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Background Advance care planning (ACP) facilitates identification and documentation of patients’ treatment preferences. Its goal aligns with that of palliative care – optimizing quality of life of seriously ill patients. However, concepts of ACP and palliative care remain poorly recognized in Chinese population. This study aims at exploring barriers to ACP from perspective of seriously ill patients and their family caregivers. Methods This is a qualitative study conducted in a Palliative Day Care Centre of Hong Kong between October 2016 and July 2017. We carried out focus groups and individual interviews for the seriously ill patients and their family caregivers. A semi-structured interview guide was used to explore participants’ experiences and attitudes about ACP. Qualitative content analysis was adopted to analyze both manifest content and latent content. Results A total of 17 patients and 13 family caregivers participated in our study. The qualitative analysis identified four barriers to ACP: 1) limited patients’ participation in autonomous decision making, 2) cognitive and emotional barriers to discussion, 3) lack of readiness and awareness of early discussion, and 4) unprepared healthcare professionals and healthcare system. Conclusions Participations of seriously ill patients, family caregivers and healthcare workers in ACP initiation are lacking respectively. A series of interventions are necessary to resolve the barriers.

The rapid demographic transition heightens the urgency to develop a monitoring mechanism for policymakers to evaluate the impact of population ageing. The Active Ageing Index (AAI), developed for 28 European Union countries, has served as a global quantitative toolkit to benchmark the diverse experience of active ageing and older people’s potential. One can presume that the experiences of Asian elders are different to those with Europeans who have different cultural backgrounds. Thus, an approach that incorporates Eastern culture needs to be developed. In this paper, key findings of the focus group discussions with older men and women across the territories of Hong Kong are summarized. The lay perceptions of active ageing in the general public are identified and compared with the constituents of the European AAI. Also, the relative importance of the indicators given by the older Chinese people were differentiated by their demographic characteristics. The extent to which the older Chinese citizens and the expert groups of the AAI revealed similar judgement on the relative importance of the indicators of active ageing are also examined. The results reported in this paper illustrate how the mixed-method approach could serve as an appropriate method in extending the active ageing research in the Asia-Pacific region. The insights obtained would inform the construction of a more meaningful AAI in the Asian context. It is argued that incorporating the perspective of older people to encapsulate the defining characteristics of active ageing will lead to a wider acceptance of the AAI in a policy-setting mechanism.

Background Colorectal cancer (CRC) screening is an effective strategy to aid early cancer detection. However, the decision to undergo screening can be affected by a variety of factors. The aims of this study were to examine current CRC screening uptake in Hong Kong and identify the factors associated with it using Andersen’s Behavioural Model as a guiding framework. Methods This cross-sectional study was conducted in Hong Kong from August 2019 to December 2020. A sample of 1317 Chinese individuals aged 50 to 75 years were recruited and completed a survey to identify predisposing, enabling, and need-for-care factors, and the colorectal cancer screening uptake rate (faecal occult blood test [FOBT] or faecal immunochemical test [FIT] and colonoscopy) was determined. Results The FOBT/FIT uptake rate was 43.9%, while that of the colonoscopy was 26.0%. The provision of a government subsidy for screening and the provision of information booklets were the most significant and second most significant enabling factors for FOBT/FIT uptake, respectively. Visiting a doctor five times or more in the previous year and being recommended to undergo a CRC screening by a doctor, were the most significant enabling factors for colonoscopy uptake. Age, the perceived benefit of and barriers to screening were important predisposing factors for FOBT/FIT and colonoscopy uptake. Conclusions Screening uptake rates in Hong Kong have significantly increased over the last decade, although they remain lower than those in other countries. Continual efforts are warranted to promote government-subsidised screening. Relevant educational materials that address the barriers identified in this study should be developed and disseminated to the public.

Individuals with intellectual disabilities (ID) may require assistance in accessing healthcare services, including cancer screening. A better understanding of the factors affecting cancer screening utilisation among these individuals is needed for the development of strategies to promote screening uptake in them. This review aimed to explore the facilitators of and barriers to cancer screening utilisation among people with ID. A literature search was conducted using five databases, and an additional snowball search yielded 16 studies for inclusion in the review. Overall, the methodological quality of these studies was good (43-100%). In this review, we noted barriers to screening among individuals with ID, including perceptions of fear, distress, and embarrassment; unpreparedness for screening; negative interactions with healthcare professionals; a lack of knowledge about cancer screening; mobility issues; a high severity of ID; and a lack of ability to provide consent and communicate verbally. Facilitators to screening among these individuals were also identified, including living in a supervised setting, prior use of other healthcare services, being educated about screening via social media, having carers accompany them to screening appointments, and having dual insurance coverage or a higher income. Our review highlights the current needs of individuals with ID undergoing cancer screening. Strategies should be developed to address these needs, such as the provision of training to healthcare professionals on how to conduct screening for people with ID.

