Patterns of sedentary behavior among older women with urinary incontinence and urinary symptoms: a scoping review

BACKGROUND

Independent of physical activity, sedentary behavior has emerged as a significant risk factor for health. Particularly, older adults spent as high as 13 h daily on sedentary activities, which account for 98% of their awake times. Although there is growing evidence revealing the potential association between sedentary behavior and urinary incontinence (UI) across populations of different ages, the relationship between sedentary behavior and urinary symptoms in older women, who are twice as likely to have UI than older men, has not been reviewed. This scoping review aimed to synthesize available evidence of the relationship between sedentary behavior and urinary symptoms in noninstitutionalized older women.

METHODS

Six electronic databases (PubMed, Web of Science, SPORTDiscus, Ovid Nursing Database, EMBASE, and MEDLINE) were searched from their inception to April 2023. Observational and experimental studies that measured sedentary behavior using objective and/or self-reported methods in older women aged 60 + years having any type of UI, with English full texts available, were included. Relevant data, including sedentary patterns (types, definitions, measurements, and daily patterns) and UI types were tabulated. A narrative synthesis of the findings was also conducted.

RESULTS

A total of seven studies (n = 1,822) were included for review and reporting. Objective measurement showed that older women with UI were engaged in > 8 h sedentary activities daily (493.3-509.4 min/day), which accounted for 73% of their awake times. The duration of self-reported sedentary behavior was lower than the time measured objectively, and the average weekday sitting time was 300-380 min/day. With or without adjustment for confounding factors (e.g., age and number of vaginal deliveries), the daily proportion of sedentary time and average duration of sedentary bouts were positively associated with the prevalence of urgency UI. Notably, sedentary patients with UI were more likely to have lower urinary tract symptoms, including bothersome incontinence, to use incontinence products, and to have nocturia episodes, than their age-matched counterparts who were less sedentary.

CONCLUSION

Our findings suggest a potential relationship between sedentary behavior and UI in older women, but the causality of the relationship remains unclear. To further inform the clinical role of sedentary behavior in the context of UI, a greater number of rigorous studies with a prospective study design is urgently needed.

The mediating effect of dispositional mindfulness on the association between UPPS-P impulsivity traits and gaming disorder among Asia-Pacific young adults

BACKGROUND

Little evidence is available to verify the mediating effect of dispositional mindfulness on the association between gaming disorder and various impulsivity traits. The present study aimed to investigate the mediating effect of dispositional mindfulness on the association between the five UPPS-P impulsivity traits and the risk of gaming disorder among young adults.

METHODS

It was an inter-regional cross-sectional study using online survey in Australia, Japan, The Philippines and China. Impulsivity measured by the UPPS-P Impulsive Behavior Scale-Short version; dispositional mindfulness measured by the Mindfulness Attention Awareness Scale; and the risk of gaming disorder measured by the Internet Gaming Disorder Scale were collected in the focal regions. Structural equation modeling was performed by SPSS AMOS version 26 to verify the study hypotheses. Bootstrapped 95% confidence interval was reported. Statistical significance was indicated by the p-value below 0.05.

RESULTS

Among the 1,134 returned questionnaires, about 40% of them aged 18-20 years and 21-23 years, respectively. 53.8% were male. 40.7% had been playing digital and video games for over 10 years. The prevalence of gaming disorder was 4.32%. The model fitness indices reflected that the constructed model had an acceptable model fit (χ2(118) = 558.994, p < 0.001; χ2/df = 4.737; CFI = 0.924; TLI = 0.890; GFI = 0.948; RMSEA = 0.058; SRMR = 0.0487). Dispositional mindfulness fully mediated the effect of positive urgency and negative urgency on the risk of gaming disorder. The effect of lack of premeditation on the risk of gaming disorder was partially mediated by dispositional mindfulness. However, dispositional mindfulness did not mediate the effect of sensation seeking on the risk of gaming disorder.

CONCLUSIONS

The varied associations between dispositional mindfulness and the five impulsivity traits hints that improving some impulsive traits may increase dispositional mindfulness and so lower the risk of gaming disorder. Despite further studies are needed to verify the present findings, it sheds light on the need to apply interventions on gamers based on their impulsivity profile. Interventions targeting at emotion regulation and self-control such as mindfulness-based interventions seem to be effective to help gamers with dominant features of urgency and lack of premeditation only. Other interventions shall be considered for gamers with high sensation seeking tendency to enhance the effectiveness of gaming disorder prevention.

Nurses' compliance to standard precautions prior to and during COVID-19

AIMS

To measure nurses' compliance with standard precautions during the COVID-19 pandemic, compare findings with previous assessments and describe the barriers affecting nurses' compliance.

BACKGROUND

Healthcare providers' compliance with standard precautions is still limited worldwide. Implementation of infection control policies in hospitals is needed internationally, especially during a pandemic. Surprisingly, studies exploring nurses' compliance with standard precautions are lacking during COVID-19.

METHODS

A multicenter cross-sectional study was adopted in two Italian hospitals. Nurses' compliance with standard precautions was measured through The Compliance with Standard Precautions Scale (Italian version). An open-ended question explored the barriers to nurses' compliance with standard precautions. Reporting, followed the STROBE guidelines.

RESULTS

A total of 201 nurses were enrolled in 2020. Nurses' compliance with standard precautions was suboptimal. A statistically significant improvement in the compliance rate with standard precautions was observed between pre- and during COVID-19 assessments. High compliance was found in the appropriate use of surgical masks, gloves and sharps disposal. Nurses perceived personal, structural and organizational barriers to standard precautions adherence.

CONCLUSION

Nurses' compliance with standard precautions was not 100%, and different factors impeded nurses to work safely. Our findings provide institutional leaders and educators with the basis for implementing policies to optimize nurse safety, well-being and patient care.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Nurses have the right to work safely, and when the shortage of personal protective equipment and nurses during an emergency threatens healthcare quality worldwide, policymakers are challenged to act by establishing an effective allocation of resources for consistent compliance with standard precautions. Moreover, nurses should actively engage in the implementation of infection control policies to improve safe behaviours among citizens and students accessing hospitals.

A longitudinal study on the change in sleep across three waves of the COVID-19 outbreaks in Hong Kong

In the year 2020, Hong Kong experienced four COVID-19 epidemic waves. The present study aimed to examine the transition of sleep disturbances and explore its associated factors across the later three epidemic waves. Among the 1138 respondents who participated in an online survey at the second wave (T1, April 2020), 338 and 378 participants also completed a follow-up at the third (T2, August 2020) and fourth waves (T3, December 2020), respectively. Participants completed the Insomnia Severity Index and an investigator-designed questionnaire regarding potential factors associated with sleep change such as perceived risk of being infected, economic stress, and confidence in the government and health care professional. Sample of this study were mainly female (67.7%), married (50.3%), young adults (54.2%) with tertiary education (81.6%). Maintaining normal sleep was the most prevalent trajectory of sleep of all three waves (50.5%), followed by persistent insomnia (17.2%) and remitted insomnia (9.0%). Besides female, older-age and lower education level, the results showed that increment in worry about family being infected (adjusted risk ratio, RR = 1.28), perceived interference of daily lives (adjusted RR = 1.19), and economic distress (adjusted RR = 1.24) were significantly associated with the development of clinical insomnia during the three epidemic waves. These factors were also associated with worsening of other sleep parameters. Insomnia being persistent across the three waves of COVID-19 outbreaks was common. Increasing economic distress, daily interference, and worry about family members being infected were associated with an increasing risk of clinical insomnia across the three COVID-19 outbreaks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00486-w.

Lesões de pele associadas ao uso de respiradores N95 entre profissionais de saúde no Brasil em 2020

Objetivo: investigar a prevalência de lesões de pele e fatores associados ao uso de respiradores N95 entre profissionais de saúde no Brasil. Método: estudo transversal realizado com 11.368 profissionais de saúde por meio de um método de amostragem dirigido por respondentes adaptado para ambientes online. Análises univariadas e multivariadas foram realizadas para investigar a associação entre a variável “lesão de pele com uso de respirador N95” e sexo, categoria profissional, local de trabalho, treinamento, diagnóstico de COVID-19 e disponibilidade suficiente de equipamentos de proteção individual de qualidade. Resultados: a prevalência de lesões cutâneas foi de 61,8%. As mulheres foram 1,203 vezes (IC 95%: 1.154-1.255) mais propensas a desenvolver uma lesão do que os homens. As chances de lesão de pele em psicólogos (RP=0,805; IC 95%: 0,678-0,956) e dentistas (RP=0,884; IC 95%: 0,788-0,992) foram menores quando comparados aos profissionais de Enfermagem. Profissionais com diagnóstico positivo para COVID-19 e que trabalham em Unidade de Cuidados Intensivos têm maior chance de apresentar lesões de pele (RP=1,074; IC 95%: 1,042-1,107); (RP=1,203; IC 95%: 1,168- 1,241), respectivamente. Conclusão: a prevalência de lesões de pele causadas pelo uso do respirador N95 foi de 61,8% e esteve associada ao sexo feminino, categoria profissional, local de trabalho, treinamento, diagnóstico de COVID-19 e disponibilidade suficiente de equipamentos de proteção individual de qualidade.

Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020

Objective: to investigate the prevalence of skin lesions and factors associated with the use of N95 respirators among health professionals in Brazil. Method: cross-sectional study conducted with 11,368 health professionals using a respondent-driven sampling method adapted for online environments. Univariate and multivariate analyses were performed to investigate the association between the “skin lesions with the use of N95 respirators” variable and gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and high-quality Personal Protective Equipment. Results: the prevalence of skin lesions was 61.8%. Women were 1.203 times (95% CI: 1.154-1.255) more likely to develop a lesion than men. The chances of skin lesions in psychologists (PR=0.805; 95% CI: 0.678-0.956) and dentists (PR=0.884; 95% CI: 0.788-0.992), were lower when compared to Nursing professionals. Professionals with a positive COVID-19 diagnosis and working in the Intensive Care Unit have an increased chance of presenting skin lesions (PR=1.074; 95% CI: 1.042-1.107); (PR=1.203; 95% CI: 1.168-1.241), respectively. Conclusion: the prevalence of skin lesions caused by the use of N95 respirators was 61.8% and was associated with female gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and highquality Personal Protective Equipment.

Uveal and conjunctival melanomas: disease course and outcomes in Chinese patients

INTRODUCTION

Epidemiological studies of ocular melanomas have largely focused on Caucasian populations. This study reviewed the course and outcomes of uveal melanoma (UM) and conjunctival melanoma (CM) in Chinese patients.

METHODS

This retrospective study included patients with UM and CM who received treatment in a tertiary eye centre in Hong Kong from January 1994 to December 2019. Data were recorded concerning patient demographics, tumour laterality, tumour characteristics, investigations performed, treatment regimen, and final outcomes.

RESULTS

During the 25-year study period, there were 13 patients with UM and 11 patients with CM who did not display nodal or systemic involvement at diagnosis. The mean ± standard deviation ages at diagnosis of UM and CM were 59 ± 15.8 and 57 ± 13.9 years, respectively. There were more men among patients with UM than among those with CM (P=0.042). Most patients with UM underwent primary enucleation (n=12; 92.3%), whereas most patients with CM underwent orbital exenteration (n=9; 81.8%). The prognosis was significantly worse for CM than for UM. The median disease-free survival were 5.2 years (range, 0.7-20.5) and 2.1 years (range, 0.1-24.9) for UM and CM, respectively. Melanoma-related mortality was significantly higher among patients with CM than among those with UM (P=0.006).

CONCLUSION

Compared with UM, CM has higher rates of systemic metastasis and tumour-related mortality in Hong Kong Chinese patients, regardless of prior definitive treatment.

Evaluation of N95 respirators on fit rate, real-time leakage, and usability among Chinese healthcare workers: study protocol of a randomized crossover trial

Background

N95 respirators are used to limit the transmission of respiratory viruses in clinical settings. There are two to three major types of N95 available for all healthcare workers in Hong Kong. However, after the coronavirus outbreak and the consequent shortage of many commonly used respirators, several new N95 respirators were adopted temporarily in clinical settings without evaluation. Prior literature indicates that traditional N95 respirators used in hospitals in Hong Kong are not fit for Chinese people and have fit rates ranging from 50 to 60%. This study aims to investigate and compare the fit rate, real-time leakage, and mask usability of traditional and new N95 respirators among Chinese healthcare workers.

Methods

This study will employ two sequential phases. Phase 1 has a cross-sectional exploratory design used to investigate the fit rate and mask usability of three types of respirators. Phase 2 will examine the effectiveness of respiratory protection by comparing traditional and new N95 respirators by a randomized crossover trial. Eligible participants will be randomly allocated through a controlled crossover experiment to either a traditional or new respirator group (n = 100 in each arm) for performing standard clinical procedures. The primary outcome (real-time leakage) will be recorded at 30 s intervals during nasopharyngeal suctioning and cardiopulmonary resuscitation. The secondary outcomes are the fit rate and mask usability. After a 2 min suctioning (15 s twice) and 4 min one-person CPR, the fit rate (assessed by standard N95 fit testing) and mask usability (measured by self-reported mask usability scale) will be recorded as data of post-procedure. After 10 min rest, measurement of real-time leakage (i.e., crossover), fit test, and usability will be repeated.

Discussion

The result of real-time leakage will be a vital indicator of the respiratory protection of Chinese healthcare workers while performing prevalent clinical procedures, such as resuscitation. The fit rate and usability result will serve as an essential reference for consumable purchase policy in clinical settings.Trial registration: ISRCTN registry: ISRCTN40115047. Retrospectively registered on May 9, 2023. https://www.isrctn.com/ISRCTN40115047.

Effect of exercise interventions on brain-derived neurotrophic factor expression in people with overweight and obesity: protocol for a systematic review and meta-analysis

INTRODUCTION

Epidemic obesity ('globobesity') has led to a considerable rise in the prevalence and incidence of many disabling conditions, including cognitive dysfunction. Recent evidence has suggested that habitual exercise can alleviate the deleterious effects of obesity on cognitive functioning across the lifespan. Given that there is a potential link among obesity, exercise, cognitive health and brain-derived neurotrophic factor (BDNF), this systematic review aims to critically appraise interventional trials on exercise and BDNF and to estimate the pooled effect of exercise training on BDNF levels among healthy individuals with overweight and obesity.

METHODS AND ANALYSIS

Six electronic databases-PubMed, MEDLINE, EMBASE, Web of Science, Ovid Nursing Database and SPORTDiscus-will be searched from their inception through December 2022. Only interventional studies, including randomised controlled trials and quasi-experimental studies, with full text available and reported in English will be included. The primary outcomes will be changes in BDNF levels among healthy subjects with overweight and obesity following either acute or chronic bouts of exercise interventions. Two reviewers will independently conduct data extraction and risk of bias assessment for included trials using the Physiotherapy Evidence Database Scale. We will produce a narrative synthesis, with findings categorised by sex, age groups and types of exercise training. Data will be extracted and pooled for meta-analyses using random-effects models.

ETHICS AND DISSEMINATION

No formal ethical approval is required for this systematic review. The findings of this review will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023414868.

Sensitivity and specificity of conventional and new face validation in determining the incomprehensible items by older people: Empirical evidence of testing 106 quality-of-life items

Objective

This methodological research aimed to investigate and compare the sensitivity and specificity of conventional and new face validation in identifying incomprehensible items empirically.

Methods

A purposive sample of 15 older people living in three residential care homes (RCHs) in Hong Kong was used to evaluate a newly developed 106 items covering seven quality-of-life dimensions. The abbreviated Mental Test (Hong Kong version; AMT) was used as a screening tool for excluding those with impaired cognition. The interview was audiotaped, and incomprehensible items were identified by the research panel accordingly (served as the gold standard). The socio-demographics of the respondents were described. Understandability (yes/no, conventional face validation method) and interpretability (4-point Likert scale, new method) were compared and used to compute the Kappa value (representing chance agreement), sensitivity, and specificity analysis.

Results

Fifteen older people were interviewed and responded to the structured interview of 106 items regarding understandability and interpretability. 61 items (57%) obtained 100% positive understandability while only 35 items (33%) obtained 100% correct interpretability.The Kappa coefficient was 0.388 (P < 0.001) of the chance agreement between understandability and interpretability. The panel confirmed that 32% of items required revision (i.e., incomprehensible items). The false negative rate of using the conventional approach was up to 70.59% while both the false positive and negative rates of using the new approach were low (0%-5.88%).

Conclusion

This empirical evidence indicated that the conventional approach of face validation for checking incomprehensible items by older people encountered a high false negative rate. On the contrary, the new approach was recommended because it demonstrated high sensitivity and specificity and low false positive and negative rates in identifying incomprehensible items.

Comparison of depressive symptoms among healthcare workers in high-risk versus low-risk areas during the first month of the COVID-19 pandemic in China

Introduction

The psychological health of healthcare workers (HCWs) has become a significant concern, particularly during the initial stage of a pandemic. This study compared the depressive symptoms among HCWs in high-risk areas (HRAs) and low-risk areas (LRAs) with matching demographics.

Methods

A cross-sectional study was employed to compare the depressive symptoms (Patient Health Questionnaire score ≥ 10), workplace environment characteristics, the Health Belief Model (HBM) and socio-demographics of the HCWs working in HRAs and LRAs in several accessible regions (mainly Hubei Province and Guangdong-Hong Kong-Macao Greater-Bay-Area) in China. Eight hundred eighty-five HCWs were recruited for unmatched analysis between March 6 and April 2, 2020. After matching with occupation and years of service using a 1:2 ratio, 146 HCWs in HRAs and 290 HCWs in LRAs were selected for matched analysis. Subgroup analyzes were performed using two individual logistic regressions to delineate the associated factors in LRAs and HRAs, respectively.

