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ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution Trial Registration To test the reliability and construct validity of the Mask Usability Scale in healthcare students and staff.A methodological study involving repeated measures.The study included two batches of participants: (1) 283 university nursing students and (2) 1753 participants composed of students (61%) and clinical staff (39%). All participants underwent N95 respirator fit tests and user seal checks. They also responded to the Mask Usability Scale, which comprises 11 items evaluated using Likert scales. The internal consistency was assessed using Cronbach's alpha and item–total correlation test. Test–retest reliability was evaluated by the intraclass correlation coefficient (ICC). The factor structure was initially identified through exploratory factor analysis (EFA), laying the groundwork for the model. This approach was followed by confirmatory factor analysis (CFA) to ensure the model fits with the standardised solution.Excluding items 9, 10 and 11, the study showed satisfactory internal consistency, evidenced by a Cronbach's alpha of 0.842 for the eight‐item scale from the combined samples. Factors, such as ‘Heat’, ‘Breathability’, ‘Tightness’ and ‘Ease in talking’ showed moderate to strong correlations. The test–retest reliability in the batch one sample was acceptable with ICCs ranging between 0.69 and 0.71 for different models. The EFA and fit indices supported a two‐factor structure. The first factor ‘Comfort and Usage’ included ‘Heat’, ‘Breathability’, ‘Tightness’, ‘Ease in talking’ and ‘Prolonged use’, which were keys for the usability of N95 respirators. The second factor ‘Suitability’ encompassed ‘Itchy’, ‘Easily displaced’ and ‘Ear soreness’. The variance explained by the first and second factors was 49% and 12%, respectively, with a strong inter‐factor correlation. The CFA results were satisfactory with fit metrics (NFI = 0.967, IFI = 0.969, TLI = 0.952, CFI = 0.969, RMSEA = 0.078 with 90% CI [0.069, 0.086] and p < 0.001) and a chi‐squared to df ratio of 13.58.The eight‐item mask usability scale exhibited satisfactory internal consistency and construct validity in both healthcare student and staff samples.The primary concern in the purchase policy of N95 respirators for clinical use is to strike the right balance between usability and fit rate (passing % of fit testing). Our study solidified the concept of quantifying the usability of respirators. With that mask usability scale measurement, a provision of benchmark and reference for the design and selection of respirators would be possible. This validated scale has significant implications for senior management in clinical settings and respirator manufacturers regarding the N95 respirator purchase policy and design.The results indicated the psychometric properties of mask usability scale in measuring the usability of N95 respirators. This scale is particularly valuable for assessing the perceptions of healthcare students and staff of factors, namely, ‘Heat’, ‘Breathability’, ‘Tightness’, ‘Ease in talking’, ‘Prolonged use’, ‘Itchy’, ‘Easily displaced’ and ‘Ear soreness’ concerning the use of N95 respirators.We adhered to EQUATOR guidelines following the STROBE statement.No patient or public contribution.ISRCTN registry: ISRCTN40115047 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The 2019 novel coronavirus (COVID-19) pandemic is associated with increases in psychiatric morbidity, including depression. It is unclear if people with depressive symptoms understand or apply COVID-19 information differently to the general population. Therefore, this study aimed to examine associations between depression, health beliefs, and face mask use during the COVID-19 pandemic among the general population in Hong Kong. This study gathered data from 11,072 Hong Kong adults via an online survey. Respondents self-reported their demographic characteristics, depressive symptoms (PHQ-9), face mask use, and health beliefs about COVID-19. Hierarchical logistic regression was used to identify independent variables associated with depression. The point-prevalence of probable depression was 46.5% (n = 5,150). Respondents reporting higher mask reuse (OR = 1.24, 95%CI 1.17–1.34), wearing masks for self-protection (OR = 1.03 95%CI 1.01–1.06), perceived high susceptibility (OR = 1.15, 95%CI 1.09–1.23), and high severity (OR = 1.33, 95%CI 1.28–1.37) were more likely to report depression. Depression was less likely in those with higher scores for cues to action (OR = 0.82, 95%CI 0.80–0.84), knowledge of COVID-19 (OR = 0.95, 95%CI 0.91–0.99), and self-efficacy to wear mask properly (OR = 0.90 95%CI 0.83–0.98). We identified a high point-prevalence of probable major depression and suicidal ideation during the COVID-19 outbreak in Hong Kong, but this should be viewed with caution due to the convenience sampling method employed. Future studies should recruit a representative probability sample in order to draw more reliable conclusions. The findings highlight that COVID-19 health information may be a protective factor of probable depression and suicidal ideation during the pandemic. Accurate and up-to-date health information should be disseminated to distressed and vulnerable subpopulations, perhaps using digital health technology, and social media platforms to prompt professional help-seeking behavior. [ABSTRACT FROM AUTHOR]