This paper expands the focal point of glocalization to the non-western context, and revisits glocalization in light of the promulgation of an international policy regime. Particularly it examines how the politics of scale in various contexts assists local pragmatic exercises and institutional organizations in building up an age-friendly city (AFC). The functioning mechanisms of glocalization are conceptualized through a triadic framework incorporating structure (mode of local governance), agents, and strategies. The empirical cases examine how AFC has been promoted in Chiayi City of Taiwan and in Hong Kong, the former two Tiger economies. Drawing on a comparative analysis of the two cases, the paper presents three major findings. Firstly, local policy networks are integral to glocalization in that they govern how different resources (i.e., political commitment, professional knowledge, human resources, communication skills, and financial resources) are synthesized under a local institutional framework. Often local policy networks reveal the fragmentation of resources provided by different stakeholders. Secondly, the case study illustrates two different modes of local governance. The Chiayi case reflects an institutionalized governing framework with both hierarchical coordination between levels of state bureaucracies and the horizontal exchange of information and resources between the state and non-state sectors. Hong Kong reflects a grassroots mode whereby the promotion and implementation of AFC initiatives are prompted among NGOs, charities, district councils, and universities. Both modes reveal pros and cons. Thirdly, academic associations have played a major role in promoting AFC, though the extent to which their advice can shape policy decisions relies much on the discretion and political commitment of district councils.

The student questionnaire (PIRLS-SQ 2011) of the Progress in International Reading Literacy Study (PIRLS) was designed to gather information from pupils on reading literacy development as to aspects of pupils’ self-lives, home, and school lives across countries/districts. In order to serve the purposes of research and international comparison, the questionnaire was translated into various languages. Using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), the current study investigates the psychometric properties of the Chinese version of the student questionnaire (PIRLS-SQCV 2011) and identifies its underlying factor structure among Chinese fourth-grade pupils in Hong Kong. A 10-factor structure model was identified and much resemblance could be drawn to the original PIRLS structure. While the similarity allows international comparisons of studies in different places following the PIRLS strategy, the findings of this study add to extant literature on the relationship between student factors and reading achievement.

Objective To evaluate the evidence from randomised controlled trials (RCTs) and quantify the effects of acupressure on anxiety among adults. Methodology RCTs published between January 1997 and February 2014, comparing acupressure with sham control, were identified from the databases Science Citation Index/Social Sciences Citation Index, Scopus, PubMed and PsycINFO. Meta-analysis of eligible studies was performed and the magnitude of the overall effect size was calculated for the anxiety outcome. Revised STRICTA (the Standards for Reporting Interventions in Clinical Trials of Acupuncture) criteria were used to appraise the acupressure procedures, and the Cochrane risk of bias tool was used to assess the methodological quality of the studies. Results Of 39 potentially relevant studies, seven RCTs met the inclusion criteria for review while five studies met the criteria for meta-analysis. All studies reported the positive effect of acupressure on relieving anxiety from the anticipation of surgery or treatment. EX-HN3 ( Yintang), HT7 ( Shenmen) were the commonest points selected and two studies used bilateral points. The acupressure procedure was generally well reported and studies had a low risk of bias. The combined results of the five trials showed a greater overall reduction in anxiety in the acupressure group than in the sham controls (standardised mean differences (SMD)=−1.11; 95% CI −1.61 to −0.61; p2=75%; χ2=16.17; p=0.003; r=0.485). Conclusions Acupressure seems to be effective in providing immediate relief of pretreatment anxiety among adults, and has a medium effect size. However, conflicting results were found for the improvements on physiological indicators. More rigorous reporting, including allocation concealment procedure, is needed to strengthen the results.

Objectives The present study aims to investigate the synergistic effects of cognitive remediation training (CRT) on Integrated Supported Employment (ISE). ISE blends individual placement support service with work-related social skills training for Chinese people suffering from schizophrenia or schizoaffective disorder. Method Ninety participants with schizophrenia or schizoaffective disorders were recruited from two psychiatric outpatient services in Hong Kong. They were randomly assigned into the ISE + CRT (n = 45) and ISE (n = 45) conditions. Blinded assessments on vocational, clinical, psychological, and neurocognitive outcomes were conducted by independent assessors. The two groups were followed up at 7 and 11 months. Results Both groups yielded similar improvements across several outcome domains assessed immediately after the interventions and at 7 and 11 month follow-ups, but no significant group differences were found. Significant positive trends over time in vocational, clinical and cognitive outcomes consistently favored the ISE + CRT condition. Conclusion While both the ISE + CRT and ISE groups demonstrated improvement in vocational, clinical, psychological, and neurocognitive outcomes, there was no evidence to show that cognitive remediation facilitated further improvement in these domains beyond gains associated with ISE alone. Further investigation is needed to fully exploit the synergistic potential of ISE combined with CRT, and to better understand which individuals experience a maximal benefit from the specific rehabilitation program components.

