Factor structure and psychometric properties of the Chinese version of the 20-item pain anxiety symptoms scale (ChPASS-20)

Context: The Pain Anxiety Symptoms Scale (PASS) was designed to assess pain-related anxiety and fear. Although the scale is a reliable measure with good psychometric properties, its validity among ethnic Chinese has yet to be evaluated. Objectives: This study aimed to translate the English-language version of the 20-item PASS into Chinese (ChPASS-20) and evaluate its factor structure, reliability, and validity. Methods: A total of 223 Chinese patients with chronic musculoskeletal pain attending orthopedic specialist clinics completed the ChPASS-20, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item Tampa Scale of Kinesiophobia, the Hospital Anxiety and Depression Scale, and questions assessing sociodemographic and pain characteristics. Results: Confirmatory factor analyses showed that all the five-factor solutions tested met the minimum acceptable fit criterion. The four ChPASS-20 subscales and the entire scale demonstrated good internal consistency (Cronbach's αs: 0.72-0.92). All ChPASS-20 scales showed significant positive correlations with depression, pain intensity, and disability. Hierarchical multiple regression analyses showed that the ChPASS-20 total score predicted concurrent depression [F(4,159) = 11.97, P < 0.001], pain intensity [F(4,161) = 2.47, P < 0.05], and pain disability [F(4,191) = 5.47, P < 0.001] scores, and the ChPASS-20 Avoidance subscale (standardized beta coefficient = 0.21, P < 0.05) emerged as a significant independent predictor of concurrent pain disability. Conclusion: Our data support the factorial validity, reliability, and construct validity of the ChPASS-20 in a Chinese population. © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.postprin

A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa.

OBJECTIVES: To (i) summarize the methods undertaken to measure physical accessibility as the spatial separation between women and health services, and (ii) establish the extent to which distance to skilled care for childbirth affects utilization in Sub-Saharan Africa. METHOD: We defined spatial separation as the distance/travel time between women and skilled care services. The use of skilled care at birth referred to either the location or attendant of childbirth. The main criterion for inclusion was any quantification of the relationship between spatial separation and use of skilled care at birth. The approaches undertaken to measure distance/travel time were summarized in a narrative format. We obtained pooled adjusted odds ratios (aOR) from studies that controlled for financial means, education and (perceived) need of care in a meta-analysis. RESULTS: 57 articles were included (40 studied distance and 25 travel time), in which distance/travel time were found predominately self-reported or estimated in a geographic information system based on geographic coordinates. Approaches of distance/travel time measurement were generally poorly detailed, especially for self-reported data. Crucial features such as start point of origin and the mode of transportation for travel time were most often unspecified. Meta-analysis showed that increased distance to maternity care had an inverse association with utilization (n = 10, pooled aOR = 0.90/1km, 95%CI = 0.85-0.94). Distance from a hospital for rural women showed an even more pronounced effect on utilization (n = 2, pooled aOR = 0.58/1km increase, 95%CI = 0.31,1.09). The effect of spatial separation appears to level off beyond critical point when utilization was generally low. CONCLUSION: Although the reporting and measurements of spatial separation in low-resource settings needs further development, we found evidence that a lack of geographic access impedes use. Utilization is conditioned on access, researchers and policy makers should therefore prioritize quality data for the evidence-base to ensure that women everywhere have the potential to access obstetric care

The health benefits of reduced air pollution: value and trade-offs

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Methods for monitoring influenza surveillance data

Background: A variety of Serfling-type statistical algorithms requiring long series of historical data, exclusively from temperate climate zones, have been proposed for automated monitoring of influenza sentinel surveillance data. We evaluated three alternative statistical approaches where alert thresholds are based on recent data in both temperate and subtropical regions. Methods: We compared time series, regression, and cumulative sum (CUSUM) models on empirical data from Hong Kong and the US using a composite index (range = 0-1) consisting of the key outcomes of sensitivity, specificity, and time to detection (lag). The index was calculated based on alarms generated within the first 2 or 4 weeks of the peak season. Results: We found that the time series model was optimal in the Hong Kong setting, while both the time series and CUSUM models worked equally well on US data. For alarms generated within the first 2 weeks (4 weeks) of the peak season in Hong Kong, the maximum values of the index were: time series 0.77 (0.86); regression 0.75 (0.82); CUSUM 0.56 (0.75). In the US data the maximum values of the index were: time series 0.81 (0.95); regression 0.81 (0.91); CUSUM 0.90 (0.94). Conclusions: Automated influenza surveillance methods based on short-term data, including time series and CUSUM models, can generate sensitive, specific, and timely alerts, and can offer a useful alternative to Serfling-like methods that rely on long-term, historically based thresholds. © Copyright 2006 Oxford University Press.postprin

Primary hyperaldosteronism among Chinese hypertensive patients: how are we doing in a local district in Hong Kong

