Views and Experience on Patient Engagement in Healthcare Professionals and Patients—How Are They Different?

A patient-centered approach is used to build a therapeutic alliance between patients and the healthcare professionals in care process which should be supported by a good engagement of both parties. The study aimed to explore the gap between healthcare professionals and patients on patient engagement in hospital. It was a cross-sectional survey. 2774 doctors and nurses from Department of Medicine of public hospitals completed the self-administered questionnaire and 1042 patients discharged from corresponding wards completed the telephone interviews. Participants were interviewed using structural questionnaires. The Mann-Whitney test or Pearson’s chi-square test was used to analyze the agreement between health-care professionals and patients on the views and experiences of patient engagement. A difference was considered to be statistically significant when the p-value was <0.05. Although both groups valued the importance of patient engagement, there was a discrepancy on understanding, views and experiences. More healthcare professionals particularly in nursing were concerned about the possible negative impact of the engagement. The majority of healthcare professionals reported that they engaged well with patients, and perceived more difficulties than patients did. The findings highlighted the mutual understanding of patient engagement, involvement and challenges encountered by both groups in Department of Medicine, which was crucial in efforts to provide meaningful patient engagement in regards to jurisdictions, health system, specialty, discipline and background of patients. It provided insight that a collaborative strategy involving both healthcare professional and patients might be an alternative approach to improving patient engagement.

Use of Cigarettes and Other Tobacco Products among Primary and Secondary School Students in Khartoum State, Sudan

Introduction: In Sudan, tobacco use is common;it is used in some form by 20% of the population. As most users start during adolescence, we aimed to determine the prevalence of ever use of tobacco products (i.e. cigarettes, herbal cigarettes, shisha and tombak) among Sudanese adolescent males and females, and to assess associations between tobacco ever use and personal characteristics. Methods: This cross-sectional study was conducted in Khartoum State, Sudan. The study data were collected in June 2014. The target population consisted of adolescents in 8th grade of primary education or 1st and 2nd grade of secondary education. They were asked to fill in a written questionnaire during the school break. Schools were randomly selected using a stratified two-stage cluster sampling design method. Results: A total of 1229 respondents (56.4% male), with a mean age of 14.5 years, were included in the analysis. Prevalence of cigarettes, herbal cigarettes, shisha and tombak ever use were 13%, 7.8% 5.9% and 3.5%, respectively. Older respondents were significantly more likely to have ever smoked cigarettes. Males were found to be significantly more likely to have ever used any tobacco products. Urban adolescents were significantly more likely to have ever used shisha. Respondents were in the bottom third percentiles with regard to academic achievements, had an almost three-fold increased risk of having ever smoked a cigarette and were at least five-fold more likely to have ever smoked herbal cigarettes. Moreover, respondents in the middle third percentiles were more than twice as likely to have ever smoked herbal cigarettes. Conclusion: As uptake of tobacco products increased significantly with age among males with a middle and lower school performance living in urban areas, timely prevention targeting adolescents, such as school-based tobacco control programmes, are recommended. Our findings show that prevention should start in primary school.

The Role of Aerosol in Climate Change,the Environment,and Human Health

Aerosol is an important component of the atmosphere,and its source,composition,distribution,and effects are highly complicated.Governments and scientists have given much attention to aerosol problems,and it has become a hot topic due to the important role it plays in climate change and the Earth's environment.In this paper,1) the importance of aerosol in climate change,the atmospheric environment,and human health is summarized;2) the recent serious problems of aerosol pollution and the shortage of current aerosol research in China are pointed out;and 3) the necessity to enhance aerosol research in China is emphasized.