This study examined anxiolytic effects of lavender oil on brain serotonin levels and anxiety-related behaviours of rats. The experimental rats were divided into five groups, which respectively received inhalation of saline, 1.25% lavender oil, 2.5% lavender oil, chlordiazepoxide (CDP), and 2.5% lavender oil co-administered with CDP. Anxiety was induced in rats using animal models including Elevated Plus Maze and Open Field. The levels of serotonin in the pre-frontal cortex and striatum of the rats, the anxiolytic effects of lavender oil and its augmentation effect as to co-administration with CDP were evaluated. The neurophysiological findings showed that groups receiving lavender oils, CDP, and 2.5% lavender oils co-administered with CDP had significantly higher level of serotonin in the pre-frontal cortex. However, the anxiolytic behavioural effects of lavender oil were found to have mixed results. This study provided preliminary evidence that inhalation of lavender oil paralleled effects of CDP in up-regulating synthesis of serotonin in rat pre-frontal cortex, and the co-administration of CDP with 2.5% lavender oil tended to augment effect of CDP on serotonin in their pre-frontal cortex and striatum. Copyright © 2013 John Wiley & Sons, Ltd.

Technology on the cloud frameworks in healthcare data management and analytics has opened new horizons for public health research. Hypertension is a significant modifiable risk factor for cardiovascular diseases. Nowadays, telemonitoring blood pressure (BP) has been suggested as an effective tool for BP control. However, elderly people always have difficulties when using electronic health monitoring devices at home. BP data capturing with cloud technology in elderly community centres under guidance and with healthcare provider alert function is a pioneer. In this study, the infrastructure of data collection is constructed on the cloud to capture behavioral data on BP meter use and BP readings. BP data will be generated by the daily use of BP measurement and uploaded to the cloud. All personal characteristics, electronic health records, BP data and call log with nurse can be encrypted and store on the cloud. The remote platform on the cloud can provide efficient analytic performance on huge volume of data with high velocity of data creation in a population-based study. Data mining on the BP measurement will help to better understand the ways to control hypertension. This platform will also be potentially used in other epidemiological studies in public health.

The home questionnaire of the Progress in International Reading Literacy Study (PIRLS-HQ 2011) was designed to gather information from parents or primary caregivers of fourth-grade pupils on their reading literacy development related to aspects of pupils’ home lives across countries/districts. The questionnaire was translated into different languages for international comparison and research purposes. This study aims to assess the psychometric properties of the Chinese version of the PIRLS 2011 home questionnaire (PIRLS-HQCV 2011) and identify the underlying factor structure using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among Chinese fourth-grade pupils in Hong Kong. A 7-factor structure model has been identified by EFA and confirmed to resemble much to the original PIRLS structure by CFA. Additional conceptually important domains have been identified which add further insights into the inconclusive results in the literature regarding the relationship between home factors and reading achievement. Implications for further studies are discussed.

The present study aims to assess psychosomatic and physical responses to a multi-component stress management program with the use of CAM and CB approaches among teaching professionals in Hong Kong.A random controlled trial (RCT) was used to compare between CB group (n = 26) and the CAM-CB group (n = 30). Interventions were administered for 1.5 h once a week for eight consecutive weeks. A self-administered questionnaire including perceived stress scale (PSS) and frequency of psychosomatic symptoms were measured at baseline (T1), immediate after the program (T2), and 4 weeks after the program (T3). Physical parameters were measured at T1 and T2.A reduction of 23% in PSS was observed in the CB group, while the CAM-CB group yielded 18% reductions in PSS from T1 to T3 [F(2,108) = 3.099; p = .049]. No significant interactions were observed in the frequency of psychosomatic symptoms and physical parameters. However, a significant downward time trend was observed (p .001) and larger percentage changes in physical responses were shown in the CAM-CB group than CB group.Clinical evidence of both the CAM-CB and CB program has been demonstrated in the current study and both approaches are easy to be self-implemented. The CAM technique might serve as an alternative choice for self-administered stress management to replace the additional time needed for professional follow-up contacts. It might further improve some physical responses such as handgrip strength and resting heart rate, which are associated with better psychosomatic health and better occupational stress management.

