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This study aimed to understand the perceptions and experiences of sexual violence among Chinese men who have sex with men (MSM) in Hong Kong.The study adopted a qualitative descriptive design with thematic analysis.Thirty-one Chinese MSM were recruited in Hong Kong from May to June 2019 using purposive sampling. Individual semi-structured interviews were conducted with the participants. The interview data were transcribed verbatim from the recordings and analysed using Braun and Clarke's thematic analysis approach.Four themes were identified: (1) different forms of sexual violence, from physical to virtual; (2) inner struggles with fears and worry; (3) low awareness and perceived risk of sexual violence - 'it has nothing to do with me' and (4) dilemma towards sexual violence prevention.The study provided qualitative evidence regarding the experiences and perceptions of sexual violence among Chinese MSM in Hong Kong. Physical and image-based forms of sexual violence were identified, which led the participants to experience psychological distress, fear of contracting human immunodeficiency virus/other sexually transmitted infections, notoriety within the gay community, and discrimination and stigmatization within their family and workplace. To reduce the risk of sexual violence, some participants were cautious about the venue in which they engaged in sex and the habit of sharing sexually explicit photos with others. However, some participants had low awareness and perceived risk of sexual violence.This study was the first to fill the research gap on sexual violence issues among Chinese MSM using dating apps in Hong Kong. The qualitative findings enhanced the scholarly understanding of Chinese MSM's perceptions and experiences of sexual violence. The study findings can help nursing staff and other healthcare professionals to develop tailored primary, secondary and tertiary sexual violence prevention programmes for MSM or beyond.

Study objective We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong. Methods We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality. Results ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality. Conclusion A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.

Aim: The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers. Design: Scoping review using Arksey and O'Malley's five-stage framework. Methods: Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation. Results: Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.

To explore factors associated with depression and COVID-19 related fear among pregnant women and new mothers.A cross-sectional survey was conducted in China from July 2020 to July 2021.A total of 3027 pregnant and new mothers were recruited.Sociodemographic characteristics and the perceptions of the COVID-19 pandemic were collected. The Patient Health Questionnaire-9 (PHQ-9) and the Fear Scale was used to assess the depressive and fear level towards the COVID-19 pandemic, respectively.Approximately 17.2% of the participants had depression (PHQ-9 ≥10). In Hong Kong, participants who perceived that they have increased knowledge to prevent infection were less likely to have depression (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.74-0.94). There was no association between perceived severity if infected and severity of spread and the depression level in our sample. An inverse relationship was found between the COVID-19 related fear level and perceived knowledge to prevent infection (Beta-coefficient [β] = -0.20; 95% CI = -0.38 to -0.02).Public health nurses need to promote accurate and up to date COVID-19 related information at clinical and community settings and implement effective screening for depression and fear symptoms to identify these high-risk groups to improve women's psychological well-being.

BACKGROUND: Although vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most desired solution to end the coronavirus disease (COVID-19) pandemic, there are growing concerns that vaccine hesitancy would undermine its potential. We examined the intention to receive vaccination against SARS-CoV-2 and the associated factors in a representative sample of Chinese adults in Hong Kong. METHODS: We did a dual-frame (landline and mobile) cross-sectional survey of a random sample of 1501 Hong Kong residents aged 18 years or older (53.6% females) in April 2020. We collected data on the intention to receive SARS-CoV-2 vaccine when it becomes available (yes/ no/ undecided), knowledge and perceptions of COVID-19, smoking, alcohol drinking, and sociodemographic factors. Prevalence estimates were weighted by the sex, age, and education of the general population of Hong Kong. RESULTS: Overall, 45.3% (95% CI: 42.3-48.4%) of the participants had intentions to vaccinate against SARS-CoV-2 when it becomes available, 29.2% (26.5-32.1%) were undecided, and 25.5% (22.9-28.2%) had no intention. The most common reason for vaccine hesitancy (undecided or no intention) was safety concerns (56.5%). Multivariable partial proportional odds model showed higher vaccine hesitancy in males, younger adults, those with no chronic disease, current smokers, and non-alcohol drinkers. After adjusting for sociodemographic and other factors, inadequate knowledge of SARS-CoV-2 transmission (adjusted ORs ranged from 1.27 to 2.63; P

