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Abstract Background Seasonal influenza vaccine (SIV) greatly reduces disease burden among school-aged children, yet parental vaccine hesitancy remains a persistent challenge. Two types of SIV are available for children in Hong Kong and other locations: inactivated influenza vaccine (IIV), administered through intramuscular injection, and live attenuated influenza vaccine (LAIV), administered via nasal spray. We aimed to understand how vaccine hesitancy shaped parental preference for LAIV versus IIV, particularly amidst important public health events, such as the COVID-19 pandemic and the massive rollout of COVID-19 vaccination campaigns. Methods We employed a concurrent mixed-methods design. The quantitative part involves longitudinal surveys spanning three years, from pre-pandemic to post-pandemic periods, tracking parental vaccine hesitancy and preference for SIV types. The qualitative part involves 48 in-depth interviews, providing insights into parental preference for SIV types, underlying reasons, and related values. Results Our quantitative analyses show an overall increase in parental vaccine hesitancy and preference for LAIV over IIV after the onset of the COVID-19 pandemic and especially after the rollout of the COVID-19 vaccination campaign. Further logistic regression modelling based on the cohort data shows that higher vaccine hesitancy, coupled with the COVID-19 vaccination campaign rollout, predicts a greater preference for LAIV over IIV. The qualitative analysis complements these results, highlighting that LAIV’s non-invasive nature aligns with parental values of prioritizing natural immunity and concerns about overmedication, leading to a more acceptable attitude towards LAIV. Conclusions Leveraging the higher acceptability of LAIV compared to IIV among parents with high vaccine hesitancy could promote childhood vaccination uptake.

This paper aims to conduct tool wear experiments on cutting SiCp/Al composite materials, and methodically reveal the wear evolution of PCD tools in some detail. Based on the experiments, five-tool wear schemes are rationally developed, including free from wear, crater wear, flank wear, combined crater and flank wear, and edge blunting. The accurate equivalent homogeneous material (EHM) turning simulation model of SiCp/Al composite material is constructed and verified using AdvantEdge software. Subsequently, comprehensive studies have been conducted to analyze the effect of various tool wear patterns on the SiCp/Al cutting process. The results indicate that the crater wear of the tool is positively correlated with the radius of curvature of the chip. Additionally, the flank wear of the tool demonstrates a negative correlation with both the thickness and length of the chips. The actual cutting temperature is 11.3% lower compared to the simulated data, whereas the actual cutting forces in the X and Y directions are 16.1% and 13.7% higher, respectively. The flank wear degree of the tool and the edge blunting both remarkably influence the cutting force in the Y direction and the surface residual stress after machining. As the degree of wear increases, the cutting force in the Y direction and the surface residual stress rise, and the penetration layer of the residual stress becomes deeper, which is attributed to the significantly enhanced ploughing effect of the tool. This study provides a valuable reference for predicting the wear status of cutting tools, particularly in machining difficult-to-machine materials.

Bacterial infections and antibiotic resistance pose significant public health challenges globally. Natural products serve as valuable sources for discovering antimicrobial agents. Rhododendron simsii Planch, a folk medicine, is traditionally used to treat various inflammatory diseases. In this study, we investigated the antibacterial metabolites derived from R. simsii Planch. Rhodosimsiin A (1), bearing a 1,5-seco-1,6 and 3,6-epoxy grayanane diterpene skeleton, representing a novel 5/6/7/6/5 pentacyclic ring system, and 3β,16α-dihydroxy-6β-ethoxy-14β-acetoxy-grayan-1(5)-ene-10-one (4), which represents the first example of the degradation of C-20 and carbonylation in C-10 diterpenoid, together with two new grayanane diterpenes (2−3), three new triterpenes (13−15), and known analogs (5−12, 16−30), were isolated from the leaves of R. simsii Planch by using the bioassay-guided method. Their structures were elucidated by comprehensive spectroscopic analyses, and absolute configurations were established by single-crystal X-ray diffraction and calculated ECD spectra. Compounds 14, 15, 18, 20, 27, 28, and 30 exhibited potent antibacterial activity with an MIC50 of 1.4–24.3 μg/mL against Staphylococcus aureus. The findings of this research indicate that secondary metabolites derived from R. simsii Planch are promising natural antimicrobial candidates.

Abstract Organic near‐infrared (NIR) room temperature phosphorescence (RTP) materials become a hot topic in bioimaging and biosensing for the large penetration depth and high signal‐to‐background ratio (SBR). However, it is challenging to achieve persistent NIR phosphorescence for severe nonradiative transitions by energy‐gap law. Herein, a universal system with persistent NIR RTP is built by visible (host) and NIR phosphorescence (guest) materials, which can efficiently suppress the nonradiative transitions by rigid environment of crystalline host materials with good matching, and further promote phosphorescence emission by the additional phosphorescence resonance energy transfer (≈100%) between them. The persistent NIR phosphorescence with ten‐folds enhancement of RTP lifetimes, compared to those of guest luminogens, can be achieved by modulation of aggregated structures of host–guest systems. This work provides a convenient way to largely prolong the phosphorescence lifetimes of various NIR luminogens, promoting their application in afterglow imaging with deeper penetration and higher SBRs.

