Search

Angie Ho Yan Lam,1 Yee Tak Derek Cheung,1 Kwan Ho Wong,2 Sau Fong Leung,3 Wai Tong Chien4 1School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; 2Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; 3School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; 4The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative RegionCorrespondence: Angie Ho Yan LamSchool of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative RegionEmail angielam@hku.hkIntroduction: Studies have shown that rumination plays a significant mediating role between dispositional mindfulness (DM) and psychopathological symptoms in both clinical and non-clinical populations. However, no studies have examined this pathway in people with schizophrenia spectrum disorders (SSDs).Methods: A cross-sectional, clinician-administered survey was conducted among people with SSDs (n = 52) in a community setting. Participants completed the Chinese versions of the Depression Anxiety Stress Scale, Five Facet Mindfulness Questionnaire-Short Form, Psychotic Symptom Rating Scale and Scale for the Assessment of Negative Symptoms. Structural equation modelling was performed to examine the pathways of mindfulness facets, rumination, negative emotions and psychotic symptoms.Results: Two facets of mindfulness (nonjudging and acting with awareness) reduced rumination and negative emotional status. Rumination fully mediated the relationship between nonjudging and negative emotions and partially mediated the relationship between acting with awareness and negative emotions. Furthermore, rumination and negative emotions sequentially mediated the relationship between acting with awareness and hallucination (B = − 0.44, 95% confidence interval [CI] = − 0.338 to − 0.045, p = 0.01) and between nonjudging and hallucination (B = − 0.356, 95% CI = − 0.255 to − 0.008, p = 0.034). The model fit the data well (χ2(2) = 1.318, p = 0.517, Tucker–Lewis index = 1.075, comparative fit index = 1, standardised root mean residual = 0.0251, root mean square error of approximation = 0.0001).Conclusion: Rumination and negative emotions serially mediated the relationship between DM and hallucination. The findings support the contribution of changes across transdiagnostic mediators underlying the therapeutic effects of mindfulness training. Further research examining the transdiagnostic processes of DM in influencing clinical outcomes in SSDs is warranted.Keywords: schizophrenia spectrum disorders, psychosis, negative emotions, depression, anxiety, stress, rumination, psychotic symptoms, mindfulness

Angie Ho Yan Lam,1 Sau Fong Leung,2 Jessie Jingxia Lin,1 Wai Tong Chien3 1School of Nursing, The University of Hong Kong, Hong Kong; 2School of Nursing, The Hong Kong Polytechnic University, Hong Kong; 3The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong KongCorrespondence: Angie Ho Yan LamSchool of Nursing, the University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong KongTel +852 3917 6975Fax +852 2872 6079Email angielam@hku.hkBackground: Emotion dysregulation has emerged as a transdiagnostic factor that potentially exacerbates the risk of early-onset, maintenance, and relapse of psychosis. Mindfulness is described as the awareness that emerges from paying attention to the present moment without judgment. It gently pulls the mind out of the negative emotions induced by the disparity between expectation and reality by focusing on the present moment, instead of worrying about the future or regretting the past. However, only a few research has ever focused on the efficacy of using a mindfulness-based intervention to improve emotion regulation in schizophrenia spectrum disorders.Purpose: The purpose of this study was to examine the effectiveness of a Mindfulness-Based Psychoeducation Programme (MBPP) on the emotion regulation of individuals with schizophrenia, in particular, to access emotion regulation strategies. The objective of this study was to find out whether MBPP is feasible for improving emotion regulation strategies, in terms of rumination, cognitive reappraisal, and expressive suppression, with a sustainable effect at a three-month follow-up.Patients and Methods: A single-blinded pilot randomised controlled trial with repeated-measures designs was adopted. Forty-six participants diagnosed with schizophrenia and its subtypes were randomised in either the 8-week mindfulness-based psychoeducation programme or treatment-as-usual (control) group.Results: The results of the Generalised Estimating Equations test indicated that the MBPP group showed a significant improvement in reappraisal at a three-month follow-up (β = − 6.59, Wald’s χ2=4.55, p=0.033), and a significant reduction in rumination across time. However, the Generalised Estimating Equations indicated no significant difference in rumination and expressive suppression in the MBPP group. Two participants reported having unwanted experiences, including feelings of terror and distress during the mindfulness practice.Conclusion: The MBPP appeared to be effective for improving emotion regulation, which will contribute to future large-scale RCT to confirm the treatment effects in more diverse groups of schizophrenic patients.Keywords: schizophrenia, mindfulness, emotion regulation, reappraisal, suppression, rumination

Wai Tong Chien, Sau Fong Leung, Frederick KK Yeung, Wai Kit Wong School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Abstract: Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients' long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major healthcare databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services. Keywords: schizophrenia, psychosocial intervention, patient-focused perspectives

