finally, intention influenced vaccination uptake directly (β=0.58). CONCLUSION The results suggest that anticipated affect seems to drive risk estimates related to seasonal influenza vaccination rather than vice versa and intention remains an important mediator of the associations of anticipated affect and cognitive risk estimate with vaccination uptake against seasonal influenza.
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Lam WWT, Chan M, Or A, Kwong A, Suen D, Fielding R. Reducing treatment decision conflict difficulties in breast cancer surgery: a randomized controlled trial. J Clin Oncol 2013; 31:2879-85. [PMID: 23835709 DOI: 10.1200/jco.2012.45.1856] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Breast cancer (BC) decision aid (DA) randomized studies are limited to DA use in consultations among Western populations and for primary surgery. Their effectiveness beyond consultations, for reconstructive surgery and in other populations, has not been evaluated. We developed a DA administered after consultation for Chinese women deciding on BC surgery and, where relevant, immediate breast reconstruction, which was evaluated in this randomized controlled trial (RCT). PATIENTS AND METHODS Overall, 276 women considering BC surgery for early-stage BC were randomly assigned to receive a DA (take-home booklet) or the standard information booklet (control condition) after the initial consultation, wherein surgeons disclosed the diagnosis and discussed treatment options with patients. Using block random assignment by week, 138 women were assigned to the DA arm and 138 to the control arm. Participants completed interview-based questionnaires 1 week after consultation and then 1, 4, and 10 months after surgery. Primary outcome measures were decisional conflict, decision-making difficulties, BC knowledge 1 week after consultation, and decision regret 1 month after surgery. Secondary outcome measures were treatment decision, decision regret 4 and 10 months after surgery, and postsurgical anxiety and depression. RESULTS The DA group reported significantly lower decisional conflict scores 1 week after consultation (P = .016) compared with women in the control arm. Women receiving the DA had significantly lower decision regret scores 4 (P = .026) and 10 months (P = .014) after surgery and lower depression scores 10 months after surgery (P = .001). CONCLUSION This RCT demonstrated DAs may benefit Chinese patients in Hong Kong by reducing decisional conflict and subsequent regret and enhance clinical services for this population.
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Vellas B, Pahor M, Manini T, Rooks D, Guralnik JM, Morley J, Studenski S, Evans W, Asbrand C, Fariello R, Pereira S, Rolland Y, Abellan van Kan G, Cesari M, Chumlea WC, Fielding R. Designing pharmaceutical trials for sarcopenia in frail older adults: EU/US Task Force recommendations. J Nutr Health Aging 2013; 17:612-8. [PMID: 23933872 PMCID: PMC4077187 DOI: 10.1007/s12603-013-0362-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An international task force of academic and industry leaders in sarcopenia research met on December 5, 2012 in Orlando, Florida to develop guidelines for designing and executing randomized clinical trials of sarcopenia treatments. The Task Force reviewed results from previous trials in related disease areas to extract lessons relevant to future sarcopenia trials, including practical issues regarding the design and conduct of trials in elderly populations, the definition of appropriate target populations, and the selection of screening tools, outcome measures, and biomarkers. They discussed regulatory issues, the challenges posed by trials of different types of interventions, and the need for standardization and harmonization. The Task Force concluded with recommendations for advancing the field toward better clinical trials.
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Fielding R, Lam WWT, Shun SC, Okuyama T, Lai YH, Wada M, Akechi T, Li WWY. Attributing variance in supportive care needs during cancer: culture-service, and individual differences, before clinical factors. PLoS One 2013; 8:e65099. [PMID: 23741467 PMCID: PMC3669056 DOI: 10.1371/journal.pone.0065099] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 04/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies using the Supportive Care Needs Survey (SCNS) report high levels of unmet supportive care needs (SCNs) in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns. METHODS Hong Kong (n = 180), Taiwanese (n = 263) and Japanese (n = 109) CRC patients' top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression. RESULTS All samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73) and Health systems and information (HSI) (38.61) SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92) and Patient care & support (PCS) (19.70; 18.38) SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (p<0.03-0.001, Bonferroni). Other SCN domains differed only between Chinese and Japanese samples (all p<0.001). Treatment status differentiated Taiwanese more starkly than Hong Kong patients. After adjustment, sample origin accounted for most variance in SCN domain scores (p<0.001), followed by age (p = 0.01-0.001) and employment status (p = 0.01-0.001). Treatment status and Disease stage, though retained, accounted for least variance. Overall accounted variance remained low. CONCLUSIONS Health service and/or cultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.
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Cowling BJ, Freeman G, Wong JY, Wu P, Liao Q, Lau EH, Wu JT, Fielding R, Leung GM. Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013. Euro Surveill 2013. [DOI: 10.2807/ese.18.19.20475-en] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Cowling BJ, Freeman G, Wong JY, Wu P, Liao Q, Lau EH, Wu JT, Fielding R, Leung GM. Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013. Euro Surveill 2013; 18:20475. [PMID: 23725807 PMCID: PMC3838615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Between 31 March and 21 April 2013, 102 laboratory-confirmed influenza A(H7N9) infections have been reported in six provinces of China. Using survey data on age-specific rates of exposure to live poultry in China, we estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages. Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date.