Psychological health among healthcare workers (HCWs) has become a major concern since the COVID-19 outbreak. HCWs perceived risks of contracting COVID-19, in relation to depression were investigated. It was hypothesized that perceived high risk of contracting COVID-19 (close contact with cases, inadequate provision of personal protective equipment, insufficient infection control training, and presence of symptoms) would be significant predictors of depression. Our cross-sectional survey was completed by HCWs across three regions (Hubei, Guangdong, Hong Kong) between March 9 to April 9 2020 using convenience sampling. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9). Prevalence of depression was 50.4% (95% CI: 44.5-56.2), 15.1% (10.1-21.9) and 12.9% (10.3-16.2) for HCWs in Hong Kong, Hubei and Guangdong, respectively. The strongest significant risk factors for depression, after adjustment, were HCWs who reported the greatest extent of feeling susceptible to contracting COVID-19 and those who reported the greatest difficulty obtaining face masks. HCWs whose family/peers greatly encouraged face mask use had lower prevalence of depression. Access to adequate supplies of personal protective equipment is essential for the psychological health of HCWs working in stressful environments, through potentially easing their perceptions of vulnerability to COVID-19. [ABSTRACT FROM AUTHOR]

Background: Although bedrail use may increase the risk of accidents among patients, bedrails are still extensively used in healthcare facilities. Therefore, the field calls for a review of bedrail use in practice. Objective: This report examined the prevalence and implications of bedrail use in rehabilitation facilities in Hong Kong. The findings are compared with the current state of bedrail use worldwide. Design and methods: This work is a cross-sectional, observational study. A secondary analysis was conducted on the database of a prospective trial. Bilateral bedrail use was observed in two Hong Kong rehabilitation hospitals. Logistic regression was performed to examine the factors associated with bedrail use. Results: A total of 3,384 restraint observations were made. The bedrail rate was 31.34%, which revealed that bedrail use was the second most commonly used physical restraint. The fall history (OR: 2.84), cognitive impairment (OR: 0.91) and functional dependency (OR: 0.79) of patients were significant predictors of bedrail use, p <.05. Conclusion: This study examines bedrail prevalence through direct observation, which is the preferred method for examining bedrail use in practice. We found that actual bedrail use is higher than the numbers reported in previous studies in Hong Kong. In addition, our research reveals that bedrails are commonly used for vulnerable patients. This finding highlights the need to change nurses' beliefs on bedrail use through education. The management of these health facilities should also aim to create an institutional environment that promotes the reduction of bedrail use. Implementation strategies on restraint reduction should also fit the culture of the organisation and local nursing practices, as well as the staff's values. Impact Statement: This study provides preliminary information about the widespread use of bedrails in Hong Kong and other countries. The research also introduces effective ways to achieve the reduction of bedrail use. [ABSTRACT FROM AUTHOR]