Background The study examined the prevalence and associated factors of influenza vaccination (IV) among the general adult population in Hong Kong. Methods A population-based, random telephone survey interviewed 1,102 Hong Kong Chinese adults aged 18-64 years old in 2006. Results Of all study participants, 95.5% had heard of IV, and only 28.1% had ever received IV. Associated factors included knowledge that IV is required annually, variables related to the Health Belief Model (HBM) (eg, perceived adverse effects, perceived efficacy), and advices given by health care professionals. Conclusions The prevalence of IV was moderately low and factors related to the HBM were found predictive of IV.

Four hundred and thirty-five Chinese smokers who had attended the first smoking cessation clinic and received stage-matched individualized cessation counseling in Hong Kong during the period of August 2000 to January 2002 were successfully followed-up between February and August 2008. Some 38% of the participants (165/495) had stopped smoking during the 12-month follow-up after treatment. Participants with higher conscientiousness score (OR = 1.65, 95% CI: 1.09 - 2.48) and lower openness to experience score (OR = 0.64, 95% CI: 0.45 - 0.92) showed a greater likelihood of quitting smoking after controlling the effect of daily cigarettes smoked and stage of readiness at baseline. The study suggests an important role of conscientiousness and openness to experience on long-term quitting behaviors following treatment, and provides useful information for the development of matched intervention for smoking cessation among Chinese smokers.

The aim of this study is to explore the efficacy of implementing a stress management programme based on a combined approach using cognitive behavioural therapy and complementary and alternative medicine for elementary school teachers who experienced mild level of stress, anxiety and/or depressive symptoms in Hong Kong. A 12-h programme involving cognitive behavioural therapy, self-management, relaxation techniques (diaphragmatic breathing and progressive muscle relaxation), mindful exercises (qigong and yoga), aromatherapy and acupressure was conducted. A quasi-experimental design was used to compare the intervention groups (n = 47) with the wait-list control groups (n = 46). The primary outcome measures were depression, anxiety and stress. Results indicated that the intervention group had significant reduction in depression [(F = 3.93; degrees of freedom (df) = 2.90; p = 0.023)], anxiety (F = 3.37; df = 2.90; p = 0.039) and stress (F = 3.63; df = 2.89; p = 0.031) when compared with the control group. Participants in both groups demonstrated lowered level of salivary cortisol at the post-assessment. The pilot results provided preliminary support to the multi-component stress management programme in relieving affective symptoms of teachers. The programme may be considered as an initial strategy to empower teachers with the abilities to cope with their affective symptoms. Further evaluation using a better designed randomized study with a larger sample size is warranted. (word: 198; max.: 200).

Eight-Section Brocades and Yijin Jing consist of some routine movements that are too difficult for frail elders. A novel health qigong protocol was developed and its effectiveness for frail elders was examined using a randomized clinical trial (RCT). An expert panel performed functional anatomy analysis and safety field test prior to the RCT. The experimental group (n=61,83±6 yr) was given a 12-week qigong exercise program, while the comparison group (n=55,84±6 yr) participated in a newspaper reading program with the same duration and frequency. Pre-, mid-, post-, and follow-up assessments were conducted. At 12 weeks, the qigong group had significant improvements in thinking operations (F=4.05,P=.02) and significant reduction of resting heart rate (F=3.14,P=.045) as compared to the newspaper reading group. A trend of improvements in grip strength and a decreasing trend of depression levels were observed among the qigong group. Significant perceived improvements in physical health (F=13.01,P=.001), activities of daily living (F=5.32,P=.03), and overall health status (F=15.26,P=.0001) were found. There are improvements in some aspects of psychosocial, cognitive, physical, and physiological domains. Clinical applications and possibilities for further research are discussed.

This randomized controlled trial examined the psychological, physical, and neurophysiological effects of a qigong exercise program on depressed elders with chronic medical illness. The experimental group (n = 21, 80 ± 7 years) was given a 12-week qigong exercise program, while the comparison group (n = 17, 81 ± 8 years) participated in a newspaper reading program with the same duration and frequency. Measurement of depression symptoms, psychosocial functioning, muscle strengths, salivary cortisol, and serum serotonin was conducted. At 12 weeks, the qigong group had significant reduction in depressive symptoms (F = 11.68; p < 0.025). Improvement in self-efficacy (F = 4.30; p < 0.050), self-concept of physical well-being (F = 6.82; p < 0.025), and right-hand grip strength (F = 5.25; p = 0.034) was also found when compared with the comparison group. A change in salivary cortisol level was found marginally insignificant between groups (F = 3.16; p = 0.087). However, a decreasing trend of cortisol level was observed. The results provided preliminary evidence for the hypotheses that the antidepressive effect of qigong exercise could be explained by improvement in psychosocial functioning and possibly down-regulation of hyperactivity of the hypothalamic-pituitary-adrenal axis.