Abstract The global rollout of COVID-19 vaccines faces a significant barrier in the form of vaccine hesitancy. This study adopts a dynamic and network perspective to explore the determinants of COVID-19 vaccine uptake in Hong Kong, focusing on multi-level determinants and their interconnections. Following the framework proposed by the Strategic Advisory Group of Experts (SAGE), the study used repeated cross-sectional surveys to map these determinants at multiple levels and investigates their interconnections simultaneously in a sample of 15,179 over two years. The results highlight the dynamic nature of COVID-19 vaccine hesitancy in an evolving pandemic. The findings suggest that vaccine confidence attitudes play crucial roles in vaccination uptake, with their importance shifting over time. The initial emphasis on vaccine safety gradually transitioned to heightened consideration of vaccine effectiveness at a later stage. The study also highlights the impact of chronic condition, age, COVID-19 case numbers, and non-pharmaceutical preventive behaviours on vaccine uptake. Higher educational attainment and being married were associated with primary and booster vaccine uptake and it may be possible to leverage these groups as early innovation adopters. Trust in government acts as a crucial bridging factor linking various variables in the networks with vaccine confidence attitudes, which subsequently closely linked to vaccine uptake. This study provides insights for designing future effective vaccination programmes for changing circumstances.

The X-ray satellite “Einstein Probe” of the Chinese Academy of Sciences (CAS) was successfully launched on 9 January 2024 at 15:03 Beijing Time from the Xichang Satellite Launch Center in China with a “Long March-2C” rocket. The Einstein Probe is equipped with two scientific X-ray telescopes. One is the Wide-field X-ray Telescope (WXT), which uses lobster-eye optics. The other is the Follow-up X-ray Telescope (FXT), a Wolter-I type telescope. These telescopes are designed to study the universe for high-energy X-rays associated with transient high-energy phenomena. The FXT consists of two modules based on 54 thin X-ray Wolter-I grazing incidence Ni-replicated mirrors produced by the Italian Media Lario company, as contributions from the European Space Agency and the Max Planck Institute for Extraterrestrial Physics (MPE), which also provided the focal-plane detectors. Meanwhile, the Institute of High Energy Physics (IHEP), together with the Harbin Institute of Technology and Xi’an Institute of Optics and Precision Mechanics, has also completed the development and production of the structural and thermal model (STM), qualification model (QM) and flight model (FM) of FXT mirrors for the Einstein Probe (EP) satellites for demonstration purposes. This paper introduces the precision manufacturing adopted in China of Wolter-I X-ray mirror mandrels similar to those used for the EP-FXT payload. Moreover, the adopted electroformed nickel replication process, based on a chemical nickel–phosphorus alloy, is reported. The final results show that the surface of the produced mandrels after demolding and the internal surface of the mirrors have been super polished to the roughness level better than 0.3 nm RMS and the surface accuracy is better than 0.2 μm, and the mirror angular resolution for single mirror shells may be as good as 17.3 arcsec HPD (Half Power Diameter), 198 arcsec W90 (90% Energy Width) @1.49 keV (Al-K line). These results demonstrate the reliability and advancement of the process. As the first efficient X-ray-focusing optics manufacturing chain established in China, we successfully developed the first focusing mirror prototype that could be used for future X-ray satellite payloads.

In several disciplines, such as X-ray astronomy, synchrotron radiation facilities, X-ray microscopy, and X-ray lithograph, X-ray-focusing mirrors are crucial parts. They make it possible for scientists and researchers to execute cutting-edge nanoscale imaging techniques, analyze the structure and properties of materials, and explore the cosmos. However, controlling deformation during the manufacturing process is crucial to ensure the production of high-quality components. The strong bonding force of the film is one of the primary causes of mirror distortion while making X-ray-focusing mirrors. As a release layer, diamond-like carbon (DLC) was coated between Au and NiP alloy to lessen distortion during the demolding process for X-ray optic mirrors. In this investigation, we first used density functional theory (DFT) simulation to determine the binding energies of NiP–Au and C–Au. The interactions were then observed by high resolution transmission electron microscopy and scanning transmission electron microscopy. When Au is deposited at low energy and room temperature on a NiP substrate, the phenomena of diffusion layer creation at the interface can be seen for the first time in direct observation. The 6.8 nm diffusion layer between Au and NiP, which causes the high binding energy, is primarily responsible for the increased adhesion strength. Molecular dynamic simulation and tensile testing were used to compute and assess the adhesion strength. According to the findings, Au–C's adhesion strength was 96.4% lower than Au–NiP's. After the DLC release layer was introduced, the deformation of mirror shape as measured by a spot measurement method of optical performance significantly improved. In addition, we created and successfully implemented the 20 nm DLC release layer for the project.

BackgroundVaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons, with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy. ObjectiveThis study was aimed at assessing the connections and relative importance of motivators and demotivators for COVID-19 vaccination in Hong Kong based on co-occurrence networks of verbal reasons for vaccination acceptance and resistance from repetitive cross-sectional surveys. MethodsWe conducted a series of random digit dialing telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were initially coded to generate categories of motivators and demotivators for COVID-19 vaccination using a bottom-up approach. Then, all the generated codes were mapped onto the 5C model of vaccine hesitancy. On the basis of the identified reasons, we conducted a co-occurrence network analysis to understand how motivating or demotivating reasons were comentioned to shape people’s vaccination decisions. Each reason’s eigenvector centrality was calculated to quantify their relative importance in the network. Analyses were also stratified by age group. ResultsThe co-occurrence network analysis found that the perception of personal risk to the disease (egicentrality=0.80) and the social responsibility to protect others (egicentrality=0.58) were the most important comentioned reasons that motivate COVID-19 vaccination, while lack of vaccine confidence (egicentrality=0.89) and complacency (perceived low disease risk and low importance of vaccination; egicentrality=0.45) were the most important comentioned reasons that demotivate COVID-19 vaccination. For older people aged ≥65 years, protecting others was a more important motivator (egicentrality=0.57), while the concern about poor health status was a more important demotivator (egicentrality=0.42); for young people aged 18 to 24 years, recovering life normalcy (egicentrality=0.20) and vaccine mandates (egicentrality=0.26) were the more important motivators, while complacency (egicentrality=0.77) was a more important demotivator for COVID-19 vaccination uptake. ConclusionsWhen disease risk is perceived to be high, promoting social responsibility to protect others is more important for boosting vaccination acceptance. However, when disease risk is perceived to be low and complacency exists, fostering confidence in vaccines to address vaccine hesitancy becomes more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age.

Vaccine hesitancy is one of the top ten threats to global health. Artificial intelligence-driven chatbots and motivational interviewing skills show promise in addressing vaccine hesitancy. This study aimed to develop and validate an artificial intelligence-driven motivational digital assistant in decreasing COVID-19 vaccine hesitancy among Hong Kong adults. The intervention development and validation were guided by the Medical Research Council’s framework with four major steps: logic model development based on theory and qualitative interviews (n = 15), digital assistant development, expert evaluation (n = 5), and a pilot test (n = 12). The Vaccine Hesitancy Matrix model and qualitative findings guided the development of the intervention logic model and content with five web-based modules. An artificial intelligence-driven chatbot tailored to each module was embedded in the website to motivate vaccination intention using motivational interviewing skills. The content validity index from expert evaluation was 0.85. The pilot test showed significant improvements in vaccine-related health literacy (p = 0.021) and vaccine confidence (p = 0.027). This digital assistant is effective in improving COVID-19 vaccine literacy and confidence through valid educational content and motivational conversations. The intervention is ready for testing in a randomized controlled trial and has high potential to be a useful toolkit for addressing ambivalence and facilitating informed decision making regarding vaccination.

This study aimed to gain insight from mothers who were successful in breastfeeding maintenance to develop interventions for promoting breastfeeding maintenance. Following the phenomenological framework, this qualitative study recruited mothers who had maintained breastfeeding for at least 4 months for in-depth interviews. A total of 30 in-depth interviews were completed. We found that almost all participants had experienced an initial adjustment period. During this period, a social support network, personal perseverance in “trying” breastfeeding and “pumping,” and adjusting expectations for breastfeeding to relieve themselves from the pressure of exclusive breastfeeding were important coping strategies. All participants then entered a stage of getting more attuned when breastfeeding was easier. During this period, seeking support from the online mother groups, deliberating medication that might affect breastfeeding, adjusting to accommodate breastfeeding and lives, and managing breastfeeding in public were the main strategies. For working mothers, despite workplace and employers' support, proactive adjustment for using the facilities and lactation breaks for breast milk expression was essential for breastfeeding continuation after returning to work. Throughout the whole journey, positive cues identified from their breastfeeding experiences that helped breastfeeding maintenance included enjoying breastfeeding, breastfeeding as a personal achievement, a healthy and thriving child, positive social feedback, bodily response, the convenience of breastfeeding, and breastfeeding as a motherhood commitment. To conclude, while mothers should be mentally prepared for the difficulties of breastfeeding, they should also be encouraged that things will always get easier as they persevere. Adjustments should be made to accommodate lives and other personal needs. Future studies should consider integrating relevant cues into existing psychosocial interventions for promoting breastfeeding maintenance.

SiCp/Al composite materials are widely used in various industries such as the aerospace and the electronics industries, primarily due to their excellent material properties. However, their machinability is significantly weakened due to their unique characteristics. Consequently, efficient and precise machining technology for SiCp/Al composite materials has become a crucial research area. By conducting a comprehensive analysis of the relevant research literature from both domestic and international sources, this study examines the processing mechanism, as well as the turning, milling, drilling, grinding, special machining, and hybrid machining characteristics, of SiCp/Al composite materials. Moreover, it summarizes the latest research progress in composite material processing while identifying the existing problems and shortcomings in this area. The aim of this review is to enhance the machinability of SiCp/Al composite materials and promote high-quality and efficient processing methods.

