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Background Patients with chronic heart failure (CHF) often experience self-management challenges associated with psychological distress and impaired health-related quality of life (HRQOL) affecting both themselves and their family caregivers. Acceptance and commitment therapy (ACT) has shown positive effects on chronically ill patients or their caregivers, but has not been assessed in the context of CHF or applied in patient-caregiver dyads. Aims This study aimed to evaluate the feasibility, acceptability, and preliminary effects of a group ACT-based intervention for patients with CHF and their family caregivers. Method A single-group pretest and post-test study was conducted in a hospital in China. A total of five patient-caregiver dyads were recruited through convenience sampling. Data on recruitment, retention, intervention adherence, homework completion, and participant satisfaction were collected as an indication of feasibility and acceptability. The effects of the ACT intervention were assessed at two time-points (baseline and immediately after the intervention) in terms of self-reported HRQOL, anxiety, depression, relationship quality, perceived health status, psychological flexibility, self-compassion of patients and their family caregivers, patients' self-care behaviors, and caregiver burden. Results Recruitment, retention, intervention adherence, and homework completion rates were acceptable. Participants were generally satisfied with the program. The preliminary findings showed a trend of greater improvement over time for most outcome measures with small-to-medium within-group effect sizes. Conclusions The ACT-based intervention is generally feasible, acceptable, and effective in patients with CHF and their family caregivers. Some modification on the intervention protocol should be considered.

Hong Kong parents’ psychological control is evident as relatively high, which might have a negative impact on their children’s life orientation and attitude. Optimism plays a central role in young people’s development, psychological well-being, and health. This study aimed to examine 1) the relationship between parental psychological control and optimism; 2) the mediating role of self-mastery between these two concepts. A cross-sectional study was employed to collect/measure Hong Kong middle-school students’ socio-demographic information, parent psychological control (measured by The Chinese Paternal Psychological Control Scale), self-mastery (measured by The Mastery Scale), and optimism (measured by The Chinese version of the 6-item Revised-Life Orientation Test). Multivariate regression analysis and Baron and Kenny’s four-step approach were adopted for the relationships/mediation analyses. A total of 9244 middle school adolescents were included in the data analysis. The average age of the adolescents was 15.11 (SD, 1.79) years (ranges from 11 to 18). The regression analysis showed that both paternal psychological control (β = -0.036, p

Developing a community-based network by training peers as anti-drug ambassadors (ADAs) is a feasible strategy to identify hidden drug abusers. The Ask, Warn, Advise, Refer and Do-it-again (AWARD) model of smoking cessation is useful for enhancing people’s confidence in making referrals to anti-drug services. This study evaluated the effectiveness of such a network by examining the change in knowledge, attitudes and practices (KAP) of 198 ADAs aged 13–18 before and after six months of our training. A one-group pre-test and repeated post-test design was used. One-way repeated-measures analysis of variance was applied to assess the changes in KAP, with p-values adjusted by Bonferroni correction. The results showed that the ADAs statistically significantly improved their KAP regarding drug abuse at the six-month follow-up compared to baseline. All ADAs who knew drug abusers (n = 3) had referred them to services based on the AWARD model. A total of 154 anti-drug abuse activities were conducted, reaching 4561 people. Based on the results, we concluded that the community-based network was effective in improving the KAP of ADAs regarding drug abuse, as well as referring hidden drug abusers. Future studies should consider implementing the network on a larger scale, thus maximizing its anti-drug capacity.

Objective This study evaluated the validity of self-reported smartphone usage data against objectively-measured smartphone usage data by directly tracking the activities in the participants’ smartphone among Chinese adolescents and young adults in Hong Kong.Methods A total of 187 participants were recruited (mean age 19.4, 71.7% female) between 2017 and 2018. A smartphone usage tracking app was installed on all participants’ smartphone for 7 consecutive days. After the 7-day monitoring period, they completed a selfadministered questionnaire on smartphone usage habits.Results Although the correlation between self-reported and objectively-measured total smartphone usage time was insignificant (ρ=-0.10, p=0.18), in three out of the four usage domains were positively and significantly correlated, namely social network (ρ=0.21, p=0.005), instant messaging (ρ=0.27, p

The Brief Experiential Avoidance Questionnaire (BEAQ) has been widely used to measure experiential avoidance (EA). However, the BEAQ is not available in Chinese. The current study aimed to translate the BEAQ into Chinese and validate it on a sample consisting of college students in China. A convenience sample of 698 students completed two surveys in June 2019 (T1) and July 2019 (T2) in a longitudinal study. Both surveys were included in the analyses. Using the T1 data, confirmatory factor analysis (CFA) showed that the original one-factor model of the BEAQ did not fit the data adequately. Moreover, exploratory factor analysis revealed that a 2-factor structure in this Chinese version of the BEAQ (labelled as cognitive avoidance and behavioural avoidance) and a subsequent CFA of the BEAQ using T2 data replicated the two-factor structure. The two BEAQ subscales demonstrated good internal consistency in T1 and T2 (Cronbach's alpha values of >0.78) and acceptable test–retest reliability over a two-month interval (ICC > 0.45). T1 cognitive avoidance scores were associated significantly with another measure of experiential avoidance and negative measures of negative affect and anxiety and depression. They also significantly predicted increased negative affect in T2. T1 behavioural avoidance scores were associated significantly with positive outcomes of positive affect, life satisfaction and resilience, and significantly reduced predicted negative affect and increased positive affect and life satisfaction in T2 but the associations were small in magnitude. Results highlight the importance of interpreting experiential avoidance through cultural lens. The Chinese version of the BEAQ could be used to measure experiential avoidance in Chinese college students and hence support further research in developing knowledge regarding the mechanisms of diverse strategies.

