Happy Family Kitchen II, a community-based participatory research (CBPR) to enhance Family Health, Happiness and Harmony in Hong Kong: A cluster randomized control trial under FAMILY Project

Oral Poster Presentation SessionHong Kong Council of Social Service and School of Public Health, HKU conducted a three-arm cluster randomized control trial (cRCT) of a community-based participatory research (CBPR) “Happy Family Kitchen II” during July 2012 to June 2013. The present paper compared intervention arm A and control arm C to determine whether CBPR intervention improved family health, happiness and harmony (3Hs). 31 organizations in Tsuen Wan and Kwai Tsing districts were randomly allocated into: intervention arms A (n=11) and B (n=10), and waitlist control arm C (n=10).Within positive psychology and an agreed similar framework, each organization organized their own program on one selected theme of “Five-Taste Model” for people aged 6+ recruited by organization. Arm A had two intervention-sessions and one tea-gathering, and arm C had tea-gathering first (intervention at 3 months later). Participants were assessed four times (T1, pre-intervention; T2, immediately post-intervention; T3 and T4, 1 and 3 months after T2). Changes of primary outcomes from T1 to T3/T4 were compared in participants aged 12+ of arms A and C. Behavior score change was greater in arm A (n=416) than arm C (n=432) at both T3 (Effect size=0.11, p=0.03) and T4 (ES=0.21, p=0.003). Family health score and happiness score changes were greater in arm A than arm C at T3, with ES=0.23 (p=0.001) and ES=0.18 (p=0.01) respectively. Mental health score and intention score changes were greater in arm A than arm C at T4, with ES=0.16 (p=0.03) and ES=0.18 (p=0.01) respectively. All changes above indicated improvements in outcomes. This was the first cRCT to evaluate a CBPR short intervention in Hong Kong, which was effective with small effect size in increasing participants’ intention and practice in healthy behaviors and improving family 3Hs, suggesting that CBPR, evidence-based and evidence-generating programmes are feasible and effective.postprin

Low handgrip strength is a predictor of osteoporotic fractures: Cross-sectional and prospective evidence from the Hong Kong Osteoporosis Study

Handgrip strength (HGS) is a potentially useful objective parameter to predict fracture since it is an indicator of general muscle strength and is associated with fragility and propensity to fall. Our objective was to examine the association of HGS with fracture, to evaluate the accuracy of HGS in predicting incident fracture, and to identify subjects at risk of fracture. We analyzed a cross-sectional cohort with 2,793 subjects (1,217 men and 1,576 women aged 50-101 years) and a subset of 1,702 subjects which were followed for a total of 4,855 person-years. The primary outcome measures were prevalent fractures and incident major fragility fractures. Each standard deviation (SD) reduction in HGS was associated with a 1.24-fold increased odds for major clinical fractures even after adjustment for other clinical factors. A similar result was obtained in the prospective cohort with each SD reduction in HGS being associated with a 1.57-fold increased hazard ratio of fracture even after adjustment for clinical factors. A combination of HGS and femoral neck bone mineral density (FN BMD) T-score values (combined T-score), together with other clinical factors, had a better predictive power of incident fractures than FN BMD or HGS T-score alone with clinical factors. In addition, combined T-score has better sensitivity and specificity in predicting incidence fractures than FN BMD alone. This study is the first study to compare the predictive ability of HGS and BMD. We showed that HGS is an independent risk factor for major clinical fractures. Compared with using FN BMD T-score of -2.5 alone, HGS alone has a comparable predictive power to BMD, and the combined T-score may be useful to identify extra subjects at risk of clinical fractures with improved specificity. © The Author(s) 2011.published_or_final_versionSpringer Open Choice, 21 Feb 201

BMD enhances clinical risk factors in predicting ten-year risk of osteoporotic fractures in Chinese men: the Hong Kong Osteoporosis Study