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Davis J, Banks I, Wrigley D, Peedell C, Pollock A, McPherson K, McKee M, Irving WL, Crome P, Greenhalgh T, Holland W, Evans D, Maryon-Davis A, Smyth A, Fleming P, Coleman M, Sharp DJ, Whincup P, Logan S, Cook D, Moore R, Rawaf S, McEewen J, West R, Yudkin JS, Clarke A, Finer N, Domizio P, Bambra C, Jones A, Feder G, Scott-Samuel A, Irvine L, Sharma A, Fitchett M, Boomla K, Folb J, Paul A, McCoy D, Tallis R, Burgess-Allen J, Edwards M, Tomlinson J, Colvin D, Gore J, Brown K, Mitchel S, Lau A, Sayer M, Clark L, Silverman R, Marmot S, Rainbow D, Carter L, Mann N, Fielding R, Logan J, Tebboth L, Arnold N, Stobbart K, Cabot K, Finer S, Edwards M, Davies D, Buttivant H, Kraemer S, Newell J, Griffiths A, Fitzgerald R, Macgibbon R, Lee A, Macklon AF, Hobson E, Jenner D, Jacobson B, Timmis A, Salim A, Evans-Jones J, Caan W, Awsare N, Pride N, Suckling R, Bratty C, Rossiter B, Hawkins D, Currie J, Camilleri-Ferrante C, Fluxman J, Bhatti O, Anson J, Etherington R, Lawrence D, Fell H, Clarke E, Ormerod J, Ormerod O, Ireland M, Duncan JAT, Chandy R, Mindell J, Mullen P, Bennett-Richards P, Hirst J, Murphy E, Martin P, Lowes S, Fleming P, Grunewald R, Reeve J, Schweiger M, Coates J, Farrelly G, Chamberlain MA, Lewis G, Young J, Scott B, Gibbs J, Landers A, Deveson P, Ingrams G, Leigh M, Gawler J, Ford A, Nixon J, McCartney M, Bareford D, Singh S, Lockwood K, Cripwell M, Ehrhardt P, Bell D, Wortley P, Tomlinson L, Hotchkiss J, Ford S, Turner G, Reissman G, Lewis D, Johnstone C, Tomson M, Torabi P, Bell D, Tomson D, Tulloch A, Johnston S, Dickinson J, McElderry E, Ross W, Holt K, Logan M, Klonin H, Jenner D, Danby J, Goodger V, Puntis J, Dickson H, Gould DA, Livingstone A, Lefevre D, Kendall B, Singh G, Hall P, Darling J, Hamlyn AN, Patel A, Erskine J, Fisher B, Hughes R, Highton C, Venning H, Singer R, Brearey S, Sikorski J, Paintin D, Feehally J, Savage W, Freud KM, Holt VJ, Gill A, Waterston T, Souza RD, Hopkinson N, Beadsworth M, Franks A, Daley H, Cullinan P, Basarab A, Folb J, Gurling H, Zinkin P, Kirwin S, Buhrs E, Brown R, West A, Marlowe G, Fellows G, Main J, Applebee J, Koperski M, Jones P, Macfarlane A, Beer N, Mason R, West R, Eisner M, Smailes A, Timms P, Knight D, Jones C, Wesby B, Lyttelton L, Morrison R, Bossano D, Walker J, Davies G, Godfrey P, Wolfe I, Nsutebu E, Stevenson N, Cheeroth S, Miller J, Johnson G, Noor R, Hall A, Bostock D, Michael B, Sharvill J, Macpherson J, Lewis D, Ma R, Middleton J, Jeffreys A, Cole J, Boswell JP, Bury B, Mitchison S, Kinmonth AL, Young G, Maclennan I, Munday P. Act now against new NHS competition regulations: an open letter to the BMA and the Academy of Medical Royal Colleges calls on them to make a joint public statement of opposition to the amended section 75 regulations. BMJ 2013; 346:f1819. [PMID: 23516260 DOI: 10.1136/bmj.f1819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lu SQ, McGhee SM, Xie X, Cheng J, Fielding R. Economic evaluation of universal newborn hepatitis B vaccination in China. Vaccine 2013; 31:1864-9. [PMID: 23384752 DOI: 10.1016/j.vaccine.2013.01.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/11/2013] [Accepted: 01/14/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate the long-term cost-effectiveness of universal newborn hepatitis B vaccination in China, an area of high endemicity. METHOD A decision tree was used to describe perinatal hepatitis B virus (HBV) transmission, early infection and impact of vaccination. A Markov model based on 1-year cycles was used to simulate these impacts for the lifetime of a cohort of 10,000,000 infants born in 2002 in China. We compared both cost and health outcomes for two strategies: universal newborn vaccination comprising a timely birth dose (HepB1) with a three-dose vaccination (HepB3) compared with no vaccination. Univariate and probabilistic sensitivity analyses using Monte Carlo simulations were performed to test parameter uncertainty. RESULTS Over the cohort's lifetime, 79,966 chronic infections, 37,553 cases of hepatocellular carcinoma (HCC) and 130,796 HBV related deaths would be prevented by universal infant vaccination. The prevalence of HBV infection is reduced by 76%. Over 743,000 life-years and 620,000 quality adjusted life years (QALYs) would be gained and there would be monetary benefits of more than 1 billion US dollars in medical care costs and lost productivity avoided. CONCLUSION The newborn vaccination programme for Hepatitis B in China both gains QALYs and saves medical care costs. It is important to ensure that timely and comprehensive vaccination programmes continue.
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Offord EA, Karagounis LG, Vidal K, Fielding R, Meydani S, Penninger JM. Nutrition and the biology of human ageing: bone health and osteoporosis / sarcopenia / immune deficiency. J Nutr Health Aging 2013; 17:712-6. [PMID: 24097029 DOI: 10.1007/s12603-013-0374-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fielding R, Gelder C, Shakespeare J. P27 QUIPP Achievement Associated with the Creation of an Accurate Home Oxygen Register and Removal of Inappropriate Short Burst Oxygen Therapy. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lam WWT, Kwok M, Liao Q, Chan M, Or A, Kwong A, Suen D, Fielding R. Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery. Health Expect 2012; 18:210-20. [PMID: 23167846 DOI: 10.1111/hex.12021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The decisional conflict scale (DCS) measures the perception of uncertainty in choosing options, factors contributing to decision conflict and effective decision making. This study examined the validity and reliability of the Chinese version of the DCS in Hong Kong Chinese women deciding breast cancer (BC) surgery. METHOD A Chinese version of the 16-item DCS was administered to 471 women awaiting initial consultation for BC diagnosis. Confirmatory factor analysis (CFA) assessed the factor structure. Internal consistency, and convergent and discriminant validities of the factor structure were assessed. RESULTS CFA revealed the original factor structure of the DCS showed poor fit to this sample. Exploratory factor analysis revealed an alternative three-factor structure, Informed and Values Clarity, Uncertainty and Effective Decision and Support, was optimal. Cronbach's alpha ranged from 0.51 to 0.87. Correlations between decision-making difficulties and satisfaction with medical consultation demonstrated acceptable convergent validity. Construct validity was supported by correlations between decision regret and psychological distress. Discriminant validity was supported by differentiation between delaying and non-delaying decision-makers. CONCLUSIONS The three-factor DCS-14 is a valid and practical measure for assessing decisional conflict in deciding BC surgery. It shows good potential for use in assessing decision satisfaction for women diagnosed with BC.
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Kause J, Fielding R, Arnell-Cullen V, Sandeman D. Team working. Care delivery model can ease winter pressures. THE HEALTH SERVICE JOURNAL 2012; 122:25-27. [PMID: 23323511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Lam WWT, Fielding R, McDowell I, Johnston J, Chan S, Leung GM, Lam TH. Perspectives on family health, happiness and harmony (3H) among Hong Kong Chinese people: a qualitative study. HEALTH EDUCATION RESEARCH 2012; 27:767-779. [PMID: 22907531 DOI: 10.1093/her/cys087] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Family harmony, an important Confucian ideal in Chinese society is believed to determine family happiness and therefore health, but is this accurate? This is a qualitative study of 41 Hong Kong Chinese family members. Individual recorded interviews were thematically analysed describing perceived interactions between harmony, happiness and health. Family harmony comprised four components: communication, mutual respect, lack of conflict and family time [notably 'Gou tong' (in Cantonese )-opportunity and willingness to spend time together-requiring good interpersonal communication, emphasized by female respondents]. Lack of conflict was emphasized, while diverse values, parenting styles and financial difficulties were common causes of conflict. Respect required reciprocity. Family happiness comprised four elements: family harmony, an important pre-requisite; mutual caring and supportive orientation; sense of security emphasizing financial security in middle-class versus sense of togetherness in lower social class groups and contentment. Healthy families were harmonious; 'typical' (children/two-parent/two-grandparent); happy; caring and respectful, with individual health and healthy behaviours. Family harmony, happiness and health are interrelated and built on a communicative, respectful, caring and contented set of attitudes, in particular allowing for family time. Harmony is apparently a core element of good family functioning.
