Chronic insomnia and its negative consequences for health and functioning of adolescents: a 12-month prospective study.

PURPOSE: To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on health and functioning of adolescents. METHODS: Data were collected from 4175 youths 11-17 at baseline and 3134 a year later sampled from managed care groups in a large metropolitan area. Insomnia was assessed by youth-reported DSM-IV symptom criteria. Outcomes are three measures of somatic health, three measures of mental health, two measures of substance use, three measures of interpersonal problems, and three of daily activities. RESULTS: Over one-fourth reported one or more symptoms of insomnia at baseline and about 5% met diagnostic criteria for insomnia. Almost 46% of those who reported one or more symptoms of insomnia in Wave 1 continued to be cases at Wave 2 and 24% met DSM-IV symptom criteria for chronic insomnia (cases in Wave 1 were also cases in Wave 2). Multivariate analyses found chronic insomnia increased subsequent risk for somatic health problems, interpersonal problems, psychological problems, and daily activities. Significant odds (p < .05) ranged from 1.6 to 5.6 for poor outcomes. These results are the first reported on chronic insomnia among youths, and corroborate, using prospective data, previous findings on correlates of disturbed sleep based on cross-sectional studies. CONCLUSIONS: Insomnia is both common and chronic among adolescents. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Chronic insomnia severely impacts future health and functioning of youths. Those with chronic insomnia are more likely to seek medical care. These data suggest primary care settings might provide a venue for screening and early intervention for adolescent insomnia.     

Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese

OBJECTIVE: To explore the attitudes of Hong Kong Chinese towards the strengths and weaknesses of traditional Chinese medicine (TCM) and Western medicine. DESIGN: Qualitative study of subjects' opinions using semi-structured focus group interviews. SETTING: Southern district of Hong Kong Island where many of the residents have a fisherman background. PARTICIPANTS: Twenty nine participants took part in eight focus group interviews. MEASUREMENTS AND MAIN RESULTS: Participants' attitudes towards TCM and Western medicine were explored in the interviews. Both TCM and Western medicine are used concurrently by many people in Hong Kong. Patients make decisions on which type of doctors they want to see for the specific illnesses that they are suffering from. They consider both types of medicines to have strengths and weaknesses: TCM being better in curing the root of the problem but quite slow in action while Western medicine is more powerful but sometimes too powerful with significant side effects. CONCLUSIONS: It is important for medical practitioners to be aware of the health attitudes of their patients from different ethnic backgrounds. It will lead to a better patient-doctor relationship and better compliance of treatment.     

Health promotion for the elderly persons in Hong Kong

By the year 2000, there will be one million elderly persons in Hong Kong. With the rise of an older population, the cost of health care is likely to increase. Studies conducted in Hong Kong have shown that over 30% of health care expenditure is spent on the elderly. Unless steps are taken to slow the onset of chronic illnesses in elderly people, health care expenditure will increase rapidly in the future. The present paper describes strategies that have been adopted for promoting a healthier elderly population in Hong Kong. The paper also reports the results of an evaluative study on the largest health promotion program for older people in Hong Kong. It seems to show that health promotion activities may have the potential to save lives, delay institutionalization, and improve life satisfaction.     

Patterns of health care utilization and health behaviors among street sex workers in Hong Kong

OBJECTIVE: To describe the current use of health services by the street-based female sex workers (FSWs) and to explore beliefs behind these health behaviors. STUDY SETTING: Community outreach approach in a few red-light districts in Hong Kong. STUDY DESIGN: A 30 min face-to-face interview was carried out in 89 women by direct approach and snowballing, followed by a focus group discussion drawn from the participants of the questionnaire. RESULTS: While these FSWs' perception of personal health was good, a considerable proportion suffered from illnesses but the consultation rate was a third of the mean rate of the general population in Hong Kong. Many street workers experienced difficulty in utilizing health service in Hong Kong and even when they did, it was mainly for acute problems. Affordable access to health public services was excluded and many found private services unaffordable due to the high price charged by the practitioners. It was common for these women to self-medicate, delay in seeking medical help, or travel back to China for treatment. CONCLUSION: The current empirical understanding of the health and health service utilization by sex workers is unbalanced. In order to reduce sexually transmitted infections (STIs) and HIV among the street sex workers, it is essential to address the fundamental issue of health care access.     