Results

HCWs in LRAs (Prevalence = 23.7%) had 1.96 times higher odds of depressive symptoms than those in HRAs (Prevalence = 15.1%) after adjusting for occupation and years of service (p < 0.001). Significant differences in workplace environment characteristics (p < 0.001) and the 5-dimension of the HBM of HCWs (p < 0.001 to p = 0.025) were found between HRAs and LRAs.Logistic regression showed that workers with years of service between 10 and 20  years (OR:6.27), ever had contact with COVID-19 patients (OR:14.33) and had higher scores of "perceived barrier" of HBM (OR:4.48) predicted depressive symptoms in HRAs while working in pneumology departments and infectious disease units (OR:0.06), and high "self-efficacy" in the HBM (OR:0.13) was a protective factor against depressive symptoms.Contrarily, in LRAs, those HCWs who worked in ICUs (OR:2.59), had higher scores of "perceived susceptibility toward the COVID-19 outbreak" (OR:1.41), "perceived severity of the pandemic" (OR:1.25), and "perceived barriers of wearing masks" (OR:1.43) in the HBM predicted depressive symptoms. High "cues to action" (OR:0.79), and better "knowledge" (OR:0.79) in the HBM were protective factors against depressive symptoms.

Conclusion

The risk of depressive symptoms of HCWS was double in LRAs than in HRAs in the first month of the COVID-19 pandemic. Furthermore, salient predictors for depressive symptoms among HCWs in HRAs and LRAs were very different.

Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020

OBJECTIVE

to investigate the prevalence of skin lesions and factors associated with the use of N95 respirators among health professionals in Brazil.

METHOD

cross-sectional study conducted with 11,368 health professionals using a respondent-driven sampling method adapted for online environments. Univariate and multivariate analyses were performed to investigate the association between the "skin lesions with the use of N95 respirators" variable and gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and high-quality Personal Protective Equipment.

RESULTS

the prevalence of skin lesions was 61.8%. Women were 1.203 times (95% CI: 1.154-1.255) more likely to develop a lesion than men. The chances of skin lesions in psychologists (PR=0.805; 95% CI: 0.678-0.956) and dentists (PR=0.884; 95% CI: 0.788-0.992), were lower when compared to Nursing professionals. Professionals with a positive COVID-19 diagnosis and working in the Intensive Care Unit have an increased chance of presenting skin lesions (PR=1.074; 95% CI: 1.042-1.107); (PR=1.203; 95% CI: 1.168-1.241), respectively.

CONCLUSION

the prevalence of skin lesions caused by the use of N95 respirators was 61.8% and was associated with female gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and highquality Personal Protective Equipment. (1) The overall prevalence of skin lesions was 61.8%. (2) The most affected professional category was Nursing. (3) Women were more likely to develop skin lesions than men.

Mediating role of self-efficacy between unmet needs and quality of life in palliative cancer caregivers

OBJECTIVE

Although unmet support needs are associated with health-related quality of life (HRQOL) in cancer caregivers, little is known about the mechanism underlying the relationship between two variables. The self-efficacy (SE) theory and literature suggest that caregiving SE is important in the perception of and reaction to caregiving demands, which in turn affects HRQOL. The aim of this study was to examine whether caregiving SE mediates the relationship between unmet support needs and HRQOL in family caregivers of palliative cancer patients.

METHODS

This secondary analysis used the data from 125 family caregivers of palliative cancer patients who were recruited from two public hospitals in Hong Kong. The caregivers completed a survey questionnaire that covered socio-demographic characteristics, unmet support needs, caregiving SE, and HRQOL. Parallel mediation analyses were conducted via SPSS PROCESS macro (Model 4) to test the hypothesized models.

RESULTS

The direct effect of unmet support needs on mental HRQOL was significant (effect = -0.49, 95% CI = -0.06 to -0.92). For the indirect effect, only caregiving SE in the domain of 'care for the care recipient' mediated the relationship between unmet support needs and mental HRQOL (effect = -0.32, 95% CI = -0.08 to -0.59).

CONCLUSION

The findings suggest that caregiving SE may function as a mechanism through which unmet support needs influence mental HRQOL in family caregivers of palliative cancer patients. Healthcare providers should consider developing supportive care interventions to improve caregivers' HRQOL by incorporating effective strategies to enhance SE and reduce unmet needs for this population.

Effects of Transcranial Pulse Stimulation (TPS) on Adults with Symptoms of Depression-A Pilot Randomized Controlled Trial

Transcranial pulse stimulation (TPS) is a recent development in non-invasive brain stimulations (NIBS) that has been proven to be effective in terms of significantly improving Alzheimer patients' cognition, memory, and execution functions. Nonetheless, there is, currently, no trial evaluating the efficacy of TPS on adults with major depression disorder (MDD) nationwide. In this single-blinded, randomized controlled trial, a 2-week TPS treatment comprising six 30 min TPS sessions were administered to participants. Participants were randomized into either the TPS group or the Waitlist Control (WC) group, stratified by gender and age according to a 1:1 ratio. Our primary outcome was evaluated by the Hamilton depression rating scale-17 (HDRS-17). We recruited 30 participants that were aged between 18 and 54 years, predominantly female (73%), and ethnic Chinese from 1 August to 31 October 2021. Moreover, there was a significant group x time interaction (F(1, 28) = 18.8, p < 0.001). Further, when compared with the WC group, there was a significant reduction in the depressive symptom severity in the TPS group (mean difference = -6.60, p = 0.02, and Cohen's d = -0.93). The results showed a significant intervention effect; in addition, the effect was large and sustainable at the 3-month follow-up. In this trial, it was found that TPS is effective in reducing depressive symptoms among adults with MDD.

A Health App for Post-Pandemic Years (HAPPY) for people with physiological and psychosocial distress during the post-pandemic era: Protocol for a randomized controlled trial

Objective

This article describes a protocol for a randomized controlled trial to evaluate the effects of a three-level Health App for Post-Pandemic Years (HAPPY) on alleviating post-pandemic physiological and psychosocial distress.

Methods

Convenience and snowball sampling methods will be used to recruit 814 people aged 18+ with physiological and/or psychosocial distress. The experimental group will receive a 24-week intervention consisting of an 8-week regular supervision phase and a 16-week self-help phase. Based on their assessment results, they will be assigned to receive interventions on mindfulness, energy conservation techniques, or physical activity training. The waitlist control group will receive the same intervention in Week 25. The primary outcome will be changes in psychosocial distress, measured using the Kessler Psychological Distress Scale (K10). Secondary outcomes will include changes in levels of fatigue (Chinese version of the Brief Fatigue Inventory), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index), pain intensity (Numeric Rating Scale), positive appraisal (Short version of the 18-item Cognitive Emotion Regulation Questionnaire), self-efficacy (Chinese version of the General Self-efficacy Scale), depression and anxiety (Chinese version of the 21-item Depression Anxiety Stress Scale), and event impact (Chinese version of the 22-item Impact of Event Scale-Revised). All measures will be administered at baseline (T0), Week 8 after the supervision phase (T1), and 24 weeks post-intervention (T2). A generalized estimating equations model will be used to examine the group, time, and interaction (Time × Group) effect of the interventions on the outcome assessments (intention-to-treat analysis) across the three time points, and to compute a within-group comparison of objective physiological parameters and adherence to the assigned interventions in the experimental group.

Conclusions

The innovative, three-level mobile HAPPY app will promote beneficial behavioral strategies to alleviate post-pandemic physiological and psychosocial distress.

Trial registration

ClinicalTrials.gov, NCT05459896. Registered on 15 July 2022.

Implementation of the compulsory universal testing scheme in Hong Kong: Mathematical simulations of a household-based pooling approach

This study aims to propose a pooling approach to simulate the compulsory universal RT-PCR test in Hong Kong and explore the feasibility of implementing the pooling method on a household basis. The mathematical model is initially verified, and then the simulation is performed under different prevalence rates and pooled sizes. The simulated population is based in Hong Kong. The simulation included 10,000,000 swab samples, with a representative distribution of populations in Hong Kong. The samples were grouped into a batch size of 20. If the entire batch is positive, then the group is further divided into an identical group size of 10 for re-testing. Different combinations of mini-group sizes were also investigated. The proposed pooling method was extended to a household basis. A representative from each household is required to perform the RT-PCR test. Results of the simulation replications, indicate a significant reduction (p < 0.001) of 83.62, 64.18, and 48.46% in the testing volume for prevalence rate 1, 3, and 5%, respectively. Combined with the household-based pooling approach, the total number of RT-PCR is 437,304, 956,133, and 1,375,795 for prevalence rates 1, 3, and 5%, respectively. The household-based pooling strategy showed efficiency when the prevalence rates in the population were low. This pooling strategy can rapidly screen people in high-risk groups for COVID-19 infections and quarantine those who test positive, even when time and resources for testing are limited.

Psychological impact on healthcare workers, general population and affected individuals of SARS and COVID-19: A systematic review and meta-analysis

Background

Any infectious disease outbreak may lead to a negative detrimental psychological impact on individuals and the community at large, however; there was no systematic review nor meta-analysis that examined the relationship between the psychological/mental health impact of SARS and COVID-19 outbreak in Asia.