BACKGROUND Healthcare avoidance in the COVID-19 Pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behaviour during pandemic waves and inferred its impact on excess non-COVID-19 death toll. OBJECTIVE To measure the impact of hospital avoidance behaviour on excess mortality using emergency department (ED) patient data from 2016 to 2021, during which Hong Kong experienced a unique COVID-19 pandemic with four distinct waves of case number surges. METHODS Our data is taken from the CDARS Hong Kong Hospital Authority administrative database, which oversees all local public hospitals and plays a prominent role in emergency care provision. To estimate excess mortality, two-stage least squares was utilised with daily tallies of ED visit and 28-day mortality. Elderly records were categorised by the residential care home for elderly status (RCHE) and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. RESULTS Compared with the average in 2016-2019 average there was a reduction in total ED visits in 2020 of 25·4%. During the same period, the 28-day mortality of non-COVID-19 ED deaths increased by 7·82% compared with 2016-2019. The estimated total elderly excess non-COVID 28-day death by reduced ED visits throughout 2020 to 2021 is 1,958 (1,100-2,820, no time lag). The actual excess death in 2020 and 2021 are 3,143 and 4,013 respectively, with 2016-2019 average as the benchmark. Death on Arrival (DOA)/ Death before Arrival (DBA) increased by 35·1% in 2020, while non-DOA/DBA mortalities increased only by a moderate 4·65%. In both DOA/DBA and non-DOA/DBA, the increases were higher during wave periods than in non-wave periods. Moreover, non-RCHE patients saw a greater reduction in ED visit than RCHE residents across all waves by more than 10%. Most of the subset comorbidities demonstrated an annualised reduction in visit in 2020. Renal diseases and severe liver diseases saw a notable death increase. CONCLUSIONS We demonstrated a statistical method to estimate hospital avoidance behaviour during a pandemic, and quantified the consequential excess 28-day mortality, with a focus on elderlies, who had high frequencies of ED visit and deaths. This study serves as an informed alert and possible investigation guideline to healthcare professionals about hospital avoidance behaviour and its consequences.

Introduction: The demanding nature of medical and health sciences studies can cause stress among students in these disciplines affecting their wellbeing and academic performance. The Perceived Stress Scale (PSS-10) is a widely used measure of perceived stress among medical students and healthcare professionals that has not yet been validated among medical and health sciences students in Hong Kong. The aim of this study is to establish the construct validity and reliability of the PSS-10 in this context. Methods: 267 final year medical and health sciences students were surveyed using the PSS-10. The data were analysed using exploratory factor analysis for construct validity and Cronbach’s alpha coefficient and corrected item-total correlations for reliability. Results: Exploratory factor analysis revealed a two-factor structure for PSS-10, with Cronbach’s alpha of 0.865 and 0.796, indicating good internal consistency. Corrected item-total correlations showed satisfactory correlation ranged from 0.539 to 0.748 for all items and their respective subscale. Both tests supported PSS-10 as a two-factor scale. Conclusion: The PSS-10 is a valid measure for assessing perceived stress in Hong Kong medical and health sciences students.

Background Studies have demonstrated that noise is associated with various health problems, such as obesity and hypertension. Although the evidence of the associations of noise with obesity and hypertension is inconsistent, there seems to be a stronger association of the latter. This study aimed to investigate the associations of noise with body mass index (BMI) and blood pressure in adults living in multi-story residential buildings. Methods A cross-sectional study was conducted in Hong Kong from February 2018 to September 2019. The Weinstein Noise Sensitivity Scale, Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered to the participants. BMI and blood pressure were assessed. Nocturnal noise exposure and total sleep duration were measured for a week. Results Five hundred adults (66.4% female), with an average age of 39 years (range: 18–80), completed the study. The average levels of nocturnal noise, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 51.3 dBA, 22.2 kg/m2, 116.0 mmHg, and 75.4 mmHg, respectively. After adjusting for sociodemographic characteristics, nocturnal noise was associated with BMI (b = 0.54, 95% CI: 0.01 to 1.06, p = 0.045) and SBP (b = 2.90, 95% CI: 1.12 to 4.68, p = 0.001). No association was detected between nocturnal noise and DBP (b = 0.79, 95% CI: − 0.56 to 2.13, p = 0.253). Specifically, higher nocturnal noise was associated with higher BMI (b = 0.72, 95% CI: 0.07 to 1.38, p = 0.031) and SBP (b = 3.91, 95% CI: 2.51 to 5.31, p p = 0.008) after additionally adjusting for lifestyle, diagnosis of hypertension, psychometric constructs, and sleep. Conclusions Indoor nocturnal noise was associated with BMI and blood pressure in females but only blood pressure in males. It is important to control nocturnal noise or use soundproofing materials in buildings to reduce noise exposure.