The Relationship with Previous Use of Community-Based Services and Informal Caregiver Support and Elderly and Informal Caregivers’ Views of Living Arrangement: Analysis of Official Statistics from 2004 to 2014

Background and Objectives: Views on living arrangement from elderly and informal caregivers are crucial to “ageing in place”. They might be related to the experience in the use of elderly care services, which remains inconclusive in previous literature. This study aimed to explore the association of previous experience in formal and informal long-term care services with views of both elderly and their informal caregivers on living arrangement. Research Design and Methods: This study adopted a cross-sectional design. Assessment records of Minimum Data Set-Home Care for community-dwelling elderly who were eligible for subsidized long-term care services in Hong Kong from 2004 to 2014 were made available. Multivariate logistic regression was applied to examine associations between both views on elder’s living arrangement from the elderly, caregivers and their previous informal caregiver support, and experience in formal care services. Results: 82,306 dyads of elderly and informal caregivers were included in the analysis. The elderly with previous use of home and community-based services (OR = 0.84, 95% CI 0.80 - 0.88) and informal caregivers (OR = 0.78, 95% CI 0.76 - 0.81) believed that the elderly should live away from home. Temporal trends of fewer elderly and caregivers supporting the idea of living away from home were also observed. Discussion and Implications: The results highlighted the importance of informal caregiver’s support and previous utilization of formal home and community-based services. It was concluded that resources and information of community-based care have a significant association with views on living at home also proper support services and training of care for the elderly should be made available to informal caregivers to reduce their burden.

Net effect of air pollution controls on health risk in the Beijing-Tianjin-Hebei region during the 2022 winter Olympics and Paralympics

Due to the non-linearity in ozone(O_(3))formation,reducing the emission of nitrogen oxides(NO_(x))may increase O_(3) concentration.Given the counteractive O_(3) response to NO_(x) reduction,overall impact of air pollution controls can be ambiguous when the assessments focus on the changes in pollutant concentrations.In this study,a risk-based method was used to gauge the net effect of air pollution controls on mortality risk in the Beijing–Tianjin–Hebei(BTH)region during the 2022 Winter Olympics and Paralympics(WOP).This mega-event presents a unique opportunity to investigate the efficacy of deep cuts in pollutant emissions.Results show that O_(3) concentrations greatly increased as nitrogen dioxide(NO_(2))concentrations decreased in the BTH.Due to the active photochemical formations,O_(3) became the dominant pollutant that affected human health during the WOP.Despite the substantial O_(3) increases,the health benefits of NO_(2) reductions overwhelmed the adverse health effects of O_(3) increases in most regions of the BTH(at 81 out of 112 stations).After considering the impacts of particulate matter,the integrated health risk of air pollution mixtures declined almost everywhere in the BTH.Our results underscore the great necessity of changing the assessment paradigm of pollution control from using concentration-based methods to using risk-based methods.Together with the carbon neutrality policy,stringent control of NO_(x)emission from combustion sources is a promising way to achieve synergistic control solutions for air pollution and climate change.

Prognostic value of alcohol consumptionand some other dietary habits for survival in a cohort of Chinese men with lung cancer

Background:Alcohol consumption and some other dietary habits are thought to be associated with lung cancer incidence.However,the effects of these habits on lung cancer prognosis have been studied rarely.The purpose of this study was to address these gaps in knowledge.Methods:We studied a cohort of 1052 Chinese men in Hong Kong who were diagnosed with primary lung cancer.Cox proportional hazards models were used to determine the prognostic values of consumption of alcohol,fresh fruits or vegetables,meat,and fried or preserved food.Results:Compared with never drinkers,men who drank alcohol 1-3 days per week had a more favorable lung cancer prognosis(hazard ratio[HR]:0.82,95%confidence interval[CI]0.68-0.97);however,this survival advantage was not significant in men who drank alcohol more frequently(HR:0.91,95%CI 0.73-1.14).Compared with men who consumed preserved or fried food only occasionally,men who consumed these foods frequently had a higher risk of lung cancer mortality(HR:1.20,95%CI 1.00-1.42).Conclusions:Occasional consumption of alcohol was a favorable survival factor for Chinese men with lung cancer.However,this survival benefit did not exist for frequent drinkers of alcohol.Chinese men with lung cancer who were frequent consumers of fried or preserved food had a worse prognosis than those who consumed these foods only occasionally.

