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Cioffi G, Waite KA, Price M, Neff C, Kruchko C, Ostrom QT, Barnholtz-Sloan JS. The impact of COVID-19 on 2020 monthly incidence trends of primary brain and other CNS tumors. Neuro Oncol 2024; 26:764-774. [PMID: 38167948 PMCID: PMC10995517 DOI: 10.1093/neuonc/noad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To mitigate disease spread, restrictions implemented in the United States surrounding the COVID-19 pandemic created an environment that led to delays in cancer diagnosis. The data needed to accurately analyze the impact of the pandemic on brain and CNS tumor incidence has not been available until now. Utilizing incidence data from the Central Brain Tumor Registry of the United States (CBTRUS) we analyzed the impact of the COVID-19 pandemic on primary brain and other CNS tumor incidence for the first year of the pandemic. METHODS Monthly age-adjusted incidence rates and incidence trends for 2019 and 2020 were determined for age at diagnosis, sex, race, ethnicity, diagnostic confirmation, behavior, tumor histopathology, and county-level urbanization. Monthly incidence rate ratios comparing 2020 and 2019 were evaluated for the same factors. RESULTS Overall, there was a notable decrease in incidence rates in March-May 2020 when compared to 2019. These decreases were driven by nonmalignant tumors, with a 50% incidence decrease between March 2020 and 2019. Individuals who were Black had a larger incidence decrease in early 2020 than individuals who were White. Radiographically confirmed tumors saw larger incidence decreases than histologically confirmed tumors. There were no changes in monthly incidence of glioblastoma in 2020 compared to 2019. CONCLUSIONS These data provide evidence that disruptions in medical care, such as governmental and health care mandates, in response to the COVID-19 pandemic resulted in an overall decreased incidence of primary brain tumors in early 2020.
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Affiliation(s)
- Gino Cioffi
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jill S Barnholtz-Sloan
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
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Plate A, Bagnoud C, Rosemann T, Senn O, Di Gangi S. Influenza vaccination patterns among at-risk patients during the Covid-19 pandemic-a retrospective cross-sectional study based on claims data. Infection 2024:10.1007/s15010-024-02175-3. [PMID: 38302673 DOI: 10.1007/s15010-024-02175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE The Covid-19 pandemic may have encouraged at-risk patients to get vaccinated against influenza for the first time. As previous vaccinations are known predictors for further vaccinations, knowledge about individual vaccination patterns, especially in first time vaccinated patients, is of great interest. The aim of this study was to determine influenza vaccination uptake rate (VUR), individual vaccination patterns and factors associated with vaccination uptake among at-risk patients. METHODS The study design was retrospective cross-sectional. Based on claims data, VUR was determined for four influenza seasons (2018/2019-2021/2022). In a cohort subgroup, with data available for all seasons, VUR, vaccination patterns and factors associated with uptake were determined. At-risk patients were people aged ≥ 65 and adult patients with chronic diseases. RESULTS We included n = 238,461 patients in the cross-sectional analysis. Overall VUR ranged between 21.8% (2018/2019) and 29.1% (2020/2021). Cohort subgroup consisted of n = 138,526 patients. Within the cohort, 56% were never vaccinated and 11% were vaccinated in all seasons. 14.3% of previously unvaccinated patients were vaccinated for the first time in the first pandemic season (2020/2021 season). The strongest predictor for vaccination was history of vaccinations in all previous seasons (OR 56.20, 95%CI 53.62-58.90, p < 0.001). CONCLUSION Influenza VUR increased during the Covid-19 pandemic, but only a minority of previously eligible but unvaccinated at-risk patients were vaccinated for the first time in the first pandemic season. Previous vaccinations are predictors for subsequent vaccinations and health care professionals should actively address at-risk patients' vaccination history in order to recommend vaccination in future seasons.
