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Sun Y, Ng MK, Chao TYS, He S, Mok SH. The impact of place attachment on well-being for older people in high-density urban environment: a qualitative study. J Aging Soc Policy 2024; 36:241-261. [PMID: 35957602 DOI: 10.1080/08959420.2022.2111168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/03/2022] [Indexed: 10/15/2022]
Abstract
Aging in place has become a popular social policy worldwide. This paper argues that well-being is an important outcome of aging in place, upon which older people develop autonomy and environmental proactivity. The temporal dimension of aging in place highlights development of place attachment, which includes place identity and place dependence. The study explores how older people, who live inhigh-density urban environments, make sense of well-being and place attachment by articulating their daily lives. Community dwelling older people aged 65 and above, who came from neighborhoods with high aging population and residential density but high and low median household incomes, were invited for focus group discussions. Multifaceted meanings of well-being include various dimensions that cover individual-collective and material-spiritual (psychological) construct. Meanings of place attachment include values of, bonding ties to, and memories about places. Three pathways are identified linking place attachment and multifaceted well-being. The study finds that social welfare and material richness are not the only determinants of well-being. Fulfillment of higher psychological needs, such as positive evaluation of life and self-actualization, should be emphasized by which older people can make the most of their life in old age.
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Affiliation(s)
- Yi Sun
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong
- Research Institute for Land and Space, The Hong Kong Polytechnic University, Hong Kong
| | - Mee Kam Ng
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong
| | | | - Shenjing He
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong
- Social Infrastructure for Equity and Wellbeing (SIEW) Lab, The University of Hong Kong, Hong Kong
| | - Sze Hin Mok
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong
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Cerin E, Chan YK, Symmons M, Soloveva M, Martino E, Shaw JE, Knibbs LD, Jalaludin B, Barnett A. Associations of the neighbourhood built and natural environment with cardiometabolic health indicators: A cross-sectional analysis of environmental moderators and behavioural mediators. ENVIRONMENTAL RESEARCH 2024; 240:117524. [PMID: 37898226 DOI: 10.1016/j.envres.2023.117524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Most studies examining the effects of neighbourhood urban design on cardiometabolic health focused solely on the built or natural environment. Also, they did not consider the roles of neighbourhood socio-economic status (SES) and ambient air pollution in the observed associations, and the extent to which these associations were mediated by physical activity and sedentary behaviours. METHODS We used data from the AusDiab3 study (N = 4141), a national cohort study of Australian adults to address the above-mentioned knowledge gaps. Spatial data were used to compute indices of neighbourhood walkability (population density, intersection density, non-commercial land use mix, commercial land use), natural environment (parkland and blue spaces) and air pollution (annual average concentrations of nitrogen dioxide (NO2) and fine particulate matter <2.5 μm in diameter (PM2.5)). Census indices were used to define neighbourhood SES. Clinical assessments collected data on adiposity, blood pressure, blood glucose and blood lipids. Generalised additive mixed models were used to estimate associations. RESULTS Neighbourhood walkability showed indirect beneficial associations with most indicators of cardiometabolic health via resistance training, walking and sitting for different purposes; indirect detrimental associations with the same indicators via vigorous gardening; and direct detrimental associations with blood pressure. The neighbourhood natural environment had beneficial indirect associations with most cardiometabolic health indicators via resistance training and leisure-time sitting, and beneficial direct associations with adiposity and blood lipids. Neighbourhood SES and air pollution moderated only a few associations of the neighbourhood environment with physical activity, blood lipids and blood pressure. CONCLUSIONS Within a low-density and low-pollution context, denser, walkable neighbourhoods with good access to nature may benefit residents' cardiometabolic health by facilitating the adoption of an active lifestyle. Possible disadvantages of living in denser neighbourhoods for older populations are having limited opportunities for gardening, higher levels of noise and less healthy dietary patterns associated with eating out.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia; School of Public Health, The University of Hong Kong, 7 Sassoon Rd., Sandy Bay, Hong Kong, Hong Kong SAR, China; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia.
| | - Mark Symmons
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia.
| | - Maria Soloveva
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia.
| | - Erika Martino
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia.
| | - Luke D Knibbs
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia; Public Health Unit, Sydney Local Health District, Camperdown, NSW, Australia.
| | - Bin Jalaludin
- School of Population Health, University of New South Wales, Randwick, NSW, Australia.
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia.