OBJECTIVES: To estimate the point prevalence of primary hyperaldosteronism in a government out-patient setting and to compare associated patient characteristics with those having essential hypertension. DESIGN: Case series with external comparison. SETTING: A single public hospital (Caritas Medical Centre) and all five associated general out-patient clinics in Sham Shui Po district in Hong Kong. PATIENTS: All patients with confirmed primary hyperaldosteronism and randomly selected patients with essential hypertension from a medical specialist clinic and general out-patient clinics, retrieved from a computer database for the period January 2007 to December 2008. MAIN OUTCOME MEASURES: Estimated point prevalence of primary hyperaldosteronism among hypertensive patients treated in the public sector of Sham Shui Po district. Patient age when hypertension was diagnosed, number of antihypertensive drugs used for treatment, and the presence of target organ damage in the patients with primary hyperaldosteronism and those with essential hypertension were compared. RESULTS: Among the 46 012 patients receiving antihypertensive treatment, 49 were confirmed to have primary hyperaldosteronism. The estimated point prevalence of primary hyperaldosteronism among these hypertensive patients was 0.106% only, which was far smaller than figures from other countries. When compared with the 147 patients with essential hypertension by multivariate analysis, those with primary hyperaldosteronism were: (1) associated with longer durations of hypertension (odds ratio=1.14; 95% confidence interval, 1.06-1.24) despite being younger at the time of study, (2) likely to be taking three or more antihypertensive drugs (odds ratio=2.51; 95% confidence interval, 1.59-3.95), and (3) more likely to have left ventricular hypertrophy (odds ratio=5.01; 95% confidence interval, 1.83-13.69). All primary hyperaldosteronism patients studied presented with hypokalaemia. The need for antihypertensive drugs was markedly reduced after adrenalectomy for adrenal adenoma. CONCLUSIONS: Primary hyperaldosteronism, which is potentially a surgically curable cause of hypertension, appeared to be underdiagnosed in our locality. Screening by aldosterone-renin ratio of high-risk individuals may help improve patient outcomes.published_or_final_versio

Prevelance and determinants of diagnostic and prognostic disclosure by radiotherapists and surgeons to patients with terminal cancer in Hong Kong

This paper identifies the prevalence and determinants of diagnostic and prognostic information given to terminally ill cancer patients in Hong Kong. Surgeons and radiotherapists (n = 153) were interviewed about the information they gave to their most recently deceased cancer patients. This was explored in relation to doctors' and patients' demographic data, diagnosis, the stage of disease at disclosure, and doctors' attitude. Diagnostic information was disclosed partially in 68% and fully in 46% of cases. Prognosis was disclosed partially in 38% and fully in less than 10% of cases. Determinants of diagnostic disclosure included doctors' attitudes about death, and perceived responsibility for disclosure. The doctor's training and work, and the patient's request for information determined the level of disclosure. After adjustment for a number of social and demographic factors, only the patient's education level remained a significant determinant of the level of prognostic disclosure. A significant proportion of terminally-ill cancer patients do not engage in discussion of diagnosis or prognosis with the doctor caring for them during the last stages of their disease. This reflects the unwillingness to discuss such matters, giving a low priority to information provision, paternalism or other factors, such as little importance being attached to such topics at the late stage of cancer. Thus many cancer patients may fail to learn important information about their disease if they have not engaged in discussion of these topics earlier in their illness. The results of this paper have important implications for medical education in caring for patients with cancer.published_or_final_versio

Pseudolaric acid B as a new class of microtubule destabilizing agent and an effective anti-tumor compound in vivo

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Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles?

BACKGROUND: Wealth quintiles derived from household asset indices are routinely used for measuring socioeconomic inequalities in the health of women and children in low and middle-income countries. We explore whether the use of wealth deciles rather than quintiles may be advantageous. METHODS: We selected 46 countries with available national surveys carried out between 2003 and 2013 and with a sample size of at least 3000 children. The outcomes were prevalence of under-five stunting and delivery by a skilled birth attendant (SBA). Differences and ratios between extreme groups for deciles (D1 and D10) and quintiles (Q1 and Q5) were calculated, as well as two summary measures: the slope index of inequality (SII) and concentration index (CIX). RESULTS: In virtually all countries, stunting prevalence was highest among the poor, and there were larger differences between D1 and D10 than between Q1 and Q5. SBA coverage showed pro-rich patterns in all countries; in four countries the gap was greater than 80 pct points. With one exception, differences between extreme deciles were larger than between quintiles. Similar patterns emerged when using ratios instead of differences. The two summary measures provide very similar results for quintiles and deciles. Patterns of top or bottom inequality varied with national coverage levels. CONCLUSION: Researchers and policymakers should consider breakdowns by wealth deciles, when sample sizes allow. Use of deciles may contribute to advocacy efforts, monitoring inequalities over time, and targeting health interventions. Summary indices of inequalities were unaffected by the use of quintiles or deciles in their calculation

Codon usage bias and the evolution of influenza A viruses. Codon Usage Biases of Influenza Virus

<p>Abstract</p> <p>Background</p> <p>The influenza A virus is an important infectious cause of morbidity and mortality in humans and was responsible for 3 pandemics in the 20^thcentury. As the replication of the influenza virus is based on its host's machinery, codon usage of its viral genes might be subject to host selection pressures, especially after interspecies transmission. A better understanding of viral evolution and host adaptive responses might help control this disease.</p> <p>Results</p> <p>Relative Synonymous Codon Usage (RSCU) values of the genes from segment 1 to segment 6 of avian and human influenza viruses, including pandemic H1N1, were studied via Correspondence Analysis (CA). The codon usage patterns of seasonal human influenza viruses were distinct among their subtypes and different from those of avian viruses. Newly isolated viruses could be added to the CA results, creating a tool to investigate the host origin and evolution of viral genes. It was found that the 1918 pandemic H1N1 virus contained genes with mammalian-like viral codon usage patterns, indicating that the introduction of this virus to humans was not through <it>in toto </it>transfer of an avian influenza virus.</p> <p>Many human viral genes had directional changes in codon usage over time of viral isolation, indicating the effect of host selection pressures. These changes reduced the overall GC content and the usage of G at the third codon position in the viral genome. Limited evidence of translational selection pressure was found in a few viral genes.</p> <p>Conclusions</p> <p>Codon usage patterns from CA allowed identification of host origin and evolutionary trends in influenza viruses, providing an alternative method and a tool to understand the evolution of influenza viruses. Human influenza viruses are subject to selection pressure on codon usage which might assist in understanding the characteristics of newly emerging viruses.</p