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Affiliation(s)
- Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
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Kalfas M, Ayling K, Jia R, Coupland C, Vedhara K, Chalder T. Fatigue during the COVID-19 pandemic - prevalence and predictors: findings from a prospective cohort study. Stress 2024; 27:2352117. [PMID: 38757166 DOI: 10.1080/10253890.2024.2352117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
The COVID-19 pandemic and consequent lockdowns had a substantial impact on mental health. Distress and fatigue are highly correlated. However, little is known about the determinants of fatigue in the general population during the pandemic. This study aimed to examine the prevalence and predictors of fatigue during the COVID-19 pandemic in the UK population. Online surveys were completed by a UK community cohort in April 2020 (wave 1), July-September 2020 (wave 2) and November-December 2020 (wave 3). In total, 3097 participants completed the wave 1 survey, and 1385 and 1087 participants (85.4% women) completed wave 2 and 3 surveys respectively. Fatigue was assessed using the Chalder Fatigue Scale at waves 2 and 3. Hair samples were provided by 827 participants (90.6% women) at wave 1 and wave 2, which were analyzed to indicate HairE (stress hormone). The mean total fatigue score during wave 2 was 14.7 (SD = 4.7), significantly higher than pre-pandemic levels observed in the community (mean difference 0.50, p = .003). At wave 2, 614 (44.3%) participants met the case definition for fatigue, only 15.6% of whom indicated that fatigue lasted for more than 6 months (suggesting it had started prior to the pandemic). Predictors of fatigue at wave 3 included being in a risk group, depression and belief in having COVID-19, which explained 23.8% of the variability in fatigue scores. Depression at wave 1 was the only significant predictor of remaining a fatigue case at wave 3. Fatigue was highly prevalent in the UK community during the COVID-19 pandemic and limited people's daily function. Depression and sociodemographic variables were significant predictors of fatigue.
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Affiliation(s)
- Michail Kalfas
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kieran Ayling
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ru Jia
- Nuffield Department of Primary Care Health Sciences, Medical Science Division, University of Oxford, Oxford, UK
| | - Carol Coupland
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Wu J, Qiu L, Xiong W, Shen Y, Li J, Wu J, Zhou Q. COVID-19 anxiety and related factors amid adjusted epidemic prevention policies: a cross-sectional study on patients with late-life depression in China. BMJ Open 2023; 13:e072725. [PMID: 38000824 PMCID: PMC10680000 DOI: 10.1136/bmjopen-2023-072725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES To explore the prevalence and associated factors of COVID-19 anxiety in patients with late-life depression (LLD) during the adjustment of epidemic prevention policies in China. DESIGN Cross-sectional study. SETTING The data analysed in this study were collected from seven regions in China between November 2022 and January 2023. PARTICIPANTS A total of 1205 patients with LLD (aged 60-78 years) participated in the survey. They completed a social demographic assessment and the Chinese version of the five-point Coronavirus Anxiety Scale (CAS). PRIMARY OUTCOME MEASURES The primary outcome was the anxiety level of the participants. Patients were categorised into two groups based on their anxiety levels, one with anxiety and one without, according to CAS scores. RESULTS The prevalence of COVID-19 anxiety in depressed older adults was 47.3%. Regression analysis revealed that the average COVID-19 anxiety score was significantly higher among females (AOR: 2.177, 95% CI 1.201 to 3.947), widowed individuals (AOR: 3.015, 95% CI 1.379 to 6.591), patients residing at a distance from healthcare facilities (AOR: 3.765, 95% CI 1.906 to 7.438), and those who frequently experienced worry (AOR: 1.984, 95% CI 1.111 to 3.543). Conversely, the anxiety score was significantly lower among divorced individuals (AOR: 0.491, 95% CI 0.245 to 0.988), those aged 70 years and above (AOR: 0.117, 95% CI 0.064 to 0.213), patients without difficulty obtaining medication (AOR: 0.027, 95% CI 0.007 to 0.097), those living with family members (AOR: 0.080, 95% CI 0.022 to 0.282) or in nursing homes compared with those living alone (AOR: 0.019, 95% CI 0.004 to 0.087). CONCLUSION Women with LLD who are widowed, live far from healthcare facilities, and are prone to excessive worry are more likely to experience anxiety. It is advisable to implement appropriate preventive measures and provide psychosocial support programmes for this vulnerable group during the COVID-19 pandemic.