Risk factors and natural history of breast cancer in younger Chinese women

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fiftytwo women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger(< 40 years old) vs older patients(≥ 40 years old) for subsequent analyses.RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise(85.4% vs 73.2%, P < 0.001), having high stress in life(46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets(20.2% vs 12.9%, P < 0.001),having alcohol drinking habit(7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity(43.3% vs 17.8%, P < 0.001) and an early age at menarche(20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology(45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion(39.6% vs 33.2%, P = 0.003), and having multifocal disease(15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.

A meta-analysis of soluble suppression of tumorigenicity 2 （sST2） and clinical outcomes in pulmonary hypertension

Suppression of Tumorigenicity 2 （ST2） is a member of the interleukin （IL）-1 receptor family The ST2 receptor exists in two isoforms - ST2 ligand （ST2L） and soluble ST2 （sST2）.ST2L is a membrane receptor and sST2 is a trun- cated receptor which is soluble in the blood, allowing it to be detected in serum. IL-33 is a member of the IL-1 family of ligand and is the fimctional ligand of ST2L receptor. It binds to the ST2L, thereby mediating its immune function.

The association of grip strength with cardiovascular diseases and all-cause mortality in people with hypertension:Findings from the Prospective Urban Rural Epidemiology China Study

Background:Both hypertension and grip strength(GS)are predictors of mortality and cardiovascular disease(CVD),but whether these risk factors interact to affect CVD and all-cause mortality is unknown.This study sought to investigate the associations of GS with the risk of major CVD incidence,CVD mortality,and all-cause mortality in patients with hypertension.Methods:GS was measured using a Jamar dynamometer(Sammons Preston,Bolingbrook,IL,USA)in participants aged 3570 years from 12 provinces included in the Prospective Urban Rural Epidemiology China Study.Cox frailty proportional hazards models were used to examine the associations of GS and hypertension and the outcomes of all-cause mortality and CVD incidence/mortality.Results:Among 39,862 participants included in this study,15,964 reported having hypertension,and 9095 had high GS at baseline.After a median follow-up of 8.9 years(interquartile range,6.79.9 years),1822 participants developed major CVD,and 1250 deaths occurred(388 as a result of CVD).Compared with normotensive participants with high GS,hypertensive patients with high GS had a higher risk of major CVD incidence(hazard ratio(HR)=2.39;95%confidence interval(95%CI):1.863.06;p<0.001)or CVD mortality(HR=3.11;95%CI:1.596.06;p<0.001)but did not have a significantly increased risk of all-cause mortality(HR=1.24;95%CI:0.921.68;p=0.159).These risks were further increased if hypertensive participants whose GS level was low(major CVD incidence,HR=3.31,95%CI:2.604.22,p<0.001;CVD mortality,HR=4.99,95%CI:2.649.43,p<0.001;and all-cause mortality,HR=1.93,95%CI:1.472.53,p<0.001).Conclusion:The present study demonstrates that low GS is associated with the highest risk of major CVD incidence,CVD mortality,and all-cause mortality among hypertensive patients.High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.

Uptake of prostate cancer screening and associated factors among Chinese men aged 50 or more: a population-based survey

Objective: To investigate the uptake rate of prostate specific antigen(PSA) testing among Hong Kong Chinese males aged 50 or above, and identify factors associated with the likelihood of undergoing a PSA test.Methods: A population-based telephone survey was conducted in Hong Kong in 2007. The survey covered demographic information, perceived health status, use of complementary therapy, cancer screening behavior, perceived susceptibility to cancer and family history of cancer. Descriptive statistics, percentages and logistic regression analysis were used for data analysis.Results: A total of 1,002 men aged 50 or above took part in the study(response rate =67%), and the uptake rate of PSA testing was found to be 10%. Employment status, use of complementary therapy, perceiving regular visits to a doctor as good for health and the recommendations of health professionals were significant factors associated with PSA testing.Conclusion: The uptake rate of PSA testing in the study population was very low. Among all the factors identified, recommendations from health professionals had the strongest association with the uptake of PSA testing, and they should therefore take an active role in educating this population about cancer prevention and detection.