Background Ambient environmental factors have been associated with respiratory infections in ecological studies, but few studies have explored the impact of indoor environmental factors in detail. The current study aimed to investigate the impact of indoor environment on the risk of acute respiratory illness (ARI) in a subtropical city. Method A prospective cohort study was conducted in 285 community-dwelling older adults from December 2016 through May 2019. Individual household indoor environment data and ARI incidence were continuously collected. A time-stratified case-crossover analysis was conducted to estimate the excess risk of ARI associated with per-unit increase of daily mean indoor temperature, relative humidity, and absolute humidity (AH). Result In total, 168 episodes of ARI were reported with an average risk of 36.8% per year. We observed a negative association of ARI with indoor AH up to 5 lag days in cool seasons, with a 6-day cumulative excess risk estimate of −9.0% (95% confidence interval, −15.9% to −1.5%). Negative associations between household temperature or relative humidity and ARI were less consistent across warm and cool seasons. Conclusions Lower indoor AH in household was associated with a higher risk of ARI in the community-dwelling older adults in Hong Kong during cold seasons.

COVID-19 has significant impacts on young smokers in their smoking behaviors. This qualitative study summarises the lived experience of young smokers during COVID-19. Moreover, through their lived experience, we aim to understand how the COVID-19 pandemic influence tobacco use behaviours in this population. A purposive sampling of 48 smokers aged between 17–25 years old is individually interviewed for 30 to 45 min. All interviews are transcribed in verbatim and analysed by two researchers separately using Colaizzi’s method of descriptive phenomenology. The results reveal the following six important themes, which could explain the mixed pattern of smoking behaviour changes in young smokers: (1) perceptions of COVID-19 and its association with smoking, (2) more time at home, (3) taking masks off to smoke, (4) the effects of COVID-19 on smokers’ financial status and academic performance, (5) reduced social gatherings, and (6) restricted access to tobacco products. To conclude, this pandemic and the anti-pandemic measures, i.e., mask mandates, stay-at-home and work-from-home orders, and class suspension, result in both new obstacles and new advantages for smoking cessation among young people. More studies should be performed to monitor any transition of tobacco products and the trajectory of use in this population during this pandemic, thus informing public health policy making.

Background: Mental health of adolescents have been exposing to risk factors associated with stress from a variety of sources. Previous studies identified that green space exposure might be effective for promoting mental health and reduction of stress. However, previous literature focused on adults, and for those which studied children and adolescents, the effects of planting and similar green activities remain to be explored. The aim of this study was to investigate the effects of a pioneer school-based program on green space use and satisfaction, and mental wellbeing indicators, among early adolescent students. Methods: This was a feasibility quasi-experiment in which intervention and control groups were studied sequentially. Three secondary schools and 55 grade 7-8 students were sampled conveniently. In the intervention school, the green space program consists of learning hydroponic planting and group practice in creating green areas at school. In the two control schools, the activities consisted of a standardized stress management program including relaxation exercise such as stretching, extension and massage. Both groups learned green diet, tasting and had green living activity, stress awareness games and learned stress coping. The activity schedule for each group (intervention and control) consisted of three one-hour sessions, each was conducted two to three weeks apart. Key outcomes were assessed with questionnaires at baseline and one month after the completion of the activity period as for each school. Data were fit with mixed model applying GEE. Results: At baseline, students were not sure whether they know how to plant herbs or prepare herbal tea. Control group at posttest had lower frequencies of using green facilities in the community and using school gardening facilities in the previous four weeks compared with intervention group and pretest. Females at posttest were associated with higher confidence in planting, and higher level of enjoyment from green activities. Other moderate to small but non-significant effects were also identified. Conclusions: In this study, the school-based green space programme was found feasible for early adolescent students with statistically supported results. Limitations have also been identified and future study with larger scale, more frequent intervention, longer follow-up and RCT design are required.