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Affiliation(s)
- Jianhong Wu
- Department of Pharmacy, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Linghe Qiu
- Department of General Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Wendian Xiong
- School of Life Sciences and Health Engineering, Jiangnan University, Wuxi, Jiangsu, China
| | - Yuan Shen
- Department of Pharmacy, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Jun Li
- Department of Pharmacy, Nanjing First Hospital, Nangjing, Jiangsu, China
| | - Ju Wu
- Department of Pharmacy, Jiangsu Provincial Rongjun Hospital, Wuxi, Jiangsu, China
| | - Qin Zhou
- Department of Pharmacy, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
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Tian YM, Wang J, Zhang WS, Jiang CQ, Jin YL, Zhu T, Zhu F, Cheng KK, Lam TH, Xu L. Association of perceived stress with memory decline in older Chinese: The Guangzhou Biobank Cohort Study. J Affect Disord 2023; 341:256-264. [PMID: 37634823 DOI: 10.1016/j.jad.2023.08.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Previous studies on associations of perceived stress with poor memory performance in older adults showed inconsistent results. We examined the prospective associations of perceived stress with memory decline using data from Guangzhou Biobank Cohort Study (GBCS). METHODS Perceived stress was measured by the Perceived Stress Scale (PSS) at baseline (2003-2006), with greater scores indicating greater stress. Memory function was measured by delayed 10-word recall test (DWRT) and immediate 10-word recall test (IWRT), with greater scores indicating better performance, at baseline and follow-up (2008-2012) examinations, analyzed as mean annual change in scores. RESULTS 9656 participants (72 % women) with mean age 61.6 (standard deviation = 6.4) years were included. During an average of 4.4 years of follow-up, after adjusting for confounders, each one-point greater PSS score was associated with mean annual decline in DWRT scores (β (95 % CI) = -0.005 (-0.008 to -0.002)). Greater Perceived Helplessness (PH) scores, but not Perceived Self-efficacy scores, was associated with greater mean annual decline in DWRT and IWRT scores (β (95 % CI) = -0.005 (-0.009 to -0.001) and - 0.012 (-0.018 to -0.005), respectively), and similar patterns were observed in five out of seven PH items (βs from -0.02 to -0.07). Interaction analysis showed that the association of greater PSS with greater decline in DWRT scores was observed only in those with low family income (β (95 % CI) = -0.08 (-0.13 to -0.04), P for interaction = 0.03). CONCLUSIONS Greater perceived stress was associated with a greater decline in delayed recall memory, especially in those with low family income.
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Affiliation(s)
- Yu Meng Tian
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiao Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wei Sen Zhang
- Guangzhou Twelfth People's Hospital, Guangzhou, China.
| | | | - Ya Li Jin
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Tong Zhu
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Feng Zhu
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tai Hing Lam
- School of Public Health, the University of Hong Kong, Hong Kong
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China; School of Public Health, the University of Hong Kong, Hong Kong; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Abdul Rashid MR, Syed Mohamad SN, Tajjudin AIA, Roslan N, Jaffar A, Mohideen FBS, Addnan FH, Baharom N, Ithnin M. COVID-19 Pandemic Fatigue and Its Sociodemographic, Mental Health Status, and Perceived Causes: A Cross-Sectional Study Nearing the Transition to an Endemic Phase in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4476. [PMID: 36901486 PMCID: PMC10001764 DOI: 10.3390/ijerph20054476] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to explore the socio-demographic characteristics, mental health status, and perceived causes of pandemic fatigue with COVID-19 pandemic fatigue among the general population of Malaysia. The data was collected online during the transition from the COVID-19 pandemic phase to the endemic phase in Malaysia from 1 to 30 April 2022. Sociodemographic data, Depression Anxiety Stress Scale-21 (DASS-21), perceived causes of pandemic fatigue, and the Fatigue Assessment Scale (FAS) were included in the survey. The chi-square test and a simple logistic regression analysis were used to identify predictors of pandemic fatigue. The completed survey (N = 775) included individuals aged 18 years or above [mean 31.98 (SD = 12.16)] from all states in Malaysia. Pandemic fatigue prevalence was 54.2%. Severe to extremely severe depression, anxiety, and stress symptoms were detected in 11.2%, 14.9%, and 9.1% of the participants, respectively. Younger age, non-Malay ethnicity, living alone, and higher income categories were significantly higher in the fatigued group. Higher DASS-21 scores on all domains were associated with higher FAS scores. Meanwhile, high scores for perceived tiredness from complying with the COVID-19 Standard Operating Procedure (SOP), perceived risk of infection from COVID-19, perceived hardship due to the pandemic, perceived public complacency during the pandemic, and perceived changes due to the pandemic were associated with a higher FAS score. This study provides valuable information for policymakers and mental health professionals worldwide on pandemic fatigue and its associated factors, including mental health status in Malaysia.
