Angela Y. M. Leung

Prevention of Acute Myocardial Infarction and Stroke among Elderly Persons by Dual Pneumococcal and Influenza Vaccination: A Prospective Cohort Study

BACKGROUND Despite World Health Organization recommendations, the rate of 23-valent pneumococcal (PPV) and influenza (TIV) vaccination among elderly persons in Hong Kong, China, is exceptionally low because of doubts about effectiveness of vaccination. The efficacy of dual vaccination remains unknown. METHODS From 3 December 2007 to 30 June 2008, we conducted a prospective cohort study by recruiting outpatients aged ≥65 years with chronic illness to participate in a PPV and TIV vaccination program. All were observed until 31 March 2009. The outcome of subjects, including the rates of death, hospitalization, pneumonia, ischemic stroke, acute myocardial infarction, and coronary and intensive care admissions, were determined. RESULTS Of the 36,636 subjects recruited, 7292 received both PPV and TIV, 2076 received TIV vaccine alone, 1875 received PPV alone, and 25,393 were unvaccinated, with a duration of follow-up of 45,834 person-years. Baseline characteristics were well matched between the groups, except that there were fewer male patients in the PPV and TIV group and fewer cases of comorbid chronic obstructive pulmonary disease among unvaccinated persons. At week 64 from commencement of the study, dual-vaccinees experienced fewer deaths (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.55-0.77]; P<.001) and fewer cases of pneumonia (HR, 0.57; 95% CI, 0.51-0.64; P<.001), ischemic stroke (HR, 0.67; 95% CI, 0.54-0.83; P<.001), and acute myocardial infarction (HR, 0.52; 95% CI, 0.38-0.71; P<.001), compared with unvaccinated subjects. Dual vaccination resulted in fewer coronary (HR, 0.59; 95% CI, 0.44-0.79; P<.001) and intensive care admissions (HR, 0.45; 95% CI, 0.22-0.94; P=.03), compared with among unvaccinated subjects. CONCLUSIONS Dual vaccination with PPV and TIV is effective in protecting elderly persons with chronic illness from developing complications from respiratory, cardiovascular, and cerebrovascular diseases, thereby reducing hospitalization, coronary or intensive care admissions, and death.

Trajectories of social engagement and depressive symptoms among long-term care facility residents in Hong Kong

BACKGROUND although social engagement and depressive symptoms are important concerns for long-term care facility residents, the dynamic relationship between them has not been adequately studied. OBJECTIVE this study examines the relationship between social engagement and depressive symptoms and changes in social engagement and depressive symptoms among Chinese residents of long-term care facilities over 6 years. DESIGN AND METHODS a latent growth model was used to analyse six waves of data collected using the Resident Assessment Instrument Minimum Data Set 2.0 in the Hong Kong Longitudinal Study on Long-Term Care Facility Residents. Ten residential facilities with a total of 1,184 eligible older adults at baseline were included in the study. RESULTS after controlling for demographic variables at baseline, a higher level of social engagement was associated with fewer depressive symptoms. Trajectories of social engagement were significantly related to trajectories of depressive symptoms. Participants who recorded positive social engagement growth reported reduction in depressive symptoms. CONCLUSION the findings of our study extend previous research by showing that increased social engagement is associated with decreased depressive symptoms over time. In long-term residential care settings, it is important for services to engage residents in meaningful social activities in order to reduce depressive symptoms.