Methods and design

A systematic search was conducted using PubMed, EMBASE, Medline, PsycINFO, and CINAHL databases from 1/1/2000 to 1/6/2020. In this systematic review and meta-analysis, we analyzed the psychological impact on confirmed/suspected cases, healthcare workers and the general public during the Severe Acute Respiratory Syndrome (SARS) outbreak and Coronavirus disease (COVID-19) epidemics. Primary outcomes included prevalence of depression, anxiety, stress, post-traumatic stress disorder, aggression, sleeping problems and psychological symptoms.

Result

Twenty-three eligible studies (N = 27,325) were included. Random effect model was used to analyze the data using STATA. Of these studies, 11 were related to the SARS outbreak and 12 related to COVID-19 outbreaks. The overall prevalence rate of anxiety during SARS and COVID-19 was 37.8% (95% CI: 21.1-54.5, P < 0.001, I2 = 96.9%) and 34.8% (95% CI: 29.1-40.4), respectively. For depression, the overall prevalence rate during SARS and COVID-19 was 30.9% (95% CI: 18.6-43.1, P < 0.001, I2 = 97.3%) and 32.4% (95% CI: 19.8-45.0, P < 0.001, I2 = 99.8%), respectively. The overall prevalence rate of stress was 9.4% (95% CI: -0.4 -19.2, P = 0.015, I2 = 83.3%) and 54.1% (95% CI: 35.7-72.6, P < 0.001, I2 = 98.8%) during SARS and COVID-19, respectively. The overall prevalence of PTSD was 15.1% (95% CI: 8.2-22.0, P < 0.001) during SARS epidemic, calculated by random-effects model (P < 0.05), with significant between-study heterogeneity (I2 = 93.5%).

Conclusion

The SARS and COVID-19 epidemics have brought about high levels of psychological distress to individuals. Psychological interventions and contingent digital mental health platform should be promptly established nationwide for continuous surveillance of the increasing prevalence of negative psychological symptoms. Health policymakers and mental health experts should jointly collaborate to provide timely, contingent mental health treatment and psychological support to those in need to reduce the global disease burden.

Systematic review registration

CRD42020182787, identifier PROSPER.

Development of generic student engagement scale in higher education: An application on healthcare students

AIM

Student engagement is an important factor to the success of higher education. This study aimed to develop a Generic Student Engagement Scale (GSES) for face-to-face and online learning.

DESIGN

This was a cross-sectional psychometric study.

METHODS

We tested the psychometric properties of GSES in 451 students at the school of nursing and health studies undertaking online and face-to-face learning at a local university in Hong Kong between 2016 and 2018.

RESULTS

Content validity, face validity and test-retest reliability of GSES were satisfactory. The 29-item GSES contains five factors "self-regulated learning," "cognitive strategy use," "experienced emotion," "teacher-student interaction," and "enjoyment of school life" with the good model fit. The GSES is a reliable and valid psychometric instrument to measure student engagement in face-to-face and online learning among undergraduates and higher diploma students. Our results implied that student engagement can be assessed in routine or research by using our instrument.

Groningen Frailty Indicator-Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy

Background

The early identification of pre-frailty and frailty among older people is a global priority because of the increasing incidence of frailty and associated adverse health outcomes. This study aimed to validate the Groningen Frailty Indicator-Chinese (GFI-C), a widely used screening instrument, and determine the optimal cut-off value in Chinese communities to facilitate pre-frailty and frailty screening.

Methods

This methodological study employed a cross-sectional and correlational design to examine the psychometric properties of GFI-C, namely, internal consistency, stability, and concurrent and construct validities. The appropriate cut-off values for pre-frailty and frailty screening in the receiver-operating characteristic (ROC) curve were determined through sensitivity and specificity analysis.

Results

A total of 350 community older people had been assessed and interviewed by a nurse. The GFI-C showed satisfactory internal consistency (Cronbach’s α = 0.87) and two-week test-retest reliability (intra-class correlation coefficient = 0.87). Concurrent validity (r = 0.76, p < 0.001) showed a moderate correlation with Fried’s frailty phenotype. The known-groups method, hypothesis testing and confirmatory factory analysis (three-factor model; χ²/df = 2.87, TLI = 0.92, CFI = 0.93, GFI = 0.92, RMR = 0.014; RMSEA = 0.073) were suitable for the establishment of construct validity. Based on the ROC and Youden’s index, the optimal cut-off GFI-C values were 2 (sensitivity, 71.5%; specificity, 84.7%) for pre-frailty and 3 for frailty (sensitivity, 88.2%; specificity, 79.6%).

Conclusions

The result indicated that GFI-C is a reliable and valid instrument for pre-frailty and frailty screening among older Chinese people in communities. For optimal diagnostic accuracy, the cut-off values of 3 for frailty and 2 for pre-frailty are recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03437-1.

Co-living with migrant domestic workers is associated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study

Loneliness (inclusive social loneliness and emotional loneliness) of older adults is a prominent public health issue internationally. Factors consistently associated with loneliness are age, gender, education, living arrangements, social network, and functional status. Intergenerational co-living with spouse and adult children is important for the exchange of social, emotional, practical, and financial support provided to older adults. Co-living with migrant domestic workers (MDWs) to care for older adults became an emergent phenomenon internationally, particularly in Asian countries. According to the convoy model of social relations, the effect of co-living with MDWs on older adults' loneliness is unknown. This study examined (1) the prevalence of loneliness among community-dwelling older adults; and (2) the association between co-living with MDWs and older adult loneliness. Using the Chinese version of the 6-item De Jong Gierveld Loneliness Scale on loneliness, 380 older adults were interviewed at busy points in Hong Kong, including subway stations. 35.3% of older adults experienced moderate-to-severe loneliness. Linear regression was performed to examine the association between co-living with MDWs and loneliness. The results showed that co-living with MDWs was significantly associated with lower levels of overall loneliness (β = -0.636; p = .022) and emotional loneliness (β = -0.298, p = .039), but not for social loneliness (β = -0.337, p = .084). While MDWs could be an attachment figure for older adults, they might not be effective in promoting the social integration of older adults. There is a need to investigate the barriers of social integration faced by older adults co-living with MDWs.

COVID-19 vaccine hesitancy and resistance in an urban Chinese population of Hong Kong: a cross-sectional study

Vaccine hesitancy against COVID-19 is prevalent. This study aimed to identify the factors associated with COVID-19 vaccination compliance among adults in Hong Kong. An online survey was conducted during an early stage of community-based COVID-19 vaccination campaign in Hong Kong. The questionnaire consisted of vaccine status, sociodemographic information, risk perception of being infected by COVID-19, and exposure to confirmed COVID cases, as well as items on sleep and mental health. The association between these variables and vaccine hesitancy was analyzed. Among the 883 participants (67.5% females, 54.5% aged 18–39), 30.6% had low vaccine hesitancy, 27.4% had high vaccine hesitancy, and 27.5% had vaccine rejection. The likelihood of having high vaccine hesitancy was higher among young (adjusted odds ratio [aOR] = 2.99; 95% confidence interval [CI]: 1.23–7.30) and middle-aged respondents (aOR = 2.99; 95% CI: 1.07–5.47) than among old respondents. Moreover, those who were married (aOR = 0.51; 95% CI: 0.29–0.88), had a full-time job (aOR = 0.55; 95% CI: 0.29–0.88), and had a greater confidence in the government (aOR = 0.68; 95% CI: 0.54–0.86) were less likely to exhibit vaccine hesitancy. Our findings showed that the prevalence of vaccine hesitancy and vaccine resistance were high. Policy makers need specific strategies to target those who may have a high risk of vaccine hesitancy and resistance.

Effectiveness of a Nurse-Led Support Programme Using a Mobile Application versus Phone Advice on Patients at Risk of Coronary Heart Disease – A Pilot Randomized Controlled Trial

Purpose

Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally. This study aimed to examine the preliminary effect of a nurse-led support programme using a mobile application versus nursing telephone advice on patients at risk of CHD living in the community.

Patients and Methods

A prospective randomized controlled trial was adopted. Sixty eligible CHD participants were randomized into the app group (App) or the nursing telephone advice (NTA) group to support their own health care and exercise. Data were collected at baseline (T0), 1 month (T1), and 3 months (T2). Outcomes were total amount of exercise, self-efficacy of chronic disease management, total time of exercise, blood pressure, and lipid concentrations. Data were analyzed using the generalized estimating equation models.

Results

Ninety-two individuals were screened for eligibility and 60 were randomized into the app group (n = 30) or NTA group (n = 30). The mean age of the participants was 60.92. The total attrition rate at T2 was 1.66%. The app group showed a moderate effect (Cohen’s d =0.43) in significant increase in exercise amount, and reduction of lipid concentration (total cholesterol d=−0.43, triglyceride d=−0.39) respectively. Other outcomes showed improvement trend but non-significant between group.