Sleep problems are prevalent among the general population and can cause various health problems, which may lead to decreased quality of life. However, little is known about nonrestorative sleep and its implications. This study aimed to examine the association between nonrestorative sleep and health-related quality of life (HRQL) in Chinese adults. Data were collected through a cross-sectional study of 500 adults in Hong Kong (66.4% female, average age of 39 years). The Short-Form-12 Health Survey version 2 (SF-12v2), Nonrestorative Sleep Scale (NRSS), Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered. Objective sleep parameters were based on participants’ sleep condition over 1 week, as measured using an ActiGraph GT9X Link. Mean standardized scores for the physical component summary (PCS) and mental component summary (MCS) of the SF-12v2 and the NRSS were 50.33 ± 6.50, 49.00 ± 9.03, and 64.77 ± 12.75, respectively. After adjusting for sociodemographic and lifestyle characteristics, sleep quality, objective sleep parameters, social support, somatic symptoms, stress, anxiety, and depression, NRSS scores were associated with PCS (b = 0.12, 95%CI: 0.06 to 0.18, p

Men who have sex with men (MSM) use dating applications (apps) to explore various romantic and sexual relationships. This qualitative study aimed to describe HIV-negative MSM's experiences with app usage, the sexual activities arranged accordingly and their experiences in using dating apps to arrange sexual encounters. Thirty-one MSM who were sexually active and who used dating apps were recruited. Individual semi-structured interviews were conducted. Qualitative data were thematically analyzed to outline significant phenomena and perceptions. The factors associated with matching on apps included sex roles, human immunodeficiency virus serostatus and availability of a venue for meetup. Facilitated by these apps, diverse types of sexual encounters were arranged. Condoms were typically used for safer intercourse, except by people who were younger and inexperienced or when drugs were consumed before or during sex (chemsex). Extensive interest in non-penetrative sexual behaviors was expressed by our sample. Searching for post-exposure prophylaxis methods and/or sexual health screenings was common after exposure to risk of infections. Sexually abusive encounters were followed by changes in sex-searching habits and lowered trust in relationship formation. The results of this study are important for the development of appropriate interventions to promote safer sexual practices among HIV-negative MSM dating app users.

The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%–100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management.

To assess the overall relative risk of diabetes in individuals with prediabetes based on updated diagnostic criteria, as compared with individuals with normoglycaemia; and to identify the study characteristics associated with the heterogeneity between studies.Meta-analysis, meta-regression.PubMed, CINAHL, British Nursing Index. Search time frame: December 1998-December 2018.The pooled relative risk of developing diabetes among individuals with prediabetes compared with those with normoglycaemia was calculated under a random effects model. Studies reported the natural progression from prediabetes to diabetes were included in this review. Sources of study heterogeneity were examined by a meta-regression.Fifty-nine eligible studies were systematically identified. The pooled relative risk for diabetes among individuals with prediabetes as compared with normoglycaemia was 5.88 (95% CI: 5.02-6.89). The annualized incidence rate (per 1,000 person-year) for diabetes among individuals with prediabetes defined by different criteria varied from 2.20-212.15, with high heterogeneity between studies (IIndividuals with prediabetes had higher risk of developing diabetes than those with normoglycaemia. Races and diagnostic criteria of prediabetes were associated with the magnitude of the estimated risk.Prediabetes is a precursor of diabetes. To screen people with prediabetes as early as possible, practitioners could consider haemoglobin A1c test as an alternative to fasting plasma glucose test. Nurses should educate people especially Asians with prediabetes for the prevention of progression to diabetes.目的: 根据更新的诊断标准,与正常血糖的个体相比,评估糖尿病前期个体患糖尿病的总体相对风险;并确定与研究间异质性相关的研究特征。 设计: 荟萃分析、荟萃回归。 数据来源: PubMed、CINAHL、英国护理学索引。搜索时间范围:1998年12月至2018年12月。 审查方法: 在随机效应模型下,计算了与正常血糖个体相比,糖尿病前期个体患糖尿病的合并相对风险度。研究报告指出,从糖尿病前期发展为糖尿病的自然发展被纳入本审查中。通过荟萃回归检查了研究的异质性来源。 结果: 系统化地确定了59项符合条件的研究。与正常血糖个体相比,糖尿病前期个体患糖尿病的合并相对风险度为5.88(95%置信区间:5.02-6.89)。按不同标准定义的糖尿病前期个体的糖尿病年发病率(每1000人-年)在2.20-212.15不等,研究间异质性较高(I2=96.64%,Q检验:P.001)。在多变量荟萃回归分析中,与白种人相比,亚洲人的相对风险度显著增加。此外,‘糖化血红蛋白A1c升高或空腹血糖受损’的人群与其他类型的糖尿病前期人群相比,相对风险度最高。 结论: 糖尿病前期个体患糖尿病的风险血糖正常个体。糖尿病前期的个体类别和诊断标准与估计的风险量级有关。 影响: 糖尿病前期是糖尿病的前兆。为了尽早筛查糖尿病前期人群,医生可以考虑用血红蛋白A1c测试来代替空腹血糖检测。护士应提醒人们,尤其是糖尿病前期的亚洲人,以防止发展成糖尿病。.

