Breast cancer application protocol: a randomised controlled trial to evaluate a self-management app for breast cancer survivors.

INTRODUCTION: The eHealth technologies that are being designed for chronic disease constitute a global trend towards health assessment and self-management. However, most of these approaches tend to focus on a single symptom or problem rather than on the multiple problems that are characteristic of many of these chronic illnesses. The aim of this study is to examine the effectiveness of and adherence to a self-management application (app) that identifies multiple problem areas related to surviving breast cancer as the targeted chronic illness. METHODS AND ANALYSIS: This is a randomised controlled study. Eligible participants will be allocated randomly into either an intervention group or a control group at a 1:1 ratio. The intervention group will be assigned to the self-management app ('Be-with-You'), while the control group will use a general health app ('Sham' app). The primary outcomes will include the differences between the two groups in their health literacy, problem-solving skills and self-management skills. The secondary outcomes will include group differences in self-efficacy, readiness for change and health-related quality of life. All of these outcomes will be measured at baseline and at 4 weeks and 12 weeks after intervention. In addition, usability of these two mobile apps will be measured at 4 weeks and 12 weeks after intervention. The planned sample size is 476. ETHICS AND DISSEMINATION: The Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University approved the study (HSEARS20190922001, 24 September 2019). Dissemination of findings will occur at the local, national and international levels. TRIAL REGISTRATION NUMBER: ChiCTR1900026244.

Cross-Cultural Adaptation and Validation of the Hong Kong Version of the Knee Injury and Osteoarthritis Outcome Score (HK-KOOS) for Patients with Knee Osteoarthritis.

INTRODUCTION: This study aimed to validate the Hong Kong version of the Knee Injury and Osteoarthritis Outcome Score (HK-KOOS) for patients with knee osteoarthritis. METHODS: Content validity was assessed using the Item and Scale Content Validity Index (I-CVI and S-CVI). Test-retest reliability and internal consistency were assessed by the Intraclass Correlation Coefficient (ICC) and Cronbach's alpha. Dimensionality was assessed by performing exploratory factor analysis (EFA). Convergent and Divergent Validity was performed by examining the correlation between the HK-KOOS and the Chinese version of the Short Form 12 (SF-12) Health Survey, the Chinese Modified Barthel Index (C-MBI), and the Visual Analogue Scale for Pain (VAS-Pain). Ceiling and floor effects were also examined. RESULTS: A total of 125 participants were recruited in this study. In general, all instructions, items, and response options were considered as understandable, indicating a satisfactory cross-cultural adaptation. The I-CVI and S-CVI scores were 0.80-1 and 0.90-1, respectively, indicating excellent content validity in terms of relevance, representativeness, and understandability. The test-retest reliability of all HK-KOOS subscales was satisfactory with ICC exceeding 0.70 for all domains. Cronbach's alpha exceeded 0.80 for all subscales, indicating satisfactory internal consistency. Medium to strong correlations were found between the HK-KOOS and the VAS-Pain, SF-12, and C-MBI. However, factor analysis indicated a seven-factor structure, rather than the original five-factor structure. Items on pain and activities of daily living were loaded in the same factors. A floor effect was present in the sports and recreation subscale. DISCUSSION AND CONCLUSIONS: Future studies should further examine the dimensionality of the KOOS. The HK-KOOS is a culturally adapted, reliable, and valid outcome measure instrument to be used in Hong Kong patients with primary knee osteoarthritis.

Chinese translation of a measure of symptom burden, functional limitations, lifestyle, and health care-seeking skills in breast cancer survivors: the Cancer Survivor Profile.