The ecology of health care in Hong Kong

To better understand the distribution of resources and health care consumption patterns in different geo-ethnic and socio-economic settings, we sought to describe the patterns of illness, care-seeking behavior and health services utilization in Hong Kong compared to the US and UK. Data were derived from the 2002 Hong Kong Thematic Household Survey covering 31,762 non-institutional and institutional residents, representing 6,504,255 persons after applying population weights. Of 1000 individuals during a 1-month period, 567 reported symptoms, 512 of whom considered seeking health care. Four hundred and forty persons visited western allopathic medical practitioners, with 372 (84.5%) in primary care and 68 (15.5%) in specialty care. There were 54 visits to traditional Chinese medical practitioners and 16 emergency room episodes. Seven individuals were hospitalized in community hospitals and on average one in 1000 were admitted to a tertiary medical center. Ninety out of the 567 who experienced symptoms undertook self-management strategies, which included over-the-counter western allopathic medications (n=54) or traditional Chinese remedies (n=14) or both (n=2), dietary modification (n=1) and rest (n=15). We have mapped the ecology of health care in Hong Kong. Monthly prevalence estimates were remarkably similar to US figures for hospital-based events, whereas there was evidence of apparent, substantial "over-consumption" of ambulatory, community-based care. Our results also indicate that the local community's care-seeking orientation still very much favors western allopathic medicine over traditional Chinese therapy, at least for acute illness episodes.     

Smoking among medical students in Hong Kong

A survey was conducted among two classes of medical students (N = 293) at the University of Hong Kong to study their smoking habits and knowledge of and attitudes toward smoking. The response rate was 97.3%. There was only one daily smoker (0.4%) and 21 occasional smokers (7.4%). While the respondents regarded health and self-discipline as the main reasons for not smoking, the social taboo against smoking among young people might have also deterred this educated elite from smoking. Many of them failed to identify the major causal role of smoking in smoking related diseases. The potential of prevention in encountering a smoking patient seen for reasons unrelated to smoking was not fully realised. There was disagreement in the banning of cigarette advertising and in increasing the price of tobacco products. In the face of aggressive marketing by the tobacco industry in the Asia-Pacific region, every undergraduate medical curriculum should include organized instruction on smoking and its control.     

中国郑州香港台湾三地青少年生存质量和心理健康比较

  目的  探讨郑州市青少年的生存质量和心理健康现状并与中国香港、台湾地区进行比较,为今后相应教育方案的制定提供依据。  方法  分层整群抽取郑州市12所中小学四至九年级6 401名学生,分别整群抽取香港和台湾地区四至九年级3 642和1 547名学生,使用儿童生活质量普适性核心量表、自尊量表、一般自我效能感量表、抑郁-焦虑-压力量表中文精简版及自制一般情况调查表进行问卷调查。  结果  郑州、香港和台湾三地区青少年在生存质量总分及各维度、自尊、自我效能、焦虑、抑郁、压力得分差异均有统计学意义(F值分别为398.17,257.90,193.53,321.34,258.89,191.30,171.28,51.13,119.00,67.40,P值均 < 0.05)。郑州市青少年生存质量总分及各维度得分高于香港地区,而自尊和焦虑得分低于台湾青少年(P值均 < 0.05)。除自尊、焦虑和压力方面,不同年级和性别郑州市青少年的生理功能、情感功能、社会功能、学校功能、自我效能、抑郁及生活质量总分差异均有统计学意义(t值分别为13.53,20.71,10.92,20.26,14.68,-16.03,21.26;6.16,3.81,-2.22,-0.33,8.76,4.16,2.71,P值< 0.01)。港台地区青少年生存质量在不同年级和性别上表现出的特征与郑州市青少年基本一致,抑郁、压力得分在年级变化上的差异与郑州市青少年相同。  结论  郑州市青少年生存质量和心理健康整体良好,且优于港台地区。需探讨青少年生存质量和心理健康状况之间的关系,以期提高青少年的生存质量水平。     

Behaviour of medical students in seeking mental and physical health care: exploration and comparison with psychology students