Poster presentations: Poster 2Introduction: Clinical risk factors with or without bone mineral density (BMD) measurements are increasingly recognized as reliable predictors of absolute fracture risk. Clinical risk factors may be population specific. The purpose of this prospective study was to determine the risk factors for osteoporotic fractures and to predict the 10-year risk of fractures in Southern Chinese male population. Materials and Methods: This is a part of the Hong Kong Osteoporosis Study. 1,525 community-dwelling, treatment-naive Southern Chinese men aged 50 or above were recruited. Baseline demographic characteristics and clinical risk factors were obtained, and BMD at the spine and hip were measured. Subjects were prospectively followed for incident low trauma fracture. Ten-year risk of major osteoporotic fracture and hip fracture was calculated using Cox proportional hazards models. Results: The mean age of subjects was 68 ± 10 years. After 3.5 ± 3 (1–14) years of follow-up, 36 non-traumatic incident fractures were reported. The incident rates for osteoporotic fractures and hip fracture were 676/100,000 and 132/100,000 person-years respectively. The most significant predictors of osteoporotic fracture were history of fall (odds ratio 14.5) and fragility fracture (odds ratio 4.4). Other predictive factors included outdoor activity <60 minutes/day, BMI < 20 kg/cm2, difficulty bending forward, use of walking aid, and age ≥ 65 years. Each SD reduction in BMD at spine or hip was associated with 1.7 to 2.6-fold increase in fracture risk. Subjects with 5 or more clinical risk factors had an absolute 10-year risk of osteoporotic fracture of 6.2%, which increased to 18.2% if they also had total hip BMD T-score ≤ -2.5. Addition of BMD information (total hip T-score score ≤ -2.5) significantly enhanced fracture risk prediction when compared to clinical risk factors only (omnibus test p=0.001). Men with multiple risk factors and low BMD T-scores have a higher absolute fracture risk while men with no risk factors and normal BMD have a lower fracture risk than that predicted by FRAX. Conclusions: Clinical risk factors are population specific and the addition of BMD measurement to risk factor assessment improves fracture risk prediction in Southern Chinese men.The 11th Regional Osteoporosis Conference (ROC), Hong Kong, 15-16 May 2010

Factors associated with osteoporosis treatment adherence in Hong Kong

Poster presentations: Poster 6Introduction: Effective prevention of osteoporotic fracture requires long term adherence to osteoporosis medication. Longitudinal studies revealed that more than 60% of patients terminated their treatment at one year and the problem increases with time. The problem of non-adherence to osteoporosis medication in Hong Kong is unclear. Objective: To assess patient adherence to osteoporosis medication in Hong Kong and to identify the associating factors for nonadherence. Method: 244 patients attended the osteoporosis clinic in Queen Mary Hospital for the first time between January 2007 and December 2008 were invited to participate in a retrospective observational study for their adherence to treatment. Baseline clinical and demographic information, bone mineral density, lifestyle risk factors were assessed by medical charts review. Details in treatment adherence, acceptance, incident fractures, hospital admission and mobility level were collected by telephone interviews. Information were verified from the Hospital Authority Electronic Patient Record System. Medication compliance was measured by proportion of days covered (PDC). A patient is considered as a complier if he/she had missed < 20% of the proportion of days covered (PDC). Results: A total of 193 patients participated in this study with 79.1 % response rate. The mean rate of medication adherence was 75.3% (PDC) after a mean follow up of 2.3 years. The rate of medication adherence decreased progressively with follow up duration (PDC: 74.5% at first year, 75.6% at second year, 63.7% at third year). The risk factors for non-adherence to treatment were self-perceived having too many medications (OR: 19.77, 95% CI: 2.41-161.99, p<0.001); self-perceived adverse effect from medication (OR: 16.98, 95% CI: 2.04-141.35, p=0.001); self-perceived cannot afford the medication (OR: 14.29, 95% CI: 1.68-121.5, p=0.004); self-perceived not requiring the medication (OR: 9.53, 95% CI: 2.99-30.42, p <0.001); bedbound (OR: 9.19, 95% CI: 1.00-84.08, p=0.035); smoking (OR: 3.97, 95% CI: 1.23-12.76, p=0.025); unsatisfied with medication (OR: 3.17, 95% CI: 1.05-9.59, p=0.04) and medication adverse effect (OR: 1.15, 95% CI: 1.04-1.27, p<0.001). Conclusion: Although the rate of non-adherence in our study was lower than reported by overseas studies, the problem exacerbated with longer treatment duration. Several self-perceived factors were found associated with patient non-adherence. This study identified the common misconceptions and concerns about osteoporosis medications among patients that required long term treatment. To lower the non-adherence rate, doctors should improve their communications with patients to resolve their concerns with long term medical therapy.The 11th Regional Osteoporosis Conference (ROC), Hong Kong, 15-16 May 2010