IntroductionHealth information about COVID-19 has been circulating in social networking sites, including unproven claims that smoking and alcohol drinking could protect against COVID-19. We examined if exposure to such claims was associated with changes in tobacco and alcohol consumption.MethodsWe conducted a population-based, landline and mobile phone survey of 1501 randomly sampled adults aged 18 years or older (47.5% male) in Hong Kong in April 2020. Respondents reported if they had ever seen claims that ‘smoking/alcohol drinking can protect against COVID-19’ from popular social networking platforms. Current tobacco and alcohol users reported if they had increased or reduced their consumption since the outbreak. Prevalence data were weighted by sex, age and education of the general adult population.Results19.0% (95% CI 16.8% to 21.4%) of all respondents reported having seen claims that ‘smoking/alcohol drinking can protect against COVID-19’ from social networking sites. Multinomial logistic regression showed that exposure to the claims was significantly associated with increased tobacco use (OR 2.37, 95% CI 1.08 to 5.20) in current tobacco users (N=280) and increased alcohol use (OR 4.16, 95% CI 2.00 to 8.67) in current drinkers (N=722), adjusting for sex, age, education level, alcohol/tobacco use status, home isolation, anxiety and depressive symptoms, and survey method.ConclusionOur results first showed that exposure to health misinformation that smoking/alcohol drinking can protect against COVID-19 was associated with self-reported increases in tobacco and alcohol consumption in Chinese during the pandemic.

Purpose Previous research has suggested the essential unidimensionality of the 12-item traditional Chinese version of the Nonrestorative Sleep Scale (NRSS). This study aimed to develop a short form of the traditional Chinese version of the NRSS without compromising its reliability and validity. Methods Data were collected from 2 cross-sectional studies with identical target groups of adults residing in Hong Kong. An iterative Wald test was used to assess differential item functioning by gender. Based on the generalized partial credit model, we first obtained a shortened version such that further shortening would result in substantial sacrifice of test information and standard error of measurement. Another shortened version was obtained by the optimal test assembly (OTA). The two shortened versions were compared for test information, Cronbach’s alpha, and convergent validity. Results Data from a total of 404 Chinese adults (60.0% female) who had completed the Chinese NRSS were gathered. All items were invariant by gender. A 6-item version was obtained beyond which the test performance substantially deteriorated, and a 9-item version was obtained by OTA. The 9-item version performed better than the 6-item version in test information and convergent validity. It had discrimination and difficulty indices ranging from 0.44 to 2.23 and − 7.58 to 2.13, respectively, and retained 92% of the test information of the original 12-item version. Conclusion The 9-item Chinese NRSS is a reliable and valid tool to measure nonrestorative sleep for epidemiological studies.