Adolescents and young adults mostly drink alcohol because of social activities. However, some drink outside of normative social contexts, exhibiting a behaviour pattern known as solitary drinking. Increasing evidence indicates that solitary drinking is strongly associated with problematic drinking in adolescents and young adults. However, it remains unclear why individuals initiate and maintain this drinking habit. To address this gap in the existing literature, the current study explored the factors contributing to solitary drinking in this population. Descriptive phenomenology was used. A convenience sample of 44 solitary drinkers aged between 10 and 24 were invited to undergo individual semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. The data were analysed by two researchers separately using Colaizzi’s method. Using qualitative descriptions, the following factors were identified as explaining the initiation and continuation of solitary drinking among adolescents and young adults: (1) enhancement and coping drinking motives, (2) social discomfort, (3) reduced self-control, (4) automatic mental process, and (5) a desperate response to stressors. Since reduced self-control plays an important role in long-term addiction, future studies should be conducted to determine potential applications of mindfulness-based interventions to improve self-control, which may prevent the progression from solitary drinking to alcohol use disorder.

Breast cancer-related lymphedema (BCRL) is a major long-term complication for post-surgery breast cancer survivors. Although several risk factors have been identified, lifestyle characteristics have been neglected in previous studies. The aim of this study was to develop and validate a nomogram for estimating this population’s risk of developing lymphedema, taking into consideration their demographic, clinical, and personal lifestyle behaviors. In a cross-sectional study, we collected data from 775 post-operative breast cancer survivors who had attended a follow-up session in the recent 10 years (primary cohort). Lymphedema was assessed using the Norman telephone questionnaire, self-reported by patients. Multiple logistic regression was used to identify risk factors for lymphedema, including demographic, clinical, and lifestyle-related factors. A nomogram was constructed based on those factors and was validated using a separate group of 314 breast cancer patients (validation cohort). The factors independently associated with lymphedema were higher body mass index (BMI), modified radical mastectomy (MRM), postsurgical infection, chemotherapy, radiotherapy, exercise of the affected arm, and the active participation in physical activity (P

We studied the association between objectively measured smartphone usage and objectively measured sleep quality and physical activity for seven consecutive days among Hong Kong adolescents and young adults aged 11-25 years (n = 357, 67% female). We installed an app that tracked the subjects' smartphone usage and had them wear an ActiGraph GT3X accelerometer on their wrist to measure their sleep quality and physical activity level. Smartphone usage data were successfully obtained from 187 participants (52.4%). The participants on average spent 2 h 46 min per day on their smartphone. Multilevel regression showed that 1 min of daytime smartphone usage was associated with 0.07 min decrease in total sleeping time that night (p = .043, 95% confidence interval [CI]: -0.14, -0.003). Broken down for different usage purposes, 1 min of daytime social network usage and games and comics was associated with a 0.28 (p = .02, 95% CI: -0.52, -0.04) min and 0.18 min (p = .01, 95% CI: -0.32, -0.04) decrease in total sleeping time that night, respectively. One minute of daytime smartphone usage was associated with an increase of 4.55 steps in the number of steps (p = .001, 95% CI: 1.77, 7.34) on the next day. To conclude, time spent on a smartphone in the daytime was associated with total sleeping time that night and number of steps the next day, but was not associated with sleep efficiency, wake after sleep onset and moderate-to-vigorous-intensity activity (MVPA) among Hong Kong adolescents and young adults.

Objectives: We studied the association between objectively-measured smartphone usage and objectively-measured sleep quality and physical activity for seven consecutive days among Hong Kong adolescents and young adults aged 11–25 (n = 357, 67% female).Methods: We installed an app that tracked the subjects’ smartphone usage and had them wear an ActiGraph GT3X accelerometer on their wrist to measure their sleep quality and physical activity level. Smartphone usage data were successfully obtained from 187 participants (52.4%).Results: The participants on average spent 2 hours 46 minutes per day on their smartphone. Multilevel regression showed that, among secondary school students, one minute of daytime smartphone usage was associated with 0.12 minute decrease in total sleeping time that night (p = 0.042, 95% CI: -0.23, -0.007). One minute of bedtime smartphone usage was associated with 0.32 minute increase in wake after sleep onset that night (p = 0.04, 95% CI: 0.02, 0.62). One minute of smartphone usage during sleep was associated with sleep efficiency (β = 0.013%, p = 0.01, 95% CI: 0.003%, 0.023%) and WASO (β=-0.05, p = 0.04, 95% CI: -0.10, -0.005). One minute of daytime smartphone usage was associated with 7.15 steps increase in the number of steps (p = 0.02, 95% CI: 1.02, 13.28) among secondary school students and 3.52 steps increase in the number of steps (p = 0.03, 95% CI: 0.37, 6.66) among university students on the next day.Conclusion: Time spent on smartphone was associated with total sleeping time, the number of steps, and MVPA among Hong Kong adolescents and young adults.

