William Ho Cheung Li

Background/Objectives: Sleep disturbance is increasingly recognized as a key contributor to symptom burden and functioning in paediatric oncology, yet comparative evidence across clinical and healthy populations remains limited. This study examined sleep quality and its association with health-related quality of life (HRQoL) in children and adolescents with cancer compared with peers with non-oncological chronic illnesses and healthy controls. Methods: A cross-sectional study was conducted at Hong Kong Children’s Hospital. Participants 6–18 years were recruited by convenience sampling into three groups (oncology, chronic illness, healthy; n = 50 each). Children and adolescents completed the Chinese Pittsburgh Sleep Quality Index (PSQI) and Pediatrics Quality of Life Inventory (PedsQL) 4.0. Group differences were tested using chi-square tests and one-way analysis of variance (ANOVA) with post hoc Tukey comparisons. Pearson correlations and hierarchical multiple linear regression examined PSQI-PedsQL associations. Results: Sleep quality differed significantly across groups (p < 0.001), with the poorest sleep observed in the oncology group. The prevalence of poor sleep (PSQI ≥ 5) was 60.0% in oncology group, compared with 40.0% in those with chronic illness and 30.0% in healthy peers. Mean global PSQI scores were 6.02 ± 3.40 in the oncology group, 4.10 ± 2.60 in the chronic illness group, and 3.30 ± 2.35 in healthy controls, with a significant overall group difference (p < 0.001). Impairments were most pronounced in sleep latency, habitual sleep efficiency, and sleep disturbances. HRQoL was lowest in the oncology group (p < 0.001). Mean PedsQL total scores were 68.98 ± 15.73 in the oncology group, 75.99 ± 14.03 in the chronic illness group, and 85.44 ± 10.26 in healthy controls, respectively, with a significant overall group difference (p < 0.001). Across the full sample, poor sleep quality was independently associated with lower HRQoL after adjustment for demographic and clinical factors (β = −0.271, p = 0.002), with no significant interaction by group. Conclusions: Children and adolescents with cancer reported clinically significant sleep impairment, driven mainly by reduced sleep quality and continuity. Routine sleep screening and targeted supportive interventions may improve HRQoL in paediatric oncology.

Background: Noncommunicable diseases (NCDs) are the leading global cause of death and are driven by modifiable behaviors, such as tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity. Recognizing that emergency department (ED) visits represent a unique opportunity to promote behavior change, this trial evaluated a digitally augmented, theory based general health promotion approach, combining a brief telephone-based intervention with mobile instant messaging support, to help discharged ED patients abstain from health risk behaviors. Methods and findings: This assessor-blinded randomized controlled trial was conducted in a major public hospital ED in Hong Kong. Adults (18–65 years) triaged as semi-urgent or non-urgent and with ≥1 health-risk behavior and smartphone access were randomized to receive a digitally augmented, theory‑based general health‑promotion intervention consisting of a brief telephone‑based AWARD‑model intervention (Ask, Warn, Advise, Refer, and Do-it-again) followed by weekly WhatsApp or WeChat messages for 6 months, or to a control group receiving brief telephone advice only. The primary outcome was self-report abstinence from ≥1 health-risk behavior at 6 months; secondary outcomes included the proportion of participants who achieved self-reported abstinence from ≥1 health-risk behavior at 12 months and reduction in the number of behaviors at 6 and 12 months. Of the 2,134 screened patients, 572 were enrolled (286 per group). At 6 months, 30.1% of the intervention participants versus 19.9% of the controls achieved self-reported abstinence (RR = 1.51; 95% CI, 1.13–2.02; P = 0.006). The intervention also significantly increased the likelihood of fewer risky behaviors at 6 (RR = 1.54; P = 0.01) and 12 (RR = 1.48; P = 0.02) months. Physical inactivity showed the greatest improvement at 6 months (31.7% versus 16.2%; P < 0.001). The effects attenuated after cessation of booster messaging. Limitations include reliance on self-reported outcomes, the single-center study design, and loss to follow-up, which may have affected the generalizability of the results. Conclusions: A digitally augmented, theory-based general health promotion strategy delivered at ED discharge through brief telephone intervention and mobile instant messaging support demonstrated short-term benefits in promoting self-reported abstinence and reducing health-risk behaviors at 6 months. However, the absence of a sustained effect at 12 months suggests that extended support or maintenance strategies may be required to maintain these improvements over time. Multicenter trials with longer follow-up are warranted to evaluate long-term effectiveness. Clinical trial registration: ClinicalTrials.gov (Registration No: NCT06077565 ).

