Sharron S. K. Leung

Physical activity for cancer survivors: meta-analysis of randomised controlled trials

Objective To systematically evaluate the effects of physical activity in adult patients after completion of main treatment related to cancer. Design Meta-analysis of randomised controlled trials with data extraction and quality assessment performed independently by two researchers. Data sources Pubmed, CINAHL, and Google Scholar from the earliest possible year to September 2011. References from meta-analyses and reviews. Study selection Randomised controlled trials that assessed the effects of physical activity in adults who had completed their main cancer treatment, except hormonal treatment. Results There were 34 randomised controlled trials, of which 22 (65%) focused on patients with breast cancer, and 48 outcomes in our meta-analysis. Twenty two studies assessed aerobic exercise, and four also included resistance or strength training. The median duration of physical activity was 13 weeks (range 3-60 weeks). Most control groups were considered sedentary or were assigned no exercise. Based on studies on patients with breast cancer, physical activity was associated with improvements in insulin-like growth factor-I, bench press, leg press, fatigue, depression, and quality of life. When we combined studies on different types of cancer, we found significant improvements in body mass index (BMI), body weight, peak oxygen consumption, peak power output, distance walked in six minutes, right handgrip strength, and quality of life. Sources of study heterogeneity included age, study quality, study size, and type and duration of physical activity. Publication bias did not alter our conclusions. Conclusions Physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancer other than breast cancer were also included, physical activity was associated with reduced BMI and body weight, increased peak oxygen consumption and peak power output, and improved quality of life.

Perceived stress and support of the Chinese postpartum ritual "doing the month".

Abstract “Doing the month” is the traditional ritual for Chinese postpartum women. A qualitative study involving in-depth interviews with 20 Hong Kong Chinese women was conducted to examine the womens perceptions of stress and support in “doing the month.” Four central themes were identified as follows: bound by the environmental constraints, difficulties in following the proscriptions of the rituals, conflicts between the parties involved, and attainment of the maternal role. The study revealed that “doing the month” is not necessarily protective and supportive of the postpartum women. It raises the critical question of how women can adapt the ritual to fit modern life. The study findings suggest that midwives and health care providers should provide culturally appropriate advice for new mothers. Suggestions are given on bridging the gap between traditional and modern postpartum practices.

Cervical cancer screening: knowledge, health perception and attendance rate among Hong Kong Chinese women.

Purpose: Cervical cancer screening has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. However, cervical screening attendance rates are still far from satisfactory in many countries. Strategies, health promotion and education programs need to be developed with clear evidence of the causes and factors relating to the low attendance rate. The study aims to assess the prediction of cervical screening attendance rate by Chinese women’s knowledge about cervical cancer and cervical screening as well as their perception of health. Patients and methods: A survey with self-reported questionnaires was conducted on 385 Chinese women recruited from a community clinic in Hong Kong. Participants were Chinese women, Hong Kong residents, aged 18–65 years, able to read Chinese or English, and were not pregnant. Results: Women aged 37 years or less, with at least tertiary education, who perceived having control over their own health and had better knowledge on risk factors, were more likely to attend cervical cancer screening. Many participants had adequate general knowledge but were unable to identify correct answers on the risk factors. Conclusion: Health promotion efforts need to focus on increasing women’s knowledge on risk factors and enhancing their perceived health control by providing more information on the link between screening and early detection with lower incidence rates and mortality from cervical cancer.

Occupational Stress, Mental Health Status and Stress Management Behaviors among Secondary School Teachers in Hong Kong.

Objective This study aimed to examine occupational stress and mental health among secondary school teachers in Hong Kong, and to identify the differences between those actively engaged in stress management behaviors and those who were not. Design Survey design was adopted using validated instruments including Occupational Stress Inventory (OSI-R), Depression Anxiety Stress Scale (DASS-21), and Health-Promoting Lifestyle Profile (HPLP) II. Setting The sample was 89 secondary school teachers who attended a professional development course offered by the University of Hong Kong in Hong Kong, People’s Republic of China. Method All 99 students who attended the professional development course were invited and 89 consented to participate and returned the completed questionnaires. Results The majority of participants (75.3 percent) reported fair to very low satisfaction with the teaching career, and 82 percent of them felt unaccountably tired or exhausted. Results of OSI-R showed that 38.6 percent had experienced strong maladaptive stress due to vocational strain but coping resource was limited with most deficits on rational and cognitive coping. Analysis of DASS-21 indicated that 30.3 percent had severe to extremely severe anxiety and 12.3 percent had severe to extremely severe depression. HPLP II revealed that participants paid little attention to their own health and the management of stress. Those who exhibited more stress management behaviors showed significantly less physical symptoms, higher satisfaction with teaching, and lower occupational stress. Conclusion Secondary teachers in Hong Kong have high occupational stress but insufficient stress coping resources. Cognitive-behavioral programs to enhance teachers’ stress management resources are recommended.

Dietary and physical activity interventions for colorectal cancer survivors: a randomized controlled trial

There has been evidence on the protective effects of diets high in fiber and low in red and processed meat (RPM), and physical activity (PA) against colorectal cancer (CRC) development, but that against CRC recurrence has been limited. This study evaluated the efficacy of a behavioral program comprising dietary and PA interventions in improving Chinese CRC survivors’ lifestyle. A 2 × 2 factorial randomized controlled trial of 223 CRC patients (82 females, mean age 65), randomly assigned to receive dietary, PA or both interventions, or usual care for 12 months, and assessed every 6 months for 24 months. Primary outcomes included two dietary and two PA targets. Secondary outcomes included changes in dietary consumptions and PA levels. Dietary interventions significantly increased the odds of achieving the targets of consuming less RPM at all time-points (OR 3.22–4.57, all p < 0.01) and refined grain (RG) at months 6 (OR 3.13, p = 0.002) and 24 (OR 2.19, p = 0.039), and reduced RPM (2.49–3.48 servings/week, all p < 0.01) and RG (0.31–0.5 servings/day, all p < 0.01) consumptions. Patients receiving PA interventions potentially spent more time on moderate-to-vigorous PA. This study demonstrated the efficacy of a behavioral program in improving dietary habits of Chinese CRC survivors.

Building life-long learning capacity in undergraduate nursing freshmen within an integrative and small group learning context

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.

Culturally sensitive, preventive antenatal group cognitive–behavioural therapy for Chinese women with depression

Postnatal depression (PND) affects 10-15% of postnatal women worldwide, yet it is poorly recognized and managed. Among the psychological interventions, which are used to manage PND, cognitive-behavioural therapy was found to be effective and promising. In the past decade, research efforts have focused on developing effective antenatal interventions to prevent PND. Strong antenatal predictors such as antenatal depressive symptoms have been identified for targeted early intervention or prevention to help reduce the risk of developing depression after childbirth. However, the findings regarding effectiveness of antenatal preventive interventions have been inconsistent. Based on the reports of previous studies, a brief group antenatal intervention using cognitive-behavioural approach is necessary, particularly one with sensitivity for Chinese woman. This paper reports the details of a nurse-led cognitive-behavioural programme developed and tested in, and for use with a sample of Hong Kong pregnant women. The trial run showed that the programme was feasible to be implemented and well received by the participants.