Richard Fielding

Prevalence of insomnia among Chinese adults in Hong Kong: a population-based study

Prevalence estimates of insomnia in western general populations are well documented, but population‐based epidemiological data on insomnia in Chinese adults are scarce. The aims of the present study were to determine the prevalence of insomnia in the general population of Hong Kong, compare components of sleep disturbances and lifestyle factors stratified by sex, and identify risk factors for insomnia. Using a population‐based cross‐sectional design, a total of 5001 Chinese adults aged ≥18u2003years completed a telephone interview on the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS) and measures of quality of life (QoL) indexed by Medical Outcomes Study 12‐item Short‐Form Health Survey (SF12), lifestyle and sociodemographic details. Insomnia was defined by a PSQI global score >5. The resultant weighted prevalence of insomnia was 39.4%, equivalent to 2.2 million affected adults in Hong Kong. Women reported significantly poorer component and global sleep quality (all Pu2003<u20030.05). Fully adjusted stepwise regression analyses identified non‐full‐time employment status, existing long‐term health problems, alcohol consumption four to seven times per week, higher HADS scores, poor mental health component of QoL and low self‐perceived health were associated significantly with insomnia (all Pu2003<u20030.05). Our results suggest that insomnia is highly prevalent among Hong Kong Chinese adults and is associated with frequent use of alcohol, poor mental health and QoL.

Prevalence and Characteristics of Chronic Pain in the General Population of Hong Kong

UNLABELLEDnWestern studies document the prevalence of chronic pain in the general adult population to be between 2 and 55%. Knowing the prevalence of chronic pain among Chinese populations provides important comparative perspective: To determine the prevalence of chronic pain in the general population of Hong Kong; evaluate the relationship of chronic pain with sociodemographic and lifestyle factors; and describe the pain characteristics among chronic pain sufferers. A total of 5,001 adults aged ≥ 18 years (response rate 58%) drawn from the general population of Hong Kong completed the Chronic Pain Grade (CPG) questionnaire, providing information on chronic pain and sociodemographic status using telephone interviews. Overall 34.9% reported pain lasting more than 3 months (chronic pain), having an average of 1.5 pain sites; 35.2% experienced multiple pain sites, most commonly of the legs, back, and head with leg and back being rated as the most significant pain areas among those with multiple pain problems. The CPG criteria classified 21.5% of those with chronic pain symptoms as Grade III or above. Fully adjusted stepwise regression analyses identified being female, older age, divorced/separated, having part-time employment, existing long-term health problems, higher HADS Anxiety scores, poor QoL (mental health component), and low self-perceived health to be significantly associated with chronic pain.nnnPERSPECTIVEnOur data evidenced that chronic pain is common in the general population of Hong Kong, and the prevalence is highest among women and middle-aged adults.

Community psychological and behavioral responses through the first wave of the 2009 influenza A(H1N1) pandemic in Hong Kong

BACKGROUNDnLittle is known about the community psychological and behavioral responses to influenza pandemics.nnnMETHODSnUsing random digit dialing, we sampled 12,965 Hong Kong residents in 13 cross-sectional telephone surveys between April and November 2009, covering the entire first wave of the 2009 influenza A(H1N1) pandemic. We examined trends in anxiety, risk perception, knowledge on modes of transmission, and preventive behaviors.nnnRESULTSnRespondents reported low anxiety levels throughout the epidemic. Perceived susceptibility to infection and perceived severity of H1N1 were initially high but declined early in the epidemic and remained stable thereafter. As the epidemic grew, knowledge on modes of transmission did not improve, the adoption of hygiene measures and use of face masks did not change, and social distancing declined. Greater anxiety was associated with lower reported use of hygiene measures but greater social distancing. Knowledge that H1N1 could be spread by indirect contact was associated with greater use of hygiene measures and social distancing.nnnCONCLUSIONSnThe lack of substantial change in preventive measures or knowledge about the modes of H1N1 transmission in the general population suggests that community mitigation measures played little role in mitigating the impact of the first wave of 2009 influenza A(H1N1) pandemic in Hong Kong.

New insights in symptom assessment: the Chinese Versions of the Memorial Symptom Assessment Scale Short Form (MSAS-SF) and the Condensed MSAS (CMSAS).