Goals Of Work: This study determined the incidence of severe oral mucositis (OM), patients' self-reported moderate and severe oral symptoms, and change of quality of life (QoL), as well as examined whether OM severity and pain scores predicted the impairment of oral function and QoL.Patients and Methods: A multicenter approach was used and 137 patients treated with stomatotoxic chemotherapy (45%), high-dose myeloablative chemotherapy with or without concomitant total body irradiation (12%), head and neck irradiation with or without concomitant chemotherapy (44%) completed the OM-specific QoL measure (OMQoL) once or twice weekly over a 4- or 10-week period, along with concurrent measures of OM using WHO Mucositis Grading System and oral symptoms using 10 cm visual analog scale.Main Results: The incidence of severe OM was 50% (n = 68). About 77-80% of patients with severe OM reported moderate or severe mouth or throat pain, and 66-78% reported moderate or severe oral functional problems. The oral symptoms peak and area-under-the-curve (AUC) scores of patients with severe OM (peak 5.6 to 6.8; AUC 3.8 to 5.2) were significantly higher than those without OM and those with mild OM (p < 0.01). The OMQoL subscales peak and AUC scores of patients with severe OM (peak 47.9 to 62.1; AUC -40.1 to -25.8) were significantly lower than those without OM and those with mild OM (p < 0.01). Of those with severe OM, 88-94% had a drop in the OMQoL subscale scores to at least 10 points from the baseline. Pain resulting from OM, in particular throat pain, is most predictive of oral functional impairment (standardized β = 0.53-0.83).Conclusions: Severe OM can cause profound pain and oral functional incapability and clinical significant impairment of QoL. [ABSTRACT FROM AUTHOR]

The aim of the study was to document MRI findings in masticator structures in patients with trismus developing after radiotherapy for nasopharyngeal carcinoma (NPC). MRI neck examinations were reviewed in 35 patients with marked trismus, defined as an interincisal gap of 25 mm or less, post-radiotherapy for NPC. Patients with trismus before treatment, infiltration of masticator structures at the time of trismus, or previous surgery involving the masticator structures were excluded. Sixteen patients had no significant abnormality in their masticator structures (46%). Nineteen patients (54%) had abnormalities comprising radiotherapy-induced masticator muscle fibrosis (n = 19), denervation atrophy of the masticator muscles secondary to mandibular nerve damage (n = 1), mandibular ramus signal abnormalities (n = 5), mandibular condyle sclerosis with or without capsular thickening (n = 5), perimasticator fibrosis extending into the masticator space (n = 3) and inflammation secondary to severe sinusitis extending into the masticator space (n = 2). Nine patients (26%) had more than one type of abnormality. Twenty-two patients (63%) had concomitant skull base osteoradionecrosis which extended into the pterygoid bases in 16 patients (45%). The presence of several MRI abnormalities in the masticator structures of patients with trismus after radiotherapy suggests that trismus is multifactorial. This study advances the understanding of mechanisms behind this debilitating side effect of radiotherapy. [ABSTRACT FROM AUTHOR]

The aim of this study was to document the sites and MRI features of radiation-induced tumors (RITs) in the head and neck following treatment for nasopharyngeal carcinoma (NPC). The MRI examinations and clinical records of 20 patients with 21 RITs were reviewed retrospectively. RITs developed 3-30 years after radiotherapy and included eleven squamous cell carcinomas, six sarcomas, two neuroendocrine carcinomas, one mucoepidermoid carcinoma and one meningioma. RITs arose in the maxillary region (9), oro/hypopharynx and oral cavity (5), external auditory canal (4), nasopharynx and sphenoid sinus (2) and brain (1). Radiation-induced carcinoma and sarcoma had MRI features that were useful to distinguish them from recurrent NPC. To improve early detection of RITs, the check areas on an MRI of a patient with previous NPC treated by radiation should always include the maxillary region, tongue, and external auditory canal/temporal bone. [ABSTRACT FROM AUTHOR]

Goals Of Work: An oropharyngeal mucositis (OM)-specific health-related quality of life measure (OMQoL) has been developed to assess the impact of OM from the perspective of patients. The current paper describes the convergent, concurrent, and known-group validities and responsiveness in relation to clinical and health outcomes.Materials and Methods: A multicenter approach was used, and 137 patients treated with different cancer therapies completed the OMQoL and the European Organization for Research and Treatment of Cancer Quality of Life questionnaire [EORTC QLQ-C30 (Ch)] twice over a 4-week period or weekly over a 7-week period, along with concurrent measures of OM and its related symptoms.Main Results: The OM-related symptom scores correlated highly with the OMQoL, confirming its convergent validity (r = -0.724--0.971, p < 0.01). Moderate correlations between the subscales of the OMQoL and EORTC QLQ-C30 (Ch) were indicative of good concurrent validity (r = 0.450-0.724, p < 0.01). The OMQoL was able to distinguish between patients with different severities of OM (p < 0.01) and types of cancer therapy (p < 0.01), providing evidence of good known-group validity. The changes in effects sizes corresponding to changes in OM curves indicate that the OMQoL is responsive to changes in OM status.Conclusions: These findings suggest that the OMQoL has very good psychometric properties and can be used as a health-related quality of life assessment for cancer patients with OM. Much work is still needed in strengthening the psychometric qualities and interpretability of the OMQoL by demonstrating its ability to detect outcome changes over time. [ABSTRACT FROM AUTHOR]