Conclusion

The CHD app is effective to motivate CHD patients for maintaining exercise amount which will be beneficial to their lipid control.

Sarcopenia and its association with objectively measured life-space mobility and moderate-to-vigorous physical activity in the oldest-old amid the COVID-19 pandemic when a physical distancing policy is in force

Introduction

The oldest-old are highly vulnerable to sarcopenia. Physical distancing remains a common and effective infection-control policy to minimize the risk of COVID-19 transmission during the pandemic. Sarcopenia is known to be associated with impaired immunity. Moderate-to-vigorous physical activity (MVPA) and life-space mobility (LSM) are potential strategies for minimizing the risk of sarcopenia. However, a physical distancing policy might jeopardize the practice of MVPA and LSM. The purposes of this study were to identify the prevalence of sarcopenia and examine the association between MVPA and LSM with sarcopenia in the community-dwelling oldest-old during the COVID-19 pandemic.

Methods

This study employed a cross-sectional and observational design. The study was conducted in 10 community centres for older people in Hong Kong during the period of the COVID-19 pandemic (September to December 2020). Eligible participants were the oldest-old people aged ≥85 years, who were community-dwelling and had no overt symptoms of cognitive impairment or depression. Key variables included sarcopenia as measured by SARC-F, LSM as measured by a GPS built into smartphones, and MVPA as measured by a wrist-worn ActiGraph GT3X+. Variables were described by mean and frequency. A multiple linear regression was employed to test the hypotheses. The dependent variable was sarcopenia and the independent variables included LSM and MVPA.

Results

This study recruited 151 eligible participants. Their mean age was 89.8 years and the majority of them were female (n = 93/151, 61.6%). The prevalence of sarcopenia was 24.5% (n = 37/151) with a margin of error of 6.86%. MVPA was negatively associated with sarcopenia in older people (β = − 0.002, SE = 0.001, p = 0.029). However, LSM was not associated with sarcopenia.

Conclusion

The prevalence of sarcopenia in the community-dwelling oldest-old population is high. MVPA is negatively associated with sarcopenia. LSM is unrelated to sarcopenia. Sarcopenia should be recognized and the oldest-old with sarcopenia should be accorded priority treatment during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02861-7.

Willingness to care for older people and associated factors in pre-registered student nurses: A multi-country survey study

BACKGROUND

Addressing nursing students' lack of interest in providing care for the aged population is a global challenge for nursing educators. Despite global interest in student nurses' readiness for older people care, almost all the literature has been identified from single countries, predominantly with high income per capita. At present, no study has been conducted to provide evidence-based data related to this topic from a multi-country perspective.

OBJECTIVE

The study's purpose was to examine the willingness to work with older persons and associated factors among student nurses from nine countries (or regions).

DESIGN

This study utilized a correlational and cross-sectional design.

SETTINGS

This was a multi-country survey study conducted in China, Chile, Egypt, Hong Kong, India, Greece, the State of Palestine (henceforth Palestine), the Philippines, and Saudi Arabia.

PARTICIPANTS

2250 baccalaureate nursing students were recruited from 10 universities in this study.

METHODS

The survey that was used to collect data comprised four parts: socio-demographic data, attitude toward aging, older person care perception, and willingness to work with such group.

RESULTS

Respondents in five regions (including Mainland China, Greece, Hong Kong, Palestine, and Saudi Arabia) stated that older persons were the least favored group for future career choices. In comparison with mainland China, respondents in Chile, India, and the Philippines were significantly more likely to be willing to care for older patients, but those in Egypt and Greece indicated a lower tendency to choose this option. Favorable attitudes toward aging and older person care perception were significantly associated with having the willingness to provide care to gerontologic patients in the future.

CONCLUSIONS

Although attitudes toward aging and older person care perception have long been confirmed as important factors that are linked with willingness in caring for older people, this study adds that location is a more influential factor. Additional research in other countries is needed to advance the knowledge in this important area.

Nurses' Attitudes Toward the Importance of Families in Nursing Care: A Multinational Comparative Study

The aim of this study was to examine nurses' attitudes about the importance of family in nursing care from an international perspective. We used a cross-sectional design. Data were collected online using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire from a convenience sample of 740 registered nurses across health care sectors from Sweden, Ontario, Canada, and Hong Kong, China. Mean levels of attitudes were compared across countries using analysis of variance (ANOVA). Multiple regression was used to identify factors associated with nurses' attitudes and to test for interactions by country. Factors associated with nurse attitudes included country, age, gender, and several practice areas. On average, nurses working in Hong Kong had less positive attitudes compared with Canada and Sweden. The effects of predictors on nurses' attitudes did not vary by country. Knowledge of nurses' attitudes could lead to the development of tailored interventions that facilitate nurse-family partnerships in care.

Prediction of problem gambling by demographics, gaming behavior and psychological correlates among gacha gamers: A cross-sectional online survey in Chinese young adults

OBJECTIVE

The objective of this study is to explore the association of problem gambling with demographics, psychological distress, and gaming behavior in young adult gacha gamers in Hong Kong.

MATERIALS AND METHODS

Cross-sectional data was collected in the first and fifth waves of COVID-19 pandemic in Hong Kong online. Participants who aged 18-25 years and had been playing gacha games over the past 12 months were recruited. Stepwise multiple regression was used to explore the association among risk of problem gambling, gaming behavior, participation in gaming activities and psychological distress. A two-sided p-value <0.05 was considered as statistical significance.

RESULTS

Three hundred and thirty-seven completed questionnaires were received with no missing data. 34.7% (n = 117) of the participants had non/low-risk of problem gambling. About 40% (n = 136) of them had moderate-risk and the remaining 25% (n = 84) were at high risk of problem gambling. A higher proportion of female participants (78.6%) were found in high-risk group as compared to 39.7% and 55.6% only in the non/low-risk and moderate-risk groups, respectively. The regression model (R ² = 0.513, F = 71.895, p < 0.001) showed that 51.3% of the variance of the total problem gambling score could be explained by stress, anxiety, monthly expenses on gacha purchases, number of motives for gacha purchase and number of gambling activities engaged.

CONCLUSION

The present study provides empirical evidence to support the association between problem gambling and microtransaction especially for gacha which is the most popular type of video game microtransaction in Asia. The established regression model suggests that gacha gamers with higher risk of problem gambling tend to have greater stress, higher anxiety level, spend more on gacha purchase, have more motives for gacha purchases and engage in more gambling activities. In contrast to the extant literature, higher proportion of female participants in high-risk group indicates that female gacha gamers are also at very high risk of becoming problem gamblers.

Effect of multimodal non-pharmacologic interventions on cognitive function for people with dementia: Systematic review

INTRODUCTION

Dementia is a progressive brain degeneration characterized by a progressive deterioration in cognition and independent living capacity (Sobral, Pestana, & Paúl, 2015). Fifty million people are living with dementia globally. This number will be projected to grow to 82 million by 2030 and 152 million by 2050 (Alzheimer's Disease International, 2020. Since dementia is complex syndrome, multimodal non-pharmacologic interventions (MNPIs) are highly recommended (Dannhauser et al., 2014; Graessel et al., 2011; Han et al., 2017; Yang et al., 2019). Currently, there is little available evidence to determine which multimodal interventions are effective for cognitive function improvement.

METHOD

A comprehensive search was done in PubMed, EMBASE, CINHAL, Web of Science and Medline international databases. The inclusion criteria of this review were; concerned adults with primary diagnosis of dementia, measured cognitive function outcome, used two or more type of interventions, published in English language and employed controlled trial study design. The quality appraisal of the studies was done by Cochrane risk of bias assessment tools for randomized controlled trail and non-randomized controlled trial studies (Sterne et al., 2016; Sterne et al., 2016).

RESULTS

Fourteen RCTs and five non-RCT studies were included in the systematic review. Nearly ninety percent of studies resulted in an improvement or maintenance of cognitive function among people with dementia. Integrated, multicomponent and dyadic based interventions implemented for longer duration resulted in improve cognitive function of people with dementia. The combination of three modes of non-pharmacologic intervention that includes exercise, music, and cognitive training with intervention design of more than three sessions per week for at least 12 - 48 weeks is recommended.

CONCLUSION

This study showed that multimodal non-pharmacologic interventions might improve cognitive functions among people with dementia. Future high quality randomized controlled trail studies with repeated-measured design on the combined effect of physical exercise, music and cognitive training on cognitive function for people with dementia is recommended.

Depressive symptoms and gender differences in older adults in Hong Kong during the COVID-19 pandemic: a network analysis approach

Background: The 2019 novel coronavirus disease (COVID-19) outbreak had a detrimental impact on the mental health of older adults. This study evaluated the central symptoms and their associations in the network of depressive symptoms and compared the network structure differences between male and female older adults in Hong Kong.

Methods: Altogether, 3,946 older adults participated in this study. We evaluated the centrality indicators for network robustness using stability and accuracy tests, and examined the potential differences between the structure and connectivity of depression networks in male and female older adults.