Abstract Monitoring community psychological and behavioural responses to coronavirus disease 2019 (COVID-19) is important for informing policy making and risk communication to sustain public compliance with challenging precautionary behaviours and mitigating the psychological impacts. Monthly telephone-based cross-sectional surveys in January–April 2020 and then weekly surveys from May through December 2020 were conducted to monitor changes in public risk perception of COVID-19, personal efficacy in self-protection, confidence in government’s ability to control the pandemic, precautionary behaviours, perceived impact of precautionary behaviours, psychological fatigue and distress in Hong Kong, and examine their inter-relationships. While worry about contracting COVID-19 increased, personal efficacy and confidence in government declined as the community incidence of COVID-19 increased. The public maintained high compliance with most precautionary behaviours throughout but relaxed behaviours that were more challenging when disease incidence declined. Public confidence in government was persistently low throughout, of which, a lower level was associated with more psychological fatigue, lower compliance with precautionary behaviours and greater psychological distress. Perceived greater negative impact of precautionary behaviours was also associated with more psychological fatigue which in turn was associated with relaxation of precautionary behaviours. Female, younger and unemployed individuals reported greater psychological distress throughout different stages of the pandemic. Risk communication should focus on promoting confidence in self-protection and pandemic control to avoid helplessness to act when the pandemic resurges. Policy making should prioritize building public trust, enhancing support for sustaining precautionary behaviours, and helping vulnerable groups to adapt to the stress during the pandemic.

The eXTP (enhanced X-ray Timing and Polarization) satellite is a prominent X-ray astronomy satellite designed primarily for conducting deep space X-ray astronomical observations. The satellite’s scientific payload consists of X-ray focusing mirrors. In order to fulfill the requirements of weight reduction and enhanced effective area, the thickness of mirrors is reduced to the sub-millimeter range and a multi-layer nested structure is employed. Manufacturing mirrors poses a significant challenge to both their quality and efficiency. The present research investigates the optimal replication process for mandrel ultraprecision machining, polishing, coating, electroforming nickel, and demolding. It analyzes the factors contributing to the challenging separation and the inability to release the mirror shells. Additionally, an automatic demolding device is developed, and the X-ray performance of the replication mirrors is verified. The fabrication process flow of the mirrors was initially introduced. To ensure the easy release of the mirror shells from the mandrels, a layer of diamond-like carbon (DLC) was applied as a release layer between the Au and NiP alloy. The adhesion strength of Au-C was found to be significantly lower than that of Au-NiP, as demonstrated by both molecular dynamic simulation and tensile testing. The development of an automatic demolding device with force feedback has been successfully completed. The reduction in the half-power diameter (HPD) of the mirror from 48 inches to 25 inches is an improvement that surpasses the production target.

Abstract Background How antimicrobial resistance (AMR) risk is communicated in news media can shape public understanding and the engagement of different sectors with AMR. This study examined online news media attention for AMR risk and analyzed how AMR risk was communicated using a global sample of English and Chinese news articles. Methods A total of 16,265 and 8335 English and Chinese news relevant to AMR risk, respectively, published in 2015–2018 were retrieved from a professional media-monitoring platform, to examine media attention for AMR and its drivers, of which, 788 articles from six main English-speaking countries and three main Chinese-speaking territories were drawn using constructed-week sampling for content analysis. Results Media attention mainly fluctuated around official reports or scientific discovery of AMR risks or solutions but seldom around reports of inappropriate antimicrobial use (AMU), and not consistently increased in response to World Antimicrobial Awareness Week. The content analysis found that (1) heterogeneous medical terminologies and the ‘superbug’ frame were most commonly used to define AMR or AMR risk; (2) a temporal increase in communicating microbial evolution as a process of AMR was identified but communication about inappropriate AMU in general consumers as the cause of AMR remained inadequate; and (3) the multifaceted consequences of AMR and individual actions that can be taken to tackle AMR were inadequately communicated. Conclusions The media should be encouraged or reoriented to communicate more about actions that can be taken by general consumers to enable collective actions and the multifaceted conseuqences of AMR to encourage one-health approach for tackling AMR.