CONTEXT: Doctors are often reluctant to seek health care through the usual channels and tend to self-diagnose and prescribe. Medical students learn attitudes and values from clinician role models and may also adopt behaviour patterns that lead them to seek help for physical and mental health problems from informal sources. OBJECTIVES: This study aimed to explore the behaviour of students in seeking health care for physical and mental health problems, comparing medical with psychology students, and to understand what barriers to conventional routes of seeking health care may affect this. METHODS: We administered a questionnaire asking for demographic details and responses to 2 vignettes in which a student from the respondent's discipline was experiencing firstly symptoms of a mental health problem and secondly symptoms of a physical health problem. Data were analysed with spss and univariate anovas to examine differences between respondents. RESULTS: A total of 172 students at the psychology and medical schools at James Cook University in Australia participated. We identified a number of barriers affecting student behaviour in seeking help, which included worries about knowing the doctor they could consult at the university health centre or having future dealings with him or her, and cost of treatment. There were differences between the 2 groups of students. DISCUSSION: There are several barriers for both psychology and medical students to accessing appropriate professional mental health care. Medical students also experience barriers to attaining appropriate physical health care when needed. Psychology and medical students were more likely to seek advice informally from friends and/or family with regard to mental health care.     

Does knowledge count? Attitudes toward smoking among medical,nursing, and pharmacy students in Hungary

Despite the fact that cigarette smoking in East Europe is a major health problem, no effective health policy responses have been developed thus far. Health care professionals represent a valuable resource for tobacco control. Therefore, we wanted to obtain information about the acceptance of smoking among medical, nursing and pharmacy students (n = 270) in Szeged, Hungary. The self-administered questionnaire contained items on smoking behavior, beliefs and attitudes related to smoking. ²-test were used to determine differences in the attitudes among students. Smoking was the most frequent among nursing students, followed by medical students. Pharmacy students not only reported smoking the least but they also showed the most acceptable attitudes toward smoking. The high frequency of smoking among students suggests that they themselves are unable to cope with avoiding the dangers of smoking. Moreover, responses reflect a generally poor appreciation of responsibility that health care professionals have in prevention. There is a need for an increasing emphasis on smoking-related attitude formation among medical and nursing students.     

The need for integrated primary health care to enhance the effectiveness of health services

With the increasing prevalence of chronic illnesses and health compromising behaviours, health care expenditure is escalating with the expansion of hospital services. Integrated primary health care would enhance the cost effectiveness of health care delivery. Recent studies on primary care health services research in Hong Kong indicated that there is a high level of inappropriate utilisation of hospital emergency services, a high prevalence of youth health risk behaviours particularly mental health which would lead to a heavy burden on health services in the future. The community based rehabilitation provided a better quality of life for chronic illness patients, better drug compliance for chronic illness patients in family practice, and a disproportionate amount of budget is spent on law reinforcement and treatment for drug abuse rather than on prevention and education. The findings strongly indicate the need to have a strong primary health care team with well trained family physicians and trained health professionals as primary care practitioners to provide services on health promotion; curative; rehabilitation and supporting services; supporting self help activities of individuals, families and groups. This would minimize compartmentalisation in health care delivery, and is also a cost effective way of providing high quality holistic and comprehensive care that meets the needs of the majority of the population.     

Knowledge and attitudes about smoking in medical students before and after a tobacco seminar

A 3-hour seminar on tobacco was introduced to second year (pre-clinical) medical students in Hong Kong in 1994. The differences in knowledge and attitudes were measured by a self-administered and anonymous questionnaire with 14 items before the seminar (n = 145), and again 2 weeks after the seminar (n = 151). The students also completed an evaluation form at the end of the seminar. Before the seminar, the students were most deficient in their knowledge on the exact magnitude of the risks from smoking and on the risks from smoking relative to the risks from air pollution and asbestos. After the seminar, their knowledge increased significantly (   P < 0.005  ). As for attitudes, in the pre-test 35% strongly agreed that tobacco advertising should be completely banned, and 50% did so in the post-test (   P = 0.02  ). The corresponding figures for banning of all forms of tobacco promotion were 26% and 43% (   P < 0.005  ). In the pre-test, one in four students strongly disagreed that doctor's advice to their patients to stop smoking is totally ineffective, with this proportion increasing to 70% in the post-test (   P < 0.005  ). The majority of the students stated that the seminar was useful. The preclinical medical curriculum should, at the very least, include a tobacco seminar. Our survey shows that it is effective in improving students' knowledge and attitudes on tobacco control.     