BACKGROUND: Eating disorders are affecting an increasing number of high school students in Western and Asian countries. The availability of an effective screening tool is crucial for early detection and prompt intervention. OBJECTIVE: The objective of this study was to examine the validity and reliability of the SCOFF questionnaire for screening eating disorders in Hong Kong high school students. DESIGN: This study adopted a cross-sectional design to examine the psychometric properties of the SCOFF questionnaire. PARTICIPANTS: A panel of 7 experts and 936 students of a high school participated in the study. METHOD: The SCOFF questionnaire was translated into Chinese and back-translated into English to ensure the linguistic equivalence. A panel of 7 experts involved in the content validation of the SCOFF questionnaire. The Eating Disorder Examination-Questionnaire (EDE-Q) was used as the 'reference standard' to assess its concurrent validity in 936 students of a high school. Its reliability was examined by internal consistency and the test-retest method at a 2-week interval and with 38 students. RESULTS: The SCOFF questionnaire achieved an agreement of 86-100% among the experts for the content relevance. Of 812 students (86.8%) who responded to this study, their SCOFF scores correlated significantly with their global scores on the EDE-Q (r=0.5, P<0.01). Students identified as potentially having eating disorders had significantly higher scores in the EDE-Q than those not identified as such by SCOFF. The SCOFF questionnaire demonstrated moderate test-retest reliability (ICC=0.66) and an acceptable internal consistency reliability (Cronbach's alpha=0.44-0.57) in comparing with previous studies. CONCLUSION: The SCOFF questionnaire has acceptable psychometric properties in the Chinese culture. It will be useful for detecting potential eating disorders and assisting health promotion activity. [ABSTRACT FROM AUTHOR]

Background: The epidermal growth factor receptor (EGFR) is commonly overexpressed in nasopharyngeal carcinoma (NPC) and gefitinib inhibits NPC growth in vitro. Method: Patients who progressed after prior platinum-based chemotherapy for recurrent NPC were given gefitinib orally at 500 mg/day at a 28-day cycle. Plasma Epstein-Barr virus (pEBV) DNA levels were obtained at specific intervals. Results: Sixteen patients enrolled and 15 were evaluable for response. The median age was 49 years (range 34-64 years), and most patients were males with metastatic NPC. No objective response was seen and three patients had stable disease (SD) for 2.8 to 8.5 months. Radiological progression of disease coincided with rising levels of pEBV DNA in most patients, while the level of a patient with the longest duration of SD fell to an undetectable level at study completion. The mean time to progression and overall survival was 2.7 (standard error, SE +/- 0.5 months) and 12 months (SE +/- 1.7 months), respectively. No unexpected drug-related toxicities were seen. The study was prematurely terminated because there was insufficient activity to warrant progression to the second stage of accrual. Conclusion: This study found limited activity of gefitinib in recurrent NPC. Further evaluation of pEBV DNA as a biomarker of response in clinical trials of target-based agents is warranted. [ABSTRACT FROM AUTHOR]

AIM: The study aims to explore the supportive behaviour of nurses as experienced by mothers of premature infants in Hong Kong. BACKGROUND: The sudden, unexpected delivery of a premature infant is an extreme shock to parents. Studies have confirmed the importance of nursing support to the relief of stress of parents. DESIGN: A descriptive study design. METHODS: A convenience sampling of 37 mothers in a neonatal Intensive Care Unit were recruited from a regional hospital to complete the 'Nurses Parent Support Tool' (NPST) which consists of four aspects: communication information support, emotional support, parental esteem support and quality care-giving support. Six mothers were interviewed after the completion of the tool to give examples of supportive and non-supportive behaviour. RESULTS: The results showed that all of the mothers rated all nursing support items as important. However, there was a significant mean difference between perceived and received nursing support. These findings demonstrated that parents desired more nursing support than they received, particularly in the area of supportive communication and the giving of information. Comparatively, emotional support was rated less important as well as having been less often received than the other three domains of support. Interviews with six mothers further gave examples and described the types, attributes and the phases of support in the Chinese setting. CONCLUSION: The findings indicate that Chinese parents are desirous of more nursing support than they received. RELEVANCE TO CLINICAL PRACTICE: Nurses should be aware of the importance of tailoring nursing support to meet the needs of parents of premature infants. [ABSTRACT FROM AUTHOR]

This research aimed to test the validity and reliability of the 'World Health Organization Mental Disorders Checklist' for use in a telehealth clinic in Hong Kong. The Checklist adopted four subscales: (i) depression; (ii) anxiety; (iii) alcohol use disorders; and (vi) functioning and disablement, and was translated from English into Chinese. It was validated by a panel of five experts to confirm its content validity (content validity index = 0.98) and cultural appropriateness in Hong Kong. The reliability of the checklist was supported by the findings of a test-retest procedure (Pearson correlation = 0.66-0.88, P < 0.01), internal consistency reliability (Cronbach's alpha = 0.54-0.83), and interrater reliability (Kendall's coefficient of concordance = 0.58-1.00, P < 0.01) involving a sample of 197 subjects from one telehealth clinic in Hong Kong. [ABSTRACT FROM AUTHOR]