Abstract Background Financial incentive is increasingly used as a mean to promote preventive care utilization (PCU), but the current Elderly Health Care Voucher Scheme (EHCVS) in Hong Kong is ineffective for encouraging PCU. Objective To explore the older people's barriers to PCU and their views on financial incentive, including EHCVS, for improving private PCU. Design and setting Focus‐group discussions were conducted in community elderly centres located in five districts of Hong Kong. Participants Community‐dwelling older people aged 60 years or above. Results Lack of understanding about preventive care and low awareness of the need for preventive care were key factors for the low motivation for PCU. Uncertainty over the level of service fee charged and concerns over service quality hindered the choice of using the private service providers under the current EHCVS. Financial incentives specific for preventive care services were thought to be cues to actions and guides for service promotion. However, some flexibility in service coverage and a set time limit of the financial incentives were preferred to accommodate individual needs. Conclusions Apart from promoting knowledge of preventive care, official monitoring for service fee and quality is important for empowering older people to choose private service providers for preventive care. Financial incentives for preventive care services should be more specific to cue service promotion and uptake of preventive care while maintaining flexibility to accommodate individual needs. Patient or public contribution Participants were recruited using purposive sampling with the coordination of community elderly centres. Data were analysed using thematic coding.

We constructed a coronavirus disease community vulnerability index using micro district-level socioeconomic and demographic data and analyzed its correlations with case counts across the 3 pandemic waves in Hong Kong, China. We found that districts with greater vulnerability reported more cases in the third wave when widespread community outbreaks occurred.

Summary: Background: COVID-19 vaccine hesitancy can lead to reduced vaccine uptake and hinder the safe relaxation of other public health measures. This study aims to explore the factors associated with vaccine hesitancy and uptake among adults before and after the implementation of the COVID-19 vaccination program in Hong Kong. Methods: Cross-sectional telephone surveys were conducted every four weeks over a nine-month period from November 2020 through July 2021. Target respondents were Hong Kong resident aged 18 or above and recruited by random-digit dialling. In each survey, responses on COVID-19 vaccine hesitancy and COVID-19 vaccine uptake were collected as primary and secondary outcomes, respectively. Data of potentially associated factors, including socio-demographics, chronic medical conditions, perceived risk of COVID-19, perceived personal efficacy in self-protection, confidence in the government's ability to control the pandemic, compliance with social distancing measures, and confidence in COVID-19 vaccines, were also collected. Multivariable logistic regression models were used to examine the factors associated with COVID-19 vaccine hesitancy at different time points. Findings: Ten cross-sectional surveys were conducted, including 7411 respondents. The levels of vaccine hesitancy fluctuated over time. From December 2020 to May 2021, the age group with the highest vaccine hesitancy was young adults 18–34y, while the vaccine hesitancy was highest among adults ≥ 65y in June-July 2021 (Fig. 2C). Our regression analyses (Fig. 3) showed that before and at the beginning of the rollout of the mass vaccination program, there was no statistically significant association between chronic medical conditions and vaccine hesitancy. However, two-five months after the program implementation respondents with chronic medical conditions were more likely to be hesitant. From January to June 2021, higher confidence in the government was associated with lower vaccine hesitancy (Fig. 3). Confidence in COVID-19 vaccines was consistently associated with lower vaccine hesitancy at different stages of the program. Interpretation: The factors associated with COVID-19 vaccine hesitancy changed over time. This study highlighted the importance to monitor temporal changes in COVID-19 vaccine hesitancy and associated factors, and adjust promotion strategies correspondingly to boost vaccination uptake. Funding: Health and Medical Research Fund, Hong Kong.

Abstract Background Despite the wide use of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34), the measurement invariance of the SCNS-SF34 across the main groups—gender and age—which might be of interest in the application of the instrument has never been confirmed. To provide an accurate assessment tool to evaluate the unmet needs of Chinese cancer patients, the present study aimed to assess the measurement invariance of the SCNS-SF34 across gender and age groups and to assess the validity and reliability of the Chinese version of the SCNS-SF34. Methods The SCNS-SF34 was administrated to 1106 Chinese cancer patients. Other instruments included the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), the Short-Form-12 Health Survey version 2 (SF-12 v2) and the Hospital Anxiety and Depression Scale (HADS). Factor structure, internal construct validity, convergent validity, known-group validity and internal consistency were assessed. Results Our data fit the original five-factor model. Multi-group confirmatory factor analysis indicated measurement invariance across age and gender groups. The domains of the SCNS-SF34 had moderate correlations with the corresponding domains of the MSAS-SF, the SF-12 v2 and the HADS, which supported convergent validity. Of the 34 items, 33 had an item-total correlation that was corrected for an overlap of > 0.4 to support the internal construct validity. The SCNS-SF34 aptly differentiated patients by age and gender. The Cronbach’s alpha coefficient ranged from 0.64 to 0.87. Conclusions We confirm the measurement invariance of the Chinese version of the SCNS-SF34 across gender and age group. It is a valid and reliable tool for evaluating the needs of Chinese patients with cancer.

ObjectivesWorking-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work (RTW) after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.MethodsOf 1,106 cancer patients assessed at six-months post-cancer treatment (baseline), 593 previously worked; detailed work status, psychological distress (HADS), physical symptom distress (MSAS-SF), supportive care needs (SCNS-SF34-C), health-related quality of life (SF12), and illness perception (B-IPQ) were assessed. Six months later (follow-up), work productivity and activity impairment were assessed (WPAI; n = 402). Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.ResultsAt baseline, 39% (232/593) were working, 26% (153/593) on sick leave, and 35% (208/593) were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.ConclusionCancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity.