A psychometric evaluation of a negative mood scale in the MDS-HC using a large sample of community-dwelling Hong Kong Chinese older adults

BACKGROUND negative mood is an important construct when assessing the health of older persons. The profile of mood states questionnaire is commonly used to measure mood; however, it might not be suitable for older adults with low education level and those who are not originated North American. OBJECTIVE to examine a negative mood scale formed by nine items in the Mood Section of the Minimum Data Set-Home Care of the Resident Assessment Instrument. METHODS a secondary analysis of data from 3,523 older persons aged 60 or over who had first applied for the long-term care services in Hong Kong and completed the screening tool in 2006. Exploratory and confirmatory factor analyses were used to test the factor structure and multiple-group confirmatory factor analysis to test the gender invariance of the Negative Mood Scale in the Minimum Data Set-Home Care. Its reliability using Cronbachs alpha was examined. RESULTS both a three-factor model at the first level and a one-factor model at the second level provided excellent fits to the overall data, and held equally well for both males and females, and two randomly split samples. Multiple-group confirmatory factor analyses revealed both genders demonstrating an equivalent pattern of factor loadings. Cronbachs alpha value was acceptable for the overall data (0.66). CONCLUSIONS the Negative Mood Scale is a reliable and valid scale and both genders responded to it using the same framework and metric, suggesting it could be used to measure negative mood in Chinese community-dwelling older adults. Further testing of the instrument is needed.

Factor structure and gender invariance of the Chinese General Self-Efficacy Scale among soon-to-be-aged adults

AIM The aim of the study was to examine the factor structure of the Chinese General Self-Efficacy Scale and gender invariance in the structure. BACKGROUND The General Self-Efficacy Scale was developed in 1981 and revised in 1995 to measure peoples beliefs or expectations about their ability to perform tasks on their own across a wide range of demanding/novel situations. While the Chinese version of the General Self-Efficacy Scale has been examined for adolescents and adults from clinical populations, its psychometric properties for community-dwelling Chinese soon-to-be-aged adults, who are in a transitional stage from adulthood to later life, have not been tested. Females have consistently reported a lower general self-efficacy level than males, but it is unclear whether the difference is a result of response bias of the inventory by gender. METHOD A convenience sample of Chinese soon-to-be-aged adults (n = 695) in 28 non-government organizations in Hong Kong completed the survey from March to May 2005. Confirmatory factor analysis was used to test the factor structure and multiple-group confirmatory factor analysis to test the gender invariance of the Chinese version of the General Self-Efficacy Scale. RESULTS The proposed factor structure of the Chinese version of the General Self-Efficacy Scale was an excellent fit to the overall data, and held equally well for both males and females, both genders demonstrating an equivalent pattern of factor loadings. The Cronbach alpha value was high (0·89). CONCLUSION The Chinese version of the General Self-Efficacy is a reliable and valid scale and both genders responded to it using the same framework and metric, thus allowing it to be used with confidence in non-clinical Chinese soon-to-be-aged adult samples.

An Evaluation of the Factor Structure of the Instrumental Activities of Daily Living Involvement and Capacity Scales of the Minimum Data Set for Home Care for Elderly Chinese Community Dwellers in Hong Kong

The objective of this study was to evaluate the factor structure of the Instrumental Activities of Daily Living (IADL) Involvement and Capacity scales of the Chinese version of the Minimum Data Set–Home Care (MDS-HC) in a sample of Chinese older adults living in Hong Kong (n = 3,523). The results of confirmatory factor analyses supported the one-factor model for both IADL Involvement and IADL Capacity scales. Evidence indicated that both scales had good internal consistency (.88) and were reliable and valid in assessing IADL among elderly Chinese community dwellers.

The Establishment and Promotion of the First Youth Quitline in Hong Kong Challenges and Opportunities

This study describes the establishment, promotion, and preliminary findings of a peer-led smoking cessation quitline for Chinese youth smokers in Hong Kong. The Youth Quitline targeted Chinese smokers aged 12 to 25, who smoked at least one cigarette in the past 30 days and were willing to leave telephone numbers for follow up. The protocol was translated from the California Smokers Helpline and we provided toll-free telephone counseling based on motivational intervention with multiple follow-up sessions for smokers who called the service. By intention-to-treat analysis, 55% reported at least one quit attempt, and the quit rate was 22.1% (self-reported 7-day point prevalence) or 17.5% (self-reported 30-day point prevalence). The Hong Kong Youth Quitline, along with enforcement of the antismoking legislation for both youth and adults, advocacy to de-normalize smoking in the society, and appropriate publicity, could help to promote quitting among youth smokers in Hong Kong.