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Lam WWT, Ye M, Fielding R. Trajectories of quality of life among Chinese patients diagnosed with nasopharynegeal cancer. PLoS One 2012; 7:e44022. [PMID: 23028484 PMCID: PMC3445583 DOI: 10.1371/journal.pone.0044022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 07/31/2012] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE This secondary longitudinal analysis describes distinct quality of life trajectories during eight months of radiation therapy (RT) among patients with nasopharyngeal cancer (NPC) and examines factors differentiating these trajectories. METHODS 253 Chinese patients with NPC scheduled for RT were assessed at pre-treatment, and 4 months and 8 months later on QoL (Chinese version of the FACT-G), optimism, pain, eating function, and patient satisfaction. Latent growth mixture modelling identified different trajectories within each of four QoL domains: Physical, Emotional, Social/family, and Functional well-being. Multinomial logistic regression compared optimism, pain, eating function, and patient satisfaction by trajectories adjusted for demographic and medical characteristics. RESULTS We identified three distinct trajectories for physical and emotional QoL domains, four trajectories for social/family, and two trajectories for functional domains. Within each domain most patients (physical (77%), emotional (85%), social/family (55%) and functional (63%)) experienced relatively stable high levels of well-being over the 8-month period. Different Physical trajectory patterns were predicted by pain and optimism, whereas for Emotion-domain trajectories pain, optimism, eating enjoyment, patient satisfaction with information, and gender were predictive. Age, appetite, optimism, martial status, and household income predicted Social/family trajectories; household income, eating enjoyment, optimism, and patient satisfaction with information predicted Functional trajectories. CONCLUSION Most patients with NPC showed high stable QoL during radiotherapy. Optimism predicted good QoL. Symptom impacts varied by QoL domain. Information satisfaction was protective in emotional and functional well-being, reflecting the importance in helping patients to establish a realistic expectation of treatment impacts.
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Fielding R, Wong WS. Prevalence of chronic pain, insomnia, and fatigue in Hong Kong. Hong Kong Med J 2012; 18 Suppl 3:9-12. [PMID: 22865215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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Wong WS, Fielding R. The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors. J Psychosom Res 2012; 73:28-34. [PMID: 22691556 DOI: 10.1016/j.jpsychores.2012.04.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/24/2012] [Accepted: 04/24/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Although research suggests there is considerable overlap among chronic pain, fatigue, and sleep disturbances, no research to date has concurrently examined their interrelationships. This study estimates the co-occurrence of these three conditions in terms of prevalence and associated factors in the general adult population. METHODS In a population-based, cross-sectional telephone survey, 5001 adults aged ≥18 years drawn from the Hong Kong general population completed the Chronic Pain Grade (CPG) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Chronic Fatigue Scale (CFS), Hospital Anxiety and Depression Scale (HADS), and socio-demographic questions. RESULTS The overall prevalence of reporting all three chronic conditions was 5.6% (95% CI: 4.9-6.4) and increased with age, being higher in women, and those in lower income and education level groups. Individuals with multiple symptoms also reported poorer mental health, and self-perceived health. Results of multi-ordinal regression analyses identified female, divorced/separated, having part time employment, retirees, unemployment, housewives, existing long-term health problems, higher HADS scores, and low self-perceived health to be significantly associated with reporting all three symptoms. CONCLUSION This study has shown that the co-occurrence of chronic pain, fatigue, and sleep disturbances was common in the general adult population. Multiple symptoms are comorbid of psychological distress.
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Au A, Lam W, Tsang J, Yau TK, Soong I, Yeo W, Suen J, Ho WM, Wong KY, Kwong A, Suen D, Sze WK, Ng A, Girgis A, Fielding R. Supportive care needs in Hong Kong Chinese women confronting advanced breast cancer. Psychooncology 2012; 22:1144-51. [PMID: 22715115 DOI: 10.1002/pon.3119] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/18/2012] [Accepted: 05/21/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Women with advanced breast cancer (ABC) are living longer, so understanding their needs becomes important. This cross-sectional study investigated the type and extent of unmet supportive care needs in Hong Kong Chinese women with advanced breast cancer. METHODS Face-to-face interviews were conducted among women with stage III or stage IV disease mostly awaiting chemotherapy (76%) to identify unmet needs using the Supportive Care Needs Survey Short Form, psychological morbidity using the Hospital Anxiety and Depression Scale, symptom distress using the Memorial Symptom Assessment Scale, and satisfaction with care using the Patient satisfaction questionnaire (PSQ-9). RESULTS About 27-72% of 198/220 (90%) women (mean age = 53.4 ± 9.74 (standard deviation) years) identified needs from the health system, information, and patient support (HSIPS) domain as the top 15 most prevalent unmet needs. 'having one member of hospital staff with whom you can talk to about all aspect of your condition, treatment, and follow-up' was most cited by 72% of the patients, with remaining unmet needs addressing mostly desire for information. Unmet need strength did not differ between women with stage III and stage IV disease, whereas women with first time diagnosis reported greater health system and information unmet needs compared with women with recurrent disease. Stepwise multiple regression analyses revealed that symptom distress was consistently positively associated with all but sexuality need domains, whereas low satisfaction with care was associated with HSIPS (β = 3.270, p < 0.001) and physical and daily living (β = 2.810, p < 0.01) domains. DISCUSSIONS Chinese women with ABC expressed need for continuity of care and improved information provision. High symptom distress was associated with lower levels of satisfaction with care. These unmet needs appear to reflect current care services shortcomings.
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Wong WS, McCracken LM, Fielding R. Factor structure and psychometric properties of the Chinese version of the 20-item Pain Anxiety Symptoms Scale (ChPASS-20). J Pain Symptom Manage 2012; 43:1131-40. [PMID: 22651953 DOI: 10.1016/j.jpainsymman.2011.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/22/2011] [Accepted: 06/28/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT The Pain Anxiety Symptoms Scale (PASS) was designed to assess pain-related anxiety and fear. Although the scale is a reliable measure with good psychometric properties, its validity among ethnic Chinese has yet to be evaluated. OBJECTIVES This study aimed to translate the English-language version of the 20-item PASS into Chinese (ChPASS-20) and evaluate its factor structure, reliability, and validity. METHODS A total of 223 Chinese patients with chronic musculoskeletal pain attending orthopedic specialist clinics completed the ChPASS-20, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item Tampa Scale of Kinesiophobia, the Hospital Anxiety and Depression Scale, and questions assessing sociodemographic and pain characteristics. RESULTS Confirmatory factor analyses showed that all the five-factor solutions tested met the minimum acceptable fit criterion. The four ChPASS-20 subscales and the entire scale demonstrated good internal consistency (Cronbach's αs: 0.72-0.92). All ChPASS-20 scales showed significant positive correlations with depression, pain intensity, and disability. Hierarchical multiple regression analyses showed that the ChPASS-20 total score predicted concurrent depression [F(4,159)=11.97, P<0.001], pain intensity [F(4,161)=2.47, P<0.05], and pain disability [F(4,191)=5.47, P<0.001] scores, and the ChPASS-20 Avoidance subscale (standardized beta coefficient=0.21, P<0.05) emerged as a significant independent predictor of concurrent pain disability. CONCLUSION Our data support the factorial validity, reliability, and construct validity of the ChPASS-20 in a Chinese population.