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Chen Y, Chan S, Bennett D, Chen X, Wu X, Ke Y, Lv J, Sun D, Pan L, Pei P, Yang L, Chen Y, Chen J, Chen Z, Li L, Du H, Yu C, Doherty A. Device-measured movement behaviours in over 20,000 China Kadoorie Biobank participants. Int J Behav Nutr Phys Act 2023; 20:138. [PMID: 38001522 PMCID: PMC10668372 DOI: 10.1186/s12966-023-01537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Movement behaviours, including physical activity, sedentary behaviour, and sleep have been shown to be associated with several chronic diseases. However, they have not been objectively measured in large-scale prospective cohort studies in low-and middle-income countries. We aim to describe the patterns of device-measured movement behaviours collected in the China Kadoorie Biobank (CKB) study. METHODS During 2020 and 2021, a random subset of 25,087 surviving CKB individuals participated in the 3rd resurvey of the CKB. Among them, 22,511 (89.7%) agreed to wear an Axivity AX3 wrist-worn triaxial accelerometer for seven consecutive days to assess their habitual movement behaviours. We developed a machine-learning model to infer time spent in four movement behaviours [i.e. sleep, sedentary behaviour, light intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA)]. Descriptive analyses were performed for wear-time compliance and patterns of movement behaviours by different participant characteristics. RESULTS Data from 21,897 participants (aged 65.4 ± 9.1 years; 35.4% men) were received for demographic and wear-time analysis, with a median wear-time of 6.9 days (IQR: 6.1-7.0). Among them, 20,370 eligible participants were included in movement behavior analyses. On average, they had 31.1 mg/day (total acceleration) overall activity level, accumulated 7.7 h/day (32.3%) of sleep time, 8.8 h/day (36.6%) sedentary, 5.7 h/day (23.9%) in light physical activity, and 104.4 min/day (7.2%) in moderate-to-vigorous physical activity. There was an inverse relationship between age and overall acceleration with an observed decline of 5.4 mg/day (17.4%) per additional decade. Women showed a higher activity level than men (32.3 vs 28.8 mg/day) and there was a marked geographical disparity in the overall activity level and time allocation. CONCLUSIONS This is the first large-scale accelerometer data collected among Chinese adults, which provides rich and comprehensive information about device-measured movement behaviour patterns. This resource will enhance our knowledge about the potential relevance of different movement behaviours for chronic disease in Chinese adults.
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Affiliation(s)
- Yuanyuan Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Shing Chan
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Derrick Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Xiaofang Chen
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yalei Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Lang Pan
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Pei Pei
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Huaidong Du
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK.
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
| | - Aiden Doherty
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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Liao B, Li X. Neighborhood Environment and Affective Walking Experience: Cluster Analysis Results of a Virtual-Environment-Based Conjoint Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1396. [PMID: 36674155 PMCID: PMC9859286 DOI: 10.3390/ijerph20021396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
There is empirical evidence that neighborhood environment characteristics influence individuals' self-reported affective walking experiences. However, much of the research investigates residents' affective walking experiences at the neighborhood level using revealed-preference methodologies, making it difficult to identify the separate impacts of characteristics. In addition, empirical studies have not shown enough evidence that individuals from different sociodemographic backgrounds have distinct affective walking experiences. Therefore, the objective of this paper is to explain how different groups of people perceive the characteristics of a neighborhood differently. To do this, this study conducts a conjoint experiment employing videos of virtual environments involving a sample of 295 respondents. Using a latent-class regression model and a multinomial logit model, we are able to determine how individuals and groups perceive neighborhood characteristics differently based on their different emotions. The results somewhat confirmed the findings of the empirical research, indicating that land use mix, connectivity, road size, open space, and greenery are related to a positive walking experience. The level of affective walking experience that individuals associate with neighborhood environmental characteristics is, however, considerably variable. Therefore, our results show that open space and road width are crucial for a walkable neighborhood since they are most helpful to individuals' subjective well-being.
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Affiliation(s)
- Bojing Liao
- Institute of Creativity and Innovation, Xiamen University, Xiamen 361005, China
| | - Xiang Li
- School of Architecture and Civil Engineering, Xiamen University, Xiamen 361005, China
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Shahunja KM, Sly PD, Huda MM, Mamun A. Trajectories of neighborhood environmental factors and their associations with asthma symptom trajectories among children in Australia: evidence from a national birth cohort study. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2022; 20:835-847. [PMID: 36406622 PMCID: PMC9672149 DOI: 10.1007/s40201-022-00824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aims to investigate the prospective associations of neighborhood environmental exposure trajectories with asthma symptom trajectories during childhood developmental stages. METHODS We considered asthma symptom, neighborhood environmental factors, and socio-demographic data from the "Longitudinal Study of Australian Children (LSAC)". Group-based trajectory modeling was applied to identify the trajectories of asthma symptom, neighborhood traffic conditions, and neighborhood livability scales (considered for safety and facilities). We used multivariable logistic regression models to assess associations between various neighborhood environmental factors and asthma symptom trajectories. RESULTS We included 4,174 children from the LSAC cohort in our study. Three distinct trajectories for asthma symptom were the outcome variables of this study. Among the neighborhood environmental factors, we identified two distinct trajectories for the prevalence of heavy traffic on street, and two trajectories of neighborhood liveability scale. Compared to the 'Low/no' asthma symptoms trajectory group, children exposed to a 'persistently high' prevalence of heavy traffic on street was also significantly associated with both 'transient high' [relative risk ratio (RRR):1.40, 95% CI:1.25,1.58) and 'persistent high' (RRR: 1.33, 95% CI:1.17,1.50)] asthma symptom trajectory groups. Trajectory of moderate and static neighborhood liveability score was at increased risk of being classified as 'transient high' (RRR:1.16, 95% CI:1.07,1.25) and 'persistent high' (RRR:1.38, 95% CI:1.27,1.50) trajectories of asthma symptom. CONCLUSION Exposure to heavy traffic and poor neighborhood liveability increased the risk of having an unfavourable asthma symptom trajectory in childhood. Reducing neighborhood traffic load and improving neighborhood safety and amenities may facilitate a favorable asthma symptom trajectory among these children. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40201-022-00824-z.