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Affiliation(s)
| | | | | | - Nuruliza Roslan
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
- Islamic Science Institute, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Aida Jaffar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Sungai Besi, Kuala Lumpur 57000, Malaysia
| | | | - Faizul Helmi Addnan
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Nizam Baharom
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Muslimah Ithnin
- Corporate Communications Unit, Ministry of Health Malaysia, Putrajaya 62000, Malaysia
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Recurrent COVID-19 Waves and Lockdown: Impact on Daily Life and Mental Health of People in Nepal. Ment Illn 2023. [DOI: 10.1155/2023/1930093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background. Lockdown is recognized as an effective measure in limiting the spread of coronavirus (COVID-19) throughout the world. However, recurrent COVID-19 infection and the extension of lockdown have threatened the livelihoods of people, mainly socioeconomic and mental health dimensions. Objective. The present study is aimed at identifying the impact of COVID-19 lockdown on the daily life and mental health of the general population of Nepal. Furthermore, the study identified the predictors of the mental health status of the people during COVID-19 lockdown. Methods. The study was conducted among 354 Nepalese people specifically the breadwinner of the family. Respondents completed the questionnaires related to the sociodemographic characteristics, COVID-19, and its impact on various aspects of life, including mental health via Depression, Anxiety, and Stress Scale-21 items (DASS-21). Data was collected through the web-based method, Google Forms questionnaire. Respondents were contacted through email and social networks (Facebook, Messenger, WhatsApp, and Viber) following a snowball approach. Data was analyzed using descriptive and inferential statistics. Logistic regression analysis was done to identify significant demographic, COVID-related, and socioeconomic factors associated with mental health outcomes. Results. Based on DASS-21 scores, the prevalence of depression, anxiety, and stress was 46.6% (mild: 22.3%, moderate: 16.7%, severe: 6.5%, and extremely severe: 1.1), 42.1% (mild: 10.2%, moderate: 18.6%, severe: 11.6%, and extremely severe: 1.7%), and 39% (mild: 16.7%, moderate: 12.7%, and severe: 9.6%), respectively. Various factors associated with COVID-19, its lockdown measures, and sociodemographic characteristics of the people were identified as the significant predictors of depression, anxiety, and stress among the general population of Nepal. Conclusion. The impact of COVID-19 lockdown on individuals’ work, income, education, living standard, lifestyle, and consequently mental health is significant. The study findings warrant the importance of understanding the impact of the COVID-19 pandemic on individuals’ all aspects of life and timely monitoring and appropriate intervention on risk groups to reduce the severity and chronicity of mental health problems.
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Chen B, Gong W, Lai AYK, Sit SMM, Ho SY, Yu NX, Wang MP, Lam TH. Family context as a double-edged sword for psychological distress amid the COVID-19 pandemic with the mediating effect of individual fear and the moderating effect of household income. Front Public Health 2023; 11:1109446. [PMID: 37033084 PMCID: PMC10076528 DOI: 10.3389/fpubh.2023.1109446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Background The COVID-19 pandemic drives psychological distress. Previous studies have mostly focused on individual determinants but overlooked family factors. The present study aimed to examine the associations of individual and family factors with psychological distress, and the mediating effect of individual fear and the moderating role of household income on the above associations. Methods We conducted a population-based cross-sectional survey on Chinese adults in Hong Kong from February to March 2021 (N = 2,251) to measure the independent variables of anti-epidemic fatigue, anti-epidemic confidence, individual and family members' fear of COVID-19, and family well-being (range 0-10), and the dependent variable of psychological distress (through four-item Patient Health Questionnaire, range 0-4). Results Hierarchical regression showed that anti-epidemic fatigue was positively (β = 0.23, 95% CI [0.18, 0.28]) while anti-epidemic confidence was negatively (β = -0.29, 95% CI [-0.36, -0.22]) associated with psychological distress. Family members' fear of COVID-19 was positively (β = 0.11, 95% CI [0.05, 0.16]) while family well-being was negatively (β = -0.57, 95% CI [-0.63, -0.51]) associated with psychological distress. Structural equation model showed that individual fear mediated the above associations except for family well-being. Multi-group analyses showed a non-significant direct effect of anti-epidemic confidence and a slightly stronger direct effect of family well-being on psychological distress among participants with lower incomes, compared to those with higher incomes. Conclusion We have first reported the double-edged effect of family context on psychological distress, with the positive association between family members' fear of COVID-19 and psychological distress fully mediated by individual fear and the negative association between family well-being and psychological distress moderated by income level. Future studies are warranted to investigate how the contagion of fear develops in the family and how the inequality of family resources impacts family members' mental health amid the pandemic.
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Affiliation(s)
- Bowen Chen
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Weijie Gong
- Department of General Practice, Medical School, Shenzhen University, Shenzhen, China
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Agnes Yuen Kwan Lai
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Shirley Man Man Sit
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- *Correspondence: Nancy Xiaonan Yu,
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Man Ping Wang,
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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