Background/Objectives: Sleep disturbance is increasingly recognized as a key contributor to symptom burden and functioning in paediatric oncology, yet comparative evidence across clinical and healthy populations remains limited. This study examined sleep quality and its association with HRQoL in children with cancer compared with peers with other chronic illnesses and healthy controls. Methods: A cross-sectional study was conducted at HKCH. Participants 6-18 years were recruited by convenience sampling into three groups (oncology, chronic illness, healthy; n=50 each). Children completed the Chinese PSQI and PedsQL 4.0. Group differences were tested using chi-square tests and one-way ANOVA with post-hoc Tukey comparisons. Pearson correlations and hierarchical multiple linear regression examined PSQI-PedsQL associations. Results: Sleep quality differed significantly across groups (p<0.001), with the poorest sleep observed in the oncology group. The prevalence of poor sleep (PSQI≥5) was 60.0% in children with cancer, compared with 40.0% in those with chronic illness and 30.0% in healthy peers. Impairments were most pronounced in sleep latency, habitual sleep efficiency, and sleep disturbances. HRQoL was lowest in the oncology group (p<0.001). Across the full sample, poor sleep quality independently predicted lower HRQoL after adjustment for demographic and clinical factors (β=−0.271, p=0.002), with no significant interaction by group. Conclusions: Children with cancer reported clinically significant sleep impairment, driven mainly by reduced sleep quality and continuity. Routine sleep screening and targeted supportive interventions may improve HRQoL in paediatric oncology.

Background: The short form of the Revised Child Anxiety and Depression Scale (RCADS-25) has been frequently used for assessing anxiety and depression in clinical and community samples. However, the Amharic version of RCADS-25 (RCADS-25(A)) has not been validated. This study aimed to evaluate the validity and reliability of RCADS-25(A) in pediatric oncology. Methods: This study included 142 children aged 8–18 years. The reliability of the scale was assessed by calculating internal consistency and test-retest reliability. Convergent validity was assessed by examining the correlation between the RCADS-25(A) and the Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL™ 4.0 GCS). Confirmatory factor analysis was conducted to evaluate the two-factor structure of RCADS-25 identified in the original version. Results: The mean age of the participants was 11.6 ± 3.2 years. The RCADS-25(A) demonstrated evidence of good validity and reliability. Cronbach’s alpha coefficients were 0.95, 0.94, and 0.96 for the anxiety subscale, depression subscale, and total scale, respectively, while intraclass correlation coefficients were 0.81, 0.80, and 0.87 for the same domains, indicating good test–retest reliability. The RCADS-25(A) correlated significantly with PedsQL™ 4.0 GCS ( r = -0.97, p < 0.001). Confirmatory factor analysis supported the two-factor model (χ2/df = 1.44; CFI = 0.95; RMSEA = 0.06; SRMR = 0.05; TLI = 0.95). Conclusions: The RCADS-25(A) appears to demonstrate promising validity and reliability, suggesting its potential utility for assessing anxiety and depression in pediatric oncology. The findings underscore the need for further validation studies employing larger and more diverse samples, as well as the adoption of multimethod assessment approaches. The use of parent-report versions and studies in other populations and Ethiopian languages are highlighted to further establish the scale’s psychometric properties and cross-cultural applicability.

Background: Studies have revealed an increasing prevalence of depressive symptoms among youth globally, including in Hong Kong, posing a serious threat to their mental health and quality of life. While it has been shown that horticultural activities are promising for reducing depressive symptoms in adults and older populations, their effectiveness among youth—particularly in Chinese communities—remains underexplored. This study examined the feasibility, applicability and effectiveness of horticultural activities in reducing depressive symptoms among Hong Kong youth, as well as reducing anxiety and enhancing self-esteem and quality of life. Methods: The intervention group attended four weekly 2-h nurse-led structured horticultural sessions on a local farm. The control group received regular mental health parameters monitoring by the researcher and a mental health information pamphlet. Outcomes, including depressive and anxiety symptoms, self-esteem and quality of life, were measured at baseline (T ₀ ), post-intervention (T ₁ ) and 4 weeks later (T ₂ ). The feasibility of the intervention was assessed through recruitment metrics and participants’ feedback. Results: Between October and December 2023, 108 Hong Kong Chinese youth aged 15–24 years who self-reported depressive symptoms, were equally and randomly assigned to either the intervention ( n = 54) or control group ( n = 54). The intervention was feasible and well accepted, with an eligibility rate of 94.2%, a recruitment rate of 77.7%, and retention rates of 88.9% at T ₁ and 69.4% at T ₂ . Horticultural activities significantly reduced the severity of depressive symptoms ( β = −1.207, 95% CI: −1.820 to − 0.043, P = .028), with the most notable improvement observed between T ₀ and T ₁ ( P = .05, generalised estimating equation [GEE] analysis). Conclusions: Horticultural activities are a feasible, low-cost and acceptable intervention for reducing depressive symptoms among Hong Kong youth. Given horticultural activities’ potential to promote mental well-being, their integration into community-based mental health programmes should be considered. Further large-scale trials are recommended to validate their broader psychological benefits. Trial registration: Chinese Clinical Trial Registry ChiCTR2300075575 (registered on 8 September 2023).