Background Notably, both international and local studies have found a high prevalence of sexually transmitted infections (STIs) and risky sexual behaviours, such as condomless anal sex, substance misuse in conjunction with sex (‘chemsex’) and group sex, among men who have sex with men (MSM) dating application (app) users. Although the use of dating apps is an emerging sexual risk factor, little effort has been expended on the promotion of safe sex and good sexual health among the users of those apps. Therefore, the aim of the proposed study is to develop and evaluate the effectiveness of an interactive web-based intervention in improving the sexual health of MSM dating app users in Hong Kong. Methods A two-armed randomised controlled trial will be conducted. Chinese MSM dating app users will be recruited and randomly allocated into either the intervention (n = 200) or control group (n = 200). Subjects in the intervention group will receive the web-based intervention containing interactive content that (1) encourages a positive attitude towards consistent condom use and HIV/STI testing and negative attitude towards chemsex and group sex; (2) positions condom use and regular HIV/STI testing as normative; and (3) targets improved perceived self-efficacy concerning condom use and negotiation and HIV/STI testing. The control group will receive only web-based information without sexual health components. Subjects in both groups will be evaluated at baseline and three and 6 months after baseline. The primary outcome will be the frequency of condomless anal sex in the past 3 months. Discussion The proposed study will aid development of culturally relevant health promotion programmes aimed at minimising the potential harm of dating app use and promoting the sexual health of MSM dating app users. The web-based intervention, if found successful, will have important clinical and policy implications, as it can be adopted by the government and non-governmental organisations targeting MSM. Moreover, the proposed intervention can reach many MSM at relatively low cost, and thus has the potential to check the burgeoning HIV/STI epidemic among MSM in Hong Kong in a cost-effective manner. Trial registration International standard randomized controlled trial number (ISRCTN) registry: ISRCTN16681863 registered on 28 April 2020.

ImportanceThe degree to which health and economic outcomes of musculoskeletal disorders are attributable to high body mass index (BMI) has not been quantified on a global scale.ObjectiveTo estimate global health and economic outcomes associated with musculoskeletal disorders—low back pain (LBP), gout, and osteoarthritis attributable to high BMI in 2019.Design, Setting, and ParticipantsThis cross-sectional study used data of 192 countries and territories from the Global Burden of Diseases, Injuries, and Risk Factors Study, World Health Organization Global Health Expenditure, World Bank, and International Labour Organization databases. Data analyses were conducted from February 24 to June 16, 2022.Main Outcomes and MeasuresPrevalence, years lived with disability (YLDs), health care costs, and productivity losses due to morbidity from LBP, gout, and osteoarthritis attributable to high BMI by region and country. Prevalence and YLDs were calculated with the population attributable fraction approach. The economic burden, including health care costs and productivity losses due to morbidity, was also quantified. Health care costs borne by the public, private, and out-of-pocket sectors were estimated based on their corresponding payment shares. Productivity losses were estimated based on the output per worker. A sensitivity analysis was conducted to arrive at the base, minimum, and maximum estimates (ie, uncertainty interval [UI]) by using the mean, lower, and upper bounds of all input variables.ResultsHigh BMI was estimated to be responsible for 36.3 million (UI, 18.4-61.0 million), 16.9 million (UI, 7.5-32.5 million), and 73.0 million (UI, 32.4-131.1 million) prevalent cases of LBP, gout, and osteoarthritis, respectively, which accounted for 7.3 million (UI, 3.0-15.0 million) YLDs across 192 countries and territories in 2019. Globally, the YLDs of musculoskeletal disorders attributable to high BMI accounted for 1.0% of all-cause YLDs in the working-age population aged 15 to 84 years. The global total costs of musculoskeletal disorders attributable to high BMI reached $180.7 billion (UI, $83.8-$333.1 billion), including $60.5 billion (UI, $30.7-$100.5 billion) in health care costs and $120.2 billion (UI, $53.1-$232.7 billion) in productivity losses. In terms of the global health care costs, 58.9% ($35.6 billion; UI, $17.8-$59.6 billion) was borne by the public sector, 24.0% ($14.5 billion; UI, $7.8-$23.2 billion) by the private sector, and 17.1% ($10.3 billion; UI, $5.1-$17.6 billion) by the out-of-pocket sector. On average, the total costs accounted for 0.2% of global gross domestic product. Great inequalities in the disease and economic burden existed across regions and countries. Nearly 80% of global health care (82.4%) and morbidity-related costs (82.9%) were paid by high-income countries, whereas more than 60% (61.4%) of global YLDs occurred in middle-income countries.Conclusions and RelevanceIn this cross-sectional study of 192 countries and territories, a substantial amount of the health and economic impact of musculoskeletal disorders was attributable to high BMI. Developing effective policies and active participation from health professionals to prevent excessive weight gain are needed. More available estimates are also needed to facilitate a global analysis.