Objective: To test the acceptability and feasibility of self-administered acupressure as an intervention for knee pain among middle-aged and older adults with knee osteoarthritis (KOA). Methods: In this pilot randomized controlled trial, 35 participants with KOA were randomized to receive self-administered acupressure (n = 17, two self-administered acupressure training sessions followed by self-practice for 6 weeks) or knee health education (n = 18, two health education sessions about KOA management followed by self-care for 6 weeks). Current pain intensity (primary outcome) was measured using a Numeric Rating Scale (NRS) at baseline and weeks 1, 2, 4 and 6 (post-intervention). Secondary outcome measures included worst and least pain intensity, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM) of the knee joints and Short-Form Six-Dimension (SF-6D) scores for health-related quality of life. Results: Participants in both groups attended all training sessions. In the self-administered acupressure group, all subjects mastered the acupressure technique and passed a consistency check. Both groups showed a decreasing trend in current knee pain intensity measured using NRS post-intervention. A medium between-group effect size (0.40) was found, but between-group differences were not statistically significant. The other secondary outcome measures were also comparable between both groups post-intervention (all p > 0.05). Conclusion: A two-session self-administered acupressure training was acceptable to and feasible in participants with KOA. The data generated allowed for calculation of a sample size for a definitive randomized controlled trial (RCT) to confirm whether self-acupressure is effective for pain management in KOA. Furthermore trials with adequate power and longer follow-up periods are warranted. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract symptoms (LUTS) comprise a highly prevalent chronic condition among the aging male population. Existing literature on the experiences of men with LUTS is scarce given that only a few studies explored medical care-seeking behaviors and coping strategies. The current understanding of the experiences of elderly males with LUTS is considerably limited. Therefore, the present study aimed to identify the experiences of living with moderate-to-severe LUTS among community-dwelling Chinese ageing males and their coping strategies to facilitate the management of LUTS by healthcare providers. Methods and findings: A qualitative exploratory design using thematic analysis was used. Semi-structured interviews with 24 Chinese ageing males with moderate-to-severe LUTS were conducted. According to the participants, LUTS adversely affect the physical aspects of their daily lives. Most of them were unwilling to seek social support and were even embarrassed to share this topic with their peers. A range of psychological responses could be observed from the participants that range from regarding the condition as a natural life course to loss of one’s self-esteem. Most of the interviewees lacked knowledge and held misconceptions toward LUTS, which prevented them from pursuing medical advice. Most of the participants also sought alternative treatments and developed self-help methods to cope with their symptoms. Conclusion: LUTS affects the physical and social aspects of sufferers. The findings of this qualitative study can raise awareness about the life experiences, perceptions, misconceptions, and help-seeking behaviors of Chinese elderly with LUTS. Proper health education and advice can be provided for this population. [ABSTRACT FROM AUTHOR]

Background: Influenza often causes winter and summer epidemics in subtropical regions, but few studies have investigated the difference in healthcare seeking behavior of patients with influenza-like illness (ILI) between these two epidemics.Methods: Household telephone surveys were conducted using random digit dialing in Hong Kong during July-August 2014 and March-April 2015. One adult from each household was interviewed for ILI symptoms and associated healthcare seeking behaviour of themselves and one child in the household (if any), during the preceding 30 days. Healthcare seeking behavior of respondents with self-reported ILI was compared between summer and winter influenza. Logistic regression was used to explore the factors associated with healthcare seeking behavior.Results: Among 516 and 539 adult respondents in the summer and winter surveys, 22.6 and 38.0 % reported ILI symptoms, and 40.9 and 46.8 % of them sought medical care, respectively. There was no significant difference in healthcare seeking behavior between the summer and winter epidemics, except a higher proportion of self-medication in summer in the adult respondents. Among 155 and 182 children reported by the adults in both surveys, the proportion of self-reported ILI was 32.9 and 40.1 % in the summer and winter surveys, respectively. Of these children, 47.1 and 56.2 % were brought for medical consultation in summer and winter, respectively. Women, adults with diabetes and those with symptoms of cough, shortness of breath, and runny nose were more likely to seek medical consultations for ILI symptoms. The factors associated with seeking medical consultations in children with ILI symptoms included being female, age under 10 years, and with symptoms of sore throat or vomiting. Those older than 60 years were less likely to self-medicate, whereas regular smokers and those with symptom of sore throat were more likely to do so.Conclusion: Healthcare seeking behavior of the general public was not significantly different between these two epidemics. However ILI was associated with increased healthcare utilization in both winter and summer epidemics in Hong Kong. [ABSTRACT FROM AUTHOR]