Kidney health for all: bridging the gap in kidney health education and literacy

The high burden of kidney disease,global disparities in kidney care,and poor outcomes of kidney failure bring a concomitant growing burden to persons affected,their families,and carers,and the community at large.Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find,understand,and use information and services to make informed health⁃related decisions and actions for themselves and others.Rather than viewing health literacy as a patient deficit,improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease.For kidney policy makers,health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care.The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders.Advances in telecommunication,including social media platforms,can be leveraged to enhance persons’and providers’education;The World Kidney Day declares 2022 as the year of“Kidney Health for All”to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy.Kidney organizations should work toward shifting the patient⁃deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers.By engaging in and supporting kidney health-centered policy making,community health planning,and health literacy approaches for all,the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.

CUF, a herbal formula for the treatment of asthma: A randomized, double-blind, placebo-controlled study in the treatment of childhood asthma

Background: Complementary and alternative medicines are increasingly used for the treatment of asthma worldwide. A five-herb herbal formula (CUF) has been found to be effective and safe in an animal model of asthma and in a preliminary clinical study. Objective: The objective of this study was to evaluate the safety and efficacy of CUF in children suffering from asthma. Design: A randomized, double blind, and placebo-controlled, parallel study. Interventions: Subjects received CUF or placebo for 6 months. Efficacy variables included changes in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), Paediatric Asthma Quality of Life Questionnaire (PAQLQ), and steroidal consumption. Results: A total of 100 asthmatic children were enrolled and assigned to two treatment groups. The first group received CUF 6 capsules (3 g/day) and the second group received placebo. There was a statistically significant difference in mean spirometric indexes in CUF group at baseline and follow-up visits. In the CUF group, the activity domain showed significant improvement (p = 0.045). FEV% was significantly improved in the CUF group (p strated. It improved the pulmonary functions of the children, namely, FEV1 and FVC. However, further research on a larger scale is warranted.

Segmentation and texture analysis with multimodel inference for the automatic detection of exudates in early diabetic retinopathy

Diabetic retinopathy (DR) is an eye disease caused by the increase of insulin in blood and may cause blindness if not treated at an early stage. Exudates are the primary sign of DR. Currently there is no fully automated method to detect exudates in the literature and it would be useful in large scale screening if fully automatic method is available. In this paper we developed a novel method to detect exudates that based on interactions between texture analysis and segmentation with mathematical morphological technique by using multimodel inference. The texture analysis involves three components: they are statistical texture analysis, high order spectra analysis, and fractal analysis. The performance of the proposed method is assessed by the sensitivity, specificity and accuracy using the public data DIARETDB1. Our results show that the sensitivity, specificity and accuracy are 95.7%, 97.6% and 98.7% (SE = 0.01), respectively. It is shown that the proposed method can be run automatically and also improve the accuracy of exudates detection significantly over most of the previous methods.

Comparing the incidence of major cardiovascular events and severe microvascular complications in patients with type 2 diabetes mellitus:A systematic review and meta-analysis