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Liao Q, Cowling BJ, Lam WT, Fielding R. Changing perception of avian influenza risk, Hong Kong, 2006-2010. Emerg Infect Dis 2012; 17:2379-80. [PMID: 22172657 PMCID: PMC3311168 DOI: 10.3201/eid1712.110298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Li WWY, Lam WWT, Au AHY, Ye M, Law WL, Poon J, Kwong A, Suen D, Tsang J, Girgis A, Fielding R. Interpreting differences in patterns of supportive care needs between patients with breast cancer and patients with colorectal cancer. Psychooncology 2012; 22:792-8. [PMID: 22419560 DOI: 10.1002/pon.3068] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/15/2012] [Accepted: 02/24/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Understanding cancer patients' supportive care needs can help optimize health-care systems and inform services development. We therefore examined the prevalence of supportive care needs in Chinese breast (BC) and colorectal cancer (CRC) patients to identify prevalence and correlates of unmet needs. METHODS We assessed supportive care needs (Supportive Care Needs Survey-Short Form), psychological distress (the Hospital Anxiety and Depression Scale), symptom distress (The Memorial Symptom Assessment Scale-Short Form), and satisfaction with care (Patient Satisfaction Questionnaire) among 210 Chinese BC (97) or CRC (104) outpatient clinic attendees. RESULTS Breast cancer patients (89.7%) reported more unmet needs (χ(2) = 4.409, p = 0.027), but both CRC and BC samples ranked unmet needs prevalence similarly, with health system and information needs reported as the most common. Younger patients reported higher health system and information and sexuality needs. After multivariate adjustment, the strength of unmet needs did not differ by cancer type. Unmet psychological, physical and daily living, and sexuality needs were positively associated with greater symptom distress. Greater health system information needs were associated with high global distress and low depression scores, whereas greater psychological needs were associated with higher anxiety scores. CONCLUSIONS Hong Kong Chinese BC and CRC patients strongly prioritized needs related to health systems and information provision. Symptoms and psychological distress were associated with unmet needs, reflecting a service shortfall in symptom management. Improving care provision by optimizing communication and clinic organization can better prepare cancer patients for their rehabilitation and improve symptom control.
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Fielding R, Chan GCF, Lam WWT. Health-related quality of life assessment for Hong Kong Chinese children with cancer. Hong Kong Med J 2011; 17 Suppl 6:13-16. [PMID: 22147353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
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Wong WS, Chen PP, Yap J, Mak KH, Tam BKH, Fielding R. Assessing depression in patients with chronic pain: a comparison of three rating scales. J Affect Disord 2011; 133:179-87. [PMID: 21565408 DOI: 10.1016/j.jad.2011.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 04/15/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Considerable evidence has suggested depression is significantly more prevalent in patients with chronic pain. A number of studies exclusively based on Western samples have evaluated the effectiveness of depression rating scales in assessing depression in the chronic pain context. The objective of this cross-sectional study was to compare within a Chinese chronic pain sample three depression rating scales commonly used in identifying depression. METHODS A total of 366 Chinese patients with chronic pain attending either an orthopedic specialist clinic (n=185) or a multidisciplinary pain clinic (n=181) in Hong Kong completed a structured interview using CIS-R and two depression rating scales, the Beck Depression Inventory (BDI standard and short form) and the Center for Epidemiological Studies-Depression (CES-D). Patient scores on the BDI and CES-D were then assessed against their responses on the CIS-R to determine their effectiveness. RESULTS The prevalence of depression was 20.2% and 57.8% in the Orthopedics and Pain Clinic sample respectively. Results of ROC analyses showed that all the three measures performed well at predicting depression with AUC ≥ 0.89 and high sensitivity and specificity. CONCLUSIONS Our findings suggest that the three depression measures assessed have good predictive validity in the Chinese chronic pain context, and they could be used as screening or diagnostic measures of depression in Chinese chronic pain patients. The decision of using a specific measure and a specific cutoff score should be based on study aim and setting.
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Wong WS, Jensen MP, Mak KH, Fielding R. Pain-related beliefs among Chinese patients with chronic pain: the construct and concurrent predictive validity of the Chinese version of the Survey of Pain Attitudes-14 (ChSOPA-14). J Pain Symptom Manage 2011; 42:470-8. [PMID: 21458222 DOI: 10.1016/j.jpainsymman.2010.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/20/2010] [Indexed: 11/21/2022]
Abstract
CONTEXT Pain beliefs as indexed by the Survey of Pain Attitudes (SOPA) have been consistently shown to predict pain adjustment outcomes in Western populations. However, its utility in non-Western populations is unclear. OBJECTIVES We evaluated the construct and predictive validity of the Chinese version of the 14-item SOPA (ChSOPA-14) in a sample of Chinese patients with chronic pain. METHODS A total of 208 Chinese patients with chronic musculoskeletal pain completed the ChSOPA-14, the Chronic Pain Grade questionnaire, the Pain Catastrophizing Scale, the Center for Epidemiological Studies-Depression Scale, and measures of sociodemographic characteristics. RESULTS Except Medical Cure, all ChSOPA-14 scales were significantly correlated with validity criterion measures (all P<0.05) in expected directions. The present Chinese sample scored the highest on the Medical Cure scale (mean=2.98, standard deviation [SD]=1.05) but the lowest on the Disability scale (mean=1.75, SD=1.67). Results of hierarchical multiple regression analyses showed that the ChSOPA-14 scales predicted concurrent depression (F(7,177)=14.51, P<0.001) and pain disability (F(7,180)=8.77, P<0.001). Pain Control (stdβ [standardized beta coefficient]=-0.13; 95% confidence interval [CI]: -3.41, -0.13; P<0.05) and Emotion (stdβ=29; 95% CI: 1.76, 5.02; P<0.001) emerged as significant independent predictors of concurrent depression whereas Disability (stdβ=0.19; 95% CI: 1.33, 7.88; P<0.01), Emotion (stdβ=16; 95% CI: 0.08, 7.59; P<0.05), and Solicitude (stdβ=-0.14; 95% CI: -7.05, -0.04; P<0.05) significantly associated with concurrent disability. CONCLUSION The findings offer preliminary evidence for the construct and concurrent predictive validity of the ChSOPA-14. This makes available a suitable instrument for chronic pain in the Chinese population and will facilitate future cross-cultural research on pain beliefs.