Care Management Service and Falls Prevention: A Case-Control Study in a Chinese Population

Objective: This study evaluates the effect of a care management service (CMS) on falls in older adults. Method: This is a retrospective case-control study with 78 CMS recipients as the case group who received CMS and another 312 community-dwelling frail elders as the control group.The groups were matched by age, gender, activity of daily living, cognitive impairment, and unsteady gait. Thus they were comparable in characteristics and frailty. Results: Among the 390 participants, 89 older adults (23.0%) had falls in the 90 days prior to the survey. After controlling for the identified risk factors for falls, the odds ratio of CMS was 0.27 (95% confidence interval = 0.110-0.663, p < .01). Discussion: These findings indicate that CMS recipients have a lower chance for falls compared to their counterparts. The two features of CMS (comprehensive assessment and multidisciplinary actions to reduce fall risks) are discussed.

Breast and colorectal cancer screening and associated correlates among Chinese older women.

OBJECTIVE To explore the participation rates for breast and colorectal cancer screening and identify associated correlates among elderly women. METHODS Logistic regressions were conducted using data collected in 2006 from 1,533 elderly women aged 60 years or above who had completed a screening instrument, the Minimum Data Set-Home Care, while applying for long-term care services at the first time in Hong Kong. RESULTS The participation rates for breast and colorectal cancer screening among frail older Chinese women were 3.7% and 10.8% respectively. Cognitive status was inversely associated with the likelihood of participation in screening (breast: OR = 0.66, 95%CI = 0.47-0.94; colon: OR = 0.81, 95%CI = 0.66-0.99), as was educational level with the likelihood of participation in breast cancer screening (no formal education: OR = 0.20, 95%CI = 0.06-0.61, some primary education: OR = 0.31, 95%CI = 0.10-1.00). CONCLUSION The delivery of cancer preventive health services to frail older women is less than ideal. Cognitive status and educational level were important factors in cancer screening behaviour. Tailor-made strategic promotion programmes targeting older women with low cognitive status and educational levels are needed to enhance awareness and acceptance within this vulnerable group.

Quitting trajectories of Chinese youth smokers following telephone smoking cessation counseling: a longitudinal study.

INTRODUCTION The smoking patterns of youth remain unknown after they have received smoking cessation counseling. This study aims to examine the quitting trajectories of Chinese youth smokers after they have received quitline services and to examine factors to predict their quitting trajectories. METHODS A total of 402 Chinese youth smokers (aged 12-25 years) called a quitline and participated in telephone follow-ups at 1 week, 1 month, and 3 and 6 months after initial telephone counseling. Finite mixture modeling was employed to examine the quitting trajectories by the SAS Proc Traj group-based modeling procedure. Hierarchical multinomial logistic regression was used to compare the baseline intention to quit smoking, prosmoking attitudes, social influences, self-efficacy to quit, smoking profile, quitting history, and demographic characteristics among the trajectory groups. RESULTS Three distinct quitting trajectory groups were identified: quitters, reducers, and persistent smokers. Both quitters and reducers dramatically reduced the level of their cigarette consumption immediately after initial counseling. Youth smokers who were intended to quit at baseline, perceived confidence to quit, and perceived importance of quitting were more likely to have successfully quit smoking at six-month follow-up. Those who had prosmoking attitudes were less likely to quit smoking. CONCLUSION The findings reveal the profiles of youth smokers who can quit successfully and can guide the development of better and relevant interventions based on the psychosocial characteristics of youth smokers. Short-term goals such as an abrupt quit attempt or immediately reducing cigarette consumption by half may be the key to help youth smokers quit successfully.

Prevalence of medication adherence and its associated factors among community-dwelling Chinese older adults in Hong Kong

The aim of present study was to describe the prevalence of medication adherence, and to examine its risk factors among Chinese community‐dwelling older adults with chronic diseases.