Stress and vulnerability in medical students

One hundred and forty Hong Kong Chinese students were surveyed early in the second year of their medical education (year 2), and compared with 138 students surveyed prior to beginning their first year of medical school and with 74 non-medical university students in their second year. In year 2 students, distress as reflected in their scores on anxiety and depression self-report scales was high, and these students reported greater utilization of health professional services as compared with the other two groups. In year 2 students, concerns related to the medical school environment and curriculum, and whether one has the endurance and ability to be successful were significant correlates with depression and anxiety. Loss of opportunity to maintain social and recreational sources of gratification correlated with anxiety. There was no difference between the sexes with regard to the development of anxiety and depression symptoms. Academically less successful students reported somewhat higher levels of depressive ideation and symptomatology. Trait anxiety correlated with the development of distress, while optimism protected against the development of distress. Active coping styles and positive reinterpretation as a coping strategy correlated negatively with distress, while wishful thinking correlated positively with distress. These findings emphasize the need for greater attention to the psychological well-being of doctors-in-training, in Hong Kong as in the Western world. These findings should be further explored in longitudinal studies, and may be helpful in designing intervention and support programmes for vulnerable students.     

Adolescent developmental issues in Hong Kong: Relevance to positive youth development programs in Hong Kong

Several adolescent developmental issues and problems in Hong Kong are examined in this paper. First, the changing adolescent substance abuse patterns are described. Second, although the overall youth crime trend was relatively stable in the past decade, shoplifting and stealing crimes deserve our concern. Third, adolescent mental health problem is a growing problem. Fourth, statistics show that unhealthy life styles, such as smoking, early sex and moral confusion are issues of concern. Fifth, the proportion of adolescents experiencing economic disadvantage has increased. Sixth, youth unemployment and non-engaged youth are growing problems when the economy of Hong Kong is undergoing re-structuring. Seventh, family and parenting problems in families with adolescents deserve our attention. Finally, the Social Development Index showed that the development of young people has gradually deteriorated in the past decade. These adolescent issues and problems provide useful pointers for designing the positive youth development program financially sponsored by the Hong Kong Jockey Club Charities Trust.     

How prepared are our future doctors for HIV/AIDS?

Three cohorts (n?=?391) of final-year medical students in Hong Kong were evaluated on their preparedness to provide HIV care. Through a self-administered questionnaire, half (53%) were assessed to be better prepared and had a lower perceived risk of infection at work, though unwillingness to manage HIV patients was reported in a minority (4.6%). For a majority of medical students (72.8%), a specially-designed clinic attachment offered the only opportunity to come face-to-face with HIV patients for the first time. With continued improvement in treatment effectiveness, HIV/AIDS is evolving to become a new chronic disease in most societies. Curriculum development in HIV medicine remains a challenge in this HAART era.     

Fear and anxiety about COVID-19 among local and overseas Chinese university students

This study aimed to establish a new COVID-19 Fear (Higher Education) scale to investigate the relationship between fear and generalised anxiety symptoms among Chinese students in mainland China, Hong Kong, and other countries. 219 Chinese university students studying in universities in mainland China (n = 76, 34.7%), Hong Kong (n = 66, 30.1%), and overseas (i.e., outside of China as international students, n = 77, 35.2%) participated in an online study from March 31, 2020 to April 4. Participants completed a newly developed COVID-19 Fear (Higher Education) scale to measure three domains of fear including fear of infection, fear of instability and fear of insecurity related to the COVID-19 pandemic. They also completed the Generalized Anxiety Disorder 7-item scale (GAD-7) on the severity of anxiety symptoms. About 9.6% of the participants could be classified as exhibiting high anxiety level according to the GAD-7. More students studying overseas (about 15%) were classified into the high GAD group when compared to students studying in both mainland China (6.6%) and Hong Kong (6.1%). MANOVA results showed that students studying in Hong Kong and overseas had more concerns related to preventive measures related to COVID-19 than their mainland counterparts did. We concluded that international students studying away from their home country would have higher risk to develop anxiety problems during a collective trauma such as the COVID-19 pandemic. Education institutions should provide support services including online support groups, social media groups for mutual support to alleviate the fear and anxiety of international students.     