Family communication is a mediator to increase family harmony, happiness and health: findings from a Community-based Participatory Research (CBPR) Project in Hong Kong

This journal suppl. contain Abstracts from the ICBM 2012 MeetingCongress Theme: Behavioral Medicine: From Basic Science to Clinical Investigation and Public HealthPoster Session C: abstract P720INTRODUCTION: Previous studies showed communication among family members is inadequate in Hong Kong. We adopted a community-based participatory research (CBPR) approach with collaboration from the academic community and service partners. Community-based programmes were designed, planned, implemented, and evaluated using a positive psychology framework and logic model to enhance family communication and wellbeing through the “Happy Family Kitchen” (HFK) programme. OBJECTIVE:(1) To enhance family functioning and communication in collaboration with various community stakeholders and NGOs so as to promote family health, happiness, and harmony (3Hs); and (2) To evaluate the effectiveness of various components of the project in terms of its structure, process, and outcomes. METHODS: The HFK was a CBPR project with three phases conducted in Yuen Long district in Hong Kong. Phase 1: started with formative needs assessments, and conducted a training of trainer program to build capacity among the community partners in the positive psychology framework, and programme design. Phase 2: The trained community partners prepared proposals and conduct special-design programmes (with booster) to promote family communication and 3Hs. Phase 3: Pre-, post- 6 weeks, and 3 month follow up surveys were conducted to assess outcomes on family communication and 3H indicators. RESULTS: A total of 1419 individuals from 612 families participated in 23 community based programs during Nov 2010 to July 2011. The majority (74.6%) of the participants (n01419) were aged 6-44, 65.0% were female, 46.6% had primary education level and 48.8% were married. The mean communication time showed a significant increase from 152.1 to 161.9 minutes (p-value<0.001) per week and an increase in the mean communication score from 67.7 to 71.4 (p-value<0.001)was observed at 3 months after the intervention. The overall mean happiness score and the mean health score showed a significant increase from7.8 (pre-intervention) to 8.0 (p-value<0.001), and the overall mean harmony score was improved from 7.9 (pre-intervention) to 8.2 (p-value<0.001) at 6 week after intervention. CONCLUSION: The HFK project seemed to be effective in enhancing family communication and increasing family 3Hs. Family communication is a mediator to improve family 3Hs and eating and dinning seemed to be an appropriate platform to enhance the quality and frequency of communication among family members in Hong Kong. Acknowledgement: The study is part of the FAMILY: A Jockey Club Initiative for a Harmonious Society, funded by The Hong Kong Jockey Club Charities Trust

Promoting family communication, harmony, happiness and health through a community-based project in Hong Kong: the Happy Family Kitchen Project II

Conference Theme: Visioning the Future of Families: Policy & Practice - 展望家庭的未来：政策和实践Group Four - Family Practice in Asian Region (第四组: 家庭服务与实践)A community-based project with a randomized controlled trial design was organized in underprivileged areas in Hong Kong. There were over 40 community partners involved aimed to enhance the residents’ family communication for optimal family health, happiness and harmony. A total of 2,519 individuals from 1,014 families participated in 31 brief intervention programmes designed and organized by 31 service units. Nearly 40% of the participants had a household income lower than HKD 10,000. The participants were randomly allocated into 3 groups (by cluster randomization): core intervention (one session, total two hours) plus booster (one session of one hour) at week 4 post-intervention (A, n=416), core intervention (B, n=408) and control (C, n=432). At 3 months after the intervention, intervention Groups A (1.9; effect size (ES)=0.17, p<0.01, n=416) and B (1.65; ES=0.15, p<0.05, n= 408) had greater increases in perceived family happiness score (score range: 0-100, the higher the better) than control Group C (0.17, n=432). Corresponding increases in perceived family health (0.09; 0.12, 0.01), family harmony (0.53; 0.52, 0.22) and family communication (1.75; 0.08, 0.62) scores were also found among the 3 groups but the differences were not significant. This was one of the first large-scale community based projects in Asia and the findings demonstrated that the simple interventions were feasible and effective in promoting positive family communication and family well-being with small effect size and reflected the success of the strong academic-social service sector partnership