PURPOSE: To produce a culturally sensitive Chinese translation of the original version of the Cancer Survivor Profile for breast cancer (CSPro-BC) survivors, which identifies problems in breast cancer patients post-primary treatment for breast cancer. METHODS: Four hundred forty-four female Chinese patients following primary treatment for breast cancer completed a Chinese translation of the CSPro-BC. Participants were randomly divided into two equal groups (n = 222). The two samples were subjected to exploratory and confirmatory factor analysis. Test-retest reliability, internal consistency, and divergent and convergent validities were also determined. RESULTS: The majority of participants were diagnosed with stage II or III breast cancer (76.1%), with a median of 16 months post-primary treatment, between the ages of 40-59, educated at the junior high school level or below (86.2%), married with children (93.7%), and unemployed (70.7%). Factor analysis generated five factors: symptom burden, function, health behavior, financial strain, and health care-seeking skills. Scales within each domain were similar to the original CSPro-BC. The measurement models for symptom burden (CFI = 0.949, RMSEA = 0.055), function (CFI = 0.925, RMSEA = 0.080), health behavior (CFI = 0.999, RMSEA = 0.015), financial strain (CFI = 0.999, RMSEA = 0.014), and health care-seeking skills (CFI = 0.964, RMSEA = 0.059) were all consistent with the original measure. Test-retest reliability was between 0.80 and 0.92. Internal consistency ranged from 0.65 to 0.95. Discriminant and concurrent validities were consistent to the original. CONCLUSIONS: The translation resulted in a valid and reliable self-assessment tool for identifying common non-medical problems in breast cancer patients' post-cancer treatment. IMPLICATIONS FOR CANCER SURVIVORS: A culturally sensitive measure of symptoms, functional limitations, lifestyle, and health care-seeking skills in Chinese-speaking breast cancer survivors is available for further testing.

Cognitive challenges while at work and work output in breast cancer survivors employed in a rapidly evolving economy.

OBJECTIVE: To determine whether work output was related to cognitive limitations while at work in occupationally active breast cancer survivors (BCS) employed in a rapidly developing economy. METHODS: Measures of demographics, job type, job stress, general distress (anxiety, depression), fatigue, work-related cognitive limitations, and work output were obtained using self-report measures in a cross-sectional study in both BCS and controls (n = 267/group). RESULTS: Groups had similar educational backgrounds, job types, and levels of job stress. The BCS group was a median of 3.2 years post-primary treatment, slightly older, more likely to be divorced, have children, and was more likely working part-time. The BCS group reported higher levels of fatigue, general distress, and lower levels of work output (p < .05). A multivariate regression adjusting for group differences indicated that cognitive symptoms at work were related to lower levels of quantity, quality, and timeliness of completed work in the BCS group (adj. R2 = .57, unstandardized coefficient = 1.062, 95% CI = .436 to 1.689). CONCLUSION: When reported in the context of work, cognitive limitations were associated with lower levels of reported work output exclusively in the BCS group. IMPLICATIONS FOR CANCER SURVIVORS: This study provides further evidence that cognitive limitations reported in the context of work in a developing country is similar to that of BCS working in more developed economies and is specific to BCS and not healthy workers with similar job types and job stress. Solutions to this problem may be applicable across countries.

Neutrophil survival and c-kit(+)-progenitor proliferation in Staphylococcus aureus-infected skin wounds promote resolution.

Polymorphonuclear neutrophils (PMNs) are critical for the formation, maintenance, and resolution of bacterial abscesses. However, the mechanisms that regulate PMN survival and proliferation during the evolution of an abscess are not well defined. Using a mouse model of Staphylococcus aureus abscess formation within a cutaneous wound, combined with real-time imaging of genetically tagged PMNs, we observed that a high bacterial burden elicited a sustained mobilization of PMNs from the bone marrow to the infected wound, where their lifespan was markedly extended. A continuous rise in wound PMN number, which was not accounted for by trafficking from the bone marrow or by prolonged survival, was correlated with the homing of c-kit(+)-progenitor cells from the blood to the wound, where they proliferated and formed mature PMNs. Furthermore, by blocking their recruitment with an antibody to c-kit, which severely limited the proliferation of mature PMNs in the wound and shortened mouse survival, we confirmed that progenitor cells are not only important contributors to PMN expansion in the wound, but are also functionally important for immune protection. We conclude that the abscess environment provides a niche capable of regulating PMN survival and local proliferation of bone marrow-derived c-kit(+)-progenitor cells.