Objectives This study aims to explore the attenuated impact of reported avoidance behaviours adherence on the transmission of COVID-19 through cross-sectional surveys in Hong Kong, in order to make up for the lack of research on avoidance behaviours fatigue.Design 40 cross-sectional telephone surveys.Setting All districts in Hong Kong.Participants 31 332 Cantonese or English-speaking participants at age of 18 years or above.Methods We collected data on behaviours and estimated the average effective reproduction number (Rt) among the Hong Kong adult population during the COVID-19 epidemic wave in November–December 2020 and compared with the preceding epidemic in June–July 2020.Results We observed a reduction in adherence to voluntary avoidance behaviours due to pandemic fatigue, but continued adherence to regulated avoidance behaviours. The average Rt during the post-work from home period was higher in November–December wave with estimated Rt of 0.81 (95% CI: 0.75 to 0.87) compared with the June–July wave with an Rt of 0.67 (95% CI: 0.60 to 0.75).Conclusions The declined effectiveness of social distancing interventions in reducing COVID-19 transmission was associated with fatigue with voluntary avoidance behaviours in Hong Kong population, implying a need for the government to reinvigorate the public to maintain effective pandemic control.

Abstract Background The 15q11‐q13 region contains three breakpoints (BP1 to BP3), and copy number variations often occur in the region. Aims 15q11‐q13 microdeletion and microduplication are usually associated with Prader‐Willi and Angelman syndromes, respectively. It is not yet clear to what extent microdeletion and microduplication affect the physical health of the fetus and the child. In this study, we examined seven fetuses ranging in gestational age from 15 to 27 weeks. Materials & Methods Detailed prenatal screening and laboratory examinations were performed, while karyotype analysis and chromosomal microarray analysis (CMA) of the amniotic fluid and umbilical cord blood were applied for genetic analysis. Results CMA analysis showed that four fetuses harbored a microdeletion and one fetus showed a microduplication at 15q11.2 BP1‐BP2, two fetuses had a microdeletion at 15q11‐q13 BP2‐BP3, and one fetus had an additional microdeletion at 16p13.11. Discussion There is no clear standard for the clinical diagnosis of 15q11‐q13 microdeletion and microduplication, some of them have clinical phenotypes or are clinically affected. Conclusion Therefore, parents of such fetuses should be informed of the possibility of microdeletions or microduplications to mitigate the psychological burden, and medical consultation and assistance should be provided when communicating the results of the mid‐gestation screening.

Summary: The transfer of molecular machine technology into aggregated states is a key step for the realization of many potential applications. Here we report three organic luminescent agents, CzS-o-py, CzS-m-py, and CzS-p-py, that can adjust organic room-temperature phosphorescence (RTP) via orderly stimulus-responsive molecular motion in the crystal. Careful analysis of the single-crystal structure before and after ordered molecular motion, coupled with theoretical calculations, reveals the effective intermolecular charge transfer generated by the dense packing mode to be responsible for the RTP effect. Accordingly, a dual anti-counterfeiting application is successfully implemented, exploiting the RTP effect of the stimulus response. The introduction of molecular mechanical technology may provide a strategy for the molecular design, internal mechanism exploration, and practical application of RTP luminescent agents.

This was a mixed-methods study comprising a questionnaire-based survey, a qualitative study, and analysis of school newsletters to evaluate elementary school staff’s acceptability, delivery challenges and communication about school-located influenza vaccination program (SIVP) in Hong Kong. We found that school staff with lower intention to implement SIVP perceived greater logistical difficulties in arranging SIVP. Challenges regarding program delivery included schools’ limited infrastructure, the burden of paperwork, the fear of being overwhelmed by multiple school-based vaccination schedules, lacking confidence in communicating with parents about influenza vaccines, and the difficulties in managing vaccination-related anxiety among children with intellectual disability. School staff were generally passive in communicating with parents and students about influenza vaccines. We also found that schools may use the school newsletters as a substitute of the formal informed consent forms. Good partnerships among government, service providers and schools should be established to minimize the burden of paperwork for school staff, facilitate early planning of SIVP, and support schools with limited infrastructure and the vaccination of children with intellectual disabilities. Training is needed to enhance school staff’s confidence in communicating with parents and students about influenza vaccines and improve information delivery to support parents’ informed decisions for children’s vaccination.