Learning Families Project - Engaging community leaders to promote social support and neighbourhood cohesion

Conference Theme: Supporting and Strengthening FamiliesPart 2 - Wisdom Sharin

Bone mineral density and serum osteoprotegerin levels in pre- and postmenopausal women

Poster presentations: Poster 3Introduction: Osteoprotegerin (OPG) is an essential regulator of bone turnover through its suppression on osteoclastogenesis. Findings from previous studies of serum OPG and bone mineral density (BMD) in humans have been conflicting. The objective of this study was to identity factors associated with serum OPG levels and to determine its effect on BMD in pre- and post- menopausal women. Methods: This is a part of the Hong Kong Osteoporosis Study. 2,343 community-dwelling, treatment and hormonal therapy naive female subjects aged 18 or above were recruited (679 premenopausal women, mean age 36.7±8.8 years; 1,664 postmenopausal women, mean age 62.6±8.5 years). Baseline demographic characteristics, serum biochemistry, hormonal profile and fasting serum OPG levels were obtained. Baseline BMD at the spine and hip were measured. Results: Serum OPG levels was correlated with age in both pre- and post-menopausal women (premenopause r=0.208, postmenopause r=0.258, both p<0.0001). After adjusting for age, OPG levels were positively correlated with serum estradiol (r=0.100, p<0.05) and negatively with follicular stimulating hormone (FSH, r=-0.114, p<0.01) in premenopausal but not postmenopausal women. In premenopausal women, higher serum OPG levels were associated with higher age- and BMI-adjusted BMD (spine r=0.147, p<0.05; femoral neck r=0.138, p<0.05; total hip r=0.148, p<0.05). In postmenopausal women, age-adjusted OPG showed no correlation with BMD in the linear regression model. However, a negative correlation was observed between OPG in quartiles and hip BMD (p-tread <0.01), but not spine BMD. Conclusions: Serum OPG level is an independent factor associated with higher BMD in pre-menopausal women. However it’s protective effect on BMD is not significant in post-menopausal women with low bone mass.The 11th Regional Osteoporosis Conference (ROC), Hong Kong, 15-16 May 2010

Survival and re-fracture rates in patients with osteoporotic fractures: The Hong Kong Osteoporosis Study

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Predictive factors for re-fracture in Chinese population with previous osteoporotic fractures

Poster presentations: Poster 8Introduction: Osteoporotic fracture is a leading cause for hospital admissions. It is known that the re-fracture rate is 3 to 5 folds higher in subjects with previous low-trauma fractures. The re-fracture rate and its predictive factors in Chinese population with previous osteoporotic fractures are unclear. The purpose of this prospective study was to determine the re-fracture rate and to identify its risk factors for Chinese with fractures. Methodology: A prospective, observational study on Southern Chinese aged 50 and above admitted to Queen Mary Hospital with low-trauma fractures of the hip, spine and distal radius. Subjects were followed yearly by telephone interview for the outcome of refracture. Information was verified from the Hospital Authority Electronic Patient Record System. Fracture of the skull, fingers, and toes were excluded. Cox proportional hazards model was used to identify the clinical risk factors for re-fractures. Results: 2,364 fracture patients (1,606 women and 758 men) admitted to Queen Mary Hospital between 2000 and 2009 were assessed. The mean age at their first fracture was 75.7 ± 10.9 years. At follow-up of 3.8 ± 2.8 years, 268 (11.3%) incident fractures were recorded. The most significant predictors for re-fracture were total hip BMD T-score 2cm shorter than at age 25, low back pain, difficult in bending forward, walk with aids, history of fall, and serum albumin < 39 g/L. In male subjects, patients with Parkinsonism and serum testosterone < 15 nmol/L were significant associated with re-fracture (Table One). Conclusions: Early identification of subjects with multiple clinical risk factors may help to reduce the re-fracture and hospital re-admission rates. Public health education on adverse lifestyle risk factors is important to reduce osteoporotic fractures.The 11th Regional Osteoporosis Conference (ROC), Hong Kong, 15-16 May 2010