People with schizophrenia have an increased risk of developing cardiometabolic diseases and a reduced life expectancy. Studies conducted mainly in Western settings report low amounts of activity and poor levels of fitness in this population. This study aims to compare physical fitness and activity levels between people with schizophrenia/healthy matched controls and investigate potential associations between these variables. A cross-sectional study was conducted with 57 community-dwelling people with schizophrenia and 57 age-, gender- and body mass index (BMI)-matched controls. Participants completed the international physical activity questionnaire and the Young Men&rsquo, s Christian Association (YMCA) fitness assessment protocol with accompanying cardiovascular/lung function tests. Cardiorespiratory fitness was significantly better in healthy matched controls than individuals with schizophrenia in all areas (all p &lt, 0.05, d = 0.38 to 1.06). Performance in best trunk flexion, half sit-ups and one-minute pulse recovery following the three-min step test were significantly worse in the schizophrenia group (all p &lt, 0001, d = 0.76 to 1.04). Higher levels of weekly moderate activity (t = &minus, 2.66, p = 0.009) and total weekly activity levels (t = &minus, 2.013, p = 0.047) were reported by the healthy controls. Levels of vigorous activity were significantly correlated with some areas of lung functioning in the schizophrenia group (all p &lt, 0.05). The findings show that Chinese people with schizophrenia have significantly poorer fitness than matched healthy controls, demonstrating the need to provide timely effective exercise-based interventions as a matter of routine to attenuate the risk of developing chronic physical illnesses.

An outbreak in Wuhan, China in late 2019 of a highly infectious new coronary pneumonia (COVID-19) led to the imposition of countrywide confinement measures from January to March 2020. This is a longitudinal study on changes in the mental health status of a college population before and after their COVID-19 confinement for the first two weeks, focusing on states of psychological distress, depression, anxiety and affectivity. The influence of possible stressors on their mental health were investigated, including inadequate supplies and fears of infection. Five hundred and fifty-five undergraduate students were recruited from Hebei Agricultural University in Baoding, China. The participants completed two online surveys&mdash, on anxiety and depression, and on positive and negative affect. One survey was conducted before the confinement and the other was conducted 15&ndash, 17 days after the start of the confinement. Increases in negative affect and symptoms of anxiety and depression (p-values &lt, 0.001) were observed after 2 weeks of confinement. Inadequate supplies of hand sanitizers, a higher year of study, and higher scores on anxiety and depression were common predictors of increased negative affect, anxiety, and depression across the confinement period. The results suggest that healthcare policymakers should carefully consider the appropriate confinement duration, and ensure adequate supplies of basic infection-control materials.

Objective: To examine the impact of a brief take-home laughter yoga practice (B-TLYP) on the multi-dimensional affects among Chinese adults in Hong Kong.Method: The intervention consisted of a one-...

AimThis study aimed to examine the relationships between socio-economic status, health-promoting lifestyles, and quality of life among Chinese nursing students.BackgroundNursing students will be future health promoters, but they may not always adopt the recommended healthy lifestyle. Currently, there are insufficient studies examining the health-promoting lifestyles of Chinese nursing students, and the impact of socio-economic status and health-promoting lifestyle on their health.MethodsThis was a cross-sectional survey. Data were collected from nursing students studying in pre-registration nursing programs of a university in Hong Kong. The survey was conducted through a self-administered questionnaire that solicited information regarding their socio-economic status, health-promoting lifestyle, quality of life, and perceptions of the barriers to adopting a health-promoting lifestyle.FindingsA total of 538 students returned completed questionnaires for analysis. Among the health-promoting lifestyle subscales, the participants performed best in interpersonal relations and worst in physical activity, and the vast majority of them did not actively engage in health-risk behaviors. Hierarchical regression analyses revealed that only 5% of the variance in quality of life was explained by socio-economic variables, whereas a total of 24% of the variance was explained when health-promoting lifestyle variables were added. In particular, health responsibility, physical activity, spiritual growth, and stress management were statistically significant predictors of quality of life.ConclusionsEarly concerns about how prepared nurses are to take on the role of promoting health still apply today. School administrators should plan the nursing curriculum to include activities that encourage student nurses to participate in health-promoting lifestyles. Future studies are needed to explore the barriers that prevent students from practicing health-promoting behavior.

AimIt is the aim of this study to explore the characteristics of influential peers identified by schoolmates, and the mechanism by which they exert their influence on their peers.BackgroundAdolescent crowds are a salient influence on the health-risk behaviors of peers, contributing to adolescent substance use such as drinking alcohol, smoking cigarettes, and taking drugs.MethodsA mixed method study. Three schools granted us access to students and those who had been nominated as influential by their peers. The students were asked to nominate and indicated the characteristics of peers whom they considered influential in a quantitative study. Those peers whom they considered influential were invited to take part in focus group interviews. A total of six focus group interviews were conducted, comprised of two groups from each school, with an average of seven participants in each group.FindingsStudents considered caring and friendliness (91.0%), being a buddy (88.5%), and entertaining/humor (86.8%) as the top three characteristics of influential peers. The interviews revealed that the students believed that they are influential because of their cheerfulness and humor, considerateness, ability to communicate, popularity and sociability, sincerity and trustworthiness, and because they possess the characteristics of a leader. They also believed that their power to influence came about through their helpfulness, accommodation, and the closeness of their relationships. Their influence was manifested in both positive and negative ways on the academic pursuits and health-risk behaviors of their peers. In order to engage at-risk students in health promotion programs, it is important to identify their influential peers, and to understand how adolescent friends may help one another to resist behaviors that pose a risk to their health.