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Li WWY, Lam WWT, Wong JHF, Chiu A, Chan M, Or A, Kwong A, Suen D, Chan SWW, Fielding R. Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women. Psychooncology 2011. [DOI: 10.1002/pon.2038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wong WS, Williams DA, Mak KH, Fielding R. Assessing attitudes toward and beliefs about pain among Chinese patients with chronic pain: validity and reliability of the Chinese version of the Pain Beliefs and Perceptions Inventory (ChPBPI). J Pain Symptom Manage 2011; 42:308-18. [PMID: 21402462 DOI: 10.1016/j.jpainsymman.2010.10.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 10/06/2010] [Accepted: 10/17/2010] [Indexed: 11/21/2022]
Abstract
CONTEXT Research consistently has evidenced the reliability and validity of the Pain Beliefs and Perceptions Inventory (PBPI). The instrument, however, has not been tested for its applicability and validity in non-Western populations. OBJECTIVES To translate the English language version of the PBPI into Chinese (ChPBPI) and to evaluate its reliability, validity, and factor structure. METHODS A total of 208 Chinese patients with mixed origin chronic pain were recruited from an orthopedic specialist outpatient clinic associated with a public hospital in Hong Kong. In addition to the ChPBPI, patients were administered the Chronic Pain Grade (CPG) questionnaire, the Pain Catastrophizing Scale (PCS), the Center for Epidemiological Studies-Depression Scale (CES-D), and questions assessing sociodemographic characteristics. RESULTS Using the original factor structure of the PBPI as a model, confirmatory factor analyses revealed that all four ChPBPI scales demonstrated good data-model fit (CFI≥0.92) and adequate internal consistency (Cronbach's αs: 0.60-0.76). The four ChPBPI scales showed significant positive correlations with CES-D, PCS, pain intensity, and disability. Results of hierarchical multiple regression analyses showed that the ChPBPI scales predicted concurrent depression (F(4, 187)=6.01, P<0.001), pain intensity (F(4, 186)=4.61, P<0.01), and pain disability (F(4, 190)=3.54, P<0.05) scores. CONCLUSION These findings support the factorial validity of the scales of the ChPBPI, and its reliability and construct validity. Now clinically relevant beliefs about pain can be assessed among Chinese patients with chronic pain.
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Chan SSC, Viswanath K, Au DWH, Ma CMS, Lam WWT, Fielding R, Leung GM, Lam TH. Hong Kong Chinese community leaders' perspectives on family health, happiness and harmony: a qualitative study. HEALTH EDUCATION RESEARCH 2011; 26:664-674. [PMID: 21536713 DOI: 10.1093/her/cyr026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper examines the views of Hong Kong community leaders on the underlying issues that affect family health, happiness and harmony (3Hs) in Hong Kong. Using a community reconnaissance method, a series of individual in-depth interviews with 26 leaders that represent neighbourhoods of diverse socio-economic status (SES) from June to August 2008 were conducted. Participants considered that changing family structure, economic situation and strong work ethic are the most salient factors that affect family 3Hs. The deprived comprehensive social security assistance recipients, single-parent families and migrant women were considered to be the most vulnerable groups to breakdown in family 3Hs and particularly, they lack family resources. Families from different SES have to overcome different challenges in order to achieve and sustain family 3Hs. Leaders from low SES neighbourhood were concerned more about providing tangible help such as child care facilities to improve family resources, whereas leaders from high SES neighbourhood focused more on preventive interventions such as education on relationship skills to achieve better family well-being. The findings offer insights in designing effective social marketing education campaigns and family-friendly workplace policy to promote social harmony through the maintenance of 3Hs families.
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Wong WS, McCracken LM, Fielding R. Factorial validity and reliability of the Chinese version of the Pain Vigilance and Awareness Questionnaire (ChPVAQ) in a sample of Chinese patients with chronic pain. PAIN MEDICINE 2011; 12:1018-25. [PMID: 21692975 DOI: 10.1111/j.1526-4637.2011.01169.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The Pain Vigilance and Awareness Questionnaire (PVAQ) has been shown to be a reliable measure for assessing attention to pain. Different factor structures have been reported in Western populations; yet, whether the known factor models could be replicated in non-Western populations and the psychometric properties of the scale remain unclear. This study aimed to examine the factorial validity and psychometric properties of the Chinese version of the PVAQ (ChPVAQ). METHODS A total of 242 Chinese patients with chronic pain completed the ChPVAQ, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item version of the Tampa Scale for Kinesiophobia (ChTSK-11), the Hospital Anxiety and Depression Scale (HADS), and questions assessing socio-demographic characteristics. RESULTS Results of confirmatory factor analyses showed that of the nine competing models tested, McCracken's two-factor correlated model for the 13-item version of PVAQ (PVAQ-13) demonstrated the best data-model fit (CFI = 0.93). The two subscales and the entire scale of ChPVAQ-13 obtained moderately high internal consistency (Cronbach's αs: 0.75-0.77). The ChPVAQ-13 scales showed significant positive correlations with HADS, ChTSK11, pain intensity, and disability scores. Results of hierarchical multiple regression analyses showed the ChPVAQ-13 scales predicted concurrent depression (F[4,187] = 6.01, P < 0.001) and pain disability (F[4,190] = 3.54, P < 0.05) scores. Passive Awareness emerged as significant independent predictor of concurrent depression (standardized beta coefficient [std β] = 0.17, P < 0.05) and pain disability (std β = 0.24, P < 0.01), while Active Vigilance (std β = 0.19, P < 0.05) predicted concurrent pain disability. CONCLUSIONS Our results offer preliminary evidence for the factorial validity and reliability the ChPVAQ-13.
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Liao Q, Cowling BJ, Lam WWT, Fielding R. The influence of social-cognitive factors on personal hygiene practices to protect against influenzas: using modelling to compare avian A/H5N1 and 2009 pandemic A/H1N1 influenzas in Hong Kong. Int J Behav Med 2011; 18:93-104. [PMID: 20949342 PMCID: PMC3088805 DOI: 10.1007/s12529-010-9123-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Understanding population responses to influenza helps optimize public health interventions. Relevant theoretical frameworks remain nascent. PURPOSE To model associations between trust in information, perceived hygiene effectiveness, knowledge about the causes of influenza, perceived susceptibility and worry, and personal hygiene practices (PHPs) associated with influenza. METHODS Cross-sectional household telephone surveys on avian influenza A/H5N1 (2006) and pandemic influenza A/H1N1 (2009) gathered comparable data on trust in formal and informal sources of influenza information, influenza-related knowledge, perceived hygiene effectiveness, worry, perceived susceptibility, and PHPs. Exploratory factor analysis confirmed domain content while confirmatory factor analysis was used to evaluate the extracted factors. The hypothesized model, compiled from different theoretical frameworks, was optimized with structural equation modelling using the A/H5N1 data. The optimized model was then tested against the A/H1N1 dataset. RESULTS The model was robust across datasets though corresponding path weights differed. Trust in formal information was positively associated with perceived hygiene effectiveness which was positively associated with PHPs in both datasets. Trust in formal information was positively associated with influenza worry in A/H5N1 data, and with knowledge of influenza cause in A/H1N1 data, both variables being positively associated with PHPs. Trust in informal information was positively associated with influenza worry in both datasets. Independent of information trust, perceived influenza susceptibility associated with influenza worry. Worry associated with PHPs in A/H5N1 data only. CONCLUSIONS Knowledge of influenza cause and perceived PHP effectiveness were associated with PHPs. Improving trust in formal information should increase PHPs. Worry was significantly associated with PHPs in A/H5N1.