The purpose of this study was to report sleep quality from 4 weeks of auricular point acupressure that was designed for chronic low back pain and determine the relationship between pain intensity and sleep quality. Participants were randomized into the APA group or the sham-APA group. At baseline assessment, 87% of the participants reported poor sleep quality. Participants who received APA had decreased daytime disturbance and improved global Pittsburgh Sleep Quality Index scores at end of intervention (EOI) and 1-month follow up compared to participants in the sham-APA group. For the APA group, both the sleep duration and wake after sleep onset decreased gradually during the 4-week APA (0.56% and 0.23% daily change, respectively). [ABSTRACT FROM AUTHOR]

The reflexive property of the ear can cause various physical attributes to appear on the auricle in the presence of bodily disorders. The association of auricular signals (presence or absence of discoloration, marks after pressing, tenderness, and electrical resistance) and diabetes mellitus (DM) should be further investigated because auricular diagnosis is an objective, painless, and noninvasive method that provides rapid access to information. A matched case-control study on 282 subjects was conducted. Cases (n=141) were defined as those diagnosed with type 2 DM (T2DM). Every subject in the case group was matched with the control by age and gender. Ear diagnosis was conducted in three aspects: inspection, electrical detection, and tenderness testing. Results suggest that the tenderness and electrical conductivity of some auricular points, including “pancreas and gallbladder,” “endocrine,” “kidney,” “lower tragus,” “heart,” and “eyes,” were associated with T2DM status in Chinese population. In the subgroup analyses, certain auricular signals were also associated with glycemic control, disease duration, and related complications. Auricular diagnosis could be considered as a screening method for vulnerable populations with T2DM risk. Thus, appropriate interventions can be implemented to prevent or delay the progression of T2DM. [ABSTRACT FROM AUTHOR]

Background Physical activity in old age probably protects against hip fracture. However, very little is known about the impact of occupation during working life, in terms of its physical activity level and the socio-economic status (SES) it indicates, on the risk of hip fracture in later life. Method A population-based case-control study was conducted on 416 subjects to investigate relationships between risk of hip fracture and occupational physical activity and occupation-related SES. Occupational physical activity was coded according to the proportion of the working day at ages 20 and 50 years that the subjects were likely to have spent sitting. The Australian Classification of Standard Occupations (ASCO) was used as the basis for the coding of SES, indicated by job titles. Results Compared with those in the intermediate category, women with a sedentary job at age 50 years (odds ratio (OR) 7.2, 95 per cent confidence interval (CI) 1.2–41.9) or a mainly weight-bearing job (OR 5.1, 95 per cent CI 1.1–23.2) had an increased risk of hip fracture. A decreasing hip fracture risk with increasing SES of the longest held job was also observed Conclusion The finding of a J-shaped relationship in women between occupational physical activity and risk of hip fracture supports the need for research into the most effective types of exercise for maintenance of bone strength. Furthermore, the protective effect of SES demonstrated in this study still need to be corroborated in other studies before establishing evidence of a causal relationship. [ABSTRACT FROM PUBLISHER]

Background: Medication and behavior therapy are the conventional treatments for attention deficit hyperactivity disorder (ADHD), but they have limitations for preschool children. Evidence suggests that pediatric tuina, which is a modality of traditional Chinese medicine, might have beneficial effects on this condition. Objective: To assess the feasibility of conducting an RCT in terms of recruitment, use, and acceptability of the parent-administered pediatric tuina for ADHD symptoms in preschoolers. Methods: It is a single-center, two-arm, parallel, open-label, pilot randomized controlled trial (RCT). Sixty children with pre-specified ADHD symptoms (hyperactivity, anxiety, and sleep disturbance) together with one of their parents will be recruited and randomized into two groups at a 1:1 ratio. Parents in the parent-administered tuina group (intervention group, n = 30) will attend an online training program to learn pediatric tuina skills for ADHD symptoms and conduct this treatment on their children at home. Parents in the parent-child interaction group (comparison group, n = 30) will attend an online training about progressive muscle relaxation exercise and do this exercise with their children at home. Additional teaching materials will be provided to the participants in both groups. Both interventions should be carried out every other day during a 2-month treatment period, with each time around 20 min. Assessment will be performed at baseline, week 4, and week 8. The primary outcome measure is the Swanson, Nolan, and Pelham parent scale; the secondary outcomes include preschool anxiety scale, children's sleep habits questionnaire, and parental stress scale. A process evaluation embedded within the outcome evaluation will be performed. Differences in the scale scores and test parameters between groups will be examined using a linear mixed-effects model. Qualitative data will be analyzed using thematic content analysis, facilitated by QSR NVivo. Discussion: This study will provide evidence on the acceptability and feasibility of pediatric tuina for ADHD in preschool children. The process evaluation will help to better understand the facilitators and barriers of the intervention functioning. Trial registration: The study was registered at ClinicalTrials.gov (Identifier: NCT04237259) on 14 February 2020. Protocol version: 2; date, 23 June 2020 [ABSTRACT FROM AUTHOR]