Psychological flexibility (PF) refers to an individual’s capacity to deal with the present moment non-judgmentally and to commit to value-based actions. This study evaluated how parental PF, psychological adjustment to a child’s illness, and psychological symptoms including anxiety, depression, and stress in parents are associated with asthma morbidity in children. Three-hundred and twenty-four parents of children aged 3–12 years with asthma completed a self-administered questionnaire to measure their PF, psychological adjustment, and symptoms of anxiety, depression, and stress, their children’s asthma symptoms and their use of bronchodilators. Structural equation modeling was used to explore the relationships among these constructs. The results showed that poor PF was significantly associated with poor psychological adjustment to the child’s illness and increased psychological symptoms in parents. Parental PF was found to be the only latent construct possessing a significant association with the child’s asthma morbidity (β = 0.27, 95% CI [0.09, 0.42], p = .002). These results suggest that by fostering their PF parents may improve their own psychological well-being as well as their child’s asthma condition.

Introduction The nine‐item Patient Health Questionnaire (PHQ‐9) is widely used to determine the severity of depression in adult populations, but its psychometric properties with regard to adolescents has been poorly explored. The present study aims to identify the factor structure and examine the measurement invariance of this instrument across genders and age groups in a Chinese adolescent sample. Methods A large sample of Chinese schoolchildren completed the PHQ‐9 in a cross‐sectional survey in Hong Kong (N = 10 933). A confirmatory factor analysis (CFA) to test the factor structure and a multiple group CFA to test the gender and age invariances of the PHQ‐9 in adolescents were conducted. Cronbach alpha was used to assess the reliability of the questionnaire, and Pearson correlations with anxiety, self‐esteem, and perceived control were used to assess its construct validity. Results The CFA results indicate that a one‐factor model with three pairs of item correlations fitted the PHQ‐9 data well, and measurement invariances by age and gender were supported. The PHQ‐9 also possesses adequate internal consistency (>.84) and is strongly correlated with anxiety (>.77), self‐esteem (

This is a secondary analysis of a previously reported randomized controlled trial, aimed at examining the mediating role of parental psychological flexibility (PF) in an Acceptance and Commitment Therapy (ACT)-based childhood asthma management program for parents.The participants were 168 parents (mean age (SD) = 38.40 (5.90) years; 88.1% mothers) and their children who had been diagnosed with asthma (mean age (SD) = 6.81 (2.50) years; 62% boys). They were randomly allocated to either the program composed of a four-session, group-based ACT plus asthma education (ACT Group) or to a group-based asthma education talk plus three telephone follow-ups (Control Group). The parents underwent assessments at baseline, and immediately, 3-months, and 6-months after the intervention for the following outcomes: PF (Acceptance and Action Questionnaire-II), psychological distress of the parents (Depression Anxiety Stress Scale-21); and the asthma symptoms and use of inhaled bronchodilators of their children.Cross-lagged panel models showed that the improvement in parental PF at post-intervention mediated the effect of ACT on reducing parental psychological distress (all beta coefficients (βs) ranged from -2.20 to - 2.30, all Ps 0.01) and childhood asthma symptoms in terms of daytime symptoms (β = -0.22, 95% CI [-0.52, -0.02], P = 0.04), nighttime symptoms (β = -0.17, 95% CI [-0.33, -0.02], P = 0.04), and the use of bronchodilators (β = -0.22, 95% CI [-0.48, -0.02], P = 0.03) at 6-months post-intervention.ACT makes a unique contribution to improving the health outcomes of parents and their children diagnosed with asthma through fostering parental PF.

This chapter discusses the development of undergraduate and post-graduate education and continuing education opportunities in Hong Kong, examine the emerging pedagogies, and discuss the current challenges in nursing education in Hong Kong. The rankings of the government-funded universities offering bachelor degree nursing programs in Hong Kong have been raised significantly from “not on the list” to within the top 45 of the QS World University Rankings. Formal nurse training in Hong Kong was established by a British nurse sent from the London Missionary Society to the Alice Ho Memorial Hospital in 1893. To equip nurses with advanced knowledge in the areas of practice, education, management, and research, universities also offer master and doctoral programs. The advancement of technology has created the digital era, with the current generation typically good at using electronic technology. High-fidelity simulators are employed in nursing curricula because of the multiple advantages that simulation offers.