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Affiliation(s)
- K M Shahunja
- UQ Poche Centre for Indigenous Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
- The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - M Mamun Huda
- UQ Poche Centre for Indigenous Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Abdullah Mamun
- UQ Poche Centre for Indigenous Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
- The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
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Bae S, Pappadis MR, Nam S, Hong I. The Role of Physical Activity and Depression on Quality of Life in Community-Dwelling Older Adults: Using Propensity Score Matching Approaches. J Aging Phys Act 2022; 30:770-777. [PMID: 34879330 PMCID: PMC9631174 DOI: 10.1123/japa.2021-0268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022]
Abstract
This study examined the association between achieving the recommended physical activity level and quality of life after controlling for depression. Health information from adults aged 65 years and older, who had participated in the seventh 2018 Korea National Health and Nutrition Examination Survey, was used. Five covariate adjustment models were used to derive robust estimates of the association between physical activity practice levels, depression, and older adults' quality of life. A total of 1,336 older adults was extracted from the seventh 2018 Korea National Health and Nutrition Examination Survey, and 31% of the older adults achieved the recommended physical activity level, whereas 69% did not. We found that the achievement of physical activity practice levels is significantly associated with the quality of life of the older adults (β = 0.024-0.031, all p < .05). Our results could be used for advocating for welfare policy changes that promote physical activity to prepare for the upcoming super-aging society.
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Affiliation(s)
- Suyeong Bae
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju-si, Gangwon-do,Republic of Korea
| | - Monique R Pappadis
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX,USA
| | - Sanghun Nam
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju-si, Gangwon-do,Republic of Korea
| | - Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju-si, Gangwon-do,Republic of Korea
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The Subjective Well-Being of Elderly Migrants in Dongguan: The Role of Residential Environment. Trop Med Infect Dis 2022; 7:tropicalmed7080199. [PMID: 36006291 PMCID: PMC9413762 DOI: 10.3390/tropicalmed7080199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
To examine the association between community and individual-level residential environment in relation to subjective well-being (SWB) amongst 470 elderly migrants in China, this community-based survey was conducted. The manner and extent to which the SWB of these elderly migrants is influenced by their residential environment was the main area of focus. The Scale of Happiness of the Memorial University of Newfoundland was used to assess SWB. SWB was found to be associated significantly with environmental factors such as social cohesion, closeness to the nearest facility of recreation, the density of recreation facilities, financial facilities, and health facilities. The health facility density (B = 0.026, p < 0.001) and recreation facility density (B = 0.032, p < 0.001) had positive associations with SWB, while financial facility density (B = −0.035, p < 0.001) had a negative association. The primary determinants of SWB for elderly migrants ranged from individual to environmental factors. Through the enhancement of the accessibility to healthcare facilities in their new homes, in addition to promoting recreational activities and social services, the SWB amongst elderly migrants could be enhanced further.
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Wang S, Yung EHK, Cerin E, Yu Y, Yu P. Older People's Usage Pattern, Satisfaction with Community Facility and Well-Being in Urban Old Districts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10297. [PMID: 36011933 PMCID: PMC9408318 DOI: 10.3390/ijerph191610297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Community facilities are an important element that supports older people's daily life and promotes their well-being. However, there is a dearth of comprehensive studies on the effect of planning and design of different types of community facilities on older people's usage patterns and satisfaction. This study aims to provide a framework to explore the relationship among the planning of community facilities, older people's usage and satisfaction level and well-being for different types of community facilities. Both spatial analysis and questionnaire survey (n = 497) methods are employed in this study. This study finds that commercial (89.34%), municipal (83.10%) and leisure (88.13%) facilities are most commonly used by older people. This study suggests that older people's frequency of visiting community facilities is mainly affected by the purpose of visiting a community facility. Planning and design quality of the community facility are found to be significantly associated with older people's satisfaction level with using a community facility. In addition, older people's higher satisfaction level and usage level of community facilities could increase their physical and psychological well-being. The findings of this study not only contribute to the knowledge gap of older people's usage and satisfaction with using community facilities but also suggest that planners should aim toward a better distribution of community facilities to improve older adults' well-being.