BACKGROUND Type 2 diabetes mellitus(T2DM)causes both macrovascular and microvascular complications.However,currently,selection of glycemic measures and their thresholds to diagnose T2DM,and efficacy outcomes in evaluation of anti-diabetic drugs is predominantly informed by the relation of T2DM to microvascular complications.We can be severely mistaken on T2DM by neglecting macrovascular complications which are generally more severe,if they also occur more commonly than microvascular complications.AIM To compare the incidence of major cardiovascular events(MACEs)and severe microvascular complications(SMICs)in T2DM patients.METHODS MEDLINE,EMBASE,and Cochrane Central Register of Controlled Trials were searched from inception to September 2017.Cohort studies or trials of T2DM patients aged 18 years or older that reported incidence of both MACEs and SMICs were included.MACEs were defined as nonfatal myocardial infarction and stroke,and cardiovascular death,while SMICs included serious retinopathy,nephropathy and diabetic disorder.The relative risk(RR)was estimated as the incidence of MACEs divided by that of SMICs in same patients and combined with meta-analysis in a random-effect model.RESULTS Twelve studies with a total of 16 cohorts and 387376 patients were included,and the combined RR was 2.02(95%CI:1.46–2.79).The higher incidence of MACEs remained in various subgroup and sensitivity analyses.CONCLUSION Patients with T2DM are much more likely to develop MACEs than SMICs.By taking more serious consequences and relatively higher incidence into consideration,macrovascular complications deserve more emphasis in developing the diagnostic criteria of T2DM and in evaluating the efficacy of antidiabetic drugs.

Development of Conceptual Framework from the View of Patients and Professionals on Patient Engagement: A Qualitative Study in Hong Kong SAR, China

Objective: To investigate patient engagement to gain understandings of professional and patient’s views and inform the development of a patient engagement conceptual framework for further development of a valid and reliable evaluated measure. Method: 17 selected hospitals from Hong Kong East Cluster, Hong Kong West Cluster, Kowloon Central Cluster, Kowloon East Cluster and New Territory East Cluster of Hospital Authority Hong Kong involved in the study. Focus groups were conducted with 37 medical staffs, which included 15 doctors and 22 nurses, and 33 patients. Semi-structured qualitative interview study, with purposive sampling and constant comparative analysis. Results: Data were analyzed using a qualitative approach of latent content analysis. Patient engagement is a multi-dimensional concept. Five hierarchical themes separately from the patient and medical staff’s perspectives containing different conceptions and attitudes related to patient engagement have been identified and summarized. Through analyzing both professional and patients’ perspectives, a hierarchical framework incorporating patients-professional dynamically fluctuating relationship was built. The framework divides engagement into five levels and five stages. Conclusions: Patient engagement is recognized by more patients and professionals as a means and a cornerstone to build the foundation of patient-centered-care. Our framework encourages that patient engagement related to not only an individual patient’s behavior but a reciprocal, dynamic and pluralistic relationship with their professionals and healthcare systems. Understand this relationship can help us better conceptualizing, evaluating, and implementing interventions to improve the population’s health.

Telemonitoring and hemodynamic monitoring to reduce hospitalization rates in heart failure： a systematic review and meta-analysis of randomized controlled trials and real-world studies

Background Heart failure is a significant problem leading to repeated hospitalizations. Telemonitoring and hemodynamic monitoring have demonstrated success in reducing hospitalization rates, but not all studies reported significant effects. The aim of this systematic review and meta-analysis is to examine the effectiveness of telemonitoring and wireless hemodynamic monitoring devices in reducing hospitalizations in heart failure. Methods ＆ Results PubMed and Cochrane Library were searched up to 1st May 2017 for articles that investigated the effects of telemonitoring or hemodynamic monitoring on hospitalization rates in heart failure. In 31,501 patients （mean age： 68 ± 12 years; 61% male; follow-up 11 ± 8 months）, telemonitoring reduced hospitalization rates with a HR of 0.73 （95% CI： 0.65-0.83; P 〈 0.0001） with significant heterogeneity （I2 = 94%）. These effects were observed in the short-term （≤ 6 months： HR = 0.77, 95% CI： 0.65-0.89; P 〈 0.01） and long-term （≥ 12 months： HR = 0.73, 95% CI： 0.62-0.87; P 〈 0.0001）. In 4831 patients （mean age 66 ± 18 years; 66% male; follow-up 13 ± 4 months）, wireless hemodynamic monitoring also reduced hospitalization rates with a HR of 0.60 （95% CI： 0.53-0.69; P 〈 0.001） with significant heterogeneity （I2 = 64%）.This reduction was observed both in the short-term （HR = 0.55, 95% CI： 0.45-0.68; P 〈 0.001; I2 = 72%） and long-term （HR = 0.64, 95% CI： 0.57-0.72; P 〈 0.001; I2 = 55%）. Conclusions Telemonitoring and hemodynamic monitoring reduce hospitalization in both short- and long-term in heart failure patients