There are very few symptom assessment instruments in Chinese. We present the validity and reliability of the Memorial Symptom Assessment Scale Short Form (MSAS-SF) and the Condensed Form MSAS (CMSAS) in Chinese cancer patients. The Chinese version of the 32-item MSAS-SF, a self-report measure for assessing symptom distress and frequency in cancer patients, was administered to 256 Chinese patients with colorectal cancer at a clinical oncology outpatient unit. Highly prevalent symptoms included worrying (59%), dry mouth (54%), lack of energy (54%), feeling sad (48%), feeling irritable (48%), and pain (41%). Both the MSAS-SF and CMSAS demonstrated good validity and reliability. For the MSAS-SF subscales, Cronbach alphas ranged from 0.84 to 0.91, and for CMSAS subscales, from 0.79 to 0.87. Moderate-to-high correlations of MSAS-SF and CMSAS subscales with appropriate European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 subscales (0.42-0.71, Ps<0.001) indicated acceptable convergent validity. Low correlations with the Rosenberg Self-Esteem and Optimism Scale (0.22, P<0.001) indicated divergent validity. MSAS subscales varied as expected with other Chinese scales--the Chinese Health Questionnaire (CHQ) and the Life Orientation Scale. Construct validity of both MSAS versions was demonstrated by effective differentiation between clinically distinct patient groups (Karnofsky scores <80% vs. > or =80% [P<0.001]; no active treatment vs. active treatment [P<0.002-0.034]; CHQ-12 scores < or =4 vs. CHQ-12 scores >4 [P<0.001]). The Number of Symptoms subscale correlated appropriately with the EORTC QLQ-C30 function (-0.46 to -0.60, P<0.001) and symptom scales (0.31-0.64, P<0.001). The average time to complete the MSAS-SF was six minutes. The Chinese versions of the MSAS-SF and CMSAS are valid and practical measures. Further validation is needed for Chinese patients with other cancer types and with other symptom instruments.

Prevalence of chronic fatigue among Chinese adults in Hong Kong: A population-based study

BACKGROUNDnEpidemiologic data is available on chronic fatigue for Western, but not for Chinese populations. The aims of the present study were to determine the prevalence of chronic fatigue in the general population of Hong Kong, compare health and lifestyle characteristics of non-chronic fatigue and chronic fatigue cases, and identify risk factors for chronic fatigue.nnnMETHODSnWe performed telephone interviews on 5001 randomly selected Chinese adults aged ≥18 years administering the Chinese version of Chronic Fatigue Scale (ChCFS), the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) indexed by Medical Outcomes Study 12-item Short-Form Health Survey (SF12). Lifestyle, and sociodemographic data were also collected. Chronic fatigue was defined according to Fukuda et al.s (1994) criteria and case criterion was a ChCFS total scores ≥4.nnnRESULTSnThe weighted prevalence of chronic fatigue was 10.7%, which was equivalent to 0.6 million adults in Hong Kong. Higher prevalence rates were found in females, older age groups, and low socioeconomic status. Fully adjusted stepwise regression analyses identified older age, retirees, housewife, existing long-term health problems, higher HADS scores, poor QoL, and low self-perceived health to be significantly associated with increased risk of chronic fatigue, whereas regular exercise was associated with decreased risk of chronic fatigue (all p<0.05).nnnLIMITATIONSnThe cross-sectional design did not allow determination of the time course and causal relationship between chronic fatigue and associated factors.nnnCONCLUSIONSnOur data evidenced that chronic fatigue is common in the general population of Hong Kong, and the prevalence increased with age and was higher in the women and lower socioeconomic population.

Construct validity of the Chinese version of the Chalder Fatigue Scale in a Chinese community sample

OBJECTIVEnThis paper aims to evaluate the factorial validity of the Chinese version of the Chalder Fatigue Scale (ChCFS) using a Chinese community sample.nnnMETHODSnA total of 201 Chinese adults completed the ChCFS, the 12-item Short-Form Health Survey (SF12), and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analysis was conducted to assess the fit of a one-factor model, a two-factor correlated model, and a three-factor hierarchical model in both the 14-item and 11-item versions of ChCFS to the current data.nnnRESULTSnChCFS successfully replicated the original two-factor structure in the current Chinese community sample, and the 11-item version demonstrated better data-model fit than the 14-item version. The instrument possessed good internal consistency (Cronbachs alpha=.863). The convergent validity with HADS and divergent validity with SF12 were also evident.nnnCONCLUSIONSnChCFS is valid and reliable among Chinese adults in the general population.