Nasopharynx cancer (NPC) occurs frequently in southern China. Radiotherapy (RT) is the standard treatment for this cancer, and weight loss is commonly observed during and for a prolonged period after RT. The determinants of this phenomenon are not well known. The nutritional status of 38 NPC patients was assessed serially before and for a 6-mo period after RT. Body weight, body composition (by dual X-ray absorptiometry), basal metabolic rate (BMR, by indirect calorimetry), and calorie intake (by 3-day dietary record) were documented at pre-RT (T0), end-RT (T1), 2 mo post-end-RT (T2), and 6 mo post-end-RT (T3). The BMI at end-RT was 21.5 +- 3.7 kg/m2 (range = 13.7-27.9 kg/m2) and was significantly lower than that at pre-RT (P < 0.001). Body weight at T1-T3 was significantly lower than that at T0 (P < 0.001). Mean percentage weight loss was 10.8% at end-RT. Fifty-five percent of patients (20 of 30) had 10% weight loss by the end of RT. BMR corrected for body weight did not change significantly among the four time points, but BMRs corrected for lean body mass at T2 and T3 were significantly lower than that at T0 (P < 0.01). Patients' calorie intake generally declined from T0 to T1 (from 1,857 P < 411 kcal to 11,68 +- 549 kcal, P < 0.001) and then increased from T1 to T3. The calorie intakes at T2 and T3 were not significantly different from that at T0 but were significantly higher than that at T1. Patients were in negative energy balance before, during, and up until 6 mo after RT. The recovery in body weight lagged behind the recovery of dietary intake. Eighty-two percent of NPC patients had significant weight loss and was in negative energy balance at the end of RT, which persisted for at least 6 mo. This finding suggests that there is room for improvement in the nutritional status of patients with NPC treated with RT. [ABSTRACT FROM AUTHOR]

Parapharyngeal tumor invasion is a known predictor of distant recurrence in stage II-III nasopharyngeal carcinoma (NPC). This study evaluated the prognostic significance of parapharyngeal and cavernous sinus vascular invasion in stage III-IV NPC, and its association with plasma Epstein-Barr virus (pEBV) DNA, disease stage, tumor volume and metabolic activity. Eligible patients underwent magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose (FDG)-positron-emission tomography (PET) and blood sampling for pEBV DNA before undergoing concurrent chemoradiotherapy. Relationship between treatment outcome and tumor vascular invasion was analyzed using Cox regression. Logistic regression was used to analyze the association between vascular invasion and other cofactors. Fifty seven patients with predominantly T3-T4 or N2-N3 stage disease were enrolled. Parapharyngeal invasion was present in 56% and cavernous sinus invasion in 19% of tumors. Multivariate analysis showed that tumor vascular invasion did not predict treatment outcome, while tumor FDG-uptake was the only significant factor that predicted survival and recurrence. Tumor vascular invasion was associated with T-stage, but not pEBV DNA or tumor volume. Parapharyngeal and cavernous sinus invasion were not significant predictors of distant recurrence following chemoradiotherapy in our cohort with locoregionally advanced NPC. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is heavily stigmatized among health professionals. Given that health professional students are future members of the workforce and will provide care for people with schizophrenia, it is essential to implement interventions aimed at reducing stigma among this group., Objective: This scoping review aimed to identify and synthesize existing literature on interventions to decrease schizophrenia stigma among health professional students, and to determine the possible gaps in the literature., Design: Nine electronic databases and gray literature were searched, including PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure, WanFang, and Google on 5 May 2023. Two researchers independently conducted data screening, data extraction, and assessed study risks. A most updated search was also done on 22 May 2024. The Cochrane risk of bias tool version 2 for randomized trials and Risk of Bias in Non-randomized Studies were used to assess the studies' risk of bias. Data synthesis and analysis were conducted by two reviewers using a narrative approach. Reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews., Results: This review included twenty-one studies with 2520 health professional students. The majority of included studies were non-randomized controlled trials (38 %) and pre-post studies (52 %). Most of the included studies were conducted in the United States (24 %). The participants in ten (48 %) studies were medical students. The number of intervention sessions ranged from one to 13, with an average of three. Seven (33 %) studies had an intervention duration of less than four weeks and 16 (76 %) studies had no follow-up. Various scales were used to assess the outcomes of schizophrenia stigma. Only two studies (10 %) indicated the intervention's ineffectiveness, with the majority of interventions led by psychiatry department faculty and individuals with schizophrenia., Conclusions: Most studies (90 %) utilized various approaches, including face-to-face or online education, direct contact with individuals with schizophrenia, or a combination thereof, to diminish stigma among health professional students. However, none addressed cultural and empathy factors in their intervention designs, and the included studies lacked theoretical guidance. The review only comprised English quantitative studies with significant heterogeneity, with 17 studies (81 %) displaying serious or high risk of bias, limiting comprehensive discussions. These findings offer valuable insights for future systematic review., Tweetable Abstract: Studies on reducing health professional students' schizophrenia stigma need to address cultural and empathy factors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Adverse and benevolent childhood experiences (ACEs and BCEs) impact health across the lifespan. No known study has investigated these associations across different health domains using a representative adult sample. This study examined the associations between adult physical, mental, and behavioral health with ACEs and BCEs based on two ACEs conceptualizations., Method: A cross-sectional population-based survey was conducted in Hong Kong. Thirteen ACEs were measured and conceptualized as cumulative ACE scores and ACE patterns. Self-reports of BCEs; 10 physical health problems; current mental health; posttraumatic stress; history of diagnosed mental illness; suicidal thought and suicide attempt; and engagement in three health risk behaviors (smoking, illicit substance misuse, binge drinking) were also included. A series of regression analyses were conducted to examine the association between childhood experiences and health., Results: In a random sample of 1,070 Hong Kong adults ( M age = 41.78 years; 53.93% female; mean ACEs = 1.64), 649 (60.65%) reported at least one ACE. Four ACE patterns were identified ( Low ACEs, Household Instability, Household Violence, and High ACEs ). Higher ACE scores associated with poorer health in a dose-response fashion. Two ACE patterns shared similar average ACE scores but differentially linked with outcomes across health domains. High BCEs negatively associated with mental and behavioral health problems., Conclusions: Public health responses to ACEs should consider both the accumulation and co-occurrence of ACE exposure. Schools, neighborhoods, and the wider community should take an active role in helping children and families create more positive experiences as a universal prevention strategy to safeguard population health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China., Methods: This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses., Results: The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians., Conclusions: There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings., (© 2024. The Author(s).)

Purpose: Chemotherapy-induced neurotoxicity in breast cancer survivors requires attention as their population are increasing. Limited qualitative study is known about breast cancer survivors' perspectives on regular walking exercise to improve post-chemotherapy neurotoxicity impairments in their free-living setting. This study explored regular walking exercise to improve post-chemotherapy neurotoxicity impairments from breast cancer survivors' perspectives., Methods: A qualitative descriptive study was conducted. A purposive sample of 15 participants experiencing neurotoxicity impairments was invited to semi-structured interviews. Textual interview data were managed in NVivo. Content analysis was performed., Results: Participants were aged 39-68 and had received 4-8 cycles of chemotherapy. Most (86.7%, n = 13) reported engaging in regular walking exercise. Four main categories emerged from the data: (1) perceived effects of regular exercise on neurotoxicity impairments, (2) unmet information needs, (3) regular walking habit being self-sustained, and (4) enablers and constraints of regular walking exercise., Conclusions: Walking exercise, as commonly employed by participants in their free-living setting, was the essence in the management of chemotherapy-induced neurotoxic conditions during survivorship. Participants undertaking walking exercise lacked informed and individualized information about the regular walking exercise regime, and vigilance to evaluate post-exercise neurotoxic conditions. These might be the unmet needs of this research area and in clinical practice. Assessing and addressing individualized endeavors in a walking exercise regime will continue to be a vital component of cancer supportive care to fill the unmet information needs in survivorship., Competing Interests: Declaration of competing interest None declared., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The emergence of new coronavirus variants and evidence of waning immunity offered by COVID-19 vaccines draw attention to the need for regular vaccination. Vaccine hesitancy is one of the top ten threats to global health. There is a dearth of knowledge on people's hesitancy to take regular COVID-19 vaccines. This study aimed to investigate the prevalence and determinants of hesitancy for regular COVID-19 vaccination. A population-based, random telephone survey was performed in Hong Kong in April 2022 ( n = 1213). The age-standardized hesitancy rate for regular COVID-19 vaccines among Hong Kong adults was 39.4% (95% CI = 35.3-44.1%), exhibiting a sloping S-shape with age. Regression analyses revealed that females, young adults, self-perceived fair/bad health, low COVID-19 vaccine uptake, and believing there are better ways for prevention of infection were positive determinants of hesitancy for regular vaccination. Vaccine confidence, perceived severity and availability, trust in manufacturers and government, and civic duty inclination were negative determinants. Tailored vaccine promotions are needed for females, young adults, and people perceiving poor health and receiving fewer doses. Information on infection severity, vaccine availability, and trust in suppliers, products, and governments are key attitude-change facilitators to decrease hesitancy for regular COVID-19 vaccination and cope with future pandemics.

Background: Many adolescents were reported to have severe depressive symptoms, and a careful assessment of its correlates is essential for prevention and intervention programs. This study aimed to gain insight into the prevalence of severe depressive symptoms and its association with factors at four levels (individual, relationship, school and society) in a large sample of Hong Kong Chinese secondary school students., Methods: Secondary school students from Secondary 1 through 7 were selected as participants using a cluster random sampling method. A questionnaire including inventories measuring 24 factors at the four levels (six individual factors, 11 relationship factors, three school factors, and four society factors) was completed by 8,963 participants (56.3% female) with a mean age of 15.1 (SD = 1.8) years. Students with a score of ≥15 on the Patient Health Questionnaire were defined as having severe depressive symptoms. The association between severe depressive symptoms and correlates were examined by t -test and χ 2 test. Logistic regression models using a hierarchical approach then examined the individual contribution of these 24 factors to severe depressive symptoms with the control of other factors in the model., Results: 7.4% of the students have severe depressive symptoms. Twenty-two of the 24 factors were significantly associated with severe depressive symptoms in bivariate analyses. In the logistic regression, 11 factors (three individual factors: age, self-esteem and self-mastery; six relationship factors: tobacco use, alcohol drinking, drug use, paternal psychological control, dinner with parents, and perceived social support from friends; one school factor: felt pressure from homework; and one society factor: number of sibling) were statistically significant. Felt pressure from homework, alcohol drinking, and perceived social support from friends were the strongest correlates of severe depressive symptoms., Conclusion: The prevalence of self-reported severe depressive symptoms in Hong Kong Chinese secondary school students was high, and the identification of multiple associated factors at the four levels simultaneously provides a knowledge basis for the development of a comprehensive, multivariate model of factors influencing severe depressive symptoms in Chinese secondary school students. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Leung, Leung, Zhang, Ruan, Yeung and Mak.)

Background: There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years., Methods: Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates., Findings: A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates., Interpretation: ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time., Funding: None., Competing Interests: Eric Yu Hai Chen has received investigator-initiated research funding and sponsored funding from Janssen and speaker honoraria from Otsuka., (© 2023 The Author(s).)

Transcranial pulse stimulation (TPS) is a recent development in non-invasive brain stimulations (NIBS) that has been proven to be effective in terms of significantly improving Alzheimer patients' cognition, memory, and execution functions. Nonetheless, there is, currently, no trial evaluating the efficacy of TPS on adults with major depression disorder (MDD) nationwide. In this single-blinded, randomized controlled trial, a 2-week TPS treatment comprising six 30 min TPS sessions were administered to participants. Participants were randomized into either the TPS group or the Waitlist Control (WC) group, stratified by gender and age according to a 1:1 ratio. Our primary outcome was evaluated by the Hamilton depression rating scale-17 (HDRS-17). We recruited 30 participants that were aged between 18 and 54 years, predominantly female (73%), and ethnic Chinese from 1 August to 31 October 2021. Moreover, there was a significant group x time interaction (F(1, 28) = 18.8, p < 0.001). Further, when compared with the WC group, there was a significant reduction in the depressive symptom severity in the TPS group (mean difference = -6.60, p = 0.02, and Cohen's d = -0.93). The results showed a significant intervention effect; in addition, the effect was large and sustainable at the 3-month follow-up. In this trial, it was found that TPS is effective in reducing depressive symptoms among adults with MDD.

Aim: This study aims to explore fourth-year nursing students' knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia., Design: This will be a descriptive qualitative study using focus-group interviews., Methods: Fourth-year nursing students on clinical placement in a hospital in Hunan province will be invited for focus-group interviews. Snowball and purposive sampling will be used to recruit nursing students for this study. Five focus-group interviews, each including six participants, will be conducted to explore participants' knowledge, attitudes, intentional behaviours, and empathy towards schizophrenia. The interview will be conducted through the online Tencent video conference platform and the interview data will be collected through the same platform. All interviews will be recorded and transcribed verbatim and analysed with the approach of the content analysis supported by NVivo 12. Simultaneous data collection and analysis will be performed, and the interviews will be continued until data saturation is met. The findings of this study will be helpful in developing effective interventions to decrease the stigma toward schizophrenia among nursing students and those who study healthcare disciplines.

Background: Since the emergence of the COVID-19 pandemic, there have been lots of published work examining the association between COVID-19 and mental health, particularly, anxiety and depression in the general populations and disease subpopulations globally. Depression is a debilitating disorder affecting individuals' level of bio-psychological-social functioning across different age groups. Since almost all studies were cross-sectional studies, there seems to be a lack of robust, large-scale, and technological-based interventional studies to restore the general public's optimal psychosocial wellbeing amidst the COVID-19 pandemic. Transcranial pulse stimulation (TPS) is a relatively new non-intrusive brain stimulation (NIBS) technology, and only a paucity of studies was conducted related to the TPS treatment on older adults with mild neurocognitive disorders. However, there is by far no study conducted on young adults with major depressive disorder nationwide. This gives us the impetus to execute the first nationwide study evaluating the efficacy of TPS on the treatment of depression among young adults in Hong Kong., Methods: This study proposes a two-armed single-blinded randomised controlled trial including TPS as an intervention group and a waitlist control group. Both groups will be measured at baseline (T1), immediately after the intervention (T2), and at the 3- month follow-up (T3)., Recruitment: A total of 30 community-dwelling subjects who are aged 18 and above and diagnosed with major depressive disorder (MDD) will be recruited in this study. All subjects will be computer randomised into either the intervention group or the waitlist control group, balanced by gender and age on a 1:1 ratio., Intervention: All subjects in each group will have to undertake functional MRI (fMRI) before and after six 30-min TPS sessions, which will be completed in 2 weeks' time., Outcomes: Baseline measurements and post-TPS evaluation of the psychological outcomes (i.e., depression, cognition, anhedonia, and instrumental activities of daily living) will also be conducted on all participants. A 3-month follow-up period will be usedto assess the long-term sustainability of the TPS intervention. For statistical analysis, ANOVA with repeated measures will be used to analyse data. Missing data were managed by multiple mutations. The level of significance will be set to p < 0.05., Significance of the Study: Results of this study will be used to inform health policy to determine whether TPS could be considered as a top treatment option for MDD., Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT05006365., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cheung, Ho, Yeung, Leung, Fong, Fong, Kranz, Beisteiner and Cheng.)

Mindfulness-based psychoeducation program (MBPP) has been proposed as a new approach to improve the overall outcomes for individuals with schizophrenia spectrum disorders. However, to date, limited studies have examined the participants' experiences of MBPP for schizophrenia., The aim of this study was to explore the experiences of individuals with schizophrenia spectrum disorders (SSDs) who underwent an 8-week MBPP with respect to their perception of the benefits and unusual challenges of mindfulness training and self-practices., Twenty-four ( n  = 24) individuals with SSDs were invited to participate in an 8-week MBPP. A total of eight participants were invited for semi-structured interview one week after the final class of MBPP. The semi-structured interview was conducted in Cantonese and data were transcribed by the first author. Of the eight participants, five participants had unusual experiences and three participants had a positive experience with MBPP. They were included to provide more candid understanding on the constituents of diverse experience towards MBPP. An interview guide was developed to understand the patients' perceptions of MBPP, the challenege in self-practising mindfulness, and the changes in how they coped with their illness during and after taking part in MBPP. Qualitative data from the semi-structured interview were recorded by a research assistant and the transcripts were proof-read by the participants to ensure accuracy. The Software NVivo 12 Pro was used to manage the qualitative data from the semi-structured interview. Thematic analysis was adopted to identify the major themes from the qualitative data., Five themes emerged: developing a state of mindfulness, empowering illness management, learning a new way to regulate emotion, encountering barriers in self-practising mindfulness and preference for bodily mindfulness., The findings provide comprehensive knowledge and deeper insights into treatment processes of mindfulness psychoeducation as an intervention for schizophrenia spectrum disorders., Impact Statement: This study establishes a body of knowledge regarding people with schizophrenia spectrum disorders who received mindfulness psychoeducation intervention. The results suggest that patients can develop a new way to regulate emotion and manage their illness through mindfulness psychoeducation. The perceived negative experience of some patients also warrants closer attention in mindfulness practice, especially for individuals with schizophrenia spectrum disorders. Further research could focus on factors leading to the negative consequences of mindfulness practice and the ways to minimize the negative consequeces.

Background: Pain affects a person's physical and psychological well-being, work performance and productivity. Working population bear their pain and continue to work which may contribute to the worsening of their pain condition. However, their pain situation was not well-examined., Objective: The aim of the study was to explore the prevalence of acute and chronic pain in the working population in Hong Kong, understand their pain management strategies and determine their preferences with regard to the use of electronic pain management materials., Methods: This was an exploratory online survey. The participants' pain history, their preferences in methods of pain management, the source of the pain management education that they had received, sources and preferences in relation to the use of the Internet for pain education, and the participants' demographic characteristics were collected., Results: A total of 210 participants joined the study, 67% of whom were experiencing pain. Of the group in pain, 71.6% were in chronic pain that has persisted for 3 months or more. Pain intensities ranged from 2.82 to 3.82 on a 10-point numeric scale. Of the participants, 85.7% reported not receiving adequate pain management education, and 91.4% of those agreed pain services were inadequate. Websites and health care professionals were the sources from which they obtained their pain management education., Conclusions: The high prevalence of pain in the working population requires special attention. Health care professionals should be proactive and an online pain management programme can be a solution to address the critical problem of pain in the working population., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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 (<-.57), and perceived control (<-.56) in the expected directions in the overall sample and in the gender and age subsamples., Discussion: The results support the claim that the PHQ-9 is a reliable and valid scale and can be used to assess and compare depressive severity across ages and genders during the period of adolescence., (© 2020 The Authors. Asia-Pacific Psychiatry published by John Wiley & Sons Australia, Ltd.)

Background: Chronic pain is highly prevalent in the working population. People tend to attempt self-initiated treatments to manage their pain. The self-efficacy of behavioural change is a suitable model for guiding the development of an electronic pain management programme (ePain). The aim in this study is to develop ePain and to evaluate its effectiveness at improving pain self-efficacy, reducing pain intensity and negative emotions, and increasing quality of life., Methods: This study will be a randomized controlled trial. ePain will take the form of a 6-week online pain management programme. Participants will be aged 15 years or above, have chronic pain, and be employed. They must complete the baseline questionnaire and will be randomized into intervention and control groups. They will receive notifications to encourage their participation in ePain and complete the evaluation questionnaires. They will complete the process evaluation at week 3, the post assessment at week 6, and the follow-up assessment at week 12. The study will focus on pain self-efficacy; pain situations; negative emotions including levels of depression, anxiety, and stress; and quality of life. The participants' opinions of ePain will be collected as feedback. Data will be analysed on an intention-to-treat basis and generalized estimating equations will be used to investigate the time-averaged difference and differences at each follow-up time., Discussion: The study will provide information about the pain situations of online users in the working population. The participants will benefit from improvements in pain self-efficacy, pain situations, emotional status, and quality of life. The study will illustrate whether online learning is an effective intervention for improving the pain self-efficacy of the working population., Trial Registration: ClinicalTrials.gov, NCT03718702. Registered on 23 October 2018.