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Lam WWT, Au AHY, Wong JHF, Lehmann C, Koch U, Fielding R, Mehnert A. Unmet supportive care needs: a cross-cultural comparison between Hong Kong Chinese and German Caucasian women with breast cancer. Breast Cancer Res Treat 2011; 130:531-41. [DOI: 10.1007/s10549-011-1592-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 05/13/2011] [Indexed: 01/29/2023]
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Lai HK, Hedley AJ, Repace J, So C, Lu QY, McGhee SM, Fielding R, Wong CM. Lung function and exposure to workplace second-hand smoke during exemptions from smoking ban legislation: an exposure-response relationship based on indoor PM2.5 and urinary cotinine levels. Thorax 2011; 66:615-23. [PMID: 21551212 DOI: 10.1136/thx.2011.160291] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The effects of workplace second-hand smoke (SHS) on lung function remain uncertain because of a lack of objective measures for SHS exposures. OBJECTIVE To determine whether an exposure-response association exists between lung function and two different markers of SHS based on indoor fine particulate (PM(2.5)) and urinary cotinine levels in non-smoking catering workers. DESIGN A cross-sectional study during a 1.5-year exemption of licensed catering premises from smoke-free legislation. Participants 186 non-smoking catering workers aged 18-65 years in Hong Kong were recruited. A declared non-smoking status was accepted in workers with exhaled breath carbon monoxide levels <6 ppm and urinary cotinine levels <100 ng/ml. MAIN OUTCOME MEASURES Lung function measures of forced expiratory volume in 1s (FEV(1) in litres), forced vital capacity (FVC in litres) and forced expiratory flow as 25-75% of FVC (FEF(25-75) in l/s) were recorded. RESULTS Indoor fine particulate (PM(2.5)) concentrations were 4.4 times as high in smoking premises (267.9 μg/m(3)) than in non-smoking premises (60.3 μg/m(3)) and were strongly associated with the probability of permitted smoking (R(2)=0.99). Smoking was the dominant source of particulates (R(2)=0.66). Compared with workers exposed to the lowest indoor PM(2.5) stratum (<25 μg/m(3)), lung function was lower in the three higher PM(2.5) strata (25-75, 75-175, >175 μg/m(3)) with FEV(1) -0.072 (95% CI -0.123 to -0.021), -0.078 (95% CI -0.132 to -0.024), -0.101 (95% CI -0.187 to -0.014); FEF(25-75) -0.368 (95% CI -0.660 to -0.077), -0.489 (95% CI -0.799 to -0.179), -0.597 (95% CI -0.943 to -0.251); and FEV(1)/FVC (%) -2.9 (95% CI -4.8 to -1.0), -3.2 (95% CI -5.1 to -1.4) and -4.4 (95% CI -7.4 to -1.3), respectively. Urinary cotinine was associated positively with indoor PM(2.5) but negatively with lung function. Consistently lower values for lung function per unit increase of indoor PM(2.5) were found. CONCLUSION Lung function is inversely associated with workplace SHS. Workplace exemptions and delays in implementing smoke-free policies and current moves to relax legislation are a major threat to the health of workers.
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Lu SQ, Fielding R, Hedley AJ, Wong LC, Lai HK, Wong CM, Repace JL, McGhee SM. Secondhand smoke (SHS) exposures: workplace exposures, related perceptions of SHS risk, and reactions to smoking in catering workers in smoking and nonsmoking premises. Nicotine Tob Res 2011; 13:344-52. [PMID: 21430065 DOI: 10.1093/ntr/ntr001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoke-free workplace legislation often exempts certain venues. Do smoking (exempted) and nonsmoking (nonexempted) catering premises' workers in Hong Kong report different perceptions of risk from and reactions to nearby smoking as well as actual exposure to secondhand smoke (SHS)? METHODS In a cross-sectional survey of 204 nonsmoking catering workers, those from 67 premises where smoking is allowed were compared with workers from 36 nonsmoking premises in Hong Kong on measures of perceptions of risk and behavioral responses to self-reported SHS exposure, plus independent exposure assessment using urinary cotinine. RESULTS Self-reported workplace SHS exposure prevalence was 57% (95% CI = 49%-65%) in premises prohibiting and 100% (95% CI = 92%-100%) in premises permitting smoking (p < .001). Workers in smoking-permitted premises perceived workplace air quality as poorer (odds ratio [OR] = 9.3, 95% CI = 4.2-20.9) with higher associated risks (OR = 3.7, 95% CI = 1.6-8.6) than workers in smoking-prohibited premises. Workers in smoking-prohibited premises were more bothered by (OR = 0.2, 95% CI = 0.1-0.5) and took more protective action to avoid SHS (OR = 0.2, 95% CI = 0.1-0.4) than workers in smoking-permitted premises. Nonwork exposure was negatively associated with being always bothered by nearby smoking (OR = 0.3, 95% CI = 0.1-0.9), discouraging nearby smoking (OR = 0.5, 95% CI = 0.2-1.1), and discouraging home smoking (OR = 0.4, 95% CI = 0.2-0.9). Urinary cotinine levels were inversely related to workers' avoidance behavior but positively related to their perceived exposure-related risks. CONCLUSIONS Different workplace smoking restrictions predicted actual SHS exposure, exposure-related risk perception, and protective behaviors. Workers from smoking-permitted premises perceived greater SHS exposure-related risks but were more tolerant of these than workers in smoking-prohibited premises. This tolerance might indirectly increase both work and nonwork exposures.
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Wong WS, Chen PP, Yap J, Mak KH, Tam BKH, Fielding R. Chronic Pain and Psychiatric Morbidity: A Comparison between Patients Attending Specialist Orthopedics Clinic and Multidisciplinary Pain Clinic. PAIN MEDICINE 2011; 12:246-59. [DOI: 10.1111/j.1526-4637.2010.01044.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lam WWT, Bonanno GA, Mancini AD, Ho S, Chan M, Hung WK, Or A, Fielding R. Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psychooncology 2011; 19:1044-51. [PMID: 20014074 DOI: 10.1002/pon.1658] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The distinct trajectories of psychological distress over the first year of the diagnosis with breast cancer (BC) and its determinants have not been explored. METHODS 285 of 405 Chinese women receiving surgery for BC were assessed at 5-day, 1-month, 4-month, and 8-month post-surgery on measures of psychological distress, optimism, treatment decision-making (TDM) difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, and physical symptom distress. Latent growth mixture modelling identified trajectories of psychological response to BC. Multinominal logistic regression compared TDM difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, optimism, and physical symptom distress, by distress pattern adjusted for age, education, employment status, and stage of disease. RESULTS Four distinct trajectories of distress were identified, namely, resilience (66%), chronic distress (15%), recovered (12%), and delayed-recovery (7%). TDM difficulties, optimism, satisfaction with consultation, and physical symptom distress predicted distress trajectories. Psychologically resilient women had less physical symptom distress at early post-surgery compared with women with other distress patterns. Compared with the resilient group, women in the recovered or chronic distress groups experienced greater TDM difficulties, whereas women in the delayed-recovery group reported greater dissatisfaction with the initial medical consultation. Women in the chronic distress group reported greater pessimistic outlook. CONCLUSION Optimism and better early post-operative treatment outcomes predicted resilience to distress. Pre-operative interventions helping women to establish a realistic expectation of treatment outcome may minimize disappointment with treatment outcome and resultant distress, whereas post-operative rehabilitation should focus on symptom management.