Young mothers face considerable challenges that can affect their mental health, with anxiety being one of the most common mental health problems observed in this population. Furthermore, pregnancy is one of the risk factors for intimate partner violence (IPV). There is thus an urgent need to explore the IPV risk faced by young mothers and its association with their mental health, anxiety in particular. The study aimed to investigate the correlation between IPV victimization and anxiety in young mothers, as well as the protective effects of social support and resilience. A total of 79 young Chinese mothers aged 16 to 25 were recruited from a special service project for young parents in Hong Kong. Just more than half (50.6%) were found to have experienced psychological aggression by their current partner, with 26.6% and 13.9%, respectively, having experienced physical assault and sexual abuse. Roughly a quarter (25.3%) perceived themselves to suffer from moderate or severe generalized anxiety disorder. Logistic regression further showed the young mothers who had experienced physical assault and/or sexual abuse by their current partners to be at least six times likelier to have moderate or severe anxiety disorder (adjusted odds ratio [aOR] = 4.51, p < .05) than those who had experienced no such violence. Young mothers with less perceived social support (aOR = 0.77, p < .01), a lower secondary level of education or below (aOR = 12.99, p < .05), and in receipt of social security assistance (aOR = 5.69, p < .05) were also likelier to have moderate or severe anxiety disorder. The results indicate the importance of social support during the critical period of young motherhood. Health care professionals need to remain alert to the impacts of IPV victimization and the risk of anxiety in young mothers with a low level of education and/or receiving financial support.

BACKGROUND Engaging students in interprofessional education for higher order thinking and collaborative problem-solving skills is challenging. This study reports the development of Virtual ER, a serious game played on a virtual platform, and how it can be an innovative way for delivering interprofessional education to medical and nursing undergraduates. OBJECTIVE We report the development of a serious online game, Virtual ER, and evaluate its effect on teamwork enhancement and clinical competence. We also explore if Virtual ER can be an effective pedagogical tool to engage medical and nursing students with different learning styles. METHODS Virtual ER is a custom-made, learning outcome–driven, case-based web app. We developed a game performance scoring system with specific mechanisms to enhance serious gaming elements. Sixty-two students were recruited from our medical and nursing programs. They played the games in teams of 4 or 5, followed by an instructor-led debriefing for concept consolidation. Teamwork attitudes, as measured by the Human Factors Attitude Survey, were compared before and after the game. Learning style was measured with a modified Honey and Mumford learning style questionnaire. RESULTS Students were satisfied with Virtual ER (mean satisfaction score 5.44, SD 0.95, of a possible 7). Overall, Virtual ER enhanced teamwork attitude by 3.02 points (95% CI 1.15-4.88, P=.002). Students with higher scores as activists (estimate 9.09, 95% CI 5.17-13.02, PP=.01) had a significantly higher degree of teamwork attitude enhancement, while students with higher scores as theorists and reflectors did not demonstrate significant changes. However, there was no difference in game performance scores between students with different learning styles. CONCLUSIONS There was considerable teamwork enhancement after playing Virtual ER for interprofessional education, in particular for students who had activist or pragmatist learning styles. Serious online games have potential in interprofessional education for the development of 21st century life skills. Our findings also suggest that Virtual ER for interprofessional education delivery could be expanded locally and globally.