Results: The overall prevalence of depressive symptoms was 43.7% (95% CI=40.6-46.7%) in males, and 54.8% (95% CI=53.1-56.5%) in females (P<0.05). Sad Mood, Guilt, Motor problems and Lack of Energy were influential symptoms in the network model. Gender differences were found in the network global strength, especially in the following edges: Sad Mood--Guilt, Concentration--Guilt, Anhedonia--Motor, Lack of Energy--Suicide, Appetite--Suicide and Concentration--Suicide.

Conclusions: Central symptoms in the depressive symptom network among male and female older adults may be prioritized in the treatment and prevention of depression during the pandemic.

Self-efficacy of emergency management of domestic helpers in pediatric home accidents: A cross-sectional survey in Hong Kong

BACKGROUND

Accidental injuries are the leading cause of deaths and disabilities in children globally and most of them occur at home. To save life and prevent sequelae, domestic helpers (DHs) require providing emergency management (i.e., first aid) to children involved in home accidents. However, their self-efficacy in emergency management for children is rarely investigated. Hence, this study aimed to tap that research gap.

METHODS

This study adopted a cross-sectional descriptive survey design. A convenience sample of 385 DHs was obtained in Hong Kong. DHs' self-efficacy in emergency management for children involved in home accidents was measured using a 12-item well-validated survey instrument "Self-Efficacy of First Aid in Unintentional Injury at Home". The total score ranged from 0 to 48. A higher score indicates greater confidence in emergency management for children involved in home accidents.

RESULTS

All the participants were women and most of them were aged between 31 and 35 years (N = 103, 26.8%). The mean score for DHs' self-efficacy in emergency management was 29.0 (SD 10.1). The three items with the lowest self-efficacy were managing bone fractures, performing cardiopulmonary resuscitation, and providing artificial respiration. Bivariate analysis showed that DHs' self-efficacy was significantly related to their educational level, first aid training, caring experience, and working experience. Multiple linear regression indicated that DHs' educational level (β = 0.136, p = 0.001) and first aid training (β = 0.532, p < 0.001) were significantly predicting their self-efficacy.

CONCLUSION

DH's self-efficacy of emergency management for children involved in home accidents was low, particularly in those severe situations and complicated first aid procedures.

Perception of E-health Technology Scale in Chinese Brief (PETS-C Brief): Translation, item reduction, and psychometric testing

Introduction

Perception of e-health is a broad concept involving many aspects of values and thoughts related to e-health. It is an important precursor to using e-health technologies to promote health. The purpose of this study is to validate an instrument for measuring perceptions of e-health technology among healthcare professionals.

Methods

This methodological study was conducted in China. We based on an existing instrument to develop a new instrument (i.e. PETS-C Brief). In phase 1, we modified and translated the existing instrument into Chinese. Subsequently, we employed the modified and translated instrument to conduct a cross-sectional survey. In phase 2, we randomly selected data from 400 participants to run an exploratory factor analysis and item analysis to reduce the number of items and develop factors. In phase 3, we employed the data from the remaining participants to run a confirmatory factor analysis to confirm the instrument structure.

Results

In phase 1, the modified and translated instrument showed good content and face validities (S-CVI = 0.96, mean comprehensibility = 93.5%). 1338 participants completed the survey. In phase 2, the number of items was reduced from 40 to 19, which demonstrated a 4-factor model. In phase 3, the goodness-of-fit of the 4-factor PETS-C Brief was shown to be acceptable (χ²/d.f. = 6.40, CFI = 0.93, RMR = 0.40, NFI = 0.92, RMSEA = 0.076, IFI = 0.93).

Discussion

This study suggests using this instrument to survey perceptions of e-health technology in Chinese people. Future studies should examine its other important psychometric properties, including convergent/discriminant and predictive validity on behaviors using e-health technology.

The Prevalence of Compulsive Buying and Hoarding Behaviours in Emerging, Early, and Middle Adulthood: Multicentre Epidemiological Analysis of Non-clinical Chinese Samples

Behavioural addictions, such as compulsive buying (CB) and hoarding, are increasingly recognised in the current psychiatric nosology, particularly in developed countries. The prevalence of these disorders may not be static but possibly altered across different age groups. However, studies on this area are rare, and only few have focused on Chinese population. This epidemiological study employs population-based cross-sectional design and collects data in two regions, i.e., Hong Kong and Mainland China. A self-reported questionnaire is constructed based on carefully validated Chinese versions of Richmond Compulsive Buying Scale and Hoarding Rating Scale. A total of 2,439 valid samples are collected and divided into three age groups, i.e., emerging, early and middle adulthood. CB and hoarding behaviours have displayed an inverted u-shaped pattern across the above age groups. In addition, the strength of correlation between the two compulsive behaviours is consistent and maintained across different age groups. These results suggest that the compulsive behaviours vary among different stages of adulthood in major cities in China. This newly discovered pattern of compulsive disorders in Chinese population is different from those in American and European populations.

Review of frailty measurement of older people: Evaluation of the conceptualization, included domains, psychometric properties, and applicability

The purposes of this review are to describe the existing research on frailty measurement of older people and to understand their characteristics, with a focus on conceptual definitions, psychometric properties, and diagnostic accuracies. We reviewed the published literature to explore if cross-cultural studies of different types of frailty measurements have been conducted and to determine their applicability in the community setting. Narrative review with limited electronic database search and cross reference searching of included studies was performed. Studies published after year 2001 were searched for using MEDLINE and CINAHL Plus databases with keywords. A total of 5144 search results were obtained, but only 42 frailty measurements were identified in 68 studies. For the type, three different measurements were indicated, namely, self-report instrument (n = 17), clinical observation assessment (n = 19), and mixed frailty assessment instrument (n = 6). Only 12 (29%) measurements examined reliability and validity. Nevertheless, over 35% did not perform any psychometric testing before applying. For diagnosis accuracies, 35 (83%) frailty measurements reported the cut-off value(s) for determining level of the frailty. However, the sensitivity (56%-89.5%) and specificity (52%-91.3%) varied. The applicability was also diverse and some frailty instruments should be only used in some specific population and mode of administration. This review provides an overview of three major types of frailty measurements used in different settings with different purposes. For estimating the prevalence of frailty of older people in a community, the self-report type may be appropriate. The psychometric properties of many reviewed instruments are reported insufficiently. The cut-off value(s) are usually suggested with diverse sensitivity and specificity. Self-report instruments, such as Groningen Frailty Indicator (GFI) and Tilburg Frailty Indicator (TFI), are the most extensively examined in terms of satisfactory psychometric properties. Thus, GFI and TFI, with the current evidence, are recommended to be used in the community setting for frailty screening tools.

The Relationship Between Compulsive Buying and Hoarding in China: A Multicenter Study

There is no previous research that has explored the correlation between compulsive buying and hoarding in the Chinese population. This study aims to determine the relationship between compulsive buying and hoarding in a sample of the Chinese population comprising participants from mainland China (emerging economy) and Hong Kong (developed economy). Self-reported measures consisting of demographic questions, the Chinese version of the Hoarding Rating Scale (CHRS), and Richmond Compulsive Buying Scale-Traditional Chinese (RCBS-TC) were administered to participants. After data collection, common method biases were precluded. The RCBS-TC and CHRS were validated by confirmatory factor analysis and found correlated by Pearson correlation coefficient. The RCBS-TC and CHRS demonstrated satisfactory levels of internal consistency (Cronbach’s α = 0.872 and 0.828, respectively). A three-factor model, including hoarding, obsessive-compulsive, and impulse control disorders, was obtained through Confirmatory Factor Analysis (CFA) with the satisfactory fit for the total sample from Hong Kong and mainland China. A significant correlation was found between RCBS-TC and CHRS (r = 0.473). Findings also showed that 14% of the participants exhibited compulsive buying behavior. This study provides sufficient proof of the reliability and validity of RCBS-TC and CHRS. Their relationship was explored based on two sets of samples from different regions in Asia, which contributes more applicability in a cross-cultural context.

Reliability, validity and acceptability of the traditional Chinese version of the carer support needs assessment tool in Hong Kong palliative care settings

Background

Among the few existing needs assessment tools for family carers, the 14-item Carer Support Needs Assessment Tool (CSNAT) is the only brief and holistic needs screening tool designed for everyday use in palliative care practices. The aim of this study was to evaluate the reliability, validity, and acceptability of the traditional Chinese version of the CSNAT in palliative care settings in Hong Kong.

Methods

This adopted a cross-sectional and correlation design with repeated measures. The participants were 125 family carers of palliative cancer patients and 10 healthcare providers (HCPs) that were recruited from two local hospitals. The evaluation of psychometric properties included the following: (1) content validity through HCPs including frontline physicians, nurses, social workers, and clinical psychologists; (2) construct validity between the CSNAT items and those of the validated tools that measured caregiver burden, social support, and caregiving self-efficacy; and (3) one-week test-retest reliability in a sub-sample of 81 caregivers. The acceptability of the tool was assessed by the carers using several closed-ended questions.