Abstract Background Poultry farmers are at high-risk from avian influenza A/H7N9 infection due to sustained occupational exposures to live poultry. This study examined factors associated with poultry farmers’ adoption of personal protective behaviours (PPBs) based on Protection Motivation Theory (PMT). Methods Totally, 297 poultry farmers in three cities of Jiangsu Province, China were interviewed during November 2013-January 2014. Data on PMT constructs, perceived trustworthiness of A/H7N9 information from mass media (formal sources), friends and family (informal sources), intention to adopt and actual adoption of PPBs and respondents’ demographics were collected. Structural equation modeling (SEM) identified associations between demographic factors and PMT constructs associated with A/H7N9-oriented PPB intention. Moderated mediation analysis examined how demographics moderated the effects of information trust on PPB intention via risk perceptions of A/H7N9. Results Respondents generally perceived low vulnerability to A/H7N9 infection. The SEM found that male respondents perceived lower severity of (β = −0.23), and lower vulnerability to (β = -0.15) A/H7N9 infection; age was positively associated with both perceived personal vulnerability to (β = 0.21) and perceived self-efficacy (β = 0.24) in controlling A/H7N9; education was positively associated with perceived response efficacy (β = 0.40). Furthermore, perceived vulnerability (β = 0.16), perceived self-efficacy (β = 0.21) and response efficacy (β = 0.67) were positively associated with intention to adopt PPBs against A/H7N9. More trust in informal information (TII) was only significantly associated with greater PPB intention through its positive association with perceived response efficacy. Age significantly moderated the associations of TII with perceived Self-efficacy and perceived response efficacy, with younger farmers who had greater TII perceiving lower self-efficacy but higher response efficacy. Conclusion Poultry farmers perceive A/H7N9 as a personally-irrelevant risk. Interventions designed to enhance perceived response efficacy, particularly among lower educated respondents may effectively motivate adoption of PPBs. Informal information may be an important resource for enhancing response efficacy.

We conducted a population survey in Hong Kong to gauge psychological and behavioral responses to the threat of influenza A(H7N9) and support for closure of live poultry markets. We found low anxiety and low levels of exposure to live poultry but mixed support for permanent closure of the markets.

A novel avian-origin influenza A(H7N9) caused a major outbreak in Mainland China in early 2013. Exposure to live poultry was believed to be the major route of infection. There are limited data on how the general public changes their practices regarding live poultry exposure in response to the early outbreak of this novel influenza and the frequency of population exposure to live poultry in different areas of China.This study investigated population exposures to live birds from various sources during the outbreak of H7N9 in Guangzhou city, China in 2013 and compared them with those observed during the 2006 influenza A(H5N1) outbreak. Adults were telephone-interviewed using two-stage sampling, stratified by three residential areas of Guangzhou: urban areas and two semi-rural areas in one of which (Zengcheng) A(H7N9) virus was detected in a chicken from wet markets. Logistic regression models were built to describe practices protecting against avian influenza, weighted by age and gender, and then compare these practices across residential areas in 2013 with those from a comparable 2006 survey.Of 1196 respondents, 45% visited wet markets at least daily and 22.0% reported buying live birds from wet markets at least weekly in April-May, 2013, after the H7N9 epidemic was officially declared in late March 2013. Of those buying live birds, 32.3% reported touching birds when buying and 13.7% would slaughter the poultry at home. Although only 10.1% of the respondents reported raising backyard birds, 92.1% of those who did so had physical contact with the birds they raised. Zengcheng respondents were less likely to report buying live birds from wet markets, but more likely to buy from other sources when compared to urban respondents. Compared with the 2006 survey, the prevalence of buying live birds from wet markets, touching when buying and slaughtering birds at home had substantially declined in the 2013 survey.Although population exposures to live poultry were substantially fewer in 2013 compared to 2006, wet markets and backyard poultry remained the two major sources of live bird exposures for the public in Guangzhou in 2013. Zengcheng residents seemed to have reduced buying live birds from wet markets but not from other sources in response to the detection of H7N9 virus in wet markets.

Illness perceptions are linked to individual help-seeking and preventive behaviors. Previous illness perception studies have identified five dimensions of illness-related experience and behaviour. The Revised Illness Perception Questionnaire (IPQ-R) for genetic predisposition (IPQ-R-GP) was developed to measure illness perceptions in those genetically-predisposed to blood disease. We adapted the IPQ-R-GP to measure perceptions of generalized cancer predisposition. This paper describes the development and validation of the Cancer Predisposition Perception Scale (CPPS).The draft CPPS scale was first administered to 167 well Hepatitis B carriers and 123 other healthy individuals and the factor structure was examined using Exploratory Factor Analysis. Then the factor structure was confirmed in a second sample comprising 148 healthy controls, 150 smokers and 152 passive smokers using Confirmatory Factor Analysis (CFA).Six-factors comprising 26 items provided optimal fit by eigen and scree-plot methods, accounting for 58.9% of the total variance. CFA indicated good fit of the six-factor model after further excluding three items. The six factors, Emotional representation (5 items), Illness coherence (4 items), Treatment control (3 items), Consequences (5 items), Internal locus of control (2 items) and External locus of control (4 items) demonstrated adequate-to-good subscale internal consistency (Cronbach's α = 0.63-0.90). Divergent validity was suggested by low correlations with optimism, self-efficacy, and scales for measuring physical and psychological health symptoms.The CPPS appears to be a valid measure of perceived predisposition to generic cancer risks and can be used to examine cancer-risk-related cognitions in individuals at higher and lower cancer risk.