Background The COVID‐19 pandemic has been associated with excess mortality and reduced emergency department attendance. However, the effect of varying wave periods of COVID‐19 on in‐hospital mortality and length of stay (LOS) for non‐COVID disease for non‐COVID diseases remains unexplored. Methods We examined a territory‐wide observational cohort of 563,680 emergency admissions between January 1 and November 30, 2020, and 709,583 emergency admissions during the same 2019 period in Hong Kong, China. Differences in 28‐day in‐hospital mortality risk and LOS due to COVID‐19 were evaluated. Results The cumulative incidence of 28‐day in‐hospital mortality increased overall from 2.9% in 2019 to 3.6% in 2020 (adjusted hazard ratio [aHR] = 1.22, 95% CI 1.20 to 1.25). The aHR was higher among patients with lower respiratory tract infection (aHR: 1.30 95% CI 1.26 to 1.34), airway disease (aHR: 1.35 95% CI 1.22 to 1.49), and mental disorders (aHR: 1.26 95% CI 1.15 to 1.37). Mortality risk in the first‐ and third‐wave periods was significantly greater than that in the inter‐wave period (p‐interaction

To explore associations of screen time (total, mobile gaming) with sleep problems in Chinese young adults.This was a 4-week daily morning (completion rate = 82.1%, 909/1107) and evening (completion rate = 92.4%, 1061/1148) assessment study in 41 university students (22 female, mean age = 22.3 [SD 4.2] years). Short sleep duration 7 h, difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and any of these three insomnia symptoms were self-reported in the morning. Mobile gaming time was self-reported in the evening, whilst total screen time was objectively tracked. Bayesian multilevel mixed-effects modeling disaggregated between- and within-person associations.Between person, longer mobile gaming time predicted short sleep duration (adjusted odds ratio [AOR] = 1.90, 95% CI 1.39, 2.69), any insomnia symptoms (AOR = 1.59, 95% CI 1.20, 2.11), difficulty initiating sleep (AOR = 3.05, 95% CI 1.51, 6.24), and difficulty maintaining sleep (AOR = 2.19, 95% CI 1.18, 3.74). Short sleep duration (adjusted b = 0.99, 95% CI 0.05, 1.95), any insomnia symptoms (adjusted b = 1.19, 95% CI 0.24, 1.94), and difficulty initiating sleep (adjusted b = 1.72, 95% CI 0.11, 3.19) reversely increased mobile gaming time. Within person, any insomnia symptoms (adjusted b = 0.17, 95% CI 0.04, 0.31) and early morning awakening (adjusted b = 0.28, 95% CI 0.08, 0.48) increased next-day mobile gaming time. Total screen time was not associated with sleep problems both between and within person.Bidirectional between-person associations of mobile gaming time with short sleep duration and insomnia symptoms informed multiple-health-behavior-change interventions. Unidirectional within-person associations of insomnia symptoms with next-day mobile gaming time informed just-in-time adaptive interventions addressing daily variations in insomnia symptoms. [250/250 word limits].

This cohort study assesses the incidence of emergency department (ED) visits in Hong Kong, China, for sexual abuse among youth before and during the COVID-19 pandemic.

Intimate partner violence (IPV) exists in various forms including physical, psychological, sexual, and economic. Although abundant literature documented the association between physical, psychological, or sexual violence with the associated mental well-being outcomes on survivors, the literature on economic violence, and its consequences were insufficient. In the past, most of the literature captured economic abuse within the scope of psychological abuse. However, different from psychological abuse, survivors of economic abuse may directly suffer from deteriorating economic well-being. Therefore, there is a need to explicitly investigate economic abuse. This paper aims to critically appraise and summarize the instruments of economic abuse and the associated mental well-being outcomes on women. This study highlights the lack of vigorous study in the area and also an underreporting of the negative impact of economic abuse. The implications and future research directions are discussed.

Aims and objectives This study aimed to evaluate the effect of a virtual simulation education programme with debriefing in undergraduate nursing students. Perceived clinical competence and learning needs of students in a simulation environment were also measured. Background Evidence showed virtual simulation education programmes provided better knowledge acquisition. However, these studies to date did not incorporate virtual simulation in the combination of a debriefing model in nursing students. Design A one-group pre-test and post-test design. Methods 188 final year undergraduate nursing students participated in the study. Linear mixed model analysis was conducted to evaluate the effect of the programme. Results Students have perceived a significant improvement in clinical competence and nursing process. Self-efficacy has also boosted. Communication and critical thinking were applied better in the traditional clinical environment. Conclusion Perceived clinical competence of Chinese nursing students has significant improvements by using virtual simulation combining a debriefing model during the COVID-19 period. Virtual simulation met students' learning needs. Future studies should include a control group for comparison and long-term measurement. Relevance to clinical practice The study provided an innovative clinical learning pedagogy to serve as a potential alternative with traditional clinical practicum during the COVID-19 period as this is substantially limited.