Results

The content validity index of the CSNAT at the scale level was 0.98. Each item of the CSNAT was significantly and moderately correlated with caregiver burden (Spearman’s r = 0.24 to 0.50) and caregiving self-efficacy (r = − 0.21 to − 0.52), but not for social support. All CSNAT items had fair to moderate test-retest reliability (weighted kappa = 0.21 to 0.48), with the exception of two items “managing your relatives’ symptoms, including giving medicines” and “having time for yourself in the day”.

Regarding the acceptability of the CSNAT, almost all HCPs were willing to use the CSNAT for carer assessment and support. 89.6% of the carers demonstrated a comprehensibility of the CSNAT tool and 92.9% felt comfortable answering the questions. Around 90% of the carers agreed to use the tool for screening, discussing needs, and making referrals.

Conclusion

The traditional Chinese version of the CSNAT is a tool with high validity and acceptability and adequate reliability that measures family carers’ support needs, which should be considered for wide application in local palliative care practices.

Sleep and Mood Disturbances during the COVID-19 Outbreak in an Urban Chinese Population in Hong Kong: A Longitudinal Study of the Second and Third Waves of the Outbreak

In response to the worsening situation of the COVID pandemic, this follow-up study aimed to assess the impact of the “third wave” of the outbreak on sleep and mood disturbances among Hong Kong citizens. A total of 339 respondents included in our last study during the second wave (4–11 August 2020) joined this survey (response rate = 51.1%). The questionnaire collected data on sleep conditions, mood, stress, and risk perception. The sleep quality and mood status were assessed using the Insomnia Severity Index (ISI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9. The weighted prevalence of insomnia, anxiety, and depression was 33.6%, 15.3%, and 22.0%, respectively. Compared with the last survey, five out of six sleep parameters significantly worsened despite the lack of difference in the ISI score. The GAD-7 score was significantly lower. Old-aged adults were less likely to maintain good sleep quality compared with middle-aged adults (adjusted OR = 4.03, 95% CI: 1.04–15.73). Respondents without psychiatric disorder were more likely to be anxiety-free across the two time points (adjusted OR = 7.12, 95% CI: 1.33–38.03). One-third of Hong Kong people reported poor sleeping quality in the third wave of the COVID-19 outbreak. Policy-makers need to propose a contingent plan to allocate mental health resources to vulnerable subpopulations.

Public knowledge of the influence of modifiable cardiovascular risk factors on dementia: a systematic literature review and meta-analysis

OBJECTIVES

This systematic review examined whether the general public are aware of the influence of modifiable cardiovascular risk factors (CVRFs) on dementia.

METHODS

Following PRISMA guidelines, five electronic databases (PubMed, Medline, CINAHL, ProQuest, and Scopus) were searched for studies published from 2009-2019, using the key terms "knowledge," "modifiable cardiovascular risk factors," and "dementia." Standardized critical appraisal instruments were used to evaluate the quality of the studies.

RESULTS

Of the 1,533 articles that were screened, 26 were included in this review. Modifiable CVRFs of dementia included behavioral factors (physical inactivity, poor dietary practices, high alcohol consumption, and heavy smoking) and medical conditions (hypertension, diabetes mellitus, hypercholesterolemia, and obesity). Although the association between CVRFs and dementia was identified (pooled prevalence is 24-50%), overall knowledge about this relationship in the general public was low. Sociodemographic variables, such as higher education, better economic status, and prior contact with a person with dementia, positively influenced dementia risk knowledge. Ethnic minorities showed good awareness of dementia risk from cardiovascular-related conditions.

CONCLUSION

Despite dementia is considered as a public health priority by World Health Organization, knowledge of the modifiable CVRFs and dementia is low in the general population. Public health policymakers should develop appropriate educational programs and interventions to equip the communities and vulnerable groups with this understanding so that they can be prepared to reduce dementia risk.

Factors associated to the practice of using masks by the population of Paraíba during the COVID-19 pandemic

OBJECTIVE

To evaluate the practice of using masks by the population of the Brazilian state of Paraíba during the COVID-19 pandemic.

METHOD

Cross-sectional, descriptive-analytical study conducted with adults living in the state of Paraíba through an online instrument from April to May 2020, through the Face Mask Use Scale of Faculdades Metropolitanas Unidas da Paraíba.

RESULTS

The participants amounted to 1,307 (100.0%) individuals, who were predominantly female (78.0%), aged 35 to 45 (32.3%), married (53.3%) and post-graduates (46.9%). The mean score for the practice of using masks was 18.7 (SD = 8.0; minimum 6.00; maximum 30). The use of masks for self-protection scored 9.8 (DP = 3.9; minimum 3.0; maximum 15.0), whereas the score for protection of others was 8.9 (SD = 4.5; minimum 3.0; maximum 15.0). In the comparison between the scores of the practice of using masks, there was a significant statistical difference for gender, education, age group, and income (p ≤ 0.01). The practice of using masks was more frequent in health environments, 7.3 (DP = 3.2).

CONCLUSION

The practice of using masks was predominant among women, people over 35, married, with an income higher than seven minimum wages, and post-graduation. The use of masks for self-protection was higher than for the protection of others and its use in health environments was higher than in the others.

Bioluminescence-based hygiene evaluation of public washroom environment: Repeated measurement of posthandwashing facilities on baseline and before and after cleaning schedule

BACKGROUND

The risk of hand recontamination is often neglected after using hand washing facilities, which can increase the spread of pathogens. The study aimed to evaluate the hygienic condition of posthandwashing facilities in public washrooms at different timeslots, particularly those near food courts and restaurants located in shopping malls.

METHODS

This observational study was conducted in 12 public washrooms that ranged from low-end, middle-end, to high-end category on 3 different timeslots including baseline, T1 (immediate postcleaning) and T2 (1-hour postcleaning, with counting the footfall). Hand-touch surfaces with a high risk of recontamination after handwashing, which included paper tower dispensers, air drying outlets, and exit door handles, were evaluated by the surface adenosine triphosphate (ATP) bioluminescence method (ATP-value). ATP-values <500 relative light units (RLUs) were considered a good hygiene. Cleaning schedules and footfalls of each sampled washroom were obtained by direct observations.

RESULTS

The overall mean ATP value of washroom was 785 RLU (N = 108); the ATP values of female and male washrooms at T2 were 203 and 3,718 RLUs, respectively. The highest ATP value was found on the exit door handles of male washrooms (range = 13-26,695 RLUs, mean = 3,229 RLU). Regarding passed/failed hygiene conditions, there were significant differences in the proportion of exit door handles between genders (P = .018) and timeslots (P = .007) as well as that of paper towel button/screw between timeslots (P= .025).

CONCLUSION

Attention should be paid at the exit door handles of male washrooms, where are high risks of cross and re-contamination.

Predicting undergraduate nursing students' willingness to care for older adults: A multicenter cross-sectional study in Asia

AIM

To investigate the willingness of nursing students in Hong Kong and Mainland China to care for the elderly and to identify the factors influencing their willingness.

DESIGN

A correlational and cross-sectional design.

METHODS

A four-part self-administered questionnaire was utilized to collect data from the undergraduate nursing students in Hong Kong and Mainland China.

RESULTS

The total sample consisted of 820 nursing students, with 481 students in Hong Kong and 339 students in Mainland China. The scores of willingness to care for older people of the two groups were similar (mean score 4.68 versus 4.44), and no significant difference was observed between the students in the two regions (p = .071). A very low proportion of the nursing students in Hong Kong (7.7%) and those in Mainland China (3.6%) ranked caring for older people as their first choice of work. No salient predictors of willingness to care for older people existed for the nursing students in Mainland China.

Moderating effect of age on the relationships between pre-frailty and body measures

This study aims to investigate the relationship between body measures and the presence of two frailty-related phenotypes, and the moderating effect of age on this relationship. This is a secondary data analysis of the baseline data of an interventional study. The participants were residents of seven districts in Hong Kong, aged 55 or older, able to ambulate independently and to function well cognitively. Pre-frailty refers to the presence of two frailty-related phenotypes: low physical activity or poor handgrip strength or both. Included in the study were 199 individuals with a mean age of 73.43 (SD 7.54). Regression models showed that body weight (OR = 0.95, 95% CI 0.92-0.99, p < .05) was significantly associated with pre-frailty, as was body height (OR = 0.88, 95% CI 0.83-0.94, p < .001). Age is a significant moderator of the relationship between pre-frailty and body weight and body height. The effect of body weight (beta = -0.044, p < .05) and height (beta = -0.16, p < .001) on pre-frailty was significant and negative in the younger age groups. The findings indicate that raw body measures (i.e. body weight, body height) are more predictive of pre-frailty than BMI in older Chinese people. However, in the old-old group, these measures are not significant predictors of pre-frailty in Chinese community-dwelling adults. Practitioners should consider adopting body measures as predictors of pre-frailty in the younger-old population.