Flattening the biological age curve by improving metabolic health:to taurine or not to taurine,that’s the question

The aging population is an important issue around the world especially in developed countries.Although med-ical advances have substantially extended life span,the same cannot be said for the duration of health span.We are seeing in-creasing numbers of elderly people who are frail and/or have multiple chronic conditions;all of these can affect the quality of life of the elderly population as well as increase the burden on the healthcare system.Aging is mechanistically related to common medical conditions such as diabetes mellitus,ischemic heart disease,cognitive decline,and frailty.A recently accepted concept termed‘Accelerated Biological Aging’can be diagnosed when a person’s biological age—as measured by biomarkers of DNA methylation—is older than their corresponding chronological age.Taurine,a conditionally essential amino acid,has received much attention in the past few years.A substantial number of animal studies have provided a strong scientific foundation sug-gesting that this amino acid can improve cellular and metabolic health,including blood glucose control,so much that it has been labelled one of the‘longevity amino acids’.In this review article,we propose the rationale that an adequately powered random-ized-controlled-trial(RCT)is needed to confirm whether taurine can meaningfully improve metabolic and microbiome health,and biological age.This trial should incorporate certain elements in order to provide the much-needed evidence to guide doctors,and also the community at large,to determine whether this promising and inexpensive amino acid is useful in improving human metabolic health.

Characterization of a smog chamber for studying formation of gas-phase products and secondary organic aerosol

Smog chambers provide a potent approach to explore the secondary organic aerosol formation under varied conditions.This study describes the construction and characterization of a new smog chamber facility for studying the formation mechanisms of gas-phase products and secondary organic aerosol from the photooxidation of volatile organic compounds.The chamber is a 5.4 m^(3) Fluorinated Ethylene Propylene(FEP)Teflon reactor with the potential to perform photooxidation experiments at controlled temperature and relative humidity.Detailed characterizations were conducted for evaluation of stability of environmental parameters,mixing time,background contamination,light intensity,and wall losses of gases and particles.The photolysis rate of NO_(2)(J_(NO2))ranged from(1.02-3.32)×10^(-3)sec^(-1),comparable to the average J_(NO2)in ambient environment.The wall loss rates for NO,NO_(2),and O_(3)were 0.47×10^(-4),0.37×10^(-4),and 1.17×10^(-4)min^(-1),while wall loss of toluene was obsoletely found in a 6 hr test.The particle number wall loss rates are(0.01-2.46)×10^(-3)min^(-1)for 40-350 nm with an average lifetime of more than one day.A series of toluene photooxidation experiments were carried out in absence of NO_xunder dry conditions.The results of the simulation experiments demonstrated that the chamber is well designed to simulate photolysis progress in the atmosphere.

Introducing the Hong Kong Medical Journal and its important role in the timely dissemination of COVID-19 related knowledge

Hong Kong Medical Journal(HKMJ)is the flagship general medical journal in the Hong Kong Special Administrative Region,China,with an international outlook.We are committed to publishing and promoting high-quality research.Led by our Editor-in-Chief,Professor Martin CS Wong,our Editorial Board is pleased to collaborate with Dr.Chen Wang,the Editor-in-Chief of the Chinese Medical Journal(CMJ),as well as the editors of CMJ to enhance the visibility of our respective journals and foster a collaborate environment that brings forth ideas and knowledge to our readers.