How common are Chinese patients with multimorbidity involved in decision-making and having a treatment plan? A cross-sectional study.

BACKGROUND: Creating a treatment plan (TP) through shared decision-making (SDM) with healthcare professionals is of paramount importance for patients with multimorbidity (MM). This study aims to estimate the prevalence of SDM and TP in patients with MM and study the association between SDM/TP with patients' confidence to manage their diseases and hospitalization within the previous 1 year. METHOD: This cross-sectional study used an internationally recognized survey. A total of 1032 patients aged 60 or above with MM were recruited from a specialist outpatient clinic, general outpatient clinic (GOPC) and a geriatric day hospital. The proportion of patients reported to have SDM and TP was estimated. Associations between the presence of SDM/TP and patients' demographic data, the confidence level to manage their illnesses and hospitalization in previous 1 year were then studied using logistic regression. RESULTS: The prevalence of SDM and TP was 35.8% and 82.1%, respectively. The presence of TP was associated with receiving healthcare from the same doctor or in the same facilities and being recruited from GOPC. The presence of SDM (OR = 1.352, P = .089) and TP (OR = 2.384, P < .001) was associated with enhanced confidence in dealing with diseases. CONCLUSION: Most people with MM had TP in Hong Kong, but fewer patients had SDM. PRACTICE IMPLICATIONS: Ways to promote SDM in HK are needed.

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong.

BACKGROUND: The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. METHODS: This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective. RESULTS: A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51-4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47-8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22-3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01-0.73). CONCLUSIONS: While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Prevalence of medical students' burnout and its associated demographics and lifestyle factors in Hong Kong.

BACKGROUND: Burnout causes personal suffering and adverse professional consequences. It is prevalent among medical students, although the relationship between burnout and lifestyle factors are understudied in Chinese medical students. Thus, this study aims to (i) estimate the prevalence of burnout among medical students in Hong Kong (HK) and (ii) delineate the relationship between burnout and various lifestyle factors. METHOD: 1,341 students were invited to complete a questionnaire from September to December 2017. Burnout was measured by the Maslach Burnout Inventory. Lifestyle factors including drinking habit, sleep habit and quality, and exercise level were assessed by validated instruments, including Alcohol Use Disorder Identification Test (AUDIT-C), Pittsburgh Sleep Quality Index (PSQI), and Godin-Shephard Leisure-Time Physical Activity (GSLTPA), respectively. Smoking status and use of self-medications were also inquired into, while demographic data was self-reported. Prevalence of burnout with confidence intervals was calculated. Difference in lifestyle and demographic data in students with or without burnout, were compared by t-test and Chi-square/Fisher's exact test. From this, all associations with significant p-value at p<0.1 were entered into the multiple logistic regression model. RESULTS: 731 students (55.6%) responded to the questionnaire. Prevalence of burnout was 27.9% (95%CI: 24.6%-31.5%). Only 3 students in the whole sample smoked; and 6.6% of students drank weekly but rarely drank more than 2 drinks per week. 6.3% and 2.3% self-medicated themselves with medications to improve their sleep and concentration, respectively. Using a multiple logistic regression model, only sleep quality and exercise level were significantly associated with the presence of burnout. CONCLUSION: Around a quarter of medical students in HK suffered from burnout. Burnout was found to be significantly associated with sleep quality and physical exercise. The study also highlighted that HK medical students lived very different lifestyles from those from other countries. More research is needed to design and establish the effectiveness of lifestyle interventional programs that enhance exercise level and sleep quality.

Frontal-subcortical protein expression following prenatal exposure to maternal inflammation.

BACKGROUND: Maternal immune activation (MIA) during prenatal life is a risk factor for neurodevelopmental disorders including schizophrenia and autism. Such conditions are associated with alterations in fronto-subcortical circuits, but their molecular basis is far from clear. METHODOLOGY/PRINCIPAL FINDINGS: Using two-dimensional differential in-gel electrophoresis (2D-DIGE) and mass spectrometry, with targeted western blot analyses for confirmation, we investigated the impact of MIA on the prefrontal and striatal proteome from an established MIA mouse model generated in C57B6 mice, by administering the viral analogue PolyI:C or saline vehicle (control) intravenously on gestation day (GD) 9. In striatum, 11 proteins were up-regulated and 4 proteins were down-regulated in the PolyI:C mice, while 10 proteins were up-regulated and 7 proteins down-regulated in prefrontal cortex (PFC). These were proteins involved in the mitogen-activated protein kinase (MAPK) signaling pathway, oxidation and auto-immune targets, including dual specificity mitogen-activated protein kinase kinase 1 (MEK), eukaryotic initiation factor (eIF) 4A-II, creatine kinase (CK)-B, L-lactate dehydrogenase (LDH)-B, WD repeat-containing protein and NADH dehydrogenase in the striatum; and guanine nucleotide-binding protein (G-protein), 14-3-3 protein, alpha-enolase, olfactory maker protein and heat shock proteins (HSP) 60, and 90-beta in the PFC. CONCLUSIONS/SIGNIFICANCE: This data fits with emerging evidence for disruption of critical converging intracellular pathways involving MAPK pathways in neurodevelopmental conditions and it shows considerable overlap with protein pathways identified by genetic modeling and clinical post-mortem studies. This has implications for understanding causality and may offer potential biomarkers and novel treatment targets for neurodevelopmental conditions.