Face Mask Wearing Behaviors, Depressive Symptoms, and Health Beliefs Among Older People During the COVID-19 Pandemic

The COVID-19 pandemic has affected more than 100 countries. Despite the global shortage of face masks, the public has adopted universal mask wearing as a preventive measure in many Asian countries. The COVID-19 mortality rate is higher among older people, who may find that wearing a face mask protects their physical health but jeopardizes their mental health. This study aimed to explore the associations between depressive symptoms, health beliefs, and face mask wearing behaviors among older people. By means of an online survey conducted between March and April 2020, we assessed depressive symptoms, health beliefs regarding COVID-19, and face mask use and reuse among community-dwelling older people. General linear models were employed to explore the associations among these variables. Of the 355 valid participants, 25.6% experienced depressive symptoms. Health beliefs regarding the perceived severity of disease (p = 0.001) and perceived efficacy of practicing preventive measures (p = 0.005) were positively associated with face mask use. Those who reused face masks (p = 0.008) had a stronger belief in disease severity (p < 0.001), had poorer cues to preventive measures (p = 0.002), and were more likely to experience depressive symptoms. Mask reuse was significantly associated with depression only among those who perceived the disease as serious (p = 0.025) and those who had poorer cues to preventive measures (p = 0.004). In conclusion, health beliefs regarding perceived severity and efficacy contributed to more frequent face mask use, which was unrelated to depressive symptoms. Older people who had a stronger belief in disease severity had less adequate cues to preventive measures and reused face masks experienced greater depressive symptoms. A moderation effect of health beliefs (i.e., disease severity and cues to preventive measures) on face mask reuse and depression was observed.

Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes

Background

The elderly population in Hong Kong is rapidly growing, and the need for residential care homes (RCHs) is increasing. The risk of being infected with micro-organisms increases among the frail and the vulnerable elderly population as their immunity system begins to deteriorate. Furthermore, the residents in RCHs are at high risk of healthcare-associated infections (HAIs) due to the confined living environments and individual co-morbidities. In relation to this, infection control practice (ICP) is considered a crucial and effective approach in preventing HAIs. This study aimed to observe the daily ICP of healthcare workers in RCH settings.

Methods

An observational study was conducted to observe daily ICP among healthcare workers in private and subsidized RCHs. Each RCH was separated into different units based on the location (common area and bedroom area) and nature of residents for successive days. The ICP episodes were observed until 200 opportunities in each unit. The ICP episodes were recorded by an electronic tool called “eRub,” which is an ICP checklist based on international guidelines.

Results

The most frequent observed ICP episodes were hand hygiene (n = 1053), the use of gloves (n = 1053) and respiratory protection (n = 1053). The overall compliance of hand hygiene was poor, with only 15% of participants performing this during the “five moments for hand hygiene.” Furthermore, the observations showed that 77.9% improperly performed the use of gloves, and 31.8% failed to wear a mask during the care provision for the elderly. However, the results showed that most healthcare workers can wear the mask in a proper way when they should. Generally, the personal care workers were the worst in terms of hand hygiene and use of gloves compared with the other types of healthcare workers.

Conclusions

Despite the fact that the practice of hand hygiene, the use of gloves, and respiratory protection were the important elements of ICP, overall compliance to these elements was still poor. Personal care workers had the most frequent contact with the residents, but they had the worst compliance rate. Hence, continued monitoring and training among healthcare workers is needed, particularly personal care workers, in this healthcare service setting.

Global Imperative of Suicidal Ideation in 10 Countries Amid the COVID-19 Pandemic

Background: The novel coronavirus (COVID-19) has had a detrimental impact on individuals' psychological well-being; however, a multi-country comparison on the prevalence of suicidal ideation due to the virus is still lacking. Objectives: To examine the prevalence and correlates of suicidal ideation among the general population across 10 countries during the COVID-19 pandemic. Materials and methods: This was a cross-sectional study which used convenience sampling and collected data by conducting an online survey. Participants were sourced from 10 Eastern and Western countries. The Patient Health Questionnaire (PHQ-9) was used to measure the outcome variable of suicidal ideation. Ordinal regression analysis was used to identify significant predictors associated with suicidal ideation. Results: A total of 25,053 participants (22.7% male) were recruited. Results from the analysis showed that the UK and Brazil had the lowest odds of suicidal ideation compared to Macau (p < 0.05). Furthermore, younger age, male, married, and differences in health beliefs were significantly associated with suicidal ideation (p < 0.05). Conclusions: The findings highlight the need for joint international collaboration to formulate effective suicide prevention strategies in a timely manner and the need to implement online mental health promotion platforms. In doing so, the potential global rising death rates by suicide during the pandemic can be reduced.

FACTORS ASSOCIATED WITH SYMPTOMS OF DEPRESSION AMONG OLDER ADULTS DURING THE COVID-19 PANDEMIC

ABSTRACT Objective: to identify factors associated with depressive symptoms among older adults during the COVID-19 pandemic. Method: a cross-sectional study developed in all regions of Brazil, using an electronic form among older adults aged 60 or over. Data were collected from April 17 to May 15, 2020. Measures of central tendency and dispersion were used. For comparison of means, Student’s t-test and analysis of variance were applied, considering p≤0.05. For association of factors, chi-square was adopted with bivariate analyzes and logistic regression. Results: nine hundred (100.0%) older adults participated in the study. The general score for symptoms of depression was 3.8 (SD=4.4), 818 (91.9%) had no or mild depressive symptoms. Women (p <0.01) have more symptoms than men. The income variable is a predictor of depressive symptoms (OR=0.56; CI: 0.34-0.91; p=0.020). Conclusion: the main factors associated with symptoms of depression were sex, income, education and occupations that expose them to COVID-19 had the highest depression scores.

THE USE OF MASKS AMONG BRAZILIAN NURSING WORKERS DURING THE COVID-19 PANDEMIC

ABSTRACT Objective: to assess the use of masks among Brazilian nursing workers during the COVID-19 pandemic. Method: cross-sectional study addressing nursing workers between March and May 2020. Data were collected online using a form addressing demographic variables and the Brazilian Portuguese version of the Face Mask Use Scale (FMUS-PB). Data were analyzed using descriptive and inferential statistics, central tendency and dispersion measures, Student’s t-test, and analysis of variance. Results: a total of 3,294 workers participated; most were nurses (85.9%), women (90.2%), lived in the southeast (36.9%), and had had contact with the COVID-19 (77.8%). The participants reported using masks in public places and at work (63.1% and 78.8%, respectively). However, only 25.8% wore masks at home. Individuals aged between 35 and 45 (p=0.002) living in the south (p<0.001) reported more frequent use of masks. Nursing technicians (p<0.001), aged ≥ 45 (p<0.001), living in the south (p<0.001), scored higher in the use of masks for self-protection and to protect others (p=0.002). Prior contact with COVID-19 resulted in the more frequent use of masks for self-protection and to protect others (p<0.001). Conclusion: the use of masks by nursing workers in public places and health settings was more frequent than at home. Additionally, masks were more frequently use for self-protection than to protect others. These results show a need to promote cultural changes toward masks for personal protection and within the family and social contexts.

Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study

OBJECTIVE

The COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep disturbances during the early phase of COVID-19 pandemic.

METHODS

This web-based cross-sectional study recruited 1138 Hong Kong adults using convenience sampling over a two-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. The Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census.

RESULTS

The weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3%, 29.8%, and 29.1%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR = 1.57, 1.72, 1.99, and 1.96 respectively, all p < 0.05).

CONCLUSION

A high proportion of people in Hong Kong felt that their sleep had worsened since the COVID-19 outbreak. Insufficient stock of masks was one of the risk factors that were associated with sleep disturbances. Adequate and stable supply of masks may play an important role to maintain the sleep health in the Hong Kong general population during a pandemic outbreak.

Factors associated with the use and reuse of face masks among Brazilian individuals during the COVID-19 pandemic

Objective

to identify the factors associated with the use and reuse of masks among Brazilian individuals in the context of the COVID-19 pandemic.

Method

cross-sectional study conducted in the five Brazilian regions, among adult individuals, via an electronic form disseminated in social media, addressing general information and the use of masks. Bivariate analysis and binary logistic regression were used to identify the factors associated with the use and reuse of masks.

Results

3,981 (100%) individuals participated in the study. In total, 95.5% (CI 95%: 94.8-96.1) reported using masks. Fabric masks were more frequently reported (72.7%; CI 95%: 71.3-74.1), followed by surgical masks (27.8%; CI 95%: 26.5-29.2). The percentage of reuse was 71.1% (CI 95%: 69.7-72.5). Most (55.8%; CI 95%: 51.7-60.0) of those exclusively wearing surgical masks reported its reuse. Being a woman and having had contact with individuals presenting respiratory symptoms increased the likelihood of wearing masks (p≤0.001). Additionally, being a woman decreased the likelihood of reusing surgical masks (p≤0.001).

Conclusion

virtually all the participants reported the use of masks, most frequently fabric masks. The findings draw attention to a risky practice, that of reusing surgical and paper masks. Therefore, guidelines, public policies, and educational strategies are needed to promote the correct use of masks to control and prevent COVID-19.