Risk perception is a reported predictor of vaccination uptake, but which measures of risk perception best predict influenza vaccination uptake remain unclear.During the main influenza seasons (between January and March) of 2009 (Wave 1) and 2010 (Wave 2),505 Chinese students and employees from a Hong Kong university completed an online survey. Multivariate logistic regression models were conducted to assess how well different risk perceptions measures in Wave 1 predicted vaccination uptake against seasonal influenza in Wave 2.The results of the multivariate logistic regression models showed that feeling at risk (β = 0.25, p = 0.021) was the better predictor compared with probability judgment while probability judgment (β = 0.25, p = 0.029 ) was better than beliefs about risk in predicting subsequent influenza vaccination uptake. Beliefs about risk and feeling at risk seemed to predict the same aspect of subsequent vaccination uptake because their associations with vaccination uptake became insignificant when paired into the logistic regression model. Similarly, to compare the four scales for assessing probability judgment in predicting vaccination uptake, the 7-point verbal scale remained a significant and stronger predictor for vaccination uptake when paired with other three scales; the 6-point verbal scale was a significant and stronger predictor when paired with the percentage scale or the 2-point verbal scale; and the percentage scale was a significant and stronger predictor only when paired with the 2-point verbal scale.Beliefs about risk and feeling at risk are not well differentiated by Hong Kong Chinese people. Feeling at risk, an affective-cognitive dimension of risk perception predicts subsequent vaccination uptake better than do probability judgments. Among the four scales for assessing risk probability judgment, the 7-point verbal scale offered the best predictive power for subsequent vaccination uptake.

Vaccination was a core component for mitigating the 2009 influenza pandemic (pH1N1). However, a vaccination program's efficacy largely depends on population compliance. We examined general population decision-making for pH1N1 vaccination using a modified Theory of Planned Behaviour (TBP).We conducted a longitudinal study, collecting data before and after the introduction of pH1N1 vaccine in Hong Kong. Structural equation modeling (SEM) tested if a modified TPB had explanatory utility for vaccine uptake among adults.Among 896 subjects who completed both the baseline and the follow-up surveys, 7% (67/896) reported being "likely/very likely/certain" to be vaccinated (intent) but two months later only 0.8% (7/896) reported having received pH1N1 vaccination. Perception of low risk from pH1N1 (60%) and concerns regarding adverse effects of the vaccine (37%) were primary justifications for avoiding pH1N1 vaccination. Greater perceived vaccine benefits (β = 0.15), less concerns regarding vaccine side-effects (β = -0.20), greater adherence to social norms of vaccination (β = 0.39), anticipated higher regret if not vaccinated (β = 0.47), perceived higher self-efficacy for vaccination (β = 0.12) and history of seasonal influenza vaccination (β = 0.12) were associated with higher intention to receive the pH1N1 vaccine, which in turn predicted self-reported vaccination uptake (β = 0.30). Social norm (β = 0.70), anticipated regret (β = 0.19) and vaccination intention (β = 0.31) were positively associated with, and accounted for 70% of variance in vaccination planning, which, in turn subsequently predicted self-reported vaccination uptake (β = 0.36) accounting for 36% of variance in reported vaccination behaviour.Perceived low risk from pH1N1 and perceived high risk from pH1N1 vaccine inhibited pH1N1 vaccine uptake. Both the TPB and the additional components contributed to intended vaccination uptake but social norms and anticipated regret predominantly associated with vaccination intention and planning. Vaccination planning is a more significant proximal determinant of uptake of pH1N1 vaccine than is intention. Intention alone is an unreliable predictor of future vaccine uptake.

Whether information sources influence health protective behaviours during influenza pandemics or other emerging infectious disease epidemics is uncertain.Data from cross-sectional telephone interviews of 1,001 Hong Kong adults in June, 2009 were tested against theory and data-derived hypothesized associations between trust in (formal/informal) information, understanding, self-efficacy, perceived susceptibility and worry, and hand hygiene and social distancing using Structural Equation Modelling with multigroup comparisons.Trust in formal (government/media) information about influenza was associated with greater reported understanding of A/H1N1 cause (β = 0.36) and A/H1N1 prevention self-efficacy (β = 0.25), which in turn were associated with more hand hygiene (β = 0.19 and β = 0.23, respectively). Trust in informal (interpersonal) information was negatively associated with perceived personal A/H1N1 susceptibility (β = -0.21), which was negatively associated with perceived self-efficacy (β = -0.42) but positively associated with influenza worry (β = 0.44). Trust in informal information was positively associated with influenza worry (β = 0.16) which was in turn associated with greater social distancing (β = 0.36). Multigroup comparisons showed gender differences regarding paths from trust in formal information to understanding of A/H1N1 cause, trust in informal information to understanding of A/H1N1 cause, and understanding of A/H1N1 cause to perceived self-efficacy.Trust in government/media information was more strongly associated with greater self-efficacy and handwashing, whereas trust in informal information was strongly associated with perceived health threat and avoidance behaviour. Risk communication should consider the effect of gender differences.