This study describes the psychometric properties of a Hong Kong Chinese version of the short form of the Support Person&rsquo, s Unmet Needs Survey (SPUNS-SF) for caregivers of patients with cancer. A convenience sample of 280 patient-caregiver dyads was recruited between April and June 2018. A subsample of 70 caregivers completed the survey again, two weeks later. A confirmatory factor analysis (CFA) examined the instrument&rsquo, s factorial structure, ordinal alpha coefficients evaluated the internal consistency, and intra-class correlation coefficients (ICCs) assessed the test-retest reliability. Convergence validity was evaluated by the correlations with sleep disturbance and caregiver burden in caregivers. The Hong Kong Chinese version of the SPUNS-SF (SPUNS-SFHKC) had a high completion rate of 96.8% (271/280) among caregivers. The original five-factor model provided an acceptable fit with the data in the CFA. The ordinal alpha coefficients were 0.866&ndash, 0.945, and the two-week test-retest reliabilities were 0.524&ndash, 0.678. The correlations of the five domains of the SPUNS-SFHKC with caregiver burden were 0.257&ndash, 0.446, and for sleep disturbance were 0.075&ndash, 0.464. The SPUNS-SFHKC has a suitable factor structure and psychometric properties for use in assessing unmet supportive needs among Chinese caregivers of patients with cancer. The applicability of the instrument for long-term use still needs to be studied.

Purpose Breast cancer (BC) survivors have a lifelong risk of developing lymphedema . This study investigated the prevalence of BC-related arm lymphedema among Chinese BC survivors diagnosed in the last 10 years and examined the demographic and clinical variables as well as lifestyle factors associated with lymphedema status. Methods In this cross-sectional study, women with BC (N = 866) who had been diagnosed and followed up in the previous 10 years were recruited from the outpatient clinic of 4 general hospitals and one cancer association in China between August 2018 and October 2019. Lymphedema status was determined using the Norman telephone questionnaire as the patient-reported occurrence of hand/lower arm/upper arm swelling. Multiple logistic regression was used to identify risk factors for lymphedema. Results The median time from BC diagnosis was 4.0 years (interquartile range, 2.0–5.0 years). 81.4% of the patients had undergone mastectomy . The prevalence of arm lymphedema among BC survivors was 49.0%. Age ≥50 years, monthly income modified radical mastectomy , postsurgical wound infection, chemotherapy, and radiotherapy were associated with an increased risk of BC-related arm lymphedema, whereas exercise of the affected arm, engagement in active physical activity, and timely reporting of symptoms of infection to a physician decreased the risk (P Conclusions Arm lymphedema is a common complication for postoperative BC survivors within 10 years. It is essential to identify patients at risk of lymphedema based on demographic, clinical, and lifestyle factors and implement interventions targeting modifiable lifestyle behaviors-eg, active physical activity during the postoperative period .

Background Although smoking has been recognized as a risk factor for many respiratory diseases, its effects of influenza-associated morbidity and mortality remain controversial. We conducted a systematic review and meta-analysis to assess the impact of smoking on influenza-associated hospital admissions, intensive care unit (ICU) admissions, and deaths. Methods We searched the databases of PubMed, CINAHL, EMBASE, and the China National Knowledge Infrastructure for all observational studies published between 1 January 2000 and 30 November 2017 on ever-active/secondhand smoking and influenza-associated hospital admissions, ICU admissions, and deaths. We pooled data using random effect models. Results The initial search retrieved 7495 articles, of which 20 studies were included for systematic review, and 12 studies (eight case-control studies, two cohort studies, and two cross-sectional studies) with 18612 subjects were included in meta-analysis. The overall quality of selected studies was moderate. Ever-active smokers had higher odds of hospital admissions (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.3, 1.7) and ICU admissions (OR 2.2; 95% CI = 1.4, 3.4) after influenza infections, as compared with never smokers. No association was observed between ever-active smoking and influenza-associated deaths. We found a positive association between secondhand smoking and influenza-associated hospital admissions, but only in children below 15 years of age. Conclusions The literature evidence showed that smoking was consistently associated with higher risk of hospital admissions after influenza infection, but the results for ICU admissions and deaths were less conclusive because of the limited number of studies.

Background: Peer-led school-based anti-smoking programs have been shown to affect the smoking behaviors of students. The aim of this study was to examine the effectiveness of a school-based peer-led live theater production advocating a smoke-free life. Methods: This is a cross-section design study. Students from the drama club were recruited as School Health Ambassadors (SHAs). The SHAs were to involve in a theater production in advocating a smoke-free life, and were provided a health education workshop from the project team on facts relating to smoking and smoke-free life. All the students in the school were to watch the theater production as school peer audience members (SPAs). Comparison will be made between the two groups of students in their attitude and decision towards living a smoke-free life after being involved in the theater production or in watching the drama. Results: A total of 409 students, 21 SHAs, and 388 SPAs were included in the project. Both the SHAs and the SPAs reported confidently about their ability to resist offers or temptation to smoke, and were determined to live a smoke-free life and refrain from smoking the first cigarette. Conclusions: A peer-led theater production advocating a smoke-free life shows some effects on students’ attitude and decision to resist offers and the temptation to smoke, and to come to the decision to live a smoke-free life and refrain from smoking the first cigarette.