Using information communication technologies as information sources of COVID-19 was associated with psychological problems, but mechanisms remain uncertain. We examined associations of COVID-19 information sources and information overload with psychological distress symptoms and explored the mediating effect of information overload in Hong Kong. A random sample of Chinese adults (N = 1501; 52.6% females; 55.0% aged 30–59) from dual landline and online surveys in April 2020 reported frequency of using traditional media, internet websites, social networking sites, instant messaging, and online discussion forums as COVID-19 information sources. Psychological distress symptoms were measured using the Patient Health Questionnaire 4-item ([PHQ-4]; 0–12). Information overload defined as a perception of being overwhelmed was measured (1–6). Linear regressions were performed to analyze the associations, and the mediating effect of information overload was examined. Greater PHQ-4 score was observed for frequent use of internet websites (adjusted b = 0.58, 95% CI 0.29, 0.87, adjusted β = 0.12) and online discussion forums (adjusted b = 0.39, 95% CI 0.08, 0.70, adjusted β = 0.08) and information overload (adjusted b = 0.54, 95% CI 0.44, 0.63, adjusted β = 0.28). Information overload mediated 44.9% and 36.9% of associations of frequent use of internet websites and online discussion forums with PHQ-4 score, respectively. Frequent use of social networking sites was associated with lower PHQ-4 score (adjusted b = −0.37, 95% CI −0.69, −0.04, adjusted β = −0.07) partially through lower information overload (37.5%). Psychological distress symptoms were associated with frequent use of internet websites and online discussion forums as COVID-19 information sources, which were mediated through information overload.

Background Engaging students in interprofessional education for higher order thinking and collaborative problem-solving skills is challenging. This study reports the development of Virtual ER, a serious game played on a virtual platform, and how it can be an innovative way for delivering interprofessional education to medical and nursing undergraduates. Objective We report the development of a serious online game, Virtual ER, and evaluate its effect on teamwork enhancement and clinical competence. We also explore if Virtual ER can be an effective pedagogical tool to engage medical and nursing students with different learning styles. Methods Virtual ER is a custom-made, learning outcome–driven, case-based web app. We developed a game performance scoring system with specific mechanisms to enhance serious gaming elements. Sixty-two students were recruited from our medical and nursing programs. They played the games in teams of 4 or 5, followed by an instructor-led debriefing for concept consolidation. Teamwork attitudes, as measured by the Human Factors Attitude Survey, were compared before and after the game. Learning style was measured with a modified Honey and Mumford learning style questionnaire. Results Students were satisfied with Virtual ER (mean satisfaction score 5.44, SD 0.95, of a possible 7). Overall, Virtual ER enhanced teamwork attitude by 3.02 points (95% CI 1.15-4.88, P=.002). Students with higher scores as activists (estimate 9.09, 95% CI 5.17-13.02, P Conclusions There was considerable teamwork enhancement after playing Virtual ER for interprofessional education, in particular for students who had activist or pragmatist learning styles. Serious online games have potential in interprofessional education for the development of 21st century life skills. Our findings also suggest that Virtual ER for interprofessional education delivery could be expanded locally and globally.

Objective: To evaluate the effects of family-based mindfulness intervention (FBMI) to promote the stress management and early development of economically disadvantaged families. Method: Families receiving social security allowance and full textbook allowance and with children aged 5–7 were recruited. Participants were randomized to an FBMI with parallel programs for parents and children ( n = 51) and to a wait-list control condition ( n = 51). Results: Intent-to-treat analyses showed more significant improvements in child attention, self-regulation, and in parenting stress, in the intervention group than in the control group. At-risk group analyses showed that the high stress group benefited in small to moderate effect sizes in parenting stress and depression, and in moderate to large effect sizes in child behavioral problem and self-regulation. Conclusions: The results provide preliminary support that FBMI can alleviate the impact of economic disadvantage. FBMI should be applied in social work practice to support disadvantaged families.

Background eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. Objective This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. Methods The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. Results The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend Conclusions Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic.