Shuzhang Zhou, Ming Fang, Billy Chun-Lung So, Hei Wa So, Paul H. Lee, Siushing Man (2026). Effects of Aquatic Exercise on Sleep Quality in Patients with Chronic Diseases: A Meta-Analysis . Healthcare.

Shuzhang Zhou, Ming Fang, Billy Chun-Lung So, Hei Wa So, Paul H. Lee, Siushing Man (2026). Effects of Aquatic Exercise on Sleep Quality in Patients with Chronic Diseases: A Meta-Analysis . Healthcare.

Mimi Mun Yee Tse, Shamay Sheung Mei Ng, Paul H. Lee, Angel Shuk Kwan Tang, Percy Poo-see Tse, Kin Pong To, Sukki Ho, Timothy Chung Ming Wu (2026). Effectiveness of a Dyadic Pain Management Program for Community-Dwelling Older Adults with Chronic Pain: A Cluster Randomized Controlled Trial . Healthcare.

Mimi Mun Yee Tse, Shamay Sheung Mei Ng, Paul H. Lee, Angel Shuk Kwan Tang, Percy Poo-see Tse, Kin Pong To, Sukki Ho, Timothy Chung Ming Wu (2026). Effectiveness of a Dyadic Pain Management Program for Community-Dwelling Older Adults with Chronic Pain: A Cluster Randomized Controlled Trial . Healthcare.

Anson Chui Yan Tang, Regina Lai‐Tong Lee, Paul Hong Lee, Winnie Lai Sheung Cheng, Shun Chan, Yufang. Guo, Yan Wang, Qing Wang, Pimpimon Wongchaiya, Lorna Kwai Ping Suen (2026). Association Among Self‐Compassion, Resilience, Positive Mental Health and Risk of Gaming Disorder in 18–30 Year Old Population in China and Thailand: A Cross‐Regional Study . Nursing Open.

Paul H. Lee (2026). The Accuracy of Single-Time-Point Physical Activity Measures Compared to Multi-Year Composite Scores from the English Longitudinal Study of Ageing . Research Quarterly for Exercise and Sport.

A novel SPECT-CT imaging platform for quantifying in vivo lung cytokine signals in COPD @article{3a3f2f2dea6d449fa0fede4e9c79eb1c, title = "A novel SPECT-CT imaging platform for quantifying in vivo lung cytokine signals in COPD", abstract = "Introduction: disease-modifying treatments such as monoclonal antibodies can be highly effective in chronic inflammatory diseases such as COPD, but often fail in clinical trials due to heterogeneity of inflammation and imperfect tools to stratify patients to select optimal therapeutic approaches. Molecular imaging provides the potential to transform precision medicine in this field. Methods: we developed and tested a novel molecular imaging platform using therapeutic monoclonal antibodies labelled with SPECT-CT detectable markers to quantify in vivo TNF involved in chronic lung inflammation in humans. We undertook a proof-of-concept clinical study involving participants with COPD and healthy controls. Participants underwent SPECT-CT imaging at 6- and 24-hours following injection of 99m-Tc-anti-TNF. Segmentation of lung regions and 99m-Tc-anti-TNF activity quantification was undertaken using novel semi-automated and AI-driven approaches. Results: a significant increase in normalised activity, representing increased TNF inflammatory activity, was seen between the two time-points in the COPD group (64.88\% +/- [SD] 31.04, p=.029) and not in healthy controls (35.38\% +/- 34.33, =.110). However, analysis at a single time-point revealed higher normalised activity in the healthy group. We demonstrated that pulmonary blood vessel density and degree of emphysema were strongly correlated with this activity signal and identified as confounding factors, highlighting the need to address differences in target-organ characteristics in COPD. Experimental methods to adjust for these factors were developed for organ-specific signal quantification. Conclusions: we report novel analysis techniques for molecular imaging of the human lung, presenting a platform which provides new insights into complex inflammatory disease and future precision medicine approaches.", author = "Benjamin Welham and Michael Bennett and Kristoffer Ostridge and Matt Guy and Clint Zvavamwe and Anna Chilcott and Sandra Johns and Francis Sundram and Spalluto, \{Mirella Cosma\} and Emily Shaw and Stephen Harden and Aiman Alzetani and Paul Lee and Lawson, \{Matthew John\} and Peter Lackie and Sofia Michopoulou and Darren Henley and Kong, \{Chia Wei\} and Aishath Fazleen and Doriana Cellura and Christopher McCrae and Adam Platt and Maria Belvisi and Staples, \{Karl J.\} and Tom Wilkinson", year = "2025", month = nov, doi = "10.1183/23120541.01246-2024", language = "English", volume = "11", journal = "ERJ Open Research", issn = "2312-0541", publisher = "European Respiratory Society", number = "6", } . ERJ Open Research.

Lorna Kwai Ping Suen, Wai Hang Kwok, Ignatius Tak Sun Yu, Sony Nai Yeung So, Kin Cheung, Paul Hong Lee, Lily Yuen Wah Ho, Ka Yan Ko, Sukki Ho, Simon Ching Lam (2025). Assessment of the Psychometric Properties of the Mask Usability Scale: A Measure of the Perceived Usability of N95 Respirators Among Healthcare Students and Staff . Journal of Advanced Nursing.

Paul Lee, Shimin Zhu, Yuxi Hu, Di Qi, Samson Tse, Ko Ling Chan, Jessica Sun (2025). Effects of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Four-Armed Randomized Controlled Trial . JMIR Pediatrics and Parenting.

Understanding infection viral exacerbation and respiratory symptoms at admission-longitudinal (UNIVERSAL) study: a prospective observational cohort study protocol @article{e65bf30db49045358e29a940ecb7e5a3, title = "Understanding infection viral exacerbation and respiratory symptoms at admission-longitudinal (UNIVERSAL) study: a prospective observational cohort study protocol", abstract = "Background: respiratory viral infections (RVIs) are a significant cause of morbidity and hospital admission worldwide. However, the management of most viral infection-associated diseases remains primarily supportive. The recent COVID-19 pandemic has underscored the urgent need for a deeper understanding of RVIs to improve patient outcomes and develop effective treatment strategies. The UNIVERSAL Study is an observational study which addresses this need by investigating the heterogeneity of RVIs in hospitalised adults, aiming to identify clinical and biological predictors of adverse outcomes. This study aims to bridge critical knowledge gaps in the clinical course and the economic impact of RVIs by characterising the phenotypic diversity of these infections and their recovery patterns following hospital admission and thus assisting with the optimal design of future interventional studies. Methods and analysis: this prospective longitudinal observational study, (Version 6, 20th September 2023), will be conducted across multiple UK secondary care sites from August 2022 onwards, with an aim to enrol 1000 participants testing positive for RVI. Adults admitted with respiratory symptoms who test positive for RVIs via the BioFire{\textregistered} FilmArray{\textregistered} System or other validated diagnostic polymerase chain reaction (PCR) tests will be enrolled. The data collected includes patient demographics, clinical history, comorbidities, and symptoms experienced prior to, during and after hospitalisation with follow-up after discharge at weeks 1, 2, 4, 8, 12, and 26. In addition, biological samples are collected at multiple time points during the hospital stay. The primary endpoints are to study the impact of different RVIs and identify predictors of disease progression and length of stay. Secondary endpoints include time to recovery and healthcare cost estimates. Exploratory endpoints focus on biomarker profiles associated with virus type and clinical outcomes. Ethics and dissemination: the study protocol received ethical approval from the relevant committees (English Ethics Reference Number: 22/WM/0119; Scottish Ethics Reference Number: 22-SS-0101, 20/09/2023). For patients who lack the capacity to consent, the study complies with the Mental Capacity Act 2005, using a consultee process where a family member, carer or an independent clinician may provide assent on behalf of the patient. Data from all the study centres will be analysed together and disseminated through peer-reviewed journals, conference presentations and workshops. The study group will ensure that participants and their families are informed of the study findings promptly and in an accessible format.", keywords = "Hospitalization, Observational Study, Patient Reported Outcome Measures, Respiratory infections, SARS-CoV-2 Infection", author = "Morelli, \{Tommaso Geraldo\} and Martha Purcell and Pedro Rodrigues and \{et al.\} and Charlie Roberts and Paul Lee and Kerensa Thorne and Alexander Allen and Angelica Cazaly and Jacqueline Nuttall and James Raftery and Gareth Griffiths and Andrew Cook and Tracy Hussell and Nicola White and Diane Griffiths and Neil Greening and Matthew Pavitt and James Myerson and Marciniak, \{Stefan J.\} and Cyrus Daneshvar and Michael Crooks and Philip Mitchelmore and Chalmers, \{James D.\} and S. Siddiqui and Staples, \{Karl J.\} and Tristan Clark and Anna Freeman and Wilkinson, \{Tom MA\}", year = "2025", month = apr, day = "9", doi = "10.1136/bmjopen-2024-093427", language = "English", volume = "15", journal = "BMJ Open", issn = "2044-6055", publisher = "BMJ Publishing Group", number = "4", } . BMJ Open.

Paul Lee, Ka-Man Carman Leung, Wing Sze Alice Lai, Yanan Zhao, Lynda Ransdell (2025). Impact of a Light Volleyball Intervention Among Older Chinese Adult Women . International Journal of Physical Activity and Health.

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021 @article{03d54bac359b448ca6061ab7a2dc1f9b, title = "Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021", abstract = "Background: the six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories. Methods: the prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.Findings: in 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46–0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were –0·5\% and –1·3\%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target. Interpretation: based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground. Funding: Bill \& Melinda Gates Foundation.", author = "\{Global Nutrition Target Collaborators\} and Arndt, \{Michael Benjamin\} and Abate, \{Yohannes Habtegiorgis\} and Mohsen Abbasi-Kangevari and \{Abd ElHafeez\}, Samar and Michael Abdelmasseh and Sherief Abd-Elsalam and Abdulah, \{Deldar Morad\} and Abdulkader, \{Rizwan Suliankatchi\} and Hassan Abidi and Olumide Abiodun and Aboagye, \{Richard Gyan\} and Hassan Abolhassani and Abtew, \{Yonas Derso\} and Eman Abu-Gharbieh and Abu-Rmeileh, \{Niveen ME\} and Acuna, \{Juan Manuel\} and Kidist Adamu and Adane, \{Denberu Eshetie\} and Addo, \{Isaac Yeboah\} and Adeyinka, \{Daniel Adedayo\} and Adnani, \{Qorinah Estiningtyas Sakilah\} and Afolabi, \{Aanuoluwapo Adeyimika\} and Fatemeh Afrashteh and Saira Afzal and Antonella Agodi and Ahinkorah, \{Bright Opoku\} and Aqeel Ahmad and Sajjad Ahmad and Tauseef Ahmad and Ali Ahmadi and Ali Ahmed and Ahmed, \{Luai A.A.\} and Marjan Ajami and Budi Aji and Hossein Akbarialiabad and Maxwell Akonde and \{Al Hamad\}, Hanadi and \{Al Thaher\}, Yazan and Samuele Cortese and Hasan, \{Md Mehedi\} and Khan, \{M. Nuruzzaman\} and Lee, \{Paul H.\} and Lee, \{Wei Chen\} and Li, \{Ming Chieh\} and Lim, \{Stephen S.\} and Nguyen, \{Phuong The\} and Gavin Pereira and Rahman, \{Md Mosfequr\} and Smith, \{Amanda E.\} and Fang Wang", year = "2024", month = dec, day = "19", doi = "10.1016/S0140-6736(24)01821-X", language = "English", volume = "404", pages = "2543--2583", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10471", } . The Lancet.

The state of health in the European Union (EU-27) in 2019 @article{0a778e577c1245ecb57fe37bd5443fdb, title = "The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019", abstract = "Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods: We used the Global Burden of Disease 2019 study estimates and 95\% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE). Results: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19\%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5\%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5\%). Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.", keywords = "European Burden of Disease Network, European Union, Global Burden of Diseases, Health status, Population health", author = "\{GBD 2019 EU State of Health Collaborators\} and Olatunde Aremu and Francesco Esposito and Fernandes, \{Jo{\~a}o c.\} and Glasbey, \{James c.\} and Giuseppe Gorini and Haro, \{Josep maria\} and Jan Hartvigsen and Hay, \{Simon i.\} and Behzad Heibati and Mehdi Hosseinzadeh and Mihaela Hostiuc and Sorin Hostiuc and Jonas, \{Jost b.\} and Tamas Joo and Jozwiak, \{Jacek jerzy\} and Mikk J{\"u}risson and Kauppila, \{Joonas h.\} and Khan, \{Moien a. b.\} and Khaled Khatab and Ai Koyanagi and \{La vecchia\}, Carlo and Ben Lacey and Lee, \{Paul h.\} and An Li", note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.", year = "2024", month = dec, doi = "10.1186/s12889-024-18529-3", language = "English", volume = "24", journal = "BMC Public Health", issn = "1471-2458", publisher = "BioMed Central", number = "1", } . BMC Public Health.

Assessment of the psychometric properties of the mask usability scale: a measure of the perceived usability of N95 respirators among healthcare students and staff @article{32244674dcab45e98f1795eca81591f1, title = "Assessment of the psychometric properties of the mask usability scale: a measure of the perceived usability of N95 respirators among healthcare students and staff", abstract = "Aim: to test the reliability and construct validity of the Mask Usability Scale in healthcare students and staff. Design: a methodological study involving repeated measures. Methods: the study included two batches of participants: (1) 283 university nursing students and (2) 1753 participants composed of students (61\%) and clinical staff (39\%). All participants underwent N95 respirator fit tests and user seal checks. They also responded to the Mask Usability Scale, which comprises 11 items evaluated using Likert scales. The internal consistency was assessed using Cronbach's alpha and item–total correlation test. Test–retest reliability was evaluated by the intraclass correlation coefficient (ICC). The factor structure was initially identified through exploratory factor analysis (EFA), laying the groundwork for the model. This approach was followed by confirmatory factor analysis (CFA) to ensure the model fits with the standardised solution. Results: excluding items 9, 10 and 11, the study showed satisfactory internal consistency, evidenced by a Cronbach's alpha of 0.842 for the eight-item scale from the combined samples. Factors, such as {\textquoteleft}Heat{\textquoteright}, {\textquoteleft}Breathability{\textquoteright}, {\textquoteleft}Tightness{\textquoteright} and {\textquoteleft}Ease in talking{\textquoteright} showed moderate to strong correlations. The test–retest reliability in the batch one sample was acceptable with ICCs ranging between 0.69 and 0.71 for different models. The EFA and fit indices supported a two-factor structure. The first factor {\textquoteleft}Comfort and Usage{\textquoteright} included {\textquoteleft}Heat{\textquoteright}, {\textquoteleft}Breathability{\textquoteright}, {\textquoteleft}Tightness{\textquoteright}, {\textquoteleft}Ease in talking{\textquoteright} and {\textquoteleft}Prolonged use{\textquoteright}, which were keys for the usability of N95 respirators. The second factor {\textquoteleft}Suitability{\textquoteright} encompassed {\textquoteleft}Itchy{\textquoteright}, {\textquoteleft}Easily displaced{\textquoteright} and {\textquoteleft}Ear soreness{\textquoteright}. The variance explained by the first and second factors was 49\% and 12\%, respectively, with a strong inter-factor correlation. The CFA results were satisfactory with fit metrics (NFI = 0.967, IFI = 0.969, TLI = 0.952, CFI = 0.969, RMSEA = 0.078 with 90\% CI [0.069, 0.086] and p < 0.001) and a chi-squared to df ratio of 13.58. Conclusion: The eight-item mask usability scale exhibited satisfactory internal consistency and construct validity in both healthcare student and staff samples. Implications for the Profession and/or Patient Care: the primary concern in the purchase policy of N95 respirators for clinical use is to strike the right balance between usability and fit rate (passing \% of fit testing). Our study solidified the concept of quantifying the usability of respirators. With that mask usability scale measurement, a provision of benchmark and reference for the design and selection of respirators would be possible. This validated scale has significant implications for senior management in clinical settings and respirator manufacturers regarding the N95 respirator purchase policy and design. Impact: the results indicated the psychometric properties of mask usability scale in measuring the usability of N95 respirators. This scale is particularly valuable for assessing the perceptions of healthcare students and staff of factors, namely, {\textquoteleft}Heat{\textquoteright}, {\textquoteleft}Breathability{\textquoteright}, {\textquoteleft}Tightness{\textquoteright}, {\textquoteleft}Ease in talking{\textquoteright}, {\textquoteleft}Prolonged use{\textquoteright}, {\textquoteleft}Itchy{\textquoteright}, {\textquoteleft}Easily displaced{\textquoteright} and {\textquoteleft}Ear soreness{\textquoteright} concerning the use of N95 respirators. Reporting Method: we adhered to EQUATOR guidelines following the STROBE statement. Patient or Public Contribution: No patient or public contribution. Trial Registration: ISRCTN registry: ISRCTN40115047.", keywords = "health care, N95 respirators, psychometrics, usability, validation", author = "Suen, \{Lorna Kwai Ping\} and Kwok, \{Wai Hang\} and Yu, \{Ignatius Tak Sun\} and So, \{Sony Nai Yeung\} and Kin Cheung and Lee, \{Paul Hong\} and Ho, \{Lily Yuen Wah\} and Ko, \{Ka Yan\} and Sukki Ho and Lam, \{Simon Ching\}", year = "2024", month = nov, day = "17", doi = "10.1111/jan.16590", language = "English", journal = "Journal of Advanced Nursing", issn = "0309-2402", publisher = "Fafo", } . Journal of Advanced Nursing.

Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 @article{ab04ec16106d489583528c7c44286cc1, title = "Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021", abstract = "Background: up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods: we estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95\% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: in 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95\% UI 6·6–7·8] deaths; 10·7\% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6\% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3\% (62·4–67·7), intracerebral haemorrhage constituted 28·8\% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8\% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2\% [53·4–117·7]), high ambient temperature (72·4\% [51·1 to 179·5]), high fasting plasma glucose (32·1\% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4\% [12·7–35·7]), low physical activity (11·3\% [1·8–34·9]), high systolic blood pressure (6·7\% [2·5–11·6]), lead exposure (6·5\% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3\% [0·5–10·5]). Interpretation: stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2021 Stroke Risk Factor Collaborators\} and Feigin, \{Valery L.\} and Abate, \{Melsew Dagne\} and Abate, \{Yohannes Habtegiorgis\} and \{Abd ElHafeez\}, Samar and Foad Abd-Allah and Ahmed Abdelalim and Atef Abdelkader and Michael Abdelmasseh and Sherief Abd-Elsalam and Parsa Abdi and Arash Abdollahi and Meriem Abdoun and Rami Abd-Rabu and Abdulah, \{Deldar Morad\} and Auwal Abdullahi and Mesfin Abebe and \{Abelda{\~n}o Zu{\~n}iga\}, \{Roberto Ariel\} and E.S. Abhilash and Abiodun, \{Olugbenga Olusola\} and Olumide Abiodun and \{Abo Kasem\}, Rahim and Aboagye, \{Richard Gyan\} and Mohamed Abouzid and Abreu, \{Lucas Guimar{\~a}es\} and Abrha, \{Woldu Aberhe\} and Dariush Abtahi and \{Abu Rumeileh\}, Samir and Ahmed Abualhasan and Hasan Abualruz and Eman Abu-Gharbieh and Ahmed Abu-Zaid and Olatunde Aremu and Soham Bandyopadhyay and Fan Cao and Bryan Chong and Emeto, \{Theophilus I.\} and Francesco Esposito and Khan, \{M. Nuruzzaman\} and Khan, \{Mohammad Jobair\} and Lee, \{Paul H.\} and Lee, \{Seung Won\} and Lee, \{Wei Chen\} and Li, \{Ming Chieh\} and Lim, \{Stephen S.\} and Rahman, \{Md Mosfequr\} and Rahman, \{Mohammad Hifz Ur\} and Abhinav Singh and Verras, \{Georgios Ioannis\} and Fang Wang and Wang, \{Yuan Pang\}", year = "2024", month = sep, day = "18", doi = "10.1016/S1474-4422(24)00369-7", language = "English", volume = "23", pages = "973--1003", journal = "The Lancet Neurology", issn = "1474-4422", publisher = "Elsevier Ltd.", number = "10", } . The Lancet Neurology.

Effects of a parent-child single-session growth mindset intervention on adolescent depression and anxiety symptoms: protocol of a 3-arm waitlist randomized controlled trial @article{7d1365750f0e48f087495c996655d497, title = "Effects of a parent-child single-session growth mindset intervention on adolescent depression and anxiety symptoms: protocol of a 3-arm waitlist randomized controlled trial", abstract = "Background: depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children's affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child's internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people. Objective: using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children's academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE. Methods: a total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis. Results: recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed. Conclusions: this study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions.", keywords = "belief in change, fixed mindset, implicit theory, mental health, secondary school students", author = "Shimin Zhu and Yuxi Hu and Ruobing Wang and Di Qi and Paul Lee and Ngai, \{So Wa\} and Qijin Cheng and Wong, \{Paul Wai Ching\}", year = "2024", month = aug, day = "30", doi = "10.2196/63220", language = "English", volume = "13", journal = "JMIR Research Protocols", issn = "1929-0748", publisher = "JMIR Publications", } . JMIR Research Protocols.

Paul Lee, Shimin Zhu, Yuxi Hu, Ruobing Wang, Di Qi, So Wa Ngai, Qijin Cheng, Paul Wai Ching Wong (2024). Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial . JMIR Research Protocols.

Development and validation of a health literacy scale for family caregivers of older people with chronic illness @article{f0e30b8a09e34b78bab71541e6deefe6, title = "Development and validation of a health literacy scale for family caregivers of older people with chronic illness", abstract = "Background: family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness.Methods: concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined.Results: a 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01).Conclusions: this study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals.", keywords = "Caregiver, Health literacy, Older people, Psychometric validation", author = "Kor, \{Patrick Pui Kin\} and Yu, \{Clare Tsz Kiu\} and Yaqin Li and Tsang, \{Alex Pak Lik\} and Tan, \{Lexi Han Zhi\} and Lam, \{Simon Ching\} and Lee, \{Paul Hong\} and Liu, \{Justina Yat Wa\} and Leung, \{Angela Yee Man\} and Lee, \{Ka Ching\}", year = "2024", month = jul, day = "1", doi = "10.1186/s12912-024-02057-x", language = "English", volume = "23", journal = "BMC Nursing", issn = "1472-6955", publisher = "BioMed Central", number = "1", } . BMC Nursing.

Burden of disease scenarios for 204 countries and territories, 2022–2050 @article{7285bd79cc254585bd483851e347aed3, title = "Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021", abstract = "Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95\% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1\% [95\% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8\% [31·0–45·0] in 2050) and south Asia (31·7\% [29·2–34·1] to 15·5\% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8\% (27·4–40·3) to 41·1\% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1\% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6\% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4\% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4\% (9·7–11·3) in the high-income super-region to 23·9\% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2\% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2\% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0\% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2021 Forecasting Collaborators\} and Vollset, \{Stein Emil\} and Ababneh, \{Hazim S.\} and Abate, \{Yohannes Habtegiorgis\} and Cristiana Abbafati and Rouzbeh Abbasgholizadeh and Mohammadreza Abbasian and Hedayat Abbastabar and \{Abd Al Magied\}, \{Abdallah H.A.\} and ElHafeez, \{Samar Abd\} and Atef Abdelkader and Michael Abdelmasseh and Sherief Abd-Elsalam and Parsa Abdi and Mohammad Abdollahi and Meriem Abdoun and Auwal Abdullahi and Mesfin Abebe and Olumide Abiodun and Aboagye, \{Richard Gyan\} and Hassan Abolhassani and Mohamed Abouzid and Aboye, \{Girma Beressa\} and Abreu, \{Lucas Guimar{\~a}es\} and Abdorrahim Absalan and Hasan Abualruz and Bilyaminu Abubakar and Abukhadijah, \{Hana Jihad Jihad\} and Giovanni Addolorato and Victor Adekanmbi and Adetunji, \{Charles Oluwaseun\} and Adetunji, \{Juliana Bunmi\} and Adeyeoluwa, \{Temitayo Esther\} and Anderson, \{David B.\} and Brown, \{Colin Stewart\} and Bryan Chong and Samuele Cortese and Emeto, \{Theophilus I.\} and Gething, \{Peter W.\} and Ali, \{Ali Hajj\} and Haque, \{Md Rabiul\} and Khan, \{Mohammad Jobair\} and Lee, \{Paul H.\} and Lee, \{Seung Won\} and Li, \{Ming Chieh\} and Lim, \{Stephen S.\} and Rahman, \{Md Mijanur Mijanur Rahman\} and Abhinav Singh and Fang Wang and Wang, \{Yuan Pang\} and Smith, \{Amanda E.\}", year = "2024", month = may, day = "18", doi = "10.1016/S0140-6736(24)00685-8", language = "English", volume = "403", pages = "2204--2256", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10440", } . The Lancet.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021 @article{1b9f7459dab242c9aad55909a3229d1d, title = "Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021", abstract = "Background: estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8\% [95\% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1\% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7\%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5\% [28·4–52·7]) and south Asia (26·3\% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2\%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2021 Demographics Collaborators\} and Schumacher, \{Austin E.\} and Kyu, \{Hmwe Hmwe\} and Antony, \{Catherine M.\} and Aravkin, \{Aleksandr Y.\} and Azhar, \{Gulrez Shah\} and Catherine Bisignano and Katrin Burkart and Cercy, \{Kelly M.\} and Eunice Chung and Kaleb Coberly and Haley Comfort and Ewerton Cousin and Culbreth, \{Garland T.\} and Matthew Cunningham and Weaver, \{Nicole Davis\} and Louisa Degenhardt and Lee Deitesfeld and Dirac, \{M. Ashworth\} and Kara Estep and Feigin, \{Valery L.\} and Flaxman, \{Abraham D.\} and Flor, \{Luisa S.\} and Force, \{Lisa M.\} and Shaw, \{David H.\} and Lim, \{Stephen S.\} and Mohammad Abdollahi and Ahmed Abu-Zaid and Soham Bandyopadhyay and Rahman, \{Md Mosfequr\} and Abhinav Singh and Emeto, \{Theophilus I.\} and Bryan Chong and Verras, \{Georgios Ioannis\} and Gething, \{Peter W.\} and Rahman, \{Md Mosfequr\} and Islam, \{Mohammad Mainul\} and Islam, \{Mohammad Mainul\} and Abhinav Singh and Abhinav Singh and Rahul Mehra and Lee, \{Paul H.\} and Lee, \{Seung Won\} and Lee, \{Seung Won\} and Lee, \{Wei Chen\} and Li, \{Ming Chieh\} and Nguyen, \{Phuong The\} and Nguyen, \{Phuong The\} and Gavin Pereira and Fang Wang and Chen Zhang", year = "2024", month = may, day = "18", doi = "10.1016/S0140-6736(24)00476-8", language = "English", volume = "403", pages = "1989--2056", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10440", } . The Lancet.

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 @article{9afd44c04fe742c0956f6ff8358dfeeb, title = "Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021", abstract = "Background: detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: the GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95\% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: global DALYs increased from 2·63 billion (95\% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2\% (95\% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1\% (1·8–6·3) in 2020 and 7·2\% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8\% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0\% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95\% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4\% (95\% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7\% [14·0–19·8]), depressive disorders (16·4\% [11·9–21·3]), and diabetes (14·0\% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0\% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2\% (1·6–2·9) between 2019 and 2021. Interpretation: putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. ", author = "\{GBD 2021 Diseases and Injuries Collaborators\} and Ferrari, \{Alize J.\} and Santomauro, \{Damian Francesco\} and Amirali Aali and Abate, \{Yohannes Habtegiorgis\} and Cristiana Abbafati and Hedayat Abbastabar and \{Abd ElHafeez\}, Samar and Michael Abdelmasseh and Sherief Abd-Elsalam and Arash Abdollahi and Auwal Abdullahi and Abegaz, \{Kedir Hussein\} and Zu{\~n}iga, \{Roberto Ariel Abelda{\~n}o\} and Aboagye, \{Richard Gyan\} and Hassan Abolhassani and Abreu, \{Lucas Guimar{\~a}es\} and Hasan Abualruz and Eman Abu-Gharbieh and Abu-Rmeileh, \{Niveen M.E.\} and Ackerman, \{Ilana N.\} and Addo, \{Isaac Yeboah\} and Giovanni Addolorato and Adebiyi, \{Akindele Olupelumi\} and Adepoju, \{Abiola Victor\} and Adewuyi, \{Habeeb Omoponle\} and Shadi Afyouni and Saira Afzal and Sina Afzal and Antonella Agodi and Aqeel Ahmad and Danish Ahmad and Firdos Ahmad and Shahzaib Ahmad and Anderson, \{David B.\} and Bryan Chong and Farah Deeba and Ferreira, \{Paulo H.\} and Gething, \{Peter W.\} and Lee, \{Paul H.\} and Lee, \{Seung Won\} and Lee, \{Wei Chen\} and Li, \{Ming Chieh\} and Lim, \{Stephen S.\} and Wei Liu and Rahman, \{Md Mosfequr\} and Abhinav Singh and Verras, \{Georgios Ioannis\} and Fang Wang and Ning Wang and Wang, \{Yuan Pang\}", year = "2024", month = may, day = "18", doi = "10.1016/S0140-6736(24)00757-8", language = "English", volume = "403", pages = "2133--2161", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10440", } . The Lancet.

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 @article{ff7bdf370ed94d7cb806baabc04bb6b1, title = "Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021", abstract = "Background: understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: the GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95\% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0\% (95\% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8\% [6·4–9·2]), smoking (5·7\% [4·7–6·8]), low birthweight and short gestation (5·6\% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4\% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7\% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0\% [15·5–28·8]), coupled with a 49·4\% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7\% [9·9–21·7] for high BMI and 7·9\% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8\% (1·6–1·9) for high BMI and 1·3\% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5\% (64·4–78·8) for child growth failure and 66·3\% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2021 Risk Factors Collaborators\} and Michael Brauer and Roth, \{Gregory A.\} and Aravkin, \{Aleksandr Y.\} and Peng Zheng and Abate, \{Kalkidan Hassen\} and Abate, \{Yohannes Habtegiorgis\} and Cristiana Abbafati and Rouzbeh Abbasgholizadeh and Abbasi, \{Madineh Akram\} and Mohammadreza Abbasian and Mitra Abbasifard and Mohsen Abbasi-Kangevari and \{Abd ElHafeez\}, Samar and Sherief Abd-Elsalam and Parsa Abdi and Mohammad Abdollahi and Meriem Abdoun and Abdulah, \{Deldar Morad\} and Auwal Abdullahi and Mesfin Abebe and Aidin Abedi and Armita Abedi and Abegaz, \{Tadesse M.\} and Zu{\~n}iga, \{Roberto Ariel Abelda{\~n}o\} and Olumide Abiodun and Abiso, \{Temesgen Lera\} and Ahmed Abu-Zaid and Soham Bandyopadhyay and Brown, \{Colin Stewart\} and Fan Cao and Cheng, \{Ching Yu\} and Bryan Chong and Samuele Cortese and Emeto, \{Theophilus I.\} and Haque, \{Md Rabiul\} and Khan, \{M. Nuruzzaman\} and Khan, \{Mohammad Jobair\} and Lee, \{Paul H.\} and Lee, \{Seung Won\} and Li, \{Ming Chieh\} and Lim, \{Stephen S.\} and Wei Liu and Nguyen, \{Phuong The\} and O'Connell, \{Erin M.\} and Maryam Rezaei and Abhinav Singh and Verras, \{Georgios Ioannis\} and Fang Wang and Wang, \{Yuan Pang\} and Zhang, \{Zhi Jiang\}", year = "2024", month = may, day = "16", doi = "10.1016/S0140-6736(24)00933-4", language = "English", volume = "403", pages = "2162--2203", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10440", } . The Lancet.

The mediating effect of dispositional mindfulness on the association between UPPS-P impulsivity traits and gaming disorder among Asia-Pacific young adults @article{5ecf11ae264c4c1ebdf407fe89739a49, title = "The mediating effect of dispositional mindfulness on the association between UPPS-P impulsivity traits and gaming disorder among Asia-Pacific young adults", abstract = "Background: little evidence is available to verify the mediating effect of dispositional mindfulness on the association between gaming disorder and various impulsivity traits. The present study aimed to investigate the mediating effect of dispositional mindfulness on the association between the five UPPS-P impulsivity traits and the risk of gaming disorder among young adults.Methods: it was an inter-regional cross-sectional study using online survey in Australia, Japan, The Philippines and China. Impulsivity measured by the UPPS-P Impulsive Behavior Scale-Short version; dispositional mindfulness measured by the Mindfulness Attention Awareness Scale; and the risk of gaming disorder measured by the Internet Gaming Disorder Scale were collected in the focal regions. Structural equation modeling was performed by SPSS AMOS version 26 to verify the study hypotheses. Bootstrapped 95\% confidence interval was reported. Statistical significance was indicated by the p-value below 0.05.Results: among the 1,134 returned questionnaires, about 40\% of them aged 18-20 years and 21-23 years, respectively. 53.8\% were male. 40.7\% had been playing digital and video games for over 10 years. The prevalence of gaming disorder was 4.32\%. The model fitness indices reflected that the constructed model had an acceptable model fit (χ 2(118) = 558.994, p < 0.001; χ 2/df = 4.737; CFI = 0.924; TLI = 0.890; GFI = 0.948; RMSEA = 0.058; SRMR = 0.0487). Dispositional mindfulness fully mediated the effect of positive urgency and negative urgency on the risk of gaming disorder. The effect of lack of premeditation on the risk of gaming disorder was partially mediated by dispositional mindfulness. However, dispositional mindfulness did not mediate the effect of sensation seeking on the risk of gaming disorder. Conclusions: the varied associations between dispositional mindfulness and the five impulsivity traits hints that improving some impulsive traits may increase dispositional mindfulness and so lower the risk of gaming disorder. Despite further studies are needed to verify the present findings, it sheds light on the need to apply interventions on gamers based on their impulsivity profile. Interventions targeting at emotion regulation and self-control such as mindfulness-based interventions seem to be effective to help gamers with dominant features of urgency and lack of premeditation only. Other interventions shall be considered for gamers with high sensation seeking tendency to enhance the effectiveness of gaming disorder prevention.", keywords = "Dispositional mindfulness, Gaming disorder, Impulsivity, UPPS-P, Young adult", author = "Tang, \{Anson Chui Yan\} and Lee, \{Regina Lai Tong\} and Lee, \{Paul Hong\} and Keiko Tanida and Shun Chan and Lam, \{Simon Ching\} and Jennifer Nailes and Malinit, \{Joy P.\} and Juangco, \{Jose Ronilo G.\} and Qing Wang and Jason Ligot and Suen, \{Lorna Kwai Ping\}", year = "2024", month = apr, day = "30", doi = "10.1186/s12888-024-05740-0", language = "English", volume = "24", journal = "BMC Psychiatry", issn = "1471-244X", publisher = "BioMed Central", number = "1", } . BMC Psychiatry.

Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100 @article{654b0514e87643fe9ac0dd4018d39d49, title = "Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021", abstract = "Background: accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: to estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95\% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: during the period from 1950 to 2021, global TFR more than halved, from 4·84 (95\% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95\% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1\%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2\% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0\%) in 2050 and only six (2·9\%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3\% (39·6–43·1) in 2050 and 54·3\% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8\% (23·7–25·8) in 2021 to 16·7\% (14·3–19·1) in 2050 and 7·1\% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2021 Fertility and Forecasting Collaborators\} and Bhattacharjee, \{Natalia V.\} and Schumacher, \{Austin E.\} and Amirali Aali and Abate, \{Yohannes Habtegiorgis\} and Rouzbeh Abbasgholizadeh and Mohammadreza Abbasian and Mohsen Abbasi-Kangevari and Hedayat Abbastabar and ElHafeez, \{Samar Abd\} and Sherief Abd-Elsalam and Mohammad Abdollahi and Abdollahifar, \{Mohammad Amin\} and Meriem Abdoun and Auwal Abdullahi and Mesfin Abebe and Abebe, \{Samrawit Shawel\} and Olumide Abiodun and Hassan Abolhassani and Meysam Abolmaali and Mohamed Abouzid and Aboye, \{Girma Beressa\} and Abreu, \{Lucas Guimar{\~a}es\} and Abrha, \{Woldu Aberhe\} and Abrigo, \{Michael R.M.\} and Dariush Abtahi and Hasan Abualruz and Bilyaminu Abubakar and Soham Bandyopadhyay and Fan Cao and Bryan Chong and Francesco Esposito and Gething, \{Peter W.\} and Khan, \{M. Nuruzzaman\} and Khan, \{Mohammad Jobair\} and Lee, \{Paul H.\} and Lee, \{Seung Won\} and An Li and Li, \{Ming Chieh\} and Lim, \{Stephen S.\} and Rahul Mehra and Nguyen, \{Phuong The\} and Mihaela Paun and Gavin Pereira and Rahman, \{Md Mosfequr\} and Shaw, \{David H.\} and Abhinav Singh and Verras, \{Georgios Ioannis\} and Fang Wang and Wang, \{Yuan Pang\} and Smith, \{Amanda E.\}", year = "2024", month = mar, day = "20", doi = "10.1016/S0140-6736(24)00550-6", language = "English", volume = "403", pages = "2057--2099", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10440", } . The Lancet.

Talking in Primary Care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost effectiveness of communication skills e-learning for practitioners on patients musculoskeletal pain and enablement @article{5f0d9422a58a4f1e8c72d0d161109940, title = "Talking in Primary Care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost effectiveness of communication skills e-learning for practitioners on patients musculoskeletal pain and enablement", abstract = "Introduction Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain. Methods and analysis A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews. Ethics approval and dissemination Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country. Trial registration number ISRCTN18010240.", keywords = "digital technology, empathy, health communication, optimism, primary health care, Musculoskeletal disorders, MEDICAL EDUCATION \& TRAINING, Patient-Centered Care, Primary Health Care, eHealth", author = "Bishop, \{Felicity L.\} and Nadia Cross and Rachel Dewar-Haggart and Emma Teasdale and Amy Herbert and Robinson, \{Michelle E.\} and Ridd, \{Matthew J.\} and Mallen, \{Christian D.\} and Clarson, \{Lorna E.\} and Jennifer Bostock and Taeko Becque and Beth Stuart and Kirsty Garfield and Leanne Morrison and Sebastien Pollet and Jane Vennik and Helen Atherton and Jeremy Howick and Geraldine Leydon and Jacqui Nuttall and Nazrul Islam and Lee, \{Paul H.\} and Paul Little and Hazel Everitt", note = "{\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.", year = "2024", month = mar, day = "19", doi = "10.1136/bmjopen-2023-081932", language = "English", volume = "14", journal = "BMJ Open", issn = "2044-6055", publisher = "BMJ Publishing Group", number = "3", } . BMJ Open.

Number of days required to reliably measure weekday and weekend total sleeping time with accelerometer @article{3bc26aa6c683444790254741f8461ef3, title = "Number of days required to reliably measure weekday and weekend total sleeping time with accelerometer: A secondary data analysis with National Health and Nutritional Survey (NHANES) 2011–2014 data", abstract = "The current standard practice for measuring sleeping time with accelerometer is to ask the participants to wear it for 7 consecutive days and analysing data from participants who have provided at least 4 days of valid data. However, this standard lacks supporting evidence. This study aims to evaluate this standard of practice by examining the reliability of measuring total sleeping time in a representative sample of US adults using accelerometer data from the National Health and Nutritional Survey (NHANES) waves 2011–2012 and 2013–2014. The sample included a total of 14,676 participants, out of which only those who provided data for seven days (n = 9510) were included in the analysis. The results revealed that the intra-class correlation coefficient (ICC) for a single day of measurement was 0.38 for weekdays and 0.27 for weekends. To achieve a reliability of 0.7, measurements for 4 and 7 nights were necessary for weekdays and weekends, respectively. Our simulation study found that the randomly-selected 3-day average of weekday sleeping time strongly correlated with the actual mean (ρ = 0.92), capturing at least 80 \% of the variance. However, the randomly-selected 1-day average of weekend sleeping time only captured about 60 \% of the variance. In conclusion, we recommend that future accelerometer research adopts a 9-day continuous measurement period, covering four weekend days, to reliably estimate both weekday and weekend sleeping time.", keywords = "Actigraphy, Measurement, Reliability, Sleep", author = "Lee, \{Paul H.\}", note = "Funding Information: None. Publisher Copyright: {\textcopyright} 2024 The Author", year = "2024", month = feb, day = "1", doi = "10.1016/j.sleep.2024.01.006", language = "English", volume = "114", pages = "178--181", journal = "Sleep Medicine", issn = "1389-9457", publisher = "Elsevier BV", } . Sleep Medicine.

Paul H. Lee, Jan Marek, Petr N&#225;levka (2024). Sleep pattern of Hong Kong residents during the 2019 anti-extradition bill controversy . Current Psychology.

Paul H. Lee (2024). Number of days required to reliably measure weekday and weekend total sleeping time with accelerometer: A secondary data analysis with National Health and Nutritional Survey (NHANES) 2011–2014 data . Sleep Medicine.

Paul H. Lee, Ali Neishabouri, Andy C.Y. Tse, Christine C. Guo (2024). Comparative Analysis and Conversion Between Actiwatch and ActiGraph Open-Source Counts . Journal for the Measurement of Physical Behaviour.

Evaluation of N95 respirators on fit rate, real-time leakage, and usability among Chinese healthcare workers @article{fdbbd360af60490f9ef983ce1b0c4906, title = "Evaluation of N95 respirators on fit rate, real-time leakage, and usability among Chinese healthcare workers: study protocol of a randomized crossover trial", abstract = "Background: N95 respirators are used to limit the transmission of respiratory viruses in clinical settings. There are two to three major types of N95 available for all healthcare workers in Hong Kong. However, after the coronavirus outbreak and the consequent shortage of many commonly used respirators, several new N95 respirators were adopted temporarily in clinical settings without evaluation. Prior literature indicates that traditional N95 respirators used in hospitals in Hong Kong are not fit for Chinese people and have fit rates ranging from 50 to 60\%. This study aims to investigate and compare the fit rate, real-time leakage, and mask usability of traditional and new N95 respirators among Chinese healthcare workers. Methods: This study will employ two sequential phases. Phase 1 has a cross-sectional exploratory design used to investigate the fit rate and mask usability of three types of respirators. Phase 2 will examine the effectiveness of respiratory protection by comparing traditional and new N95 respirators by a randomized crossover trial. Eligible participants will be randomly allocated through a controlled crossover experiment to either a traditional or new respirator group (n = 100 in each arm) for performing standard clinical procedures. The primary outcome (real-time leakage) will be recorded at 30 s intervals during nasopharyngeal suctioning and cardiopulmonary resuscitation. The secondary outcomes are the fit rate and mask usability. After a 2 min suctioning (15 s twice) and 4 min one-person CPR, the fit rate (assessed by standard N95 fit testing) and mask usability (measured by self-reported mask usability scale) will be recorded as data of post-procedure. After 10 min rest, measurement of real-time leakage (i.e., crossover), fit test, and usability will be repeated. Discussion: The result of real-time leakage will be a vital indicator of the respiratory protection of Chinese healthcare workers while performing prevalent clinical procedures, such as resuscitation. The fit rate and usability result will serve as an essential reference for consumable purchase policy in clinical settings. Trial registration: ISRCTN registry: ISRCTN40115047. Retrospectively registered on May 9, 2023. https://www.isrctn.com/ISRCTN40115047.", keywords = "Chinese healthcare workers, crossover trial, fit rate, N95 respirators, real-time leakage, usability", author = "Lam, \{Simon Ching\} and Aderonke Odetayo and Yu, \{Ignatius Tak Sun\} and So, \{Sony Nai Yeung\} and Kin Cheung and Lee, \{Paul Hong\} and Suen, \{Lorna Kwai Ping\}", year = "2023", month = nov, day = "17", doi = "10.3389/fpubh.2023.1266607", language = "English", volume = "11", journal = "Frontiers in Public Health", issn = "2296-2565", publisher = "Frontiers Media SA", } . Frontiers in Public Health.

Comparing the effectiveness of physical exercise intervention and melatonin supplement in improving sleep quality in children with ASD @article{be1b99a4e0d0419581c02a457de271bb, title = "Comparing the effectiveness of physical exercise intervention and melatonin supplement in improving sleep quality in children with ASD", abstract = "Purpose: previous studies have demonstrated that physical exercise can modulate the endogenous melatonin level in children with autism spectrum disorder (ASD) and improve their sleep quality. However, it remains unclear whether physical exercise or melatonin supplement, or a combination of both, is more effective in improving sleep quality in this population. The purpose of this study is to answer this research question by comparing the effectiveness of three types of interventions (physical exercise vs. melatonin supplement or a combination of both) in improving sleep quality in children with ASD.Methods: sixty-two (62) children diagnosed with ASD were randomly assigned to one of four groups: cycling (n = 18), melatonin supplement (n = 14), a combination of both (n = 12), and placebo control group (n = 18). Four (4) sleep parameters (sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset) were assessed.Results: the results revealed a significant improvement in sleep efficiency, sleep onset latency, and sleep duration in all of the interventions, but not in the placebo control group. However, no significant group differences were found among the interventions (ps >.05).Conclusion: our findings suggest similar effectiveness of physical exercise and melatonin supplementation in improving sleep quality in children with ASD.", keywords = "Autism, Children, Melatonin Supplement, Physical Exercise, Sleep", author = "Tse, \{Andy C.Y.\} and Lee, \{Paul H.\} and Sit, \{Cindy H.P.\} and Poon, \{Eric Tsz-chun\} and F. Sun and Pang, \{Chi Ling\} and Cheng, \{James C.H.\}", note = "Funding Information: the work described in this paper was partially supported by the General Research Fund the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. 18616522).", year = "2023", month = nov, day = "11", doi = "10.1007/s10803-023-06172-7", language = "English", journal = "Journal of Autism and Developmental Disorders", issn = "0162-3257", publisher = "Springer", } . Journal of Autism and Developmental Disorders.

How COVID-19 ceases all older adult services & the way out for community-dwelling older adults with chronic pain @article{f210780b5d00493e9feec1775236ecb3, title = "How COVID-19 ceases all older adult services \& the way out for community-dwelling older adults with chronic pain", abstract = "The COVID-19 pandemic started at the beginning of 2020. It significantly impacted the older adults in Hong Kong, with most of the community centers and elderly centers being closed down under various restrictive measures. Thus, community-based health promotion activities were temporarily paused, which decreased older adults{\textquoteright} health-promoting behaviors and motivation to stay active. This research aimed to improve the quality of life and the health of older adults with chronic pain through the pain management program. This study was conducted face-to-face on the campus of Hong Kong Metropolitan University. This dyadic pain management program (DPM) was an 8-week group-based program. The DPM comprised 4 weeks of campus-based activities and 4 weeks of digital-based activities delivered via a WhatsApp group. An 80\% participation rate in the campus-based activities was regarded as completing the DPM. The control group only received lesson leaflets. Pain intensity, pain self-efficacy, psychological health of pain victims, caregiver burden inventory, and a semi-structured interview were evaluated at week 1 (T0), week 8 (T1), and week 12 (T2) after randomization. The IBM-SPSS version 22 was used to perform statistical analyses. Using non-pharmacological methods and regular exercise for 12 weeks improved physical health in terms of pain intensity, pain self-efficacy, and psychological health in anxiety, depression, and stress. For caregivers, their burden decreased after the pain management program. These findings indicated that Pender{\textquoteright}s Health Promotion Model is helpful to empower the participants and their caregivers with knowledge, skills, and power to manage their chronic pain situations. Utilizing this model as a framework, Researchers can design more effective non-pharmacological interventions for older adults to increase their engagement in health-promoting activities in the community.", keywords = "chronic pain, COVID-19, older adults, pain management", author = "Tse, \{Mimi Mun Yee\} and Ng, \{Shamay Sheung Mei\} and Vivian Lou and Lo, \{Raymond S.K.\} and Cheung, \{Daphne Sze Ki\} and Lee, \{Paul H.\} and Tang, \{Shuk Kwan\} and Leung, \{Siu Hang\} and Tse, \{Percy Poo See\}", year = "2023", month = sep, day = "15", doi = "10.21926/obm.neurobiol.2303183", language = "English", volume = "7", journal = "OBM Neurobiology", issn = "2573-4407", publisher = "LIDSEN Publishing Inc", number = "3", } . OBM Neurobiology.

Comparative analysis and conversion between Actiwatch and ActiGraph open-source counts @article{d90ac826a5d8483c8c25b08c30060460, title = "Comparative analysis and conversion between Actiwatch and ActiGraph open-source counts", abstract = "Body-worn sensors have contributed to a rich and growing body of literature in public health and clinical research in the last decades. A major challenge in sensor research is the lack of consistency and standardization of the collection and reporting of the sensor data. The algorithms used to derive these activity counts can be vastly different between manufactures and not always transparent to the researchers. With Philips, one of the major research-grade wearable device manufacturers, discontinuing this product line, many researchers are left in need of alternative solutions and at the risk of not being able to relate their historical data using the Philips Actiwatch 2 devices to future findings with other devices. We herein provide a comparison analysis and conversion method that can be used to convert activity counts from Philips to those from ActiGraph, another major manufacturer who provide both raw acceleration data and count data based on their open-source algorithm to the research community. This work provides an approach to maximize the scientific value of historical actigraphy data collected by the Actiwatch devices to support research continuity in this community. The conversion, however, is not perfect and only offers an approximation, due to the intrinsic difference in the count algorithms between the two accelerometers, and the permanent information loss during data reduction. We encourage future research using body-worn sensors to retain the raw sensor data to ensure data consistency, comparability, and the ability to leverage future algorithm improvement.", keywords = "accelerometry, calibration, measurement, motion sensor, physical activity, sedentary behavior", author = "Lee, \{Paul H.\} and Ali Neishabouri and Tse, \{Andy C.Y.\} and Guo, \{Christine C.\}", year = "2023", month = aug, day = "21", doi = "10.1123/jmpb.2022-0054", language = "English", volume = "7", journal = "Journal for the Measurement of Physical Behaviour", issn = "2575-6605", publisher = "Human Kinetics", number = "1", } . Journal for the Measurement of Physical Behaviour.

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021 @article{78ebfd73e4dc4d71b71f673b08a20a99, title = "Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021", abstract = "Background: diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods: estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings: in 2021, there were 529 million (95\% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1\% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3\% [8·7–9·9]) and, at the regional level, in Oceania (12·3\% [11·5–13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1\% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0\% (95·1–96·8) of diabetes cases and 95·4\% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2\% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3\% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10\% in two super-regions: 16·8\% (16·1–17·6) in north Africa and the Middle East and 11·3\% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6\%) of 204 countries and territories will have an age-standardised rate greater than 10\%. Interpretation: diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2021 Diabetes Collaborators\} and Ong, \{Kanyin Liane\} and Stafford, \{Lauryn K.\} and McLaughlin, \{Susan A.\} and Boyko, \{Edward J.\} and Vollset, \{Stein Emil\} and Smith, \{Amanda E.\} and Dalton, \{Bronte E.\} and Joe Duprey and Cruz, \{Jessica A.\} and Hailey Hagins and Lindstedt, \{Paulina A.\} and Amirali Aali and Abate, \{Yohannes Habtegiorgis\} and Abate, \{Melsew Dagne\} and Mohammadreza Abbasian and Zeinab Abbasi-Kangevari and Mohsen Abbasi-Kangevari and ElHafeez, \{Samar Abd\} and Rami Abd-Rabu and Abdulah, \{Deldar Morad\} and Abdullah, \{Abu Yousuf Md\} and Vida Abedi and Hassan Abidi and Aboagye, \{Richard Gyan\} and Hassan Abolhassani and Eman Abu-Gharbieh and Ahmed Abu-Zaid and Adane, \{Tigist Demssew\} and Adane, \{Denberu Eshetie\} and Addo, \{Isaac Yeboah\} and Adegboye, \{Oyelola A.\} and Victor Adekanmbi and Adepoju, \{Abiola Victor\} and Adnani, \{Qorinah Estiningtyas Sakilah\} and Afolabi, \{Rotimi Felix\} and Gina Agarwal and Aghdam, \{Zahra Babaei\} and Lee, \{Wei Chen\} and Lee, \{Paul H.\} and Lee, \{Seung Won\} and Li, \{Ming Chieh\} and Lim, \{Stephen S.\} and Md Moniruzzaman and Rahman, \{Mohammad Hifz Ur\} and Rahman, \{Md Mosfequr\} and Salomon, \{Joshua A.\} and Verras, \{Georgios Ioannis\} and Fang Wang and Wu, \{Yi Fan\} and Zhang, \{Zhi Jiang\}", year = "2023", month = jul, day = "15", doi = "10.1016/S0140-6736(23)01301-6", language = "English", volume = "402", pages = "203--234", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10397", } . The Lancet.

A survey of the workplace experiences of police force employees who are autistic and/or have attention deficit hyperactivity disorder @article{4204971376e845d78f0cc5549a29fbc5, title = "A survey of the workplace experiences of police force employees who are autistic and/or have attention deficit hyperactivity disorder", abstract = "Background: there has been little focus on autism and attention-deficit hyperactivity disorder (ADHD) in occupational groups, particularly in high-demand roles such as the police. Aims To describe the characteristics and experiences of UK-based police force employees who are autistic and/or have ADHD, including the benefits and challenges their conditions bring to their occupation, their need for reasonable adjustments, and their co-occurring mental illnesses. Method: an online survey was developed, containing both quantitative and qualitative elements. Survey invitations were disseminated through the National Police Autism Association. The survey was open from 23 April to 23 July 2022. Results: a total of 117 participants participated in the survey, including 66 who were autistic and 51 with ADHD. Participants who were autistic and/or had ADHD widely reported both benefits and challenges related to their condition(s) in policing work. Both the autistic and ADHD groups widely reported having requested workplace adjustments related to their condition(s), although these were frequently not made. Anxiety (n = 57; 49\%) and depression (n = 40; 36\%) were both highly prevalent among the participants. The qualitative findings identified four themes: (a) motivations for taking on this career, (b) rewards of the role, (c) challenges of the job and (d) challenges regarding career progression. Conclusions: police force employees who are autistic and/or have ADHD reported that their conditions provided both benefits and challenges with respect to policing work, and that they had requested related workplace adjustments, although such adjustments frequently do not take place. Healthcare professionals need to recognise the importance of workplace considerations and advocacy for people who are autistic and/or have ADHD.", keywords = "attention-deficit hyperactivity disorder, Autism spectrum disorder, comorbidity, developmental disorder, stigma and discrimination", author = "Tromans, \{Samuel J.\} and Alison Drewett and Lee, \{Paul H.\} and Michelle O'Reilly", year = "2023", month = jul, day = "6", doi = "10.1192/bjo.2023.508", language = "English", volume = "9", journal = "BJPsych Open", issn = "2056-4724", publisher = "Cambridge University Press", number = "4", } . BJPsych Open.

Effects of an individualised exercise programme plus Behavioural Change Enhancement (BCE) strategies for managing fatigue in frail older adults @article{26d19e629ecb46a6834b8734e1af6b76, title = "Effects of an individualised exercise programme plus Behavioural Change Enhancement (BCE) strategies for managing fatigue in frail older adults: a cluster randomised controlled trial", abstract = "Background: To the best of our knowledge, although ageing-induced fatigue could cause adverse outcomes such as frailty, there is currently no intervention for it. This study evaluated the effects of an individualised exercise programme with/without BCE strategies on reducing fatigue in older adults. Methods: A three-armed cluster-randomised controlled trial (RCT) was conducted with 184 participants (mean age: 79.1 ± 6.4; mean frailty score: 2.8 + 0.8) from 21 community centres (ClinicalTrials.gov: NCT03394495). They were randomised into either: the COMB group (n = 64), receiving 16 weeks of exercise training plus the BCE programme; the EXER group (n = 65), receiving exercise training and health talks; or the control group (n = 55), receiving only health talks. Fatigue was assessed using the Multi-dimensional Fatigue Inventory (range: 20 to 100, with higher scores indicating higher fatigue levels) at baseline, and immediately, 6 months, and 12 months post-intervention. Results: The GEE analyses showed significant interaction (time x group) between the COMB and control groups immediately (p < 0.001), 6 months (p < 0.001), and 12 months (p < 0.001) post-intervention. Comparing the COMB and EXER groups, there was a significant interaction immediately (p = 0.013) and at 12 months post-intervention (p = 0.007). However, no significant difference was seen between the EXER group and control group at any time point. Conclusions: The COMB intervention showed better immediate and sustainable effects (i.e., 12 months after the intervention) on reducing fatigue in frail older adults than exercise training or health education alone. Trial registration: ClinicalTrials.gov (NCT03394495), registered on 09/01/2018.", keywords = "Behaviour change enhancement, Exercise, Fatigue, Frailty, Humans, Aged, 80 and over, Quality of Life, Aged, Frail Elderly, Exercise Therapy/methods, Fatigue/therapy", author = "Liu, \{Justina Y.W.\} and Yin, \{Yue Heng\} and Kor, \{Patrick P.K.\} and Kwan, \{Rick Y.C.\} and Lee, \{Paul H.\} and Chien, \{Wai Tong\} and Siu, \{Parco M.\} and Hill, \{Keith D.\}", note = "Funding Information: This study was funded by the Hong Kong University Grants Committee and the Hong Kong Polytechnic University (ref. no. 1560717). Publisher Copyright: {\textcopyright} 2023, The Author(s).", year = "2023", month = jun, day = "16", doi = "10.1186/s12877-023-04080-0", language = "English", volume = "23", pages = "370", journal = "BMC Geriatrics", issn = "1471-2318", publisher = "BioMed Central", number = "1", } . BMC Geriatrics.

The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults @article{48dd3299ff174756b67ab0e8716724e3, title = "The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults: a cross-sectional study", abstract = "Purpose: To explore older adults{\textquoteright} perceived relationship quality with migrant domestic workers (MDWs) and examine the correlation between older adult/MDW (O-M) relationship quality and loneliness of community-dwelling older adults. Materials and methods: In this cross-sectional study, older adults living with MDWs were conveniently recruited from neighbourhood elderly centers in Hong Kong. Loneliness and O-M relationship quality were assessed by the 6-item De Jong Gierveld Loneliness Scale and the mutuality scale, respectively. Older adults{\textquoteright} demographic and functional characteristics, and MDW's nationality, spoken language and years of service in the dyad were also collected. Hierarchical multiple regression analyses were conducted to examine the contributions of 1) demographic variables and functional status, 2) MDW characteristics, 3) perceived social network and 4) perceived O-M relationship quality on loneliness. Results: The 178 participants [mean age 83.44 (SD 7.05 years); 155 (87.1\%) women and 23 men (22.9\%)] were socially lonely (1.07 ± 1.15) and close to being lonely overall (1.90 ± 1.68), and emotionally (0.84 ± 0.97). The mean O-M relationship quality was poor (1.42 ± 0.79), which was significantly correlated with overall (β = -0.33, 95\% CI: -0.65 to -0.01, P value = 0.045), and social (β= -0.24, 95\% CI: -0.46 to -0.01, P value = 0.04) loneliness, but not significantly correlated to emotional loneliness. Conclusion: Better perceived O-M relationship quality is correlated with a lower level of loneliness among older adults. Strategies to improve O-M relationship quality may alleviate loneliness among older adults.", keywords = "Loneliness, Migrant domestic workers, Mutuality, Older adults, Relationship quality, Social support, Cross-Sectional Studies, Humans, Loneliness/psychology, Independent Living, Male, Emotions, Transients and Migrants, Aged, 80 and over, Female, Aged", author = "Ho, \{Ken H.M.\} and Hung, \{Maria S.Y.\} and Youjuan Zhang and Xue Bai and Cheung, \{Daphne S.K.\} and Chow, \{Meyrick C.M.\} and Lee, \{Paul H.\} and Chien, \{Wai Tong\}", note = "Funding Information: Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials disclosed in this article. This study was funded by the Faculty Development Scheme, Research Grant Council, Hong Kong SAR, China (FDS, RGC Ref. No.: UGC/FDS/H01/20). Publisher Copyright: {\textcopyright} 2023 The Author(s)", year = "2023", month = jun, day = "1", doi = "10.1016/j.archger.2023.104952", language = "English", volume = "109", pages = "104952", journal = "Archives of Gerontology and Geriatrics", issn = "0167-4943", publisher = "Elsevier Ireland Ltd.", } . Archives of Gerontology and Geriatrics.

Richard J. Packer, Nick Shrine, Robert Hall, Carl A. Melbourne, Rebecca Thompson, Alex T. Williams, Megan L. Paynton, Anna L. Guyatt, Richard J. Allen, Paul H. Lee, et al. (2023). Genome-wide association study of chronic sputum production implicates loci involved in mucus production and infection . European Respiratory Journal.

The effects of an e-health brisk walking intervention in increasing moderate-to-vigorous physical activity in physically inactive older people with cognitive frailty @article{a2799624d50644f09587f06aa59ff982, title = "The effects of an e-health brisk walking intervention in increasing moderate-to-vigorous physical activity in physically inactive older people with cognitive frailty: study protocol for a randomized controlled trial", abstract = "Background: cognitive frailty is a risk for many adverse health outcomes that are commonly observed in older people. Physical activity is known to be effective to reserve cognitive frailty but the prevalence of physical inactivity is still high in older people. E-health enhances behavioural change effects through an innovative way to deliver behavioural change methods that can enhance the behavioural change effects. However, its effects on older people with cognitive frailty, its effects compared with conventional behavioural change methods, and the sustainability of the effects are unclear. Methods: this study employs a single-blinded, two-parallel-group, non-inferiority, randomized controlled trial design with a 1:1 group allocation ratio. Eligible participants are aged 60 years or above, have cognitive frailty and physical inactivity, and possess a smartphone for more than six months. The study will be conducted in community settings. In the intervention group, participants will receive a 2-week brisk-walking training followed by a 12-week e-health intervention. In the control group, participants will receive a 2-week brisk-walking training followed by a 12-week conventional behavioural change intervention. The primary outcome is minutes of moderate-to-vigorous physical activity (MVPA). This study aims to recruit a total of 184 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention. Ethics and dissemination: the trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) on 7th March 2023, https://clinicaltrials.gov/ct2/show/NCT05758740 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022136). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields. Trial registration: the trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) and all items come from the World Health Organization Trial Registration Data Set. The latest version of the protocol was published online on 7th March 2023.", keywords = "Brisk walking, Cognitive frailty, E-health, Moderate-to-vigorous physical activity (MVPA)", author = "Kwan, \{Rick Yiu Cho\} and Liu, \{Justina Yat Wa\} and Lee, \{Paul Hong\} and Sin, \{Olive Suk Kan\} and Wong, \{Julia Sze Wing\} and Fu, \{Mei Rosemary\} and Suen, \{Lorna Kwai Ping\}", note = "Funding Information: This project is funded by the Research Grants Council for the Competitive Research Funding Schemes for the Local Self-financing Degree sector under the Faculty Development Scheme [Reference number: UGC/FDS17/H04/22]. The funder provided financial support for the purchase of study materials and supporting the salary of the research staff. The role of the funder is to monitor adherence to the study procedures according to the details written in the research protocol. The funder is not involved in the implementation of the study procedures. Publisher Copyright: {\textcopyright} 2023, The Author(s).", year = "2023", month = may, day = "17", doi = "10.1186/s13063-023-07335-8", language = "English", volume = "24", journal = "Trials", issn = "1745-6215", publisher = "BioMed Central", number = "1", } . Trials.

The relationships among executive functions, self-regulation, and physical exercise in children with autism spectrum disorder @article{d2f2f2f1429742feb1ce791eb084dcab, title = "The relationships among executive functions, self-regulation, and physical exercise in children with autism spectrum disorder", abstract = "Physical exercise is widely reported beneficial to executive functions in children with autism spectrum disorder. However, its impact on self-regulation in the population remains unknown. This study is to test whether two types of physical exercise (cognitively engaging vs non-cognitively engaging) benefited self-regulation and whether the social, emotional, and physical needs of an individual mediated the exercise–executive function and exercise–self-regulation relationships. Sixty-four children diagnosed with autism spectrum disorder were randomly assigned into 1 of 3 groups: learning to ride a bicycle (n = 23), stationary cycling (n = 19), or an active control with walking (n = 22). Two executive functions (flexibility and inhibition), self-regulation and the mediating roles of perceived social support, enjoyment, stress, physical self-efficacy, and perceived physical fitness were assessed. Participants in the learning to ride a bicycle group significantly improved their executive functions (p values <.01). The learning to ride a bicycle group and the stationary cycling group also significantly enhanced their self-regulation (p values <.001). Mediation analyses showed that physical self-efficacy and perceived physical fitness partially mediated the exercise–executive function relationship. Meanwhile, perceived social support significantly mediated the exercise–self-regulation relationship (p <.05). Our findings highlight the value of cognitively engaging exercise on enhancing executive functions in children with autism spectrum disorder in part by improving their physical self-efficacy and perceptions of fitness. Lay abstract: This study examined the impacts of two types of physical exercises (two-wheel cycling vs stationary cycling) on cognition and self-regulation among 64 children with autism spectrum disorder. It also explored the role of social, emotional, and physical needs of an individual in the relationship between exercise, cognition, and self-regulation. Results showed that participants in the two-wheel cycling group showed significant improvements in their cognition and that the two exercise groups also enhanced their self-regulation. Moreover, this study also revealed that the social need is crucial in mediating the relationship between exercise and self-regulation. This study strengthens the notion that cognitively engaging exercise is more beneficial than the non-cognitively engaging exercise in enhancing cognition in children with autism spectrum disorder.", keywords = "autism, children, cognitive function, executive function, physical exercise, self-regulation", author = "Tse, \{Andy C.Y.\} and Liu, \{Venus H.L.\} and Lee, \{Paul H.\} and Anderson, \{David I.\} and Lakes, \{Kimberley Dawn\}", note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work described in this paper was supported by two grants: general research fund from Research Grants Council (project no. EdUHK 18603818) and funding support to General Research Fund from EdUHK (project no. RG21/2019-2020R). Publisher Copyright: {\textcopyright} The Author(s) 2023.", year = "2023", month = may, day = "10", doi = "10.1177/13623613231168944", language = "English", pages = "1--15", journal = "Autism", issn = "1362-3613", publisher = "SAGE Publications", } . Autism.

Changes in relative peripheral refraction in children who switched from single-vision lenses to Defocus Incorporated Multiple Segments lenses @article{32ade6d2b683495ebb4538ad589c67a5, title = "Changes in relative peripheral refraction in children who switched from single-vision lenses to Defocus Incorporated Multiple Segments lenses", abstract = "Purpose: To investigate changes in relative peripheral refraction (RPR) associated with myopia progression in children who wore single-vision (SV) lenses for 2 years and switched to Defocus Incorporated Multiple Segments (DIMS) lenses in the third year versus children who wore DIMS lenses for 3 years. Methods: In the first 2 years, children were allocated randomly to wear either DIMS or SV lenses. In the third year, children in the DIMS group continued to wear these lenses, while those in the SV group were switched to DIMS lenses (Control-to-DIMS group). Central and peripheral refraction and axial length were monitored every 6 months. Results: Over 3 years, the DIMS group (n = 65) showed good myopia control and maintained a relatively constant and symmetrical RPR profile without significant changes. In the first 2 years, children who wore SV lenses (n = 55) showed asymmetrical RPR changes, with significant increases in hyperopic RPR at 20° nasal (N) (mean difference: 0.88 ± 1.06 D, p < 0.0001) and 30N (mean difference: 1.07 ± 1.09 D, p < 0.0001). The Control-to-DIMS group showed significant myopia retardation after wearing DIMS lenses in the third year. When compared with the RPR changes in the first 2 years, significant reductions in hyperopic RPR were observed at 20N (mean difference: −1.14 ± 1.93 D, p < 0.0001) and 30N (mean difference: −1.07 ± 1.17 D, p < 0.0001) in the third year. However, no significant difference between the RPR changes found in the nasal retina and temporal retina (p > 0.05) was noted in the third year. Conclusion: Symmetrical changes in RPR were found in children switching from SV to DIMS lenses, and a symmetrical pattern of RPR was noted in children who wore DIMS for 3 years. Myopia control using myopic defocus in the mid-periphery influenced the RPR changes and retarded myopia progression by altering the eye's growth pattern.", keywords = "eye growth pattern, myopia control, myopic defocus, relative peripheral refraction, retinal shape, Refraction, Ocular, Humans, Retina, Eyeglasses, Disease Progression, Myopia/therapy, Child, Hyperopia", author = "Zhang, \{Han Yu\} and Lam, \{Carly Siu Yin\} and Tang, \{Wing Chun\} and Lee, \{Paul H.\} and Tse, \{Dennis Y.\} and To, \{Chi Ho\}", note = "Funding Information: CSY Lam received funding support from the InnoHK initiative and the Hong Kong Special Administrative Region Government. This study was also supported by Hong Kong PolyU grants RUQT, ZG5N, ZGAB and ZGD5, and partly supported by collaborative research by HOYA Corporation, Tokyo, Japan. Funding Information: This collaborative research was partially supported by HOYA Corporation, Tokyo, Japan (CSY Lam, CH To). Patents titled {\textquoteleft}Spectacle Lens{\textquoteright} in China (CN104678572 B) and USA (US10268050 B2) were issued on 27 April 2018 and 23 April 2019, respectively (CSY Lam, CH To). Publisher Copyright: {\textcopyright} 2022 College of Optometrists.", year = "2023", month = may, doi = "10.1111/opo.13086", language = "English", volume = "43", pages = "319--326", journal = "Ophthalmic and Physiological Optics", issn = "0275-5408", publisher = "Springer Nature", number = "3", } . Ophthalmic and Physiological Optics.

Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years @article{5735520e665247568dbdffed85e2307e, title = "Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years", abstract = "This study evaluated the long-term myopia control effect and safety in children wearing Defocus Incorporated Multiple Segments (DIMS) spectacle lenses. Participants who completed the 2-year RCT were followed for a total of 6 years; their cycloplegic refractions and axial length were measured. Group 1 (n = 36) wore DIMS spectacles for 6 years; Group 2 (n = 14) wore DIMS lens for the first 3.5 years and SV spectacles afterwards; Group 3 (n = 22) wore SV spectacles in the first 2 years and switched to DIMS; Group 4 (n = 18) wore SV spectacles in the first 2 years, switched to DIMS for 1.5 years and then SV spectacles again. Group 1 showed no significant differences in myopia progression (− 0.52 ± 0.66 vs. − 0.40 ± 0.72D) and axial elongation (0.32 ± 0.26 vs. 0.28 ± 0.28 mm, both p > 0.05) between the first and the later 3 years. In the last 2.5 years, DIMS lens groups (Groups 1 and 3) had less myopia progression and axial elongation than the single vision groups (Groups 2 and 4). There was no evidence of rebound after stopping the treatment. Post-wear visual functions in all groups were within norms. The results supported that DIMS lenses provided sustained myopia control without adverse effects over the 6-year study period. Trial registration: clinicaltrials.gov; NCT02206217.", author = "Lam, \{Carly Siu Yin\} and Tang, \{Wing Chun\} and Zhang, \{Han Yu\} and Lee, \{Paul H.\} and Tse, \{Dennis Yan Yin\} and Hua Qi and Natalia Vlasak and To, \{Chi Ho\}", note = "Funding Information: This was a collaborative research study with Hoya Corporation (Tokyo, Japan) supported by their funding H-ZGAB and PolyU grants: 848K, RUQT and funding support from InnoHK initiative and the Hong Kong Special Administrative Region Government. Hoya also manufactured spectacle lenses and provided frames. The authors thank Yee Mui Kwok for liaison with the parents and data entry. Publisher Copyright: {\textcopyright} 2023, The Author(s).", year = "2023", month = apr, day = "4", doi = "10.1038/s41598-023-32700-7", language = "English", volume = "13", pages = "5475", journal = "Scientific Reports", issn = "2045-2322", publisher = "Nature Research", number = "1", } . Scientific Reports.

Geoffrey C. H. Chu, Lily Y. L. Chan, Chi-wai Do, Andy C. Y. Tse, Teris Cheung, Grace P. Y. Szeto, Billy C. L. So, Regina L. T. Lee, Paul H. Lee (2023). Association between time spent on smartphones and digital eye strain: A 1-year prospective observational study among Hong Kong children and adolescents . Environmental Science and Pollution Research.

Paul Lee, Shimin Zhu, Samson Tse, Ko Ling Chan, Qijin Cheng, Jessica Sun (2023). Examination of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Study Protocol of a 3-Arm Cluster Randomized Controlled Trial . JMIR Research Protocols.

Preferences for end-of-life care and decision-making among Chinese community-dwelling older adults @article{fbacb0c9128a44caad449607992fbc00, title = "Preferences for end-of-life care and decision-making among Chinese community-dwelling older adults: A comparative cross-sectional study in Hong Kong and Wuhan in China", abstract = "This study aimed to describe and compare end-of-life care and decision-making preferences among Chinese community-dwelling older adults between Wuhan and Hong Kong in China. The study adopted a cross-sectional correlation design and recruited a convenience sample of 259 older adults, aged ≥65 years old from five community centers in Wuhan and Hong Kong. Participants completed a validated structured questionnaire that measured their end-of-life care and decision-making preferences. Multivariate logistic regression analyses were conducted. Results showed that Wuhan participants were significantly more likely to view “trying every means to extend the life span” as very important/important; and they perceived “support from religious personnel” as unimportant/very unimportant. Different from those older adults in Hong Kong, the Wuhan participants significantly chose their home as the preferred place for end-of-life care and death. They also tended to prefer family members to enact the decision-maker role in end-of-life decision situations. The study suggests older adults in Hong Kong and Wuhan have some differences in preferences for end-of-life care and decision-making, which provides the basis for future development of culturally relevant community-based end-of-life care.", keywords = "community, culture, decision-making, end-of-life care, family care, older adults", author = "Cheng, \{Hui Lin\} and Enid Kwong and Kitty Chan and Claudia Lai and Xi, \{Xin Xue\} and Paul Lee and \{et al.\}", note = "Funding Information: The authors thank the participants for their contributions to the study. Publisher Copyright: {\textcopyright} 2022 John Wiley \& Sons Australia, Ltd.", year = "2023", month = mar, day = "1", doi = "10.1111/nhs.12990", language = "English", volume = "25", pages = "63--72", journal = "Nursing and Health Sciences", issn = "1441-0745", publisher = "Fafo", number = "1", } . Nursing and Health Sciences.

Paul Lee, Hui‐Lin Cheng, Enid Kwong, Kitty Chan, Claudia Lai, Xin‐Xue Xi (2023). Preferences for end‐of‐life care and decision‐making among Chinese community‐dwelling older adults: A comparative cross‐sectional study in Hong Kong and Wuhan in China . Nursing & Health Sciences.

Inappropriate analysis of a cluster randomized controlled trial due to not accounting for nesting and clustering [response to letter] @article{e92012ad63124617becef7841bded0e5, title = "Inappropriate analysis of a cluster randomized controlled trial due to not accounting for nesting and clustering [response to letter]", author = "Cheung, \{Daphne Sze Ki\} and Lee, \{Paul Hong\} and Lai, \{Claudia Kam Yuk\}", note = "Funding Information: The primary study was funded by Ho Cheung Shuk Yuen Charitable Foundation and this additional analysis received no funding support.", year = "2023", month = feb, day = "18", doi = "10.2147/CIA.S403587", language = "English", volume = "18", pages = "231--233", journal = "Clinical Interventions in Aging", issn = "1176-9092", publisher = "Dove Medical Press Ltd", } . Clinical Interventions in Aging.

Daphne Sze Ki Cheung, Paul Hong Lee, Claudia Kam Yuk Lai (2023). Inappropriate Analysis of a Cluster Randomized Controlled Trial Due to Not Accounting for Nesting and Clustering [Response to Letter] . Clinical Interventions in Aging.

Nathan J Cheetham, Milla Kibble, Andrew Wong, Richard J Silverwood, Anika Knuppel, Dylan M Williams, Olivia KL Hamilton, Paul H Lee, Charis Bridger Staatz, Giorgio Di Gessa, et al. (2023). Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors in two UK longitudinal studies . eLife.

Bilberry-containing supplements on severe dry eye disease in young and middle-aged adults @article{f13f672d549540dab322cb0c19b13644, title = "Bilberry-containing supplements on severe dry eye disease in young and middle-aged adults: A 3-month pilot analysis", abstract = "Purpose: To explore the effect of bilberry and fish oil combination supplement on a small clinical sample patient-base with severe dry eyes. Methods: Twenty-four subjects were recruited with twelve randomly assigned to the intervention and control groups, respectively. Inclusion criteria included severe dry eye symptoms determined by scores >33 from the Ocular Surface Disease Index (OSDI) questionnaire. The intervention group was instructed to take an oral supplement with key ingredients of 600 mg bilberry extract and 240 mg docosahexaenoic acid-refined fish oil once daily for 3 months. The control group did not take any supplements. Mean changes in OSDI score, non-invasive tear break-up time (NITBUT), phenol red thread test (PRT), and percentage of meibomian gland openings were used as outcome measures. Testing was done at baseline, 1-month, and 3-month follow-up. Comparison between the treatment and control groups, and the younger adult and middle-age groups were performed. Results: The mean baseline values for the treatment and control groups were not clinically different. The OSDI score, NITBUT, PRT, and percentage of meibomian gland openings improved after taking the supplements for 3 months. The OSDI score, NITBUT, and PRT showed clinical improvements between the intervention and control groups. These improvements were consistent between the two age groups. Conclusion: This study suggested preliminary improvements in signs and symptoms of severe dry eyes that were independent of age after taking dietary supplementation of bilberry extract and fish oil for 3 months. Further studies using more device-based measures and a placebo supplement are warranted.", keywords = "anthocyanins, dietary, extract, fish oil, Ocular Surface Disease, phenol red thread test", author = "Yu, \{Wing Y.\} and Chan, \{Lily Y.L.\} and Aden Chung and Lee, \{Paul H.\} and Woo, \{George C.\}", note = "Copyright {\textcopyright} 2023 Yu, Chan, Chung, Lee and Woo.", year = "2023", month = jan, day = "19", doi = "10.3389/fnut.2023.1061818", language = "English", volume = "10", pages = "1061818", journal = "Frontiers in Nutrition", issn = "2296-861X", publisher = "Frontiers Research Foundation", } . Frontiers in Nutrition.

The overlapping burden of the three leading causes of disability and death in sub-Saharan African children @article{14585c383081419a9d0dcf0cab5527a5, title = "The overlapping burden of the three leading causes of disability and death in sub-Saharan African children", abstract = "Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival.", author = "\{LBD Triple Burden Collaborators\} and Reiner, \{Robert C.\} and Welgan, \{Catherine A.\} and Troeger, \{Christopher E.\} and Baumann, \{Mathew M.\} and Weiss, \{Daniel J.\} and Aniruddha Deshpande and Blacker, \{Brigette F.\} and Miller-Petrie, \{Molly K.\} and Lucas Earl and Samir Bhatt and Hassan Abolhassani and Abosetugn, \{Akine Eshete\} and Eman Abu-Gharbieh and Victor Adekanmbi and Adetokunboh, \{Olatunji O.\} and Mohammad Aghaali and Budi Aji and Fares Alahdab and Ziyad Al-Aly and Alhassan, \{Robert Kaba\} and Saqib Ali and Hesam Alizade and Aljunid, \{Syed Mohamed\} and Amir Almasi-Hashiani and Al-Mekhlafi, \{Hesham M.\} and Altirkawi, \{Khalid A.\} and Nelson Alvis-Guzman and Amare, \{Azmeraw T.\} and Saeed Amini and Amugsi, \{Dickson A.\} and Robert Ancuceanu and Andrei, \{Catalina Liliana\} and Fereshteh Ansari and Davood Anvari and Appiah, \{Seth Christopher Yaw\} and Jalal Arabloo and Olatunde Aremu and Atout, \{Maha Moh{\textquoteright}d Wahbi\} and Marcel Ausloos and Floriane Ausloos and Ayanore, \{Martin Amogre\} and Aynalem, \{Yared Asmare\} and Azene, \{Zelalem Nigussie\} and Gething, \{Peter W.\} and Lee, \{Paul H.\} and Lim, \{Stephen S.\} and Rahman, \{Mohammad Hifz Ur\} and Salomon, \{Joshua A.\} and Smith, \{David L.\} and Zhang, \{Zhi Jiang\}", year = "2022", month = dec, day = "6", doi = "10.1038/s41467-022-34240-6", language = "English", volume = "13", journal = "Nature Communications", issn = "2041-1723", publisher = "Nature Publishing Group", number = "1", } . Nature Communications.

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018 @article{aabf915a3de04daa9c911e39a985cf76, title = "Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018", abstract = "Background: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50\% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70\% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30\% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.", keywords = "Africa, Demographics, Geostatistics, HIV, HIV prevalence, Mapping, Spatial statistics", author = "\{on behalf of Local Burden of Disease sub-Saharan Africa HIV Prevalence Collaborators\} and Emily Haeuser and Serfes, \{Audrey L.\} and Cork, \{Michael A.\} and Mingyou Yang and Hedayat Abbastabar and Abhilash, \{E. S.\} and Maryam Adabi and Adebayo, \{Oladimeji M.\} and Victor Adekanmbi and Adeyinka, \{Daniel Adedayo\} and Saira Afzal and Ahinkorah, \{Bright Opoku\} and Keivan Ahmadi and Ahmed, \{Muktar Beshir\} and Yonas Akalu and Akinyemi, \{Rufus Olusola\} and Akunna, \{Chisom Joyqueenet\} and Fares Alahdab and Alanezi, \{Fahad Mashhour\} and Alanzi, \{Turki M.\} and Alene, \{Kefyalew Addis\} and Alhassan, \{Robert Kaba\} and Vahid Alipour and Amir Almasi-Hashiani and Nelson Alvis-Guzman and Ameyaw, \{Edward Kwabena\} and Saeed Amini and Amugsi, \{Dickson A.\} and Robert Ancuceanu and Davood Anvari and Appiah, \{Seth Christopher Yaw\} and Jalal Arabloo and Olatunde Aremu and Asemahagn, \{Mulusew A.\} and Jafarabadi, \{Mohammad Asghari\} and Awedew, \{Atalel Fentahun\} and Quintanilla, \{Beatriz Paulina Ayala\} and Ayanore, \{Martin Amogre\} and Aynalem, \{Yared Asmare\} and Samad Azari and Azene, \{Zelalem Nigussie\} and Darshan, \{B. B.\} and Babalola, \{Tesleem Kayode\} and Baig, \{Atif Amin\} and Maciej Banach and B{\"a}rnighausen, \{Till Winfried\} and Bell, \{Arielle Wilder\} and Lee, \{Paul H.\} and Katherine Wilson and Zhang, \{Zhi Jiang\}", note = "Publisher Copyright: {\textcopyright} 2022, The Author(s).", year = "2022", month = dec, doi = "10.1186/s12916-022-02639-z", language = "English", volume = "20", journal = "BMC Medicine", issn = "1741-7015", publisher = "BioMed Central", number = "1", } . BMC Medicine.

The prevalence of onchocerciasis in Africa and Yemen, 2000–2018 @article{d5119cde6900405ab13c688514200315, title = "The prevalence of onchocerciasis in Africa and Yemen, 2000–2018: a geospatial analysis", abstract = "Background: Onchocerciasis is a disease caused by infection with Onchocerca volvulus, which is transmitted to humans via the bite of several species of black fly, and is responsible for permanent blindness or vision loss, as well as severe skin disease. Predominantly endemic in parts of Africa and Yemen, preventive chemotherapy with mass drug administration of ivermectin is the primary intervention recommended for the elimination of its transmission. Methods: A dataset of 18,116 geo-referenced prevalence survey datapoints was used to model annual 2000–2018 infection prevalence in Africa and Yemen. Using Bayesian model-based geostatistics, we generated spatially continuous estimates of all-age 2000–2018 onchocerciasis infection prevalence at the 5 × 5-km resolution as well as aggregations to the national level, along with corresponding estimates of the uncertainty in these predictions. Results: As of 2018, the prevalence of onchocerciasis infection continues to be concentrated across central and western Africa, with the highest mean estimates at the national level in Ghana (12.2\%, 95\% uncertainty interval [UI] 5.0–22.7). Mean estimates exceed 5\% infection prevalence at the national level for Cameroon, Central African Republic, Democratic Republic of the Congo (DRC), Guinea-Bissau, Sierra Leone, and South Sudan. Conclusions: Our analysis suggests that onchocerciasis infection has declined over the last two decades throughout western and central Africa. Focal areas of Angola, Cameroon, the Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Mali, Nigeria, South Sudan, and Uganda continue to have mean microfiladermia prevalence estimates exceeding 25\%. At and above this level, the continuation or initiation of mass drug administration with ivermectin is supported. If national programs aim to eliminate onchocerciasis infection, additional surveillance or supervision of areas of predicted high prevalence would be warranted to ensure sufficiently high coverage of program interventions.", keywords = "Geospatial model, Neglected tropical diseases, Onchocerciasis", author = "\{LBD 2019 Neglected Tropical Diseases Collaborators\} and Schmidt, \{Chris A.\} and Cromwell, \{Elizabeth A.\} and Elex Hill and Donkers, \{Katie M.\} and Schipp, \{Megan F.\} and Johnson, \{Kimberly B.\} and Pigott, \{David M.\} and Jaffar Abbas and Victor Adekanmbi and Adetokunboh, \{Olatunji O.\} and Ahmed, \{Muktar Beshir\} and Alanezi, \{Fahad Mashhour\} and Alanzi, \{Turki M.\} and Vahid Alipour and Andrei, \{Catalina Liliana\} and Tudorel Andrei and Davood Anvari and Appiah, \{Seth Christopher Yaw\} and Muhammad Aqeel and Jalal Arabloo and Jafarabadi, \{Mohammad Asghari\} and Marcel Ausloos and Baig, \{Atif Amin\} and Maciej Banach and B{\"a}rnighausen, \{Till Winfried\} and Krittika Bhattacharyya and Bhutta, \{Zulfiqar A.\} and Ali Bijani and Brady, \{Oliver J.\} and Bragazzi, \{Nicola Luigi\} and Butt, \{Zahid A.\} and Felix Carvalho and Chattu, \{Vijay Kumar\} and Dahlawi, \{Saad M.A.\} and Giovanni Damiani and Demeke, \{Feleke Mekonnen\} and Kebede Deribe and Dharmaratne, \{Samath Dhamminda\} and Daniel Diaz and Alireza Didarloo and Lucas Earl and Zaki, \{Maysaa El Sayed\} and \{El Tantawi\}, Maha and Nazir Fattahi and Eduarda Fernandes and Foigt, \{Nataliya A.\} and Masoud Foroutan and Franklin, \{Richard Charles\} and Lee, \{Paul H.\} and Zhang, \{Zhi Jiang\}", note = "Publisher Copyright: {\textcopyright} 2022, The Author(s).", year = "2022", month = dec, doi = "10.1186/s12916-022-02486-y", language = "English", volume = "20", journal = "BMC Medicine", issn = "1741-7015", publisher = "BioMed Central", number = "1", } . BMC Medicine.

A dyadic pain management program for community-dwelling older adults with chronic pain: study protocol for a cluster randomized controlled trial @article{4b3cf8fe485c4b2285024eab309d5533, title = "A dyadic pain management program for community-dwelling older adults with chronic pain: study protocol for a cluster randomized controlled trial", abstract = "Community-dwelling older adults suffer from chronic pain. Pain negatively affects their physical and psychosocial wellbeing. The majority of pain management education and programs focus only on older adults. Their informal caregivers should be involved in pain management. A dyadic pain management program for reducing pain and psychological health symptoms, and improving pain self-efficacy, quality of life, and physical function in older adults is proposed for evaluation of its effectiveness. This will be a cluster randomized controlled trial. Community-dwelling older adults aged 60 or above and their informal caregivers will be recruited. The dyadic pain management program will be an eight-week group-based program. The participants in the experimental group will receive four weeks of center-based, face-to-face activities and four weeks of digital-based activities via a WhatsApp group. The control group will receive the usual care and a pain management pamphlet. Data will be collected at baseline, and at the eighth-week and sixteenth-week follow-up session. The outcome measurements will include pain intensity, pain self-efficacy, perceived quality of life, depression, anxiety, and stress levels. Data on the caregiver burden will be collected from the informal caregivers. Because of the COVID-19 pandemic, all social activities have been suspended. In the near future, as the pandemic subsides, the dyadic pain management program will be launched to benefit community-dwelling older adults and informal caregivers and to reduce their pain and the care burden, respectively.", keywords = "chronic pain, community-dwelling older adults, dyadic pain management, randomized controlled trial", author = "Tse, \{Mimi M. Y.\} and Ng, \{Shamay S. M.\} and Vivian Lou and Raymond Lo and Cheung, \{Daphne Sze Ki\} and Paul Lee and Tang, \{Angel S. K.\}", note = "Funding Information: This research was funded by Health and Medical Research Fund, Food and Health Bureau, Hong Kong SAR, grant number 04190158. Publisher Copyright: {\textcopyright} 2022 by the authors.", year = "2022", month = oct, doi = "10.3390/ijerph191912186", language = "English", volume = "19", journal = "International Journal of Environmental Research and Public Health", issn = "1660-4601", publisher = "MDPI", number = "19", } . International Journal of Environmental Research and Public Health.

Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism @article{8410401aa3cb411c90bcb0b2f363a5c6, title = "Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism", abstract = "Poor sleep quality and low behavioral functioning are commonly reported in children with autism spectrum disorder. This study examined the impact of exercise on sleep on melatonin level and behavioral functioning in the population. Children with autism spectrum disorder(n = 55; age = 10.97 ± 1.90) were randomly allocated to a morning jogging intervention group or a control group. Participants{\textquoteright} sleep was measured using actigraphy and sleep log assessments. Twenty-four-hour and first morning urinary 6-sulfatoxymelatonin were used to determine whether the exercise intervention could elicit changes in melatonin levels. Behavioral functioning of the participants was assessed by the repetitive subscale of the Gilliam Autism Rating Scale–3rd edition. All assessments were carried out in baseline, post-intervention, or regular treatment, and follow-up to elucidate the sustainability of the exercise effects. Positive changes were observed between baseline and post-intervention in actigraphy-assessed sleep efficiency and wake after sleep onset, as well as melatonin level and behavioral functioning within the intervention group (ps < 0.017). However, no significant changes were observed in all measurements between post-intervention and follow-up (ps > 0.05). The findings suggest that physical exercise is effective to improve sleep with an increase in melatonin level. It can also reduce repetitive behaviors in children with autism spectrum disorder. Lay abstract: This study examined the impact of physical exercise on sleep and behavioral functioning in children (aged 8–12 years) with autism spectrum disorders. It also investigated whether exercise would alter endogenous melatonin level among the population. Participants were divided into two groups: exercise group (12–week, 30-min morning jogging intervention) and a control group (i.e. did not receive any physical exercise intervention during the study period). Significant improvements on sleep and behavioral functioning were found in the exercise group, but not in the control group Moreover, a significant increase in melatonin level was also shown in the exercise group. Findings of this study reconfirmed the sleep and behavioral benefits of exercise in children with autism spectrum disorder. Melatonin-mediated mechanism should be further explored to develop an effective treatment intervention.", keywords = "Autism Spectrum Disorder/therapy, Autistic Disorder, Child, Exercise, Humans, Melatonin, Sleep, Sleep Wake Disorders/therapy", author = "Tse, \{Andy C.Y.\} and Lee, \{Paul H.\} and Jihui Zhang and Chan, \{Roy C.Y.\} and Ho, \{Amy W.Y.\} and Lai, \{Elvis W.H.\}", note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Early Career Scheme of Research Grant Council (grant number: 28602517) and the Funding Support to GRF Proposal Rated 3.5 (grant number: RG 21/2019-2020R) of the Education University of Hong Kong. Publisher Copyright: {\textcopyright} The Author(s) 2022.", year = "2022", month = oct, doi = "10.1177/13623613211062952", language = "English", volume = "26", pages = "1712--1722", journal = "Autism", issn = "1362-3613", publisher = "SAGE Publications", number = "7", } . Autism.

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000–18 @article{c1db9f79b7e94401a8d2337303291b2a, title = "Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000–18: a geospatial modelling study", abstract = "Background: More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods: We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings: Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95\%. 66\% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95\% uncertainty interval 147 000–257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation: Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Funding: Bill \& Melinda Gates Foundation.", author = "\{Local Burden of Disease Household Air Pollution Collaborators\} and Frostad, \{Joseph Jon\} and Nguyen, \{Quynh Anh P.\} and Baumann, \{Mathew M.\} and Blacker, \{Brigette F.\} and Marczak, \{Laurie B.\} and Aniruddha Deshpande and Wiens, \{Kirsten E.\} and LeGrand, \{Kate E.\} and Johnson, \{Kimberly B.\} and Mohsen Abbasi-Kangevari and Amir Abdoli and Hassan Abolhassani and Abreu, \{Lucas Guimar{\~a}es\} and Abrigo, \{Michael R.M.\} and Abu-Rmeileh, \{Niveen M.E.\} and Victor Adekanmbi and Anurag Agrawal and Ahmed, \{Muktar Beshir\} and Ziyad Al-Aly and Alanezi, \{Fahad Mashhour\} and Alcalde-Rabanal, \{Jacqueline Elizabeth\} and Vahid Alipour and Altirkawi, \{Khalid A.\} and Nelson Alvis-Guzman and Alvis-Zakzuk, \{Nelson J.\} and Amegah, \{Adeladza Kofi\} and Saeed Amini and Fatemeh Amiri and Amugsi, \{Dickson A.\} and Robert Ancuceanu and Andrei, \{Catalina Liliana\} and Tudorel Andrei and Ernoiz Antriyandarti and Davood Anvari and Jalal Arabloo and Morteza Arab-Zozani and Athari, \{Seyyed Shamsadin\} and Marcel Ausloos and Getinet Ayano and Aynalem, \{Yared Asmare\} and Samad Azari and Badiye, \{Ashish D.\} and Baig, \{Atif Amin\} and Kalpana Balakrishnan and Maciej Banach and Sanjay Basu and Neeraj Bedi and Lee, \{Paul H.\} and Wang, \{Yuan Pang\} and Zhang, \{Zhi Jiang\}", note = "Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license", year = "2022", month = oct, doi = "10.1016/S2214-109X(22)00332-1", language = "English", volume = "10", pages = "e1395--e1411", journal = "The Lancet Global Health", issn = "2214-109X", publisher = "Elsevier BV", number = "10", } . The Lancet Global Health.

A Dyadic Pain Management Program for Community-Dwelling Older Adults with Chronic Pain: Study Protocol for a Cluster Randomized Controlled Trial <head> <META HTTP-EQUIV="Refresh" CONTENT="0;URL=/servlet/useragent"> </head> . International Journal of Environmental Research and Public Health.

Paul Lee, Mimi M. Y. Tse, Shamay S. M. Ng, Vivian Lou, Raymond Lo, Daphne Sze Ki Cheung, Angel S. K. Tang (2022). A Dyadic Pain Management Program for Community-Dwelling Older Adults with Chronic Pain: Study Protocol for a Cluster Randomized Controlled Trial . International Journal of Environmental Research and Public Health.

Prediction of problem gambling by demographics, gaming behavior and psychological correlates among gacha gamers: A cross-sectional online survey in Chinese young adults @article{c1e3f6dbd9404214a0c7884ea8a84da8, title = "Prediction of problem gambling by demographics, gaming behavior and psychological correlates among gacha gamers: A cross-sectional online survey in Chinese young adults", abstract = "Objective: the objective of this study is to explore the association of problem gambling with demographics, psychological distress, and gaming behavior in young adult gacha gamers in Hong Kong. Materials and methods: cross-sectional data was collected in the first and fifth waves of COVID-19 pandemic in Hong Kong online. Participants who aged 18–25 years and had been playing gacha games over the past 12 months were recruited. Stepwise multiple regression was used to explore the association among risk of problem gambling, gaming behavior, participation in gaming activities and psychological distress. A two-sided p-value <0.05 was considered as statistical significance. Results: three hundred and thirty-seven completed questionnaires were received with no missing data. 34.7\% (n = 117) of the participants had non/low-risk of problem gambling. About 40\% (n = 136) of them had moderate-risk and the remaining 25\% (n = 84) were at high risk of problem gambling. A higher proportion of female participants (78.6\%) were found in high-risk group as compared to 39.7\% and 55.6\% only in the non/low-risk and moderate-risk groups, respectively. The regression model (R 2 = 0.513, F = 71.895, p < 0.001) showed that 51.3\% of the variance of the total problem gambling score could be explained by stress, anxiety, monthly expenses on gacha purchases, number of motives for gacha purchase and number of gambling activities engaged. Conclusion: the present study provides empirical evidence to support the association between problem gambling and microtransaction especially for gacha which is the most popular type of video game microtransaction in Asia. The established regression model suggests that gacha gamers with higher risk of problem gambling tend to have greater stress, higher anxiety level, spend more on gacha purchase, have more motives for gacha purchases and engage in more gambling activities. In contrast to the extant literature, higher proportion of female participants in high-risk group indicates that female gacha gamers are also at very high risk of becoming problem gamblers. ", keywords = "Chinese young adults, gacha, problem gambling, psychological distress, video game microtransaction", author = "Tang, \{Anson Chui Yan\} and Lee, \{Paul Hong\} and Lam, \{Simon Ching\} and Siu, \{Summer Cho Ngan\} and Ye, \{Carmen Jiawen\} and Lee, \{Regina Lai-Tong\}", note = "Funding Information: We would like to thank all those who kindly volunteered to participate in the study and student who assisted the data collection. Publisher Copyright: Copyright {\textcopyright} 2022 Tang, Lee, Lam, Siu, Ye and Lee.", year = "2022", month = aug, day = "5", doi = "10.3389/fpsyt.2022.940281", language = "English", volume = "13", journal = "Frontiers in Psychiatry", issn = "1664-0640", publisher = "Frontiers Media SA", } . Frontiers in Psychiatry.

Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children @article{91ec1f73dad4427ca9a1b350a02582b6, title = "Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study", abstract = "Aims: To determine myopia progression in children who continued to wear the defocus incorporated multiple segments (DIMS) lenses or switched from single vision (SV) to DIMS lenses for a 1-year period following a 2-year myopia control trial. Methods: 128 children participated in this study. The children who had worn DIMS lenses continued to wear DIMS lenses (DIMS group), and children who had worn SV lenses switched to wear DIMS lenses (Control-to-DIMS group). Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at 6-month interval. Historical controls were age matched to the DIMS group at 24 months and used for comparing the third-year changes. Results: Over 3 years, SER and AL changes in the DIMS group (n=65) were-0.52±0.69D and 0.31±0.26 mm; these changes were not statistically significant over time (repeated measures analysis of variance, p>0.05). SER (-0.04±0. 38D) and AL (0.08±0.12 mm) changes in the Control-to-DIMS group (n=55) in the third year were less compared with the first (mean difference=0.45 ± 0.30D, 0.21±0.11 mm, p<0.001) and second (0.34±0.30D, 0.12±0.10 mm, p<0.001) years. Changes in SER and AL in both groups over that period were significantly less than in the historical control group (DIMS vs historical control: mean difference=-0.18±0.42D, p=0.012; 0.08±0.15 mm, p=0.001; Control-to-DIMS versus historical control: adjusted mean differences=-0.30±0.42D, p<0.001; 0.12±0.16 mm, p<0.001). Conclusions: Myopia control effect was sustained in the third year in children who had used the DIMS spectacles in the previous 2 years and was also shown in the children switching from SV to DIMS lenses.", keywords = "Child, Child, Preschool, China/epidemiology, Disease Progression, Eyeglasses, Follow-Up Studies, Humans, Myopia/therapy, Refraction, Ocular", author = "Lam, \{Carly S.Y.\} and Tang, \{Wing Chun\} and Lee, \{Paul H.\} and Zhang, \{Han Yu\} and Hua Qi and Keigo Hasegawa and To, \{Chi Ho\}", note = "Funding Information: Funding This was a collaborative research project supported by HOYA, Tokyo, Japan (PolyU grant numbers ZG5N), other PolyU grants: ZVN1, ZVN2, ZE1A, 8-8475, and by an RGC Research Impact Fund: R5032-18. The sponsor also provided specially manufactured spectacle lenses and frames. Funding Information: Competing interests This collaborative research was supported by HOYA Corporation, Tokyo, Japan. Patents titled {\textquoteright}Spectacle Lens{\textquoteright} in China (CN104678572 B) and USA (US10268050 B2) were issued on 27 April 2018 and 23 April 2019 respectively. Publisher Copyright: {\textcopyright} 2022 BMJ Publishing Group. All rights reserved.", year = "2022", month = aug, day = "1", doi = "10.1136/bjophthalmol-2020-317664", language = "English", volume = "106", pages = "1110--1114", journal = "British Journal of Ophthalmology", issn = "0007-1161", publisher = "BMJ Publishing Group", number = "8", } . British Journal of Ophthalmology.

Whole-genome sequencing reveals host factors underlying critical COVID-19 @article{2eada2a0014e45e589fd01818fdeaec3, title = "Whole-genome sequencing reveals host factors underlying critical COVID-19", abstract = "Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease.", author = "Athanasios Kousathanas and Erola Pairo-Castineira and Konrad Rawlik and \{et al.\} and \{GenOMICC investigators\} and \{23andMe investigators\} and \{COVID-19 Human Genetics Initiative\} and Rebecca Cusack and Lee, \{Paul H.\}", year = "2022", month = jul, day = "7", doi = "10.1038/s41586-022-04576-6", language = "English", volume = "607", pages = "97--103", journal = "Nature", issn = "0028-0836", publisher = "Nature Research", number = "7917", } . Nature.

Study protocol for a randomized controlled trial comparing the effectiveness of physical exercise and melatonin supplement on treating sleep disturbance in children with autism spectrum disorders @article{12f9485832a04f8785833e1d19c57bfe, title = "Study protocol for a randomized controlled trial comparing the effectiveness of physical exercise and melatonin supplement on treating sleep disturbance in children with autism spectrum disorders", abstract = "Background: Previous study showed that both melatonin supplement and physical exercise intervention could improve sleep quality in children with autism spectrum disorders (ASD) with the increase in endogenous melatonin level. However, none of the studies have directly compared the effectiveness between the two interventions on treating sleep disturbance in children with ASD. Without direct comparison, we do not know which intervention is better. Thus, we designed a study to compare which intervention is more effective to treat sleep disturbance in children with ASD and to examine whether the combination of the two could be the most efficacious. We present a protocol for conducting a randomized controlled trial to compare the effectiveness of physical exercise and melatonin supplement on treating sleep disturbance in children with ASD. Study design: The proposed study will be a four-group randomised control trial (RCT) design, with equal allocation of participants to the three intervention groups and one control group. Methods: All eligible participants will be randomly allocated to a morning jogging group, a melatonin supplement group, a combination group and a control group. Changes in sleep quality will be monitored through actigraphic assessment and parental sleep logs. Melatonin levels represented by 6-sulfoxymelatonin will be measured from the participants' 24-h and the first morning void urinary samples. All the assessments will be carried out before the intervention (T1), in the mid of the study (5 weeks after the commencement of the study) (T2) and after the 10-week intervention (T3). Level of statistical significance will be set at 5\% (i.e. p < .05). The results of this trial will be submitted for publication in peer-reviewed journal. Findings: The findings will provide evidence to determine whether physical exercise or melatonin supplement or the combination of interventions is the most effective to treat sleep disturbance in children with ASD.", keywords = "Autism Spectrum Disorder/complications, Child, Exercise, Humans, Melatonin/therapeutic use, Randomized Controlled Trials as Topic, Sleep Quality, Sleep Wake Disorders/etiology", author = "Tse, \{Andy Choi Yeung\} and Lee, \{Paul Hong\} and Lau, \{Esther Yuet Ying\} and Cheng, \{James Ching Hei\} and Ho, \{Amy Wing Yin\} and Lai, \{Elvis Wing Him\}", note = "Publisher Copyright: {\textcopyright} 2022 TSE et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.", year = "2022", month = jul, day = "6", doi = "10.1371/journal.pone.0270428", language = "English", volume = "17", journal = "PLoS ONE", issn = "1932-6203", publisher = "PLOS", number = "7", } . PLoS ONE.

Andy Choi Yeung Tse, Walid Kamal Abdelbasset, Paul Hong Lee, Esther Yuet Ying Lau, James Ching Hei Cheng, Amy Wing Yin Ho, Elvis Wing Him Lai (2022). Study protocol for a randomized controlled trial comparing the effectiveness of physical exercise and melatonin supplement on treating sleep disturbance in children with autism spectrum disorders . PLOS ONE.

Co-living with migrant domestic workers is associated with a lower level of loneliness among community-dwelling older adults @article{ae31e3935349487f94890fcb2c5e444c, title = "Co-living with migrant domestic workers is associated with a lower level of loneliness among community-dwelling older adults: a cross-sectional study", abstract = "Loneliness (inclusive social loneliness and emotional loneliness) of older adults is a prominent public health issue internationally. Factors consistently associated with loneliness are age, gender, education, living arrangements, social network, and functional status. Intergenerational co-living with spouse and adult children is important for the exchange of social, emotional, practical, and financial support provided to older adults. Co-living with migrant domestic workers (MDWs) to care for older adults became an emergent phenomenon internationally, particularly in Asian countries. According to the convoy model of social relations, the effect of co-living with MDWs on older adults' loneliness is unknown. This study examined (1) the prevalence of loneliness among community-dwelling older adults; and (2) the association between co-living with MDWs and older adult loneliness. Using the Chinese version of the 6-item De Jong Gierveld Loneliness Scale on loneliness, 380 older adults were interviewed at busy points in Hong Kong, including subway stations. 35.3\% of older adults experienced moderate-to-severe loneliness. Linear regression was performed to examine the association between co-living with MDWs and loneliness. The results showed that co-living with MDWs was significantly associated with lower levels of overall loneliness (β = −0.636; p =.022) and emotional loneliness (β = −0.298, p =.039), but not for social loneliness (β = −0.337, p =.084). While MDWs could be an attachment figure for older adults, they might not be effective in promoting the social integration of older adults. There is a need to investigate the barriers of social integration faced by older adults co-living with MDWs.", keywords = "co-living, intergenerational, living arrangements, loneliness, migrant domestic workers, older adults, social support", author = "Ho, \{Ken Hok Man\} and Cheung, \{Daphne Sze Ki\} and Lee, \{Paul Hong\} and Lam, \{Simon Ching\} and Kwan, \{Rick Yiu Cho\}", note = "Funding Information: This work was supported by the School Research Grant of School of Nursing, Tung Wah College (Grant number: 2018‐04‐52 SRG180403). Publisher Copyright: {\textcopyright} 2021 John Wiley \& Sons Ltd.", year = "2022", month = jul, day = "1", doi = "10.1111/hsc.13520", language = "English", volume = "30", pages = "e1123--e1133", journal = "Health and Social Care in the Community", issn = "0966-0410", publisher = "National Museums and Galleries on Merseyside", number = "4", } . Health and Social Care in the Community.

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990–2019 @article{e9532c427e4442a2a41dd449c8a47d85, title = "Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990–2019: an analysis of data from the Global Burden of Disease Study 2019", abstract = "Background: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95\% uncertainty intervals. Findings: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95\% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4\% (9·49–17·5) of deaths and 13·6\% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50\% (4·22–9·53) of deaths and 5·92\% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50\%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation: Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2019 Diabetes and Air Pollution Collaborators\} and Katrin Burkart and Kate Causey and Cohen, \{Aaron J.\} and Wozniak, \{Sarah S.\} and Salvi, \{Devashri Digvijay\} and Cristiana Abbafati and Victor Adekanmbi and Adsuar, \{Jose C.\} and Keivan Ahmadi and Fares Alahdab and Ziyad Al-Aly and Vahid Alipour and Nelson Alvis-Guzman and Amegah, \{Adeladza Kofi\} and Andrei, \{Catalina Liliana\} and Tudorel Andrei and Fereshteh Ansari and Jalal Arabloo and Olatunde Aremu and Timur Aripov and Ebrahim Babaee and MacIej Banach and Anthony Barnett and B{\"a}rnighausen, \{Till Winfried\} and Neeraj Bedi and Masoud Behzadifar and Yannick B{\'e}jot and Bennett, \{Derrick A.\} and Bensenor, \{Isabela M.\} and Bernstein, \{Robert S.\} and Krittika Bhattacharyya and Ali Bijani and Antonio Biondi and Somayeh Bohlouli and Susanne Breitner and Hermann Brenner and Butt, \{Zahid A.\} and C{\'a}mera, \{Luis Alberto\} and Carlos Cantu-Brito and Felix Carvalho and Ester Cerin and Chattu, \{Vijay Kumar\} and Chauhan, \{Bal Govind\} and Choi, \{Jee Young Jasmine\} and Chu, \{Dinh Toi\} and Xiaochen Dai and Lee, \{Paul H.\} and Yong Liu and Irfan Ullah and Lim, \{Stephen S.\}", note = "Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license", year = "2022", month = jul, doi = "10.1016/S2542-5196(22)00122-X", language = "English", volume = "6", pages = "e586--e600", journal = "The Lancet Planetary Health", issn = "2542-5196", publisher = "Elsevier", number = "7", } . The Lancet Planetary Health.

Ken Hok Man Ho, Daphne Sze Ki Cheung, Paul Hong Lee, Simon Ching Lam, Rick Yiu Cho Kwan(2022). Co‐living with migrant domestic workers is associated with a lower level of loneliness among community‐dwelling older adults: A cross‐sectional study . Health & Social Care in the Community. Wiley

Five-step hand hygiene programme for students with mild intellectual disability: abridged secondary publication @article{ed3e5049548e4161bf11e400e525f880, title = "Five-step hand hygiene programme for students with mild intellectual disability: abridged secondary publication", abstract = "The simplified five-step hand-washing procedure is more effective than the World Health Organization seven-step hand-washing procedure in terms of improvement in hand-washing quality and absenteeism rate in children with mild intellectual disabilities.", author = "R.L.T. Lee and C. Leung and H. Chen and Tong, \{W. K.\} and Lee, \{P. H.\}", year = "2022", month = jun, day = "1", language = "English", volume = "28", pages = "S41--S42", journal = "Hong Kong medical journal = Xianggang yi xue za zhi", issn = "1024-2708", publisher = "Hong Kong Academy of Medicine Press", number = "3", }. Hong Kong medical journal = Xianggang yi xue za zhi.

“How are you doing?” on the healthy aging of the community-dwelling oldest-old in the shadow of the COVID-19 pandemic @article{21deeb07f2cd42ed9fd2de1ea263f7c1, title = "“How are you doing?” on the healthy aging of the community-dwelling oldest-old in the shadow of the COVID-19 pandemic", abstract = "Objective: globally, the oldest-old population is growing rapidly. Little is known about the perceived well-being of the community-dwelling oldest-old, especially during the COVID-19 pandemic. This study examined the oldest-old{\textquoteright}s perceptions of aging well and the COVID-related impacts on them. Methods: semi-structured in-depth interviews with 22 adults aged 85 or above were conducted with purposive sampling methods. Transcripts were analyzed using thematic analysis. Results: four main themes emerged: 1) sustaining functional ability; 2) staying active with a positive attitude; 3) feeling grateful for support from society and family; 4) COVID-19-related anxieties and policies destabilizing their well-being. Discussion: this study provides direct evidence from the oldest-old on how they maintained their well-being. While they valued support from society and family, COVID-19-related measures disturbed their routines and prevented them from self-attaining well-being. The findings should be considered when developing interventions for this vulnerable group.", keywords = "Aging well, COVID-19, Healthy aging, Oldest-old", author = "Lo, \{Shirley K.L.\} and Liu, \{Justina Y.W.\} and Cheung, \{Daphne S.K.\} and Yin, \{Yue Heng\} and Ng, \{Siu Ying\} and \{P.K. Kor\}, Patrick and Lin Yang and Chan, \{Siu Kay\} and Kwan, \{Rick Y.C.\} and Lee, \{Paul H.\} and Chiang, \{Vico C.L.\}", note = "Publisher Copyright: {\textcopyright} The Author(s) 2022.", year = "2022", month = may, day = "18", doi = "10.1177/01640275221100949", language = "English", volume = "45", pages = "280--290", journal = "Research on Aging", issn = "0164-0275", publisher = "JISC Techdis Service; ALT", number = "3-4", } . Research on Aging.

Physical restraint events in psychiatric hospitals in Hong Kong @article{782a110872174a8c9ca3071d8f12bdbe, title = "Physical restraint events in psychiatric hospitals in Hong Kong: a cohort register study", abstract = "The need to better monitor coercion practices in psychiatric hospitals has been recognised. We aim to describe how physical restraint events occur in psychiatric hospitals and identify factors associated with physical-restraint use. A cohort register study was used. We analyzed physical restraint documents among 14 wards in two psychiatric hospitals in Hong Kong (1 July and 31 December 2018). In total, 1798 incidents occurred (the rate of physical restraint event 0.43). Typically, physically restrained patients were in early middle-age, of both genders, diagnosed with schizophrenia-spectrum and other psychotic disorders, and admitted voluntarily. Alternate methods for physical restraint were reported, such as an explanation of the situation to the patients, time-out or sedation. A longer period of being physically restrained was associated with being male, aged ≥40 years, having involuntary status, and neurodevelopmental-disorder diagnosis. Our findings support a call for greater action to promote the best practices in managing patient aggression and decreasing the use of physical restraint in psychiatric wards. The reasons for the use of physical restraint, especially for those patients who are admitted to a psychiatric hospital on a voluntary basis and are diagnosed with neurodevelopmental disorders, needs to be better understood and analysed.", keywords = "coercion, Hong Kong, hospital, physical restraint, psychiatric, register", author = "\{et al.\} and Maritta V{\"a}lim{\"a}ki and Lam, \{Yuen Ting Joyce\} and Kirsi Hipp and Cheng, \{Po Yee Ivy\} and Tony Ng and Glendy Ip and Paul Lee and Teris Cheung and Daniel Bressington and Tella Lantta", note = "Funding: This research was funded by the Hong Kong Polytechnic University (grant number: 1-ZE84) and the Academy of Finland fund (grant numbers: 294298, 307367). Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.", year = "2022", month = may, day = "16", doi = "10.3390/ijerph19106032", language = "English", volume = "19", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "10", } . International Journal of Environmental Research and Public Health.

Paul Lee, Maritta V&#228;lim&#228;ki, Yuen Ting Joyce Lam, Kirsi Hipp, Po Yee Ivy Cheng, Tony Ng, Glendy Ip, Teris Cheung, Daniel Bressington, Tella Lantta(2022). Physical Restraint Events in Psychiatric Hospitals in Hong Kong: A Cohort Register Study . International Journal of Environmental Research and Public Health. 19. (10). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 6032. {MDPI} {AG}

Paul Lee, Maritta V&#228;lim&#228;ki, Yuen Ting Joyce Lam, Kirsi Hipp, Po Yee Ivy Cheng, Tony Ng, Glendy Ip, Teris Cheung, Daniel Bressington, Tella Lantta (2022). Physical Restraint Events in Psychiatric Hospitals in Hong Kong: A Cohort Register Study . International Journal of Environmental Research and Public Health.

The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990–2019 @article{9283919d566544ee9b7c68e1542ab5e9, title = "The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990–2019: Findings from the Global Burden of Disease Study 2019", abstract = "Background: Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods: Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95\% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings: In 2019, rates per 100,000 population were 16,983 (95\% UI 12,823 – 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432–912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9–412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9\%;9·4-20·1) and drug use disorders (16·9\%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (–29·1\%;23·8-38·5). YLLs decreased in self-harm (–27·9\%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation: Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding: The Bill and Melinda Gates Foundation", keywords = "Europe, Mental disorders, Mental health, Self-harm, Substance use, Young people", author = "\{GBD 2019 mental disorders collaborator\} and Giulio Castelpietra and Knudsen, \{Ann Kristin Skrindo\} and Agardh, \{Emilie E.\} and Benedetta Armocida and Massimiliano Beghi and Iburg, \{Kim Moesgaard\} and Giancarlo Logroscino and Rui Ma and Fabrizio Starace and Nicholas Steel and Giovanni Addolorato and Andrei, \{Catalina Liliana\} and Tudorel Andrei and Ayuso-Mateos, \{Jose L.\} and Maciej Banach and B{\"a}rnighausen, \{Till Winfried\} and Francesco Barone-Adesi and Bhagavathula, \{Akshaya Srikanth\} and Felix Carvalho and M{\'a}rcia Carvalho and Chandan, \{Joht Singh\} and Chattu, \{Vijay Kumar\} and Couto, \{Rosa A.S.\} and Nat{\'a}lia Cruz-Martins and Dargan, \{Paul I.\} and Keshab Deuba and \{da Silva\}, \{Diana Dias\} and Fagbamigbe, \{Adeniyi Francis\} and Eduarda Fernandes and Pietro Ferrara and Florian Fischer and Gaal, \{Peter Andras\} and Alessandro Gialluisi and Haagsma, \{Juanita A.\} and Haro, \{Josep Maria\} and Hasan, \{M. Tasdik\} and Hasan, \{Syed Shahzad\} and Sorin Hostiuc and Licia Iacoviello and Ivo Iavicoli and Elham Jamshidi and Jonas, \{Jost B.\} and Tamas Joo and Jozwiak, \{Jacek Jerzy\} and Katikireddi, \{Srinivasa Vittal\} and Kauppila, \{Joonas H.\} and Khan, \{Moien A.B.\} and Adnan Kisa and Sezer Kisa and Mika Kivim{\"a}ki and Paul Lee", note = "Funding Information: Please see appendix section for more detailed information about individual author contributions to the research, divided into the following categories: providing data or critical feedback on data sources; developing methods or computational machinery; providing critical feedback on methods or results; drafting the manuscript or revising it critically for important intellectual content; and managing the overall research enterprise. Members of the core research team for this topic area had full access to the underlying data used to generate estimates presented in this article. All other authors had access to and reviewed estimates as part of the research evaluation process, which includes additional stages of formal review. T W B{\"a}rnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. F Carvalho acknowledges support from Funda{\c c}{\~a}o para a Ci{\^e}ncia e a Tecnologia (FCT), I.P. in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences - UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy - i4HB; FCT/MCTES (Minist{\'e}rio da Ci{\^e}ncia, Tecnologia e Ensino Superior) through the project UIDB/50006/2020. M Carvalho acknowledges the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. J S Chandan is funded on a lectureship post by the National Institute of Health Research (NIHR) and has been awarded funds from the NIHR and the Youth Endowment Fund. S Dias da Silva acknowledges the projects UIDP/04378/2021 and UIDB/04378/2021 of the Research Unit on Applied Molecular Biosciences–UCIBIO; the project LA/P/0140/2021 of the Associate Laboratory Institute for Health and Bioeconomy–i4HB; and TOXRUN – Toxicology Research Unit, University Institute of Health Sciences, IUCS-CESPU, Portugal. A J Ferrari is supported by a National Health and Medical Research Council Early Career Fellowship Grant APP1121516 and is employed by the Queensland Centre for Mental Health Research which receives core funding from the Queensland Department of Health. S V Katikireddi would like to acknowledge funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC\_UU\_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). J H Kauppila reports research grants from Sigrid Jus{\'e}lius Foundation and the Finnish Cancer Foundation. M Kivimaki was supported by the Wellcome Trust (221854/Z/20/Z) and the Medical Research Council, UK (MR/R024227/1, MR/S011676/1). M Kumar would like to acknowledge funding support from K43 TW010716-04/NIH Fogarty International Centre. T Lallukka is supported by the Social Insurance Institution of Finland (grant 29/26/2020). J A Loureiro was supported by Funda{\c c}{\~a}o para a Ci{\^e}ncia e T{\'e}cnologia (FCT) under the Scientific Employment Stimulus [CEECINST/00049/2018]. J J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professorship), and is employed by The Queensland Centre for Mental Health Research which receives core funding from the Queensland Health. A-F A Mentis would like to acknowledge funding {\textquoteleft}MilkSafe: A novel pipeline to enrich formula milk using omics technologies{\textquoteright}, a research co-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH - CREATE - INNOVATE (project code: T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860) both outside the submitted work. J P Silva acknowledges support, through Portuguese national funds via FCT/MCTES, from grants number UIDP/04378/2021 and UIDB/04378/2021 of the Research Unit on Applied Molecular Biosciences (UCIBIO), and LA/P/0140/2021 of the Associate Laboratory Institute for Health and Bioeconomy (i4HB). To download the data used in these analyses, please visit the Global Health Data Exchange GBD 2019 website (http://ghdx.healthdata.org/gbd-2019). F M J Postma reports stock or stock options from Health-Ecore and PAG, outside the submitted work. N Steel reports grants from Public Health England to their institution, outside the submitted work. R M Viner reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Canadian Academy of Child \& Adolescent Psychiatry for lecture on mental health aspects of COVID-19 pandemic; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as the President of Royal College of Paediatrics \& Child Health, 2018-2021; all outside the submitted work. Publisher Copyright: {\textcopyright} 2022 The Author(s)", year = "2022", month = may, doi = "10.1016/j.lanepe.2022.100341", language = "English", volume = "16", pages = "100341", journal = "The Lancet Regional Health - Europe", issn = "2666-7762", publisher = "Elsevier Ltd.", } . The Lancet Regional Health - Europe.

Bedtime smart device usage and accelerometer-measured sleep outcomes in children and adolescents @article{46e9293127994588a212fe3006ce3180, title = "Bedtime smart device usage and accelerometer-measured sleep outcomes in children and adolescents", abstract = "Purpose: we analyzed the association between bedtime smart device usage habits and accelerometer-measured sleep outcomes (total sleeping time, sleep efficiency, and wake after sleep onset) in Hong Kong children and adolescents aged 8–14. Methods: a total of 467 students in Hong Kong participated in this study from 2016 to 2017. They self-reported their bedtime smart device usage habits. The primary caregiver of each participant was also invited to complete a self-administered questionnaire about the family{\textquoteright}s social-economic status and bedtime smart device usage habits. An ActiGraph GT3X accelerometer was used to assess participants{\textquoteright} 7-day sleep outcomes. Results: the mean age of the participants was 10.3 (SD 1.9), and 54\% were girls. Among the participants, 27\% (n = 139) used a smart device before sleep, and 33\% (n = 170) kept the smart device on before sleep. In total, 27\% (n = 128) placed the smart device within reach before sleep, 23\% (n = 107) would wake up when notifications were received, and 25\% (n = 117) immediately checked the device after being awakened by a notification. Multiple regression controlling for age, sex, socio-economic status, and other confounders showed that those who woke up after receiving a notification had a statistically longer sleeping time (19.7 min, 95\% CI: 0.3, 39.1, p = 0.046), lower sleep efficiency (− 0.71\%, 95\% CI − 1.40, − 0.02, p = 0.04), and a longer wake after sleep onset (2.6 min, 95\% CI: 0.1, 5.1, p = 0.045) than those who did not. Nonetheless, all primary caregivers{\textquoteright} bedtime smart device habits were insignificantly associated with all sleep outcomes of their children. Conclusion: those who woke up after receiving smart device notifications had lower sleep efficiency and longer wake after sleep onset than those who did not, and they compensated for their sleep loss by lengthening their total sleep time.", keywords = "Actigraphy, Cross-sectional, Hong Kong, Smartphone, Youth", author = "Lee, \{Paul H.\} and Tse, \{Andy C.Y.\} and Teris Cheung and Do, \{C. W.\} and Szeto, \{Grace P.Y.\} and So, \{Billy C.L.\} and Lee, \{Regina L.T.\}", note = "{\textcopyright} 2021. The Author(s).", year = "2022", month = apr, day = "30", doi = "10.1007/s11325-021-02377-1", language = "English", volume = "26", pages = "477--487", journal = "Sleep and Breathing", issn = "1520-9512", publisher = "Springer Science and Business Media B.V.", number = "1", } . Sleep and Breathing.

Myopia control effect Is influenced by baseline relative peripheral refraction in children wearing Defocus Incorporated Multiple Segments (DIMS) Spectacle Lenses @article{54a792474baa40cf92ad1e5bd649644f, title = "Myopia control effect Is influenced by baseline relative peripheral refraction in children wearing Defocus Incorporated Multiple Segments (DIMS) Spectacle Lenses", abstract = "The aim of this study is to investigate if baseline relative peripheral refraction (RPR) influences the myopia control effects in Chinese myopic children wearing Defocus Incorporated Multiple Segments (DIMS) lenses. Peripheral refraction at 10◦, 20◦, and 30◦ nasal (10 N, 20 N, 30 N) and temporal (10 T, 20 T, 30 T) retina were measured at six-month intervals for children who participated in a 2-year randomized controlled trial. The relationship between the baseline peripheral refractions and myopia progression and axial length changes were analysed. A total of 79 children and 81 children in the DIMS and single vision (SV) group were investigated, respectively. In the DIMS group, more baseline myopic RPR spherical equivalent (SE) was associated with more myopic progression (10 N: r = 0.36, p = 0.001; 20 N: r = 0.35, p = 0.001) and greater axial elongation (10 N: r = −0.34, p = 0.001; 20 N: r = −0.29, p = 0.006) after adjusting for co-factors. In the SV group, baseline RPR had association with only myopia progression (10 N: r = 0.37, p = 0.001; 20 N: r = 0.36, p = 0.001; 30 N: r = 0.35, p = 0.002) but not with axial elongation after Bonferroni correction (p > 0.008). No statistically significant relationship was found between temporal retina and myopia progression or axial elongation in both groups. Children with baseline myopic RPR had statistically significant more myopia progression (mean difference around −0.40 D) and more axial elongation (mean difference 0.15 mm) when compared with the children having baseline hyperopic RPR in the DIMS group but not in the SV group. In conclusion, the baseline RPR profile may not influence future myopia progression or axial elongation for the SV lens wearers. However, DIMS lenses slowed down myopia progression and was better in myopia control for the children with baseline hyperopic RPR than the children with myopic RPR. This may partially explain why myopia control effects vary among myopic children. Customised myopic defocus for individuals may optimise myopia control effects, and further research to determine the optimal dosage, with consideration of peripheral retinal profile, is warranted.", keywords = "myopia, myopia control, myopic defocus, relative peripheral refraction", author = "Hanyu Zhang and Lam, \{Carly S.Y.\} and Tang, \{Wing Chun\} and Myra Leung and Hua Qi and Lee, \{Paul H.\} and To, \{Chi Ho\}", note = "Funding Information: Funding: This was a collaborative research project supported by HOYA, Tokyo, Japan and Hong Kong PolyU grants: RUQT, 848K, ZVN1 and ZG5N. The sponsor also provided specially manufactured spectacle lenses and frames. Funding Information: Conflicts of Interest: This collaborative research was partially supported by HOYA Corporation, Tokyo, Japan. Dr Hua Qi is an employee in the R\&D of HOYA Corporation, Tokyo, Japan. Patents titled {\textquoteleft}Spectacle Lens{\textquoteright} in China (CN104678572 B) and USA (US10268050 B2) were issued on 27 April 2018 and 23 April 2019, respectively. Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.", year = "2022", month = apr, day = "20", doi = "10.3390/jcm11092294", language = "English", volume = "11", journal = "Journal of Clinical Medicine", issn = "2077-0383", publisher = "MDPI", number = "9", } . Journal of Clinical Medicine.

Hanyu Zhang, Carly S. Y. Lam, Wing-Chun Tang, Myra Leung, Hua Qi, Paul H. Lee, Chi-Ho To(2022). Myopia Control Effect Is Influenced by Baseline Relative Peripheral Refraction in Children Wearing Defocus Incorporated Multiple Segments (DIMS) Spectacle Lenses . Journal of Clinical Medicine. 11. (9). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 2294. {MDPI} {AG}

Psychometric properties of the Mindsets of Depression, Anxiety, and Stress Scale (MDASS) in Chinese young adults and adolescents @article{d6e33bbb5589438da369b7c32188a14b, title = "Psychometric properties of the Mindsets of Depression, Anxiety, and Stress Scale (MDASS) in Chinese young adults and adolescents", abstract = "Aim: Mindset has been found to be closely related to mental health symptoms. Yet no scale for the Mindsets of Depression, Anxiety, and Stress (MDASS) has been validated. This study developed a 12-item MDASS with four items in each domain and examined its psychometric properties among young adults and adolescents. Methods: Young adults (Study 1: N = 1735, aged 18–25) and adolescents (Study 2, N = 1648, aged 9–16) completed socio-demographics information, MDASS (unidirectional items in Study 1 and bi-directional items in Study 2), and mental health symptoms measures. Both samples were randomly divided into two equal sub-samples, one for exploratory factor analysis (EFA) to identify the factor structure, the other for confirmatory factor analysis (CFA) to assess the goodness-of-fit of EFA models. Spearman correlations were used to assess the convergent validity of MDASS with measures of depression, anxiety, and stress. Results: In Study 1, EFA yielded a three-factor model with underlying factors of fixed mindsets on depression, anxiety, and stress; CFA revealed a good goodness-of-fit (CFI and TFI >0.95; RMSEA and SRMR <0.08). In Study 2 with reversed items, EFA and CFA yielded a complex model structure. Fixed mindsets were positively correlated with depression, anxiety, and stress symptoms (all absolute correlations >0.3) in both studies. Conclusion: MDASS is a reliable scale with clear factor structure to measure mindsets of negative emotions among early adults. MDASS is suggested to use only fixed-mindset statements. The MDASS are highly associated with symptoms of depression, anxiety, and stress.", keywords = "fixed mindset, growth mindset, implicit theory, mental health, validation", author = "Shimin Zhu and Yanqiong Zhuang and Paul Lee", note = "Funding Information: This work was supported by an Early Career Scheme Fund awarded to SZ from the Hong Kong Research Grant Council (Ref:25605418) Funding information Publisher Copyright: {\textcopyright} 2021 John Wiley \& Sons Australia, Ltd.", year = "2022", month = apr, day = "2", doi = "10.1111/eip.13177", language = "English", volume = "16", pages = "380--392", journal = "Early Intervention in Psychiatry", issn = "1751-7885", publisher = "Fafo", number = "4", } . Early Intervention in Psychiatry.

Hanyu Zhang, Carly S. Y. Lam, Wing-Chun Tang, Myra Leung, Hua Qi, Paul H. Lee, Chi-Ho To (2022). Myopia Control Effect Is Influenced by Baseline Relative Peripheral Refraction in Children Wearing Defocus Incorporated Multiple Segments (DIMS) Spectacle Lenses . Journal of Clinical Medicine.

Sarcopenia and its association with objectively measured life-space mobility and moderate-to-vigorous physical activity in the oldest-old amid the COVID-19 pandemic when a physical distancing policy is in force @article{41ffc34590c44c999d3f03a71905b75f, title = "Sarcopenia and its association with objectively measured life-space mobility and moderate-to-vigorous physical activity in the oldest-old amid the COVID-19 pandemic when a physical distancing policy is in force", abstract = "Introduction: The oldest-old are highly vulnerable to sarcopenia. Physical distancing remains a common and effective infection-control policy to minimize the risk of COVID-19 transmission during the pandemic. Sarcopenia is known to be associated with impaired immunity. Moderate-to-vigorous physical activity (MVPA) and life-space mobility (LSM) are potential strategies for minimizing the risk of sarcopenia. However, a physical distancing policy might jeopardize the practice of MVPA and LSM. The purposes of this study were to identify the prevalence of sarcopenia and examine the association between MVPA and LSM with sarcopenia in the community-dwelling oldest-old during the COVID-19 pandemic. Methods: This study employed a cross-sectional and observational design. The study was conducted in 10 community centres for older people in Hong Kong during the period of the COVID-19 pandemic (September to December 2020). Eligible participants were the oldest-old people aged ≥85 years, who were community-dwelling and had no overt symptoms of cognitive impairment or depression. Key variables included sarcopenia as measured by SARC-F, LSM as measured by a GPS built into smartphones, and MVPA as measured by a wrist-worn ActiGraph GT3X+. Variables were described by mean and frequency. A multiple linear regression was employed to test the hypotheses. The dependent variable was sarcopenia and the independent variables included LSM and MVPA. Results: This study recruited 151 eligible participants. Their mean age was 89.8 years and the majority of them were female (n = 93/151, 61.6\%). The prevalence of sarcopenia was 24.5\% (n = 37/151) with a margin of error of 6.86\%. MVPA was negatively associated with sarcopenia in older people (β = − 0.002, SE = 0.001, p = 0.029). However, LSM was not associated with sarcopenia. Conclusion: The prevalence of sarcopenia in the community-dwelling oldest-old population is high. MVPA is negatively associated with sarcopenia. LSM is unrelated to sarcopenia. Sarcopenia should be recognized and the oldest-old with sarcopenia should be accorded priority treatment during the COVID-19 pandemic.", keywords = "Aged, Aged, 80 and over, COVID-19/epidemiology, Cross-Sectional Studies, Exercise, Female, Humans, Male, Pandemics/prevention \& control, Physical Distancing, Policy, Sarcopenia/diagnosis", author = "Kwan, \{Rick Yiu Cho\} and Liu, \{Justina Yat Wa\} and Yin, \{Yue Heng\} and Lee, \{Paul Hong\} and Ng, \{Siu Ying\} and Cheung, \{Daphne Sze Ki\} and Kor, \{Patrick Pui Kin\} and Lam, \{Simon Ching\} and Lo, \{Shirley Ka Lai\} and Lin Yang and Chan, \{Siu Kay\} and Chiang, \{Vico Chung Lim\}", note = "{\textcopyright} 2022. The Author(s).", year = "2022", month = mar, day = "25", doi = "10.1186/s12877-022-02861-7", language = "English", volume = "22", journal = "BMC Geriatrics", issn = "1471-2318", publisher = "BioMed Central", number = "1", } . BMC Geriatrics.

Paul H. Lee, Andy C. Y. Tse, Teris Cheung, C. W. Do, Grace P. Y. Szeto, Billy C. L. So, Regina L. T. Lee(2022). Bedtime smart device usage and accelerometer-measured sleep outcomes in children and adolescents . Sleep and Breathing. Springer Science and Business Media {LLC}

Paul H. Lee, Anna L. Guyatt, Catherine John, Altaf Ali, Xueyang Wang, Alexander T. Williams, Bo Zhao, Chiara Batini, Catherine Bee, Emma Adams, et al. (2021). Extended Cohort for E-health, Environment and DNA (EXCEED) COVID-19 focus . Wellcome Open Research.

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues @article{6adb3f1865b34df19c5e0a0ee9a32ec8, title = "SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues", abstract = "Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99\% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types.", keywords = "colocalization, COVID-19, eQTL, GWAS, SARS-CoV-2", author = "Matteo D'Antonio and Nguyen, \{Jennifer P.\} and Arthur, \{Timothy D.\} and Hiroko Matsui and \{The COVID-19 Host Genetics Initiative\} and Agnieszka D'Antonio-Chronowska and Frazer, \{Kelly A.\} and Neale, \{Benjamin M.\} and Mark Daly and Andrea Ganna and Christine Stevens and Pathak, \{Gita A.\} and Andrews, \{Shea J.\} and Masahiro Kanai and Mattia Cordioli and Andrea Ganna and Juha Karjalainen and Pathak, \{Gita A.\} and Renato Polimanti and Andrews, \{Shea J.\} and Mattia Cordioli and Matti Pirinen and Masahiro Kanai and Nadia Harerimana and Kumar Veerapen and Brooke Wolford and Huy Nguyen and Matthew Solomonson and Christine Stevens and Liao, \{Rachel G.\} and Karolina Chwialkowska and Amy Trankiem and Balaconis, \{Mary K.\} and Caroline Hayward and Anne Richmond and Archie Campbell and Marcela Morris and Chloe Fawns-Ritchie and Glessner, \{Joseph T.\} and Shaw, \{Douglas M.\} and Xiao Chang and Hannah Polikowski and Wilson, \{James F.\} and Lee, \{Paul H.\} and Saleh Alqahtani and Faisal Almalki and Sara Alotaibi and Li, \{Kevin W.\} and Ferreira, \{Manuel A.R.\} and Sun, \{Yan V.\} and Daniel King", year = "2021", month = nov, day = "16", doi = "10.1016/j.celrep.2021.110020", language = "English", volume = "37", journal = "Cell Reports", issn = "2211-1247", publisher = "Cell Press", number = "7", } . Cell Reports.

The changes of suicidal ideation status among young people in Hong Kong during COVID-19 @article{250cb5897f4a4164806d285f8808df5d, title = "The changes of suicidal ideation status among young people in Hong Kong during COVID-19: a longitudinal survey", abstract = "Background:: Pandemics affect the physical and mental well-being of all potentially at-risk young people globally. This longitudinal study examines changes of suicidal ideation status among adolescents during COVID-19. Method: A follow-up after nine-months of a school-based survey among 1,491 secondary school students was conducted during COVID-19. Psychological well-being, psychological factors, family support, and COVID-19-related experiences were examined. Results: The prevalence of suicidal ideation were 24\% and 21\% among the participants before and during COVID-19, respectively. In particular, 897 (65.0\%) remained non-suicidal, 193 (14.0\%) recovered from being suicidal, 148 (10.7\%) newly reported being suicidal, and 143 (10.4\%) remained suicidal. Respondents who remained suicidal were found to have significantly higher depression, anxiety, stress, loneliness, and social anxiety, fixed mind-set, lower meaning of life and self-control; and lower parental support and supervision than the other three groups. Participants with suicidal ideation reported more negative perceptions about COVID-19 than non-suicidal participants. Multinomial logistic regression showed that anxiety, trait anxiety and life satisfactory in baseline were associated with suicidal ideation at follow-up. Limitation:: This study was limited by the small number of protective variables being included in the baseline survey to examine the potential reasons for the recovery of suicidal ideation at follow-up. Conclusion: Poor psychological well-being, lower level of family support, and negative impacts of the pandemic were consistently associated with students{\textquoteright} presence of suicidal ideation during the pandemic. Further intervention studies are needed to examine effects of mental health consequences of COVID-19 on youth mental health and to promote positive youth well-being.", keywords = "COVID-19, Mental health, Secondary school students, Suicidal ideation", author = "Shimin Zhu and Yanqiong Zhuang and Paul Lee and Wong, \{Paul W.C.\}", note = "Funding Information: This work was supported by the Hong Kong Research Grant Council (Ref: 25605418 ) awarded to Shimin Zhu. We would like to thank the participants of the study and the schools for their assistance with the participant recruitment. Publisher Copyright: {\textcopyright} 2021", year = "2021", month = nov, day = "1", doi = "10.1016/j.jad.2021.07.042", language = "English", volume = "294", pages = "151--158", journal = "Journal of Affective Disorders", issn = "0165-0327", publisher = "Elsevier BV", number = "11", } . Journal of Affective Disorders.

Paul LEE, Shimin ZHU, Yanqiong ZHUANG, Paul W.C. WONG (2021). The changes of suicidal ideation status among young people in Hong Kong during COVID-19: A longitudinal survey . Journal of Affective Disorders.

Enhancing the physical activity levels of frail older adults with a wearable activity tracker‐based exercise intervention @article{d04980482f1e44b591ba9eff090bf4d1, title = "Enhancing the physical activity levels of frail older adults with a wearable activity tracker‐based exercise intervention: A pilot cluster randomized controlled trial", abstract = "A wearable activity tracker (WAT) incorporated with behavioral change techniques (BCTs) increases physical activity in younger adults; however, its effectiveness with frail older adults is unknown. The feasibility and preliminary effects of a WAT‐based exercise intervention to increase physical activity levels in frail older adults was investigated in this pilot study involving 40 community‐dwelling frail older adults. The experimental group received a 14‐week WAT‐based group exercise intervention and a 3‐month follow‐up, while the control group only received similar physical training and all BCTs. The recruitment rate was 93\%, and the average attendance rate was 85.2\% and 82.2\% in the WAT and control groups, respectively, establishing feasibility. Adherence to wearing the WAT was 94.2\% and 92\% during the intervention and follow‐up periods, respec-tively. A significant interaction effect between time and group was found in all physical assess-ments, possibly lasting for 3 months post‐intervention. However, no significant difference between groups was observed in any daily activity level by the ActiGraph measurement. The majority of the WAT group{\textquoteright}s ActiGraph measurements reverted to baseline levels at the 1‐month follow‐up. Thus, the WAT‐based exercise program has potential for employment among community‐dwelling frail older adults, but sustaining the effects after the intervention remains a major challenge.", keywords = "Cluster‐RCT, Frailty, Physical activity, Wearable activity tracker", author = "Liu, \{Justina Y.W.\} and Kwan, \{Rick Y.C.\} and Yin, \{Yue Heng\} and Lee, \{Paul H.\} and Siu, \{Judy Yuen Man\} and Xue Bai", note = "Funding Information: Funding: This project was funded by the Faculty of Health and Social Sciences{\textquoteright} Faculty Collabora‐ tive Research Scheme between Social Sciences and Health Sciences, the Hong Kong Polytechnic University (Project ID: P0001273). Publisher Copyright: {\textcopyright} 2021 by the authors. Li-censee MDPI, Basel, Switzerland.", year = "2021", month = oct, day = "1", doi = "10.3390/ijerph181910344", language = "English", volume = "18", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "19", } . International Journal of Environmental Research and Public Health.

Justina Y. W. Liu, Rick Y. C. Kwan, Yue-Heng Yin, Paul H. Lee, Judy Yuen-man Siu, Xue Bai(2021). Enhancing the Physical Activity Levels of Frail Older Adults with a Wearable Activity Tracker-Based Exercise Intervention: A Pilot Cluster Randomized Controlled Trial . International Journal of Environmental Research and Public Health. 18. (19). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 10344. {MDPI} {AG}

Effect of a telecare case management program for older adults who are homebound during the COVID-19 pandemic @article{7afd7f738baf48a7b27b116005e6f948, title = "Effect of a telecare case management program for older adults who are homebound during the COVID-19 pandemic: a pilot randomized clinical trial", abstract = "Importance: Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage. Objective: To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic. Design, Setting, and Participants: This randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months. Interventions: Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls. Main Outcomes and Measures: The primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis. Results: A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4\%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (β = 1.68; 95\% CI, -0.68 to 4.03; P =.16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (β = -8.30; 95\% CI, -13.14 to -3.47; P =.001) and quality of life (physical component score: β = 4.99; 95\% CI, 0.29-9.69; P =.04). Conclusions and Relevance: In this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results. Trial Registration: ClinicalTrials.gov Identifier: NCT04304989.", author = "Wong, \{Arkers Kwan Ching\} and Wong, \{Frances Kam Yuet\} and Chow, \{Karen Kit Sum\} and Wong, \{Siu Man\} and Lee, \{Paul Hong\}", note = "Funding/Support: This work was supported by grant P0031004 from the NICHE (Dr A. K. C. Wong). Publisher Copyright: {\textcopyright} 2021 American Society of Civil Engineers (ASCE). All rights reserved.", year = "2021", month = sep, day = "9", doi = "10.1001/jamanetworkopen.2021.23453", language = "English", volume = "4", journal = "JAMA Network Open", publisher = "American Medical Association", number = "9", } . JAMA Network Open.

Effect of aquatic exercise on sleep efficiency of adults with chronic musculoskeletal pain @article{9096c388965b488e919227833ea2d879, title = "Effect of aquatic exercise on sleep efficiency of adults with chronic musculoskeletal pain", abstract = "Background: Aerobic exercise improves sleep for people who have difficulty in sleeping soundly, but most research to date has focused on land-based exercise. There has been only very limited research into the effect of aquatic exercise on people with chronic musculoskeletal (MSK) pain. The purpose of this study is to examine the effect of a 6-week aquatic exercise program on sleep efficiency among adults with chronic MSK pain. Methods: A total of 30 adults with chronic MSK pain were recruited by convenience sampling and assigned into intervention and control groups by a trained research assistant. Their sleep efficiency, sleep quality, activity level, stress level, and pain level were measured with ActiGraph GT3X accelerometer before and after the intervention group completed a 6-week, biweekly program of aquatic exercise. Results: Following intervention, the intervention group had significantly longer total true sleep time (by 27.6 min, P =.006); greater sleep efficiency (+3.01\%, P =.005); and less pain (−1.33/10, P =.026). The control group had significantly shorter total true sleep time by 5.8 minutes (P =.036) while changes in the other outcomes were not significant. Conclusions: Six weeks of moderate-intensity aquatic exercise may improve sleep efficiency and reduce pain for persons suffering chronic MSK pain.", keywords = "Actigraphy, Aerobic training, Hydrotherapy, Insomnia, Pool training", author = "So, \{Billy C.L.\} and Kwok, \{Sze C.\} and Lee, \{Paul H.\}", note = "Funding Information: The authors would like to thank the students at the Hong Kong Polytechnic University for their assistance, especially: Ms C.T. Tam, Mr Louis Li, Ms Nathania Suen, Ms Samuela Suen, Ms Irene To for their data collection. The authors would like to thank Mr Harry Lee for providing support over the hydrotherapy facilities and Mr Falcon Tsang, Mr Pat Wan, and Ms Rose Yu for implementation of aquatic aerobic program. The cost of ActiGraph was supported by the Health and Medical Research Fund (Ref 12131741) from Food and Health Bureau of the Hong Kong Special Administrative Region, China, and the General Research Fund Early Career Scheme (Ref: PolyU 251056/16M) from University Grants Committee of the Hong Kong Special Administrative Region, China. Publisher Copyright: {\textcopyright} 2021 Human Kinetics, Inc.", year = "2021", month = sep, doi = "10.1123/jpah.2020-0476", language = "English", volume = "18", pages = "1037--1045", journal = "Journal of Physical Activity and Health", issn = "1543-3080", publisher = "Human Kinetics", number = "9", } . Journal of Physical Activity and Health.

Justina Y. W. Liu, Rick Y. C. Kwan, Yue-Heng Yin, Paul H. Lee, Judy Yuen-man Siu, Xue Bai (2021). Enhancing the Physical Activity Levels of Frail Older Adults with a Wearable Activity Tracker-Based Exercise Intervention: A Pilot Cluster Randomized Controlled Trial . International Journal of Environmental Research and Public Health.

Effectiveness of a peer-led pain management program in relieving chronic pain and enhancing pain self-efficacy among older adults @article{46f6b995a7e14cd39aa5239dfd5b6e88, title = "Effectiveness of a peer-led pain management program in relieving chronic pain and enhancing pain self-efficacy among older adults: a clustered randomized controlled trial", abstract = "Chronic pain is common in nursing home residents, who may have difficulty seeking out pain management strategies. Peer support model show promise as a strategy for managing chronic conditions. This was a clustered randomized controlled trial. A peer-led pain management program was provided for the experimental group. Pain situation, depression, quality of life, non-drug strategies used, and pain knowledge were measured. A total of 262 participants joined the study (146 were allocated as experimental group and 116 as control group). Before our intervention, the mean pain score reported was as high as 6.36 on a 10-point Likert Scale. The high intensity of their pain very much interfered with the daily activities of the participants. Pain interference was high and the participants had poor coping as indicated by the low pain self-efficacy. Depression and a low quality of life score was found. Upon completion of our PAP, there was a significant increase in pain self-efficacy, pain interference as well as quality of life for the participants in the experimental group and not in the control group, and this improvement sustained in 3-month follow up. The present study used a peer support models and proven to be effective in managing pain and pain related situations for nursing home residents with chronic pain. The peer volunteers involved in the pain management program taught relevant pain knowledge and pain management strategies to help our participants. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03823495, NCT03823495.", keywords = "chronic pain, nursing home residents, pain management program, peer-led, randomized controlled trial", author = "Tse, \{Mimi M.Y.\} and Ng, \{Shamay S.M.\} and Lee, \{Paul H.\} and Xue Bai and Raymond Lo and Tang, \{Shuk Kwan\} and Chan, \{Ka Long\} and Yajie Li", note = "Funding Information: This research was supported by the Health and Medical Research Fund of the Food and Health Bureau, Hong Kong SAR Government (Ref. 15161051). Funding Information: The authors thank all of the participating nursing homes, as well as the Institute of Active Aging and the School of Nursing, The Hong Kong Polytechnic University. Funding. This research was supported by the Health and Medical Research Fund of the Food and Health Bureau, Hong Kong SAR Government (Ref. 15161051). Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2021 Tse, Ng, Lee, Bai, Lo, Tang, Chan and Li.", year = "2021", month = aug, day = "5", doi = "10.3389/fmed.2021.709141", language = "English", volume = "8", journal = "Frontiers in Medicine", issn = "2296-858X", publisher = "Frontiers Media SA", } . Frontiers in Medicine.

Temporal association between objectively measured smartphone usage, sleep quality and physical activity among Chinese adolescents and young adults @article{dcac2f631f5d4907afeae98b451d1212, title = "Temporal association between objectively measured smartphone usage, sleep quality and physical activity among Chinese adolescents and young adults", abstract = "We studied the association between objectively measured smartphone usage and objectively measured sleep quality and physical activity for seven consecutive days among Hong Kong adolescents and young adults aged 11–25 years (n = 357, 67\% female). We installed an app that tracked the subjects{\textquoteright} smartphone usage and had them wear an ActiGraph GT3X accelerometer on their wrist to measure their sleep quality and physical activity level. Smartphone usage data were successfully obtained from 187 participants (52.4\%). The participants on average spent 2 h 46 min per day on their smartphone. Multilevel regression showed that 1 min of daytime smartphone usage was associated with 0.07 min decrease in total sleeping time that night (p =.043, 95\% confidence interval [CI]: −0.14, −0.003). Broken down for different usage purposes, 1 min of daytime social network usage and games and comics was associated with a 0.28 (p =.02, 95\% CI: −0.52, −0.04) min and 0.18 min (p =.01, 95\% CI: −0.32, −0.04) decrease in total sleeping time that night, respectively. One minute of daytime smartphone usage was associated with an increase of 4.55 steps in the number of steps (p =.001, 95\% CI: 1.77, 7.34) on the next day. To conclude, time spent on a smartphone in the daytime was associated with total sleeping time that night and number of steps the next day, but was not associated with sleep efficiency, wake after sleep onset and moderate-to-vigorous-intensity activity (MVPA) among Hong Kong adolescents and young adults.", keywords = "exercise, gaming, screen, smart device, smartphone monitoring, youth", author = "Lee, \{Paul H.\} and Tse, \{Andy C.Y.\} and Wu, \{Cynthia S.T.\} and Mak, \{Yim Wah\} and Uichin Lee", note = "Funding Information: This study was funded by the General Research Fund Early Career Scheme (Ref: PolyU 251056/16M) from the University Grants Committee of the Hong Kong Special Administrative Region, China. Funding Information: This study was funded by the General Research Fund Early Career Scheme (Ref: PolyU 251056/16M) from the University Grants Committee of the Hong Kong Special Administrative Region, China. The authors would like to thank Mr Ming Wong (Hong Kong Polytechnic University) for data collection and data management of the current study. Publisher Copyright: {\textcopyright} 2020 European Sleep Research Society", year = "2021", month = aug, day = "1", doi = "10.1111/jsr.13213", language = "English", volume = "30", journal = "Journal of Sleep Research", issn = "0962-1105", publisher = "John Wiley and Sons Inc", number = "4", } . Journal of Sleep Research.

Paul H. Lee, Andy C. Y. Tse, Cynthia S. T. Wu, Yim Wah Mak, Uichin Lee (2021). Temporal association between objectively measured smartphone usage, sleep quality and physical activity among Chinese adolescents and young adults . Journal of Sleep Research.

Paul Lee, Stefanos Tyrovolas, Iago Gin&#233;-V&#225;zquez, Daniel Fern&#225;ndez, Marianthi Morena, Ai Koyanagi, Mark Janko, Josep Maria Haro, Yang Lin, William Pan, et al.(2021). Estimating the COVID-19 Spread Through Real-time Population Mobility Patterns: Surveillance in Low- and Middle-Income Countries . Journal of Medical Internet Research. {JMIR} Publications Inc.

Estimating the COVID-19 spread through real-time population mobility patterns @article{3d61886315b0448cbb93038e079f115c, title = "Estimating the COVID-19 spread through real-time population mobility patterns: Surveillance in low-and middle-income countries", abstract = "Background: On January 21, 2020, the World Health Organization reported the first case of severe acute respiratory syndrome coronavirus 2, which rapidly evolved to the COVID-19 pandemic. Since then, the virus has also rapidly spread among Latin American, Caribbean, and African countries. Objective: The first aim of this study is to identify new emerging COVID-19 clusters over time and space (from January 21 to mid-May 2020) in Latin American, Caribbean, and African regions, using a prospective space–time scan measurement approach. The second aim is to assess the impact of real-time population mobility patterns between January 21 and May 18, 2020, under the implemented government interventions, measurements, and policy restrictions on COVID-19 spread among those regions and worldwide. Methods: We created a global COVID-19 database, of 218 countries and territories, merging the World Health Organization daily case reports with other measures such as population density and country income levels for January 21 to May 18, 2020. A score of government policy interventions was created for low, intermediate, high, and very high interventions. The population{\textquoteright}s mobility patterns at the country level were obtained from Google community mobility reports. The prospective space–time scan statistic method was applied in five time periods between January and May 2020, and a regression mixed model analysis was used. Results: We found that COVID-19 emerging clusters within these five periods of time increased from 7 emerging clusters to 28 by mid-May 2020. We also detected various increasing and decreasing relative risk estimates of COVID-19 spread among Latin American, Caribbean, and African countries within the period of analysis. Globally, population mobility to parks and similar leisure areas during at least a minimum of implemented intermediate-level control policies (when compared to low-level control policies) was related to accelerated COVID-19 spread. Results were almost consistent when regional stratified analysis was applied. In addition, worldwide population mobility due to working during high implemented control policies and very high implemented control policies, when compared to low-level control policies, was related to positive COVID-19 spread. Conclusions: The prospective space–time scan is an approach that low-income and middle-income countries could use to detect emerging clusters in a timely manner and implement specific control policies and interventions to slow down COVID-19 transmission. In addition, real-time population mobility obtained from crowdsourced digital data could be useful for current and future targeted public health and mitigation policies at a global and regional level.", keywords = "COVID-19, Database, Digital public health, Emerging countries, Estimate, Low and middle-income countries, Mobile data, Pattern, Policy, Real-time, Social distancing, Surveillance, Transmission", author = "\{et al.\} and Stefanos Tyrovolas and Iago Gin{\'e}-V{\'a}zquez and Daniel Fern{\'a}ndez and Marianthi Morena and Ai Koyanagi and Mark Janko and Haro, \{Josep Maria\} and Yang Lin and Paul Lee and William Pan and Demosthenes Panagiotakos and Alex Molassiotis", note = "Funding Information: ST was supported by the Foundation for Education and European Culture, the Miguel Servet programme (reference CP18/00006), and the Fondos Europeos de Desarrollo Regional. DF is a Serra H{\'u}nter Fellow and was supported by Marsden grant E2987-3648 administrated by the Royal Society of New Zealand, and by grant 2017 SGR 622 (GRBIO) administrated by the Departament d'Economia i Coneixement de la Generalitat de Catalunya (Spain). WP was supported by NASA-ROSES Grant NNX15AP74G. Publisher Copyright: {\textcopyright}Stefanos Tyrovolas, Iago Gin{\'e}-V{\'a}zquez, Daniel Fern{\'a}ndez, Marianthi Morena, Ai Koyanagi, Mark Janko, Josep Maria Haro, Yang Lin, Paul Lee, William Pan, Demosthenes Panagiotakos, Alex Molassiotis.", year = "2021", month = jun, day = "1", doi = "10.2196/22999", language = "English", volume = "23", journal = "Journal of Medical Internet Research", issn = "1438-8871", publisher = "JMIR Publications, Inc.", number = "6", } . Journal of Medical Internet Research.

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 @article{74828462a16b450fbaf91dfe3163588e, title = "Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18: a modelling study", abstract = "Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2·8 (95\% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676·5 (513·6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guij{\'a} District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100 000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81·1\%] of 4087 units) and number of deaths (3325 [81·4\%]), nearly all appeared well short of the targeted 75\% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75\% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas. Funding: Bill \& Melinda Gates Foundation.", author = "\{LBD HIV Incidence Mortality Collaborators\} and Benn Sartorius and VanderHeide, \{John D.\} and Mingyou Yang and Goosmann, \{Erik A.\} and Julia Hon and Emily Haeuser and Cork, \{Michael A.\} and Samantha Perkins and Deepa Jahagirdar and Schaeffer, \{Lauren E.\} and Serfes, \{Audrey L.\} and LeGrand, \{Kate E.\} and Hedayat Abbastabar and Abebo, \{Zeleke Hailemariam\} and Abosetugn, \{Akine Eshete\} and Eman Abu-Gharbieh and Accrombessi, \{Manfred Mario Kokou\} and Adebayo, \{Oladimeji M.\} and Adegbosin, \{Adeyinka Emmanuel\} and Victor Adekanmbi and Adetokunboh, \{Olatunji O.\} and Adeyinka, \{Daniel Adedayo\} and Ahinkorah, \{Bright Opoku\} and Keivan Ahmadi and Ahmed, \{Muktar Beshir\} and Yonas Akalu and Akinyemi, \{Oluwaseun Oladapo\} and Akinyemi, \{Rufus Olusola\} and Addis Aklilu and Akunna, \{Chisom Joyqueenet\} and Fares Alahdab and Ziyad Al-Aly and Noore Alam and Alamneh, \{Alehegn Aderaw\} and Alanzi, \{Turki M.\} and Alemu, \{Biresaw Wassihun\} and Alhassan, \{Robert Kaba\} and Tilahun Ali and Vahid Alipour and Saeed Amini and Robert Ancuceanu and Fereshteh Ansari and Anteneh, \{Zelalem Alamrew\} and Davood Anvari and Razique Anwer and Appiah, \{Seth Christopher Yaw\} and Lee, \{Paul H.\} and Rahman, \{Mohammad Hifz Ur\} and Irfan Ullah and Zhang, \{Zhi Jiang\}", note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license", year = "2021", month = jun, doi = "10.1016/S2352-3018(21)00051-5", language = "English", volume = "8", pages = "e363--e375", journal = "The Lancet HIV", issn = "2352-3018", publisher = "Elsevier Ltd.", number = "6", } . The Lancet HIV.

Paul Lee, Shimin Zhu, Yanqiong Zhuang, Jessica Chi-Mei Li, Paul W C Wong(2021). Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study . JMIR Serious Games. {JMIR} Publications Inc.

Shimin Zhu, Paul H. Lee, Paul W. C. Wong(2021). Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours . BJPsych Open. 7. (3). Royal College of Psychiatrists

Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours @article{a47c7cc1480844148ca4040ebcfa4a31, title = "Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours", abstract = "Background: self-harm and suicidal behaviour are recognised as public health concerns. Prolonged social withdrawal behaviour, or hikikomori, is reported as a risk factor for suicidal behaviour.  Aims: to examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students.  Method: a cross-sectional online survey was conducted with three universities in southern China. A two-stage random sampling was adopted for recruitment, with students in different years of study, in different departments of each participating university. Hierarchical logistic regression analyses were conducted to investigate the sociodemographic and psychological correlates of self-harm and suicidal behaviours among male and female participants with hikikomori status.  Results: of the students who completed the online survey, 1735 (72.23\%) were included in the analysis; 11.5\% (n = 200) reported self-harm behaviour and 11.8\% (n = 204) reported suicidal behaviours in the past 12 months. Men showed a higher prevalence rate of self-harm than women (14.7\% v. 10.8\%, P = 0.048), but a similar rate of suicidal behaviours (11.9\% v. 11.3\%, P = 0.78). The overall prevalence rate of social withdrawal behaviour was 3.2\% (7.0\% for men and 2.3\% for women, P < 0.001). Prolonged social withdrawal behaviour status was significantly associated with self-harm (odds ratio 2.00, 95\% CI 1.22-3.29) and suicidal behaviour (odds ratio 2.35, 95\% CI 1.45-3.81). However, the associations became statistically insignificant after adjustment for psychological factors in the final models in the logistic regression analyses.  Conclusions: prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.", keywords = "China, hikikomori, prolonged social withdrawal behaviour, Self-harm, suicidal behaviour", author = "Shimin Zhu and Lee, \{Paul H.\} and Wong, \{Paul W.C.\}", year = "2021", month = apr, day = "30", doi = "10.1192/bjo.2021.47", language = "English", volume = "7", journal = "BJPsych Open", issn = "2056-4724", publisher = "Cambridge University Press", number = "3", } . BJPsych Open.

Investigating the matching relationship between physical exercise and stereotypic behavior in children with autism @article{0649dbd484bf4118add583e61530547f, title = "Investigating the matching relationship between physical exercise and stereotypic behavior in children with autism", abstract = "Purpose: Physical exercise has been shown to be effective in reducing stereotypic behaviors in children with autism spectrum disorder. One possible mechanism concerns the matching hypothesis between exercise and behavior. The present study sought to examine this matching exercise-behavior relationship. Methods: Participants (N = 21, 17 males and 4 females, Mage = 11.07 ± 1.44 yr, Mheight = 1.46 ± 0.99 m, and Mweight = 40.60 ± 8.25 kg), with observable forms of hand-flapping and body-rocking stereotypic behaviors, underwent three separate days of conditions, one for the control condition, one for the 10-min ball-tapping exercise condition, and one for the 10-min jogging condition, in a randomized order. The frequency of each type of stereotypic behavior was videotaped from 15 min before to 60 min after the exercise. Results: Results revealed that only hand-flapping stereotypic behaviors were significantly reduced in the ball-tapping exercise condition (P < 0.017), whereas only body-rocking stereotypic behaviors were significantly reduced in the jogging exercise condition (P < 0.017). However, the behavioral benefit diminished at 45 min after the respective exercise. CONCLUSION: Physical exercise should be topographically matched with stereotypic behavior to produce desirable behavioral benefits in children with autism spectrum disorder.", author = "Tse, \{Andy C.Y.\} and Liu, \{Venus H.L.\} and Lee, \{Paul H.\}", note = "Publisher Copyright: Copyright {\textcopyright} 2020 by the American College of Sports Medicine.", year = "2021", month = apr, day = "1", doi = "10.1249/MSS.0000000000002525", language = "English", volume = "53", pages = "770--775", journal = "Medicine and Science in Sports and Exercise", issn = "0195-9131", publisher = "Lippincott Williams \& Wilkins", number = "4", } . Medicine and Science in Sports and Exercise.

Leisure and problem gaming behaviors among children and adolescents during school closures caused by covid-19 in hong kong @article{7776b649d66d47f78359e75d98934782, title = "Leisure and problem gaming behaviors among children and adolescents during school closures caused by covid-19 in hong kong: Quantitative cross-sectional survey study", abstract = "Background: School closures during the COVID-19 pandemic may have exacerbated students' loneliness, addictive gaming behaviors, and poor mental health. These mental health issues confronting young people are of public concern. Objective: This study aimed to examine the associations between loneliness and gaming addiction behaviors among young people in Hong Kong and to investigate how familial factors, psychological distress, and gender differences moderate these relationships. Methods: This cross-sectional study was conducted in June 2020 when schools reopened after 6 months of school closures. Participants included 2863 children and adolescents in primary (Grades 4 to 6) and secondary (Grades 7 and 8) schools (female participants: 1502/2863, 52.5\%). Chi-square tests, one-way analyses of variance, and independent-samples t tests were performed to compare the differences of distribution in gaming addiction behaviors across gender, age, and other sociodemographic characteristics. Multinomial logistic regression analyses were conducted to identify factors that relate to excessive or pathological gaming behaviors separately, in comparison with leisure gaming. Results: A total of 83.0\% (2377/2863) of the participants played video games during the COVID-19 pandemic. The prevalence of excessive and pathological game addiction behaviors was 20.9\% (597/2863) and 5.3\% (153/2863), respectively. More male students had gaming addiction symptoms than female students. The multinomial logistic regressions showed that feeling lonely was associated with more problematic gaming behaviors, and the association was stronger for older female students. Low socioeconomic status, less parental support and less supervision, and poor mental health were risk factors for gaming addiction behaviors, especially among primary school students. Conclusions: Loneliness was associated with gaming addiction behaviors; the findings from this study suggested that this association was similar across gender and age groups among young people. Familial support and supervision during school closures can protect young people from developing problematic gaming behaviors. Results of this study have implications for prevention and early intervention on behalf of policy makers and game developers.", keywords = "COVID-19, COVID-19 lockdown, Excessive gaming, Familial factors, Leisure gaming, Loneliness, Pathological gaming, School closure", author = "Shimin Zhu and Yanqiong Zhuang and Paul Lee and \{Chi-Mei Li\}, Jessica and Wong, \{Paul W.C.\}", note = "Publisher Copyright: {\textcopyright} 2021 JMIR Medical Informatics.", year = "2021", month = apr, doi = "10.2196/26808", language = "English", volume = "9", journal = "JMIR Serious Games", issn = "2291-9279", publisher = "JMIR Publications", number = "2", } . JMIR Serious Games.

Carly SY Lam, Wing Chun Tang, Paul H Lee, Han Yu Zhang, Hua Qi, Keigo Hasegawa, Chi Ho To (2021). Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study . British Journal of Ophthalmology.

Effects of Tai Chi or exercise on sleep in older adults with insomnia @article{c18a83f26a0e411d911379a9ce7844aa, title = "Effects of Tai Chi or exercise on sleep in older adults with insomnia: A Randomized Clinical Trial", abstract = "Importance: Previous studies that have shown Tai Chi to improve sleep were mainly based on subjective assessments, which might have produced results confounded by self-reporting bias. Objective: To compare the effectiveness of tai chi for improving sleep in older adults with insomnia with conventional exercise and a passive control group using actigraphy-based objective measurements. Design, Setting, and Participants: This randomized, 3-arm, parallel group, assessor-masked clinical trial was conducted at a single research unit in Hong Kong between August 2014 and August 2018. Eligible participants, aged 60 years or older and with chronic insomnia, were randomly allocated into tai chi training, exercise, and control groups. Interventions: 12-week tai chi training, 12-week conventional exercise, and no intervention control. Main Outcomes and Measures: Primary outcomes were measures taken from actigraphy sleep assessment. Secondary outcomes included remission of insomnia, insomnia treatment response, Pittsburgh Sleep Quality Index score, Insomnia Severity Index score, and self-reported sleep using a 7-day sleep diary. Assessments were performed at baseline, end of the intervention (postintervention), and 24 months after the intervention (follow-up). Data analysis was performed from September 2018 to August 2020. Results: A total of 320 participants (mean [SD] age, 67.3 [6.8] years; mean [SD] insomnia duration, 124.4 [134.5] months; 256 [80.0\%] women) were randomly allocated into control (110 participants), exercise (105 participants), and tai chi (105 participants) groups and included in the data analysis. Compared with the control group, the exercise and tai chi groups showed improved sleep efficiency (exercise vs control: adjusted mean difference, +3.5\%; 95\% CI, 1.8-5.2; P < .001; tai chi vs control: adjusted mean difference, +3.4\%; 95\% CI, 1.6-5.1; P < .001) and reductions of wake time after sleep onset (exercise vs control: -17.0 minutes; 95\% CI, -24.9 to -9.0; P < .001; tai chi vs control: -13.3 minutes; 95\% CI, -21.3 to -5.2; P = .001) and number of awakenings (exercise vs control: -2.8 times; 95\% CI, -4.0 to -1.6; P < .001; tai chi vs control: -2.2 times; 95\% CI, -3.5 to -1.0; P < .001) as assessed by actigraphy at postintervention; although there were no significant differences between the exercise and tai chi groups. The actigraphy-assessed beneficial effects were maintained in both intervention groups at follow-up. Conclusions and Relevance: Conventional exercise and tai chi improved sleep and the beneficial effects sustained for 24 months, although the absolute improvements in sleep parameters were modest. Improvements in objective sleep parameters were not different between the tai chi and exercise groups, suggesting that tai chi can be an alternative approach for managing insomnia. Trial Registration: ClinicalTrials.gov Identifier: NCT02260843.", author = "\{et al.\} and Siu, \{Parco M.\} and Yu, \{Angus P.\} and Tam, \{Bjorn T.\} and Chin, \{Edwin C.\} and Yu, \{Doris S.\} and Chung, \{Ka Fai\} and Hui, \{Stanley S.\} and Jean Woo and Fong, \{Daniel Y.\} and Lee, \{Paul H.\} and Wei, \{Gao X.\} and Irwin, \{Michael R.\}", year = "2021", month = feb, day = "15", doi = "10.1001/jamanetworkopen.2020.37199", language = "English", volume = "4", pages = "e2037199", journal = "JAMA Network Open", publisher = "American Medical Association", number = "2", } . JAMA Network Open.

Face mask wearing behaviors, depressive symptoms, and health beliefs among older people during the COVID-19 pandemic @article{3548c71cf7af49458f5ee2b7e1fe1ccf, title = "Face mask wearing behaviors, depressive symptoms, and health beliefs among older people during the COVID-19 pandemic", abstract = "The COVID-19 pandemic has affected more than 100 countries. Despite the global shortage of face masks, the public has adopted universal mask wearing as a preventive measure in many Asian countries. The COVID-19 mortality rate is higher among older people, who may find that wearing a face mask protects their physical health but jeopardizes their mental health. This study aimed to explore the associations between depressive symptoms, health beliefs, and face mask wearing behaviors among older people. By means of an online survey conducted between March and April 2020, we assessed depressive symptoms, health beliefs regarding COVID-19, and face mask use and reuse among community-dwelling older people. General linear models were employed to explore the associations among these variables. Of the 355 valid participants, 25.6\% experienced depressive symptoms. Health beliefs regarding the perceived severity of disease (p = 0.001) and perceived efficacy of practicing preventive measures (p = 0.005) were positively associated with face mask use. Those who reused face masks (p = 0.008) had a stronger belief in disease severity (p < 0.001), had poorer cues to preventive measures (p = 0.002), and were more likely to experience depressive symptoms. Mask reuse was significantly associated with depression only among those who perceived the disease as serious (p = 0.025) and those who had poorer cues to preventive measures (p = 0.004). In conclusion, health beliefs regarding perceived severity and efficacy contributed to more frequent face mask use, which was unrelated to depressive symptoms. Older people who had a stronger belief in disease severity had less adequate cues to preventive measures and reused face masks experienced greater depressive symptoms. A moderation effect of health beliefs (i.e., disease severity and cues to preventive measures) on face mask reuse and depression was observed.", keywords = "COVID-19, older people, health beliefs, depressive symptoms, face mask wearing behaviors", author = "Kwan, \{Rick Yiu Cho\} and Lee, \{Paul Hong\} and Cheung, \{Daphne Sze Ki\} and Lam, \{Simon Ching\}", year = "2021", month = feb, day = "5", doi = "10.3389/fmed.2021.590936", language = "English", volume = "8", journal = "Frontiers in Medicine", issn = "2296-858X", publisher = "Frontiers Media SA", } . Frontiers in Medicine.

Validation of self-reported smartphone usage against objectively-measured smartphone usage in hong kong chinese adolescents and young adults @article{e9e5e5cf908144628c7651a52c4fd5fe, title = "Validation of self-reported smartphone usage against objectively-measured smartphone usage in hong kong chinese adolescents and young adults", abstract = "Objective This study evaluated the validity of self-reported smartphone usage data against objectively-measured smartphone usage data by directly tracking the activities in the participants{\textquoteright} smartphone among Chinese adolescents and young adults in Hong Kong. Methods: A total of 187 participants were recruited (mean age 19.4, 71.7\% female) between 2017 and 2018. A smartphone usage tracking app was installed on all participants{\textquoteright} smartphone for 7 consecutive days. After the 7-day monitoring period, they completed a self-administered questionnaire on smartphone usage habits. Results: Although the correlation between self-reported and objectively-measured total smartphone usage time was insignificant (ρ=-0.10, p=0.18), in three out of the four usage domains were positively and significantly correlated, namely social network (ρ=0.21, p=0.005), instant messaging (ρ=0.27, p<0.001), and games (ρ=0.64, p<0.001). Participants{\textquoteright} self-report of the total time spent on smart-phones exceeded the objective data by around 760 min per week (self-reported 1,930.3 min/wk vs. objectively-measured 1,170.7 min/ wk, p<0.001). Most of the over-reporting was contributed by the web browsing domain (self-reported 447.8 min/wk vs. objectively-mea-sured 33.3 min/wk, p<0.001). Conclusion: Our results showed large discrepancies between self-reported smartphone and objectively-measured smartphone usage except for self-reported usage on game apps.", keywords = "Chinese, Information technology, Mobile phone, Smartphone monitoring, Valid", author = "Lee, \{Paul H.\} and Tse, \{Andy C.Y.\} and Wu, \{Cynthia S.T.\} and Mak, \{Yim Wah\} and Uichin Lee", note = "Funding Information: This study was supported by the University Grants Committee of the Hong Kong Special Administrative Region, China, in the form of a grant from the General Research Fund Early Career Scheme (Ref: PolyU 251056/16M). The sponsor had no role in designing or conducting this re- Publisher Copyright: {\textcopyright} 2021 Korean Neuropsychiatric Association 95.", year = "2021", month = feb, day = "2", doi = "10.30773/pi.2020.0197", language = "English", volume = "18", pages = "95--100", journal = "Psychiatry Investigation", issn = "1738-3684", publisher = "Korean Neuropsychiatric Association", number = "2", } . Psychiatry Investigation.

Sleep pattern in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data @article{db8f89d794b44f96931ac5e6b3acaa65, title = "Sleep pattern in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data", abstract = "Background: To stop the spread of the new coronavirus disease in 2019 (COVID-19), many countries had completely locked down. This lockdown restricted the everyday life of the affected residents and changed their mobility pattern, but its effects on sleep pattern were largely unknown. Methods: Here, utilizing one of the largest crowdsourced database (Sleep as Android), we analyzed the sleep pattern of 25 217 users with 1 352 513 sleep records between 1 January and 29 April 2020 in the US and 16 European countries (Germany, UK, Spain, France, Italy, The Netherlands, Belgium, Hungary, Denmark, Finland, Norway, Czech, Sweden, Austria, Poland and Switzerland) with more than 100 records in all days of 2020. Results: During the COVID-19 pandemic, the sleeping pattern before and after the country-level lockdown largely differed. The subjects increased their sleep duration by an average of 11.3 to 18.6 min on weekday nights, except Denmark (4.9 min) and Finland (7.1 min). In addition, subjects form all 16 European countries delayed their sleep onset from 10.7 min (Sweden) to 29.6 min (Austria). CONCLUSION: During the COVID-19 pandemic, residents in the US and 16 European countries delayed their bedtime and slept longer than usual.", author = "Lee, \{Paul H.\} and Jan Marek and Petr N{\'a}levka", note = "Publisher Copyright: {\textcopyright} The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.", year = "2021", month = feb, day = "1", doi = "10.1093/eurpub/ckaa208", language = "English", volume = "31", pages = "23--30", journal = "European Journal of Public Health", issn = "1101-1262", publisher = "Oxford University Press", number = "1", } . European Journal of Public Health.

Paul H Lee, Jan Marek, Petr N&#225;levka(2021). Sleep pattern in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data . European Journal of Public Health. Oxford University Press ({OUP})

Global imperative of suicidal ideation in 10 countries amid the COVID-19 pandemic @article{bd3b150a81974f26802a297420e34e82, title = "Global imperative of suicidal ideation in 10 countries amid the COVID-19 pandemic", abstract = "Background: The novel coronavirus (COVID-19) has had a detrimental impact on individuals' psychological well-being; however, a multi-country comparison on the prevalence of suicidal ideation due to the virus is still lacking. Objectives: To examine the prevalence and correlates of suicidal ideation among the general population across 10 countries during the COVID-19 pandemic. Materials and methods: This was a cross-sectional study which used convenience sampling and collected data by conducting an online survey. Participants were sourced from 10 Eastern and Western countries. The Patient Health Questionnaire (PHQ-9) was used to measure the outcome variable of suicidal ideation. Ordinal regression analysis was used to identify significant predictors associated with suicidal ideation. Results: A total of 25,053 participants (22.7\% male) were recruited. Results from the analysis showed that the UK and Brazil had the lowest odds of suicidal ideation compared to Macau (p < 0.05). Furthermore, younger age, male, married, and differences in health beliefs were significantly associated with suicidal ideation (p < 0.05). Conclusions: The findings highlight the need for joint international collaboration to formulate effective suicide prevention strategies in a timely manner and the need to implement online mental health promotion platforms. In doing so, the potential global rising death rates by suicide during the pandemic can be reduced.", keywords = "COVID-19, mental health promotion, multi-country, PHQ-9 = Patient Health Questionnaire, suicidal ideation", author = "\{The International Research Collaboration on COVID-19\} and Teris Cheung and Lam, \{Simon Ching\} and Lee, \{Paul Hong\} and Xiang, \{Yu Tao\} and Yip, \{Paul Siu Fai\} and Suen, \{Lorna Kwai Ping\} and Ho, \{Hilda Sze Wing\} and Lam, \{Kin Bong Hubert\} and Huang, \{Emma Yun Zhi\} and Ying Xiao and Pereira-{\'a}vila, \{Fernanda Maria Vieira\} and Elucir Gir and Menevse Yildirim and Intepeler, \{Seyda Seren\} and Tella Lantta and Kyungmi Lee and Nayeon Shin and Parial, \{Laurence Lloyd\} and Rossing, \{Tor Michael\} and Hon, \{Ching Yuk\} and Merissa Tsang and \{Braz Poeys\}, \{Jessica P.\} and Fong, \{Tommy Kwan Hin\} and Shun Chan", note = "Funding Information: This project has been partially funded by the Brazilian National Council for Scientific and Technological Development (CNPq, Portuguese: Conselho Nacional de Desenvolvimento Cient{\'i}fico e Tecnol{\'o}gico) (ref: 401371/2020-4). Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2021 Cheung, Lam, Lee, Xiang, Yip and the International Research Collaboration on COVID-19.", year = "2021", month = jan, day = "13", doi = "10.3389/fpsyt.2020.588781", language = "English", volume = "11", journal = "Frontiers in Psychiatry", issn = "1664-0640", publisher = "Frontiers Media SA", } . Frontiers in Psychiatry.

Association between time spent on smart devices and change in refractive error @article{b8f1434e02ef4a76939ee5f312ef5036, title = "Association between time spent on smart devices and change in refractive error: a 1-year prospective observational study among Hong Kong children and adolescents", abstract = "This study examined the association between smart device usage and the 1-year change in refractive error among a representative sample of Hong Kong children and adolescents aged 8–14 years. A total of 1597 participants (49.9\% male, mean age 10.9, SD 2.0) who completed both baseline (2017–2018) and 1-year follow-up (2018–2019) eye examinations were included in the present study. The non-cycloplegic auto-refractive error was measured and the average spherical equivalent refraction (SER) was analyzed. The participants also self-reported their smart device usage at baseline. Multivariate regression adjusted for age, sex, baseline SER, parents{\textquoteright} short-sightedness, BMI, time spent on moderate-to-vigorous physical activity (MVPA), and caregiver-reported socio-economic status showed that, compared with the reference group (<2 h per day on both smartphone and tablet usages), those who spent ≥2 h per day using a smartphone and <2 h per day using a tablet had a significantly negative shift in refractive error (1-year change in SER −0.25 vs. −0.09 D, p = 0.01) for the right eye, while the level of significance was marginal (1-year change −0.28 vs. −0.15 D, p = 0.055) for the left eye. To conclude, our data suggested spending at most 2 h per day on both smartphones and tablets.", keywords = "Handheld device, Myopia, Prospective, Smartphone, Tablet, Teenage", author = "\{et al.\} and Do, \{Chi Wai\} and Chan, \{Lily Y.L.\} and Tse, \{Andy C.Y.\} and Teris Cheung and So, \{Billy C.L.\} and Tang, \{Wing Chun\} and Yu, \{W. Y.\} and Chu, \{Geoffrey C.H.\} and Szeto, \{Grace P.Y.\} and Lee, \{Regina L.T.\} and Lee, \{Paul H.\}", note = "Funding Information: Funding: The Food and Health Bureau of the Hong Kong Special Administrative Region, China, provided financial support in the form of a grant from the Health and Medical Research Fund (Ref 13144041). The equipment/resources were donated by a COVD Research Grant, Vision of Love Fund, and The Hong Kong Jockey Club Charities Trust Fund. The sponsors had no role in designing or conducting this research. Publisher Copyright: {\textcopyright} 2020 by the authors. Licensee MDPI, Basel, Switzerland.", year = "2020", month = dec, day = "1", doi = "10.3390/ijerph17238923", language = "English", volume = "17", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "23", } . International Journal of Environmental Research and Public Health.

Comparing sleep patterns between children with autism spectrum disorder and children with typical development @article{5a539db97f4f48939e0e0a75df24480d, title = "Comparing sleep patterns between children with autism spectrum disorder and children with typical development: a matched case–control study", abstract = "Children with autism spectrum disorder are often reported to have more sleep deficits and poorer sleep quality compared with children with typical development. However, most previous studies have serious methodological limitations, such as varying sample sizes in the comparison groups, wide age range of participants, and body mass index not matched between participants. This study investigated whether sleep patterns differed between children with autism spectrum disorder and those with typical development using a carefully matched case–control design and incorporating both actigraphy and sleep log assessments. A total of 78 children diagnosed with autism spectrum disorder were matched with 78 typical development controls in this study. The matched variables included age, gender, and body mass index. The results showed that children with autism spectrum disorder had shorter sleep duration, reduced sleep efficiency, longer sleep-onset latency, and longer wake after sleep onset than children with typical development (ps < 0.05). Further studies are needed to explore the mechanisms underlying these sleep deficits in children with autism spectrum disorder. Lay abstract: This study compared the sleep pattern between children with autism spectrum disorders and children with typical development using a matched case–control design (matched age, gender, and body mass index). Significant differences were found in night-time sleep duration (total amount of sleep at night), sleep efficiency (percentage of time spent asleep), sleep-onset latency (length of time that it takes to transit from awake to asleep), and wake after sleep onset (total amount of time spent awake after defined sleep onset). Findings showed that children with autism spectrum disorder had poorer sleep quality than children with typical development. Mechanisms underlying the differences should be further explored in order to develop an effective treatment intervention.", keywords = "autism spectrum disorder, children, sleep, typical development", author = "Tse, \{Andy C.Y.\} and Yu, \{C. C.W.\} and Lee, \{Paul H.\}", note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was financially supported by EdUHK departmental seed funding (Ref no.: R4002). Publisher Copyright: {\textcopyright} The Author(s) 2020.", year = "2020", month = nov, day = "1", doi = "10.1177/1362361320936827", language = "English", volume = "24", pages = "2298--2303", journal = "Autism", issn = "1362-3613", publisher = "SAGE Publications", number = "8", } . Autism.

Chi-wai Do, Lily Y. L. Chan, Andy C. Y. Tse, Teris Cheung, Billy C. L. So, Wing Chun Tang, W. Y. Yu, Geoffrey C. H. Chu, Grace P. Y. Szeto, Regina L. T. Lee, et al. (2020). Association between Time Spent on Smart Devices and Change in Refractive Error: A 1-Year Prospective Observational Study among Hong Kong Children and Adolescents . International Journal of Environmental Research and Public Health.

Andy CY Tse, CCW Yu, Paul H Lee (2020). Comparing sleep patterns between children with autism spectrum disorder and children with typical development: A matched case–control study . Autism.

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019 @article{929b348e799340b5948277bd1fd29126, title = "Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019", abstract = "Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill \& Melinda Gates Foundation.", author = "\{et al.\} and Cristiana Abbafati and Abbas, \{Kaja M.\} and Mohsen Abbasi-Kangevari and Foad Abd-Allah and Ahmed Abdelalim and Mohammad Abdollahi and Ibrahim Abdollahpour and Abegaz, \{Kedir Hussein\} and Hassan Abolhassani and Victor Aboyans and Abreu, \{Lucas Guimar{\~a}es\} and Abrigo, \{Michael R.M.\} and Ahmed Abualhasan and Abu-Raddad, \{Laith Jamal\} and Abushouk, \{Abdelrahman I.\} and Maryam Adabi and Victor Adekanmbi and Adeoye, \{Abiodun Moshood\} and Adetokunboh, \{Olatunji O.\} and Davoud Adham and Advani, \{Shailesh M.\} and Ashkan Afshin and Gina Agarwal and Aghamir, \{Seyed Mohammad Kazem\} and Anurag Agrawal and Tauseef Ahmad and Keivan Ahmadi and Mehdi Ahmadi and Hamid Ahmadieh and Ahmed, \{Muktar Beshir\} and Akalu, \{Temesgen Yihunie\} and Akinyemi, \{Rufus Olusola\} and Tomi Akinyemiju and Blessing Akombi and Akunna, \{Chisom Joyqueenet\} and Fares Alahdab and Ziyad Al-Aly and Khurshid Alam and Samiah Alam and Tahiya Alam and Alanezi, \{Fahad Mashhour\} and Alanzi, \{Turki M.\} and Alemu, \{Biresaw Wassihun\} and Gething, \{Peter W.\} and Hasan, \{Md Mehedi\} and Yang Liu and Roberts, \{Nicholas L.S.\} and Salomon, \{Joshua A.\} and Wang, \{Yuan Pang\} and Lim, \{Stephen S.\} and Paul Lee", note = "Funding Information: I N Ackerman reports grants from Victorian Government, outside of the submitted work. C A T Antonio reports personal fees from Johnson \& Johnson (Philippines), outside of the submitted work. E Beghi reports grants from Italian Ministry of Health and SOBI and personal fees from Arvelle Therapeutics, outside of the submitted work. Y B{\'e}jot reports personal fees from AstraZeneca, Bristol Myers Squibb, Pfizer, and Medtronic, Merck Sharpe \& Dohme, and Amgen; grants and personal fees from Boehringer-Ingelheim; personal fees and non-financial support from Servier; and non-financial support from Biogen, outside of the submitted work. P S Briant reports personal fees from WHO, outside of the submitted work. H Christensen reports personal fees from Bristol Myers Squibb, Bayer, and Boehringer Ingelheim, outside of the submitted work. L Degenhardt reports grants from Indivior and Seqirus, outside of the submitted work. S J Dunachie reports grants from the Fleming Fund at the UK Department of Health and Social Care, during the conduct of the study. L M Haile reports personal fees from WHO, outside of the submitted work. S M S Islam reports grants from National Heart Foundation of Australia and Deakin University, during the conduct of the study. S L James reports grants from Sanofi Pasteur and employment from Genentech, outside of the submitted work. P Jeemon reports and Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust—Department of Biotechnology, India Alliance (2015–2020). V Jha reports grants from Baxter Healthcare, GlaxoSmithKline, Zydus Cadilla, NephroPlus, and Biocon, outside of the submitted work. J J Jozwiak reports personal fees from Amgen, ALAB Laboratoria, Teva, Synexus, and Boehringer Ingelheim, outside of the submitted work. S V Katikireddi reports grants from NRS Senior Clinical Fellowship, Scottish Government Chief Scientist Office, and the UK Medical Research Council, during the conduct of the study. S Lewington reports grants from the UK Medical Research Council and the CDC Foundation (with support from Amgen), outside of the submitted work. K J Looker reports grants from WHO and GlaxoSmithKline, outside of the submitted work. S Lorkowski reports personal fees from Akcea Therapeutics, Amedes, Amgen, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo, Merck Sharp \& Dohme, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and Upfield and non-financial support from Preventicus, outside of the submitted work. R A Lyons reports grants from Health Data Research UK, outside of the submitted work. J Massano reports personal fees from Abbvie, Bial, Merck Sharp \& Dohme, and Zambon and other support from Boston Scientific, GE Healthcare, Medtronic, and Roche, outside of the submitted work. W Mendoza is a Program Analyst in Population and Development at the UN Population Fund Country Office in Peru, an institution that does not necessarily endorse this study. M Moradi-Lakeh reports personal fees from Novartis, outside of the submitted work. J F Mosser reports grants from the Bill \& Melinda Gates Foundation, during the conduct of the study. S Nomura reports grants from the Japanese Ministry of Education, Culture, Sports, Science, and Technology. S B Patten reports funding from the Cuthbertson \& Fischer Chair in Pediatric Mental Health, during the conduct of the study. T Pilgrim reports grants and personal fees from Biotronik and Boston Scientific, grants from Edwards Lifesciences, and personal fees from HighLife SAS for his work as a member of clinical event committee for a study sponsored by HighLife SAS, outside of the submitted work. M J Postma reports grants and personal fees from Merck Sharp \& Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Bristol Myers Squibb, AstraZeneca, Sanofi, IQVIA, and Seqirus; personal fees from Quintiles, Novartis, and Pharmerit; grants from Bayer, BioMerieux, WHO, EU, FIND, Antilope, DIKTI, LPDP, and Budi; and other support from Ingress Health, PAG, and Asc Academics, outside of the submitted work. E Pupillo reports grants from AIFA, outside of the submitted work. A E Schutte reports personal fees from Omron, Servier, Novartis, Takeda, and Abbott, outside of the submitted work. M G Shrime reports grants from Damon Runyon Cancer Research Foundation and Mercy Ships, outside of the submitted work. J A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM, Trio Health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Spherix, Practice Point Communications, National Institutes of Health, and the American College of Rheumatology; personal fees from Simply Speaking; other support from Amarin Pharmaceuticals and Viking Pharmaceuticals; and non-financial support from the steering committee of OMERACT (an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies), US Food and Drug Administration, Arthritis Advisory Committee, Veterans Affairs Rheumatology Field Advisory Committee, and the editor and director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside of the submitted work. S T S Skou reports personal fees from Journal of Orthopaedic \& Sports Physical Therapy and Munksgaard and grants from The Lundbeck Foundation, outside of the submitted work; and being co-founder of GLA:D. GLA:D is a non-profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. J D Stanaway reports grants from Bill \& Melinda Gates Foundation, during the conduct of the study. R Uddin reports travel and accommodation reimbursement from Deakin University Institute for Physical Activity and Nutrition, outside of the submitted work. All other authors declare no competing interests. Publisher Copyright: {\textcopyright} 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license", year = "2020", month = oct, day = "17", doi = "10.1016/S0140-6736(20)30925-9", language = "English", volume = "396", pages = "1204--1222", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10258", } . The Lancet.

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 @article{a22b4208cb874728a91ecbc1ef1448a7, title = "Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019", abstract = "Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95\% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6\% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach \$1398 pooled health spending per capita (US\$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding: Bill \& Melinda Gates Foundation.", author = "\{et al.\} and Rafael Lozano and Nancy Fullman and Mumford, \{John Everett\} and Megan Knight and Barthelemy, \{Celine M.\} and Cristiana Abbafati and Hedayat Abbastabar and Foad Abd-Allah and Mohammad Abdollahi and Aidin Abedi and Hassan Abolhassani and Abosetugn, \{Akine Eshete\} and Abreu, \{Lucas Guimar{\~a}es\} and Abrigo, \{Michael R.M.\} and \{Abu Haimed\}, \{Abdulaziz Khalid\} and Abushouk, \{Abdelrahman I.\} and Maryam Adabi and Adebayo, \{Oladimeji M.\} and Victor Adekanmbi and Jaimie Adelson and Adetokunboh, \{Olatunji O.\} and Davoud Adham and Advani, \{Shailesh M.\} and Ashkan Afshin and Gina Agarwal and Pradyumna Agasthi and Aghamir, \{Seyed Mohammad Kazem\} and Anurag Agrawal and Tauseef Ahmad and Akinyemi, \{Rufus Olusola\} and Fares Alahdab and Ziyad Al-Aly and Khurshid Alam and Albertson, \{Samuel B.\} and Alemu, \{Yihun Mulugeta\} and Alhassan, \{Robert Kaba\} and Muhammad Ali and Saqib Ali and Vahid Alipour and Aljunid, \{Syed Mohamed\} and Fran{\c c}ois Alla and Almadi, \{Majid Abdulrahman Hamad\} and Olatunde Aremu and Hasan, \{Md Mehedi\} and Lim, \{Stephen S.\} and Roberts, \{Nicholas L.S.\} and Joshua Salomon and Shaw, \{David H.\} and Irfan Ullah and Paul Lee", note = "Funding Information: Lucas Guimar{\~a}es Abreu acknowledges support from Coordena{\c c}{\~a}o de Aperfei{\c c}oamento de Pessoal de N{\'i}vel Superior - Brasil (Capes) - Finance Code 001, Conselho Nacional de Desenvolvimento Cient{\'i}fico e Tecnol{\'o}gico (CNPq) and Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science \& Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried B{\"a}rnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Funda{\c c}{\~a}o para a Ci{\^e}ncia e a Tecnologia (FCT), IP, under the Norma TransitĀ3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P\_40\_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC\_UU\_12017/13 \& MC\_UU\_12017/15), Scottish Government Chief Scientist Office (SPHSU13 \& SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Iv{\'a}n Landires is a member of the Sistema Nacional de InvestigaciĀ3n (SNI), which is supported by the Secretar{\'i}a Nacional de Ciencia Tecnolog{\'i}a e Innovaci{\'o}n (SENACYT), Panam{\'a}. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health \& Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 - Norma transitĀ3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 - Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship - Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Su{\'a}rez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria In{\^e}s Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigaci{\'o}n en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabar{\'e}s-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Funding Information: Ali Almasi reports a patent null pending. Robert Ancuceanu reports receiving consultancy and speakers' fees from various pharmaceutical companies. Ettore Beghi reports grants from the Italian Ministry of Health, grants from SOBI, and personal fees from Arvelle Therapeutics, outside the submitted work. Hanne Christensen reports personal fees from Bristol-Myers Squibb, Bayer, Boehringer-Ingelheim, outside the submitted work. Vivekanand Jha reports grants from GlaxoSmithKline, grants from Baxter Healthcare, personal fees from NephroPlus, grants from Biocon, grants from Zydus Cadilla, outside the submitted work. Jacek Jerzy Jozwiak reports personal fees from Amgen, Alab, Teva, Synexus, and Boehringer Ingelheim, outside the submitted work. Srinivasa Vittal Katikireddi reports support from the Medical Research Council and from the Scottish Government Chief Scientist Office, during the conduct of the study. Walter Mendoza is Program Analyst in Population and Development at the United Nations Population Fund-UNFPA Country Office in Peru, an institution which does not necessarily endorse this study. Jonathan F Mosser reports grants from the Bill and Melinda Gates Foundation, during the conduct of the study. Shuhei Nomura reports grants from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. Thomas Pilgrim reports grants and personal fees from Biotronik and Boston Scientific, grants from Edwards Lifesciences, and personal fees from HighLife SAS for his work as a member of clinical event committee for a study sponsored by HighLife Sas, outside the submitted work. Maarten J Postma reports grants and personal fees from MSD, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Bristol-Myers Squibb, AstraZeneca, Sanofi, IQVIA, and Seqirus; personal fees from Quintiles, Novartis, and Pharmerit; 2\% of stocks from Ingress Health, 100\% of stocks from PAG, being an advisor to Asc Academics; and grants from Bayer, BioMerieux, WHO, the EU, FIND, Antilope, DIKTI, LPDP, and Budi, outside the submitted work. Elisabetta Pupillo reports grants from AIFA, outside the submitted work. Miloje Savic is an employee of GlaxoSmithKline Biologicals, Wavre, Belgium, and holds GlaxoSmithKline restricted shares. Aletta Elisabeth Schutte reports personal fees from Omron Healthcare, Servier, Novartis, Takeda, and Abbott, outside the submitted work. Mark G Shrime reports grants from Mercy Ships and Damon Runyon Cancer Research Foundation, outside the submitted work. Jasvinder A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Spherix, Practice Point communications, the National Institutes of Health and the American College of Rheumatology; personal fees from Simply Speaking, holding stock in Amarin pharmaceuticals and Viking pharmaceuticals, non-financial support from the FDA Arthritis Advisory Committee, non-financial support from Steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, non-financial support from the Veterans Affairs Rheumatology Field Advisory Committee, and non-financial support from the Editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside the submitted work. Jeffrey D Stanaway reports grants from the Bill and Melinda Gates Foundation, during the conduct of the study. Fotis Topouzis reports grants from Pfizer, Thea, Rheon, Pharmaten, Bayer, and Bausch \& Lomb; and grants and personal fees from Novartis and Omikron, outside the submitted work. Riaz Uddin worked as a visiting fellow at Deakin University Institute for Physical Activity and Nutrition (IPAN), which paid for his travel (including flights and transport), accommodation, and meals from Deakin University, outside the submitted work. Funding Information: Lucas Guimar{\~a}es Abreu acknowledges support from Coordena{\c c}{\~a}o de Aperfei{\c c}oamento de Pessoal de N{\'i}vel Superior - Brasil (Capes) - Finance Code 001, Conselho Nacional de Desenvolvimento Cient{\'i}fico e Tecnol{\'o}gico (CNPq) and Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science \& Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried B{\"a}rnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Funda{\c c}{\~a}o para a Ci{\^e}ncia e a Tecnologia (FCT), IP, under the Norma TransitĀ 3 ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P\_40\_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC\_UU\_12017/13 \& MC\_UU\_12017/15), Scottish Government Chief Scientist Office (SPHSU13 \& SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Iv{\'a}n Landires is a member of the Sistema Nacional de InvestigaciĀ 3 n (SNI), which is supported by the Secretar{\'i}a Nacional de Ciencia Tecnolog{\'i}a e Innovaci{\'o}n (SENACYT), Panam{\'a}. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health \& Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 - Norma transitĀ 3 ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 - Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship - Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Su{\'a}rez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria In{\^e}s Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigaci{\'o}n en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabar{\'e}s-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada. Publisher Copyright: {\textcopyright} 2020 Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license", year = "2020", month = oct, day = "17", doi = "10.1016/S0140-6736(20)30750-9", language = "English", volume = "396", pages = "1250--1284", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10258", } . The Lancet.

Global burden of 87 risk factors in 204 countries and territories, 1990–2019 @article{fd2c5b4d95bc4ddc8b1f3357b205d728, title = "Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019", abstract = "Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95\% uncertainty interval [UI] 9·51–12·1) deaths (19·2\% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4\% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6\% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill \& Melinda Gates Foundation.", author = "\{et al.\} and Cristiana Abbafati and Abbas, \{Kaja M.\} and Mohsen Abbasi-Kangevari and Foad Abd-Allah and Ahmed Abdelalim and Mohammad Abdollahi and Ibrahim Abdollahpour and Abegaz, \{Kedir Hussein\} and Hassan Abolhassani and Victor Aboyans and Abreu, \{Lucas Guimar{\~a}es\} and Abrigo, \{Michael R.M.\} and Ahmed Abualhasan and Abu-Raddad, \{Laith Jamal\} and Abushouk, \{Abdelrahman I.\} and Maryam Adabi and Victor Adekanmbi and Adeoye, \{Abiodun Moshood\} and Adetokunboh, \{Olatunji O.\} and Davoud Adham and Advani, \{Shailesh M.\} and Ashkan Afshin and Gina Agarwal and Aghamir, \{Seyed Mohammad Kazem\} and Anurag Agrawal and Tauseef Ahmad and Keivan Ahmadi and Mehdi Ahmadi and Hamid Ahmadieh and Ahmed, \{Muktar Beshir\} and Akalu, \{Temesgen Yihunie\} and Akinyemi, \{Rufus Olusola\} and Tomi Akinyemiju and Blessing Akombi and Akunna, \{Chisom Joyqueenet\} and Fares Alahdab and Ziyad Al-Aly and Khurshid Alam and Samiah Alam and Tahiya Alam and Alanezi, \{Fahad Mashhour\} and Alanzi, \{Turki M.\} and Alemu, \{Biresaw Wassihun\} and Gething, \{Peter W.\} and Hasan, \{Md Mehedi\} and Yang Liu and Roberts, \{Nicholas L.S.\} and Salomon, \{Joshua A.\} and Wang, \{Yuan Pang\} and Lim, \{Stephen S.\} and Paul Lee", note = "Funding Information: C A T Antonio reports personal fees from Johnson \& Johnson (Philippines), outside of the submitted work. E Beghi reports grants from Italian Ministry of Health and SOBI, and personal fees from Arvelle Therapeutics, outside of the submitted work. Y B{\'e}jot reports personal fees from AstraZeneca, Bristol-Myers Squibb, Pfizer, Medtronic, Merck Sharpe \& Dohme, and Amgen; grants and personal fees from Boehringer Ingelheim; personal fees and non-financial support from Servier; and non-financial support from Biogen, outside of the submitted work. M L Bell reports grants from US Environmental Protection Agency, National Institutes of Health (NIH), and from Wellcome Trust Foundation, during the conduct of the study; and Honorarium or travel reimbursement from the NIH (for review of grant proposals), American Journal of Public Health (participation as editor), Global Research Laboratory and Seoul National University, Royal Society, Ohio University, Atmospheric Chemistry Gordon Research Conference, Johns Hopkins Bloomberg School of Public Health, Arizona State University, Ministry of the Environment Japan, Hong Kong Polytechnic University, University of Illinois–Champaign, and the University of Tennessee–Knoxville, outside of the submitted work. H Christensen reports personal fees from Bristol Myers Squibb, Bayer, and Boehringer Ingelheim, outside of the submitted work. S-C Chung reports grants from GlaxoSmithKline, outside of the submitted work. L Degenhardt reports grants from Indivior and Seqirus, outside of the submitted work. S M S Islam reports grants from National Heart Foundation of Australia and Deakin University, during the conduct of the study. S L James reports grants from Sanofi Pasteur and employment from Genentech, outside of the submitted work. V Jha reports grants from Baxter Healthcare, GlaxoSmithKline, Zydus Cadilla, and Biocon and personal fees from NephroPlus, outside of the submitted work. J J Jozwiak reports personal fees from Amgen, ALAB Laboratoria, Teva, Synexus, and Boehringer Ingelheim, outside of the submitted work. S V Katikireddi reports grants from NRS Senior Clinical Fellowship, UK Medical Research Council, and the Scottish Government Chief Scientist Office, during the conduct of the study. M Kivim{\"a}ki reports grants from the Medical Research Council, UK (MR/R024227/1), during the conduct of the study. S Lorkowski reports personal fees from Akcea Therapeutics, Amedes, Amgen, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo, Merck Sharp \& Dohme, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and Upfield, and non-financial support from Preventicus, outside of the submitted work. R V Martin reports grants from the Natural Science and Engineering Research Council of Canada, during the conduct of the study. T R Miller reports having a contract from the AB InBev Foundation, outside of the submitted work. J F Mosser reports grants from the Bill \& Melinda Gates Foundation, during the conduct of the study. S Nomura reports grants from the Ministry of Education, Culture, Sports, Science, and Technology. S B Patten reports funding from the Cuthbertson \& Fischer Chair in Pediatric Mental Health at the University of Calgary, during the conduct of the study. C D Pond reports personal fees from Nutricia, outside of the submitted work; and grants from the National Medical Research council in relation to dementia, and travel grants and remuneration related to education of primary care professionals in relation to dementia. M J Postma reports grants from BioMerieux, WHO, European Union, FIND, Antilope, DIKTI, LPDP, Bayer, and Budi; personal fees from Quintiles, Novartis, and Pharmerit; grants and personal fees from IQVIA, Bristol-Myers Squibb, Astra Zeneca, Seqirus, Sanofi, Merck Sharpe \& Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, and Novavax; stocks from Ingress Health, and PAG; and is acting as adviser to Asc Academics, all outside of the submitted work. I Rakovac reports grants from WHO, during the conduct of the study. A E Schutte reports personal fees from Omron, Servier, Takeda, Novartis, and Abbott, outside of the submitted work. J A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio Health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Spherix, Practice Point Communications, the NIH, and the American College of Rheumatology; personal fees from Simply Speaking; stock options in Amarin Pharmaceuticals and Viking Pharmaceuticals; membership in the steering committee of OMERACT (an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies), the FDA Arthritis Advisory Committee, and the Veterans Affairs Rheumatology Field Advisory Committee; and non-financial support from UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside of the submitted work. S T S Skou reports personal fees from Journal of Orthopaedic \& Sports Physical Therapy and Munksgaard and grants from The Lundbeck Foundation, outside of the submitted work; and being co-founder of GLA:D. GLA:D is a non-profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. J D Stanaway reports grants from the Bill \& Melinda Gates Foundation, during the conduct of the study. D J Stein reports personal fees from Lundbeck, and Sun, outside of the submitted work. F Topouzis reports grants from Pfizer, Thea, Novartis, Rheon, Omikron, Pharmaten, Bayer, and Bausch \& Lomb; and personal fees from Novartis, and Omikron, outside of the submitted work. R Uddin reports travel and accommodation reimbursement from Deakin University Institute for Physical Activity and Nutrition, outside of the submitted work. All other authors declare no competing interests. Publisher Copyright: {\textcopyright} 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license", year = "2020", month = oct, day = "17", doi = "10.1016/S0140-6736(20)30752-2", language = "English", volume = "396", pages = "1223--1249", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10258", } . The Lancet.

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019 @article{d33ea372a90d48eb801da07820e9b527, title = "Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019", abstract = "Background: accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019.Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric.Findings: the global TFR decreased from 2·72 (95\% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1\% (95\% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95\% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7\%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019.Interpretation: over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring.Funding: Bill \& Melinda Gates Foundation.", author = "\{GBD 2019 Demographics Collaborators\} and S. Sabour and M. Abdollahi and A. Hassan and M. Sadeghi and S. Basu and J. Park and J.L. Stubbs and A.M. Almulhim and S.I. Hay and A.D. Lopez and H. Wang and S.S. Lim and C.J.L. Murray and C.S. Crowe and J.A. Anderson and J. Cao and J.T. Fox and T.D. Frank and J.E. Fuller and C. Han and J.D. Harvey and N.J. Henry and S.L. James and C.O. Johnson and S.C. Johnson and M. Knight and K.M. Lau and H. Liu and Z. Liu and J. Ma and A. Marks and E.A. May and M. Nguyen and E. Nichols and M.R. Nixon and S.A. Pease and S. Roberts and N.L.S. Roberts and D.H. Shaw and K.E. Simpson and A. Smith and C.N. Spencer and H.J. Taylor and J. Wang and A. Watson and S. Watson and S. Wilson and J. Wu and R. Xu and H.W. York and J.T. Zhao and P. Zheng and Y. Guo and S. Li and J. Zhang and A. Ahmadi and Mills, \{E. J.\} and A.T. Olagunju and T. Ahmad and S. Maleki and M.B. Ahmed and C. Wu and J.S. Ji and P.B. Mitchell and S. Alam and R.V. Martin and M. Ali and S. Ali and M. Khan and M. Hasan and J.J. McGrath and H.E. Erskine and C. Angus and P.H. Lee and O. Aremu and M. Islam and M. Rahman and P.W. Gething and A.M. Briggs and Miller, \{T. R.\} and R.S. Shetty and A. Joshi and S. Balakrishnan and A.S. Mohammed and S. Roberts and M.A. Stokes and K. Ball and S. Islam and Davis, \{A. C.\} and J. West and M.L. Bell and E.L. Collins and Y. Zhao and D.A. Bennett and Y. Wang and Y. Liu and G. Khan and J.K. Das and S. Hassan and J.L. Fisher and F. Castro and T. Cai and B.J. Hall and J.V. Santos and J. Chang and K. Chang and M. Kumar and J.L. Ward and M.T. Chung and M.I. Schmidt and J. Leigh and M. Cross and M.L. Ferreira and E.U.R. Smith and Cross, \{D. H.\} and H. Dai and A. Pandey and G. Davey and T.H. Nguyen and H.T. Do and S.R. Robinson and X. Liu and R.C. Franklin and S. Hameed and G.J. Milne and S.S. Gupta and M.R. Phillips and C.T. Nguyen and H.L.T. Nguyen and R. Hussain and T. Yamada and M. Kumar and E.A. Khan and Y. Kim and S. Yoon and M. Shin and C. Kim and Y. Kim and D. Kim and P. Kumar and P. Singh and B. Li and L. Lim and S. Liu and M. Mahmoudi and C. Mapoma and S. Mukhopadhyay and G. Nagel and J.A. Singh and S. Nair and S. Ong and S.K. Patel and M. Pathak and S. Paudel and S. Rao and S. Ullah and J.A. Salomon and R. Sharma and J. Shin and D.A.S. Silva and A. Singh and N. Thomas and I. Ullah and F. Wang and X.G. Zhao and Y. Wang and C. Yu and Z. Zhang and H. Wang and A. Wu and Y. Xie and Y. Yu and S. Zaidi and J. Zhang and Y. Zhang and C. Zhu", year = "2020", month = oct, day = "15", doi = "10.1016/S0140-6736(20)30977-6", language = "English", volume = "396", pages = "1160--1203", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10258", } . The Lancet.

Five insights from the Global Burden of Disease Study 2019 @article{3f15fb069c9b450b8cfaa5120e263382, title = "Five insights from the Global Burden of Disease Study 2019", abstract = "The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.", author = "\{GBD 2019 Viewpoint Collaborators\} and S. Sabour and M. Abdollahi and A. Hassan and M. Sadeghi and S. Basu and J. Park and J.L. Stubbs and A.M. Almulhim and S.I. Hay and A.D. Lopez and H. Wang and S.S. Lim and C.J.L. Murray and C.S. Crowe and J. Cao and J.T. Fox and T.D. Frank and J.E. Fuller and C. Han and J.D. Harvey and N.J. Henry and S.L. James and C.O. Johnson and S.C. Johnson and M. Knight and K.M. Lau and H. Liu and Z. Liu and J. Ma and A. Marks and E.A. May and M. Nguyen and E. Nichols and M.R. Nixon and S.A. Pease and S. Roberts and N.L.S. Roberts and D.H. Shaw and K.E. Simpson and A. Smith and C.N. Spencer and H.J. Taylor and J. Wang and A. Watson and S. Watson and S. Wilson and J. Wu and R. Xu and H.W. York and J.T. Zhao and P. Zheng and Y. Guo and S.W.H. Lee and S. Li and J. Zhang and A. Ahmadi and E.J. Mills and A.T. Olagunju and T. Ahmad and S. Maleki and M.B. Ahmed and C. Wu and J.S. Ji and P.B. Mitchell and S. Alam and R.V. Martin and M. Ali and S. Ali and M. Khan and M. Hasan and J.J. McGrath and H.E. Erskine and C. Angus and P.H. Lee and O. Aremu and M. Islam and M. Rahman and P.W. Gething and A.M. Briggs and T.R. Miller and R.S. Shetty and A. Joshi and S. Balakrishnan and A.S. Mohammed and S. Roberts and M.A. Stokes and K. Ball and S. Islam and A.C. Davis and J. West and M.L. Bell and E.L. Collins and Y. Zhao and D.A. Bennett and Y. Wang and Y. Liu and G. Khan and J.K. Das and S. Hassan and J.L. Fisher and F. Castro and T. Cai and B.J. Hall and J.V. Santos and J. Chang and K. Chang and M. Kumar and J.L. Ward and M.T. Chung and M.I. Schmidt and J. Leigh and M. Cross and M.L. Ferreira and E.U.R. Smith and D.H. Cross and H. Dai and A. Pandey and G. Davey and T.H. Nguyen and H.T. Do and S.R. Robinson and X. Liu and R.C. Franklin and S. Hameed and G.J. Milne and S.S. Gupta and M.R. Phillips and C.T. Nguyen and H.L.T. Nguyen and R. Hussain and T. Yamada and M. Kumar and E.A. Khan and Y. Kim and S. Yoon and M. Shin and C. Kim and Y. Kim and D. Kim and P. Kumar and P. Singh and B. Li and L. Lim and S. Liu and M. Mahmoudi and C. Mapoma and S. Mukhopadhyay and G. Nagel and J.A. Singh and S. Nair and S. Ong and S.K. Patel and M. Pathak and S. Paudel and S. Rao and S. Ullah and J.A. Salomon and R. Sharma and J. Shin and D.A.S. Silva and A. Singh and N. Thomas and I. Ullah and F. Wang and X.G. Zhao and Y. Wang and C. Yu and Z. Zhang and H. Wang and A. Wu and Y. Xie and Y. Yu and S. Zaidi and J. Zhang and Y. Zhang and C. Zhu and Jason Anderson", year = "2020", month = oct, day = "15", doi = "10.1016/S0140-6736(20)31404-5", language = "English", volume = "396", pages = "1135--1159", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10258", } . The Lancet.

An exploration of the use of visually appealing contexts in a pain management program @article{26962b5685834bb994c7f2ab3f8ede72, title = "An exploration of the use of visually appealing contexts in a pain management program", abstract = "Purpose: Pleasant pictures can help to reduce stress, promote positive feelings, and even facilitate recovery from diseases. Visual stimulation is an approach of distraction that can effectively reduce pain thresholds and increase pain tolerances. The number of older adults who suffer from pain has increased due to age-related diseases. Technology is increasingly being applied to the management of acute pain. The pain situation among older people was explored in this study, and a visually appealing pain management program was designed with the participants{\textquoteright} experiences in mind. Methods: This was a descriptive observational study. Participants were recruited from local nursing homes. Results: A total of 165 older adults joined the study. The mean age of the participants was 85.6. More female than male participants experienced pain and the intensity of their pain was significantly greater. The results showed no significant differences in pain interferences between males and females. The participants stated that photographs of family members, homes, and natural scenery made them feel relaxed and happy, and reminded them of past happy times. They preferred to view those visually appealing pictures using digital devices (iPad/iPhone) to seeing hard copy versions. Conclusion: A digital-based pain management program using visually appealing contexts for older adults can be implemented. The patients{\textquoteright} experiences were collected and will be considered when developing a future program.", keywords = "Chronic pain, Digital-based, Distraction, Older adults, Visual", author = "Tse, \{Mimi Mun Yee\} and Ng, \{Shamay S.M.\} and Xue Bai and Lee, \{Paul Hong\} and Raymond Lo and Yeung, \{Suey Shuk Yu\} and Yajie Li and Tang, \{Shuk Kwan\}", note = "Funding Information: This research was funded by the Health and Medical Research Fund of the Food and Health Bureau, Hong Kong SAR Government (Ref. 15161051). Publisher Copyright: {\textcopyright} 2020, European Geriatric Medicine Society.", year = "2020", month = oct, day = "1", doi = "10.1007/s41999-020-00339-6", language = "English", volume = "11", pages = "821--827", journal = "European Geriatric Medicine", issn = "1878-7649", publisher = "Springer Science and Business Media B.V.", number = "5", } . European Geriatric Medicine.

Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population @article{936ba36a19d84478a52293b78d63728a, title = "Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study", abstract = "Objective: The COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep disturbances during the early phase of COVID-19 pandemic. Methods: This web-based cross-sectional study recruited 1138 Hong Kong adults using convenience sampling over a two-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. The Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census. Results: The weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3\%, 29.8\%, and 29.1\%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9\%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR = 1.57, 1.72, 1.99, and 1.96 respectively, all p < 0.05). Conclusion: A high proportion of people in Hong Kong felt that their sleep had worsened since the COVID-19 outbreak. Insufficient stock of masks was one of the risk factors that were associated with sleep disturbances. Adequate and stable supply of masks may play an important role to maintain the sleep health in the Hong Kong general population during a pandemic outbreak.", keywords = "Coronavirus, Epidemic, Insomnia, Masks, Pandemic, Web-based", author = "\{et al.\} and Yu, \{Branda Yee Man\} and Yeung, \{Wing Fai\} and Lam, \{Jason Chun Sing\} and Yuen, \{Sam Chun Sum\} and Lam, \{Simon Ching\} and Chung, \{Vincent Chi Ho\} and Chung, \{Ka Fai\} and Lee, \{Paul Hong\} and Ho, \{Fiona Yan Yee\} and Ho, \{Janice Yuen Shan\}", note = "Publisher Copyright: {\textcopyright} 2020 Elsevier B.V.", year = "2020", month = oct, doi = "10.1016/j.sleep.2020.07.009", language = "English", volume = "74", pages = "18--24", journal = "Sleep Medicine", issn = "1389-9457", publisher = "Elsevier BV", number = "10", } . Sleep Medicine.

A validation study of the use of smartphones and wrist-worn ActiGraphs to measure physical activity at different levels of intensity and step rates in older people @article{6fce41f1b9494a1a9905f3cb0739882d, title = "A validation study of the use of smartphones and wrist-worn ActiGraphs to measure physical activity at different levels of intensity and step rates in older people", abstract = "Background: Physical activity promotes healthy ageing in older people. Accurate measurement of physical activity in free-living environment is important in evaluating physical activity interventions. Research question:What is the criterion validity of 1)an ActiGraph to identify physical activity at different intensity levels and 2)an ActiGraph and a smartphone to measure step rate? Methods: Community-dwelling older people aged≥60 were recruited. The index tests were using ActiGraph worn in different positions (i.e.,both wrists and hip) to measure physical activity intensity and step rate and using smartphone (i.e., Samsung J2 pro and Google Fit) worn in different positions (i.e.,trousers pocket and waist pouch) to measure the step rate. The reference standards were using indirect calorimetry (i.e.,CosMedK4b 2) to measure physical activity intensity and using direct observation for step rate. Subjects were exposed in different physical activity intensity levels (i.e.,sedentary:MET < 1.5,light: MET = 1.5–2.99, moderate:MET = 3.0–6.0, vigorous:MET>6) and step rates through walking on a treadmill at different speeds (i.e.,2−8 km) for approximately 30 min. Spearman's rho, ROC analysis, and percentage error were employed to report the criterion validity. Results:31 participants completed the tests. ActiGraphs worn in different body positions could significantly differentiate physical activity intensity at the levels of “light- or-above” (VM cut-off = 279.5–1959.1,AUC = 0.932−0.954), “moderate-or-above” (VM cut- off = 1051.0–4212.9,AUC = 0.918−0.932), and “vigorous” (VM cut-off = 3335.4–5093.0, AUC = 0.890−0.907) well with different cut-off points identified. The step rate measured by direct observation correlated significantly with ActiGraph and smartphone (rho = 0.415−0.791). Both ActiGraph and smartphone at different positions generally underestimated the step rate (\%error= -20.5,-30.3). Significance: A wrist-worn ActiGraph can accurately identify different physical activity intensity levels in older people, but lower cut-off points in older people should be adopted. To measure step rate, a hip-mounted ActiGraph is preferable than a wrist- worn one. A smartphone employing Google Fit generally underestimates step rate but it gives a relatively more accurate estimation of step rate when the older people walk at a speed of 4−8 km/h.", keywords = "ActiGraph, Older people, Physical activity, Smartphones, Step rate", author = "Kwan, \{Rick Yiu Cho\} and Liu, \{Justina Yat Wa\} and Deborah Lee and Tse, \{Choi Yeung Andy\} and Lee, \{Paul Hong\}", note = "Funding Information: This work was supported by School of Nursing, The Hong Kong Polytechnic University [grant numbers: BE08]This project was partially funded by the School of Nursing, The Hong Kong Polytechnic University (Grant Number: BE08). We are also thankful for Ms Ruby Chen from the Department of Health and Physical Education, The Education University of Hong Kong, for providing tremendous technical support of the Human Performance Laboratory setups. Funding Information: This project was partially funded by the School of Nursing, The Hong Kong Polytechnic University (Grant Number: BE08). We are also thankful for Ms Ruby Chen from the Department of Health and Physical Education , The Education University of Hong Kong , for providing tremendous technical support of the Human Performance Laboratory setups. Funding Information: This work was supported by School of Nursing , The Hong Kong Polytechnic University [grant numbers: BE08 ] Publisher Copyright: {\textcopyright} 2020 Elsevier B.V.", year = "2020", month = oct, doi = "10.1016/j.gaitpost.2020.09.022", language = "English", volume = "82", pages = "306--312", journal = "Gait and Posture", issn = "0966-6362", publisher = "Elsevier BV", number = "10", } . Gait and Posture.

Branda Yee-Man Yu, Wing-Fai Yeung, Jason Chun-Sing Lam, Sam Chun-Sum Yuen, Simon Ching Lam, Vincent Chi-Ho Chung, Ka-Fai Chung, Paul Hong Lee, Fiona Yan-Yee Ho, Janice Yuen-Shan Ho (2020). Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study . Sleep Medicine.

The global distribution of lymphatic filariasis, 2000–18 @article{b09467b754944e3e99c4539e5a8b71b7, title = "The global distribution of lymphatic filariasis, 2000–18: a geospatial analysis", abstract = "Background: Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. Methods: A global dataset of georeferenced surveyed locations was used to model annual 2000–18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000–18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected. Findings: We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95\% uncertainty interval 174–234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6–5·7 million) in the region of the Americas to 107 million (91–134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43–63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. Interpretation: Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease. Funding: Bill \& Melinda Gates Foundation.", author = "\{Local Burden of Disease 2019 Neglected Tropical Diseases Collaborators\} and Aniruddha Deshpande and Miller-Petrie, \{Molly K.\} and Johnson, \{Kimberly B.\} and A. Abdoli and Abrigo, \{Michael R.M.\} and Victor Adekanmbi and Adetokunboh, \{Olatunji O.\} and S. Adinarayanan and E. Ahmadpour and Ahmed, \{Muktar Beshir\} and Akalu, \{Temesgen Yihunie\} and Alanzi, \{T. M.\} and C. Alinia and Vahid Alipour and Amit, \{Arianna Maever L.\} and Anber, \{N. H.\} and R. Ancuceanu and Z. Andualem and F. Ansari and Antonio, \{Carl Abelardo T.\} and D. Anvari and S. Appiah and Jalal Arabloo and Arnold, \{B. F.\} and Marcel Ausloos and Ayanore, \{Martin Amogre\} and A. Badirzadeh and Baig, \{A. A.\} and Maciej Banach and Baraki, \{A. G.\} and B{\"a}rnighausen, \{Till Winfried\} and Mohsen Bayati and Krittika Bhattacharyya and Bhutta, \{Zulfiqar A.\} and Ali Bijani and Bockarie, \{M. J.\} and D. Bisanzio and Biswas, \{Raaj Kishore\} and Somayeh Bohlouli and Jorge Cano and Felix Carvalho and Chattu, \{Vijay Kumar\} and C. Chavshin and Cormier, \{Natalie Maria\} and King, \{J. D.\} and S. Maleki and Nguyen, \{T. H.\} and E. Hill and Irfan Ullah and Z. Zhang and Paul Lee", note = "Funding Information: This research was supported by the Bill \& Melinda Gates Foundation (grant OPP1132415). We acknowledge WHO collaboration and leadership in this analysis. We also acknowledge the individuals and programmes who routinely collect and report this data to WHO. Individual acknowledgments are provided in appendix 1 (p 12). Funding Information: This research was supported by the Bill \& Melinda Gates Foundation (grant OPP1132415). We acknowledge WHO collaboration and leadership in this analysis. We also acknowledge the individuals and programmes who routinely collect and report this data to WHO. Individual acknowledgments are provided in appendix 1 (p 12) . Publisher Copyright: {\textcopyright} 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY 4.0 license.", year = "2020", month = sep, day = "1", doi = "10.1016/S2214-109X(20)30286-2", language = "English", volume = "8", pages = "e1186--e1194", journal = "The Lancet Global Health", issn = "2214-109X", publisher = "Elsevier BV", number = "9", } . The Lancet Global Health.

A cluster randomized controlled trial of a simplified 5-step handwashing technique versus a conventional 7-step handwashing technique among Chinese students with intellectual disabilities @article{85edfa16e12048b98610c7253259ef18, title = "A cluster randomized controlled trial of a simplified 5-step handwashing technique versus a conventional 7-step handwashing technique among Chinese students with intellectual disabilities", abstract = "Objective: To compare the effects of the simplified 5-step and the conventional 7-Step hand hygiene programme in a cluster randomized controlled trial among students with intellectual disabilities. Method: A total of 472 Chinese students with intellectual disabilities were randomized to either simplified 5-step or conventional 7-step hand hygiene programme. Assessments included handwashing technique, cleanliness and sick leave days. Results: Handwashing technique scores (g = 0.25, 95\% CI [0.18, 0.32]) and hand cleanliness scores (g = 0.33, 95\% CI [0.26, 0.4]) in intervention group were significantly higher than those scores in control group at 6th month post-intervention although there were significant increases in the scores within both groups. The mean number of sick leave days decreased between baseline and 10 month in both groups according to descriptive statistics. Conclusions: It is feasible and effective to adopt the simplified 5-step intervention as a standardized handwashing technique for the population group with intellectual disabilities.", keywords = "A cluster randomized controlled trial, children with intellectual disabilities, hand hygiene intervention, simplified 5-step handwashing technique", author = "Lee, \{Regina L.T.\} and Cynthia Leung and Hong Chen and Lee, \{Paul H.\} and Kwok, \{Stephen W.H.\}", note = "Publisher Copyright: {\textcopyright} 2020 John Wiley \& Sons Ltd", year = "2020", month = sep, day = "1", doi = "10.1111/jar.12731", language = "English", volume = "33", pages = "1090--1099", journal = "Journal of Applied Research in Intellectual Disabilities", issn = "1360-2322", publisher = "Fafo", number = "5", } . Journal of Applied Research in Intellectual Disabilities.

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17 @article{1fdf592203b8430facbde99fc9acc972, title = "Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17", abstract = "Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0\% (95\% uncertainty interval [UI] 39·4–40·7) to 50·3\% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3\% (95\% UI 46·1–46·5) in 2017, compared with 28·7\% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80\%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6\% (95\% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95\% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1\% (95\% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9\% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Funding: Bill \& Melinda Gates Foundation.", author = "\{Local Burden of Disease WaSH Collaborators\} and Aniruddha Deshpande and Miller-Petrie, \{Molly K.\} and Lindstedt, \{Paulina A.\} and Baumann, \{Mathew M.\} and Johnson, \{Kimberly B.\} and Blacker, \{Brigette F.\} and Hedayat Abbastabar and Foad Abd-Allah and Ahmed Abdelalim and Ibrahim Abdollahpour and Abegaz, \{Kedir Hussein\} and Abejie, \{Ayenew Negesse\} and Abreu, \{Lucas Guimar{\~a}es\} and Abrigo, \{Michael R.M.\} and Ahmed Abualhasan and Accrombessi, \{Manfred Mario Kokou\} and Adamu, \{Abdu A.\} and Adebayo, \{Oladimeji M.\} and Adedeji, \{Isaac Akinkunmi\} and Adedoyin, \{Rufus Adesoji\} and Victor Adekanmbi and Adetokunboh, \{Olatunji O.\} and Adhikari, \{Tara Ballav\} and Mohsen Afarideh and Marcela Agudelo-Botero and Mehdi Ahmadi and Keivan Ahmadi and Ahmed, \{Anwar E.\} and Ahmed, \{Muktar Beshir\} and Akalu, \{Temesgen Yihunie\} and Akanda, \{Ali S.\} and Fares Alahdab and Ziyad Al-Aly and Noore Alam and Samiah Alam and Alamene, \{Genet Melak\} and Alanzi, \{Turki M.\} and James Albright and Ammar Albujeer and Alcalde-Rabanal, \{Jacqueline Elizabeth\} and Animut Alebel and Olatunde Aremu and Hasan, \{Md Mehedi\} and Lee, \{Paul H.\} and Rahman, \{Mohammad Hifz Ur\} and Smith, \{David L.\} and Thompson, \{Robert L.\} and Irfan Ullah and Usman, \{Muhammad Shariq\} and Wang, \{Yuan Pang\}", note = "Publisher Copyright: {\textcopyright} 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.", year = "2020", month = sep, doi = "10.1016/S2214-109X(20)30278-3", language = "English", volume = "8", pages = "e1162--e1185", journal = "The Lancet Global Health", issn = "2214-109X", publisher = "Elsevier BV", number = "9", } . The Lancet Global Health.

Regina L. T. Lee, Cynthia Leung, Hong Chen, Paul H. Lee, Stephen W. H. Kwok (2020). A cluster randomized controlled trial of a simplified 5‐step handwashing technique versus a conventional 7‐step handwashing technique among Chinese students with intellectual disabilities . Journal of Applied Research in Intellectual Disabilities.

Paul H. Lee, Jan Marek, Petr N&#225;levka(2020). Crowdsourced smartphone data reveal altered sleep/wake pattern in quarantined Chinese during the COVID-19 outbreak . Chronobiology International. 37. (8). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1181--1190. Informa {UK} Limited

Crowdsourced smartphone data reveal altered sleep/wake pattern in quarantined Chinese during the COVID-19 outbreak @article{2d36ff3ac44d4fbcabe08990d7b10d9d, title = "Crowdsourced smartphone data reveal altered sleep/wake pattern in quarantined Chinese during the COVID-19 outbreak", abstract = "The Chinese Government quarantined Wuhan on 23 January 2020 and thereafter the Hubei province, affecting a total of 59 million citizens, to cease the spread of the coronavirus disease in 2019 (COVID-19). The effects of this lockdown on the psychological and mental health of both the affected and unaffected Chinese are largely unknown currently. We utilized one of the largest crowdsourced databases (Sleep as Android) that consisted of 15,681 sleep records from 563 users in China to estimate the change in the sleep pattern of Chinese users during the span of 30 December 2019 to 8 March 2020 with reference to 64,378 sleep records of 1,628 users for the same calendar period of years 2011–2019. The sleep pattern in China changed drastically after 23 January 2020 when the law of quarantine and suspension of Wuhan became effective. The two major findings are: (1) Chinese people increased their sleep duration by an average of 20 min and delayed their sleep onset by an average of 30 min at weekdays, while they maintained a similar sleep duration at weekends, and (2) larger changes were found in several subgroups, including those in Wuhan (80 sleep records from 3 users), female subjects, and those aged ≤ 24 years. Overall, Chinese people slept later and longer than usual during the COVID-19 pandemic quarantine.", keywords = "altered sleep duration and pattern, COVID-19 pandemic confinement, crowdsourcing, sleep as Android App, wuhan China", author = "Lee, \{Paul H.\} and Jan Marek and Petr N{\'a}levka", note = "Publisher Copyright: {\textcopyright} 2020 Taylor \& Francis Group, LLC.", year = "2020", month = aug, day = "2", doi = "10.1080/07420528.2020.1792486", language = "English", volume = "37", pages = "1181--1190", journal = "Chronobiology International", issn = "0742-0528", publisher = "Taylor \& Francis", number = "8", } . Chronobiology International.

Rick YC Kwan, Deborah Lee, Paul H Lee, Mimi Tse, Daphne SK Cheung, Ladda Thiamwong, Kup-Sze Choi(2020). Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial . JMIR mHealth and uHealth. {JMIR} Publications Inc.

Effects of an mHealth brisk walking intervention on increasing physical activity in older people with cognitive frailty @article{694611ce0d2d454799bd5654628a555a, title = "Effects of an mHealth brisk walking intervention on increasing physical activity in older people with cognitive frailty: pilot randomized controlled trial", abstract = "Background: Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. Objective: We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. Methods: An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ≥60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. Results: We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85\%). The recruitment rate was 33\% (33/99), the participant retention rate was 91\% (30/33), and the attendance rate of all the face-to-face sessions was 100\% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1\%). ActiGraph (58/66 days, 88\%) and smartphone (54/56 days, 97\%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. Conclusions: Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects.", keywords = "Brisk walking, Cognitive frailty, Moderate-to-vigorous physical activity, Older people, Smartphone", author = "Kwan, \{Rick Y.C.\} and Deborah Lee and Lee, \{Paul H.\} and Mimi Tse and Cheung, \{Daphne S.K.\} and Ladda Thiamwong and Choi, \{Kup Sze\}", note = "Funding Information: This project is funded by the School of Nursing, The Hong Kong Polytechnic University (BE08). We would like to thank our collaborators Mr. Gary Sham and Ms. Cathy Cheung from the Central and Western District Elderly Community Centre, St. James' Settlement, and Mr. Law from Jane Shu Tsao Neighborhood Elderly Centre, Hong Kong Mutual Encouragement Association Limited, for supporting this project by providing venues and for coordinating participant recruitment. Funding Information: This project is funded by the School of Nursing, The Hong Kong Polytechnic University (BE08). We would like to thank our collaborators Mr. Gary Sham and Ms. Cathy Cheung from the Central and Western District Elderly Community Centre, St. James{\textquoteright} Settlement, and Mr. Law from Jane Shu Tsao Neighborhood Elderly Centre, Hong Kong Mutual Encouragement Association Limited, for supporting this project by providing venues and for coordinating participant recruitment. Publisher Copyright: {\textcopyright} Rick YC Kwan, Deborah Lee, Paul H Lee, Mimi Tse, Daphne SK Cheung, Ladda Thiamwong, Kup-Sze Choi. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 31.07.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/)", year = "2020", month = jul, day = "31", doi = "10.2196/16596", language = "English", volume = "8", journal = "JMIR mHealth and uHealth", issn = "2291-5222", publisher = "JMIR Publications, Inc.", number = "7", } . JMIR mHealth and uHealth.

私人民营疗养院助理护士的压力伤害预防方案的效果:组群随机对照试验 @article{8a64ad94c6174be9960bb4969c51b7d6, title = "私人民营疗养院助理护士的压力伤害预防方案的效果:组群随机对照试验", abstract = "Clinical Trial Aim: To examine the effectiveness of a pressure injury prevention program for private for-profit nursing homes. Design: This study was a two-arm cluster randomized controlled trial. Ten private for-profit nursing homes made up the clusters. Methods: The participants were nursing home residents who aged 60 or above regardless of whether or not having pre-existing pressure injuries and also three types of nursing home assistants who provided direct care to the residents from 10 private for-profit nursing homes. These 10 nursing homes were randomly assigned to either the experimental or the control group. There were 477 and 536 resident participants and 51 and 62 nursing assistant participants in the experimental and control groups, respectively. The residents were the study participants and the nursing assistant participants were the interveners. The experimental group had the pressure injury prevention program implemented while the control group received the usual care. The primary study outcome which was the pressure injury incidence was analysed by GEE. Significance was set at a p-value of ≤.05. The data were collected between September 2017–March 2018. Result: There were significant interactive effects of time and group on the incidence of pressure injuries (p =.0015) and on the skill performance of the nursing assistant participants (p <.0001). Conclusions: An evidence-based pressure injury prevention program reduced the development of the pressure injuries and improved the skill performance of the nursing assistant participants. It is highly recommended that private for-profit nursing homes with high proportion of non-professional nursing assistants and insufficient nurses adopt this program for improving the prevention care of pressure injuries. Impact: This research has an impact on prevention care of pressure injury in private for-profit nursing homes with high proportion non-professional nursing assistants which have the similar characteristics as the nursing homes studied in various regions and countries. Trial registration: The Controlled Trial registration ID is NCT02270385.", keywords = "nursing assistants, nursing home care, pressure injury prevention", author = "Kwong, \{Enid W.Y.\} and Chen, \{Liang Y.\} and Kwan, \{Rick Y.C.\} and Lee, \{Paul H.\}", note = "Funding Information: The study was financially supported by the external funding that is Health and Medical Research Fund of the Food and Health Bureau, Hong Kong, China (project number:12131711). There was no other involvement from the funding source. Publisher Copyright: {\textcopyright} 2020 John Wiley \& Sons Ltd", year = "2020", month = jul, day = "1", doi = "10.1111/jan.14391", language = "Chinese (Traditional)", volume = "76", pages = "1780--1793", journal = "Journal of Advanced Nursing", issn = "0309-2402", publisher = "Fafo", number = "7", } . Journal of Advanced Nursing.

The diversified defocus profile of the near-work environment and myopia development @article{ee156fac6ff14dd9ae726652758e514e, title = "The diversified defocus profile of the near-work environment and myopia development", abstract = "Purpose: To quantify the defocus characteristics in the near-work environment at home and investigate the relationship with subsequent myopia progression. Methods: Fifty subjects (aged 7–12 years) were recruited and followed for 1 year. The home near-work environment (writing desk) was measured at a baseline home-visit using the Kinect-for-Windows to capture a 3-dimensional image. The depth values of the image were then converted into scene defocus with respect to the subject{\textquoteright}s viewpoint. The defocus characteristics were quantified as the dioptric volume (the total amount of net defocus, or DV) and standard deviation of the defocus values (SDD). Information on home size, time spent outdoors, and in front of a desk were also obtained. Univariate correlation, and multivariate regression were used to assess the association between myopia progression, defocus characteristics, and other co-variates. Results: The baseline spherical equivalent refraction (M) and refraction change over 1 year (∆M) were − 1.51 ± 2.02 D and − 0.56 ± 0.45 D respectively. DV was not significantly correlated with ∆M (Spearman{\textquoteright}s ρ = −0.25, p = 0.08), while SDD was negatively correlated to ∆M (Spearman{\textquoteright}s ρ = −0.42, p = 0.003). Although SDD was not a significant predictor in multivariate analysis, the regional DV at 15°–20° eccentricity was significant (p = 0.001). Home size (F2,50 = 7.01, p = 0.002) and time spent outdoors (Independent t = −2.13, p = 0.04) were also associated with ∆M, but not time spent in front of desk (Independent t = 0.78, p = 0.44). Conclusion: The defocus profile in the home environment within the para-central field of view is associated with childhood refractive error development.", keywords = "home size, living environment, myopia, near work", author = "Choi, \{Kai Yip\} and Mok, \{Angela Yuen ting\} and Do, \{Chi wai\} and Lee, \{Paul Hong\} and Chan, \{Henry Ho lung\}", note = "Funding Information: The authors acknowledge Dr Maureen Boost for providing advice in the preparation of the manuscript. This study was supported by General Research Fund from the Research Grants Council of the Hong Kong Special Administrative Region, China (PolyU 151001/17M) and Internal Research Grants, The Hong Kong Polytechnic University (Z0GF). Publisher Copyright: {\textcopyright} 2020 The Authors. Ophthalmic and Physiological Optics published by John Wiley \& Sons Ltd on behalf of College of Optometrists", year = "2020", month = jul, day = "1", doi = "10.1111/opo.12698", language = "English", volume = "40", pages = "463--471", journal = "Ophthalmic and Physiological Optics", issn = "0275-5408", publisher = "Springer Nature", number = "4", } . Ophthalmic and Physiological Optics.

The quality of the reported sample size calculation in clinical trials on COVID-19 patients indexed in PubMed @article{29b5f8cb170f4a7a9447acf563d59e32, title = "The quality of the reported sample size calculation in clinical trials on COVID-19 patients indexed in PubMed", abstract = "Letter to the Editor: Given the utmost priority of COVID-19 research, many medical journals, especially the leading ones, expedited the review process of these papers. It was expected that the amount of submitted papers for peer review would raise sharply and the deadline of the review period at the COVID-19 outbreak will be tightened. Therefore, sample size calculation of these papers, a component that was being omitted in more than 40\% of the published randomized controlled trials,1 might be neglected during the peer review process. Most importantly, authors of these papers were also rushing to conduct their COVID-19 research and they might not have seek necessary statistical consultation regarding sample size calculation. The CONsolidated Standards Of Reporting Trials (CONSORT) statement recommends trial reports to provide all essential information on the determination of sample size, including the level of statistical significance, the desired level of power, and the estimated effect size of the treatment. However, the degree of compliance to the CONSORT statement regarding sample size calculation of the newly-published COVID-19 trial papers is unknown. Therefore, we reviewed all clinical trials on COVID-19 patients published from 1st January 2020 to 4th April 2020 indexed in PubMed", keywords = "Protocol, Sample size, SARS-CoV-2, Statistics, Trials", author = "Lee, \{Paul H.\}", year = "2020", month = jul, day = "1", doi = "10.1016/j.ejim.2020.04.057", language = "English", volume = "77", pages = "139--140", journal = "European Journal of Internal Medicine", issn = "0953-6205", publisher = "Elsevier BV", number = "7", } . European Journal of Internal Medicine.

Kai Yip Choi, Angela Yuen‐ting Mok, Chi‐wai Do, Paul Hong Lee, Henry Ho‐lung Chan(2020). The diversified defocus profile of the near‐work environment and myopia development . Ophthalmic and Physiological Optics. 40. (4). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 463--471. Wiley

Enid W.‐Y. Kwong, Liang Y. Chen, Rick Y.‐C. Kwan, Paul H. Lee (2020). The effectiveness of a pressure injury prevention program for nursing assistants in private for‐profit nursing homes: A cluster randomized controlled trial . Journal of Advanced Nursing.

Paul H. Lee(2020). The quality of the reported sample size calculation in clinical trials on COVID-19 patients indexed in PubMed . European Journal of Internal Medicine. 77. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 139--140. Elsevier {BV}

Mimi Tse, Yajie Li, Shuk Kwan Tang, Shamay S. M. Ng, Xue Bai, Paul H. Lee, Raymond Lo, Suey Shuk Yu Yeung(2020). An Exploration of the Effectiveness of a Peer-Led Pain Management Program (PAP) for Nursing Home Residents with Chronic Pain and an Evaluation of Their Experiences: A Pilot Randomized Controlled Trial . International Journal of Environmental Research and Public Health. 17. (11). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 4090. {MDPI} {AG}

An exploration of the effectiveness of a peer-led pain management program (PAP) for nursing home residents with chronic pain and an evaluation of their experiences @article{b804e547515d49f294ad0226981926bd, title = "An exploration of the effectiveness of a peer-led pain management program (PAP) for nursing home residents with chronic pain and an evaluation of their experiences: a pilot randomized controlled trial", abstract = "Background: 80\% of nursing home residents have reported chronic pain, which is often accepted by older adults as part of aging. Peer support models are being used to help individuals manage their chronic conditions and overcome the challenges of limited healthcare resources. The aims of this study were: (i) to examine the effectiveness of a 12 week peer-led pain management program (PAP) for nursing home residents and (ii) to evaluate their experiences. Methods: A cluster randomized controlled trial (RCT) was used. The 12 week pain management program was provided for the experimental group. Outcomes were measured at three time points. The participants{\textquoteright} satisfaction and acceptance were evaluated by a semi-structured interview after the program was completed. Results: Pain self-efficacy, pain intensity, pain interference, pain knowledge, and depression levels improved after the completion of the 12 week peer-led PAP. The pain-intensity level reported at week 12 was significantly lower in the experimental group than in the control group. Semi-structured interviews showed that the nursing home residents were satisfied with the pain education that they received. Conclusions: The 12 week peer-led PAP appeared to improve the pain-related and psychological outcome measures in nursing home residents, and the feedback on the peer-led PAP from the nursing home residents was positive.", keywords = "Older adults, Pain education, Pain management program, Peer led", author = "Mimi Tse and Yajie Li and Tang, \{Shuk Kwan\} and Ng, \{Shamay S.M.\} and Xue Bai and Lee, \{Paul H.\} and Raymond Lo and Yeung, \{Suey Shuk Yu\}", note = "Funding Information: Funding: This study was funded by the Health and Medical Research Fund of the Food and Health Bureau, Hong Kong SAR Government (Ref. 15161051). Funding Information: This study was funded by the Health and Medical Research Fund of the Food and Health Bureau, Hong Kong SAR Government (Ref. 15161051). Publisher Copyright: {\textcopyright} 2020 by the authors.", year = "2020", month = jun, day = "8", doi = "10.3390/ijerph17114090", language = "English", volume = "17", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "11", } . International Journal of Environmental Research and Public Health.

The effectiveness of acupressure in the management of depressive symptoms and in improving quality of life in older people living in the community @article{e4a3269cc1a643f59a1d0530dd7cbcb0, title = "The effectiveness of acupressure in the management of depressive symptoms and in improving quality of life in older people living in the community: a randomised sham-controlled trial", abstract = "Objective: The primary aim of the current trial was to assess the clinical effectiveness of acupressure in the management of depression in elderly people compared to patients receiving sham acupressure or standard care alone. Methods: Randomized sham-controlled trial of acupressure, sham acupressure and standard care alone in older patients with depression living in the community. Patients with a score>/=8 in the Geriatric Depression Scale were recruited for this study. Intervention/sham treatments were provided four times/week for three months. Assessments related to depressive symptoms (primary outcome), well-being, resilience, spirituality and quality of life domains were carried out at baseline, end of the intervention and three-months after the intervention. Results: 118 patients were randomized to intervention (n = 40), sham (n = 40) or control arm (n = 38), with 84 patients providing final analysis data. Significant reduction in mean score of depressive symptoms was found in the acupressure group (from 10.6 (sd = 0.03) to 7.7 (sd = 0.07), p < 0.001 at end of intervention and 8.7 (sd = 0.8), p = 0.002 at follow-up) and the sham acupressure group (from 10.5 (sd = 0.3) to 8.4 (sd = 0.8), p = 0.005) at end of intervention and 8.4 (sd = 0.8), p = 0.006 at follow-up but not in the control group (from 10.8 to 9.9, p = 0.20). Resilience (p = 0.02) and spirituality (p = 0.02) were also improved in the intervention group at the end of intervention assessment but this change was not sustained at follow-up. Mind-body-spirit well-being and social functioning were improved both at the end of intervention and follow-up in the experimental as well as sham group. The sham group showed additional improvements in daily functioning and environmental quality of life. Conclusions: Although acupressure improved outcomes, a placebo effect was evident. Acupressure may be an effective approach to manage depression in elderly patients, but more evidence is needed in the future before it can be recommended for practice as well as more clear elucidation of any placebo effects.", keywords = "acupressure, Depression, elderly, quality of life, randomized trial, well-being", author = "Alex Molassiotis and Lorna Suen and Claudia Lai and Ben Chan and Wat, \{Karen Hong Yun\} and Jenny Tang and To, \{Kui lung\} and Leung, \{Cheung on\} and Sara Lee and Paul Lee and Chien, \{Wai Tong\}", note = "Funding Information: This trial was funded by the Angel S.P. Chan Lau endowment fund from the HK Polytechnic University. Publisher Copyright: {\textcopyright} 2019, {\textcopyright} 2019 Informa UK Limited, trading as Taylor \& Francis Group.", year = "2020", month = jun, day = "2", doi = "10.1080/13607863.2019.1584789", language = "English", volume = "24", pages = "1001--1009", journal = "Aging and Mental Health", issn = "1360-7863", publisher = "Taylor \& Francis", number = "6", } . Aging and Mental Health.

Symptom clusters in postchemotherapy neutropenic fever in hematological malignancy @article{44bc2dbb911c498e8df715f6e5d91192, title = "Symptom clusters in postchemotherapy neutropenic fever in hematological malignancy: associations among sickness behavior symptom cluster, inflammatory biomarkers of procalcitonin and C-reactive protein, and febrile measures", abstract = "Context: Little research has been conducted to investigate symptom clusters in postchemotherapy neutropenic fever (NF), their relationships with inflammatory biomarkers, and febrile outcome measures in patients with hematological malignancy, a population with high febrile rates incurring considerable costs to the health care system. Objectives: The aim of the present study was to investigate these. Methods: One hundred four NF episodes were observed in patients with hematological malignancy who were enrolled in the study. Patient-reported symptoms were recorded using the M.D. Anderson Symptom Inventory. Inflammatory biomarkers of procalcitonin (PCT) and C-reactive protein (CRP), vital signs, blood specimens for cultures, blood cell counts, and biochemistry were also collected. Serious complications from NF were reviewed from medical records if documented. Exploratory factor analysis and Spearman's rank correlation were used in the data analysis. Results: Three symptom clusters—sickness behavior, chemotherapy neurotoxicity, and emesis—were identified by exploratory factor analysis. The factor score of the sickness behavior cluster was significantly correlated with CRP (P < 0.05), PCT (P < 0.01), and the highest (P < 0.05) and maximum increased in (P < 001) temperatures at the onset (first day) of neutropenic fever. Conclusion: This study identified symptom clusters of sickness behavior, chemotherapy neurotoxicity, and emesis and highlighted significant associations between sickness behavior cluster, PCT, CRP, and febrile temperatures at the onset of postchemotherapy NF. These areas have lacked exploration in previous research. Monitoring and analyzing patient-reported sickness behavior symptoms, PCT, CRP, and temperature data would provide significant complementary data for the management and surveillance of postchemotherapy NF in hematological malignancy.", keywords = "C-reactive protein, hematological malignancy, M.D. Anderson Symptom Inventory, postchemotherapy neutropenic fever, procalcitonin, Sickness behavior symptom cluster", author = "Chan, \{Choi Wan\} and Lee, \{Paul Hong\} and Alex Molassiotis and Lee, \{Harold Kwok Kuen\}", note = "Funding Information: The authors have no conflicts of interest to declare. This research was supported by The Hong Kong Polytechnic University Block Grant (1-ZE81). The authors give thanks to the Chief of Services, Dr. Law, staff of the hematological unit, and staff of the Medical Record Office for the facilitation of patient recruitment and medical record review. The authors are also grateful to Jackie Cheung, Isaac Cheng, Cindy Kwan, Sally Chan, Suki Ho, Lorelei Ip, and Carmen Ip for their assistance in data collection and to the patients whose participation made this research possible. Publisher Copyright: {\textcopyright} 2019 American Academy of Hospice and Palliative Medicine", year = "2020", month = jun, day = "1", doi = "10.1016/j.jpainsymman.2019.12.372", language = "English", volume = "59", pages = "1204--1211", journal = "Journal of Pain and Symptom Management", issn = "0885-3924", publisher = "Elsevier Inc.", number = "6", } . Journal of Pain and Symptom Management.

Mimi Tse, Yajie Li, Shuk Kwan Tang, Shamay S. M. Ng, Xue Bai, Paul H. Lee, Raymond Lo, Suey Shuk Yu Yeung (2020). An Exploration of the Effectiveness of a Peer-Led Pain Management Program (PAP) for Nursing Home Residents with Chronic Pain and an Evaluation of Their Experiences: A Pilot Randomized Controlled Trial . International Journal of Environmental Research and Public Health.

Sample sizes in COVID-19–related research @article{0ac5be3462d145a39266158d3516e58c, title = "Sample sizes in COVID-19–related research", abstract = "Letter: Cheung and colleagues warned that underpowered studies that committed a type II error will discourage clinicians from using effective treatment.1 I agreed with this argument. Because the number of published clinical trials on coronavirus disease 2019 (COVID-19) patients has been increasing rapidly, I have reviewed all these trials published between Jan. 1, 2020, and Mar. 25, 2020, and indexed in PubMed, and assessed the quality of their sample size calculation.", author = "Lee, \{Paul H.\}", note = "{\textcopyright} 2020 Joule Inc. or its licensors", year = "2020", month = apr, day = "27", doi = "10.1503/cmaj.75308", language = "English", volume = "192", journal = "CMAJ", issn = "0820-3946", publisher = "Canadian Medical Association", number = "17", } . CMAJ.

The effect of e-health interventions promoting physical activity in older people @article{34e30883e54547d6b710d85c97d7a3aa, title = "The effect of e-health interventions promoting physical activity in older people: a systematic review and meta-analysis", abstract = "Introduction: The objectives of this review paper were to synthesize the data from randomized controlled trials in the literature to come to a conclusion on the effects of e-health interventions on promoting physical activity in older people. Methods: The Medline, CINAHL, Embase, PsycINFO, and SportDiscus databases were searched for articles about studies that 1) recruited subjects with a mean age of > 50 years, 2) tested e-health interventions, 3) employed control groups with no or less advanced e-health strategies, 4) measured physical activity as an outcome, 5) were published between 1st January 2008 and 31st May 2019, and 6) employed randomized controlled trials. The risk of bias in individual studies was assessed using the Physiotherapy Evidence Database scale. To examine the effects of the interventions, variables quantifying the amount of physical activity were extracted. The within-group effects of individual studies were summarized using Hedges g and 95\% confidence intervals. Between-group effects were summarized by meta-analyses using RevMan 5.0 with a random effect model. Results: Of the 2810 identified studies, 38 were eligible, 25 were included in the meta-analyses. The within-group effect sizes (Hedges g) of physical activity in the intervention group at T1 ranged from small to large: physical activity time (0.12 to 0.84), step counts (- 0.01 to 11.19), energy expenditure (- 0.05 to 0.86), walking time (0.13 to 3.33), and sedentary time (- 0.12 to - 0.28). The delayed effects as observed in T2 and T3 also ranged from small to large: physical activity time (0.24 to 1.24) and energy expenditure (0.15 to 1.32). In the meta-analysis, the between-group effect of the e-health intervention on physical activity time measured by questionnaires, physical activity time measured by objective wearable devices, energy expenditure, and step counts were all significant with minimal heterogeneity. Conclusion: E-health interventions are effective at increasing the time spent on physical activity, energy expenditure in physical activity, and the number of walking steps. It is recommended that e-health interventions be included in guidelines to enhance physical activity in older people. Further studies should be conducted to determine the most effective e-health strategies.", keywords = "E-health, Older people, Physical activity, Physical activity energy expenditure, Step count", author = "Kwan, \{Rick Yiu Cho\} and Dauda Salihu and Lee, \{Paul Hong\} and Mimi Tse and Cheung, \{Daphne Sze Ki\} and Inthira Roopsawang and Choi, \{Kup Sze\}", note = "Publisher Copyright: {\textcopyright} 2020 The Author(s).", year = "2020", month = apr, day = "21", doi = "10.1186/s11556-020-00239-5", language = "English", volume = "17", journal = "European Review of Aging and Physical Activity", issn = "1813-7253", publisher = "Mathematical Association", number = "1", } . European Review of Aging and Physical Activity.

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 @article{fc9e43bac73c4aa2a4ef6fea79388e11, title = "Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017", abstract = "A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4\% (62.3 (55.1–70.8) million) to 6.4\% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization{\textquoteright}s Global Nutrition Target of <5\% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2\% (30 (22.8–38.5) million) in 2000 to 6.0\% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.", author = "\{LBD Double Burden of Malnutrition Collaborators\} and Kinyoki, \{Damaris K.\} and Ross, \{Jennifer M.\} and Alice Lazzar-Atwood and Munro, \{Sandra B.\} and Schaeffer, \{Lauren E.\} and Mahdieh Abbasalizad-Farhangi and Masoumeh Abbasi and Hedayat Abbastabar and Ahmed Abdelalim and Amir Abdoli and Mohammad Abdollahi and Ibrahim Abdollahpour and Abdulkader, \{Rizwan Suliankatchi\} and Abebe, \{Nebiyu Dereje\} and Abebo, \{Teshome Abuka\} and Abegaz, \{Kedir Hussein\} and Hassan Abolhassani and Abreu, \{Lucas Guimar{\~a}es\} and Abrigo, \{Michael R.M.\} and Abushouk, \{Abdelrahman I.\} and Accrombessi, \{Manfred Mario Kokou\} and Dilaram Acharya and Maryam Adabi and Adebiyi, \{Akindele Olupelumi\} and Adedeji, \{Isaac Akinkunmi\} and Victor Adekanmbi and Adeoye, \{Abiodun Moshood\} and Adetokunboh, \{Olatunji O.\} and Davoud Adham and Aduroja, \{Posi Emmanuel\} and Advani, \{Shailesh M.\} and Mohsen Afarideh and Mohammad Aghaali and Anurag Agrawal and Tauseef Ahmad and Keivan Ahmadi and Sepideh Ahmadi and Ahmed, \{Muktar Beshir\} and Rushdia Ahmed and Olufemi Ajumobi and Olatunde Aremu and Fernandes, \{Jo{\~a}o C.\} and Hasan, \{Md Mehedi\} and Khan, \{Mohammad Saud\} and Khan, \{Muhammad Shahzeb\} and Lee, \{Paul H.\} and Irfan Ullah and Usman, \{Muhammad Shariq\} and Wang, \{Yuan Pang\} and Zhang, \{Zhi Jiang\}", note = "Publisher Copyright: {\textcopyright} 2020, The Author(s).", year = "2020", month = apr, day = "20", doi = "10.1038/s41591-020-0807-6", language = "English", volume = "26", pages = "750--759", journal = "Nature Medicine", issn = "1078-8956", publisher = "Nature Research", number = "5", } . Nature Medicine.

Associations between quality of life, psychosocial well-being and health-related behaviors among adolescents in Chinese, Japanese, Taiwanese, Thai and the Filipino populations @article{20eff7c74bf3400abcff87c8f6662ecb, title = "Associations between quality of life, psychosocial well-being and health-related behaviors among adolescents in Chinese, Japanese, Taiwanese, Thai and the Filipino populations: a cross-sectional survey", abstract = "Health-related behaviors during adolescence have lifelong impacts. However, there are unclear areas regarding the associations between health-related quality of life and demographic characteristics, as well as physical and psychosocial indicators. The aim of this study was to examine the associations between quality of life and body weight, sleep outcome, social support by age, and cohabitants, given that income, self-esteem, lifestyle, emotional, social and behavioral problems were taken into account among adolescents in East and Southeast Asia. A cross-sectional survey was conducted in Zhengzhou of China, Hong Kong, Kansai region of Japan, Taipei of Taiwan, Bangkok of Thailand and Manila of the Philippines between 2016 and 2017 among 21,359 urban adolescents aged between 9 and 16. The results showed that adolescents who had better self-esteem and control of emotions and behaviors had much higher level of perceived quality of life. Those who were overweight or obese, sleepy in the daytime, and not living with parents had worse quality of life compared with those who were not. In conclusion, psychosocial well-being should have a higher priority in the promotion of quality of life among Asian adolescents. Nevertheless, further studies are required to explore the differences in perceived quality of life between genders and countries.", keywords = "Adolescents, Asia Pacific region, Domains of psychosocial well-being, Lifestyle, Mental health, Quality of life, Socio-demographic factors", author = "\{et al.\} and Lee, \{Regina L.T.\} and Chien, \{Wai Tong\} and Jason Ligot and Nailes, \{Jennifer M.\} and Keiko Tanida and Sachi Takeuchi and Masanori Ikeda and Sachiyo Miyagawa and Toshisaburo Nagai and Rutja Phuphaibul and Chatsiri Mekviwattanawong and Su, \{Ing Ya\} and Zhang, \{Rui Xing\} and Lee, \{Paul H.\} and Kwok, \{Stephen W.H.\}", note = "Funding Information: Funding: This research was funded by the Central Research Fund, The Hong Kong Polytechnic University, project code 4-ZZEU. The APC was funded by the Central Research Fund. Publisher Copyright: {\textcopyright} 2020 by the authors. Licensee MDPI, Basel, Switzerland.", year = "2020", month = apr, day = "1", doi = "10.3390/ijerph17072402", language = "English", volume = "17", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "7", } . International Journal of Environmental Research and Public Health.

Regina L.T. Lee, Wai Tong Chien, Jason Ligot, Jennifer M. Nailes, Keiko Tanida, Sachi Takeuchi, Masanori Ikeda, Sachiyo Miyagawa, Toshisaburo Nagai, Rutja Phuphaibul, et al. (2020). Associations Between Quality of Life, Psychosocial Well-being and Health-Related Behaviors Among Adolescents in Chinese, Japanese, Taiwanese, Thai and the Filipino Populations: A Cross-Sectional Survey . International Journal of Environmental Research and Public Health.

Obestatin and growth hormone reveal the interaction of central obesity and other cardiometabolic risk factors of metabolic syndrome @article{8ca32e3d76f949759c91d149b8f779fe, title = "Obestatin and growth hormone reveal the interaction of central obesity and other cardiometabolic risk factors of metabolic syndrome", abstract = "Metabolic syndrome (MetS) is a multi-factorial disorder including central obesity (CO), insulin resistance, hyperglycemia, dyslipidemia and hypertension which increases the risk of diabetes mellitus and cardiovascular diseases. CO is considered as an essential component of MetS according to International Diabetes Federation (IDF), which may further modulate distinct signalling pathways compared with the other four MetS risk factors. Given that ghrelin signalling and the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis regulates energy balance and metabolic homeostasis, this study examined the changes in various ghrelin products and circulating hormones in response to the interaction between CO and other MetS components including blood pressure, fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol in 133 Hong Kong Chinese adults. Circulating obestatin and GH were increased and reduced, respectively, by either CO or the other 4-risk factor cluster. These changes were further augmented by the presence of all MetS risk factors. However, changes of ghrelin levels were not mediated by CO but the other MetS risk factors. Our findings suggest that CO does not predict all the dysregulation of signalling pathways in individuals with MetS. Although CO and other MetS may share common signalling targets (i.e., obestatin and GH), CO does not contribute to the perturbation of ghrelin signalling.", author = "\{et al.\} and Yu, \{Angus P.\} and Ugwu, \{Felix N.\} and Tam, \{Bjorn T.\} and Lee, \{Paul H.\} and Vicki Ma and Simon Pang and Chow, \{Angel S.\} and Cheng, \{Kenneth K.\} and Lai, \{Christopher W.\} and Wong, \{Cesar S.\} and Siu, \{Parco M.\}", note = "Funding Information: This study was supported by the Hong Kong Research Grants Council General Research Fund (Project Number 17103818), the University of Hong Kong Seed Fund for Basic Research, and the Hong Kong Polytechnic University Research Fund (RU3N). The authors thank all the volunteer subjects who contributed to this study. Publisher Copyright: {\textcopyright} 2020, The Author(s).", year = "2020", month = mar, day = "26", doi = "10.1038/s41598-020-62271-w", language = "English", volume = "10", journal = "Scientific Reports", issn = "2045-2322", publisher = "Nature Research", number = "1", } . Scientific Reports.

Obestatin and growth hormone reveal the interaction of central obesity and other cardiometabolic risk factors of metabolic syndrome <head> <META HTTP-EQUIV="Refresh" CONTENT="0;URL=/servlet/useragent"> </head> . Scientific Reports.

Effect of a school-based hand hygiene program for Malawian children @article{99b426f1511040d2ae58ed75b96cd710, title = "Effect of a school-based hand hygiene program for Malawian children: a cluster randomized controlled trial", abstract = "Background: Proper handwashing technique can reduce the mortality of a child. This study aimed to evaluate the impact of a school-based hand hygiene program on the handwashing compliance of children and school absenteeism in Southern Africa. Methods: We conducted a 2-arm cluster randomized trial in which 6 private primary schools were allocated randomly to either intervention (3 schools) or control (3 schools) groups. The intervention group consisted of implementing a series of planned activities and measures of hand hygiene program over 9 months. Parameters of primary and secondary outcomes were estimated with generalized estimating equations. Results: There were no significant between-group differences in demographic characteristics. The knowledge scores in the intervention group were significantly higher than the scores in the control group, and the technique scores in the intervention group were significantly higher than the scores in the control group after baseline. Further, after the third month, the cleanliness scores in the intervention group were significantly higher than the scores in the control group. In addition, the number of sick leave days decreased in the intervention group. Conclusions: The impact of the school-based hand hygiene program was positive. It can be used in both the planning and development of a hand hygiene protocol to increase the handwashing compliance rate of schoolchildren and to reduce school absenteeism in developing countries.", keywords = "Developing countries, Handwashing compliance rate, Health policy, School absenteeism, Schoolchildren, Simplified handwashing procedure", author = "Mbakaya, \{Balwani Chingatichifwe\} and Paul Lee and Lee, \{Regina Lai Tong\}", note = "Funding Information: The authors would like to thank the research assistants for their help in collecting the data and conducting the training sessions on hand hygiene in the intervention schools. We would also like to thank Mr Stephen Kwok Wai Hang for his critical review and help with the statistical analysis. Last, we would like to thank the schoolchildren and school personnel staff of the 6 participating primary schools, as well as the parents and/or guardians of the participating schoolchildren. Publisher Copyright: {\textcopyright} 2019", year = "2019", month = dec, day = "1", doi = "10.1016/j.ajic.2019.06.009", language = "English", volume = "47", pages = "1460--1464", journal = "American Journal of Infection Control", issn = "0196-6553", publisher = "Elsevier Inc.", number = "12", } . American Journal of Infection Control.

Psychometric properties and demographic correlates of the smartphone addiction scale-short version among Chinese children and adolescents in Hong Kong @article{fa1bb3281c6843dd8fa77b34fb23d602, title = "Psychometric properties and demographic correlates of the smartphone addiction scale-short version among Chinese children and adolescents in Hong Kong", abstract = "Nearly all children and teens in Hong Kong own a smartphone. There is currently no validated instrument that measures whether they use their phone too much. This study tested the psychometric properties of a translated Chinese version of the Smartphone Addiction Scale-Short Version (SAS-SV) and examined the demographic correlates of smartphone addiction among Hong Kong children and adolescents. A total of 1,901 primary school children and secondary school pupils were recruited from 15 Hong Kong schools. Furthermore, 1,797 primary caregivers were asked to complete a self-administered questionnaire on their socioeconomic status and educational attainment. The study used exploratory factor analysis (EFA) to identify the factor structure of SAS-SV for half the participants (n = 951), while confirmatory factor analysis (CFA) was used to assess the goodness-of-fit of EFA models for the remaining half (n = 951). Spearman correlations were used to assess the convergent validity of the SAS-SV, taking account of time spent by subjects on phones per day, the Smart Device Addiction Screening Tool (SDAST), the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Center for Epidemiological Studies Depression Scale for Children (CES-DC). EFA generated a three-factor model (with factors labeled {"}dependency,{"} the incidence of a {"}problem,{"} and {"}time spent{"}). CFA confirmed this model yielded an acceptable goodness-of-fit (Comparative Fit Index = 0.96, Tucker Lewis Index = 0.95, and root-mean-square error of approximation = 0.06). SAS-SV was positively correlated with SDAST (ρ = 0.59), PSQI (ρ = 0.29), and CES-D (ρ = 0.35), and negatively correlated with MSPSS (ρ = -0.10). A linear regression model showed that female adolescents, those with highly educated caregivers and those who spent more time using smartphones on their holidays, had on average higher SAS-SV scores, meaning they showed greater vulnerability to becoming addicted. The study found that SAS-SV is a valid scale for estimating excessive smartphone use among Hong Kong children and adolescents.", keywords = "addictive behaviors, Chinese, information technology, mobile phones, validation", author = "\{et al.\} and Teris Cheung and Lee, \{Regina L.T.\} and Tse, \{Andy C.Y.\} and Do, \{Chi Wai\} and So, \{Billy C.L.\} and Szeto, \{Grace P.Y.\} and Lee, \{Paul H.\}", note = "Funding Information: The Food and Health Bureau of the Hong Kong Special Administrative Region, China, provided financial support in the form of a grant from the Health and Medical Research Fund (Ref 13144041). The sponsor had no role in designing or conducting this research. Publisher Copyright: {\textcopyright} 2019, Mary Ann Liebert, Inc.", year = "2019", month = nov, day = "7", doi = "10.1089/cyber.2019.0325", language = "English", volume = "22", pages = "714--723", journal = "Cyberpsychology, Behavior, and Social Networking", issn = "2152-2715", publisher = "SAGE Publications", number = "11", } . Cyberpsychology, Behavior, and Social Networking.

Determining the optimal number of wearing-days given a fixed number of accelerometers in population-level study @article{2c7a881b47ab4ef1b5cfcb309fa9e354, title = "Determining the optimal number of wearing-days given a fixed number of accelerometers in population-level study", abstract = "Background: In research using accelerometers to measure physical activity, the number of accelerometers that can be utilized in a study and the study duration are both constrained. It means that increasing the number of accelerometer wearing days for all subjects leads to a decrease in the total number of participants the study can recruit. We used simulations to find the optimal combination of the number of wearing days and number of participant given a fixed number of accelerometer days. Methods: Two scenarios were studied here, including estimation of population physical activity level and the association between physical activity level and a health outcome. Another similar simulation was conducted by bootstrapping the National Health and Nutrition Examination Survey (NHANES) 2003-2006 accelerometer data (n = 4,069). Results: The simulation results of the first scenario showed that the error was minimized when the number of wearing days was 1 to 2. Simulation results of the second scenario showed that the optimal number of wearing days increased with the total number of accelerometer days and decreased with intra-class correlation (ICC). Conclusion: We developed a tool for researchers to determine the optimal combination of the number of the accelerometer wearing days and the total number of participants and showed that 1 to 2 accelerometer wearing days is optimal for estimation of population physical activity level.", keywords = "Accelerometry, Epidemiology, Measurement, Optimization, Statistics", author = "Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2018 Paul H. Lee.", year = "2019", month = nov, day = "5", doi = "10.2188/jea.JE20180095", language = "English", volume = "29", pages = "432--443", journal = "Journal of Epidemiology", issn = "0917-5040", publisher = "Japan Epidemiology Association", number = "11", } . Journal of Epidemiology.

Paul H. Lee(2019). Determining the Optimal Number of Wearing-Days Given a Fixed Number of Accelerometers in Population-Level Study . Journal of Epidemiology. Japan Epidemiological Association

Understanding smartphone usage in college classrooms @article{071f98bc14ea44658576035e02d6b85e, title = "Understanding smartphone usage in college classrooms: a long-term measurement study", abstract = "Smartphone usage is widespread in college classrooms, but there is a lack of measurement studies. We conducted a 14-week measurement study in the wild with 84 first-year college students in Korea. We developed a data collection and processing tool for usage logging, mobility tracking, class evaluation, and class attendance detection. Using this dataset, we quantify students' smartphone usage patterns in the classrooms, ranging from simple use duration and frequency to temporal rhythms and interaction patterns. Furthermore, we identify the key predictors of students{\textquoteright} in-class smartphone use and their semester grades. Our results reveal that students use their phones for more than 25\% of effective class duration, and phone distractions occur every 3–4 min for over a minute in duration. The key predictors of in-class smartphone use are daily usage habits and class characteristics, and in-class phone usage is negatively correlated with student grades.", keywords = "Academic performance, In-class smartphone use, Multitasking behaviors, Objective measurements, Smartphone distraction", author = "\{et al.\} and Inyeop Kim and Rihun Kim and Heepyung Kim and Duyeon Kim and Kyungsik Han and Lee, \{Paul H.\} and Gloria Mark and Uichin Lee", note = "Funding Information: This work was supported by LG Yonam Foundation and Next-Generation Information Computing Development Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT ( NRF-2017M3C4A7083534 ). Publisher Copyright: {\textcopyright} 2019", year = "2019", month = nov, day = "1", doi = "10.1016/j.compedu.2019.103611", language = "English", volume = "141", journal = "Computers and Education", issn = "0360-1315", publisher = "Elsevier Ltd.", number = "11", } . Computers and Education.

Inyeop Kim, Rihun Kim, Heepyung Kim, Duyeon Kim, Kyungsik Han, Paul H. Lee, Gloria Mark, Uichin Lee(2019). Understanding smartphone usage in college classrooms: A long-term measurement study . Computers & Education. 141. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 103611. Elsevier {BV}

Tracking development assistance for health from China, 2007-2017 @article{1a906b632d2645699327643ab744a867, title = "Tracking development assistance for health from China, 2007-2017", abstract = "Introduction In recent years, China has increased its international engagement in health. Nonetheless, the lack of data on contributions has limited efforts to examine contributions from China. Existing estimates that track development assistance for health (DAH) from China have relied primarily on one dataset. Furthermore, little is known about the disbursing agencies especially the multilaterals through which contributions are disbursed and how these are changing across time. In this study, we generated estimates of DAH from China from 2007 through 2017 and disaggregated those estimates by disbursing agency and health focus area. Methods We identified the major government agencies providing DAH. To estimate DAH provided by each agency, we leveraged publicly available development assistance data in government agencies' budgets and financial accounts, as well as revenue statements from key international development agencies such as the WHO. We reported trends in DAH from China, disaggregated contributions by disbursing bilateral and multilateral agencies, and compared DAH from China with other traditional donors. We also compared these estimates with existing estimates. Results DAH provided by China grew dramatically, from US\$323.1 million in 2007 to \$652.3 million in 2017. During this period, 91.8\% of DAH from China was disbursed through its bilateral agencies, including the Ministry of Commerce (\$3.7 billion, 64.1\%) and the National Health Commission (\$917.1 million, 16.1\%); the other 8.2\% was disbursed through multilateral agencies including the WHO (\$236.5 million, 4.1\%) and the World Bank (\$123.1 million, 2.2\%). Relative to its level of economic development, China provided substantially more DAH than would be expected. However, relative to population size and government spending, China's contributions are modest. Conclusion In the current context of plateauing in the growth rate of DAH contributions, China has the potential to contribute to future global health financing, especially financing for health system strengthening.", keywords = "Health economics, Health policy, Health systems", author = "\{et al.\} and Micah, \{Angela E.\} and Yingxi Zhao and Chen, \{Catherine S.\} and Zlavog, \{Bianca S.\} and Golsum Tsakalos and Abigail Chapin and Stephen Gloyd and Jost Jonas and Lee, \{Paul H.\} and Shiwei Liu and Ng, \{Man Tat Alexander\} and Phillips, \{Michael R.\} and Enrico Rubagotti and Kun Tang and Shenglan Tang and Mustafa Younis and Yunquan Zhang and Murray, \{Christopher J.L.\} and Dieleman, \{Joseph L.\}", note = "Funding Information: Additionally, we used project-level data on Ebola funding from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) Financial Tracking Service website to supplement our data based on the support that China provided during the Ebola crisis,26which was channelled through MOFCOM. Funding Information: Second, due to data availability, we are not yet able to track development assistance disbursed through NGOs, the military, and the Central Committee of the Communist Party of China, or at the local government level, or the health-related emergency aid from the Red Cross Society of China. China has only a few NGOs operating abroad, including the China Foundation for Poverty Alleviation. We were unable to disaggregate the health share of their annual expenditures listed in their publicly available annual report. However, according to the few available financial reports, we observed that DAH disbursed through this channel is less than 1\% of the total DAH disbursed.44 Similarly, we were not able to disaggregate the health-related emergency aid from the Red Cross since the majority of its aid projects were for emergency settings such as in flood zones and after earthquakes, and the available reported data were not disaggregated. Their department account only listed development aid in 2013 and 2016, and DAH disbursed through this channel is less than 0.1\% of the total DAH disbursed.45 Furthermore, although we did not include DAH disbursed through the Communist Party of China and the military due to data availability, we noted that the International Liaison Department of the Communist Party of China and the People{\textquoteright}s Liberation Army Navy provided some development aid projects related to health, including the hospital ship {\textquoteleft}Peace Ark{\textquoteright}.46 47 Our DAH estimates are also restricted to aid disbursed through the central government level, thus excluding the disbursements for medical teams and a few other health aid projects that are implemented by local governments, especially provincial governments. Typically, the medical teams are funded by three sources—central National Health Commission, provincial National Health Commission and provincial hospitals.48Due to significantly diverse salary and stipend data provided by the hospitals, we are unable to track this proportion. For the local government level, we compared the total foreign aid disbursed by the central government and total foreign aid disbursed by the local government using information from the finance yearbooks. We found that the local government only started disbursements after 2010, and this was estimated to be at most 0.77\% of the central government aid budget.23 Therefore, we restricted our estimates to central government disbursements. These exclusions may result in an underestimation of contributions of DAH from China. Funding Information: While China has increased DAH disbursement dramatically for the past decades, it remains a recipient of DAH. China received a total of \$802.3 million in assistance from the Global Fund from 2003 to 2013, and in 2014 graduated from the Global Fund{\textquoteright}s support.42 In 2016, a total of \$244.5 million in assistance was given to China through major bilateral donors including Germany, USA, and UK, and multilateral agencies including the World Bank and Asian Development Bank, and the Bill \& Melinda Gates Foundation.35 Nonetheless, the relative volume of DAH received by China is lower than DAH contributions from China. Funding Information: We identified four Chinese government agencies that are the primary agencies responsible for the disbursement of DAH. The identification of these agencies was informed by a white paper on foreign aid published by the Chinese State Council in 2011 and other research.13 15 21 The four agencies were the National Health Commission (NHC), the Ministry of Commerce (MOFCOM), the Ministry of Education (MOE) and the Export-Import Bank of China (EXIM). We excluded other government entities from the analyses based on six reasons: (1) The Ministry of Finance and the People{\textquoteright}s Bank of China did not disburse development aid bilaterally, mostly contributing to multilateral agencies and the South-South Cooperation Fund has not yet disbursed funds. (2) The China Development Bank, Silk Road Fund and China-Africa Development Fund disbursed loans, but the loans were not concessional and therefore not considered as DAH. (3) The Red Cross Society of China mostly disbursed aid in emergency situations, and our definition of DAH precludes emergency response humanitarian support; and the limited number of non-emergency projects are usually through Ministry of Commerce. (4) The Ministry of Foreign Affairs, Ministry of Human Resources and Social Security, National Development and Reform Commission, All China Woman Federation, Ministry of Science and Technology, Ministry of Agriculture, Ministry of Civil Affairs, and State Oceanic Administration had no health-related aid disbursements based on literature review. (5) For non-governmental organisations including the China Foundation for Poverty Alleviation and Lifeline Express, the disbursement data available were incomplete and not disaggregated. (6) The Chinese embassies and consulates and the Chinese Centre for Disease Control and Prevention also disbursed DAH, although the disbursements were administratively reported under other government agencies that we included —the Ministry of Commerce and the National Health Commission. eTable 2 in the online supplementary file provides additional details on the basis of inclusion or exclusion of each government agency in the analysis. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.", year = "2019", month = oct, day = "8", doi = "10.1136/bmjgh-2019-001513", language = "English", volume = "4", journal = "BMJ Global Health", issn = "2059-7908", publisher = "BMJ Publishing Group", number = "5", } . BMJ Global Health.

Social media use and depressive symptoms among Hong Kong young adults during the period of 2019 extradition bill controversy @article{ef7d5619937645038b8dea0c1c3bca98, title = "Social media use and depressive symptoms among Hong Kong young adults during the period of 2019 extradition bill controversy", abstract = "Letter to the Editor: In March 2019, the Hong Kong government has proposed a highly controversial bill on amending the Fugitive Offenders Ordinance and Mutual Legal Assistance in Criminal Matters Ordinance, commonly known as the extradition bill. The introduction of this bill induced enormous controversies in the Hong Kong society due to the possible extradition to China. Before the second reading of the bill (scheduled on June 12, 2019), more than 1 million Hong Kong people demonstrated on June 9 daytime to show their concerns. On June 12, a few thousand protestors attempted to block the traffic around Legislative Council to the second reading of the bill. After the government had declined to withdraw the bill, another demonstration on June 16 with 2 million protestors expressed their concerns again.", author = "Lee, \{Paul H.\}", note = "Funding Information: The University Grants Committee of the Hong Kong Special Administrative Region, China , provided financial support in the form of a grant from the the General Research Fund Early Career Scheme (Ref: PolyU 251056/16M). The sponsor had no role in designing or conducting this research. ", year = "2019", month = oct, day = "1", doi = "10.1016/j.ajp.2019.08.012", language = "English", volume = "45", pages = "38--40", journal = "Asian Journal of Psychiatry", issn = "1876-2018", publisher = "Elsevier BV", number = "10", } . Asian Journal of Psychiatry.

Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder @article{5612b4b0dd91491f8bce3125ba1697ca, title = "Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: A randomized controlled trial", abstract = "Sleep disturbance and executive dysfunction have been widely reported in children with autism spectrum disorder. While the positive impacts of physical activity on sleep quality and cognition are documented in children with typical development, similar studies in children with autism spectrum disorder are scarce. The objective of this study was to examine the impact of physical activity on sleep quality and cognition in children with autism spectrum disorder. A total of 40 children diagnosed with autism spectrum disorder (mean age = 9.95 years) were randomly assigned into two groups: physical activity intervention and control. Four sleep parameters (sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset) and two executive functions (inhibition control and working memory) were assessed. Results revealed a significant improvement in sleep efficiency, sleep onset latency, and sleep duration in the intervention group but not in the control group during weekdays. Moreover, a significant improvement in inhibitory control was shown in the intervention group but not in the control group. No significant improvement in working memory capacity was documented in either group (ps > 0.05). Our findings highlight the value of physical activity in improving sleep quality and cognition among children with autism spectrum disorder, but specific physical activity may be required to benefit individual executive functions.", keywords = "autism spectrum disorder, children, inhibition control, physical activity, sleep, working memory", author = "Tse, \{Choi Yeung Andy\} and Lee, \{Hong Paul\} and Chan, \{Ka Shing Kevin\} and Edgar, \{Veronica Bordes\} and Alison Wilkinson-Smith and Lai, \{Wing Him Elvis\}", note = "Funding Information: The authors would like to thank staff members Mr. Daniel Ling and Ms. Joyce Chan for their assistance in data collection, and student helpers Mr. Lau Man Kit, Mr. Lee Chin Hung, Miss Liu Hok Ling, Mr. Ng Cheuk Sam, Mr. Ng Ping Fun, and Mr. So Fung Yeuk for carrying out the physical activity intervention. The authors would also like to express their gratitude to all the children who participated in this study, and the participants{\textquoteright} teachers and parents for their support. The authors would also like to thank Benjamin Knight, MSc, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work described in this article was partially supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. EdUHK 28602517). Publisher Copyright: {\textcopyright} The Author(s) 2019.", year = "2019", month = oct, day = "1", doi = "10.1177/1362361318823910", language = "English", volume = "23", pages = "1699--1710", journal = "Autism", issn = "1362-3613", publisher = "SAGE Publications", number = "7", } . Autism.

Angela E Micah, Yingxi Zhao, Catherine S Chen, Bianca S. Zlavog, Golsum Tsakalos, Abigail Chapin, Stephen Gloyd, Jost Jonas, Paul H Lee, Shiwei Liu, et al.(2019). Tracking development assistance for health from China, 2007–2017 . BMJ Global Health. 4. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString e001513. {BMJ}

Choi Yeung Andy Tse, Hong Paul Lee, Ka Shing Kevin Chan, Veronica Bordes Edgar, Alison Wilkinson-Smith, Wing Him Elvis Lai (2019). Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: A randomized controlled trial . Autism.

Lesson learned from peer volunteers in a peer-led pain management program among nursing home residents @article{15e2d6f03e084938b8733e04c114142a, title = "Lesson learned from peer volunteers in a peer-led pain management program among nursing home residents", abstract = "Background: Chronic pain is common among older adults and is associated with adverse physical and psychological outcomes. Given the burden of pain and limited healthcare resources, devising innovative and cost-effective ways of managing chronic pain is of high priority. The aim of this paper is to explore the experiences and perceptions of peer volunteers (PVs) in a peer-led pain management program among nursing home residents in Hong Kong. Methods: Forty-six PVs were recruited and trained to lead a pain management program (PAP). The PAP consisted of one 1 hour session per week for 12 weeks. It included 20 min of physical exercises performed under the supervision of PVs, followed by 30 min of pain management education, including information on pain situations, the impacts of pain, the use of drugs and non-drug strategies for pain management, demonstrations, and return demonstrations of various non-drug pain management techniques. Quantitative data were collected from questionnaires (demographics, pain situation, and pain knowledge) for all PVs. Qualitative data (PVs{\textquoteright} experiences in leading the PAP, their perceived benefits, barriers encountered, and recommendations for improving the PAP) were collected at week 12 (upon completion of the PAP). Data were analyzed using the Statistical Package for Social Sciences and content analysis for qualitative data. Results: A total of 46 PVs were recruited (34 females, 74\%), with a mean ± SD age of 61.0 ± 5.1 years. Thirty-one of them reported having chronic pain. Before the training, their self-rated pain knowledge was 40.0 ± 20.5 (maximum 100 points) while their actual pain knowledge score was 86.1 ± 10.6 (maximum 100 points). The PVs reported an improvement in their knowledge and skills after leading PAPs. No PVs reported having received any negative comments about their role in leading the PAP but mentioned that they had received feedback on how to improve the program. Conclusions: This study provides further evidence that peer-led pain management programs are feasible and can lead to positive experiences for the PVs. Peer support models are coming into wide use because they show promise in helping patients to manage chronic conditions. Peer volunteers will become important resources in elderly care. The barriers that were identified may lead to improvements in the design and planning of future PAPs.", keywords = "Nursing homes, Pain management, Peer groups, Volunteer", author = "\{et al.\} and Tse, \{Mimi Mun Yee\} and Ng, \{Shamay Sheung Mei\} and Xue Bai and Lee, \{Paul Hong\} and Raymond Lo and Cheung, \{Daphne Sze Ki\} and Kin Cheung and Yeung, \{Suey Shuk Yu\}", note = "Funding Information: Funding: This study was supported by the Health and Medical Research Fund (Ref. 15161051) of the Food and Health Bureau, Hong Kong SAR Government. The funding body played no role in the design of the study or in the collection, analysis, and interpretation of the data or in the writing of the manuscript. Publisher Copyright: {\textcopyright} 2019 by the authors. Licensee MDPI, Basel, Switzerland.", year = "2019", month = sep, day = "1", doi = "10.3390/ijerph16173097", language = "English", volume = "16", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "17", } . International Journal of Environmental Research and Public Health.

Paul Lee, Mimi Tse, Shamay Ng, Xue Bai, Raymond Lo, Daphne Sze Ki Cheung, Kin Cheung, Suey Yeung(2019). Lesson Learned from Peer Volunteers in a Peer-Led Pain Management Program among Nursing Home Residents . International Journal of Environmental Research and Public Health. 16. (17). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 3097. {MDPI} {AG}

The association between demographic characteristics, lifestyle health behaviours, and quality of life among adolescents in Asia Pacific region @article{11443f158b684af4a43e6790a2df3fd5, title = "The association between demographic characteristics, lifestyle health behaviours, and quality of life among adolescents in Asia Pacific region", abstract = "Background: Given the risk of physical and psychosocial health that emerge in adolescents that are continuing into adulthood, identifying and addressing early signs of health-related quality of life (HRQoL) decline provides an opportunity to ensure that young people have a healthier progression through adolescence. Aim: To investigate the association between demographic characteristics, lifestyle health behaviours, and HRQoL of adolescents who live in Asia Pacific region, including Hong Kong in China, Beijing in China, Akashi in Japan, Seoul in South Korea, and Bangkok in Thailand. Methods: A cross-sectional self-reported survey carried out in a sample of 2296 adolescents that were aged 9–16 years (mean= 12.0; standard deviation [SD] = 1.63) was conducted in the five cities of the Asia Pacific region between January and August 2017. Demographic characteristics, adolescent lifestyle behaviours, and HRQoL were measured with demographic questionnaire, Adolescent Lifestyle Questionnaire{\textquoteright}s (ALQ) seven domains and Paediatric Quality of Life{\textquoteright}s (PedsQL 4.0) global score, respectively. Mixed multilevel model (MMLM) was used to fit the data. Results: After adjusting the demographic variables, one score increase in ALQ physical participation, nutrition, social support, and identity awareness are associated with an increase in PedsQL global score. On the contrary, one score increase in ALQ health practices is associated with a decrease in the PedsQL global score. The estimated mean of PedsQL global score of South Korea, Beijing, and Japan were better, while the score of Thailand and Hong Kong were poorer. Conclusions: Differentiating the impacts of promoting health behaviours among different countries can help in better understanding the health needs of adolescents in each country, especially in the Asia Pacific region, so that adequate and relevant resources can be allocated to reduce health-risk taking behaviours among this vulnerable group for health-promoting strategies.", keywords = "Adolescents, Asia Pacific region, Demographic characteristics, Lifestyle health behaviours, Quality of life", author = "\{et al.\} and Lee, \{Regina L.T.\} and Chien, \{Wai Tong\} and Keiko Tanida and Sachi Takeuchi and Phuphaibul Rutja and Kwok, \{Stephen W.H.\} and Lee, \{Paul H.\}", note = "Funding Information: Funding: This research was funded by Central Research Fund (Project code is 4-ZZEU), School of Nursing, The Hong Kong Polytechnic University, Hong Kong; and Grant for Child Welfare Problem Research Project 2014, Ministry of Health, Labour and Welfare, Japan. Publisher Copyright: {\textcopyright} 2019 by the authors.", year = "2019", month = jul, day = "1", doi = "10.3390/ijerph16132324", language = "English", volume = "16", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "13", } . International Journal of Environmental Research and Public Health.

A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients @article{53659661063643fb8ce90d8b342fa709, title = "A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test", abstract = "This article reports on the feasibility and effect of the brief hope intervention (BHI) in terms of increasing the hope level and psychological and physical health outcomes of rehabilitating cancer patients (RCP). Chinese RCP living in the community were invited to join the study. The BHI consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between. There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals. A one-group pre- and postintervention design was used. Outcome measures included the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression Scale (CES-D), and the State Hope Scale. Recruitment, attrition, and qualitative feedback were collected to understand their comments on BHI. A total of 40 participants were recruited (female 92.3\%). The mean age was 57.2 years (SD = 6.7). The participants had significant improvement in all aspects of the Memorial Symptom Assessment Scale, with moderate-to-large effect sizes (d = 0.49–0.74). The changes in present hope and depression scores were insignificant, with small effect sizes (d = 0.17–0.34). The BHI seemed to be promising in producing both physical and psychological benefits in RCP.", keywords = "brief intervention, cancer patient, feasibility, hope, rehabilitation", author = "Kitty Chan and Wong, \{Frances K.Y.\} and Lee, \{Paul H.\}", note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Internal Research Funds (DGRF 2015/16 G-UA8V) from The Hong Kong Polytechnic University. Publisher Copyright: {\textcopyright} The Author(s) 2019.", year = "2019", month = may, day = "8", doi = "10.1177/2377960819844381", language = "English", volume = "5", journal = "SAGE Open Nursing", issn = "2377-9608", publisher = "JISC Techdis Service; ALT", } . SAGE Open Nursing.

Smoking and Influenza-associated Morbidity and Mortality @article{08895630bab24b6baa0cdfc13b6330f9, title = "Smoking and Influenza-associated Morbidity and Mortality: A Systematic Review and Meta-analysis", abstract = "Background: Although smoking has been recognized as a risk factor for many respiratory diseases, its effects of influenza-associated morbidity and mortality remain controversial. We conducted a systematic review and meta-analysis to assess the impact of smoking on influenza-associated hospital admissions, intensive care unit (ICU) admissions, and deaths. Methods: We searched the databases of PubMed, CINAHL, EMBASE, and the China National Knowledge Infrastructure for all observational studies published between 1 January 2000 and 30 November 2017 on ever-active/secondhand smoking and influenza-associated hospital admissions, ICU admissions, and deaths. We pooled data using random effect models. Results: The initial search retrieved 7495 articles, of which 20 studies were included for systematic review, and 12 studies (eight case-control studies, two cohort studies, and two cross-sectional studies) with 18612 subjects were included in meta-analysis. The overall quality of selected studies was moderate. Ever-active smokers had higher odds of hospital admissions (odds ratio [OR] = 1.5; 95\% confidence interval [CI] = 1.3, 1.7) and ICU admissions (OR 2.2; 95\% CI = 1.4, 3.4) after influenza infections, as compared with never smokers. No association was observed between ever-active smoking and influenza-associated deaths. We found a positive association between secondhand smoking and influenza-associated hospital admissions, but only in children below 15 years of age. Conclusions: The literature evidence showed that smoking was consistently associated with higher risk of hospital admissions after influenza infection, but the results for ICU admissions and deaths were less conclusive because of the limited number of studies.", keywords = "Influenza, Meta-analysis, Morbidity, Mortality, Smoking", author = "\{et al.\} and Lefei Han and Jinjun Ran and Mak, \{Yim Wah\} and Suen, \{Lorna Kwai Ping\} and Lee, \{Paul H.\} and Peiris, \{Joseph Sriyal Malik\} and Lin Yang", note = "Publisher Copyright: Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved.", year = "2019", month = may, day = "1", doi = "10.1097/EDE.0000000000000984", language = "English", volume = "30", pages = "405--417", journal = "Epidemiology", issn = "1044-3983", publisher = "Lippincott Williams \& Wilkins", number = "3", } . Epidemiology.

家庭护理人在参与智力残疾的肥胖儿童及青少年的体重管理计划中的体验:一项探究性研究 @article{9e6701cac9894bf6954c398b17c9ed5c, title = "家庭护理人在参与智力残疾的肥胖儿童及青少年的体重管理计划中的体验:一项探究性研究", abstract = "Aim: To gain insight into the experiences of family carers participating in a weight management programme via mHealth tools for overweight children and adolescents with intellectual disabilities. Background: Many weight reduction programs fail to show positive and sustainable impacts due to not involving parents, who are usually unavailable to attend school-based health programs. The mHealth interactive interventions were carried out in September 2015–August 2016, engaging carers to monitor and sustain their children's healthy lifestyle behaviours at home being one way to achieve this. Design: Qualitative research design to conduct focus group discussion with family carers involved in a school-based weight management programme via the mHealth interventions. Methods: An exploratory study was used to examine family carers{\textquoteright} views of participating in a weight management programme. Focus group interviews examined the in-depth experiences of 20 family carers in providing social support and monitoring lifestyle behaviours via the mHealth interactive interventions. Results: Twenty family carers were recruited and four themes emerged: (a) improving family carer–child interactions and communications; (b) gaining useful and practical health information from experts; (c) supporting each other via an mHealth platform; and (d) appreciating the collaborative effort between school personnel and family carers. Family carers stressed the usefulness of the mHealth interactive interventions in monitoring and sustaining the children's healthy lifestyle behaviours at home. Conclusion: The mHealth interactive interventions for increasing family carers{\textquoteright} involvement and monitoring were well received. The findings provide new insights into using mHealth interventions in future weight management programmes involving parental participation in the home environment.", keywords = "family carers{\textquoteright} participation, intellectual disabilities, mHealth interactive interventions, overweight children and adolescents, weight management programme involving parental participation", author = "Lee, \{Regina L.T.\} and Michael Brown and Cynthia Leung and Hong Chen and Lobo Louie and Chen, \{Jyu Lin\} and Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2018 John Wiley \& Sons Ltd", year = "2019", month = feb, day = "1", doi = "10.1111/jan.13845", language = "Chinese (Traditional)", volume = "75", pages = "388--399", journal = "Journal of Advanced Nursing", issn = "0309-2402", publisher = "Fafo", number = "2", } . Journal of Advanced Nursing.

Calibration of wrist-worn ActiWatch 2 and ActiGraph wGT3X for assessment of physical activity in young adults @article{ab6a9f938b5b4c71a75eae8f7df52974, title = "Calibration of wrist-worn ActiWatch 2 and ActiGraph wGT3X for assessment of physical activity in young adults", abstract = " Background: The validity of Actiwatch 2 in assessing sleep was evident, but its validity in assessing physical activity (PA) level was unknown. Research question: The objective of this study was to validate the wrist-worn Actiwatch 2 and ActiGraph wGT3X as a measurement of PA level against energy expenditure measured by indirect calorimetry. Methods: Twenty-seven university students aged 18–26 were recruited from July 2016 to May 2017. They were instructed to run at different speeds (4, 6, 8, 10, and 12 km/h) on a treadmill, each speed for 10 min. Oxygen consumption and carbon dioxide production of the subjects was measured by indirect calorimetry using the Cosmed K4b 2 gas analyzer. Each subjects wore a single pair of accelerometers (Actiwatch 2 and ActiGraph wGT3X) on both wrists. Results: All the accelerometers were strongly correlated (ρ=0.83-0.94, all p-values <0.001), and all four accelerometers were strongly correlated with the METs obtained from the Cosmed K4b 2 (ρ=0.72-0.74, all p-values <0.001). Regression analysis showed that the non-dominant wrist-worn Actiwatch 2 cutoff cpm for moderate and vigorous PA were 399 and 1,404, respectively; for the ActiGraph wGT3X-BT the corresponding cutoffs were 4,514 and 15,044, respectively. The goodness-of-fit of the MET prediction equations were all >75\%. When classifying the activities as either sedentary, light activity, moderate-intensity activity, or vigorous-intensity activity using the MET prediction equations, the agreements between the four accelerometers and that by the Cosmed K4b 2 were high, all AUCs were above 80\% except those of the Actiwatch worn on the left (non-dominant) wrist. The Bland-Altman plots show that, for all four accelerometers, the biases were close to zero and error variances were largest when the mean measurements were around 6 METs. Significance: We showed that wrist-worn Actiwatch 2 and ActiGraph wGT3X-BT were strongly correlated in PA assessment. ", keywords = "Accelerometry, Calibration, Cut-points, Measurement, Motion sensor, Physical activity", author = "Paul Lee and Tse, \{C. Y.\}", note = "Funding Information: The Food and Health Bureau of the Hong Kong Special Administrative Region, China provided financial support in the form of Health and Medical Research Fund (Ref 12131741 ). The sponsor had no role in the design or conduct of this research. Publisher Copyright: {\textcopyright} 2018 Elsevier B.V.", year = "2019", month = feb, doi = "10.1016/j.gaitpost.2018.11.023", language = "English", volume = "68", pages = "141--149", journal = "Gait and Posture", issn = "0966-6362", publisher = "Elsevier BV", number = "2", } . Gait and Posture.

Paul Lee, C.Y. Tse(2019). Calibration of wrist-worn ActiWatch 2 and ActiGraph wGT3X for assessment of physical activity in young adults . Gait & Posture. 68. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 141--149. Elsevier {BV}

Regina L.T. Lee, Michael Brown, Cynthia Leung, Hong Chen, Lobo Louie, Jyu‐Lin Chen, Paul H. Lee(2019). Family carers’ experiences of participating in a weight management programme for overweight children and adolescents with intellectual disabilities: An exploratory study . Journal of Advanced Nursing. 75. (2). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 388--399. Wiley

The association between workplace violence and physicians’ and nurses’ job satisfaction in macau @article{8347778299ed4f19935c0853ba01328a, title = "The association between workplace violence and physicians{\textquoteright} and nurses{\textquoteright} job satisfaction in macau", abstract = "Background This paper describes the association between workplace violence and job satisfaction among physicians and nurses in Macau. Convenience sampling was sourced from six health centers under the Macau Health Bureau. Methods This study uses a cross-sectional self-administrative survey. The study used case studies research instruments for workplace violence in the health sector by country (from the ILO, ICN, WHO, PSI), the Minnesota Satisfaction Questionnaire and Perceived Stress Scale. The data collection period spanned from August to December, 2014. Data analysis Multiple logistic regression examines levels of intrinsic and extrinsic satisfaction in physicians and nurses and significant correlates affecting their job satisfaction. Results A total of 720 (14.9\% physicians) participants were recruited. 57.2\% of participants reported physical and psychological workplace violence in the preceding year. The most common forms of workplace violence were verbal abuse (53.4\%), physical assault (16.1\%), bullying / harassment (14.2\%), sexual harassment (4.6\%) and racial harassment (2.6\%). Nurses were at a significantly higher risk of physical assault and verbal abuse compared to physicians. Patients, patients{\textquoteright} relatives, and colleagues were the main perpetrators. Worry about WPV, on-call duty and shift work, experience of bullying and verbal abuse and employment sector emerged as significant correlates affecting the intrinsic and extrinsic job satisfaction of physicians and nurses. Frontline staff, aged 30 and 39, coming from an ethnic minority, and perceived stress were significant correlates affecting nurses{\textquoteright} job satisfaction. Conclusions WPV remains a significant concern in healthcare settings in Macau. Stakeholders should legally enforce a zero-tolerance policy towards WPV within healthcare workplaces. WPV is detrimental to healthcare professionals{\textquoteright} mental wellbeing, risking irreversible physical and psychological harm for its victims.", author = "Teris Cheung and Lee, \{Paul H.\} and Yip, \{Paul S.F.\}", note = "Publisher Copyright: {\textcopyright} 2018 Cheung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.", year = "2018", month = dec, doi = "10.1371/journal.pone.0207577", language = "English", volume = "13", journal = "PLoS ONE", issn = "1932-6203", publisher = "PLOS", number = "12", } . PLoS ONE.

Effects of play activities program for nursing home residents with dementia on pain and psychological well-being @article{1e0cbe1203504a808823340919305c9f, title = "Effects of play activities program for nursing home residents with dementia on pain and psychological well-being: Cluster randomized controlled trial", abstract = "Aim: The prevalence of chronic pain among nursing home residents with dementia is high. This present study aimed to explore the effectiveness of a play activities program among nursing home residents with dementia. Methods: Each nursing home was randomly assigned to an experimental group or control group. A 1-h play activities program was offered weekly for 8 weeks to the experimental group, whereas participants in the control group read books and magazines for 15 min weekly for the 8 weeks. Outcome measures were assessed at baseline, post-intervention (at week 8) and 4 weeks after the intervention. Results: A total of 53 nursing home residents from four nursing homes were recruited. There were significant treatment effects on pain, depression and happiness level when comparing the experimental group and control group. However, there were no treatment effects on activities of daily living, social engagement, behavioral symptoms and mobility between the two groups. Conclusion: The play activities program was useful in reducing pain and improving the psychological health of nursing home residents with dementia. Geriatr Gerontol Int 2018; 18: 1485–1490.", keywords = "depression, group therapy, pain, psychological and social aspects", author = "\{et al.\} and Tse, \{Mimi M.Y.\} and Lau, \{Joyce L.\} and Rick Kwan and Daphne Cheung and Tang, \{Angel S.K.\} and Ng, \{Shamay S.M.\} and Lee, \{Paul H.\} and Yeung, \{Suey S.Y.\}", note = "Publisher Copyright: {\textcopyright} 2018 Japan Geriatrics Society", year = "2018", month = oct, day = "11", doi = "10.1111/ggi.13509", language = "English", volume = "18", pages = "1485--1490", journal = "Geriatrics and Gerontology International", issn = "1444-1586", publisher = "John Wiley and Sons Inc", number = "10", } . Geriatrics and Gerontology International.

Paul H Lee (2018). Effectiveness of therapeutic clowning on handwashing habits remains unknown . Evidence Based Nursing.

One year of yoga training alters ghrelin axis in centrally obese adults with Metabolic Syndrome @article{87feb194076f45d7842e496cccab8cb3, title = "One year of yoga training alters ghrelin axis in centrally obese adults with Metabolic Syndrome", abstract = "Introduction: Metabolic syndrome (MetS) is a multiplex cardiometabolic manifestation associated with type 2 diabetes mellitus and cardiovascular diseases. Yoga training has been shown to alleviate MetS. Recently, circulatory ghrelin profile was demonstrated to be associated with MetS. This study examined the effects of 1 year of yoga training on β-cell function and insulin resistance, and the involvement of metabolic peptides, including unacylated ghrelin (UnAG), acylated ghrelin (AG), obestatin, growth hormone (GH), and insulin, in the beneficial effects of yoga training in centrally obese adults with MetS. Methods: This was a follow up study, in which data of risk factors of MetS, physical performance tests [resting heart rate (HR), chair stand test (CS), chair sit and reach test (CSR), back scratch test (BS), and single leg stand tests (SLS)] and serum samples of 79 centrally obese MetS subjects aged 58 ± 8 years (39 subjects received 1-year yoga training and 40 subjects received no training) were retrieved for analyses. β-cell function and insulin resistance were examined by Homeostasis Model Assessment (HOMA). Circulating levels of UnAG, AG, obestatin, GH, and insulin were determined by enzyme-linked immunosorbent assay using fasting serum samples. Generalized estimating equation analysis and Mann-Whitney U-test were used to detect statistically significant differences between groups. Results: Waist circumference (WC) was significantly decreased after yoga intervention (control: +2\%; yoga:-4\%). Significant improvements in HR (control: +2\%; yoga:-5\%), CS (control:-1\%; yoga: +24\%), CSR left (control: worsen by 0.90 cm; yoga: improved by 4.21 cm), CSR right (control: worsen by 0.75 cm; yoga: improved by 4.28 cm), right side of BS (control: improved by 0.19 cm; yoga: improved by 4.31 cm), SLS left (control:-10\%; yoga: +86\%), and SLS right (control:-6\%; yoga: +47\%) were observed after 1-year yoga training. No significant difference was found between the two groups in insulin, HOMA indices, and disposition index. Yoga training significantly increased circulating GH (control:-3\%; yoga: +22\%), total circulating ghrelin (control:-26\%; yoga: +13\%), and UnAG (control:-27\%; yoga: +14\%), whereas decreased AG (control:-7\%; yoga:-33\%) and obestatin (control: +24\%; yoga:-29\%). Conclusion: One-year of yoga training modulated total ghrelin, UnAG, AG, obestatin, and GH while exerting beneficial effects on physical functions and central obesity in adults with MetS. The beneficial effects of yoga may be associated with the alteration of ghrelin gene product and GH.", keywords = "Acylated ghrelin, Ghrelin, Growth hormone, Insulin, Mind-body exercise, Obesity, Obestatin, Unacylated ghrelin", author = "Yu, \{Angus P.\} and Ugwu, \{Felix N.\} and Tam, \{Bjorn T.\} and Lee, \{Paul H.\} and Lai, \{Christopher W.\} and Wong, \{Cesar S.C.\} and Lam, \{Wendy W.\} and Sinead Sheridan and Siu, \{Parco M.\}", note = "Funding Information: This study was supported by the Hong Kong Polytechnic University Research Fund (RU3N), the University of Hong Kong Seed Fund for Basic Research, and the Hong Kong Jockey Club Charities Trust. Publisher Copyright: {\textcopyright} 2007-2018 Frontiers Media S.A. All Rights Reserved.", year = "2018", month = sep, day = "20", doi = "10.3389/fphys.2018.01321", language = "English", volume = "9", journal = "Frontiers in Physiology", issn = "1664-042X", publisher = "Frontiers Media SA", number = "9", } . Frontiers in Physiology.

Ghrelin axis reveals the interacting influence of central obesity and hypertension @article{5c5f7f0646c84f799b6c5c02552b7a06, title = "Ghrelin axis reveals the interacting influence of central obesity and hypertension", abstract = "Objective: This study aimed to investigate how central obesity and hypertension modulate unacylated ghrelin (UnAG), acylated ghrelin (AG), obestatin, growth hormone (GH), and the ratios of UnAG/obestatin, AG/obestatin, and total ghrelin/obestatin. Methods: Circulatory abundances of UnAG, AG, obestatin and GH were determined in 387 Hong Kong Chinese female adults with age between 24 to 86 years based on a 2 × 2 factorial design of hypertension (blood pressure ≥140/90 mmHg) and central obesity (waist circumference or WC ≥80 cm). Participants were categorized as neither hypertensive nor centrally obese (NHNO; n = 105), hypertensive but not centrally obese (HNO; n = 102), centrally obese but not hypertensive (NHO; n = 74) and hypertensive and centrally obese (NO; n = 106). Pearson's correlation analyses were performed to detect the association between the peptides examined with WC and blood pressure. The main and interaction effects of hypertension and central obesity were examined by generalized estimating equations analyses. Results: Correlation analyses revealed that systolic blood pressure was negatively correlated with AG/obestatin, UnAG/obestatin and total ghrelin/obestatin ratios, AG, total ghrelin, and GH, while diastolic blood pressure was negatively correlated with UnAG/obestatin, total ghrelin/obestatin ratios, and GH. WC was negatively correlated with AG/obestatin, UnAG/obestatin, and total ghrelin/obestatin ratios, UnAG, AG, total ghrelin, GH, and obestatin. Interaction effects of hypertension and central obesity were observed on UnAG/obestatin, AG/obestatin and total ghrelin/obestatin ratios, and obestatin. Obestatin in NHO group was significantly higher compared to NHNO and HO groups. UnAG/obestatin, AG/obestatin, and total ghrelin/obestatin ratios were higher in NHNO group compared to HNO and HO groups. Main effects of central obesity and hypertension were observed in UnAG, total ghrelin and GH. The HO group manifested the lowest level of UnAG, total ghrelin and GH among all the groups studied. Main effect of hypertension was observed on AG, suggesting that hypertensive individuals exhibited lower levels of AG regardless of central obesity. Conclusion: Circulatory ghrelin gene products and GH exhibit different modes of modulation in response to the co-manifestation of multiple cardiovascular risk factors compared with a single risk factor alone.", keywords = "Central obesity, Ghrelin, Growth hormone, Hypertension, Obestatin", author = "Yu, \{Angus P.\} and Ugwu, \{Felix N.\} and Tam, \{Bjorn T.\} and Lee, \{Paul H.\} and Lai, \{Christopher W.\} and Wong, \{Cesar S.C.\} and Siu, \{Parco M.\}", note = "Funding Information: This study was supported by the University of Hong Kong Seed Fund for Basic Research, Hong Kong Polytechnic University Research Fund (RU3N) and the Hong Kong Jockey Club Charities Trust. Publisher Copyright: {\textcopyright} 2007 - 2018 Frontiers Media S.A. All Rights Reserved.", year = "2018", month = sep, day = "12", doi = "10.3389/fendo.2018.00534", language = "English", volume = "9", journal = "Frontiers in Endocrinology", issn = "1664-2392", publisher = "Frontiers Media SA", number = "9", } . Frontiers in Endocrinology.

Adipokines demonstrate the interacting influence of central obesity with other cardiometabolic risk factors of metabolic syndrome in Hong Kong Chinese adults @article{09c0f1f771a64106a0bd698da711642a, title = "Adipokines demonstrate the interacting influence of central obesity with other cardiometabolic risk factors of metabolic syndrome in Hong Kong Chinese adults", abstract = "Objective Metabolic syndrome (MetS) or prediabetes is a complex disorder that is defined by a clustering of cardiometabolic risk factors, including obesity, hypertriglyceridemia, reduced high-density lipoprotein (HDL) cholesterol, hypertension, and insulin resistance. Among cardiometabolic risk factors, central obesity plays a key role in the development of MetS through alterations in the secretion of adipokines and interacts with other MetS risk factors to unfavorably influence overall cardiometabolic risk. Obesity has grasped epidemic proportions in Asia, which has the highest number of people with diabetes in the world. But, the importance of central obesity in the clustering of all four MetS risk factors or vice versa in predicting severity of MetS has not yet been investigated in Asian population. Therefore, the present study examined the influence of central obesity on circulating levels of adipokines through its interaction with the clustering of cardiometabolic risk factors of MetS including hyperglycemia, hypertriglyceridemia, dyslipidemia and hypertension in Hong Kong Chinese adults. Subjects Blood samples from 83 Hong Kong Chinese adults, who were previously screened for MetS according to the guideline of the United States National Cholesterol Education Program Expert Panel Adult Treatment Panel III criteria were selected. Insulin and adipokines, including visfatin, chemerin, plasminogen activator inhibitor-1 (PAI-1), resistin, C-C motif chemokine ligand 2 (CCL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumour necrosis factor-α (TNF-α), leptin and adiponectin were assessed. Results The interacting effect of central obesity with all of the other four MetS risk factors increased the proinflammatory status of adipokines (TNF-α, leptin) and decreased the anti-inflammatory status of adipokine (adiponectin). Conclusion Our results indicate that the inflammatory status of MetS may be more severe in the presence of central obesity. Adipokines, as biomarkers for pathophysiological changes, may help to improve early patient identification and to predict MetS-associated morbidity and mortality.", author = "\{et al.\} and Rashmi Supriya and Tam, \{Bjorn T.\} and Yu, \{Angus P.\} and Lee, \{Paul H.\} and Lai, \{Christopher W.\} and Cheng, \{Kenneth K.\} and Yau, \{Sonata Y.\} and Chan, \{Lawrence W.\} and Yung, \{Benjamin Y.\} and Sinead Sheridan and Siu, \{Parco M.\}", note = "Funding Information: We declare all the funding or sources of support received during this specific study as the following, and all the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This study was supported by the Hong Kong Research Grants Council Hong Kong Ph.D. Fellowship Scheme (RTVX PF13-11753), the Hong Kong Polytechnic University Research Fund (RTAS and 1-ZE17), The University of Hong Kong Seed Fund for Basic Research, and the Hong Kong Research Grants Council General Research Fund (PolyU 5632/10M). Publisher Copyright: {\textcopyright} 2018 Supriya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.", year = "2018", month = aug, day = "16", doi = "10.1371/journal.pone.0201585", language = "English", volume = "13", journal = "PLoS ONE", issn = "1932-6203", publisher = "PLOS", number = "8", } . PLoS ONE.

The effectiveness of an on-line training program for improving knowledge of fire prevention and evacuation of healthcare workers @article{da88b14b038144b68f261f6976daa575, title = "The effectiveness of an on-line training program for improving knowledge of fire prevention and evacuation of healthcare workers: a randomized controlled trial", abstract = "Background Hospitals are vulnerable to fires and the evacuation process is challenging. However, face-to-face fire prevention and evacuation training may take healthcare workers{\textquoteright} time away from patient care; therefore, effective on-line training may be warranted. We carried out and examined the effectiveness of an on-line education and training of fire prevention and evacuation training for healthcare workers in China by a randomized controlled trial using convenience sampling from five public hospitals in China. Methods A total of 128 participants were recruited between December 2014 and March 2015. The authors built a webpage that included the informed consent statement, pre-test questionnaire, video training, and post-test questionnaire. After completing the pre-test questionnaire, participants were randomly assigned to watch the intervention video (basic response to a hospital fire) or the control video (introduction to volcanic disasters). A 45-item questionnaire on knowledge of fire prevention and evacuation was administered before and after the video watching. This questionnaire were further divided into two subscales (25-item generic knowledge of fire response and 20-item hospital-specific knowledge of fire prevention and evacuation). One point was awarded for each correct answer. Results Half of the participants (n = 64, 50\%) were randomized into the intervention group and the remaining 64 (50\%) were randomized into the control group. For generic knowledge of fire prevention and evacuation, those in the intervention group improved significantly (from 16.16 to 20.44, P < 0.001) while the scores of those in the control group decreased significantly (from 15.27 to 13.70, P = 0.03). For hospital-specific knowledge of fire prevention and evacuation, those in the intervention group (from 10.75 to 11.33, P = 0.15) and the control group (from 10.38 to 10.16, P = 0.54) had insignificant change. For total score, those in the intervention group improved significantly (from 26.91 to 31.77, P < 0.001) while those in the control group decreased insignificantly (from 25.64 to 23.86, P = 0.07). After the intervention, the difference between the scores of the intervention group and the control group on all three knowledge areas of fire prevention and evacuation (generic, hospital-specific, and total) were significant (all Ps < 0.05). Conclusions An on-line fire training program delivered via educational video can effectively improve healthcare workers{\textquoteright} knowledge of fire prevention and evacuation.", author = "Lee, \{Paul H.\} and Baoguo Fu and Wangting Cai and Jingya Chen and Zhenfei Yuan and Lifen Zhang and Xiuhong Ying", note = "Publisher Copyright: {\textcopyright} 2018 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.", year = "2018", month = jul, day = "5", doi = "10.1371/journal.pone.0199747", language = "English", volume = "13", journal = "PLoS ONE", issn = "1932-6203", publisher = "PLOS", number = "7", } . PLoS ONE.

Paul H. Lee, Sara Geale, Baoguo Fu, Wangting Cai, Jingya Chen, Zhenfei Yuan, Lifen Zhang, Xiuhong Ying (2018). The effectiveness of an on-line training program for improving knowledge of fire prevention and evacuation of healthcare workers: A randomized controlled trial . PLOS ONE.

Adjusted analysis @article{7a39786965284892b922c5a1b187d992, title = "Adjusted analysis", abstract = "Typical questions: 1. I am testing the effect of drug on height, however, there is great variability in height because of confounders, e.g., age, genetics, diet, etc. A simple power analysis suggests that I will need a very large sample size. How can I reduce the requisite sample size to something I can handle? 2. In the statistical analysis, what variables should I control for, e.g., age, weight, etc.? Experimental design is a design of study aiming at evaluating the effect of a treatment on some particular outcomes by randomly assigning the subjects into either receiving the treatment or not. Experimental design has been widely used to identify causal relationship as confounding effects are removed by the randomization procedure. Therefore, experimental design is the design that provides the highest level of evidence", author = "Lee, \{Paul H.\}", year = "2018", month = jul, day = "1", doi = "10.1016/j.yjmcc.2018.05.011", language = "English", volume = "120", pages = "28--30", journal = "Journal of Molecular and Cellular Cardiology", issn = "0022-2828", publisher = "Academic Press", } . Journal of Molecular and Cellular Cardiology.

Paul H. Lee(2018). Adjusted analysis . Journal of Molecular and Cellular Cardiology. 120. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 28--30. Elsevier {BV}

Choosing an appropriate physical exercise to reduce stereotypic behavior in Children with autism spectrum disorders @article{ca87bc9e918149cdbaa798a711b59b70, title = "Choosing an appropriate physical exercise to reduce stereotypic behavior in Children with autism spectrum disorders: a non-randomized crossover study", abstract = "Considerable evidence has shown that physical exercise could be an effective treatment in reducing stereotypical autism spectrum disorder (ASD) behaviors in children. The present study seeks to examine the underlying mechanism by considering the theoretical operant nature of stereotypy. Children with ASD (n = 30) who exhibited hand-flapping and body-rocking stereotypies were asked to participate in both control (story-time) and experimental (ball-tapping-exercise intervention) conditions. The experimental condition comprised 15 min of ball tapping during which the children were asked to tap a plastic ball as many times as they could. Results indicated that hand-flapping stereotypy was significantly reduced but body-rocking stereotypy following the ball-tapping-exercise intervention was not. These results not only confirm the positive impact of exercise intervention on stereotypic behavior as shown in many previous studies, but further suggest that physical exercise should be matched with the biomechanics of stereotypy to produce a desirable behavioral benefit.", keywords = "Autism spectrum disorder, Children, Physical exercise, Repetitive behavior, Stereotypy", author = "Tse, \{C. Y.Andy\} and Pang, \{C. L.\} and Lee, \{Paul H.\}", note = "Funding Information: Acknowledgments This research was supported by Dean{\textquoteright}s Research Fund of the Education University of Hong Kong. The authors would like to express their gratitude to all the teachers, parents and children who are involved in this study, and the research assistant and student helpers who helped with data collection and other contributions. Publisher Copyright: {\textcopyright} 2017, Springer Science+Business Media, LLC, part of Springer Nature.", year = "2018", month = may, day = "1", doi = "10.1007/s10803-017-3419-3", language = "English", volume = "48", pages = "1666--1672", journal = "Journal of Autism and Developmental Disorders", issn = "0162-3257", publisher = "Springer", number = "5", } . Journal of Autism and Developmental Disorders.

The burden of mental disorders in the Eastern Mediterranean region, 1990–2015 @article{40177ffa1c85483aba8f47f04a128b42, title = "The burden of mental disorders in the Eastern Mediterranean region, 1990–2015: findings from the global burden of disease 2015 study", abstract = "Objectives: Mental disorders are among the leading causes of nonfatal burden of disease globally. Methods: We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Results: Mental disorders contributed to 4.7\% (95\% uncertainty interval (UI) 3.7–5.6\%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. Conclusions: The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.", keywords = "Anxiety disorders, Burden of disease, Depressive disorders, Eastern Mediterranean region, Mental health", author = "\{GBD 2015 Eastern Mediterranean Region Mental Health Collaborators\} and Raghid Charara and Charbel Elbcheraoui and Ibrahim Khalil and Maziar Moradi-Lakeh and Ashkan Afshin and Kassebaum, \{Nicholas J.\} and Michael Collison and Krohn, \{Kristopher J.\} and Adrienne Chew and Farah Daoud and Charlson, \{Fiona J.\} and Danny Colombara and Louisa Degenhardt and Rebecca Ehrenkranz and Erskine, \{Holly E.\} and Ferrari, \{Alize J.\} and Michael Kutz and Janni Leung and Damian Santomauro and Haidong Wang and Whiteford, \{Harvey A.\} and Abajobir, \{Amanuel Alemu\} and Foad Abd-Allah and Abraha, \{Haftom Niguse\} and Abu-Raddad, \{Laith J.\} and Aliasghar Ahmadkiadaliri and Alireza Ahmadi and Ahmed, \{Kedir Yimam\} and Ahmed, \{Muktar Beshir\} and Allami, \{Faris Hasan\} and Khurshid Alam and Deena Alasfoor and Reza Alizadeh-Navaei and Alkaabi, \{Juma M.\} and Fatma Al-Maskari and Rajaa Al-Raddadi and Altirkawi, \{Khalid A.\} and Nahla Anber and Hossein Ansari and Hamid Asayesh and Asghar, \{Rana Jawad\} and Atey, \{Tesfay Mehari\} and Tadesse Awokeayele and Till B{\"a}rnighausen and Umar Bacha and Aleksandra Barac and Barker-Collo, \{Suzanne L.\} and Baune, \{Bernhard T.\} and Shahrzad Bazargan-Hejazi and Paul Lee", note = "Funding Information: This research was funded by the Bill \& Melinda Gates Foundation. Publisher Copyright: {\textcopyright} 2017, The Author(s).", year = "2018", month = may, day = "1", doi = "10.1007/s00038-017-1006-1", language = "English", volume = "63", pages = "25--37", journal = "International Journal of Public Health", issn = "1661-8556", publisher = "Frontiers Media SA", } . International Journal of Public Health.

Burden of obesity in the Eastern Mediterranean Region @article{b9d1340eaa8343ce90b137eb1df0a49b, title = "Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study", abstract = "Objectives: We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR). Methods: We estimated the prevalence of overweight and obesity among children (2–19 years) and adults (≥20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach. Results: The prevalence of obesity increased for adults from 15.1\% (95\% UI 13.4–16.9) in 1980 to 20.7\% (95\% UI 18.8–22.8) in 2015. It increased from 4.1\% (95\% UI 2.9–5.5) to 4.9\% (95\% UI 3.6–6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3\% of total deaths and DALYs, respectively, for all ages. Conclusions: This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden.", keywords = "Burden of disease, Eastern Mediterranean Region, Obesity", author = "\{GBD 2015 Eastern Mediterranean Region Obesity Collaborators\} and Mokdad, \{Ali H.\} and \{El Bcheraoui\}, Charbel and Ashkan Afshin and Raghid Charara and Ibrahim Khalil and Maziar Moradi-Lakeh and Kassebaum, \{Nicholas J.\} and Michael Collison and Farah Daoud and Krohn, \{Kristopher J.\} and Adrienne Chew and Biryukov, \{Stan H.\} and Leslie Cornaby and Foreman, \{Kyle J.\} and Michael Kutz and Patrick Liu and Marissa Reitsma and Patrick Sur and Haidong Wang and Ben Zipkin and Johan {\"A}rnl{\"o}v and Cristiana Abbafati and Abdulle, \{Abdishakur M.\} and Abu-Rmeileh, \{Niveen M.E.\} and Ahmed, \{Muktar Beshir\} and Ziyad Al-Aly and Khurshid Alam and Reza Alizadeh-Navaei and Ala'a Alkerwi and Altirkawi, \{Khalid A.\} and Nelson Alvis-Guzman and Baune, \{Bernhard T.\} and Neeraj Bedi and Bennett, \{Derrick A.\} and Beyene, \{Addisu S.\} and Bhutta, \{Zulfiqar A.\} and Birhanu, \{Mulugeta M.\} and Hadi Danawi and Fereshtehnejad, \{Seyed Mohammad\} and Florian Fischer and Gebrehiwot, \{Tsegaye Tewelde\} and Gill, \{Paramjit Singh\} and Gona, \{Philimon N.\} and Vipin Gupta and Habtewold, \{Tesfa Dejenie\} and Hamadeh, \{Randah Ribhi\} and Samer Hamidi and Hareri, \{Habtamu Abera\} and Masako Horino and Mohamed Hsairi and Paul Lee", note = "Funding Information: This research was funded by the Bill \& Melinda Gates Foundation. Publisher Copyright: {\textcopyright} 2017, The Author(s).", year = "2018", month = may, day = "1", doi = "10.1007/s00038-017-1002-5", language = "English", volume = "63", pages = "165--176", journal = "International Journal of Public Health", issn = "1661-8556", publisher = "Frontiers Media SA", } . International Journal of Public Health.

Maternal mortality and morbidity burden in the Eastern Mediterranean Region @article{48a409b240c241ac87e94ccb8d8110b2, title = "Maternal mortality and morbidity burden in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study", abstract = "Objectives: Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. Methods: We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. Results: The maternal mortality ratio in the EMR decreased 16.3\% from 283 (241–328) maternal deaths per 100,000 live births in 1990 to 237 (188–293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. Conclusion: Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life.", keywords = "Burden of disease, Eastern Mediterranean Region, Maternal health, Maternal mortality", author = "\{GBD 2015 Eastern Mediterranean Region Maternal Mortality Collaborators\} and Mokdad, \{Ali H.\} and Ibrahim Khalil and Michael Collison and \{El Bcheraoui\}, Charbel and Raghid Charara and Maziar Moradi-Lakeh and Ashkan Afshin and Adrienne Chew and Farah Daoud and Krohn, \{Kristopher J.\} and Danny Colombara and Rebecca Ehrenkranz and Michael Kutz and Haidong Wang and Abajobir, \{Amanuel Alemu\} and Foad Abd-Allah and Abraha, \{Haftom Niguse\} and Abu-Raddad, \{Laith J.\} and Kiadaliri, \{Aliasghar Ahmad\} and Alireza Ahmadi and Ahmed, \{Kedir Yimam\} and Ahmed, \{Muktar Beshir\} and \{Al Lami\}, \{Faris Hasan\} and Khurshid Alam and Deena Alasfoor and Reza Alizadeh-Navaei and Alkaabi, \{Juma M.\} and Fatma Al-Maskari and Rajaa Al-Raddadi and Altirkawi, \{Khalid A.\} and Nahla Anber and Hossein Ansari and Hamid Asayesh and Asghar, \{Rana Jawad\} and Atey, \{Tesfay Mehari\} and Ayele, \{Tadesse Awoke\} and Till B{\"a}rnighausen and Umar Bacha and Aleksandra Barac and Barker-Collo, \{Suzanne L.\} and Baune, \{Bernhard T.\} and Shahrzad Bazargan-Hejazi and Neeraj Bedi and Bensenor, \{Isabela M.\} and Adugnaw Berhane and Beyene, \{Addisu Shunu\} and Bhutta, \{Zulfiqar A.\} and Boneya, \{Dube Jara\} and Rohan Borschmann and Wang, \{Yuan Pang\} and Paul Lee", note = "Funding Information: This research was funded by the Bill \& Melinda Gates Foundation. Publisher Copyright: {\textcopyright} 2017, The Author(s).", year = "2018", month = may, day = "1", doi = "10.1007/s00038-017-1004-3", language = "English", volume = "63", pages = "47--61", journal = "International Journal of Public Health", issn = "1661-8556", publisher = "Frontiers Media SA", } . International Journal of Public Health.

Validation study of accelerometer in measuring some sleep parameters in adults—reply @article{c2de5b37f4914805accc047db86e74fd, title = "Validation study of accelerometer in measuring some sleep parameters in adults—reply", abstract = "Invited Letter to the Editor: Dr. Kawada raised three concerns about our study. First, the validity of the reference accelerometer, Actiwatch 2, was questioned, as there existed only validation study in children and adolescents (against polysomnography). Second, there are a number of thresholds for classifying sleep and awake epochs and they perform differently in measuring different sleep parameters. Third, subjects with insomnia may have little motion during wakefulness and these wakefulness time might be misclassified as sleep by accelerometers", author = "Lee, \{Paul H.\}", year = "2018", month = may, day = "1", doi = "10.1007/s11325-017-1552-z", language = "English", volume = "22", journal = "Sleep and Breathing", issn = "1520-9512", publisher = "Springer Science and Business Media B.V.", number = "2", } . Sleep and Breathing.

Study protocol for a randomised controlled trial examining the association between physical activity and sleep quality in children with autism spectrum disorder based on the melatonin-mediated mechanism model @article{b7ccd2cfed1543369a968fc513b8cf63, title = "Study protocol for a randomised controlled trial examining the association between physical activity and sleep quality in children with autism spectrum disorder based on the melatonin-mediated mechanism model", abstract = "Introduction Sleep disturbance is commonly observed in children with autism spectrum disorders (ASD). Disturbed sleep may exacerbate the core symptoms of ASD. Behavioural interventions and supplemental melatonin medication are traditionally used to improve sleep quality, but poor sustainability of behavioural intervention effects and use of other medications that metabolise melatonin may degrade the effectiveness of these interventions. However, several studies have suggested that physical activity may provide an effective intervention for treating sleep disturbance in typically developing children. Thus, we designed a study to examine whether such an intervention is also effective in children with ASD. We present a protocol (4 December 2017) for a jogging intervention with a parallel and two-group randomised controlled trial design using objective actigraphic assessment and 6-sulfatoxymelatonin measurement to determine whether a 12-week physical activity intervention elicits changes in sleep quality or melatonin levels. Methods and analysis All eligible participants will be randomly allocated to either a jogging intervention group or a control group receiving standard care. Changes in sleep quality will be monitored through actigraphic assessment and parental sleep logs. All participants will also be instructed to collect a 24-hour urine sample. 6-sulfatoxymelatonin, a creatinine-adjusted morning urinary melatonin representative of the participant's melatonin levels, will be measured from the sample. All assessments will be carried out before the intervention (T1), immediately after the 12-week intervention or regular treatment (T2), 6 weeks after the intervention (T3) and 12 weeks after the intervention (T4) to examine the sustainability of the intervention effects. The first enrolment began in February 2018. Ethics and dissemination Ethical approval was obtained through the Human Research Ethics Committee, Education University of Hong Kong. The results of this trial will be submitted for publication in peer-reviewed journals. Trial registration number NCT03348982.", keywords = "children with autism spectrum disorders, melatonin, physical activity, sleep", author = "Tse, \{Andy C.Y.\} and Lee, \{Paul H.\} and Jihui Zhang and Lai, \{Elvis W.H.\}", note = "Funding Information: Funding This work was supported by the Early Career Scheme of Research Publisher Copyright: {\textcopyright} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.", year = "2018", month = apr, day = "13", doi = "10.1136/bmjopen-2017-020944", language = "English", volume = "8", journal = "BMJ Open", issn = "2044-6055", publisher = "BMJ Publishing Group", number = "4", } . BMJ Open.

Andy C Y Tse, Paul H Lee, Jihui Zhang, Elvis W H Lai (2018). Study protocol for a randomised controlled trial examining the association between physical activity and sleep quality in children with autism spectrum disorder based on the melatonin-mediated mechanism model . BMJ Open.

Adipokine profiling in adult women with central obesity and hypertension @article{40f05634adac47849c96afa67daf5c7b, title = "Adipokine profiling in adult women with central obesity and hypertension", abstract = "Central obesity and hypertension are common risk factors for the metabolic syndrome, cardiovascular and renal diseases. Studies have shown that it is more difficult to control blood pressure and prevent end-organ damage in obese individuals with hypertension compared to their non-obese counterparts, especially among women. Obese females have a 6 times higher risk of developing hypertension than non-obese females while obese males are at a 1.5 times higher risk of developing hypertension, compared to their non-obese counterparts. Indeed, the inter-relationship between obesity and hypertension is unclear. Adipokines have been proposed to play a mediating role in the relationship between obesity and hypertension and are involved in the pathogenesis of metabolic diseases. Therefore, this study sought to determine the role of adipokines (adiponectin, plasminogen activator inhibitor-1, leptin, and tumor necrosis factor-α) in hypertensive Hong Kong Chinese women with central obesity. A total of 387 women aged 58 ± 11 years who were examined with a 2 × 2 factorial design for central obesity (waist circumference ≥ 80 cm) and hypertension (blood pressure ≥ 140/90 mmHg), were recruited from a pool of 1,492 Hong Kong Chinese adults who were previously screened for metabolic syndrome. Subjects with hyperglycemia, hypertriglyceridemia, and dyslipidemia were excluded to eliminate confounding effects. Our findings revealed that hypertensive women with central obesity had a lower anti-inflammatory status (adiponectin) and a higher pro-inflammatory status (TNF-α) than obese alone or hypertensive alone women. Also, women with central obesity had higher circulatory PAI-1 and leptin concentrations than their non-obese counterparts. We conclude that obesity may shift toward a more pro-inflammatory state and may become more severe in the presence of hypertension or vice versa.", keywords = "Abdominal obesity, Adipocyte, Coronary artery disease, Diabetes, High blood pressure, Inflammation, Renal disease, Stroke", author = "\{et al.\} and Rashmi Supriya and Yung, \{Benjamin Y.\} and Yu, \{Angus P.\} and Lee, \{Paul H.\} and Lai, \{Christopher W.\} and Cheng, \{Kenneth K.\} and Yau, \{Suk Y.\} and Chan, \{Lawrence W.C.\} and Sinead Sheridan and Siu, \{Parco M.\}", note = "Publisher Copyright: {\textcopyright} 2018 Supriya, Yung, Yu, Lee, Lai, Cheng, Yau, Chan, Sheridan and Siu.", year = "2018", month = mar, day = "27", doi = "10.3389/fphys.2018.00294", language = "English", volume = "9", journal = "Frontiers in Physiology", issn = "1664-042X", publisher = "Frontiers Media SA", number = "3", } . Frontiers in Physiology.

Yoga training modulates adipokines in adults with high-normal blood pressure and metabolic syndrome @article{4a405b56c79944438b2377c17145f10a, title = "Yoga training modulates adipokines in adults with high-normal blood pressure and metabolic syndrome", abstract = "Metabolic syndrome (MetS) is associated with diabetes mellitus and cardiovascular diseases. Our previous study indicated that people with MetS showed a decrease in waist circumference and a decreasing trend in blood pressure after 1-year yoga. This study investigated the effect of yoga on MetS people with high-normal blood pressure by exploring modulations in proinflammatory adipokines (leptin, chemerin, visfatin, and plasminogen activator inhibitor-1 or PAI-1) and an anti-inflammatory adipokine (adiponectin). A total of 97 Hong Kong Chinese individuals aged 57.6 ± 9.1 years with MetS and high-normal blood pressure were randomly assigned to control (n = 45) and yoga groups (n = 52). Participants in the control group were not given any intervention but were contacted monthly to monitor their health status. Participants in the yoga group underwent a yoga training program with three 1-hour yoga sessions weekly for 1 year. The participants{\textquoteright} sera were harvested and assessed for adipokines. Generalized estimating equation (GEE) was used to examine the interaction effect between 1-year time (pre vs post), and intervention (control vs yoga). GEE analyses revealed significant interaction effects between 1-year time and yoga intervention for the decreases in leptin and chemerin and the increase in adiponectin concentration in the sera examined. These results demonstrated that 1-year yoga training decreased proinflammatory adipokines and increased anti-inflammatory adipokine in adults with MetS and high-normal blood pressure. These findings support the beneficial role of yoga in managing MetS by favorably modulating adipokines.", keywords = "adipokine, high blood pressure, hypertension, metabolic syndrome, mind-body exercise", author = "\{et al.\} and Rashmi Supriya and Yu, \{Angus P.\} and Lee, \{Paul H.\} and Lai, \{Christopher W.\} and Cheng, \{Kenneth K.\} and Yau, \{Sonata Y.\} and Chan, \{Lawrence W.\} and Yung, \{Benjamin Y.\} and Siu, \{Parco M.\}", note = "Funding Information: This study was supported by the Hong Kong Research Grants Council Hong Kong Ph.D. Fellowship Scheme (RTVX PF13-11753), The Hong Kong Polytechnic University Research Fund (1-ZE17), and The University of Hong Kong Seed Fund for Basic Research. Funding Information: Hong Kong Research Grants Council Hong Kong Ph.D. Fellowship Scheme, Grant/ Award Number: RTVX PF13-11753; Hong Kong Polytechnic University Research Fund, Grant/Award Number: 1-ZE17; The University of Hong Kong Seed Fund for Basic Research Publisher Copyright: {\textcopyright} 2017 John Wiley \& Sons A/S. Published by John Wiley \& Sons Ltd", year = "2018", month = mar, day = "1", doi = "10.1111/sms.13029", language = "English", volume = "28", pages = "1130--1138", journal = "Scandinavian Journal of Medicine and Science in Sports", issn = "0905-7188", publisher = "Blackwell Munksgaard", number = "3", } . Scandinavian Journal of Medicine and Science in Sports.

Rashmi Supriya, Angus P. Yu, Paul H. Lee, Christopher W. Lai, Kenneth K. Cheng, Sonata Y. Yau, Lawrence W. Chan, Benjamin Y. Yung, Parco M. Siu (2018). Yoga training modulates adipokines in adults with high‐normal blood pressure and metabolic syndrome . Scandinavian Journal of Medicine & Science in Sports.

A new statistical model for the Day Reconstruction Method @article{75f99e6dd0b04f73a5e049ffa4f29edf, title = "A new statistical model for the Day Reconstruction Method", abstract = "The Day Reconstruction Method (DRM) is a method to measure one's subjective affective status by soliciting information in a questionnaire about the previous day's activities. We developed a new model to examine the association of daily activities, the friendliness of interacting partners, and time-of-day on net affect scores among 10,377 adults participating in the World Health Organization's Study on global ageing and adult health (SAGE). A multilevel regression was fitted and the time-of-day effect was modeled by restricted cubic spline. The net affect score was a serpentine curve; stable from 4 a.m. to 6 a.m., increased from 7 a.m. to 12 noon, and became stable onwards. Participants had the highest net affect scores during religious activities (0.48, 95\% confidence interval [CI]: 0.44, 0.53), and they enjoyed leisure activities, exercising, and household responsibilities more than work. Compared with events that lacked interacting partners, activities with very friendly interacting partners were associated with higher net affect scores (0.21, 95\% CI: 0.19, 0.22), but events with slightly friendly interacting partners, slightly irritating or very irritating partners had lower net affect scores. To conclude, researchers using DRM for assessing well-being status across time should include the type of activities and the friendliness of the interacting partners.", keywords = "data analysis, non-linear, questionnaire, well-being, World Health Organization", author = "Lee, \{Paul H.\} and Tse, \{Andy C.Y.\} and Lee, \{Ka Yiu\}", note = "Publisher Copyright: Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.", year = "2017", month = dec, day = "1", doi = "10.1002/mpr.1547", language = "English", volume = "26", journal = "International Journal of Methods in Psychiatric Research", issn = "1049-8931", publisher = "Wiley-Blackwell", number = "4", } . International Journal of Methods in Psychiatric Research.

Paul H. Lee, Andy C.Y. Tse, Ka Yiu Lee (2017). A new statistical model for the Day Reconstruction Method . International Journal of Methods in Psychiatric Research.

Diagnosis checking of statistical analysis in RCTs indexed in PubMed @article{75887721468a4f3bb1b78fee3d6cea94, title = "Diagnosis checking of statistical analysis in RCTs indexed in PubMed", abstract = "Background: Statistical analysis is essential for reporting of the results of randomized controlled trials (RCTs), as well as evaluating their effectiveness. However, the validity of a statistical analysis also depends on whether the assumptions of that analysis are valid. Objective: To review all RCTs published in journals indexed in PubMed during December 2014 to provide a complete picture of how RCTs handle assumptions of statistical analysis. Methods: We reviewed all RCTs published in December 2014 that appeared in journals indexed in PubMed using the Cochrane highly sensitive search strategy. The 2014 impact factors of the journals were used as proxies for their quality. The type of statistical analysis used and whether the assumptions of the analysis were tested were reviewed. Results: In total, 451 papers were included. Of the 278 papers that reported a crude analysis for the primary outcomes, 31 (27·2\%) reported whether the outcome was normally distributed. Of the 172 papers that reported an adjusted analysis for the primary outcomes, diagnosis checking was rarely conducted, with only 20\%, 8·6\% and 7\% checked for generalized linear model, Cox proportional hazard model and multilevel model, respectively. Study characteristics (study type, drug trial, funding sources, journal type and endorsement of CONSORT guidelines) were not associated with the reporting of diagnosis checking. Conclusion: The diagnosis of statistical analyses in RCTs published in PubMed-indexed journals was usually absent. Journals should provide guidelines about the reporting of a diagnosis of assumptions.", keywords = "Assumption, diagnosis, protocol, statistics, trials", author = "Lee, \{Paul H.\} and Tse, \{Andy C.Y.\}", note = "Publisher Copyright: {\textcopyright} 2017 Stichting European Society for Clinical Investigation Journal Foundation", year = "2017", month = nov, day = "1", doi = "10.1111/eci.12833", language = "English", volume = "47", pages = "847--852", journal = "European Journal of Clinical Investigation", issn = "0014-2972", publisher = "John Wiley and Sons Inc", number = "11", } . European Journal of Clinical Investigation.

Paul H. Lee, Andy C. Y. Tse (2017). Diagnosis checking of statistical analysis in RCTs indexed in PubMed . European Journal of Clinical Investigation.

Paul Lee, Regina Lee, Cynthia Leung, Hong Chen, Lobo Louie, Michael Brown, Jyu-Lin Chen, Gordon Cheung (2017). The Impact of a School-Based Weight Management Program Involving Parents via mHealth for Overweight and Obese Children and Adolescents with Intellectual Disability: A Randomized Controlled Trial . International Journal of Environmental Research and Public Health.

The impact of a school-based weight management program involving parents via mhealth for overweight and obese children and adolescents with intellectual disability @article{5403c64d3a364abeba7ecd41fd274492, title = "The impact of a school-based weight management program involving parents via mhealth for overweight and obese children and adolescents with intellectual disability: a randomized controlled trial", abstract = "There is a scarcity of resources and studies that utilize targeted weight management interventions to engage parents via mHealth tools targeting obese children and adolescents with mild intellectual disabilities (MIDs) extended from school to a home setting. To test the feasibility and acceptability of a school-based weight program (SBWMP) involving parents via mHealth tools designed to reduce weight, enhance knowledge and adopt healthy lifestyles, and thereby achieve better psychosocial well-being among children and adolescents with MIDs. Four special schools were randomly assigned as intervention or control schools. Students from the intervention group (n = 63) were compared to those in the control group (n = 52), which comprised those with usual school planned activities and no parental involvement. Demographics were considered as covariates in a general linear model, an ordinal regression model and a binary logistic regression model analyzing the relationships between the SBWMP and the outcome variables at baseline (T0) and six months later (T1). Body weight, body mass index, and triceps and subscapular skinfold thickness were lower in the intervention group compared to the control group, although the differences were not statistically significant. There was a positive and direct impact of the SBWMP on students{\textquoteright} health knowledge and psychological impacts in the intervention group. The SBWMP extended to the home involving parents via mHealth tools is a feasible and acceptable program for this group with MIDs and their parents.", keywords = "Engaging parents via mhealth tools, Home setting, Overweight and obese schoolchildren with mild intellectual disabilities, School-based weight management program", author = "\{et al.\} and Lee, \{Regina Lai Tong\} and Cynthia Leung and Hong Chen and Louie, \{Lobo H.T.\} and Michael Brown and Chen, \{Jyu Lin\} and Gordon Cheung and Lee, \{Paul H.\}", note = "Funding Information: Acknowledgments: This study was funded by the Research Grant Council—General Research Fund 2014/5, PolyU 154027/14H. The research team would like to express their sincere thanks to the participating schools and school personnel for their endless support, with special thanks to the participating parents as well. Publisher Copyright: {\textcopyright} 2017 by the authors. Licensee MDPI, Basel, Switzerland.", year = "2017", month = oct, day = "5", doi = "10.3390/ijerph14101178", language = "English", volume = "14", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "10", } . International Journal of Environmental Research and Public Health.

Childhood exposure to constricted living space @article{3ffa81faf4884e23bbcaee1416957c41, title = "Childhood exposure to constricted living space: a possible environmental threat for myopia development", abstract = "Purpose: People in Hong Kong generally live in a densely populated area and their homes are smaller compared with most other cities worldwide. Interestingly, East Asian cities with high population densities seem to have higher myopia prevalence, but the association between them has not been established. This study investigated whether the crowded habitat in Hong Kong is associated with refractive error among children. Methods: In total, 1075 subjects [Mean age (S.D.): 9.95 years (0.97), 586 boys] were recruited. Information such as demographics, living environment, parental education and ocular status were collected using parental questionnaires. The ocular axial length and refractive status of all subjects were measured by qualified personnel. Results: Ocular axial length was found to be significantly longer among those living in districts with a higher population density (F2,1072 = 6.15, p = 0.002) and those living in a smaller home (F2,1072 = 3.16, p = 0.04). Axial lengths were the same among different types of housing (F3,1071 = 1.24, p = 0.29). Non-cycloplegic autorefraction suggested a more negative refractive error in those living in districts with a higher population density (F2,1072 = 7.88, p < 0.001) and those living in a smaller home (F2,1072 = 4.25, p = 0.02). After adjustment for other confounding covariates, the population density and home size also significantly predicted axial length and non-cycloplegic refractive error in the multiple linear regression model, while axial length and refractive error had no relationship with types of housing. Conclusions: Axial length in children and childhood refractive error were associated with high population density and small home size. A constricted living space may be an environmental threat for myopia development in children.", keywords = "childhood refractive error, constricted living space, epidemiology, living environment, myopia, myopia prevalence", author = "\{et al.\} and Choi, \{Kai Yip\} and Yu, \{Wing Yan\} and Lam, \{Christie Hang I.\} and Li, \{Zhe Chuang\} and Chin, \{Man Pan\} and Yamunadevi Lakshmanan and Wong, \{Francisca Siu Yin\} and Do, \{Chi Wai\} and Lee, \{Paul Hong\} and Chan, \{Henry Ho Lung\}", note = "Funding Information: This study was supported by General Research Fund from the Research Grants Council of the Hong Kong Special Administrative Region, China (PolyU 5605/13M) and Internal Research Grants, The Hong Kong Polytechnic University (G-YBBS, Z0GF). The authors would like to acknowledge Dr. J Neuville for proofreading the manuscript, and Dr. JX Lian for providing statistical advice. Publisher Copyright: {\textcopyright} 2017 The Authors Ophthalmic \& Physiological Optics {\textcopyright} 2017 The College of Optometrists", year = "2017", month = sep, day = "1", doi = "10.1111/opo.12397", language = "English", volume = "37", pages = "568--575", journal = "Ophthalmic and Physiological Optics", issn = "0275-5408", publisher = "Springer Nature", number = "5", } . Ophthalmic and Physiological Optics.

Kai Yip Choi, Wing Yan Yu, Christie Hang I Lam, Zhe Chuang Li, Man Pan Chin, Yamunadevi Lakshmanan, Francisca Siu Yin Wong, Chi Wai Do, Paul Hong Lee, Henry Ho Lung Chan(2017). Childhood exposure to constricted living space: a possible environmental threat for myopia development . Ophthalmic and Physiological Optics. 37. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 568--575. Wiley

Workplace violence toward physicians and nurses @article{f15fa6d266074fde9a3dcf90fd2488a5, title = "Workplace violence toward physicians and nurses: prevalence and correlates in Macau", abstract = "This paper sets out to estimate the prevalence of workplace violence in relation to socio-demographic characteristics of physicians and nurses working in healthcare settings in Macau. Background: Concerted efforts worldwide to reduce workplace violence (WPV) have not yet removed medical-related professionals from the threat of patients{\textquoteright}, family members{\textquoteright}, and colleagues{\textquoteright} physical and other assaults in Southeast Asia. Methods: The study employs a cross-sectional design to estimate the prevalence and examines the socio-economic and psychological correlates of WPV among medical doctors and nurses in Macau. The data collection period spanned from August to December 2014. Multiple logistic regression examines the prevalence rates of WPV and its associated factors in doctors and nurses. Results: A total of 107 doctors (14.9\%) and 613 nurses (85.1\%) participated in the study; 57.2\% had suffered WPV in the preceding year. The most common forms of workplace violence were verbal abuse (53.4\%), physical assault (16.1\%), bullying/harassment (14.2\%), sexual harassment (4.6\%), and racial harassment (2.6\%). Most violence was perpetrated by patients and their relatives, colleagues, and supervisors. Conclusions: WPV remains a significant concern in healthcare settings in Macau. Macau{\textquoteright}s local health authority should consider putting in place a raft of zero-tolerance policies designed to prevent it.", keywords = "Doctors, Macau, Mental health, Nurses, Occupational stress, Workplace violence", author = "Teris Cheung and Lee, \{Paul H.\} and Yip, \{Paul S.F.\}", note = "Publisher Copyright: {\textcopyright} 2017 by the authors.", year = "2017", month = aug, day = "4", doi = "10.3390/ijerph14080879", language = "English", volume = "14", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "8", } . International Journal of Environmental Research and Public Health.

Paul Lee, Teris Cheung, Paul Yip (2017). Workplace Violence toward Physicians and Nurses: Prevalence and Correlates in Macau . International Journal of Environmental Research and Public Health.

Is weekend-only physical activity enough to compensate for a sedentary lifestyle? @article{37753e9551ab49eb884e0a8188cc2f8f, title = "Is weekend-only physical activity enough to compensate for a sedentary lifestyle?", abstract = "To the Editor: In their Original Investigation published in a recent issue of JAMA Internal Medicine, O{\textquoteright}Donovan et al1 claim that “weekend warrior” and other leisure time physical activity patterns characterized by 1 or 2 sessions per week may be sufficient to reduce all-cause, cardiovascular disease, and cancer mortality risks. We notice that the authors may have overlooked a major confounder in this study: the geographical variations within the sample. ", author = "Lam, \{Michael Huen Sum\} and Lee, \{Paul H.\} and Lee, \{Ka Yiu\}", year = "2017", month = aug, day = "1", doi = "10.1001/jamainternmed.2017.2380", language = "English", volume = "177", pages = "1224", journal = "JAMA Internal Medicine", issn = "2168-6106", publisher = "American Medical Association", number = "8", } . JAMA Internal Medicine.

The associations between religion, bereavement and depression among Hong Kong nurses @article{52a274a0f347474cb88492098c224d56, title = "The associations between religion, bereavement and depression among Hong Kong nurses", abstract = "Background: This paper is to examine the associations between religion, bereavement and depression among nursing professionals using a cross-sectional survey design. There is little empirical evidence in Asia suggesting that religion may either increase or lower the likelihood of nursing professionals being depressed. Methods: We analyzed the results of a Mental Health Survey soliciting data from 850 Hong Kong nurses (aged 21-59, 178 males) regarding their mental well-being and associated factors, including participants' socio-economic profile and recent life-events. Multiple linear regression analyses examined associations between religion, bereavement and depression. Results: Religious faith is weakly associated with lower self-reported depression in bereavement. Conclusions: Our findings confirm those studies suggesting that religion positively affects mental health and yet healthcare providers have yet to assimilate this insight.", keywords = "Bereavement, Depression, Mental health, Nurses, Religion", author = "Teris Cheung and Lee, \{Paul H.\} and Yip, \{Paul S.F.\}", note = "Funding Information: Association of Hong Kong Nursing Staff for recruiting participants in this study. Special thanks go to Dr. Calais Chan, Associate Professor in the Department of Psychology, University of Hong Kong, who allowed us to use his translated Chinese version of the DASS21 in our study. Publisher Copyright: {\textcopyright} 2017 The Author(s).", year = "2017", month = jul, day = "4", doi = "10.1186/s13104-017-2588-7", language = "English", volume = "10", journal = "BMC Research Notes", issn = "1756-0500", publisher = "BioMed Central", number = "1", } . BMC Research Notes.

Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome @article{bd414fd1189145a2806b83fa733cfaba, title = "Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome", abstract = "Background: The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need. Method: First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey. Results: Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided. Conclusion: It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors.", keywords = "Bouts, Breaks, Interruptions, Lying, Non-screen-based time, Physical inactivity, Reclining, Screen time, Sedentary behavior, Sitting, Standing, Stationary behavior", author = "\{on behalf of SBRN Terminology Consensus Project Participants\} and \{et al.\} and Tremblay, \{Mark S.\} and Salom{\'e} Aubert and Barnes, \{Joel D.\} and Saunders, \{Travis J.\} and Valerie Carson and Latimer-Cheung, \{Amy E.\} and Chastin, \{Sebastien F.M.\} and Altenburg, \{Teatske M.\} and Chinapaw, \{Mai J.M.\} and Saeideh Aminian and Lauren Arundell and Trina Hinkley and Jill Hnatiuk and Atkin, \{Andrew J.\} and Kevin Belanger and Chaput, \{Jean Philippe\} and Katie Gunnell and Richard Larouche and Taru Manyanga and Gibbs, \{Bethany Barone\} and Rebecca Bassett-Gunter and Stuart Biddle and Aviroop Biswas and Josephine Chau and Rachel Colley and Tara Coppinger and Catharine Craven and Carlos Cristi-Montero and \{de Assis Teles Santos\}, Douglas and \{del Pozo Cruz\}, Borja and \{del Pozo-Cruz\}, Jesus and Paddy Dempsey and \{do Carmo Santos Gon{\c c}alves\}, \{Ricardo Filipe\} and Ulf Ekelund and Laura Ellingson and Victor Ezeugwu and Claire Fitzsimons and Alberto Florez-Pregonero and Friel, \{Ciar{\'a}n P.\} and Andreas Fr{\"o}berg and Lora Giangregorio and Linda Godin and Shannon Halloway and Pauliina Husu and Mohammad Kadir and Karagounis, \{Leonidas G.\} and Annemarie Koster and Jeroen Lakerveld and Martin Lamb and Paul Lee", note = "Publisher Copyright: {\textcopyright} 2017 The Author(s).", year = "2017", month = jun, day = "10", doi = "10.1186/s12966-017-0525-8", language = "English", volume = "14", journal = "International Journal of Behavioral Nutrition and Physical Activity", issn = "1479-5868", publisher = "BioMed Central", number = "1", } . International Journal of Behavioral Nutrition and Physical Activity.

Seasonal influenza vaccination among Chinese health care workers @article{c906094416dc42149516e187992729a1, title = "Seasonal influenza vaccination among Chinese health care workers", abstract = "We conducted a study to examine the knowledge, attitudes, and opinions of health care workers (HCWs) and the factors associated with receipt of influenza vaccination in HCWs during August 2015 in 3 hospitals in Jiangsu Province, China. Among the 173 doctors and 220 nurses included in this study, the proportions who received vaccination for the 2014-2015 season were 14\% and 13\%, respectively. Ninety-eight percent of doctors and 99\% of nurses maintained their vaccination practice over 4 seasons.", keywords = "Attitudes, Knowledge, Survey, Vaccine", author = "Lee, \{Paul H.\} and Cowling, \{Benjamin J.\} and Lin Yang", note = "Publisher Copyright: {\textcopyright} 2017 Association for Professionals in Infection Control and Epidemiology, Inc.", year = "2017", month = may, day = "1", doi = "10.1016/j.ajic.2016.05.038", language = "English", volume = "45", pages = "575--578", journal = "American Journal of Infection Control", issn = "0196-6553", publisher = "Elsevier Inc.", number = "5", } . American Journal of Infection Control.

The quality of the reported sample size calculations in randomized controlled trials indexed in PubMed @article{688af89679b248a7959852b1e7f74e3b, title = "The quality of the reported sample size calculations in randomized controlled trials indexed in PubMed", abstract = "Background There are limited data on the quality of reporting of information essential for replication of the calculation as well as the accuracy of the sample size calculation. We examine the current quality of reporting of the sample size calculation in randomized controlled trials (RCTs) published in PubMed and to examine the variation in reporting across study design, study characteristics, and journal impact factor. We also reviewed the targeted sample size reported in trial registries. Methods We reviewed and analyzed all RCTs published in December 2014 with journals indexed in PubMed. The 2014 Impact Factors for the journals were used as proxies for their quality. Results Of the 451 analyzed papers, 58.1\% reported an a priori sample size calculation. Nearly all papers provided the level of significance (97.7\%) and desired power (96.6\%), and most of the papers reported the minimum clinically important effect size (73.3\%). The median (inter-quartile range) of the percentage difference of the reported and calculated sample size calculation was 0.0\% (IQR − 4.6\%;3.0\%). The accuracy of the reported sample size was better for studies published in journals that endorsed the CONSORT statement and journals with an impact factor. A total of 98 papers had provided targeted sample size on trial registries and about two–third of these papers (n = 62) reported sample size calculation, but only 25 (40.3\%) had no discrepancy with the reported number in the trial registries. Conclusions The reporting of the sample size calculation in RCTs published in PubMed-indexed journals and trial registries were poor. The CONSORT statement should be more widely endorsed.", keywords = "Crossover, Factorial, Protocol, Sample size, Trials", author = "Lee, \{Paul H.\} and Tse, \{Andy C.Y.\}", note = "Publisher Copyright: {\textcopyright} 2016 European Federation of Internal Medicine", year = "2017", month = may, day = "1", doi = "10.1016/j.ejim.2016.10.008", language = "English", volume = "40", pages = "16--21", journal = "European Journal of Internal Medicine", issn = "0953-6205", publisher = "Elsevier BV", number = "5", } . European Journal of Internal Medicine.

Paul H. Lee, Benjamin J. Cowling, Lin Yang(2017). Seasonal influenza vaccination among Chinese health care workers . American Journal of Infection Control. 45. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 575--578. Elsevier {BV}

Examining the error of mis-specifying nonlinear confounding effect with application on accelerometer-measured physical activity @article{d52ce76a1c8e4abd83856947e1a2ef00, title = "Examining the error of mis-specifying nonlinear confounding effect with application on accelerometer-measured physical activity", abstract = "Purpose: Some confounders are nonlinearly associated with dependent variables, but they are often adjusted using a linear term. The purpose of this study was to examine the error of mis-specifying the nonlinear confounding effect. Methods: We carried out a simulation study to investigate the effect of adjusting for a nonlinear confounder in the estimation of a causal relationship between the exposure and outcome in 3 ways: using a linear term, binning into 5 equal-size categories, or using a restricted cubic spline of the confounder. Continuous, binary, and survival outcomes were simulated. We examined the confounder across varying measurement error. In addition, we performed a real data analysis examining the 3 strategies to handle the nonlinear effects of accelerometer-measured physical activity in the National Health and Nutrition Examination Survey 2003–2006 data. Results: The mis-specification of a nonlinear confounder had little impact on causal effect estimation for continuous outcomes. For binary and survival outcomes, this mis-specification introduced bias, which could be eliminated using spline adjustment only when there is small measurement error of the confounder. Real data analysis showed that the associations between high blood pressure, high cholesterol, and diabetes and mortality adjusted for physical activity with restricted cubic spline were about 3\% to 11\% larger than their counterparts adjusted with a linear term. Conclusion: For continuous outcomes, confounders with nonlinear effects can be adjusting with a linear term. Spline adjustment should be used for binary and survival outcomes on confounders with small measurement error.", keywords = "Causality, confounding factors, simulation, statistical models", author = "Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2017 SHAPE America.", year = "2017", month = apr, day = "3", doi = "10.1080/02701367.2017.1296101", language = "English", volume = "88", pages = "203--208", journal = "Research Quarterly for Exercise and Sport", issn = "0270-1367", publisher = "Routledge", number = "2", } . Research Quarterly for Exercise and Sport.

Hand hygiene intervention strategies to reduce diarrhoea and respiratory infections among schoolchildren in developing countries @article{dfadde302969422ba080daa35708741f, title = "Hand hygiene intervention strategies to reduce diarrhoea and respiratory infections among schoolchildren in developing countries: a systematic review", abstract = "Effective and appropriate hand-washing practice for schoolchildren is important in preventing infectious diseases such as diarrhoea, which is the second most common cause of death among school-age children in sub-Saharan Africa. The objective of the review was to identify hand hygiene intervention strategies to reduce infectious diseases such as diarrhoea and respiratory tract infections among schoolchildren aged 6–12 years in developing countries. Published research articles were searched from databases covering a period from as far back as the creation of the databases to November 2015. Eight randomized controlled trials (RCT/CRCT) from developing countries met the inclusion criteria. The Jadad Scale for appraising RCT/CRCT studies revealed methodological challenges in most studies, such that 75\% (6/8) were rated as low-quality articles. The review found that hand hygiene can reduce the incidence of diarrhoea and respiratory conditions. Three hand hygiene intervention strategies utilized were training, funding and policy, with training and funding implemented more commonly than policy. These strategies were not only used in isolation but also in combination, and they qualified as multi-level interventions. Factors that influenced hand washing were contextual, psychosocial and technological. Findings can inform school health workers in categorizing and prioritizing activities into viable strategies when implementing multi-level hand-washing interventions. This review also adds to the existing evidence that multi-level hand-washing interventions can reduce the incidence of diarrhoea, respiratory infections, and school absenteeism. Further evidence-based studies are needed with improved methodological rigour in developing countries, to inform policy in this area.", keywords = "Developing countries, Diarrhoea, Hand washing, Multi-level intervention, Respiratory infections, Schoolchildren, Strategies", author = "Mbakaya, \{Balwani Chingatichifwe\} and Lee, \{Paul H.\} and Lee, \{Regina L.T.\}", note = "Publisher Copyright: {\textcopyright} 2017 by the authors. Licensee MDPI, Basel, Switzerland.", year = "2017", month = apr, day = "1", doi = "10.3390/ijerph14040371", language = "English", volume = "14", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "4", } . International Journal of Environmental Research and Public Health.

Paul Lee, Balwani Mbakaya, Regina Lee (2017). Hand Hygiene Intervention Strategies to Reduce Diarrhoea and Respiratory Infections among Schoolchildren in Developing Countries: A Systematic Review . International Journal of Environmental Research and Public Health.

Anthropometric profile of Hong Kong children and adolescents @article{68a444a3d323471483bff474d7e15214, title = "Anthropometric profile of Hong Kong children and adolescents: the Wellness Population of Youth Study", abstract = "Childhood obesity has been a public health concern increasingly. We investigated the age- and sex-specific body mass index (BMI), blood pressure level, and other obesity measures in Hong Kong children and adolescents. We used the data from Wellness Population of Youth Study, a health examination for anthropometric measurements among children and adolescents (aged 9–15 years) in Hong Kong, conducted in Oct 2012–Jun 2013 (n = 4410). Anthropometric measures including weight, height, pulse, systolic and diastolic blood pressures, triceps and scapula skinfold thickness, and waist circumference were measured following universal standard protocol. Overweight and obesity were classified using the 2000 International Obesity Task Force, 2007 World Health Organization, and 2000 Centers of Disease Control and Prevention age- and sex-specific growth charts. Hypertension was categorized using Centers of Disease Control and Prevention and Chinese standards. The prevalence of obesity, overweight, and hypertension of Hong Kong adolescents according to the above definitions were 5.4\%–15.1\%, 20.8\%–25.9\%, and 12.0\%–13.8\%, respectively. Boys had higher systolic blood pressure, waist, BMI, and waist-to-height ratio (all P <.001). Systolic and diastolic blood pressures, scapula skinfold, waist, and BMI increased with age, while pulse and waist-to-height ratio decreased with age. To conclude, compared with worldwide data, the situations of obesity and overweight among Hong Kong children and adolescents were more severe.", keywords = "Blood pressure, body mass index, Chinese, population-based study", author = "Lee, \{Regina L.T.\} and Lee, \{Paul H.\} and Sze, \{Daniel M.Y.\} and Chien, \{Wai Tong\}", note = "Publisher Copyright: {\textcopyright} 2017 American Society of Hypertension", year = "2017", month = apr, day = "1", doi = "10.1016/j.jash.2017.01.007", language = "English", volume = "11", pages = "196--203.e4", journal = "Journal of the American Society of Hypertension", issn = "1933-1711", publisher = "Elsevier Ireland Ltd.", number = "4", } . Journal of the American Society of Hypertension.

Regina L.T. Lee, Paul H. Lee, Daniel M.Y. Sze, Wai Tong Chien(2017). Anthropometric profile of Hong Kong children and adolescents: the Wellness Population of Youth Study . Journal of the American Society of Hypertension. Elsevier {BV}

Cohort profile @article{f7e6018f25d94f03a3accf97e0619187, title = "Cohort profile: Family cohort", abstract = "The FAMILY Cohort is a longitudinal study of health, happiness and family harmony (the '3Hs') at individual, household and neighbourhood levels in Hong Kong. Using a family living in the same household as the sampling unit, the study (n ¼ 20 279 households and 46 001 participants) consists of a composite sample from several sources, including: a population-representative random core sample (n ¼ 8115 households and 19 533 participants); the first-degree relatives of this sample (n ¼ 4658 households and 11 063 participants); and oversampling in three new towns (n ¼ 2891 households and 7645 participants) and in three population subgroups with anticipated changes in family dynamics (n ¼ 909 households and 2160 participants). Two household visits and five telephone- or web-based follow-ups were conducted over 2009-14. Data collected include socio-demographics, anthropometrics, lifestyle and behavioural factors, measures of social capital, and standardized instruments assessing the 3Hs. We also intend to collect biomaterials in future. The analytical plan includes multilevel inter-relations of the 3Hs for individuals, households, extended families and neighbourhoods. With Hong Kong's recent history of socioeconomic development, the FAMILY Cohort is therefore relevant to global urban populations currently experiencing similarly rapid economic growth. The FAMILY Cohort is currently set up as a supported access resource.", author = "\{et al.\} and Leung, \{Gabriel M.\} and Ni, \{Michael Y.\} and Wong, \{Paul T.K.\} and Lee, \{Paul H.\} and Chan, \{Brandford H.Y.\} and Stewart, \{Sunita M.\} and \{Mary Schooling\}, C. and Johnston, \{Janice M.\} and Lam, \{Wendy W.T.\} and Chan, \{Sophia S.C.\} and Ian McDowell and Lam, \{Tai Hing\}", note = "Funding Information: The Hong Kong Jockey Club Charities Trust was the sole funder of the FAMILY Project from 2007 to 2014. Publisher Copyright: {\textcopyright} The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association", year = "2017", month = apr, doi = "10.1093/ije/dyu257", language = "English", volume = "46", journal = "International Journal of Epidemiology", issn = "0300-5771", publisher = "Oxford University Press", number = "2", } . International Journal of Epidemiology.

The convergent validity of Actiwatch 2 and ActiGraph Link accelerometers in measuring total sleeping period, wake after sleep onset, and sleep efficiency in free-living condition @article{f586b803c7d74653adb75d5cf6cf6815, title = "The convergent validity of Actiwatch 2 and ActiGraph Link accelerometers in measuring total sleeping period, wake after sleep onset, and sleep efficiency in free-living condition", abstract = "Purpose: Physical activity (PA) and sleep are important to health; thus, it is important for researchers to have valid tools to measure them. Accelerometers have been proven valid for measuring PA and sleep, but only one device does this simultaneously: the ActiGraph Link (ActiGraph, LLC); however, the sleep-monitoring function has not been validated. This study aimed to evaluate the predictive power of ActiGraph Link sleep parameters against a validated accelerometer (Actiwatch 2, Phillips Respironics Mini-Mitter). Methods: A total of 49 Hong Kong adults aged 18–64 provided valid data on both accelerometers on their non-dominant wrist for seven consecutive days. Epochs from both accelerometers were classified as either sleep or awake using seven established algorithms (Cole-Kripke, Sadeh, Sazonov, high sensitivity threshold, medium sensitivity threshold, low sensitivity threshold, and neural network model), and these data were transformed to total sleeping period, wake after sleep onset, and sleep efficiency. Results: The non-zero count data for both accelerometers (331,103 observations) were strongly correlated with a Spearman correlation of 0.83 (p < 0.001). The total sleeping period was highly correlated (Spearman correlation ranged from 0.74 to 0.90) regardless of the algorithms used. All algorithms yielded insignificant difference in total sleep time measured by the two accelerometers (p > 0.05) with a negligible effect size of d < 0.2. The agreement of sleep/wake status was high for all algorithms, with accuracy ranging from 93.05 \% (Sadeh{\textquoteright}s algorithm) to 96.13 \% (Cole-Kripke{\textquoteright}s algorithm). Conclusions: Results showed that the sleep function of the ActiGraph Link performs similar to a validated accelerometer (Actiwatch 2) and provides an opportunity to measure both sleep and PA simultaneously.", keywords = "Accelerometry, ActiGraph, Motor activity, Sleeping duration, Validation", author = "Lee, \{Paul H.\} and Suen, \{Lorna K.P.\}", note = "Funding Information: The Food and Health Bureau of the Hong Kong Special Administrative Region, China, provided financial support in the form of Health and Medical Research Fund (Ref 12131741). The sponsor had no role in the design or conduct of this research. Publisher Copyright: {\textcopyright} 2016, Springer-Verlag Berlin Heidelberg.", year = "2017", month = mar, day = "1", doi = "10.1007/s11325-016-1406-0", language = "English", volume = "21", pages = "209--215", journal = "Sleep and Breathing", issn = "1520-9512", publisher = "Springer Science and Business Media B.V.", number = "1", } . Sleep and Breathing.

Paul Lee, Stephen Kwok, Regina Lee (2017). Smart Device Use and Perceived Physical and Psychosocial Outcomes among Hong Kong Adolescents . International Journal of Environmental Research and Public Health.

Smart device use and perceived physical and psychosocial outcomes among Hong Kong adolescents @article{351c856f376b4649bdfbbd17b7330af6, title = "Smart device use and perceived physical and psychosocial outcomes among Hong Kong adolescents", abstract = "Excessive electronic screen-based activities have been found to be associated with negative outcomes. The aim of this study was to investigate the prevalences and patterns of smart device activities and the purposes and perceived outcomes related to smart device use, and the differences in patterns of smart device activities between adolescents who did and did not perceive these outcomes. The study was a cross-sectional survey of Hong Kong primary and secondary school students. Demographic characteristics, purpose and pattern of the activities, and frequencies of the outcomes were measured. Data from 960 adolescents aged 10-19 were analyzed. Nearly 86\% of the sample use smart device daily. The one-week prevalence of perceived sleep deprivation, eye discomfort, musculoskeletal discomfort, family conflict and cyberbullying victimization related to smart device use were nearly 50\%, 45\%, 40\%, 20\% and 5\% respectively. More than 25\% of the respondents were at risk of negative outcomes related to smart device activities for more than 1 h per day, browsing and gaming on at least 4 days per week and watching TV/movies and posting on more than 2 days per week. Their patterns of smart device activities may put a significant number of them at risk of negative outcomes.", keywords = "Adolescents, Physical and psychosocial outcomes, Smart device", author = "Kwok, \{Stephen Wai Hang\} and Lee, \{Paul Hong\} and Lee, \{Regina Lai Tong\}", note = "Publisher Copyright: {\textcopyright} 2017 by the authors; licensee MDPI, Basel, Switzerland.", year = "2017", month = feb, day = "18", doi = "10.3390/ijerph14020205", language = "English", volume = "14", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "2", } . International Journal of Environmental Research and Public Health.

Distance from home to the nearest tobacco outlet may not reflect the true accessibility @article{10ca4581c4c5469db1305668856e7536, title = "Distance from home to the nearest tobacco outlet may not reflect the true accessibility", abstract = "To the Editor: In their Original Investigation in a recent issue of JAMA Internal Medicine, Pulakka et al1 examined the association between walking distance from home to the nearest tobacco outlet and smoking cessation and relapse. We noticed several limitations that should be considered", author = "Lee, \{Ka Yiu\} and Lam, \{Michael Huen Sum\} and Lee, \{Paul H.\}", year = "2017", month = feb, day = "1", doi = "10.1001/jamainternmed.2016.8590", language = "English", volume = "177", pages = "287", journal = "JAMA Internal Medicine", issn = "2168-6106", publisher = "American Medical Association", number = "2", } . JAMA Internal Medicine.

Paul H Lee, Choi-Wan Chan(2016). Energy intake, energy required and mortality in an older population . Public Health Nutrition. 19. (17). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 3178--3184. Cambridge University Press ({CUP})

Energy intake, energy required and mortality in an older population @article{22a5ad6171a34d88a154ef9cd7b0d090, title = "Energy intake, energy required and mortality in an older population", abstract = "Objectives The present study evaluated the association between energy intake, energy required and mortality in older adults. Design A cohort study with a mean of 10·67 (sd 4·74) years of follow-up. Participants completed a 24 h dietary recall. Energy required per day was computed by BMR. Deaths through 2006 were identified from the National Death Index. A Cox regression was used to estimate the hazard ratios (HR) of quantiles of energy intake and energy required on all-cause and CVD mortality, adjusting for demographics, socio-economic status and co-morbidity. Setting The National Health and Nutrition Examination Survey (NHANES) III, 1988-1994. Subjects A total of 4846 participants aged 60 years or above were analysed. Results Within the follow-up period, there were a total of 2954 deaths (61·0 \%), 51·9 \% were caused by CVD. Relative to those in quartile 1 of energy intake, only quartile 4 was associated with all-cause mortality and CVD mortality with HR of 0·86 (95 \% CI 0·77, 0·96, P=0·006) and 0·76 (95 \% CI 0·65, 0·89, P=0·001), respectively. On the other hand, relative to those in quartile 1 of energy required, all quartiles of participants had a lower risk of all-cause mortality and CVD mortality. The interaction effects between energy intake and energy required with all-cause and CVD mortality were insignificant (P=0·70 and 0·61, respectively). Conclusions Independent of energy required, higher energy intake was associated with lower HR of both all-cause and CVD mortality in older adults.", keywords = "Energy intake, Gerontology, Harris-Benedict equation, Longitudinal study, Population-based", author = "Lee, \{Paul H.\} and Chan, \{Choi Wan\}", note = "Publisher Copyright: {\textcopyright} Copyright The Authors 2016.", year = "2016", month = dec, day = "1", doi = "10.1017/S1368980016001750", language = "English", volume = "19", pages = "3178--3184", journal = "Public Health Nutrition", issn = "1368-9800", publisher = "Cambridge University Press", number = "17", } . Public Health Nutrition.

Play activities program to relieve chronic pain and enhance functional mobility and psychological well-being for frail older adults @article{2e5b3fcf452f4ce0bd1bd5aba285c26a, title = "Play activities program to relieve chronic pain and enhance functional mobility and psychological well-being for frail older adults: a pilot cluster randomized controlled trial", abstract = "Chronic pain is common in frail older adults. Pain can alter psychological status, causing higher levels of loneliness and depression and lower levels of happiness and life satisfaction. Pain hinders functional mobility and activities of daily living, and frail older adults consequently participate less in social activities, resulting in a deterioration of physical health and quality of life. Play activities are widely used in children, and their therapeutic effects are well established. Benefits include better communication skills, social skills, and cognitive ability. Play activities are also effective in reducing fear and anxiety for hospitalized children4 and postsurgical pain in children.5 The social effects of play activities may help to reduce pain.6Older adults living in nursing homes tend to be lonelier and more socially isolated than individuals of other ages, which places them at greater risk of negative consequences of pain. The literature on play activities for older adults is scanty, but the potential beneficial effects of play activities in this age group warrant investigation. It was therefore the aim of this study to explore the therapeutic effects of play activities on the physical and psychological health of frail older adults.", author = "\{et al.\} and Tse, \{Mimi M.Y.\} and Ng, \{Shamay S.M.\} and Lee, \{Paul H.\} and Claudia Lai and Enid Kwong and Liu, \{Justina Y.W.\} and John Yuen and Xue Bai and Yeung, \{Suey S.Y.\}", year = "2016", month = oct, day = "1", doi = "10.1111/jgs.14374", language = "English", volume = "64", pages = "e86--e88", journal = "Journal of the American Geriatrics Society", issn = "0002-8614", publisher = "John Wiley and Sons Inc", number = "10", } . Journal of the American Geriatrics Society.

Understanding sociobehavioral mitigators of depressive symptoms among U.S. young adults @article{8f98d93bfbfb436094ebbb2a641fa5bd, title = "Understanding sociobehavioral mitigators of depressive symptoms among U.S. young adults", abstract = "This study drew upon an ecological system framework to examine a model focusing on the interrelationship among depressive symptoms, sense of mastery, moderate-to-vigorous physical activity (MVPA), religiosity, and relations with parents and romantic partners among U.S. young adults aged 24 to 34. Cross-sectional data from the National Longitudinal Study of Adolescent Health (N = 4,982), obtained in 2008 and 2009, were analyzed using structural equation modeling techniques. The associations of MVPA, relations with parents, and relations with romantic partner to depressive symptoms were mediated through mastery. Relations with one's romantic partner were a stronger predictor of depressive symptoms than relations with parents, while the influence of religiosity on relations with romantic partner was largely mediated by relations with parents. The results highlight the sociobehavioral buffers of depressive symptoms that are peculiar to young adulthood. Further intervention research in preventing and treating depressive symptoms should consider incorporating the sociobehavioral factors that are tailored to the specific age group.", keywords = "depressive symptoms, mastery, physical activity, relations with parents, religiosity, romantic relationships", author = "Yazhuo Deng and Lee, \{Ka Yiu\} and Lam, \{Michael Huen Sum\} and Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2016, Copyright {\textcopyright} Taylor \& Francis Group, LLC.", year = "2016", month = oct, day = "1", doi = "10.1080/08964289.2014.987718", language = "English", volume = "42", pages = "217--226", journal = "Behavioral Medicine", issn = "0896-4289", publisher = "Routledge", number = "4", } . Behavioral Medicine.

Physical activity, sedentary behaviors, and Epstein-Barr virus antibodies in young adults @article{5b8baf7469d84427929ef6b7db1b70c8, title = "Physical activity, sedentary behaviors, and Epstein-Barr virus antibodies in young adults", abstract = "This study aimed to elucidate the associations between physical activity, sedentary behaviors, and Epstein-Barr virus (EBV) antibody levels (as an indirect marker of cell-mediated immunity, CMI). This study made use of a 14-year longitudinal study with a representative sample of adolescents in the US. A total of 3361 participants (42.1\% male) aged 11 to 21 years at baseline who completed Wave I (1994–1995), Wave III (2001 − 2002), and Wave IV (2008) surveys of the National Longitudinal Study of Adolescent Health (Add Health) were analyzed. Physical activity and sedentary behaviors at Waves I and III were assessed using interviewer-administered questionnaire. EBV viral capsid antigen (VCA) IgG antibody levels at Wave IV were analyzed from dried blood spot assays. Adjusted for confounders, among males, one additional day spent per week on strenuous sports at Wave III were associated with a decrease of 4.09 AU/ml in EBV antibody levels (p = 0.012), while one additional hour spent per week viewing videos at Wave I was associated with an increase of 0.83 AU/ml in EBV antibody levels (p = 0.026). Among females, one additional day spent per week on individual sports at Wave III were associated with a decrease of 4.63 AU/ml in EBV antibody levels (p = 0.014), while sedentary behaviors were not associated with EBV antibody levels. To conclude, physical activity and sedentary behaviors were associated with CMI among males and physical activity was associated with CMI among females.", keywords = "Add Health, Cell-mediated immunity, Exercise, Herpesvirus, Longitudinal study, Pediatrics", author = "Lee, \{Paul H.\}", note = "Funding Information: The author received no funding for this study. The author discloses no conflict of interest. No financial support was received for this manuscript. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website ( http://www.cpc.unc.edu/addhealth ). No direct support was received from grant P01-HD31921 for this analysis. Publisher Copyright: {\textcopyright} 2016 Elsevier Inc.", year = "2016", month = oct, day = "1", doi = "10.1016/j.physbeh.2016.06.026", language = "English", volume = "164", pages = "390--394", journal = "Physiology and Behavior", issn = "0031-9384", publisher = "Elsevier Inc.", number = "Pt.A, 10", } . Physiology and Behavior.

Substitution of SF-36 by SF-12 among Hong Kong Chinese older adults @article{75c77287e732495c9a2e3357c5930c5f, title = "Substitution of SF-36 by SF-12 among Hong Kong Chinese older adults: secondary analysis of randomized controlled trials", abstract = "Purpose: This study aims to examine the appropriateness of substituting the Short-Form 36 (SF-36) by its shortened version (SF-12) in measuring health-related quality of life (HRQoL) in older Chinese population. Methods: Secondary analysis of two transitional care management programs, conducted from 2009 to 2012, were analyzed (n = 1188, aged 60–97). Participants were discharged patients with respiratory disease, type 2 diabetes, cardiac disease, and renal disease, and were classified according to number of chronic diseases. SF-36 was administered at baseline and 4-week follow-up. Results: Both overestimations and underestimations of HRQoL by SF-12 were found. Most domain scores of SF-36 and SF-12 were highly correlated (Spearman correlation (ρ) > 0.85), with the exception of General Health (ρ = 0.64) and Vitality subscales (ρ = 0.82). Multiple linear regression adjusted for demographic characteristics showed that the four out of eight domains of SF-36 and SF-12 were equivalent in measuring the difference across numbers of chronic diseases (all p < 0.05). Paired sample t tests in 989 (83.2 \%) who completed the SF-36 survey 4 weeks after baseline showed that SF-12 overestimated the 4-week changes in most of the domains. Conclusions: The use of the Chinese version of SF-12v2 for reporting the change over time in quality of life among medical patients after hospital discharge may need to be interpreted with caution. The SF-12 tends to underestimate the difference when compared with the SF-36.", keywords = "Discharged patients, Elderly, Quality of life, Scale development, Validity", author = "Lee, \{Paul H.\} and Wong, \{Frances K.Y.\} and Wang, \{Shao Ling\} and Chow, \{Susan K.Y.\}", note = "Funding Information: The health-social partnership transitional care management program was supported by The Hong Kong Jockey Club Charities Trust (PolyU Account 5ZH60) and the enhanced transitional care management program was supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (RGC Ref No. 547909). The funding bodies were not involved in study design, data collection, data analysis, interpretation, writing the report, nor the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2016, International Society of Behavioral Medicine.", year = "2016", month = oct, day = "1", doi = "10.1007/s12529-016-9542-2", language = "English", volume = "23", pages = "635--644", journal = "International Journal of Behavioral Medicine", issn = "1070-5503", publisher = "Routledge", number = "5", } . International Journal of Behavioral Medicine.

Physical activity, sedentary behaviors, and Epstein-Barr virus antibodies in young adults <head> <META HTTP-EQUIV="Refresh" CONTENT="0;URL=/servlet/useragent"> </head> . Physiology & Behavior.

C. W. Chan, P. H. Lee (2016). Association between dietary fibre intake with cancer and all‐cause mortality among 15 740 adults: the National Health and Nutrition Examination Survey III . Journal of Human Nutrition and Dietetics.

Mimi M. Y. Tse, Shamay S. M. Ng, Paul H. Lee, Claudia Lai, Enid Kwong, Justina Y. W. Liu, John Yuen, Xue Bai, Suey S. Y. Yeung (2016). Play Activities Program to Relieve Chronic Pain and Enhance Functional Mobility and Psychological Well‐Being for Frail Older Adults: A Pilot Cluster Randomized Controlled Trial . Journal of the American Geriatrics Society.

Remaining questions concerning wearable devices @article{edaed5a1f6804272ab7abebfd6e88950, title = "Remaining questions concerning wearable devices", author = "Lee, \{Paul H.\}", year = "2016", month = sep, day = "1", doi = "10.1001/jamainternmed.2016.4750", language = "English", volume = "176", pages = "1408", journal = "JAMA Internal Medicine", issn = "2168-6106", publisher = "American Medical Association", number = "9", } . JAMA Internal Medicine.

Effects of a peer-led pain management program for nursing home residents with chronic pain @article{de9530dec90641e58c5ac2cac1b62f0e, title = "Effects of a peer-led pain management program for nursing home residents with chronic pain: a pilot study", abstract = "Objectives To examine the feasibility of a peer-led pain management program among nursing home residents. Design A quasi-experimental design. Setting Two nursing homes. Subjects Fifty nursing home residents. Methods The experimental group (n = 32) was given a 12-week group-based peer-led pain management program. There were two 1-hour sessions per week. Education in pain and demonstrations of nonpharmacological pain management strategies were provided. The research team and 12 trained peers led the sessions. The control group (n = 18) received one 1-hour session of pain management program each week over 12 weeks from the research team only. Outcome measures for the participants were collected at baseline (P1) and at week 12 (P2). Data from peer volunteers were collected prior to training (V1) and at week 12 (V2). T-tests were used to compare the differences in outcome measures collected at two time points. Results There was a significant reduction in pain intensity from 5.8 ± 2.6 (P1) to 3.4 ± 2.5 (P2) for the experimental group (p = 0.003) and from 6.3 ± 3.0 (P1) to 3.1±2.4 (P2) for the control group (p = 0.001). Activities of daily living significantly improved for both the experimental group (p = 0.008) and the control group (p = 0.014). There was an enhancement in happiness level for the experimental group (p < 0.001), while the loneliness level dropped significantly for the experimental group (p < 0.001) and the control group (p = 0.031). The peer volunteers showed a significant increase in self-rated pain management knowledge (2.9 ± 2.6 to 8.1 ± 1.2, p<0.001)andself-efficacyinvolunteering(5.8±2.9 to 8.3 ± 1.5, p = 0.032). Conclusion The peer-led pain management program was feasible and has potential in relieving chronic pain and enhancing the physical and psychological health of nursing home residents.", keywords = "Chronic pain, Exercise, Older adults, Pain management, Peer", author = "Tse, \{Mimi Mun Yee\} and Yeung, \{Suey Shuk Yu\} and Lee, \{Paul Hong\} and Ng, \{Shamay Sheung Mei\}", note = "Publisher Copyright: {\textcopyright} 2016 American Academy of Pain Medicine. All rights reserved.", year = "2016", month = sep, day = "1", doi = "10.1093/pm/pnv121", language = "English", volume = "17", pages = "1648--1657", journal = "Pain Medicine (United States)", issn = "1526-2375", publisher = "Oxford University Press", number = "9", } . Pain Medicine (United States).

Covariate adjustments in randomized controlled trials increased study power and reduced biasedness of effect size estimation @article{9eb2795599e6483fa4c18baafaf70779, title = "Covariate adjustments in randomized controlled trials increased study power and reduced biasedness of effect size estimation", abstract = "Objectives This study aims to show that under several assumptions, in randomized controlled trials (RCTs), unadjusted, crude analysis will underestimate the Cohen's d effect size of the treatment, and an unbiased estimate of effect size can be obtained only by adjusting for all predictors of the outcome. Study Design and Setting Four simulations were performed to examine the effects of adjustment on the estimated effect size of the treatment and power of the analysis. In addition, we analyzed data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (older adults aged 65–94), an RCT with three treatment arms and one control arm. Results We showed that (1) the number of unadjusted covariates was associated with the effect size of the treatment; (2) the biasedness of effect size estimation was minimized if all covariates were adjusted for; (3) the power of the statistical analysis slightly decreased with the number of adjusted noise variables; and (4) exhaustively searching the covariates and noise variables adjusted for can lead to exaggeration of the true effect size. Analysis of the ACTIVE study data showed that the effect sizes adjusting for covariates of all three treatments were 7.39–24.70\% larger than their unadjusted counterparts, whereas the effect size would be elevated by at most 57.92\% by exhaustively searching the variables adjusted for. Conclusion All covariates of the outcome in RCTs should be adjusted for, and if the effect of a particular variable on the outcome is unknown, adjustment will do more good than harm.", keywords = "Adjustment, Cohen's d effect size, Covariates, Data analysis, Epidemiology, Trials", author = "Lee, \{Paul H.\}", note = "Funding Information: Funding: The ACTIVE intervention trials are supported by grants from the National Institute on Aging and the National Institute of Nursing Research to Hebrew Senior Life ( U01NR04507 ), Indiana University School of Medicine ( U01NR04508 ), Johns Hopkins University ( U01AG14260 ), New England Research Institutes ( U01AG14282 ), Pennsylvania State University ( U01AG14263 ), the University of Alabama at Birmingham ( U01AG14289 ), and the University of Florida ( U01AG14276 ). Inferences expressed here are those of the authors and are not necessarily reflective of the academic or funding agencies involved. Publisher Copyright: {\textcopyright} 2016 Elsevier Inc.", year = "2016", month = aug, day = "1", doi = "10.1016/j.jclinepi.2016.02.004", language = "English", volume = "76", pages = "137--146", journal = "Journal of Clinical Epidemiology", issn = "0895-4356", publisher = "Elsevier Inc.", number = "8", } . Journal of Clinical Epidemiology.

Paul H. Lee(2016). Covariate adjustments in randomized controlled trials increased study power and reduced biasedness of effect size estimation . Journal of Clinical Epidemiology. 76. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 137--146. Elsevier {BV}

Frances Kam Yuet Wong, Alina Yee Man Ng, Paul Hong Lee, Po-tin Lam, Jeffrey Sheung Ching Ng, Nancy Hiu Yim Ng, Michael Mau Kwong Sham (2016). Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial . Heart.

Effects of a transitional palliative care model on patients with end-stage heart failure @article{19b4c9f5f8c347a98c65973c57e11ab2, title = "Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial", abstract = "Objective To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge. Methods This was a randomised controlled trial conducted in three hospitals in Hong Kong. The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service, and who met the specified inclusion criteria. The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up, provided by a nurse case manager supported by a multidisciplinary team. The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge, compared using {\"I} ‡ 2 tests and Poisson regression, respectively. Secondarily, change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale (ESAS). Results The intervention group (n=43) had a significantly lower readmission rate than the control group (n=41) at 12 weeks (intervention 33.6\% vs control 61.0\% {\"I} ‡ 2 =6.8, p=0.009). The mean number (SE) of readmissions for the intervention and control groups was, respectively, 0.42 (0.10) and 1.10 (0.16) and the difference was significant (p=0.001). The relative risk (CI) for 12-week readmissions for the intervention group was 0.55 (0.35 to 0.88). There was no significant difference in readmissions between groups at 4 weeks. However, when compared with the control group, the intervention group experienced significantly higher clinical improvement in depression (45.9\% vs 16.1\%, p<0.05), dyspnoea (62.2\% vs 29.0\%, p<0.05) and total ESAS score (73.0\% vs 41.4\%, p<0.05) at 4 weeks. There were significant differences between groups in changes over time in quality of life (QOL) measured by McGill QOL (p<0.05) and chronic HF (p<0.01) questionnaires. Conclusions This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF. Trial registration number HKCTR-1562; Results.", author = "Wong, \{Frances Kam Yuet\} and Ng, \{Alina Yee Man\} and Lee, \{Paul Hong\} and Lam, \{Po Tin\} and Ng, \{Jeffrey Sheung Ching\} and Ng, \{Nancy Hiu Yim\} and Sham, \{Michael Mau Kwong\}", note = "Publisher Copyright: {\textcopyright} 2016 Published by the BMJ Publishing Group Limited. For permission to use.", year = "2016", month = jul, day = "15", doi = "10.1136/heartjnl-2015-308638", language = "English", volume = "102", pages = "1100--1108", journal = "Heart", issn = "1355-6037", publisher = "BMJ Publishing Group", number = "14", } . Heart.

Examining non-linear associations between accelerometer-measured physical activity, sedentary behavior, and all-cause mortality using segmented Cox Regression @article{64fcde0789fe4b399b789d6b8f6f608f, title = "Examining non-linear associations between accelerometer-measured physical activity, sedentary behavior, and all-cause mortality using segmented Cox Regression", abstract = "Healthy adults are advised to perform at least 150 min of moderate-intensity physical activity weekly, but this advice is based on studies using self-reports of questionable validity. This study examined the dose-response relationship of accelerometer-measured physical activity and sedentary behaviors on all-cause mortality using segmented Cox regression to empirically determine the break-points of the dose-response relationship. Data from 7006 adult participants aged 18 or above in the National Health and Nutrition Examination Survey waves 2003–2004 and 2005–2006 were included in the analysis and linked with death certificate data using a probabilistic matching approach in the National Death Index through December 31, 2011. Physical activity and sedentary behavior were measured using ActiGraph model 7164 accelerometer over the right hip for 7 consecutive days. Each minute with accelerometer count <100; 1952–5724; and ≥5725 were classified as sedentary, moderate-intensity physical activity, and vigorous-intensity physical activity, respectively. Segmented Cox regression was used to estimate the hazard ratio (HR) of time spent in sedentary behaviors, moderate-intensity physical activity, and vigorous-intensity physical activity and all-cause mortality, adjusted for demographic characteristics, health behaviors, and health conditions. Data were analyzed in 2016. During 47,119 person-year of follow-up, 608 deaths occurred. Each additional hour per day of sedentary behaviors was associated with a HR of 1.15 (95\% CI 1.01, 1.31) among participants who spend at least 10.9 h per day on sedentary behaviors, and each additional minute per day spent on moderate-intensity physical activity was associated with a HR of 0.94 (95\% CI 0.91, 0.96) among participants with daily moderate-intensity physical activity ≤14.1 min. Associations of moderate physical activity and sedentary behaviors on all-cause mortality were independent of each other. To conclude, evidence from this study supported at least 15 min per day of moderate-intensity physical activity and no more than 10.9 h per day of sedentary behaviors as recommendations to reduce all-cause mortality.", keywords = "dose-response relationship, exercise, public health, restricted cubic spline, sitting, survival analysis", author = "Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2016 Lee.", year = "2016", month = jun, day = "29", doi = "10.3389/fphys.2016.00272", language = "English", volume = "7", journal = "Frontiers in Physiology", issn = "1664-042X", publisher = "Frontiers Media SA", number = "6", } . Frontiers in Physiology.

Use of the modified Borg scale and numerical rating scale to measure chronic breathlessness @article{ea74aef439bb440fa726e9bda90e23e4, title = "Use of the modified Borg scale and numerical rating scale to measure chronic breathlessness: A pooled data analysis", author = "\{Breathlessness Research Interest Group (BRIG)\} and Johnson, \{Miriam J.\} and Lucy Close and Gillon, \{Suzie C.\} and Alex Molassiotis and Lee, \{Paul H.\} and Farquhar, \{Morag C.\} and Claudia Bausewein and Saskie Dorman and Sara Booth and Stephen Oxberry and Farida Malik and Steffen Simon and Kyle Pattinson and Janelle Yorke and Patrick White", year = "2016", month = jun, day = "1", doi = "10.1183/13993003.02089-2015", language = "English", volume = "47", pages = "1861--1864", journal = "European Respiratory Journal", issn = "0903-1936", publisher = "European Respiratory Society", number = "6", } . European Respiratory Journal.

Logit tree models for discrete choice data with application to advice-seeking preferences among Chinese Christians @article{33feb94e05704f4d98bd2c3e1a0e6312, title = "Logit tree models for discrete choice data with application to advice-seeking preferences among Chinese Christians", abstract = "Logit models are popular tools for analyzing discrete choice and ranking data. The models assume that judges rate each item with a measurable utility, and the ordering of a judge{\textquoteright}s utilities determines the outcome. Logit models have been proven to be powerful tools, but they become difficult to interpret if the models contain nonlinear and interaction terms. We extended the logit models by adding a decision tree structure to overcome this difficulty. We introduced a new method of tree splitting variable selection that distinguishes the nonlinear and linear effects, and the variable with the strongest nonlinear effect will be selected in the view that linear effect is best modeled using the logit model. Decision trees built in this fashion were shown to have smaller sizes than those using loglikelihood-based splitting criteria. In addition, the proposed splitting methods could save computational time and avoid bias in choosing the optimal splitting variable. Issues on variable selection in logit models are also investigated, and forward selection criterion was shown to work well with logit tree models. Focused on ranking data, simulations are carried out and the results showed that our proposed splitting methods are unbiased. Finally, to demonstrate the feasibility of the logit tree models, they were applied to analyze two datasets, one with binary outcome and the other with ranking outcome.", keywords = "Binary data, Decision tree, Multinomial data, Ranking data, Variable selection", author = "\{et al.\} and Yu, \{Philip L.H.\} and Lee, \{Paul H.\} and Cheung, \{S. F.\} and Lau, \{Esther Y.Y.\} and Mok, \{Doris S.Y.\} and Hui, \{Harry C.\}", note = "Funding Information: The research of Philip L. H. Yu was supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 7473/05H). We thank the associate editor and two anonymous referees for their helpful suggestions for improving this article. Publisher Copyright: {\textcopyright} 2015, Springer-Verlag Berlin Heidelberg.", year = "2016", month = jun, day = "1", doi = "10.1007/s00180-015-0588-4", language = "English", volume = "31", pages = "799--827", journal = "Computational Statistics", issn = "0943-4062", publisher = "Springer Science and Business Media B.V.", number = "2", } . Computational Statistics.

Anticipatory Nausea, risk factors, and Its impact on chemotherapy-induced nausea and vomiting @article{1fa157321f8540eb964465802de67601, title = "Anticipatory Nausea, risk factors, and Its impact on chemotherapy-induced nausea and vomiting: results from the Pan European Emesis Registry Study", abstract = "Context Anticipatory (prechemotherapy) nausea (AN) is a classic conditioned symptom not responding well to current antiemetics. Minimal work has been done to assess its risk factors and impact on chemotherapy-induced nausea and vomiting (CINV). Objectives To evaluate risk factors for AN and assess its impact on CINV development. Methods We analyzed data (n = 991) from a prospective observational multisite study in eight European countries over three cycles of chemotherapy. Patient/treatment characteristics were collected before chemotherapy. History of nausea/vomiting (yes/no), patient expectation of CINV (0-100 mm visual analog scale, [VAS]), and prechemotherapy anxiety (0-100 mm VAS) also were collected before chemotherapy. A patient-completed diary during each chemotherapy cycle obtained information on AN in the 24 hours before chemotherapy administration and nausea and vomiting (episodes of vomiting and severity of nausea) daily for five days after administration of chemotherapy (0-100 mm VAS). Results AN was reported by 8.3\%-13.8\% of patients, increasing in frequency and intensity over each cycle. Every 1 mm increase in AN on the VAS was significantly associated with 2\%-13\% of increase in the likelihood of CINV (all P-values <0.05). Key predictors of AN in Cycle 1 included metastatic disease and prechemotherapy anxiety. However, predictors of AN in subsequent cycles included prechemotherapy anxiety and AN and CINV experience in the previous cycle, the latter being the strongest predictor (odds ratio = 3.30-4.09 for CINV outcomes over the cycles). Conclusion AN is a challenging symptom, and its prevention needs to consider better CINV prevention in the previous cycles as well as managing prechemotherapy anxiety.", keywords = "Anticipatory nausea, antiemetics, cancer, chemotherapy-related nausea and vomiting, prechemotherapy nausea", author = "\{et al.\} and Alexander Molassiotis and Lee, \{Paul H.\} and Burke, \{Thomas A.\} and Mario Dicato and Pere Gascon and Fausto Roila and Matti Aapro", note = "Funding Information: The observational study was funded by Merck Sharpe \& Dohme Corp ., but the analysis was performed, and the article written independently without company support. Conflict of interest statements of all authors are listed as follows: 1) Alexander Molassiotis: research funding and consultancies: Merck \& Co. Ltd., Helsinn, Tesaro, Acacia Pharma; 2) Paul H. Lee: no conflict of interest declared; 3) Thomas A. Burke: employee of Merck \& Co. Ltd.; 4) Mario Dicato: consultancy: Merck \& Co. Ltd.; 5) Pere Gascon: Merck \& Co. Ltd.; 6) Fausto Roila: consultancies: Merck \& Co. Ltd.; 7) Matti Aapro: consultancies and grant support: Helsinn \& Eisai and consultancies: Tesaro, Taiho, Mundipharma, and Merck \& Co. Ltd. Publisher Copyright: {\textcopyright} 2016 American Academy of Hospice and Palliative Medicine.", year = "2016", month = jun, day = "1", doi = "10.1016/j.jpainsymman.2015.12.317", language = "English", volume = "51", pages = "987--993", journal = "Journal of Pain and Symptom Management", issn = "0885-3924", publisher = "Elsevier Inc.", number = "6", } . Journal of Pain and Symptom Management.

Identification of confounder in epidemiologic data contaminated by measurement error in covariates @article{690e0e8e85194579b45354a6d4c0b8fe, title = "Identification of confounder in epidemiologic data contaminated by measurement error in covariates", abstract = "Background: Common methods for confounder identification such as directed acyclic graphs (DAGs), hypothesis testing, or a 10 \% change-in-estimate (CIE) criterion for estimated associations may not be applicable due to (a) insufficient knowledge to draw a DAG and (b) when adjustment for a true confounder produces less than 10 \% change in observed estimate (e.g. in presence of measurement error). Methods: We compare previously proposed simulation-based approach for confounder identification that can be tailored to each specific study and contrast it with commonly applied methods (significance criteria with cutoff levels of p-values of 0.05 or 0.20, and CIE criterion with a cutoff of 10 \%), as well as newly proposed two-stage procedure aimed at reduction of false positives (specifically, risk factors that are not confounders). The new procedure first evaluates potential for confounding by examination of correlation of covariates and applies simulated CIE criteria only if there is evidence of correlation, while rejecting a covariate as confounder otherwise. These approaches are compared in simulations studies with binary, continuous, and survival outcomes. We illustrate the application of our proposed confounder identification strategy in examining the association of exposure to mercury in relation to depression in the presence of suspected confounding by fish intake using the National Health and Nutrition Examination Survey (NHANES) 2009-2010 data. Results: Our simulations showed that the simulation-determined cutoff was very sensitive to measurement error in exposure and potential confounder. The analysis of NHANES data demonstrated that if the noise-to-signal ratio (error variance in confounder/variance of confounder) is at or below 0.5, roughly 80 \% of the simulated analyses adjusting for fish consumption would correctly result in a null association of mercury and depression, and only an extremely poorly measured confounder is not useful to adjust for in this setting. Conclusions: No a prior criterion developed for a specific application is guaranteed to be suitable for confounder identification in general. The customization of model-building strategies and study designs through simulations that consider the likely imperfections in the data, as well as finite-sample behavior, would constitute an important improvement on some of the currently prevailing practices in confounder identification and evaluation.", keywords = "Causal effect, Change-in-estimate, Confounding, Epidemiology, Model-selection, Simulation", author = "Lee, \{Paul H.\} and Igor Burstyn", note = "Publisher Copyright: {\textcopyright} 2016 Lee and Burstyn.", year = "2016", month = may, day = "18", doi = "10.1186/s12874-016-0159-6", language = "English", volume = "16", journal = "BMC Medical Research Methodology", issn = "1471-2288", publisher = "BioMed Central", number = "1", } . BMC Medical Research Methodology.

Suicidality among Hong Kong nurses @article{2e333cbacf9f4635b250c65a1e141e54, title = "Suicidality among Hong Kong nurses: prevalence and correlates", abstract = "Empirical Research – Quantitative: Aims: The study estimates the prevalence and examines the socio-economic and psychological correlates of suicidality among professional nurses in Hong Kong. Background: Suicide rates among middle-aged employed groups have been increasing over the past few decades. There is a concern that medical occupational groups worldwide are at elevated risk of suicide. Nonetheless there are few population-based studies of suicide dealing with working-age Asian nurses. Design: The study uses a cross-sectional survey design. Method: Data were collected in Hong Kong over 4 weeks from October-November 2013. Statistical methods including descriptive analysis and univariate and multivariate cumulative logit modelling were used to examine the weighted prevalence rates of past-year suicidality and its associated factors in nurses. Results: A total of 850 nurses participated in the study; 14·9\% of participants had contemplated suicide while 2·9\% had attempted suicide once or more in the past year. Women report suicidal thoughts or attempts more often than men. Religion, poor health, deliberate self-harm, depressive symptoms and poor self-perceived physical and mental health were significantly associated with nurses' suicidality. Conclusions: Nurse professionals are not immune from mental health issues. Hong Kong's local health authority should put in place a raft of suicide prevention initiatives to promote mental wellness in the profession.", keywords = "Anxiety, Depression, Mental health, Nurses, Stress, Suicidal ideation, Suicidality", author = "Teris Cheung and Lee, \{Paul H.\} and Yip, \{Paul S.F.\}", note = "Publisher Copyright: {\textcopyright} 2016 John Wiley \& Sons Ltd.", year = "2016", month = apr, day = "1", doi = "10.1111/jan.12869", language = "English", volume = "72", pages = "836--848", journal = "Journal of Advanced Nursing", issn = "0309-2402", publisher = "Fafo", number = "4", } . Journal of Advanced Nursing.

Teris Cheung, Paul H. Lee, Paul S.F. Yip(2016). Suicidality among Hong Kong nurses: prevalence and correlates . Journal of Advanced Nursing. 72. (4). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 836--848. Wiley

Effects of a transitional palliative care model on patients with end-stage heart failure @article{63fc44465b7f425692e7cbec040faad5, title = "Effects of a transitional palliative care model on patients with end-stage heart failure: study protocol for a randomized controlled trial", abstract = "Background: Heart failure (HF) is characterized by high rates of readmission after hospitalization, and readmission is a major contributor to healthcare costs. The transitional care model has proven efficacy in reducing the readmission rate and economic outcomes, and increasing satisfaction with care. However, the effectiveness of the transitional care model has not been evaluated in patients with end-stage HF. This study was designed to compare the customary hospital-based care and a comprehensive transitional care model, namely the Home-based Palliative HF Program (HPHP), in terms of readmission rate, quality of life, and satisfaction with care among end-stage HF patients under palliative care. Methods/design: This is a randomized controlled trial taking place in hospitals in Hong Kong. We have been recruiting patients with end-stage HF who are identified as appropriate for palliative care during hospitalization, on referral by their physicians. A set of questionnaires is collected from each participant upon discharge. Participants are randomized to receive usual care (customary hospital-based care) or the intervention (HPHP). The HPHP will be implemented for up to 12 months. Outcome measures will be performed at 1, 3, 6, and 12 months post-discharge. The primary outcome of this study is quality of life measured by the Chronic Heart Failure Questionnaire - Chinese version; secondary outcomes include readmission rate, symptom intensity, functional status, and satisfaction with care. Discussion: This study is original and will provide important information for service development in the area of palliative care. The introduction of palliative care to end-stage organ failure patients is new and has received increasing attention worldwide in the last decade. This study adopts the randomized controlled trial, a vigorous research design, to establish scientific evidence in exploring the best model for end-stage HF patients receiving palliative care.", keywords = "End-stage heart failure, Health services utilization, Palliative care, Quality of life, Transitional care", author = "Ng, \{Alina Yee Man\} and Wong, \{Frances Kam Yuet\} and Lee, \{Paul Hong\}", note = "Funding Information: This study is funded by the Hong Kong University Grants Committee, General Research Fund, Research Grants Council (PolyU 5492/12H), and a Postgraduate Research Student Grant from the Hong Kong Polytechnic University (Ref. RPBS). We thank the palliative care teams of the study hospitals for their clinical advice on this study. We are grateful to the volunteers and participants of the study. Publisher Copyright: {\textcopyright} 2016 Ng et al.", year = "2016", month = mar, day = "31", doi = "10.1186/S13063-016-1303-7", language = "English", volume = "17", journal = "Trials", issn = "1745-6215", publisher = "BioMed Central", number = "1", } . Trials.

Structure and validity of family harmony scale @article{18a258d26c8f4a348a763da3367fb781, title = "Structure and validity of family harmony scale: an instrument for measuring harmony", abstract = "Culture plays a role in mental health, partly by defining the characteristics that are indicative of positive adjustment. In Chinese cultures, positive family relationships are considered central to well-being. The culturally emphasized characteristic of family harmony may be an important factor associated with psychopathology. This article presents the development and psychometric examination of the Family Harmony Scale (FHS), an indigenously developed 24-item instrument tapping family harmony in 17,461 Hong Kong residents from 7,791 households. A higher-order model with 1 second-order factor and 5 first-order factors fit the data well and showed factorial invariance across sex and participants in different family roles. A 5-item short form (FHS-5) was also developed, with 1 item from each first-order factor. The short scale showed, as expected, a single-factor structure with good fit. Both scales demonstrated high internal consistency, acceptable test-retest reliability, and good convergent and discriminant validity. The 24-item FHS was negatively associated with depressive symptoms after accounting for individual risk factors and general family function. Family harmony moderated the relationship between life stress and depressive symptoms such that those individuals who reported low family harmony had stronger associations between life stress and depressive symptoms. This study adds to the literature a systematically developed, multidimensional measure of family harmony, which may be an important psychological protective factor, in a large urban Chinese sample. The FHS-5 minimizes operational and respondent burdens, making it an attractive tool for large-scale epidemiological studies with Chinese populations in urban settings, where over half of China's 1.4 billion people reside.", keywords = "China, Depressive symptoms, Family harmony", author = "\{et al.\} and Sushma Kavikondala and Stewart, \{Sunita M.\} and Ni, \{Michael Y.\} and Chan, \{Brandford H.Y.\} and Lee, \{Paul H.\} and Li, \{Kin Kit\} and Ian McDowell and Johnston, \{Janice M.\} and Chan, \{Sophia S.\} and Lam, \{T. H.\} and Lam, \{Wendy W.T.\} and Richard Fielding and Leung, \{Gabriel M.\}", note = "Publisher Copyright: {\textcopyright} 2015 American Psychological Association.", year = "2016", month = mar, day = "1", doi = "10.1037/pas0000131", language = "English", volume = "28", pages = "307--318", journal = "Psychological Assessment", issn = "1040-3590", publisher = "American Psychological Association", number = "3", } . Psychological Assessment.

Sushma Kavikondala, Sunita M. Stewart, Michael Y. Ni, Brandford H. Y. Chan, Paul H. Lee, Kin-Kit Li, Ian McDowell, Janice M. Johnston, Sophia S. Chan, T. H. Lam, et al. (2016). Structure and validity of Family Harmony Scale: An instrument for measuring harmony . Psychological Assessment.

The development and psychometric evaluation of the Perception of Play Questionnaire for older adults @article{5a8aac18ae6d4338b8047876ced729a6, title = "The development and psychometric evaluation of the Perception of Play Questionnaire for older adults", abstract = "The objective was to develop and test the psychometric properties of the Perception of Play Questionnaire among older adults. Item generation, content validation, scale piloting for item validation, and assessment of construct validity were employed to develop the questionnaire. A 17-item Perception of Play Questionnaire was developed. Items described how older adults view play from positive and negative prospective. Satisfactory results were found for content validity. The Cronbach{\textquoteright}s alpha was.775. Correlations between perception of play and life satisfaction, happiness, and loneliness were demonstrated with statistical significance (p < 0.05). There were significant difference in multiple linear regression for frailty to Timed Up and Go Test (p < 0.01). The Perception of Play Questionnaire can help to understand how older people view the concept and their acceptance level of play. The data gathered using the questionnaire can aid in planning interventions to improve the health of older people.", author = "Tse, \{Mimi Mun Yee\} and Kwan, \{Tang Shuk\} and Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2016 Taylor \& Francis.", year = "2016", month = feb, day = "1", doi = "10.1080/03601277.2015.1071600", language = "English", volume = "42", pages = "79--88", journal = "Educational Gerontology", issn = "0360-1277", publisher = "Routledge", number = "2", } . Educational Gerontology.

Study protocol of a cluster randomized controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention programme for private for-profit nursing homes @article{6a3634cc9a244fb294b9f152473dac77, title = "Study protocol of a cluster randomized controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention programme for private for-profit nursing homes", abstract = "Background: Because the demand for government-subsidized nursing homes in Hong Kong outstrips the supply, the number of for-profit private nursing homes has been increasing rapidly. However, the standard of care in such homes is always criticized. Pressure ulcers are a major long-term care issue that is closely associated with the quality of care delivered in nursing home settings. The aim of this study is to evaluate the effectiveness of a pressure ulcer prevention programme for residents in private for-profit nursing homes. Methods/design: This is a two-arm cluster randomized controlled trial with an estimated sample size of 1088 residents and 74 care staff from eight for-profit private nursing homes. Eligible nursing homes will be those classified as category A2 homes in the Enhanced Bought Place Scheme (EBPS), having a capacity of around 130-150 beds, and no structured PU prevention protocol and/or programmes in place. Care staff will be health workers, personal care workers, and nurses who are front-line staff providing direct care to residents. Eight nursing homes will be randomly assigned to either an experimental or control group. The experimental group will be provided with an intensive training programme and will be involved in the implementation of a 16-week pressure ulcer prevention protocol, while the control group will deliver the usual pressure ulcer prevention care. The study outcomes are the pressure ulcer prevention knowledge and skills of the care staff and the prevalence and incidence of pressure ulcers. Data on the knowledge and skills of care staff, and prevalence of pressure ulcer will be collected at the base line, and then at the 8th week and at completion of the implementation of the protocol. The assessment of the incidence of pressures will start from before the commencement of the intensive training course to the end of the implementation of the protocol. Discussion: In view of the negative impact of pressure ulcers, it is important to have an effective and evidence-based pressure ulcer prevention programme to improve preventive care in private for-profit nursing homes. The programme will potentially improve the knowledge and skills of care staff on the prevention of pressure ulcers and also lead to a reduction in the development of pressure ulcers in nursing homes.", keywords = "Gerontology, Nursing home, Pressure ulcer prevention, Protocol", author = "Kwong, \{Enid Wai Yung\} and Lee, \{Paul Hong\} and Yeung, \{Kwan Mo\}", note = "Funding Information: This project is funded by the Health and Medical Research Fund of the Food and Health Bureau, Hong Kong, which is an external grant (project number: 1131711). Publisher Copyright: {\textcopyright} 2016 Kwong et al.", year = "2016", month = jan, day = "18", doi = "10.1186/s12877-016-0189-2", language = "English", volume = "16", journal = "BMC Geriatrics", issn = "1471-2318", publisher = "BioMed Central", number = "1", } . BMC Geriatrics.

Predictors of participation in a telephone-based Acceptance and Commitment Therapy for smoking cessation study @article{723e8d6fb9ce427f8695358c03776a2c, title = "Predictors of participation in a telephone-based Acceptance and Commitment Therapy for smoking cessation study", abstract = "Background: Little is known about factors that influence participation in smoking cessation trials among Chinese populations. The aim of this study is to explore the characteristics of individuals who chose to participate and those who chose not to participate in a proactive telephone-based acceptance and commitment therapy program for smoking cessation within a Chinese sample, and to identify predictors of program participation. Understanding the factors that predict participation in smoking cessation trials may allow researchers and healthcare professionals to target their recruitment efforts to increase the enrollment of smokers in smoking cessation programs. Methods: Participants were proactively recruited from six primary healthcare centers. Current cigarette smokers were screened for eligibility and then invited to complete a baseline questionnaire for the trial. The differences in characteristics between participants and non-participants as well as factors predictive of participation were analyzed using Chi-square tests and logistics regression. Results: A total of 30,784 clinic attendees were approached. From these, 3,890 (12.6 \%) smokers were screened and identified. Of the 3,890 smokers, 420 (10.8 \%) were eligible to participate and completed the baseline questionnaires. The analysis showed that participants (n = 142) and non-participants (n = 278) differed significantly in terms of demographics, smoking-related, and psychological variables. The following characteristics were found to predict program participation: those with a relatively high level of dependence on nicotine (OR = 3.75; 95 \% CI = 1.25-11.23), those in the contemplation (OR = 7.86; 95 \% CI = 2.90-21.30) or preparation (OR = 24.81; 95 \% CI = 8.93-68.96) stages of change, and those who had abstained for one month or less in a previous attempt at quitting (OR = 3.77; 95 \% CI = 1.68-8.47). Conclusions: The study shed light on the factors predictive of participation in a counseling-based smoking cessation program among a Chinese population. The results were encouraging, as most significant predictors (e.g., nicotine dependence, stage of change in smoking cessation) can be feasibly addressed or modified with interventions. No significant predictive relationships were found between psycho-social variables or socio-demographic variables and participation. Efforts should be made to increase the enrollment of smokers who are seemingly not yet ready to quit, and to tailor the program to fit the program's participants.", keywords = "Acceptance and commitment therapy, Participation, Smoking cessation program", author = "Mak, \{Yim Wah\} and Lee, \{Paul H.\} and Loke, \{Alice Yuen\}", note = "Funding Information: This study is part of a trial funded by the Health and Medical Research Fund (Project No. 09101421), Food and Health Bureau, Government Secretariat, The Government of the Hong Kong Special Administration Region, The People{\textquoteright}s Republic of China. No funder has had any role in the preparation of the manuscript or in the decision to submit it. We thank our research colleagues Mr. Matthew LEE Kin-cheung, Ms. Juana Ha, Mr. Hoi Hong Hei, and Ms. Hui Hoi Ting for conducting subject recruitment, data collection, and assessments, and for their work in managing the project, and Ms. Wong Men Heng, Marian for providing administrative support. We are grateful to our colleagues at the six centers of the three organizations for their administrative support in screening and recruiting participants for this study. Publisher Copyright: {\textcopyright} 2015 Mak et al.", year = "2015", month = dec, day = "23", doi = "10.1186/s12889-015-2650-0", language = "English", volume = "15", journal = "BMC Public Health", issn = "1471-2458", publisher = "BioMed Central", number = "1", } . BMC Public Health.

Effect of low-intensity exercise on physical and cognitive health in older adults @article{99c456fe0de54875abf0a87f20a35dce, title = "Effect of low-intensity exercise on physical and cognitive health in older adults: a Systematic Review", abstract = "Background: It is well known that physical exercise is important to promote physical and cognitive health in older population. However, inconsistent research findings were shown regarding exercise intensity, particularly on whether low-intensity exercise (1.5 metabolic equivalent tasks (METs) to 3.0 METs) can improve physical and cognitive health of older adults. This systematic review aimed to fill this research gap. The objective of this study is to conduct a systematic review of the effectiveness of low-intensity exercise interventions on physical and cognitive health of older adults. Methods: Published research was identified in various databases including CINAHL, MEDLINE, PEDro, PubMed, Science Direct, SPORTDiscus, and Web of Science. Research studies published from January 01, 1994 to February 01, 2015 were selected for examination. Studies were included if they were published in an academic peer-reviewed journal, published in English, conducted as randomized controlled trial (RCT) or quasi-experimental studies with appropriate comparison groups, targeted participants aged 65 or above, and prescribed with low-intensity exercise in at least one study arm. Two reviewers independently extracted the data (study, design, participants, intervention, and results) and assessed the quality of the selected studies. Fifteen studies met the inclusion criteria. Quality index ranged from 15 to 18 mean = 18.3 with a full score of 28, indicating a moderate quality. Most of the outcomes reported in these studied were lower limb muscle strength (n = 9), balancing (n = 7), flexibility (n = 4), and depressive symptoms (n = 3). Results: Out of the 15 selected studies, 11 reported improvement in flexibility, balancing, lower limb muscle strength, or depressive symptoms by low-intensity exercises. Conclusions: The current literature suggests the effectiveness of low-intensity exercise on improved physical and cognitive health for older adults. It may be a desired intensity level in promoting health among older adults with better compliance, lower risk of injuries, and long-term sustainability.", keywords = "Cognitive health, Low-intensity exercise, Older adults, Physical health", author = "Tse, \{Andy C.Y.\} and Wong, \{Thomson W.L.\} and Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2015, Tse et al.", year = "2015", month = dec, day = "1", doi = "10.1186/s40798-015-0034-8", language = "English", volume = "1", journal = "Sports Medicine - Open", issn = "2198-9761", publisher = "SpringerOpen", number = "1", } . Sports Medicine - Open.

Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual disability @article{bc1c5d71cf1440a3b14febb4a1fe458f, title = "Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual disability", abstract = "Background: Infectious diseases are common among schoolchildren as a result of their poor hand hygiene, especially in those who have developmental disabilities. Methods: A quasi-experimental study using a pre- to post-test design with a control group was used to test the feasibility and sustainability of simplified 5-step handwashing techniques to measure the hand hygiene outcome for students with mild intellectual disability. Sickness-related school absenteeism was compared. Results: The intervention group experienced a significant increase in the rating of their handwashing quality in both hands from pre- to post-test: left dorsum (+1.05, P <.001); right dorsum (+1.00, P <.001); left palm (+0.98, P <.001); and right palm (+1.09, P <.001). The pre- to post-test difference in the intervention group (+1.03, P <.001) was significantly greater than the difference in the control group (+0.34, P =.001). There were no differences between the post-test and the sustainability assessment in the intervention group. The intervention school experienced a significantly lower absenteeism rate (0.0167) than the control group in the same year (0.028, P =.04).Students in this study showed better performance in simplified handwashing techniques and experienced lower absenteeism than those using usual practice in special education school settings. Conclusion: The simplified 5-step hand hygiene technique has been proven effective in reducing the spread of infectious diseases.", keywords = "Multidimensional strategies", author = "Lee, \{Regina L.T.\} and Cynthia Leung and Tong, \{Wah Kun\} and Hong Chen and Lee, \{Paul H.\}", note = "Funding Information: Funding/Support: Supported by the Health and Medical Research Fund 2013/2014. (reference no. 13121452). Publisher Copyright: Copyright {\textcopyright} 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.", year = "2015", month = sep, day = "1", doi = "10.1016/j.ajic.2015.03.023", language = "English", volume = "43", pages = "907--912", journal = "American Journal of Infection Control", issn = "0196-6553", publisher = "Elsevier Inc.", number = "9", } . American Journal of Infection Control.

The association between time spent in sedentary behaviors and blood pressure @article{05af2069e5a048bbb22d9a3f4fe241f9, title = "The association between time spent in sedentary behaviors and blood pressure: a systematic review and meta-analysis", abstract = "Background and Objective: Sedentary behaviors, defined as waking behaviors with low energy expenditure while sitting, are positively associated with several adverse health outcomes. However, the association between sedentary behaviors and blood pressure (BP) is inconclusive. This study aimed to conduct a systematic review and meta-analysis on the association between time spent in sedentary behaviors and BP. Methods: We searched PubMed, MEDLINE, and Web of Science for papers published before August 2014 that assessed the association between time spent in sedentary behaviors and BP. Studies on both adults and children were included. Only good quality studies were included. The pooled estimates of systolic BP (SBP) and diastolic BP (DBP) increase per hour of time spent in sedentary behaviors a day were computed using a fixed-effects model and a random-effects model, respectively. Another pooled estimate of odds ratio per hour of time spent in sedentary behaviors a day on having high BP was computed using a fixed-effects model. A sub-group analysis was conducted for studies using self-reported and objectively assessed time spent in sedentary behaviors separately. Results: A total of 31 papers of good quality were included in the systematic review, 18 of which found no association between time spent in sedentary behaviors and BP (58.1 \%). A total of 28 papers were included in the meta-analysis. Pooled effects showed that an additional hour of time spent in sedentary behaviors per day was associated with an increase of 0.06 mmHg (108,228 participants, 95 \% CI 0.01–0.11, p = 0.01) of SBP and 0.20 mmHg (107,791 participants, 95 \% CI 0.10–0.29, p < 0.001) of DBP. Accelerometer-assessed time spent in sedentary behaviors was not associated with either SBP (p = 0.06) or DBP (p = 0.33). The odds ratio (OR) of having high BP with an additional hour of time spent in sedentary behaviors per day was 1.02 (98,798 participants, 95 \% CI 1.003–1.03, p = 0.02). Conclusions: Self-reported but not accelerometer-assessed time spent in sedentary behaviors was associated with BP. Further studies are warranted to determine the preventive effect of reducing sedentary behaviors on high BP.", author = "Lee, \{Paul H.\} and Wong, \{Frances K.Y.\}", note = "Publisher Copyright: {\textcopyright} 2015, Springer International Publishing Switzerland.", year = "2015", month = jun, day = "26", doi = "10.1007/s40279-015-0322-y", language = "English", volume = "45", pages = "867--880", journal = "Sports Medicine", issn = "0112-1642", publisher = "Springer International Publishing AG", number = "6", } . Sports Medicine.

Association of auricular reflective points and status of type 2 diabetes mellitus @article{03192d49e19e4c498583845453d7a02e, title = "Association of auricular reflective points and status of type 2 diabetes mellitus: A matched case-control study", abstract = "The reflexive property of the ear can cause various physical attributes to appear on the auricle in the presence of bodily disorders. The association of auricular signals (presence or absence of discoloration, marks after pressing, tenderness, and electrical resistance) and diabetes mellitus (DM) should be further investigated because auricular diagnosis is an objective, painless, and noninvasive method that provides rapid access to information. A matched case-control study on 282 subjects was conducted. Cases (n = 141) were defined as those diagnosed with type 2 DM (T2DM). Every subject in the case group was matched with the control by age and gender. Ear diagnosis was conducted in three aspects: inspection, electrical detection, and tenderness testing. Results suggest that the tenderness and electrical conductivity of some auricular points, including {"}pancreas and gallbladder,{"} {"}endocrine,{"} {"}kidney,{"} {"}lower tragus,{"} {"}heart,{"} and {"}eyes,{"} were associated with T2DM status in Chinese population. In the subgroup analyses, certain auricular signals were also associated with glycemic control, disease duration, and related complications. Auricular diagnosis could be considered as a screening method for vulnerable populations with T2DM risk. Thus, appropriate interventions can be implemented to prevent or delay the progression of T2DM.", author = "\{et al.\} and Suen, \{Lorna Kwai Ping\} and Yeh, \{Chao Hsing\} and Kwan, \{Jojo Yee Mei\} and Lee, \{Paul Hong\} and Yeung, \{Grace Sau Ping\} and Wong, \{Esther C.Y.\} and Lau, \{Billie C.\} and Tsang, \{Samuel Chi Hung\} and Cheung, \{Alice Siu Ping\} and Yeung, \{Vincent Tok Fai\}", note = "Publisher Copyright: {\textcopyright} 2015 Lorna Kwai-Ping Suen et al.", year = "2015", month = may, day = "19", doi = "10.1155/2015/981563", language = "English", volume = "2015", journal = "Evidence-based Complementary and Alternative Medicine", issn = "1741-427X", publisher = "Hindawi Limited", } . Evidence-based Complementary and Alternative Medicine.

A sensitivity analysis on the variability in accelerometer data processing for monitoring physical activity @article{8c0b874474304ae98ff41d0153f68078, title = "A sensitivity analysis on the variability in accelerometer data processing for monitoring physical activity", abstract = "Background: Accelerometers are gaining popularity for measuring physical activity, but there are many different ways to process accelerometer data. A sensitivity analysis was conducted to study the effect of varying accelerometer data processing protocols on estimating the association between PA level and socio-demographic characteristics using the National Health and Nutrition Examination Survey (NHANES) accelerometer data. Methods: The NHANES waves 2003-2004 and 2005-2006 accelerometer data (. n=. 14,072) were used to investigate the effect of changing the accelerometer non-wearing time and valid day definitions on the demographic composition of the filtered datasets and the association between physical activity (PA) and socio-demographic characteristics (sex, age, race, educational level, marital status). Results: Under different filtering rules (minimum number of valid day and definition of non-wear time), the demographic characteristics of the final sample varied. The proportion of participants aged 20-29 decreased from 18.9\% to 15.8\% when the minimum number of valid days required increased from 1 to 4 (. p for trend. <. 0.001), whereas that for aged ≥70 years increased from 18.9\% to 20.6\% (. p for trend. <. 0.001). Furthermore, with different filters, the effect of these demographic variables and PA varied, with some variables being significant under certain filtering rules but becoming insignificant under some other rules. Conclusions: The sensitivity analysis showed that the significance of the association between socio-demographic variables and PA could be varied with the definition of non-wearing time and minimum number of valid days.", keywords = "Accelerometry, Data analysis, Lifestyles, Motor activity, NHANES", author = "Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2014 Elsevier B.V.", year = "2015", month = feb, day = "1", doi = "10.1016/j.gaitpost.2014.12.008", language = "English", volume = "41", pages = "516--521", journal = "Gait and Posture", issn = "0966-6362", publisher = "Elsevier BV", number = "2", } . Gait and Posture.

Paul Lee, Ka Lee, Duncan Macfarlane (2014). Associations between Moderate-to-Vigorous Physical Activity and Neighbourhood Recreational Facilities: The Features of the Facilities Matter . International Journal of Environmental Research and Public Health.

Associations between moderate-to-vigorous physical activity and neighbourhood recreational facilities @article{d09426de4f604a10957d197523b0a9aa, title = "Associations between moderate-to-vigorous physical activity and neighbourhood recreational facilities: the features of the facilities matter", abstract = "Objectives: To examine the associations between objectively-assessed moderate-to-vigorous physical activity (MVPA) and perceived/objective measures of neighbourhood recreational facilities categorized into indoor or outdoor, public, residential or commercial facilities. The associations between facility perceptions and objectively-assessed numbers of recreational facilities were also examined. Method: A questionnaire was used on 480 adults to measure local facility perceptions, with 154 participants wearing ActiGraph accelerometers for ≥4 days. The objectively-assessed number of neighbourhood recreational facilities were examined using direct observations and Geographical Information System data.Results: Both positive and negative associations were found between MVPA and perceived/objective measures of recreational facilities. Some associations depended on whether the recreational facilities were indoor or outdoor, public or residential facilities. The objectively-assessed number of most public recreational facilities was associated with the corresponding facility perceptions, but the size of effect was generally lower than for residential recreational facilities. Conclusions: The objectively-assessed number of residential outdoor table tennis courts and public indoor swimming pools, the objectively-assessed presence of tennis courts and swimming pools, and the perceived presence of bike lanes and swimming pools were positive determinants of MVPA. It is suggested to categorize the recreational facilities into smaller divisions in order to identify unique associations with MVPA.", keywords = "GIS, MVPA, Neighbourhood, Recreational facilities", author = "Lee, \{Ka Yiu\} and Lee, \{Paul H.\} and Duncan Macfarlane", note = "Publisher Copyright: {\textcopyright} 2014 by the authors; licensee MDPI, Basel, Switzerland.", year = "2014", month = dec, day = "4", doi = "10.3390/ijerph111212594", language = "English", volume = "11", pages = "12594--12610", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "12", } . International Journal of Environmental Research and Public Health.

To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability @article{3835682aafe84f3ca02c85636cd7564d, title = "To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: a pilot study", abstract = "A quasi-experimental study using a pretest-posttest design with a control group was used to evaluate the effects of a simplified 5-step multimedia visualization hand hygiene improvement program by schoolchildren with mild intellectual disability (MID). A total of twenty schoolchildren aged 6-12 years old with MID (12 males) were recruited and they were assigned into intervention (n= 10) and control (n= 10) groups. To evaluate the quality of their hand washing, Glow gel, which contains plastic simulated germs that are visible under an ultra-violet lamp, was applied to participants' hands to assess the quality of hand washing by comparing the amount of visible Glow gel before and after hand washing using a 4-point scale. Four raters used this 4-point scale to assess the quality of hand washing through digital photo images of the participants' hands. A total of eight digital photos per participant were taken. A fifteen-minute hand washing training session was conducted every school day for 4 weeks for the intervention group. Those in the control group received no training. A multimedia visual package on steps of hand washing was presented together with a reward system, whereby a number of stars were earned each week depending on the quality of hand washing. Results showed encouraging findings, as the schoolchildren in the intervention group showed significant improvement in hand washing (p< 0.001) and the improvement was stronger than that of the control group (p= 0.02). To conclude, a systematic instruction emphasizing multimedia visualization in a hand washing improvement program can be successfully implemented in a special school, and the effect of integrating multimedia visuals in the hand hygiene program could improve hand hygiene among schoolchildren with MID.", keywords = "Effectiveness, Multisensory stimulation, Schoolchildren with mild intellectual disability, Simplified hand hygiene program", author = "Lee, \{Regina L.T.\} and Lee, \{Paul H.\}", year = "2014", month = nov, doi = "10.1016/j.ridd.2014.07.016", language = "English", volume = "35", pages = "3014--3025", journal = "Research in Developmental Disabilities", issn = "0891-4222", publisher = "Elsevier Inc.", number = "11", } . Research in Developmental Disabilities.

Association between adolescents' physical activity and sedentary behaviors with change in BMI and risk of type 2 Diabetes @article{e110df6b89a140aa90406a7e0e755c4d, title = "Association between adolescents' physical activity and sedentary behaviors with change in BMI and risk of type 2 Diabetes", abstract = "This study aims at identifying the association between physical activity (PA) and sedentary behavior (SB) patterns during adolescents on the future increase in BMI and risk of diabetes during young adulthood. A total of 3,717 participants aged 11 to 21 at baseline who completed Waves I (1994-1995), II (1996), III (2001-2002), and IV (2008) surveys of the National Longitudinal Study of Adolescent Health (Add Health) were analyzed. Physical activity and sedentary behavior patterns were assessed using an interviewer-administered questionnaire at Waves I, II, and III. A participant was classified as having diabetes at Wave IV according to WHO guidelines. The k-means cluster analysis was used to identify the number of PA and SB patterns assessed using interviewer-administered questionnaire. The k-means cluster analysis identified three clusters; 575 (15.5\%), 2,140 (57.6\%), and 1,002 (27.0\%) participants belonged to the low PA high SB (LPAHSB), the LPALSB, and the HPALSB cluster respectively. Relative to the LPALSB cluster, the HPALSB cluster had lower increase in BMI from Wave III to Wave IV (P=0.03), whereas the difference between LPAHSB cluster and LPALSB cluster was not significant (P=0.09). The odds of developing diabetes at Wave IV was significant for the LPAHSB cluster (OR=1.69, 95\% CI= 1.04, 2.75) but not significant for the HPALSB cluster (OR=0.87, 95\% CI=0.52, 1.47) relative to the LPALSB cluster. To conclude, PA but not SB during adolescence predicted change in BMI during young adulthood. SB but not PA during adolescence predicted type 2 diabetes during young adulthood.", author = "Lee, \{Paul H.\}", note = "Funding Information: This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website ( http://www.cpc.unc.edu/addhealth ). No direct support was received from grant P01-HD31921 for this analysis. Publisher Copyright: {\textcopyright} 2014 Paul H Lee.", year = "2014", month = oct, day = "23", doi = "10.1371/journal.pone.0110732", language = "English", volume = "9", journal = "PLoS ONE", issn = "1932-6203", publisher = "PLOS", number = "10", } . PLoS ONE.

Resampling methods improve the predictive power of modeling in class-imbalanced datasets @article{32d5638e364d4665be7d1141e35aa763, title = "Resampling methods improve the predictive power of modeling in class-imbalanced datasets", abstract = "In the medical field, many outcome variables are dichotomized, and the two possible values of a dichotomized variable are referred to as classes. A dichotomized dataset is class-imbalanced if it consists mostly of one class, and performance of common classification models on this type of dataset tends to be suboptimal. To tackle such a problem, resampling methods, including oversampling and undersampling can be used. This paper aims at illustrating the effect of resampling methods using the National Health and Nutrition Examination Survey (NHANES) wave 2009–2010 dataset. A total of 4677 participants aged ≥20 without self-reported diabetes and with valid blood test results were analyzed. The Classification and Regression Tree (CART) procedure was used to build a classification model on undiagnosed diabetes. A participant demonstrated evidence of diabetes according to WHO diabetes criteria. Exposure variables included demographics and socio-economic status. CART models were fitted using a randomly selected 70\% of the data (training dataset), and area under the receiver operating characteristic curve (AUC) was computed using the remaining 30\% of the sample for evaluation (testing dataset). CART models were fitted using the training dataset, the oversampled training dataset, the weighted training dataset, and the undersampled training dataset. In addition, resampling case-to-control ratio of 1:1, 1:2, and 1:4 were examined. Resampling methods on the performance of other extensions of CART (random forests and generalized boosted trees) were also examined. CARTs fitted on the oversampled (AUC = 0.70) and undersampled training data (AUC = 0.74) yielded a better classification power than that on the training data (AUC = 0.65). Resampling could also improve the classification power of random forests and generalized boosted trees. To conclude, applying resampling methods in a class-imbalanced dataset improved the classification power of CART, random forests, and generalized boosted trees.", keywords = "Automated classifier, Data mining, Decision tree, Oversampling, Predictive power, Rare events", author = "Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2014 by the authors; licensee MDPI, Basel, Switzerland.", year = "2014", month = sep, day = "18", doi = "10.3390/ijerph110909776", language = "English", volume = "11", pages = "9776--9789", journal = "International Journal of Environmental Research and Public Health", issn = "1661-7827", publisher = "MDPI", number = "9", } . International Journal of Environmental Research and Public Health.

Paul Lee (2014). Resampling Methods Improve the Predictive Power of Modeling in Class-Imbalanced Datasets . International Journal of Environmental Research and Public Health.

Should we adjust for a confounder if empirical and theoretical criteria yield contradictory results? A simulation study @article{6da3f14f447b4c9597cf25ace9d8895b, title = "Should we adjust for a confounder if empirical and theoretical criteria yield contradictory results? A simulation study", abstract = "Confounders can be identified by one of two main strategies: empirical or theoretical. Although confounder identification strategies that combine empirical and theoretical strategies have been proposed, the need for adjustment remains unclear if the empirical and theoretical criteria yield contradictory results due to random error. We simulated several scenarios to mimic either the presence or the absence of a confounding effect and tested the accuracy of the exposure-outcome association estimates with and without adjustment. Various criteria (significance criterion, Change-in-estimate(CIE) criterion with a 10\% cutoff and with a simulated cutoff) were imposed, and a range of sample sizes were trialed. In the presence of a true confounding effect, unbiased estimates were obtained only by using the CIE criterion with a simulated cutoff. In the absence of a confounding effect, all criteria performed well regardless of adjustment. When the confounding factor was affected by both exposure and outcome, all criteria yielded accurate estimates without adjustment, but the adjusted estimates were biased. To conclude, theoretical confounders should be adjusted for regardless of the empirical evidence found. The adjustment for factors that do not have a confounding effect minimally effects. Potential confounders affected by both exposure and outcome should not be adjusted for.", author = "Lee, \{Paul H.\}", year = "2014", month = aug, day = "15", doi = "10.1038/srep06085", language = "English", volume = "4", journal = "Scientific Reports", issn = "2045-2322", publisher = "Nature Research", } . Scientific Reports.

Psychometric evaluation of the Chinese version of the subjective happiness scale @article{d1ed319ed0424961ab9e6c58f054356c, title = "Psychometric evaluation of the Chinese version of the subjective happiness scale: evidence from the Hong Kong family cohort", abstract = "Background: With China's rapid economic growth in the past few decades, there is currently an emerging focus on happiness. Cross-cultural validity studies have indicated that the four-item Subjective Happiness Scale (SHS) has high internal consistency and stable reliability. However, the psychometric characteristics of the SHS in broader Chinese community samples are unknown. Purpose: We evaluated the factor structure and psychometric properties of the SHS in the Hong Kong general population. Methods: The Chinese SHS was derived using forward-backward translation. Of the Cantonese-speaking participants aged ≥15 years, 2,635 were randomly selected from the random sample component of the FAMILY Cohort, a territory-wide cohort study in Hong Kong. In addition to the SHS, a single-item overall happiness scale, the Patient Health Questionnaire-9 (PHQ-9), the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR) scale, and the Medical Outcomes Study 12-item short-form version 2 (SF-12) mental and physical health scales were administered. Results: Exploratory and confirmatory factor analyses supported a single factor with high loadings for the four SHS items. Multiple group analyses indicated factor invariance across sex and age groups. Cronbach's alpha was 0.82, and 2-week test-retest reliability (n∈=∈191) was 0.70. The SHS correlated significantly with single-item overall happiness (Spearman's rho [ρ]∈=∈0.57), Family APGAR (ρ∈=∈0.26), PHQ-9 (ρ∈=∈-0.34), and mental health-related quality of life (ρ∈=∈0.40) but showed a lower correlation with physical health (ρ∈=∈0.15). A regression model that included the PHQ-9 and Family APGAR scores explained 37 \% of the variance in SF-12 mental health scores; adding the SHS raised the variance explained to 41 \%. Conclusions: Our results support the reliability and validity of the SHS as a relevant component in the measurement battery for mental well-being in a Chinese general population.", keywords = "Chinese, Construct validity, Family study, Public health, Subjective Happiness Scale, Well-being", author = "\{et al.\} and Hairong Nan and Ni, \{Michael Y.\} and Lee, \{Paul H.\} and Tam, \{Wilson W.S.\} and Lam, \{Tai Hing\} and Leung, \{Gabriel M.\} and Ian McDowell", note = "Funding Information: Acknowledgments This study was a part of the project “FAMILY: A Jockey Club Initiative for a Harmonious Society” funded by The Hong Kong Jockey Club Charities Trust. We sincerely thank Dr. Ben Li and Mr. Paul Wong, who worked for the FAMILY Cohort in its early phase.", year = "2014", month = aug, doi = "10.1007/s12529-014-9389-3", language = "English", volume = "21", pages = "646--652", journal = "International Journal of Behavioral Medicine", issn = "1070-5503", publisher = "Routledge", number = "4", } . International Journal of Behavioral Medicine.

Peer volunteers in an integrative pain management program for frail older adults with chronic pain @article{5283e9560427428ab789d999b0b91d8a, title = "Peer volunteers in an integrative pain management program for frail older adults with chronic pain: Study protocol for a randomized controlled trial", abstract = "Background: Chronic pain is common among the older population. A literature review on pain management program showed that exercise, yoga, massage therapy, Tai Chi, and music therapy could significantly reduce pain. In spite of the proven benefits of pain management programs, these intervention programs were effective only in the short term, and older adults would resume their old habits. It has been suggested that interventions comprising some type of social support have great potential to increase the participation of older adults. Therefore, we propose the inclusion of peer volunteers in an integrated pain management program to relieve pain among frail older adults. This study aims to explore the effectiveness of an integrated pain management program supplemented with peer volunteers in improving pain intensity, functional mobility, physical activity, loneliness levels, happiness levels, and the use of non-pharmacological pain-relieving methods among frail older adults with chronic pain.Methods/Design: We intend to recruit 30 nursing home residents and 30 peer volunteers from the Institute of Active Ageing in Hong Kong in a group trial for an 8-week group-based integrated pain management program. There will be 16 sessions, with two 1-hour sessions each week.The primary outcome will be pain levels, while secondary outcomes will be assessed according to functional mobility, physical activity, loneliness levels, happiness levels, the use of non-pharmacological pain-relieving methods, and through a questionnaire for volunteers.Discussion: In view of the high prevalence of chronic pain among older adults and its adverse impacts, it is important to provide older adults with tools to control their pain. We propose the use of peer volunteers to enhance the effects of an integrated pain management program. It is expected that pain can be reduced and improvements can be achieved among older adults in the areas of physical activity, functional mobility, loneliness levels, happiness levels, and the use of non-pharmacological pain relieving methods. Using these results, we will assess the need to conduct a larger study with a randomized controlled design.Trial registration: This trial was registered on 24 February 2014 at the Australian New Zealand Clinical Trials Registry (ANZCTR) with the trial number: ACTRN12614000195651.", keywords = "gerontology, non-pharmacological, pain, peer volunteers, physical activity, protocol", author = "Tse, \{Mimi M.Y.\} and Lee, \{Paul H.\} and Ng, \{Sheung M.\} and Tsien-Wong, \{Bik K.\} and Yeung, \{Suey S.Y.\}", note = "Funding Information: This study is intended to be submitted to the General Research Fund (2014/15) of the Research Grants Council for project funding.", year = "2014", month = jun, day = "3", doi = "10.1186/1745-6215-15-205", language = "English", volume = "15", journal = "Trials", issn = "1745-6215", publisher = "BioMed Central", number = "1", } . Trials.

Self-reported oral health and quality of life @article{494c2eebdddf4b0ba92fa50925689114, title = "Self-reported oral health and quality of life: a latent growth curve analysis", abstract = "Background: The longitudinal associations between oral health (OH) and physical and mental health-related quality of life (HRQoL) are unclear. Purpose: This study examined the relationship of self-reported OH with the trajectories of physical and mental HRQoL in Hong Kong at 3, 9, and 15 months after the measurement period using a latent growth curve model. Methods: This study included 5,710 participants recruited in the FAMILY project cohort study during March-October 2009. Self-report OH was measured using a five-point single-item scale, and HRQoL was measured using the physical component scale (PCS) and mental component scale (MCS) of Short Form 12. Latent growth curve model was used to compute the relationship of self-reported OH with the trajectories on HRQoL over time, adjusted for age and sex. Results: The latent growth curve model gave good fit to both the PCS (normed fit index (NFI)=0.98, comparative fit index (CFI)=0.99, and standardized root mean square residual (SRMR)=0.03) and MCS (NFI=0.97, CFI=0.98, and SRMR=0.03). Better self-reported OH was associated with higher PCS and MCS at the baseline. The longitudinal association with PCS remained constant over time (coefficient=-0.02, p=0.07) but that with MCS diminished over time with baseline oral health status (coefficient=-0.04, p=0.002). Conclusion: Better self-reported OH status was associated with higher level of physical and mental HRQoL, and with negative change in mental HRQoL.", keywords = "Dentistry, Epidemiology, Longitudinal, Structural equation model, Survey", author = "Lee, \{Paul H.\} and McGrath, \{Colman P.J.\} and Kong, \{Angie Y.C.\} and Lam, \{T. H.\}", note = "Funding Information: This study was part of the FAMILY Project cohort study, funded by a local charity, the Hong Kong Jockey Club Charities Trust, as an Initiative for a Harmonious Society. Sampling was based on a random selection of residential addresses provided by the Hong Kong Census and Statistics Department. A family was eligible when all members aged 15 years or older, who lived in the same address and could understand Cantonese, agreed to participate. For the present analyses, we used baseline data on the first 5,000 families interviewed during March–October 2009. All eligible members were interviewed by trained interviewers who entered the data into tablet PCs. The details of the interview had been described in the FAMILY Project website (http:// www.family.org.hk/lang/en-us/household-survey) and elsewhere [13]. Telephone/web-based follow-ups were conducted after the participants had completed the household interviews for 3, 9, and 15 months. As poor OH has both short-term (e.g., pain due to irreversible pulpitis) and long-term (e.g., tooth loss due to chronic periodontitis) impact on HRQoL, these time intervals were able to capture both acute and long-term effect of the health discrepancy at baseline. Only the first 5,000 families were included as the HRQoL of the remaining families were not assessed in the telephone/ web-based follow-ups. Over 95 \% of the follow-up interviews were conducted via telephone, while less than 5 \% were done using internet surveys. The follow-up rates were 64 \% at 3 months, 75 \% at 9 months, and 68 \% at 15 months, and only those completing all follow-ups (n=5,710, 46 \%) were included in the present analysis. Written consent was obtained from participants (parental consent was also obtained for participants under 18) and this study was approved by the Institutional Review Board of the University of Hong Kong (reference number UW 09–387).", year = "2014", month = apr, day = "25", doi = "10.1007/s12529-013-9310-5", language = "English", volume = "21", pages = "358--363", journal = "International Journal of Behavioral Medicine", issn = "1070-5503", publisher = "Routledge", number = "2", } . International Journal of Behavioral Medicine.

Is a cutoff of 10% appropriate for the change-in-estimate criterion of confounder identification? @article{7133fe4b60144768a0c4f3b5bfcbd03a, title = "Is a cutoff of 10\% appropriate for the change-in-estimate criterion of confounder identification?", abstract = "Background: When using the change-in-estimate criterion, a cutoff of 10\% is commonly used to identify confounders. However, the appropriateness of this cutoff has never been evaluated. This study investigated cutoffs required under different conditions. Methods: Four simulations were performed to select cutoffs that achieved a significance level of 5\% and a power of 80\%, using linear regression and logistic regression. A total of 10 000 simulations were run to obtain the percentage differences of the 4 fitted regression coefficients (with and without adjustment). Results: In linear regression, larger effect size, larger sample size, and lower standard deviation of the error term led to a lower cutoff point at a 5\% significance level. In contrast, larger effect size and a lower exposure-confounder correlation led to a lower cutoff point at 80\% power. In logistic regression, a lower odds ratio and larger sample size led to a lower cutoff point at a 5\% significance level, while a lower odds ratio, larger sample size, and lower exposure-confounder correlation yielded a lower cutoff point at 80\% power. Conclusions: Cutoff points for the change-in-estimate criterion varied according to the effect size of the exposure-outcome relationship, sample size, standard deviation of the regression error, and exposure-confounder correlation.", keywords = "Causality, Confounding factors, Regression, Simulation, Statistical models", author = "Lee, \{Paul H.\}", year = "2014", month = mar, day = "5", doi = "10.2188/jea.JE20130062", language = "English", volume = "24", pages = "161--167", journal = "Journal of Epidemiology", issn = "0917-5040", publisher = "Japan Epidemiology Association", number = "2", } . Journal of Epidemiology.

Feasibility and effects of TAI CIA I for the promotion of sleep quality and quality of life a single-group study in a sample of older Chinese individuals in Hong Kong @article{439a661aed35432db9855cf7248020da, title = "Feasibility and effects of TAI CIA I for the promotion of sleep quality and quality of life a single-group study in a sample of older Chinese individuals in Hong Kong", abstract = "Poor sleep in later life is a global issue that reduces many individuals' quality of life (QOL). The purpose of this pilot study was to test the feasibility and effects of a simplified tai chi exercise intervention on sleep quality and QOL among Chinese community-dwelling older adults with poor sleep quality. This single-group, descriptive feasibility study included 34 individuals with poor sleep quality who agreed to participate in a 12-week tai chi intervention. Twenty-six individuals completed the program (23.5\% dropout rate). Older adults with poor sleep quality who completed the intervention showed significant improvement in the Medical Outcomes Study Short Form-36 mental component and the Pittsburgh Sleep Quality Index global and component scores. The low recruitment and attendance and high dropout rates might be associated with participants' age, gender, and sleep quality. Further long-term studies are required to examine the potential effects of the tai chi intervention.", author = "\{Mei-Han Lo\}, Catherine and Lee, \{Paul H.\}", year = "2014", month = mar, day = "1", doi = "10.3928/00989134-20131028-08", language = "English", volume = "40", pages = "46--52", journal = "Journal of Gerontological Nursing", issn = "0098-9134", publisher = "Slack Incorporated", number = "3", } . Journal of Gerontological Nursing.

Lo, Catherine Mei-Han, Lee, Paul H.(2014). Feasibility and Effects of TAI CHI for the Promotion of Sleep Quality and Quality of Life A Single-Group Study in a Sample of Older Chinese Individuals in Hong Kong . Journal of Gerontological Nursing. 40. (3). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 46-52.

Lee, P.H.(2014). Should we adjust for a confounder if empirical and theoretical criteria yield contradictory results? A simulation study . Scientific Reports. 4.

Nan, H., Ni, M.Y., Lee, P.H., Tam, W.W.S., Lam, T.H., Leung, G.M., McDowell, I.(2014). Psychometric evaluation of the Chinese version of the subjective happiness scale: Evidence from the Hong Kong family cohort . International Journal of Behavioral Medicine. 21. (4). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 646-652.

Mei-Han Lo, C., Lee, P.(2014). Feasibility and effects of TAI CIA I for the promotion of sleep quality and quality of life a single-group study in a sample of older Chinese individuals in Hong Kong . Journal of Gerontological Nursing. 40. (3). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 46-52.

Tse, M.M.Y., Lee, P.H., Ng, S.M., Tsien-Wong, B.K., Yeung, S.S.Y.(2014). Peer volunteers in an integrative pain management program for frail older adults with chronic pain: Study protocol for a randomized controlled trial . Trials. 15. (1).

Lee, Paul H., McGrath, Colman P. J., Kong, Angie Y. C., Lam, T. H.(2014). Self-reported Oral Health and Quality of Life: A Latent Growth Curve Analysis . International Journal of Behavioral Medicine. 21. (2). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 358-363.

Lee, P.H., McGrath, C.P.J., Kong, A.Y.C., Lam, T.H.(2014). Self-reported oral health and quality of life: A latent growth curve analysis . International Journal of Behavioral Medicine. 21. (2). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 358-363.

Lee, P.H.(2014). Is a cutoff of 10% appropriate for the change-in-estimate criterion of confounder identification? . Journal of Epidemiology. 24. (2). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 161-167.

Nan, H., Ni, M.Y., Lee, P.H., Tam, W.W.S., Lam, T.H., Leung, G.M., McDowell, I.(2014). Psychometric Evaluation of the Chinese Version of the Subjective Happiness Scale: Evidence from the Hong Kong FAMILY Cohort . International Journal of Behavioral Medicine. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1-7.

Lee, Paul H.(2014). Is a Cutoff of 10% Appropriate for the Change-in-Estimate Criterion of Confounder Identification? . Journal of Epidemiology. 24. (2). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 161-167.

Factor analysis for paired ranked data with application on parent-child value orientation preference data @article{004cbfb82021426f8a13d09bfd433348, title = "Factor analysis for paired ranked data with application on parent-child value orientation preference data", abstract = "Ranking data appear in everyday life and arise in many fields of study such as marketing, psychology and politics. Very often, the key objective of analyzing and modeling ranking data is to identify underlying factors that affect the individuals' choice behavior. Factor analysis for ranking data is one of the most widely used methods to tackle the aforementioned problem. Recently, Yu et al. [J R Stat Soc Ser A (Statistics in Society) 168:583-597, 2005] have developed factor models for ranked data in which each individual is asked to rank a set of items. However, paired ranked data may arise when the same set of items are ranked by a pair of judges such as a couple in a family. This paper extended the factor model to accommodate such paired ranked data. The Monte Carlo expectation-maximization algorithm was used for parameter estimation, at which the E-step is implemented via the Gibbs Sampler. For model assessment and selection, a tailor-made method called the bootstrap predictive checks approach was proposed. Simulation studies were conducted to illustrate the proposed estimation and model selection method. The proposed method was applied to analyze a parent-child partially ranked data collected from a value priorities survey carried out in the United States.", keywords = "GHK method, Monte Carlo expectation-maximization, Predictive Checks, Ranking data", author = "Yu, \{Philip L.H.\} and Lee, \{Paul H.\} and Wan, \{W. M.\}", note = "Funding Information: The research of Philip L. H. Yu was supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 7473/05H). We thank the two anonymous referees for their helpful suggestions for improving this article. ", year = "2013", month = oct, doi = "10.1007/s00180-012-0387-0", language = "English", volume = "28", pages = "1915--1945", journal = "Computational Statistics", issn = "0943-4062", publisher = "Springer Science and Business Media B.V.", number = "5", } . Computational Statistics.

Factors associated with participant compliance in studies using accelerometers @article{7576508e2c9d4b1f9ba0e787a32df2b2, title = "Factors associated with participant compliance in studies using accelerometers", abstract = "Some participants wear the accelerometer for the duration specified by the researchers but many do not. We investigated a range of demographic factors associated with participant compliance in obtaining analyzable accelerometer data. A total of 3601 participants (aged 47.6 ± 13.1 years, 44.6\% male) were included. They were asked to wear an accelerometer (ActiGraph) for four consecutive days after completing a household survey during March 2009-January 2011 in Hong Kong. Participants wore the accelerometer on average for 13.9. h in a 24-h day. No significant difference was found between males and females (p = 0.38). Using log-linear regression, it was found that older participants (0.5\% more wearing hours for each year of age, p< 0.001), those with full-time job (p< 0.01), with tertiary education (p< 0.01), non-smokers (p< 0.01) and with high self-reported health (p< 0.05) wore the accelerometer for more hours. These results provide details for estimating compliance rates for samples with different characteristics and thus sample size calculation to account for participant compliance.", keywords = "Accelerometry, Activity monitor, Adherence, Participation, Physical activity", author = "Lee, \{Paul H.\} and Macfarlane, \{Duncan J.\} and Lam, \{T. H.\}", note = "Funding Information: This study was a part of the project “FAMILY: a Jockey Club Initiative for a Harmonious Society” supported by The Hong Kong Jockey Club Charities Trust. The funding body played no part in the data analysis, drafting of the manuscript, and the decision to submit for publication. We sincerely thank Prof. Gabriel Leung, Dr. Wilson W. S. Tam, Dr. Ying-Ying Yu, Dr. Ben K. K. Li, and Mr. Paul T. K. Wong (School of Public Health, The University of Hong Kong) for their role in the development of the survey instruments and the preparatory work for this research. Conflict of interest ", year = "2013", month = sep, doi = "10.1016/j.gaitpost.2013.04.018", language = "English", volume = "38", pages = "912--917", journal = "Gait and Posture", issn = "0966-6362", publisher = "Elsevier BV", number = "4", } . Gait and Posture.

A cluster analysis of patterns of objectively measured physical activity in Hong Kong @article{77ff694a30ad4b7db25041e8e02594e4, title = "A cluster analysis of patterns of objectively measured physical activity in Hong Kong", abstract = "Objective The health benefits of exercise are clear. In targeting interventions it would be valuable to know whether characteristic patterns of physical activity (PA) are associated with particular population subgroups. The present study used cluster analysis to identify characteristic hourly PA patterns measured by accelerometer. Design Cross-sectional design. Setting Objectively measured PA in Hong Kong adults. Subjects Four-day accelerometer data were collected during 2009 to 2011 for 1714 participants in Hong Kong (mean age 44·2 years, 45·9 \% male). Results Two clusters were identified, one more active than the other. The 'active cluster' (n 480) was characterized by a routine PA pattern on weekdays and a more active and varied pattern on weekends; the other, the 'less active cluster' (n 1234), by a consistently low PA pattern on both weekdays and weekends with little variation from day to day. Demographic, lifestyle, PA level and health characteristics of the two clusters were compared. They differed in age, sex, smoking, income and level of PA required at work. The odds of having any chronic health conditions was lower for the active group (adjusted OR = 0·62, 95 \% CI 0·46, 0·84) but the two groups did not differ in terms of specific chronic health conditions or obesity. Conclusions Implications are drawn for targeting exercise promotion programmes at the population level.", keywords = "Body composition, Chronic disease, Exercise, Motor activity, Sedentary lifestyle", author = "Lee, \{Paul H.\} and Yu, \{Ying Ying\} and Ian McDowell and Leung, \{Gabriel M.\} and Lam, \{T. H.\}", year = "2013", month = aug, doi = "10.1017/S1368980012003631", language = "English", volume = "16", pages = "1436--1444", journal = "Public Health Nutrition", issn = "1368-9800", publisher = "Cambridge University Press", number = "8", } . Public Health Nutrition.

Data imputation for accelerometer-measured physical activity @article{f99f4d7809044cf3bca66e0c8df48ffe, title = "Data imputation for accelerometer-measured physical activity: the combined approach 123", abstract = "Background: Accelerometers are gaining popularity for the assessment of the physical activity level; however, compliance is a problem that results in missing data. Data from study days in which the accelerometer is not worn for a number of hours that are sufficient to reach a predetermined cutoff value are considered invalid and discarded. The problem of missing data is commonly handled by imputation; however, all traditional imputation methods ignore the available information from invalid days. Objective: In this study, I propose a new approach to the imputation of missing accelerometer data that takes into account the data available from invalid days. Design: A total of 4069 participants in NHANES waves 2003-2004 and 2005-2006 who provided 7 d of valid accelerometer data were used to illustrate this new approach. The method of imputation was a combined approach that combined the available data from valid days and invalid days to impute missing values. Simulation studies were carried out to compare this new combined approach with the traditional imputation method for 1) accuracy and 2) effect-size estimation of the sexphysical activity relation by using the root mean squared error (RMSE). Results: The combined approach performed significantly better than traditional imputation method (all t tests P<0..001), with the percentage reduction of the RMSE for accuracy and effect-size estimation that ranged from 12.4\% to 17.3\% and 19.8\% to 32.9\%, respectively. Conclusion: The combined approach significantly outperforms the traditional imputation algorithm.", author = "Lee, \{Paul H.\}", year = "2013", month = may, day = "1", doi = "10.3945/ajcn.112.052738", language = "English", volume = "97", pages = "965--971", journal = "American Journal of Clinical Nutrition", issn = "0002-9165", publisher = "Elsevier BV", number = "5", } . American Journal of Clinical Nutrition.

For non-exercising people, the number of steps walked is more strongly associated with health than time spent walking @article{5d2e0a1524e04b579007082e70ae167f, title = "For non-exercising people, the number of steps walked is more strongly associated with health than time spent walking", abstract = "Objective: This study examined the associations between walking (number of steps and minutes spent) and seven health indicators, including chronic health conditions, depressive symptoms, and blood pressure, among nonexercising people who did not regularly engage in any non-walking moderate-to-vigorous physical activity in Hong Kong. Design: Under the FAMILY project, the number of steps per day and minutes spent walking were measured using an accelerometer. Participants (n= 2417) whose only form of physical activity was walking were included in the present analysis. Methods: Three indicators of walking (number of steps, minutes spent walking at moderate intensity, and minutes spent walking at light intensity) was measured by accelerometer. Associations between these indicators and seven health conditions were measured by the difference in z scores for those with, and those without, each health condition, adjusted for age and sex. Results: The number of steps per day was significantly and inversely associated with hypertension (difference in z= -0.22, p< 0.01), cancer (difference in z= -0.43, p< 0.05), stroke (difference in z= -0.63, p< 0.01), depressive symptoms (difference in z= -0.15, p< 0.01), health-related quality-of-life (difference in z= -0.13, p< 0.05), and pulse rate (difference in z= -0.11, p< 0.01). By contrast, time spent walking as measured by accelerometer was associated only with a single health indicator (hypertension, difference in z= -0.14, p< 0.05). Conclusions: Even among non-exercising people, accumulating number of steps appears to be related to fewer health problems and should be promoted as an accessible form of exercise, especially for those who lack the time or ability to engage in physical activity of at least moderate intensity.", keywords = "Accelerometer, Chronic disease, Exercise, Motor activity, Sedentary lifestyle", author = "Lee, \{Paul H.\} and Hairong Nan and Yu, \{Ying Ying\} and Ian McDowell and Leung, \{Gabriel M.\} and Lam, \{T. H.\}", note = "Funding Information: This study was a part of the project “FAMILY: a Jockey Club Initiative for a Harmonious Society” supported by The Hong Kong Jockey Club Charities Trust . The funding body played no part in the data analysis, paper writing, or the decision to submit for publication. We sincerely thank Dr. Wilson W. S. Tam, Dr. Ben K. K. Li, and Mr. Paul T. K. Wong (School of Public Health, The University of Hong Kong) for their contributions to the Cohort Study. ", year = "2013", month = may, doi = "10.1016/j.jsams.2012.10.005", language = "English", volume = "16", pages = "227--230", journal = "Journal of Science and Medicine in Sport ", issn = "1440-2440", publisher = "Elsevier Ltd.", number = "3", } . Journal of Science and Medicine in Sport.

Effects of depressive symptoms and family satisfaction on health related quality of life @article{8714c73a7da24f09905da6cadf638764, title = "Effects of depressive symptoms and family satisfaction on health related quality of life: the Hong Kong FAMILY Study", abstract = "Objective: To examine the effect of depressive symptoms and satisfaction with family support (FS) on physical and mental Health Related Quality of Life (HRQoL). Methods: Data were obtained from the Hong Kong FAMILY Project baseline survey in 2009-2011, which included 16,039 community residents (age ≥20). The FS was measured using the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR, range 0-10) Questionnaire. HRQoL were assessed using the SF-12 version 2. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived neighborhood cohesion were also assessed. Results: In a multilevel regression model, socio-demographic and behavioral variables explained 21\% and 19\% of the variance in physical and mental HRQoL. The presence of depressive symptoms (PHQ-9 score ≥10, standardized coefficients, β of -1.73) and high FS (APGAR score 7-10, 1.15) were associated with mental HRQoL, after adjustment for age, education, household monthly income, drinking status, physical activity, chronic conditions, life stress and neighborhood cohesion. Not FS but the presence of depressive symptoms (β of -0.88) was associated with physical HRQoL. The presence of depressive symptoms in women than men were more associated with a poorer physical HRQoL (p<0.01) while depressive symptoms in men were associated with a decrease in mental HRQoL (p<0.001). The interaction between FS and depressive symptoms was nonsignificant in relation to HRQoL. Among those with depressive symptoms, high FS was associated with a better mental HRQoL (41.1 vs. 37.9, p<0.001) in women but not contribute to variance in men. Conclusions: Higher FS and presence of depressive symptoms were significantly associated with HRQoL in general population in Hong Kong. Among those with depressive symptoms, high FS was associated with a favorable mental HRQoL in women but not men.", author = "Hairong Nan and Lee, \{Paul H.\} and Ni, \{Michael Y.\} and Chan, \{Brandford H.Y.\} and Lam, \{Tai Hing\}", year = "2013", month = mar, day = "14", doi = "10.1371/journal.pone.0058436", language = "English", volume = "8", journal = "PLoS ONE", issn = "1932-6203", publisher = "PLOS", number = "3", } . PLoS ONE.

Self-report poor oral health and chronic diseases @article{68f6884fbdd943f5b12fc98a689c92aa, title = "Self-report poor oral health and chronic diseases: the Hong Kong FAMILY project", abstract = "Objective To assess the association between self-reported oral health (SROH) and general health, this study examined the cross-sectional associations between SROH and nine chronic health conditions, namely cancer, diabetes, high blood pressure, high cholesterol, thyroid disease, nervous system disease, eye/nose/throat disease, stomach/intestinal disease, and musculoskeletal disease in Hong Kong. Methods This study included 41 641 participants recruited in the FAMILY Project cohort study during March 2009-March 2011. SROH was measured on a 5-point Likert scale. Multiple logistic regression model was used to analyze the effect of dichotomized SROH (0: very good/good/average, 1: bad/very bad) on nine chronic health conditions, adjusted for age, sex, education, personal income, smoking and drinking habits, Body mass index (BMI), and blood pressures. Results All the nine chronic health conditions investigated were associated with SROH. SROH showed the strongest cross-sectional association with nervous system disease (odds ratio = 3.30, P < 0.001), while the odds ratio with other significant chronic health conditions ranged from 1.13 (high cholesterol, P = 0.033)-1.73 (stomach/intestinal disease, P < 0.001). Conclusions Poor SROH is associated with cancer, diabetes, high blood pressure, high cholesterol, thyroid disease, nervous system disease, eye/nose/throat disease, stomach/intestinal disease, and musculoskeletal disease.", keywords = "chronic disease, dentistry, diabetes, epidemiology, hypertension, survey", author = "Lee, \{Paul H.\} and McGrath, \{Colman P.J.\} and Kong, \{Angie Y.C.\} and Lam, \{Tai Hing\}", year = "2013", month = jan, day = "21", doi = "10.1111/cdoe.12037", language = "English", volume = "41", pages = "451--458", journal = "Community Dentistry and Oral Epidemiology", issn = "0301-5661", publisher = "Blackwell Munksgaard", number = "5", } . Community Dentistry and Oral Epidemiology.

Lee, Paul H., Yu, Philip L. H.(2013). An R package for analyzing and modeling ranking data . Bmc Medical Research Methodology. 13.

Paul H. Lee, Philip L.H. Yu(2013). An R package for analyzing and modeling ranking data . BMC Medical Research Methodology. 13. (1). BioMed Central

Nan, Hairong, Lee, Paul H., Ni, Michael Y., Chan, Brandford H. Y., Lam, Tai-Hing(2013). Effects of Depressive Symptoms and Family Satisfaction on Health Related Quality of Life: The Hong Kong FAMILY Study . Plos One. 8. (3).

Lee, P.H., Yu, P.L.H.(2013). An R package for analyzing and modeling ranking data . BMC Medical Research Methodology. 13. (1).

Lee, P.H., Yu, Y.-Y., McDowell, I., Leung, G.M., Lam, T.H.(2013). A cluster analysis of patterns of objectively measured physical activity in Hong Kong . Public Health Nutrition. 16. (8). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1436-1444.

Lee, Paul H., Nan, Hairong, Yu, Ying-Ying, McDowell, Ian, Leung, Gabriel M., Lam, T. H.(2013). For non-exercising people, the number of steps walked is more strongly associated with health than time spent walking . Journal of Science and Medicine in Sport. 16. (3). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 227-230.

Lee, Paul H., Yu, Ying-Ying, McDowell, Ian, Leung, Gabriel M., Lam, T. H.(2013). A cluster analysis of patterns of objectively measured physical activity in Hong Kong . Public Health Nutrition. 16. (8). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1436-1444.

Lee, Paul H., McGrath, Colman P. J., Kong, Angie Y. C., Lam, Tai Hing(2013). Self-report poor oral health and chronic diseases: the Hong Kong FAMILY project . Community Dentistry and Oral Epidemiology. 41. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 451-458.

Lee, P.H., Nan, H., Yu, Y.-Y., McDowell, I., Leung, G.M., Lam, T.H.(2013). For non-exercising people, the number of steps walked is more strongly associated with health than time spent walking . Journal of Science and Medicine in Sport. 16. (3). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 227-230.

Lee, P.H.(2013). Data imputation for accelerometer-measured physical activity: The combined approach . American Journal of Clinical Nutrition. 97. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 965-971.

Lee, Paul H.(2013). Data imputation for accelerometer-measured physical activity: the combined approach . American Journal of Clinical Nutrition. 97. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 965-971.

Chan, Brandford H. Y., Nan, Hairong, Lee, Paul H., Ni, Michael Y., McDowell, Ian, Lam, T. H.(2013). PERCEIVED NEIGHBORHOOD COHESION (NC) AND EDUCATION: INDIVIDUAL AND COMBINED EFFECTS ON DAILY SMOKING AND HEAVIER DRINKING IN HONG KONG CHINESE. American Journal of Epidemiology. 177. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString S31.

Yu, P.L.H., Lee, P.H., Wan, W.M.(2013). Factor analysis for paired ranked data with application on parent-child value orientation preference data . Computational Statistics. 28. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1915-1945.

Nan, H., Lee, P.H., Ni, M.Y., Chan, B.H.Y., Lam, T.-H.(2013). Effects of Depressive Symptoms and Family Satisfaction on Health Related Quality of Life: The Hong Kong FAMILY Study . PLoS ONE. 8. (3).

Lee, P.H., Macfarlane, D.J., Lam, T.H.(2013). Factors associated with participant compliance in studies using accelerometers . Gait and Posture. 38. (4). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 912-917.

Lee, P.H., McGrath, C.P.J., Kong, A.Y.C., Lam, T.H.(2013). Self-report poor oral health and chronic diseases: The Hong Kong FAMILY project . Community Dentistry and Oral Epidemiology. 41. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 451-458.

Yu, Philip L. H., Lee, Paul H., Wan, W. M.(2013). Factor analysis for paired ranked data with application on parent-child value orientation preference data . Computational Statistics. 28. (5). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1915-1945.

Lee, Paul H., McDowell, Ian, Fielding, Richard, Chan, Sophia S. C., Stewart, Sunita M., Nan, Hairong, Chan, Brandford H. Y., Ni, Michael Y., Lam, Tai-hing, Leung, Gabriel M.(2013). VALIDATING THE FAMILY HARMONY SCALE IN HONG KONG CHINESE: JOCKEY CLUB FAMILY PROJECT. American Journal of Epidemiology. 177. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString S84.

Nan, Hairong, Ni, Michael Y., Lee, Paul H., Tam, Wilson W. S., Yu, Ying Ying, Lam, Tai-Hing, Leung, Gabriel M., McDowell, Ian(2013). PSYCHOMETRIC EVALUATION OF THE CHINESE VERSION OF THE SUBJECTIVE HAPPINESS SCALE. American Journal of Epidemiology. 177. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString S83.

Paul H. Lee, Sunita M. Stewart, Vivian M. C. Lun, Michael H. Bond, Xiaonan Yu, T. H. Lam (2012). Validating the concord index as a measure of family relationships in China . Journal of Family Psychology.

Validating the concord index as a measure of family relationships in China @article{c9010f784a9a445c80965efad9b9510e, title = "Validating the concord index as a measure of family relationships in China", abstract = "Interest in family functioning across cultures has become more widespread, but our instruments have not kept pace by measuring constructs that are especially relevant outside the West. We present the psychometric properties of the Concord Index (CI) in the family context. The CI examines qihe, translated most closely into English as concord. The term includes concepts of harmony and mutuality, and is a characteristic of dyadic relationships valued in Chinese cultural groups that form about a fifth of the world's population. The scale was adapted to measure 2 types of family relationships: specific dyadic relationships within the family between any individual family member and another (the A-P perspective), as well as an individual's composite assessment of all his/her family relationships (the A-FAM perspective). The 10-item measure was internally consistent, stable over 2 weeks, and showed factor invariance across gender, age, relationship, and household size for A-P and A-FAM perspectives. The A-P correlated negatively with disagreement with the partner. The A-FAM correlated with measures of family functioning, well-being, leisure time spent with family members, and with measures of emotional but not physical symptoms. Furthermore, the A-FAM measure added predictive power to individual measures of emotional functioning in assessing subjective happiness. The CI adds to other {"}imported{"} instruments designed to measure family function in Chinese populations because of its brevity, its adaptability for measuring dyadic and global family relationships across family roles, its easily understood items, and its incremental validity in predicting well-being beyond individually focused measures.", keywords = "Chinese, Family, Harmony, Indigenous, Scale", author = "Lee, \{Paul H.\} and Stewart, \{Sunita M.\} and Lun, \{Vivian M.C.\} and Bond, \{Michael H.\} and Xiaonan Yu and Lam, \{T. H.\}", year = "2012", month = dec, doi = "10.1037/a0029994", language = "English", volume = "26", pages = "906--915", journal = "Journal of Family Psychology", issn = "0893-3200", publisher = "American Psychological Association", number = "6", } . Journal of Family Psychology.

Depressive symptoms in people with chronic physical conditions @article{1cf07b2029f248388a0cda6fe4a1c8b0, title = "Depressive symptoms in people with chronic physical conditions: prevalence and risk factors in a Hong Kong community sample", abstract = "Background: Depression is predicted to become one of the two most burdensome diseases worldwide by 2020 and is common in people with chronic physical conditions. However, depression is relatively uncommon in Asia. Family support is an important Asian cultural value that we hypothesized could protect people with chronic physical conditions from developing depression. We investigated depressive symptom prevalence and risk factors in a Chinese sample with chronic medical conditions, focusing on the possible protective role of family relationships.Methods: Data were obtained from the Hong Kong Jockey Club FAMILY Project cohort study in 2009-2011, which included 6,195 participants (age ≥15) with self-reported chronic conditions. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived family support and neighborhood cohesion were assessed. Factors associated with a non-somatic (PHQ-6) depression score were also examined.Results: The prevalence of depressive symptoms (PHQ-9 scores ≥5) was 17\% in those with one or more chronic conditions, and was more prevalent in women than in men (19.7\% vs. 13.9\%; p < 0.001). In multilevel analyses, life stress, number of chronic conditions and satisfaction with family support explained 43\% of the variance in PHQ-9 scores (standardized regression coefficients of 0.46, 0.15, and -0.12 respectively, all p <0.001). Body mass index, problem alcohol drinking, physical activity, and unmarried status were significantly associated with PHQ-9 scores, although these associations were weak. Variables associated with depression explained 35\% of the variance in non-somatic (PHQ-6) depression scores. Satisfaction with family support played a stronger protective role against depressive symptoms (both PHQ-9 and PHQ-6 scores) among women than men (p < 0.05).Conclusions: Acute life stress and the number of chronic conditions, together with socio-demographic factors, explain most variance in depressive symptoms among chronically ill Chinese individuals. Somatic items in the PHQ-9 increased the depression scores but they did not alter the pattern of predictors. Family support appears to be an important protective factor in Chinese cultures for individuals with chronic conditions.", keywords = "Chinese, Chronic conditions, Community, Depressive symptoms, Family functioning, PHQ-9, Populations", author = "Hairong Nan and Lee, \{Paul H.\} and Ian McDowell and Ni, \{Michael Y.\} and Stewart, \{Sunita M.\} and Lam, \{Tai H.\}", note = "Funding Information: This project was funded by The Hong Kong Jockey Club Charities Trust. We thank Professor Gabriel M. Leung (Department of Community Medicine, School of Public Health, The University of Hong Kong), who established and led the FAMILY Project cohort study in its early phase.", year = "2012", month = nov, day = "14", doi = "10.1186/1471-244X-12-198", language = "English", volume = "12", journal = "BMC Psychiatry", issn = "1471-244X", publisher = "BioMed Central", } . BMC Psychiatry.

Mixtures of weighted distance-based models for ranking data with applications in political studies @article{c39f7df141af49d9b19ae321ae34581d, title = "Mixtures of weighted distance-based models for ranking data with applications in political studies", abstract = "Analysis of ranking data is often required in various fields of study, for example politics, market research and psychology. Over the years, many statistical models for ranking data have been developed. Among them, distance-based ranking models postulate that the probability of observing a ranking of items depends on the distance between the observed ranking and a modal ranking. The closer to the modal ranking, the higher the ranking probability is. However, such a model assumes a homogeneous population, and the single dispersion parameter in the model may not be able to describe the data well. To overcome these limitations, we formulate more flexible models by considering the recently developed weighted distance-based models which can allow different weights for different ranks. The assumption of a homogeneous population can be relaxed by an extension to mixtures of weighted distance-based models. The properties of weighted distance-based models are also discussed. We carry out simulations to test the performance of our parameter estimation and model selection procedures. Finally, we apply the proposed methodology to analyze synthetic ranking datasets and a real world ranking dataset about political goals priority.", keywords = "Distance-based models, Mixtures models, Ranking data", author = "Lee, \{Paul H.\} and Yu, \{Philip L.H.\}", note = "Funding Information: The research of Philip L. H. Yu was supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 7473/05H). We thank the associate editor and three anonymous referees for their helpful suggestions for improving this article. ", year = "2012", month = aug, day = "1", doi = "10.1016/j.csda.2012.02.002", language = "English", volume = "56", pages = "2486--2500", journal = "Computational Statistics and Data Analysis", issn = "0167-9473", publisher = "Elsevier BV", number = "8", } . Computational Statistics and Data Analysis.

Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults @article{f8628ca6abf14d9abf1fe70bddb12f2d, title = "Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults", abstract = "Background: Sleep disturbance is a complex health problem in ageing global populations decreasing quality of life among many older people. Geographic, cultural, and ethnic differences in sleep patterns have been documented within and between Western and Asian populations. The aim of this study was to explore sleep problems among Hong Kong seniors by examining the prevalence of poor sleep quality, the relationship between sleep quality and health-related quality of life, and associated factors of good sleepers in different age groups.Methods: This cross-sectional study used convenience sampling and gathered data during face-to-face interviews. Older community-dwelling individuals (n = 301) were recruited in community centres in 2010. The Pittsburgh Sleep Quality Index and Medical Outcomes Study Short Form-36 were used to measure sleep quality and health-related quality of life. The Medical Outcomes Study Short Form-36 domain scores were compared between good and bad sleepers and between long and short sleepers using Hotelling's T-Square test. SF-36 domain scores were placed into a logistic regression model that controlled for significant demographic variables (gender, educational level, perceived health).Results: Most (77.7\%) participants were poor sleepers. Participants who had global Pittsburgh Sleep Quality Index scores <5 and slept ≥5.5 h/night had better health-related quality of life. Vitality, emotional role, physical functioning, and bodily pain domain scores were associated factors of good sleepers in different age groups.Conclusions: This study found a strong negative association between sleep deprivation (poor quality, short duration) and health-related quality of life. Associated factors for good sleep quality in later life differ among age groups in relation to universal age-related changes, and should be addressed by social policies and health-care programmes.", keywords = "Nursing, Older Chinese, Quality of life, Sleep", author = "Lo, \{Catherine M.H.\} and Lee, \{Paul H.\}", year = "2012", month = jun, day = "18", doi = "10.1186/1477-7525-10-72", language = "English", volume = "10", journal = "Health and Quality of Life Outcomes", issn = "1477-7525", publisher = "BioMed Central", } . Health and Quality of Life Outcomes.

Lo, C.M.H., Lee, P.H.(2012). Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults . Health and Quality of Life Outcomes. 10.

Lee, Paul H., Yu, Philip L. H.(2012). Mixtures of weighted distance-based models for ranking data with applications in political studies . Computational Statistics & Data Analysis. 56. (8). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 2486-2500.

Lo, Catherine M. H., Lee, Paul H.(2012). Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults . Health and Quality of Life Outcomes. 10.

Nan, H., Lee, P.H., McDowell, I., Ni, M.Y., Stewart, S.M., Lam, T.H.(2012). Depressive symptoms in people with chronic physical conditions: Prevalence and risk factors in a Hong Kong community sample . BMC Psychiatry. 12.

Lee, P.H., Yu, P.L.H.(2012). Mixtures of weighted distance-based models for ranking data with applications in political studies . Computational Statistics and Data Analysis. 56. (8). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 2486-2500.

Lee, P.H., Stewart, S.M., Lun, V.M.C., Bond, M.H., Yu, X., Lam, T.H.(2012). Validating the concord index as a measure of family relationships in China . Journal of Family Psychology. 26. (6). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 906-915.

Lee, Paul H., Stewart, Sunita M., Lun, Vivian M. C., Bond, Michael H., Yu, Xiaonan, Lam, T. H.(2012). Validating the Concord Index as a Measure of Family Relationships in China . Journal of Family Psychology. 26. (6). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 906-915.

Lee, Paul H., Nan, Hairong, Chan, Brandford H. Y., McDowell, Ian, Leung, Gabriel M., Lam, Tai Hing(2012). Objectively Measured Physical Activity And Health-related Quality Of Life: The Hong Kong Family Project. Medicine and Science in Sports and Exercise. 44. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 529.

Nan, Hairong, Lee, Paul H., McDowell, Ian, Ni, Michael Y., Stewart, Sunita M., Lam, Tai Hing(2012). Depressive symptoms in people with chronic physical conditions: prevalence and risk factors in a Hong Kong community sample . Bmc Psychiatry. 12.

Validity of the international physical activity questionnaire short form (IPAQ-SF) @article{6bf56831ba5944b68c915b5b951692f4, title = "Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review", abstract = "Background: The International Physical Activity Questionnaire - Short Form (IPAQ-SF) has been recommended as a cost-effective method to assess physical activity. Several studies validating the IPAQ-SF have been conducted with differing results, but no systematic review of these studies has been reported.Methods: The keywords {"}IPAQ{"}, {"}validation{"}, and {"}validity{"} were searched in PubMed and Scopus. Studies published in English that validated the IPAQ-SF against an objective physical activity measuring device, doubly labeled water, or an objective fitness measure were included.Results: Twenty-three validation studies were included in this review. There was a great deal of variability in the methods used across studies, but the results were largely similar. Correlations between the total physical activity level measured by the IPAQ-SF and objective standards ranged from 0.09 to 0.39; none reached the minimal acceptable standard in the literature (0.50 for objective activity measuring devices, 0.40 for fitness measures). Correlations between sections of the IPAQ-SF for vigorous activity or moderate activity level/walking and an objective standard showed even greater variability (-0.18 to 0.76), yet several reached the minimal acceptable standard. Only six studies provided comparisons between physical activity levels derived from the IPAQ-SF and those obtained from objective criterion. In most studies the IPAQ-SF overestimated physical activity level by 36 to 173 percent; one study underestimated by 28 percent.Conclusions: The correlation between the IPAQ-SF and objective measures of activity or fitness in the large majority of studies was lower than the acceptable standard. Furthermore, the IPAQ-SF typically overestimated physical activity as measured by objective criterion by an average of 84 percent. Hence, the evidence to support the use of the IPAQ-SF as an indicator of relative or absolute physical activity is weak.", author = "Lee, \{Paul H.\} and Macfarlane, \{Duncan J.\} and Lam, \{TH H.\} and Stewart, \{Sunita M.\}", note = "Funding Information: This research was part of the project “FAMILY: A Jockey Club Initiative for a Harmonious Society” funded by the Hong Kong Jockey Club Charities Trust.", year = "2011", month = oct, day = "21", doi = "10.1186/1479-5868-8-115", language = "English", volume = "8", journal = "International Journal of Behavioral Nutrition and Physical Activity", issn = "1479-5868", publisher = "BioMed Central", } . International Journal of Behavioral Nutrition and Physical Activity.

Performance of the international physical activity questionnaire (short form) in subgroups of the Hong Kong chinese population @article{24ae4f19a45b462ca8bb6384eb52d582, title = "Performance of the international physical activity questionnaire (short form) in subgroups of the Hong Kong chinese population", abstract = "Background: The International Physical Activity Questionnaire (IPAQ-SF) has been validated and recommended as an efficient method to assess physical activity, but its validity has not been investigated in different population subgroups. We examined variations in IPAQ validity in the Hong Kong Chinese population by six factors: sex, age, job status, educational level, body mass index (BMI), and visceral fat level (VFL).Methods: A total of 1,270 adults (aged 42.9 ± SD 14.4 years, 46.1\% male) completed the Chinese version of IPAQ (IPAQ-C) and wore an accelerometer (ActiGraph) for four days afterwards. The IPAQ-C and the ActiGraph were compared in terms of estimated Metabolic Equivalent Task minutes per week (MET-min/wk), minutes spent in activity of moderate or vigorous intensity (MVPA), and agreement in the classification of physical activity.Results: The overall Spearman correlation (ρ) of between the IPAQ-C and ActiGraph was low (0.11 ± 0.03; range in subgroups 0.06-0.24) and was the highest among high VFL participants (0.24 ± 0.05). Difference between self-reported and ActiGraph-derived MET-min/wk (overall 2966 ± 140) was the smallest among participants with tertiary education (1804 ± 208). When physical activity was categorized into over or under 150 min/wk, overall agreement between self-report and accelerometer was 81.3\% (± 1.1\%; subgroup range: 77.2\%-91.4\%); agreement was the highest among those who were employed full-time in physically demanding jobs (91.4\% ± 2.7\%).Conclusions: Sex, age, job status, educational level, and obesity were found to influence the criterion validity of IPAQ-C, yet none of the subgroups showed good validity (ρ = 0.06 to 0.24). IPAQ-SF validity is questionable in our Chinese population.", keywords = "Accelerometry, Assessment, Exercise, MET, Validation", author = "Lee, \{Paul H.\} and Yu, \{Y. Y.\} and Ian McDowell and Leung, \{Gabriel M.\} and Lam, \{T. H.\} and Stewart, \{Sunita M.\}", year = "2011", month = aug, day = "1", doi = "10.1186/1479-5868-8-81", language = "English", volume = "8", journal = "International Journal of Behavioral Nutrition and Physical Activity", issn = "1479-5868", publisher = "BioMed Central", } . International Journal of Behavioral Nutrition and Physical Activity.

Lee, P.H., Yu, Y.Y., McDowell, I., Leung, G.M., Lam, T.H., Stewart, S.M.(2011). Performance of the international physical activity questionnaire (short form) in subgroups of the Hong Kong chinese population . International Journal of Behavioral Nutrition and Physical Activity. 8.

Lee, Paul H., Yu, Y. Y., McDowell, Ian, Leung, Gabriel M., Lam, T. H., Stewart, Sunita M.(2011). Performance of the international physical activity questionnaire (short form) in subgroups of the Hong Kong chinese population . International Journal of Behavioral Nutrition and Physical Activity. 8.

Lee, P.H., Macfarlane, D.J., Lam, T.H., Stewart, S.M.(2011). Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review . International Journal of Behavioral Nutrition and Physical Activity. 8.

Lee, Paul H., Macfarlane, Duncan J., Lam, T. H., Stewart, Sunita M.(2011). Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review . International Journal of Behavioral Nutrition and Physical Activity. 8.

A margin scheme that advises on when to change required margin @article{633674d8040e4dffbcbd11f2187e6275, title = "A margin scheme that advises on when to change required margin", abstract = "The purpose of a margin requirement is to protect a clearinghouse from members' defaults resulting from big losses due to adverse movement of futures prices. To decide on how much a margin is required, a clearinghouse may refer to a benchmark margin defined as a constant multiple of the forecasted volatility. However, a benchmark margin only advises on a desirable margin level. It gives no advice on whether a clearinghouse should alter existing required margin. This paper proposes a margin scheme that can advise on when to change the required margin and if a change is recommended, to what level it should be changed. The proposed margin scheme can be devised so that the coverage probability and change frequency are controlled at target levels deemed appropriate by the clearinghouse. The proposed margin scheme needs a volatility forecast as input. This paper shows that among a large number of volatility forecasts, implied volatility gives the best results. This confirms a conjecture that implied volatility may have more information content than other volatility forecasts as far as margin setting is concerned.", keywords = "Clearinghouse, GARCH model, Implied volatility, Margin in futures market, Volatility forecasts", author = "Kin Lam and Yu, \{P. L.H.\} and Lee, \{P. H.\}", year = "2010", month = nov, day = "16", doi = "10.1016/j.ejor.2010.04.028", language = "English", volume = "207", pages = "524--530", journal = "European Journal of Operational Research", issn = "0377-2217", publisher = "Elsevier BV", number = "1", } . European Journal of Operational Research.

Distance-based tree models for ranking data @article{4bd3986d8045482cace586a911ca05ec, title = "Distance-based tree models for ranking data", abstract = "Ranking data has applications in different fields of studies, like marketing, psychology and politics. Over the years, many models for ranking data have been developed. Among them, distance-based ranking models, which originate from the classical rank correlations, postulate that the probability of observing a ranking of items depends on the distance between the observed ranking and a modal ranking. The closer to the modal ranking, the higher the ranking probability is. However, such a model basically assumes a homogeneous population and does not incorporate the presence of covariates. To overcome these limitations, we combine the strength of a tree model and the existing distance-based models to build a model that can handle more complexity and improve prediction accuracy. We will introduce a recursive partitioning algorithm for building a tree model with a distance-based ranking model fitted at each leaf. We will also consider new weighted distance measures which allow different weights for different ranks in formulating more flexible distance-based tree models. Finally, we will apply the proposed methodology to analyze a ranking dataset of Inglehart's items collected in the 1999 European Values Studies.", keywords = "Decision tree, Distance-based model, Ranking data", author = "Lee, \{Paul H.\} and Yu, \{Philip L.H.\}", year = "2010", month = jun, day = "1", doi = "10.1016/j.csda.2010.01.027", language = "English", volume = "54", pages = "1672--1682", journal = "Computational Statistics and Data Analysis", issn = "0167-9473", publisher = "Elsevier BV", number = "6", } . Computational Statistics and Data Analysis.

Lam, K., Yu, P.L.H., Lee, P.H.(2010). A margin scheme that advises on when to change required margin . European Journal of Operational Research. 207. (1). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 524-530.

Lam, K, Yu, PLH, Lee, PH(2010). A margin scheme that advises on when to change required margin . European Journal of Operational Research. 207. (1). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 524-530.

Lee, P.H., Yu, P.L.H.(2010). Distance-based tree models for ranking data . Computational Statistics and Data Analysis. 54. (6). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1672-1682.

Lee, PH, Yu, PLH(2010). Distance-based tree models for ranking data . Computational Statistics & Data Analysis. 54. (6). Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 1672-1682.

Paul Lee, Shimin Zhu, Yuxi Hu, Di Qi, Samson Tse, Ko Ling Chan, Jessica Sun (2024). Effects of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Four-Armed Randomized Controlled Trial (Preprint) .

Paul Lee, Shimin Zhu, Yuxi Hu, Ruobing Wang, Di Qi, So Wa Ngai, Qijin Cheng, Paul Wai Ching Wong (2024). Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial (Preprint) .

Paul H. Lee, Ali Neishabouri, Andy C. Y. Tse, Christine C Guo (2022). Comparative Analysis and Conversion between ActiWatch and ActiGraph Open-Source Counts .

Paul Lee, Shimin Zhu, Samson Tse, Ko Ling Chan, Qijin Cheng, Jessica Sun (2022). Examination of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Study Protocol of a 3-Arm Cluster Randomized Controlled Trial (Preprint) .

Nathan J. Cheetham, Milla Kibble, Andrew Wong, Richard J. Silverwood, Anika Knuppel, Dylan M. Williams, Olivia K. L. Hamilton, Paul H. Lee, Charis Bridger Staatz, Giorgio Di Gessa, et al.(2022). Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors . Cold Spring Harbor Laboratory

Corrigendum: Evaluation of N95 respirators on fit rate, real-time leakage, and usability among Chinese healthcare workers: study protocol of a randomized crossover trial(Front. Public Health., (2023), 11, (1266607), 10.3389/fpubh.2023.1266607) @article{ae3d8cb21e8d4d209a4eb476fb972978, title = "Corrigendum: Evaluation of N95 respirators on fit rate, real-time leakage, and usability among Chinese healthcare workers: study protocol of a randomized crossover trial(Front. Public Health., (2023), 11, (1266607), 10.3389/fpubh.2023.1266607)", abstract = "In the published article, there was an error in the Funding statement. The Funding statement for the article erroneously was displayed as “Health and Medical Research Fund (Research Fund Secretariat, Research Office, Health Bureau, Hong Kong ref no: HMRF210401)”. The correct Funding statement is “The Health and Medical Research Fund, the Health Bureau, The Government of the Hong Kong Special Administrative Region (Ref No. 20190322)”. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.", keywords = "Chinese healthcare workers, crossover trial, fit rate, N95 respirators, real-time leakage, usability", author = "Lam, \{Simon Ching\} and Aderonke Odetayo and Yu, \{Ignatius Tak Sun\} and So, \{Sony Nai Yeung\} and Kin Cheung and Lee, \{Paul Hong\} and Suen, \{Lorna Kwai Ping\}", year = "2024", month = jan, day = "30", doi = "10.3389/fpubh.2024.1367687", language = "English", volume = "12", journal = "Frontiers in Public Health", issn = "2296-2565", publisher = "Frontiers Media SA", } . Frontiers in Public Health.

Editorial @article{a7a186811b5b4556a6568ad366a44059, title = "Editorial: Adverse health consequences of excessive smartphone usage, volume II", abstract = "Excessive smartphone usage has diverse negative social, emotional, and physical wellbeing consequences and may lead to self-control and productivity problems as reviewed in Buscha and McCarthy (1). This special topic on Adverse health consequences of excessive smartphone usage, volume II covers the latest research results on anxiety, negative emotion, and physical health issues", keywords = "adverse health consequences, anxiety and negative emotion, emotional and physical wellbeing problems, excessive smartphone usage, problematic smartphone usage", author = "Uichin Lee and Lee, \{Paul H.\}", note = "Funding Information: This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Korean Government (MSIT) (2020R1A4A1018774 and 2022R1A2C2011536). ", year = "2022", month = aug, day = "9", doi = "10.3389/fpubh.2022.984398", language = "English", volume = "10", journal = "Frontiers in Public Health", issn = "2296-2565", publisher = "Frontiers Media SA", } . Frontiers in Public Health.

Editorial @article{62d645fa30c84ee59137cceec331b730, title = "Editorial: Adverse health consequences of excessive smartphone usage", abstract = "The use of smartphones has been increasing rapidly in recent years. Following their growing dominance in our lives, there are numerous research investigations about the impact of smartphone usage on health outcomes. In this Research Topic, we have collected four contributions about the adverse health consequences of excessive smartphone usage. Short video sharing has becoming popular for smartphone users, and TikTok, which was originated in China, has become one of the most popular apps in the world since its foundation in 2016. Montag et al. reviewed the psychological impacts of TikTok on its users. They found that (1) the reason of people use TikTok could be derived using gratification theory, social impact theory, and self-determination theory; (2) most TikTok users are young and motivated, and (3) the usage pattern of TikTok is yet to be studied, but shown to be very different of the usage patterns of other social media platforms such as Instagram or Facebook. Smartphone addiction is an emerging risk factors of mental health problems, and its identification was of utmost importance. Park et al. identified significant characteristics of smartphone addicted users among 600 Korean adults using online survey.", keywords = "addiction, mobile, screen, smartphone, technology", author = "Lee, \{Paul H.\}", year = "2021", month = jul, day = "26", doi = "10.3389/fpubh.2021.689968", language = "English", volume = "9", journal = "Frontiers in Public Health", issn = "2296-2565", publisher = "Frontiers Media SA", } . Frontiers in Public Health.

Paul Lee, Maritta V&#228;lim&#228;ki, Man Sing Wong, Rick Yiu Cho Kwan, Man Hon Chung, Kup-Sze Choi, Lin Yang, Xinyu Yu, Rui Zhu, Sau-Fong Leung (2021). Mobility, well-being, and community participation among people with depression: an observation study using geographically-explicit ecological momentary assessment (GEMA) (Preprint) .

Paul Lee, Shimin Zhu, Yanqiong Zhuang, Jessica Chi-Mei Li, Paul W C Wong(2020). Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study (Preprint) . {JMIR} Publications Inc.

Paul Lee, Stefanos Tyrovolas, Iago Gin&#233;-V&#225;zquez, Daniel Fern&#225;ndez, Marianthi Morena, Ai Koyanagi, Mark Janko, Josep Maria Haro, Yang Lin, William Pan, et al.(2020). Estimating the COVID-19 Spread Through Real-time Population Mobility Patterns: Surveillance in Low- and Middle-Income Countries (Preprint) . {JMIR} Publications Inc.

Paul H Lee, Andy C. Y. Tse, Cynthia S. T. Wu, Yim Wah Mak, Uichin Lee(2020). Objectively-Measured Smartphone Usage, Sleep Quality, and Physical Activity Among Chinese Adolescents and Young Adults . Research Square

Rick YC Kwan, Deborah Lee, Paul H Lee, Mimi Tse, Daphne SK Cheung, Ladda Thiamwong, Kup-Sze Choi(2019). Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial (Preprint) . {JMIR} Publications Inc.

Paul Lee, Mimi Tse, Shamay Sheung Mei NG, Xue BAI, Raymond LO, Daphne Cheung, Kin Cheung, Suey Shuk Yu YEUNG(2019). Lesson Learnt from Peer Volunteers in a Peer-Led Pain Management Program among Nursing Home Residents . {MDPI} {AG}

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6)) @article{95c0a08aab9949609e28ea41a15ac060, title = "Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))", abstract = "Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95\% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0\% (59·6–62·4) of deaths and 48·3\% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9\% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5\% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6\% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.", author = "\{GBD 2017 Risk Factor Collaborators\} and Stanaway, \{Jeffrey D.\} and Ashkan Afshin and Emmanuela Gakidou and Lim, \{Stephen S.\} and Degu Abate and Abate, \{Kalkidan Hassen\} and Cristiana Abbafati and Nooshin Abbasi and Hedayat Abbastabar and Foad Abd-Allah and Jemal Abdela and Ahmed Abdelalim and Ibrahim Abdollahpour and Abdulkader, \{Rizwan Suliankatchi\} and Molla Abebe and Zegeye Abebe and Abera, \{Semaw F.\} and Abil, \{Olifan Zewdie\} and Abraha, \{Haftom Niguse\} and Abrham, \{Aklilu Roba\} and Abu-Raddad, \{Laith Jamal\} and Abu-Rmeileh, \{Niveen M.E.\} and Accrombessi, \{Manfred Mario Kokou\} and Dilaram Acharya and Pawan Acharya and Adamu, \{Abdu A.\} and Adane, \{Akilew Awoke\} and Adebayo, \{Oladimeji M.\} and Adedoyin, \{Rufus Adesoji\} and Victor Adekanmbi and Zanfina Ademi and Adetokunboh, \{Olatunji O.\} and Adib, \{Mina G.\} and Amha Admasie and Olatunde Aremu and Cheng, \{Ching Yu\} and Cyrus Cooper and Fernandes, \{Joao C.\} and Gething, \{Peter W.\} and Khan, \{Muhammad Ali\} and Khan, \{Muhammad Ali\} and Lee, \{Paul H.\} and Nguyen, \{Ha Thu\} and Rahman, \{Mohammad Hifz Ur\} and Salomon, \{Joshua A.\} and Smith, \{David L.\} and Irfan Ullah and Usman, \{Muhammad Shariq\} and Wang, \{Yuan Pang\} and Kai Zhang", year = "2019", month = jun, day = "22", doi = "10.1016/S0140-6736(19)31429-1", language = "English", volume = "393", pages = "e44", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10190", } . The Lancet.

Effectiveness of therapeutic clowning on handwashing habits remains unknown @article{8a83b453d18649ff944e3dfc5e969b94, title = "Effectiveness of therapeutic clowning on handwashing habits remains unknown", abstract = "Implications for practice and research: Further interventions targeting preschool children can consider delivery methods involving clowns and other entertaining methods.The effectiveness of the therapeutic clowning approach should be compared with existing teaching methods. Context: Handwashing is an effective and convenient practice to prevent many infectious diseases. Children, especially preschoolers, will benefit the most from proper handwashing as they are vulnerable to infectious diseases. Traditional educations on handwashing may not effectively engage preschool children. Arıkan and colleagues proposed an entertaining method, that is, using therapeutic clowning, to teach handwashing technique among preschool children.2 They evaluated their proposed therapeutic clowning by their subjects{\textquoteright} handwashing habit and hand cleanliness. Methods: Arıkan and colleagues conducted a randomised controlled trial to examine the effectiveness of the proposed therapeutic clowning teaching method. Children aged 4–6 years were recruited in two kindergartens in Erzurum, Turkey, in 2016. A total of 90 subjects were randomly assigned to the experimental group and 105 were assigned to the control group. Those in the experimental group received 4 weekly handwashing demonstration by a research assistant who was dressed up as a clown. They also watched a cartoon film demonstration of 5–10 min about basic knowledge of infectious disease and handwashing techniques. Those in the control group received no intervention.", author = "Lee, \{Paul H.\}", year = "2018", month = oct, day = "1", doi = "10.1136/eb-2018-102972", language = "English", volume = "21", pages = "104", journal = "Evidence-Based Nursing", issn = "1367-6539", publisher = "BMJ Publishing Group", number = "4", } . Evidence-Based Nursing.

Erratum:Measuring progress and projecting attainment on the basis of past trends of the health-related sustainable development goals in 188 countries; an analysis from the Global Burden of Disease Study 2016 (The Lancet (2017) 390(10100) (1423–1459) (S014067361732336X)(10.1016/S0140-6736(17)32336-X)) @article{812c49dc51b14b9c9cdea141ad8143a7, title = "Erratum:Measuring progress and projecting attainment on the basis of past trends of the health-related sustainable development goals in 188 countries; an analysis from the Global Burden of Disease Study 2016 (The Lancet (2017) 390(10100) (1423–1459) (S014067361732336X)(10.1016/S0140-6736(17)32336-X))", abstract = "GBD 2016 SDG Collaborators. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390: 1423–59—In figure 8B of this Article (published Online First on Sept 12, 2017), the number of indicator targets has been changed from 1 to 9 for Turkmenistan, from 0 to 1 for Afghanistan, and from 1 to 2 for Yemen. Ettore Beghi, Neeraj Bhala, H{\'e}l{\`e}ne Carabin, Raimundas Lunevicius, Donald H Silberberg, and Caitlyn Steiner have been added to the list of GBD 2016 SDG Collaborators. Their affiliations, along with the affiliation of Soumya Swaminathan, have been added to the Affiliations section. These corrections have been made to the online version as of Sept 18, 2017, and the printed Article is correct.", author = "\{GBD 2016 SDG Collaborators\} and Nancy Fullman and Barber, \{Ryan M.\} and Abajobir, \{Amanuel Alemu\} and Abate, \{Kalkidan Hassen\} and Cristiana Abbafati and Abbas, \{Kaja M.\} and Foad Abd-Allah and Abdulkader, \{Rizwan Suliankatchi\} and Abdulle, \{Abdishakur M.\} and Abera, \{Semaw Ferede\} and Victor Aboyans and Abu-Raddad, \{Laith J.\} and Abu-Rmeileh, \{Niveen M.E.\} and Adedeji, \{Isaac Akinkunmi\} and Olatunji Adetokunboh and Ashkan Afshin and Anurag Agrawal and Sutapa Agrawal and \{Ahmad Kiadaliri\}, Aliasghar and Hamid Ahmadieh and Ahmed, \{Muktar Beshir\} and Aichour, \{Miloud Taki Eddine\} and Aichour, \{Amani Nidhal\} and Ibtihel Aichour and Sneha Aiyar and Akinyemi, \{Rufus Olusola\} and Nadia Akseer and Ziyad Al-Aly and Khurshid Alam and Noore Alam and Deena Alasfoor and Alene, \{Kefyalew Addis\} and Reza Alizadeh-Navaei and Ala'a Alkerwi and Fran{\c c}ois Alla and Peter Allebeck and Christine Allen and Bennett, \{James R.\} and Cyrus Cooper and Fernandes, \{Jo{\~a}o C.\} and Gething, \{P W.\} and Johnson, \{Sarah Charlotte\} and Lee, \{Paul H.\}", note = "Publisher Copyright: {\textcopyright} 2017 Elsevier Ltd", year = "2017", month = sep, day = "30", doi = "10.1016/S0140-6736(17)32441-8", language = "English", volume = "390", pages = "e23", journal = "The Lancet", issn = "0140-6736", publisher = "Elsevier BV", number = "10102", } . The Lancet.

Measuring device-specific physical activity trackability in multi-device environments @inproceedings{8482e66f697e48e4b3570aac1d1a530f, title = "Measuring device-specific physical activity trackability in multi-device environments", abstract = "Wrist-worn wearables such as smartwatches and fitness trackers have become widely used with smartphones in recent years. Interestingly, both types of devices support physical activity tracking, but that is only available when users wear or carry their devices, and thus, trackability is heavily influenced by user contexts. To analyze physical activity trackability in a multi-device environment, this paper explores device-specific coverage measures based on activity bouts.", keywords = "device coverage, physical activity, smartphones, wearables, Smartphones, Device Coverage, Wearables, Physical Activity", author = "Sangjun Park and Eunji Park and Lee, \{Paul H.\} and Uichin Lee", note = "Funding Information: This research was supported by the Basic Science Research Program through the National Research Founda- tion(NRF) of Korea, funded by the Korean government (MSIT) (2020R1A4A1018774). Funding Information: This research was supported by the Basic Science Research Program through the National Research Founda-tion(NRF) of Korea, funded by the Korean government (MSIT) (2020R1A4A1018774). Publisher Copyright: {\textcopyright} 2023 IEEE.; 2023 IEEE International Conference on Big Data and Smart Computing (BigComp) ; Conference date: 13-02-2023 Through 16-02-2023", year = "2023", month = mar, day = "20", doi = "10.1109/BigComp57234.2023.00096", language = "English", isbn = "9781665475785", series = "Proceedings - 2023 IEEE International Conference on Big Data and Smart Computing, BigComp 2023", publisher = "IEEE", pages = "393--394", editor = "Hyeran Byun and Ooi, \{Beng Chin\} and Katsumi Tanaka and Sang-Won Lee and Zhixu Li and Akiyo Nadamoto and Giltae Song and Young-guk Ha and Kazutoshi Sumiya and Wu Yuncheng and Hyuk-Yoon Kwon and Takehiro Yamamoto", booktitle = "Proceedings of the 2023 IEEE International Conference on Big Data and Smart Computing (BigComp)", address = "United States", } . Proceedings of the 2023 IEEE International Conference on Big Data and Smart Computing (BigComp).

Lee, P.H., Yu, P.L.H.(2010). Mixtures of weighted distance-based models for ranking data . Proceedings of COMPSTAT 2010 - 19th International Conference on Computational Statistics, Keynote, Invited and Contributed Papers. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 517-524.

Paul H. Lee, Philip L.H. Yu(2010). Mixtures of weighted distance-based models for ranking data . Proceedings of COMPSTAT 2010 - 19th International Conference on Computational Statistics, Keynote, Invited and Contributed Papers. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 517--524. Physica Verlag

Yu, P.L.H., Wan, W.M., Lee, P.H.(2011). Decision tree modeling for ranking data . Preference Learning. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 83-106.

Philip L.H. Yu, Wai Ming Wan, Paul H. Lee(2011). Decision tree modeling for ranking data . Preference Learning. Microsoft.AspNetCore.Mvc.Localization.LocalizedHtmlString 83--106. Springer Berlin, Heidelberg