Introduction: Studies have found that increased mobile phone use (MPU) is associated with multiple health issues such as depression, disordered sleep and pain. However, the current situation and interrelationships of these problems remain unexplored in the Hong Kong population., Objectives: This study aimed to understand the situation and problematic use of mobile phones by Hong Kong secondary school students and to investigate depressive symptoms, bodily pain and daytime sleepiness and the associations of these factors with MPU in Hong Kong secondary school students., Methods: This quantitative cross-sectional design study was based on self-administered questionnaires completed at five secondary schools. The questionnaire comprised five sections: MPU as measured by the Chinese version of the 10-Item Mobile Phone Problem Use Scale (CMPPUS-10); depressive symptoms according to the Depression Anxiety Stress Scale-21 Chinese Version (DASS-21); bodily pain according to the Brief Pain Inventory Short Form Chinese (BPISF-C); daytime sleepiness as measured using the Chinese version of the Epworth Sleepiness Scale (CESS) and socio-demographic questions., Results: A total of 686 students were recruited. The CMPPUS-10 score correlated positively with the average daily duration of MPU and the presence of depression, daytime sleepiness and bodily pain. Problematic mobile phone users received significantly higher scores for depression severity, bodily pain and daytime sleepiness. Health problems were significantly more severe in female than in male students. Bodily pain and daytime sleepiness mediated the relationship of MPU with depression., Conclusions: Problematic MPU was associated with depression, bodily pain and daytime sleepiness. These findings will inform further studies of MPU-related health problems., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: People with depression often experience disabilities that limit their social and physical capacity, daily function, and quality of life. Depressive symptoms and their implications on daily activities are often measured retrospectively using subjective measurement tools. Recently, more objective and accurate electronic data collection methods have been used to describe the daily life of people with depressive disorders. The results, however, have not yet been systematically reviewed. We aim to provide a knowledge basis for the use of tracking technologies in examining life-space mobility among adults with depression and those with anxiety as a comorbidity., Methods and Analysis: A systematic review with a narrative approach for different types of study design will be conducted. The following databases will be used to gather data from 1994 to the present: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, Cochrane Library, Scopus, Web of Science, Health Technology Assessment Database and IEEE Xplore. The study selection will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Methodological appraisal of studies will be performed using the Crowe Critical Appraisal Tool as well as the Cochrane Risk-of-Bias Tool for randomised controlled trials. A narrative synthesis of all included studies will be conducted., Ethics and Dissemination: Because there will be no human involvement in the actual systematic review, no ethical approval will be required. The results will be disseminated in a peer-reviewed journal and in a conference presentation., Prospero Registration Number: CRD42019127102., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To examine levels of knowledge about dementia and attitudes towards dementia in low- and middle-income countries (LMICs), identify sources to turn to for help, and explore the relationship between knowledge and attitudes., Methods: This mixed methods study with both quantitative (a cross-sectional survey) and qualitative (focus group interviews) components was conducted in Cambodia, the Philippines, and Fiji in 2017-18. A survey was completed by the citizens of the three countries, and two focus group interviews were conducted in each country to generate a context-specific understanding of dementia literacy within the local LMIC setting. The quantitative component utilized the Alzheimer's Disease Knowledge Scale and the Dementia Attitude Scale, while knowledge, attitudes, and views on seeking help for dementia was discussed in the focus group interviews (qualitative component)., Results: A total of 476 participants completed the survey. Another 54 participants (39 females and 15 males) were invited to join six focus group interviews to express their views on dementia. Positive attitudes were noted despite the level of dementia knowledge was low. Families and religious figures were viewed as the sources for help. Controlling for demographics, country-specific predictors of positive attitudes towards dementia were found., Conclusions: The involvement of family members and religious leaders in dementia education could enhance the recognition of dementia. Specific kinds of dementia knowledge should be targeted to educate the public in different countries., (© 2019 John Wiley & Sons, Ltd.)

Background: Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels. Pharmacological pain management has been shown to be effective in older adults. However, as drugs can have various side effects, non-pharmacological pain management is preferred for community-dwelling older adults. This systematic review evaluates the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for community-dwelling older adults., Methods: Five databases, namely, CINHAL, Journals@Ovid, Medline, PsycInfo, and PubMed, were searched for articles. The criteria for inclusion were: full-text articles published in English from 2005 to February 2019 on randomized controlled trials, with chronic non-cancer pain as the primary outcome, in which pain was rated by intensity, using non-pharmacological interventions, and with participants over 65 years old, community-dwelling, and mentally competent. A quality appraisal using the Jadad Scale was conducted on the included articles., Results: Ten articles were included. The mean age of the older adults was from 66.75 to 76. The interventions covered were acupressure, acupuncture, guided imagery, qigong, periosteal stimulation, and Tai Chi. The pain intensities of the participants decreased after the implementation of the intervention. The net changes in pain intensity ranged from - 3.13 to - 0.65 on a zero to ten numeric rating scale, in which zero indicates no pain and ten represents the worst pain., Conclusions: Non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults, and can be promoted widely in the community.

Background: Laughter Yoga (LY) is a group-based intervention involving simulated laughter, gentle stretching, rhythmic breathing and meditation. There is some limited evidence that LY reduces depressive symptoms over the short term. However, the quality of previous LY studies is poor and none involved working-aged people with a clinical diagnosis of depression. Therefore, this study aimed to investigate the feasibility and potential efficacy of LY for improving residual mood, anxiety and stress symptoms in adults diagnosed with depression., Methods: Fifty participants were randomised to the group LY intervention (n = 23) consisting of eight sessions over four weeks, or treatment-as-usual (n = 27). Participants completed the Depression Anxiety Stress Scale and the Short Form 12 item Health Survey at baseline (T0), post-intervention (T1) and at 3 months follow-up (T2). LY participants also completed a Client Satisfaction Questionnaire (CSQ8) at T1 and eleven participated in individual qualitative interviews at T2., Results: The LY group had statistically greater decreases in depression and improvements in mental health related quality of life compared to the control group from T0 to T1. The CSQ8 scores indicated a favourable level of satisfaction with the LY intervention. The qualitative interviews highlighted aspects of the intervention that were effective and those requiring modification., Limitations: Limitations include the small sample size and treatment-as-usual control group., Conclusions: A full scale RCT of LY could be feasible if some modifications were made to the protocol/intervention. The intervention may be effective to improve depression and mental health related quality of life immediately post intervention., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Metal halide perovskite has emerged as a promising material for light-emitting diodes. In the past, the performance of devices has been improved mainly by optimizing the active and charge injection layers. However, the large refractive index difference among different materials limits the overall light extraction. Herein, we fabricate efficient methylammonium lead bromide light-emitting diodes on nanophotonic substrates with an optimal device external quantum efficiency of 17.5% which is around twice of the record for the planar device based on this material system. Furthermore, optical modelling shows that a high light extraction efficiency of 73.6% can be achieved as a result of a two-step light extraction process involving nanodome light couplers and nanowire optical antennas on the nanophotonic substrate. These results suggest that utilization of nanophotonic structures can be an effective approach to achieve high performance perovskite light-emitting diodes.