Eating ability predicts subsequent quality of life in Chinese patients with breast, liver, lung, or nasopharyngeal carcinoma: A longitudinal analysis

Eating dysfunction is a well-recognized consequence of orophagic tract cancers, but also occurs with other cancers. There is a relative absence of data assessing the impact of eating function on QoL in cancer populations other than those with disease of the oro-phagic tract. We assessed longitudinal changes in eating function and quality of life (QoL), and examined whether eating function predicted QoL over time in a sample of Chinese patients with breast, lung, liver, and nasopharyngeal cancers. Overall, 1 079 patients with breast, liver, lung, or nasopharyngeal carcinoma were assessed during their first outpatient visit (baseline) and at two follow-up interviews (FU1 and FU2). Three dimensions of eating function, including ability, appetite, and enjoyment, were assessed using three 11-point self-rated items. QoL was measured by the Chinese version of the Functional Assessment of Cancer Therapy-General Scale (FACT-G (Ch)). Linear mixed effects (LME) models evaluated mean differences on eating function and QoL scores across interviews and across cancer groups, and the effects of eating function on QoL. After adjustment for socio-demographic and medical variables, pain and depression, eating function significantly predicted patient overall (standardized βs ranged from 0.091 to 0.163, ps<0.05), physical (standardized βs ranged from 0.101 to 0.200, ps<0.05), and functional (standardized βs ranged from 0.120 to 0.162, ps<0.05) aspects of QoL scores over time. Eating dysfunction significantly impacts QoL in cancer populations other than those with orophagic disease. Change of eating function appears to be a common problem in cancer patients regardless of cancer site.

Cohort Profile: FAMILY Cohort

The FAMILY Cohort is a longitudinal study of health, happiness and family harmony (the 3Hs) at individual, household and neighbourhood levels in Hong Kong. Using a family living in the same household as the sampling unit, the study (n = 20u2009279 households and 46u2009001 participants) consists of a composite sample from several sources, including: a population-representative random core sample (nu2009=u20098115 households and 19u2009533 participants); the first-degree relatives of this sample (n = 4658 households and 11u2009063 participants); and oversampling in three new towns (nu2009=u20092891 households and 7645 participants) and in three population subgroups with anticipated changes in family dynamics (nu2009=u2009909 households and 2160 participants). Two household visits and five telephone- or web-based follow-ups were conducted over 2009-14. Data collected include socio-demographics, anthropometrics, lifestyle and behavioural factors, measures of social capital, and standardized instruments assessing the 3Hs. We also intend to collect biomaterials in future. The analytical plan includes multilevel inter-relations of the 3Hs for individuals, households, extended families and neighbourhoods. With Hong Kongs recent history of socioeconomic development, the FAMILY Cohort is therefore relevant to global urban populations currently experiencing similarly rapid economic growth. The FAMILY Cohort is currently set up as a supported access resource.

Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery

The decisional conflict scale (DCS) measures the perception of uncertainty in choosing options, factors contributing to decision conflict and effective decision making. This study examined the validity and reliability of the Chinese version of the DCS in Hong Kong Chinese women deciding breast cancer (BC) surgery.

Public risk perception and attitudes towards live poultry markets before and after their closure due to influenza A(H7N9), Hong Kong, January–February 2014

BACKGROUNDnThe study investigated public risk perception regarding influenza A(H7N9) and attitudes towards closure of live poultry markets (LPMs) before and after LPMs closed in Hong Kong.nnnMETHODSnTwo population-based surveys were conducted before and after LPMs closed in January-February 2014, respectively. Adults were recruited using random digital dialing.nnnRESULTSnIn total, 670 and 1011 respondents completed the survey before and after closure of LPMs, respectively. Perceived susceptibility to H7N9 infection was low across surveys. Among respondents who completed the survey after LPMs closed, only 14.6% agreed that temporary closure of LPMs caused inconvenience to the daily life; 38.7% valued the Chinese tradition of live poultry consumption more than controlling the risk of avian influenza; 54.6% recognized greater risk of influenza epidemic associated with LPMs. Support for permanent closure of LPMs which was comparably low across surveys was strongly associated with perceived risk of avian influenza related to LPMs, the effectiveness of LPM closure in control of avian influenza and the inconvenience caused by closure.nnnCONCLUSIONSnRisk communication that promotes peoples perceived risk of avian influenza associated with LPMs and the effectiveness of LPM closure in control of avian influenza outbreaks may improve support for permanent closure of LPMs.