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Au AHY, Lam WWT, Chan MCM, Or AYM, Kwong A, Suen D, Wong AL, Juraskova I, Wong TWT, Fielding R. Development and pilot-testing of a Decision Aid for use among Chinese women facing breast cancer surgery. Health Expect 2011; 14:405-16. [PMID: 21223468 DOI: 10.1111/j.1369-7625.2010.00655.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Women choosing breast cancer surgery encounter treatment decision-making (TDM) difficulties, which can cause psychological distress. Decision Aids (DAs) may facilitate TDM, but there are no DAs designed for Chinese populations. We developed a DA for Chinese women newly diagnosed with breast cancer, for use during the initial surgical consultation. AIMS Conduct a pilot study to assess the DA acceptability and utility among Chinese women diagnosed with breast cancer. METHODS Women preferred the DA in booklet format. A booklet was developed and revised and evaluated in two consecutive pilot studies (P1 and P2). On concluding their initial diagnostic consultation, 95 and 38 Chinese women newly diagnosed with breast cancer received the draft and revised draft DA booklet, respectively. Four-day post-consultation, women had questionnaires read out to them and to which they responded assessing attitudes towards the DA and their understanding of treatment options. RESULTS The original DA was read/partially read by 66/22% (n = 84) of women, whilst the revised version was read/partially read by 74/16% (n = 35), including subliterate women (χ(2) = 0.76, P = 0.679). Knowledge scores varied with the extent the booklet was read (P1: F = 12.68, d.f. 2, P < 0.001; P2: F = 3.744, d.f. 2, P = 0.034). The revised, shorter version was graphically rich and resulted in improved perceived utility, [except for the 'treatment options' (χ(2) = 5.50, P = 0.019) and 'TDM guidance' (χ(2) = 8.19, P = 0.004) sections] without increasing anxiety (F = 0.689, P = 0.408; F = 3.45, P = 0.073). CONCLUSION The DA was perceived as acceptable and useful for most women. The DA effectiveness is currently being evaluated using a randomized controlled trial.
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Fielding R, Lam TH, Ho SY, Janus ED. Subjective health and fibrinogen in a healthy Chinese cohort. Br J Health Psychol 2010; 9:523-32. [PMID: 15509359 DOI: 10.1348/1359107042304533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study explores standard cardiovascular (CVD) risk factors in a healthy population sample, with low CVD prevalence and presumed higher social connectedness as potential mechanisms linking subjective health (SH) and physical health. METHOD A population-based, telephone-sampled, cross-sectional study recruited a healthy subset of 2280 Chinese adults who subsequently underwent a free medical examination. Serum total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, fibrinogen, fasting glucose, 2-hour post-load glucose, blood pressure and adiposity were compared between respondents reporting good SH and those reporting poor SH over the past 3 months, on a 4-point, single-item measure. RESULTS After adjustment for age, gender, education, exercise, marital and smoking status, only serum fibrinogen significantly differentiated the two groups. Respondents reporting Very poor or Poor SH had a significantly greater likelihood of raised mean fibrinogen levels compared with those reporting Good or Very good SH (Adjusted Odds Ratio 1.37, 95% CL 1.002-1.84, p < .05). CONCLUSIONS There is a small but robust association between SH and fibrinogen in this low CVD prevalent population unexplained by known pre-existing disease.
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Lam WWT, Shing YT, Bonanno GA, Mancini AD, Fielding R. Distress trajectories at the first year diagnosis of breast cancer in relation to 6 years survivorship. Psychooncology 2010; 21:90-9. [PMID: 21132676 DOI: 10.1002/pon.1876] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 09/14/2010] [Accepted: 10/13/2010] [Indexed: 11/12/2022]
Abstract
PURPOSE To explore how initial trajectories of distress experienced during the first year following diagnosis with early-stage breast cancer (ESBC) relate to subsequent long-term(6 years) psychosocial outcomes. METHODS 285/303 Chinese women recruited 1-week post-surgery for predominantly ESBC were assessed for distress with the Chinese Health Questionnaire at 1, 4, and 8 months later.Latent growth mixture modeling revealed four distinct distress trajectories during the first 8 months following surgery (Lam et al., 2010). Six years later we reassessed 186 of these 285 women, comparing scores on the Hospital Anxiety and Depression Scale, Impact of Events Scale, and Chinese Social Adjustment Scale by first 8 months’ distress trajectory. RESULTS Distress trajectories over the first 8 months post-operatively predicted psychosocial outcomes 6 years later. Women with stable low levels of distress over the first 8 months postoperatively(resilient group) had the best 6-year psychosocial outcomes. Women who experienced chronic distress had significantly greater longer-term psychological distress, cancer-related distress, and poorer social adjustment in comparison to women in the resilient group. Women in the recovered or delayed-recovery groups were comparable to those in the resilient group, except for concerns about appearance and sexuality, and self-image. CONCLUSION Women with an illness trajectory characterized by chronic distress over the first 8 months post-operatively had poorest longer-term psychosocial outcomes. Clarification of determinants of chronic distress and means for early identification of at-risk women are needed.This will enable targeted optimization of interventions to prevent and manage chronic distress,improving ESBC rehabilitation efficiency.
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Lim EJ, Morgan J, Fielding R. Cervical screening uptake in immunocompromised women in Waikato, New Zealand. Int J STD AIDS 2010; 21:835-6. [DOI: 10.1258/ijsa.2010.010222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A one-year retrospective case study was undertaken of cervical cytology in two cohorts of immunocompromised women: those with HIV infection or renal transplants in the Waikato region of New Zealand. Uptake of cervical screening in the two groups was compared with national guidelines. The results showed that HIV patients' uptake was close to the national recommendation for annual cytology (84% had a smear in 18 months); they were more likely to have cytology performed in an HIV-related care setting. Renal transplant patients had lower uptake (56% in 18 months), a finding similar to internationally reported data. Local discussions of these results identified potential influencing factors, which included inadequate dissemination of updated guidelines and inadequate documentation of immunocompromised health status on the national cervical screening programme database. This audit supports including cervical cytology as part of an annual review in all immunocompromised patients.