Most noncommunicable disease patients who continue smoking are chronic users with no intention to quit. This multicentre randomised controlled trial evaluated the effectiveness of brief motivational interviewing (MI) delivered using mobile instant messaging on smoking abstinence in this population. Overall, 728 adults were recruited and randomised (1:1) to the intervention or control group. Intervention group received a face-to-face brief MI session followed by instant messaging-delivered brief MI for 6 months. Control group received a face-to-face health advice consultation and a self-help booklet. Follow-ups were conducted at 3, 6, and 12 months. The primary outcome was biochemically validated smoking abstinence at 12 months, defined as self-reported abstinence from smoking in the last 7 days confirmed by exhaled carbon monoxide P = 0.03). Secondary outcomes were also significantly higher in the intervention group, including validated abstinence at 6 months (4.7% vs 1.4%; RR, 3.40; 95% CI, 1.27–9.12; P = 0.02) and intention to quit at both 3 months (30.8% vs 18.9%; RR, 1.63; 95% CI, 1.25–2.13; P < 0.001) and 6 months (33.7% vs 24.1%; RR, 1.40; 95% CI, 1.10–1.79; P = 0.01). The intervention could be easily integrated into existing smoking cessation services, effectively motivating individuals who had no intention of quitting to quit—addressing one of the major challenges in tobacco control.

Background: Tobacco use remains a leading cause of preventable morbidity and mortality worldwide. While smoking prevalence has recently declined in Hong Kong, progress has slowed. Plain packaging may reduce product appeal and enhance the impact of pictorial health warnings (PHWs), supporting reduced tobacco use. Methods: A cross-sectional study was conducted from August to November 2023 among 1,256 adult smokers in Hong Kong. Participants were recruited at outdoor public smoking hotspots and shown branded and plain cigarette packs with 85% PHWs. Perceptions of pack attractiveness, noticeability of PHWs, smoking-related harm, behavioural intentions, and support for plain packaging were assessed through structured interviews. Quantitative data were weighted by age and sex, and qualitative responses were analysed thematically. Results: Most participants perceived plain packs as less attractive (79.8%) and PHWs on plain packs were more noticeable (57.5%) than branded packs. About 45.1% perceived plain packs as disgusting, and 28.0% agreed they better conveyed severe smoking harms than branded packs. While only 17.3% reported plain packs may reduce their intention to smoke, 33.1% reported that it could deter youth from smoking. Support for plain packaging was moderate, with 35.7% in favour and 34.5% neutral. The qualitative findings reinforced these perceptions. Conclusion: Smokers perceived plain packaging as less attractive, the PHWs on it as more noticeable, and potentially useful in preventing smoking initiation in youth. These findings support the integration of plain packaging into Hong Kong’s tobacco control strategy and offer valuable insights for jurisdictions considering similar legislation.

Background: Postprostatectomy incontinence (PPI) is a common complication after robot-assisted radical prostatectomy and significantly impairs patients’ quality of life. Although behavioral interventions such as pelvic floor muscle training and bladder diaries are evidence-based, their effectiveness is often limited by poor adherence and lack of personalization. Objective: This study aimed to develop and evaluate a reinforcement learning (RL)–driven clinical behavioral intervention-supporting system (CBISs) for adaptive, personalized rehabilitation in patients with PPI. Methods: The study comprised 2 sequential stages. First, the CBISs was developed through (1) construction of a medical record database from a prospective cohort of PPI patients using standardized 3-day bladder diaries, (2) design of functional modules and user interfaces based on clinical rehabilitation needs, and (3) development of an RL model using XGBoost (extreme gradient boosting) and Bayesian optimization to generate individualized training plans. Second, a separate cohort of 16 patients participated in a single-arm, pre-post pilot study to evaluate feasibility and preliminary outcome trends over a 3-month intervention period, with assessments based on bladder diary parameters and system usage metrics. Results: The CBISs successfully implemented an adaptive, closed-loop behavioral rehabilitation framework that dynamically tailored training recommendations according to individual voiding patterns, fluid intake behaviors, and adherence signals. Feasibility outcomes were favorable, with high system engagement observed throughout the intervention (mean usage frequency 5.2, SD 1.1 times per day). In exploratory pre-post analyses (n=16), consistent directional improvements were observed across multiple outcomes. Mean daytime urinary frequency decreased from 5.74 (SD 1.21) episodes per day to 4.69 (SD 1.08) episodes per day, while median nighttime urinary frequency declined from 1.8 (IQR 1.6-2.2) episodes per night to 1.0 (IQR 1.0-1.6) episodes per night. Median incontinence episodes were reduced from 7.0 (IQR 6.0-11.0) episodes per day to 4.0 (IQR 2.0-6.0) episodes per day. Objective urine leakage measured by the 1-hour pad test decreased from a median of 8.5 (IQR 4.0-19.0) g to 3.5 (IQR 2.0-9.0) g. Patient-reported symptom burden, assessed using the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-UI SF), showed a median reduction from 14.0 (IQR 12.0-20.0) points to 9.0 (IQR 6.0-16.0) points. Although several within-participant changes were statistically detectable, effect magnitudes varied across individuals. Given the single-arm design, small sample size, and lack of a control group, findings are presented as exploratory and hypothesis-generating rather than confirmatory of clinical efficacy. Conclusions: The CBISs represents the first RL-powered digital therapeutic system for PPI, enabling adaptive, evidence-based behavioral optimization. By addressing limitations of static rehabilitation protocols and declining adherence, it offers a scalable approach for personalized PPI management. Future multicenter trials are needed to confirm its clinical effectiveness.