Summary of studies on the views of stakeholders on the choice of mode of delivery. (DOCX 68 kb)

Table S1. NICE appraisal checklist for quantitative studies. Table S2. NICE appraisal checklist for qualitative studies. (DOCX 71 kb)

BACKGROUND: Few trials have been conducted to address the psychological difficulties of parents in managing their child’s asthma. Fostering parental psychological flexibility through Acceptance and Commitment Therapy (ACT) may help parents to accept these psychological difficulties and improve their management of childhood asthma. METHODS: In this randomized controlled trial, a 4-session, group-based ACT plus asthma education (ACT group) was compared with an asthma education talk plus 3 telephone follow-ups (control group) to train parents of children diagnosed with asthma. The use of health care services due to asthma exacerbations in children and the psychological well-being of their parents were assessed before, immediately after, and at 6 months after the intervention. RESULTS: A total of 168 parents and their children aged 3 to 12 years with asthma were consecutively recruited in a public hospital in Hong Kong. When compared with the control group, children whose parents were in the ACT group made significantly fewer emergency department visits (adjusted 6-month incidence rate ratio = 0.20; confidence interval [CI] 0.08 to 0.53; P = .001) due to asthma exacerbations at 6 months postintervention. These parents also reported a decrease in psychological inflexibility (mean difference = −5.45; CI −7.71 to −3.30; P = .014), less anxiety (mean difference = −2.20; CI −3.66 to −0.73; P = .003), and stress (mean difference = −2.50; CI −4.54 to −0.47; P = .016). CONCLUSIONS: Integrating ACT into parental asthma education was effective at decreasing parental anxiety and stress and reducing the asthma-related emergency department visits of children at 6 months postintervention.

Background: Many parents have difficulty managing childhood asthma. In Hong Kong (HK), while medication is the primary form of treatment, traditional Chinese medicine is another favored option. In addition, HK follows a dual-track healthcare system, which may pose unique experiences for Chinese parents in managing childhood asthma. This qualitative descriptive study aimed to explore the experiences of HK Chinese parents in caring for their children with asthma. Methods: Fourteen HK Chinese mothers of children (aged 3&ndash, 10) suffering from asthma were purposively sampled to participate in individual, semi-structured interviews. A realist approach following conventional content analysis was used to interpret the interviews. Results: The mothers expressed feelings of uncertainty, fear of asthma crises, and searched for ways to cope. As long as their child&rsquo, s asthma symptoms recurred, the mothers&rsquo, distress continued. Their distress was sometimes exacerbated by self-doubt and worries over whether they would receive adequate support from their family and healthcare professionals. Conclusions: Helping parents to understand their limits may help them be more open to varied aspects of their caregiving experiences, and thus to cope better. Psychological interventions together with traditional educational training may help to alleviate the psychological difficulties of parents.

Previous studies have shown that nursing interventions are effective in helping people to stop smoking, but that the participation of nurses in tobacco control activities has been far from satisfactory. The primary objective of this study is to identify factors that encourage or discourage nurses from participating in providing smoking-cessation interventions to their clients, based on the 5 A’s (ask, advise, assess, assist, arrange) framework. A cross-sectional survey was conducted among 4413 nurses in Hong Kong from different clinical specialties. A logistics regression analysis found that predictors for the practicing of all of the 5 A’s are nurses who want to receive training in smoking-cessation interventions, those who have received such training, and those who are primarily working in a medical unit or in ambulatory/outpatient settings. The regression model also showed that attitude towards smoking cessation was positively associated with all of the 5 A’s. The results indicate a need to encourage and provide nurses with opportunities to receive training on smoking-cessation interventions. Strategies to persuade nurses to provide smoking-cessation interventions are also important, since nurses are motivated to perform smoking-cessation interventions when they feel a stronger sense of mission to control tobacco use.

Dyspnea has been found to be an independent predictor of mortality among patients with respiratory diseases and is often regarded as a difficult symptom to control in patients with interstitial lung diseases (ILDs). Previous studies have found an association of psychological and physiological factors with dyspnea among patients with chronic obstructive airway diseases. However, symptom management of hospitalized patients with ILDs has been hampered by difficulty in priority, since they are often admitted with multiple psycho-physiological needs. This study examined the prevalence of dyspnea and the psycho-physiological factors associated with it among hospitalized Chinese patients with ILDs. We studied 165 hospitalized patients with ILDs recruited consecutively over three months in a public hospital in Guangzhou, China. Dyspnea and common psycho-physiological factors, including cough symptoms, activity capacity, lung function, physical and mental health status, and anxiety and depression symptoms, were measured. By ordered logistic regression, level of dyspnea statistically significantly affected performance in a six-minute walk test and physical functioning in work or other regular daily activities in hospitalized patients with ILDs. Respiratory rehabilitation with an appropriate intensity of exercise training or other strategies for enhancing the physical functioning of this population with moderate and severe levels of dyspnea should be prioritized.