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Liao Q, Cowling B, Lam WT, Ng MW, Fielding R. Situational awareness and health protective responses to pandemic influenza A (H1N1) in Hong Kong: a cross-sectional study. PLoS One 2010; 5:e13350. [PMID: 20967280 PMCID: PMC2953514 DOI: 10.1371/journal.pone.0013350] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 09/16/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Whether information sources influence health protective behaviours during influenza pandemics or other emerging infectious disease epidemics is uncertain. METHODOLOGY Data from cross-sectional telephone interviews of 1,001 Hong Kong adults in June, 2009 were tested against theory and data-derived hypothesized associations between trust in (formal/informal) information, understanding, self-efficacy, perceived susceptibility and worry, and hand hygiene and social distancing using Structural Equation Modelling with multigroup comparisons. PRINCIPAL FINDINGS Trust in formal (government/media) information about influenza was associated with greater reported understanding of A/H1N1 cause (β = 0.36) and A/H1N1 prevention self-efficacy (β = 0.25), which in turn were associated with more hand hygiene (β = 0.19 and β = 0.23, respectively). Trust in informal (interpersonal) information was negatively associated with perceived personal A/H1N1 susceptibility (β = -0.21), which was negatively associated with perceived self-efficacy (β = -0.42) but positively associated with influenza worry (β = 0.44). Trust in informal information was positively associated with influenza worry (β = 0.16) which was in turn associated with greater social distancing (β = 0.36). Multigroup comparisons showed gender differences regarding paths from trust in formal information to understanding of A/H1N1 cause, trust in informal information to understanding of A/H1N1 cause, and understanding of A/H1N1 cause to perceived self-efficacy. CONCLUSIONS/SIGNIFICANCE Trust in government/media information was more strongly associated with greater self-efficacy and handwashing, whereas trust in informal information was strongly associated with perceived health threat and avoidance behaviour. Risk communication should consider the effect of gender differences.
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Au A, Lam WWT, Kwong A, Suen D, Tsang J, Yeo W, Suen J, Ho WM, Yau TK, Soong I, Wong KY, Sze WK, Ng A, Girgis A, Fielding R. Validation of the Chinese version of the Short-form Supportive Care Needs Survey Questionnaire (SCNS-SF34-C). Psychooncology 2010; 20:1292-300. [DOI: 10.1002/pon.1851] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/13/2010] [Accepted: 08/16/2010] [Indexed: 11/08/2022]
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Wong WS, Fielding R. Prevalence and characteristics of chronic pain in the general population of Hong Kong. THE JOURNAL OF PAIN 2010; 12:236-45. [PMID: 20875775 DOI: 10.1016/j.jpain.2010.07.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 05/03/2010] [Accepted: 07/08/2010] [Indexed: 11/30/2022]
Abstract
UNLABELLED Western studies document the prevalence of chronic pain in the general adult population to be between 2 and 55%. Knowing the prevalence of chronic pain among Chinese populations provides important comparative perspective: To determine the prevalence of chronic pain in the general population of Hong Kong; evaluate the relationship of chronic pain with sociodemographic and lifestyle factors; and describe the pain characteristics among chronic pain sufferers. A total of 5,001 adults aged ≥ 18 years (response rate 58%) drawn from the general population of Hong Kong completed the Chronic Pain Grade (CPG) questionnaire, providing information on chronic pain and sociodemographic status using telephone interviews. Overall 34.9% reported pain lasting more than 3 months (chronic pain), having an average of 1.5 pain sites; 35.2% experienced multiple pain sites, most commonly of the legs, back, and head with leg and back being rated as the most significant pain areas among those with multiple pain problems. The CPG criteria classified 21.5% of those with chronic pain symptoms as Grade III or above. Fully adjusted stepwise regression analyses identified being female, older age, divorced/separated, having part-time employment, existing long-term health problems, higher HADS Anxiety scores, poor QoL (mental health component), and low self-perceived health to be significantly associated with chronic pain. PERSPECTIVE Our data evidenced that chronic pain is common in the general population of Hong Kong, and the prevalence is highest among women and middle-aged adults.
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Cowling BJ, Ng DMW, Ip DKM, Liao Q, Lam WWT, Wu JT, Lau JTF, Griffiths SM, Fielding R. Community psychological and behavioral responses through the first wave of the 2009 influenza A(H1N1) pandemic in Hong Kong. J Infect Dis 2010; 202:867-76. [PMID: 20677945 DOI: 10.1086/655811] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Little is known about the community psychological and behavioral responses to influenza pandemics. METHODS Using random digit dialing, we sampled 12,965 Hong Kong residents in 13 cross-sectional telephone surveys between April and November 2009, covering the entire first wave of the 2009 influenza A(H1N1) pandemic. We examined trends in anxiety, risk perception, knowledge on modes of transmission, and preventive behaviors. RESULTS Respondents reported low anxiety levels throughout the epidemic. Perceived susceptibility to infection and perceived severity of H1N1 were initially high but declined early in the epidemic and remained stable thereafter. As the epidemic grew, knowledge on modes of transmission did not improve, the adoption of hygiene measures and use of face masks did not change, and social distancing declined. Greater anxiety was associated with lower reported use of hygiene measures but greater social distancing. Knowledge that H1N1 could be spread by indirect contact was associated with greater use of hygiene measures and social distancing. CONCLUSIONS The lack of substantial change in preventive measures or knowledge about the modes of H1N1 transmission in the general population suggests that community mitigation measures played little role in mitigating the impact of the first wave of 2009 influenza A(H1N1) pandemic in Hong Kong.
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Wong WS, Kwok HY, Luk KDK, Chow YF, Mak KH, Tam BKH, Wong ET, Fielding R. Fear of movement/(re)injury in Chinese patients with chronic pain: Factorial validity of the Chinese version of the Tampa Scale for Kinesiophobia. J Rehabil Med 2010; 42:620-9. [PMID: 20603691 DOI: 10.2340/16501977-0575] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the factor structure of the Chinese version of the Tampa Scale for Kinesiophobia (TSK). DESIGN Chinese patients with chronic pain attending either orthopaedic specialist services (n = 216) or multidisciplinary specialist pain services (n = 109) participated in this study. METHODS Subjects completed the Chinese version of TSK, The Chronic Pain Grade Questionnaire, Hospital Anxiety and Depression Scale, and questions assessing socio-demographic characteristics. Confirmatory factor analyses were used to compare hierarchical and correlated models of 5 different factor solutions previously reported in patients with chronic pain in the West. RESULTS Confirmatory factor analyses demonstrated inequality of the TSK factor structure, in that the TSK11 for the orthopaedics sample was best represented by a two-factor correlated model (S-Bchi2 = 49.593; comparative fit index (CFI) = 0.93; normed filt index (NFI) = 0.911; root mean square error of approximation (RMSEA) = 0.025) comprising 2 first-order factors, Somatic Focus (TSK11-SF) and Activity Avoidance (TSK-AA). The pain clinic sample showed a one-factor structure as best representing the TSK4's underlying dimensions (CFI = 0.971; NFI = 0.912; RMSEA = 0.048). There was no evidence to support a single overarching concept of kinesiophobia. CONCLUSION The TSK appears to have utility in Chinese chronic pain populations. Elucidation of the TSK's psychometrics properties in other Chinese/Asian pain populations with different diagnoses and presentations of pain problems is warranted.
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