[Display omitted] • Representative survey data from Singapore, Hong Kong, Australia from Jan – Feb 2021. • Current smokers, Asians, living with vulnerable population increases vaccine intent. • Being diet and hygiene conscious increases vaccine intent. • People's trust in health system efficacy has a predilection for vaccination. • Self-efficacy mediates amid perceived susceptibility & barrier predicting vaccine intent. COVID-19 pandemic has caused significant morbidity and mortality globally. As vaccines have been developed under expedited conditions, their safety and efficacy are being questioned by some populations leading to vaccine hesitancy, resulting in delayed vaccine uptake and herd immunity. This study aims to adopt a combination of Health Belief Model and other independent risk factors associated with high vaccine acceptance. An anonymized cross-sectional survey was distributed between 15 January and 3 February 2021 across Singapore, Hong Kong and Australia among adult respondents through a certified online panel. Exploratory factor analysis and confirmatory factor analysis were carried out to assess perception constructs followed by multivariate regression modelling to assess factors associated with high vaccine acceptance against SARS_CoV-2. A total of 3,133 anonymised participants from Singapore (n = 1,009), Australia (n = 1,118) and Hong Kong (n = 1,006) completed the survey. While age and gender were not significantly associated, Asian ethnicity, current smokers and self-efficacy were significant associated factors of increased vaccine acceptance. While specific practices like taking micronutrients more frequently, cleaning and disinfecting their house more often were positively associated with increased vaccine acceptance, seeking medical help for COVID-19 symptoms like loss of smell/taste and overall COVID-19 knowledge score were negatively associated. Increased likelihood of vaccine acceptance was seen among those that obtained COVID-19 information less frequently and used digital media or non-health-related sources like influencers as a source of information. Among the eight perception constructs, perceived susceptibility and perceived response efficacy were positively associated, while perceived barriers were negatively associated with high vaccine acceptance. While demographic parameters have weak association with vaccine acceptance, perceptions and practices parameters can help to better understand and influence vaccine acceptance. Study findings should provide guidance on the risk communication strategy to enhance vaccine acceptance for vaccination and boosters against new SARS-CoV-2 variants. [ABSTRACT FROM AUTHOR]

Introduction: Mobile technology has revolutionised the way people interact with others and gain access to healthcare services. Given that cultural background is a strong moderator for technology penetration, this systematic review aims to examine end-user perceptions and design recommendations for mobile health applications among Asian older people., Methods and Analysis: Five electronic databases (PubMed, CINAHL, PsycINFO, Medline and Cochrane Central Register of Controlled Trials) will be searched until May 2025. Studies conducted on Asian older people aged 60+ years, with English/Chinese full text available, will be included. Narrative approaches and effect direction plots will be used for data analyses. Risk of bias across studies will be examined using Cochrane Risk of Bias 2 and Risk of Bias in Nonrandomised Studies of Interventions, whereas the quality of evidence will be assessed by Shekelle's classification scheme., Ethics and Dissemination: No ethical approval will be required. The findings will be disseminated through peer-reviewed journal articles., Prospero Registration Number: CRD42024562861., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)