Although there is a high prevalence of smoking among individuals with schizophrenia, no previous attempt has been made to explore experiences of tobacco use and cessation within a Chinese sample of this population. A qualitative descriptive study was conducted to explore through the use of individual and semi-structured interviews the experiences of tobacco use and quitting in a sample Chinese population with schizophrenia. Twenty-three eligible participants with schizophrenia who currently smoke were recruited from three community residential mental health service settings. Four main themes representing the experiences of the participants were uncovered in this study: (1) smoking and illness, (2) environment and culture, (3) reasons for smoking, and (4) beliefs about cessation methods. The findings indicated that the participants considered the disease to be far more harmful than smoking, and perceived many benefits to smoking. Although some thought of quitting at times, most gave up the idea or failed to quit due to internal factors such as disease-related suffering, the use of an avoidance coping strategy, and a lack of cessation support. The most notable finding concerns the use of avoidance coping by the participants, who relied on smoking as a way to avoid the suffering brought about by the disease.

Screen viewing is considered to have adverse impacts on the sleep of adolescents. Although there has been a considerable amount of research on the association between screen viewing and sleep, most studies have focused on specific types of screen viewing devices such as televisions and computers. The present study investigated the duration with which currently prevalent screen viewing devices (including televisions, personal computers, mobile phones, and portable video devices) are viewed in relation to sleep duration, sleep quality, and daytime sleepiness among Hong Kong adolescents (N = 762). Television and computer viewing remain prevalent, but were not correlated with sleep variables. Mobile phone viewing was correlated with all sleep variables, while portable video device viewing was shown to be correlated only with daytime sleepiness. The results demonstrated a trend of increase in the prevalence and types of screen viewing and their effects on the sleep patterns of adolescents.

Summary Background Life-long learning involves the development of skills in critical thinking (CT), effective group process (GP), and self-directedness (SDL). Recent studies have shown that small group learning with active interactions is effective in enabling students to develop themselves as independent learners beyond graduation. With a view to integrative learning, the purpose of this study was to evaluate life-long learning outcomes through the work of small group teaching and learning for a class of undergraduate nursing freshmen during one academic year. Methods A mixed-methods approach was used to evaluate the CT, GP and SDL of 99 freshmen with a self-assessment questionnaire before and after their learning activities in three nursing courses, and to identify themes from a total of six focus group interviews with the students and teachers. Results The CT, GP and SDL results obtained from self-assessment did not indicate significant differences. Four themes emerged from the qualitative analysis. Discussion Many factors contributed to the results on life-long learning skill development of students in this study. The qualitative analysis provided good insights for future teaching and learning development. Conclusions With a developmental perspective, life-long learning may be better developed and evaluated over a longer period of time in the nursing program.

Aim: This study aimed to explore the experiences and perceptions of nurses caring for dying patients and their families in the acute medical admission setting. Methods: A qualitative interpretive descriptive methodology was used to explore the experiences and perceptions of 15 nurses recruited via purposive sampling from three acute medical wards of a hospital in Hong Kong. Results: The nurses perceived insufficiency and experienced great mental and physiological strain regarding their caring roles in this setting. Four themes were derived from the findings: lack of preparedness for patients’ deaths, reflecting on their own nursing roles for dying patients, reflecting on the meaning of death and their personal experiences of the death of their own family members, and coping with caring for dying patients. Conclusions: There are similarities between these experiences and those of nurses in similar settings in different cultures. There is a need for further research into and educational preparation of nurses in bereavement care and means of coping with somatic, cognitive, behavioural, and emotional responses in an environment where the emphasis is on curing people who are dying rather than caring for them.

Background The spouse is generally the primary informal caregiver for cancer patients. Many studies have explored the experience of caregiving for cancer patients, but it is unclear whether there are gender differences in the spousal caring experience for cancer patients. Aim This review describes the recent published research on the stress process of spousal caregiving experience for cancer patients, and aims to identify any gender differences in the caregiving experience. Methods Electronic, manual and author's searches were conducted. Articles included were published in English and Chinese, from January 2000 to March 2012. Study population is couples coping with cancer. Focus is on caregiving experience for spouse with cancer, and findings include both male and female spousal caregivers in quantitative studies. The databases searched included MEDLINE, CINAHL, Science Citation Index Expanded, Scopus, PsycINFO and the China Academic Journal Full-text Database. The key search terms used were ‘cancer’ or ‘oncology’ or ‘carcinoma’ AND ‘caregiver’ or ‘caregiving’ or ‘carer’ AND ‘gender differences’ or ‘gender’ AND ‘spouse’ or ‘couple’ or ‘partner’. Spousal caregiving experiences of cancer patients were explored by adopting the ‘stress process’ of the Cancer Family Caregiving Experience Model from the gender perspective. Results Twenty-five articles were identified and included in this review. It was revealed that female spousal caregivers perceived higher level negative experience in caregiving, such as lower mental health, lower physical health, poorer health-related quality of life, lower life satisfaction and decreased marital satisfaction than male spousal caregivers. However, female spousal caregivers are more likely to experience personal growth than male spousal caregivers. Conclusion This review identified that female spousal caregivers for cancer patients had higher levels of negative experience in caregiving. A better understanding of the spousal caregiving experience will provide healthcare professionals with the information needed to develop interventions to support and prepare spousal caregivers to care for their loved ones with cancer.