新冠肺炎流行期间医学生焦虑情绪及其影响因素

  目的  分析医学生在新型冠状病毒(COVID-19)流行期间焦虑情绪状况及其影响因素,为有针对性开展心理防护提供理论依据。  方法  采用非概率抽样(方便抽样)的方式选取安徽省2所医学院校6 276名医学生为调查对象,利用问卷星制作问卷,包括一般情况问卷、焦虑自评量表(SAS)等;通过微信、QQ等网络平台,在COVID-19流行期间对被试的焦虑情绪及其影响因素进行匿名调查。  结果  医学生焦虑得分为(38.52±7.76)分,焦虑情绪检出率为8.9%。医学生在性别、辅导员在COVID-19流行期提醒注意防护频次、本/专科生、户籍所在地、自评近期健康状况、所居住小区是否有COVID-19确诊患者、关注度、盲目消毒、自评自己被感染的风险、恐慌程度等方面焦虑情绪检出率差异均有统计学意义(P值均 < 0.05);多因素Logistic回归分析结果显示,本科生(OR=1.25)、自评自己感染COVID-19的风险高(OR=1.71)、特别恐慌(OR=2.75)与焦虑情绪呈正相关;女生(OR=0.62)、来自农村(OR=0.80)、自评近期健康状况一般(OR=0.06)、健康状况较好(OR=0.11)、健康状况很好(OR=0.30)、所居住小区无COVID-19确诊患者(OR=0.67),对COVID-19疫情每天关注一两次(OR=0.47)、频繁关注(OR=0.38)、盲目消毒行为一般(OR=0.53)、盲目消毒行为较少(OR=0.32)与焦虑情绪呈负相关。  结论  COVID-19流行期间,医学生焦虑得分较高,不同性别、本专科层次医学生存在差别。医学生应做好心理调适,适度关注相关信息,正确认识疫情;学校辅导员应多关心学生,并进行多方式的相关知识宣传教育。     

Examining costs of chronic conditions in a Medicaid population

PURPOSE: To compare health care costs and their components in patients with chronic illnesses. DESIGN: Quasi-experimental retrospective database analysis of an integrated state-Medicaid dataset. METHODS: Nine chronic illnesses and 28 two-disease combinations were evaluated in 284,060 patients. Dependent variables were total cost and the component costs (hospital, physician, home health and medical supplies, and pharmacy). Statistical analysis included analysis of variance (ANOVA) and multiple analysis of variance (MANOVA). RESULTS: The nine chronic illnesses studied were: psychosis, depression, cardiovascular illness, congestive heart failure, diabetes, acid peptic illness, respiratory illness/asthma, hypertension, and anxiety. Psychosis and depression patients had the highest mean yearly costs at $6,964 and $5,505, respectively. Highest component costs were mental health practitioners for psychosis and hospital costs for depression. All other conditions had significantly lower yearly costs. Component costs consisted primarily of pharmacy and hospital costs. Psychosis was a component in 5 of the 7 most costly chronic-disease concurrences. The highest disease-concurrence mean cost was for psychosis and depression ($18,318). CONCLUSIONS: The unique resource needs of different chronic illnesses should be considered in benchmarking and evaluating chronic-disease management programs.     

Smoking in adolescence: methods for health education and smoking cessation. A MIRNET study

The purpose of this study was to explore smoking behaviors and attitudes among adolescents. A self-administered questionnaire was used to sample adolescents presenting for health care to physicians belonging to MIRNET, a network of family physicians collaborating on research across Michigan. The questionnaire was anonymous and was completed before the visit. Physicians or office nurses were asked to complete a brief face sheet on their patient's demographic information and smoking status, which was linked to the questionnaire through a code number. Twenty-seven percent of female patients and 16% of male patients were smoking and 57% had tried smoking. Knowledge regarding health risks of smoking was high, and the major reasons given for starting to smoke were curiosity and peer behavior. Current smokers reported greater alcohol and marijuana use and cited problems with stress and anxiety, peer behavior, boredom, and the influence of smoking parents and relatives as factors in continuing to smoke. Patients' suggestions for successful smoking cessation focused on peers, explicit messages through pictures, and medication.