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Affiliation(s)
- Siqiang Wang
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong, China
| | - Esther Hiu Kwan Yung
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Yifan Yu
- College of Architecture and Urban Planning, Tongji University, Shanghai 200092, China
| | - Peiheng Yu
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong, China
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Compernolle S, Cerin E, Barnett A, Zhang CJP, Van Cauwenberg J, Van Dyck D. The role of socio-demographic factors and physical functioning in the intra- and interpersonal variability of older adults' sedentary time: an observational two-country study. BMC Geriatr 2022; 22:495. [PMID: 35681115 PMCID: PMC9178546 DOI: 10.1186/s12877-022-03186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insight into the variability of older adults' sedentary time is needed to inform future interventions. The aim of this study was to examine the intra- and interpersonal variability in sedentary time, and the moderating role of socio-demographics, physical functioning and geographical location in this variability. METHODS Cross-sectional data from 818 community-dwelling older adults (mean age: 74.8 years; 61.1%women) of the Active Lifestyle and the Environment in Chinese Seniors and Belgian Environmental Physical Activity Study in Seniors were used. An interview questionnaire was administered to collect socio-demographic information. The Short Physical Performance Battery was performed to evaluate physical functioning, and Actigraph GT3X( +) accelerometers were used to estimate sedentary time. Linear mixed models with random intercepts at the neighborhood, person and day levels examined the variability in sedentary time, and the moderating role of socio-demographics, physical functioning and geographical location within this variability. RESULTS Most of the variance in accelerometry-assessed sedentary time was due to intrapersonal variability across periods of the day (72.4%) followed by interpersonal variability within neighborhoods (25.6%). Those who were older, men, lived in Hong Kong, and experienced a lower level of physical functioning were more sedentary than their counterparts. Sedentary time increased throughout the day, with highest levels of sedentary time observed between 6:00 and 9:00 pm. The patterns of sedentary time across times of the day differed by gender, educational attainment, age, physical functioning and/or geographical location. No significant differences were detected between week and weekend day sedentary time. CONCLUSIONS The oldest old, men, and those with functional limitations are important target groups for sedentary behavior interventions. As sedentary time was the highest in the evening future sedentary behavior intervention should pay particular attention to the evening hours. The variations in diurnal patterns of sedentary time between population subgroups suggest that personalized just-in-time adaptive interventions might be a promising strategy to reduce older adults' sedentary time.
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Affiliation(s)
- Sofie Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
- Research Foundation Flanders (FWO), Brussels, Belgium.
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Jelle Van Cauwenberg
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Han Y, Zhang L, Fang Y. Novel subgroups of functional ability in older adults and their associations with adverse outcomes. BMC Geriatr 2022; 22:390. [PMID: 35505297 PMCID: PMC9066860 DOI: 10.1186/s12877-022-03081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background There is no general agreement on a standard form of functional classification in older adults and is mainly assessed by Activities of Daily Living (ADL) and/or Instrument Activity of Daily Living. A refined classification based on evaluation the limitations of intrinsic capacity, environment and social interaction, could provide a basis to predict the future disability and identify individuals with increased risk of adverse outcomes. Methods A new functional classification among older adults aged 60 and over was conducted by latent class analysis and compared with the traditional classifications, based on the China Health and Retirement Longitudinal Study. To further investigate the scientific validity of this new classification, associations with 7-year mortality and ADLs impairments among categories were tested by using Survival curves and Cox proportional hazard models. This was followed by the confirmatory analysis related to the prospective data. Competing risk analysis was also performed to analysis the sensitivity to further support our conclusions. Results Five categories were identified among 5,992 older adults which gave the best fitting, yielding a significant Bootstrap Likelihood Ratio Test (p < 0.001) and Lo-Mendell-Rubin adjusted likelihood ratio test (p < 0.001), with an entropy over 0.80. The presence of five categories: “health” (34.0%), “sub-disorder status” (36.6%), “acute diseases” (10.3%), “somatic functional disorder” (7.7%), and “viability disorder” (11.4%), which matched well with the functional independence rates by the international classifications. Among them, those in “sub-disorder status” were considered as an intermediate status between disability and health. The findings also revealed that those who were in “acute disease”, “somatic functional disorders”, “health” and “sub-disorder status” had a significant lower risk of mortality and ADLs limitations than “viability disorder”. And the risks gradually increased towards the less functionally independent end of the classification. However, the distribution of characteristics among five categories were in a synchronous change, indicating a stable classification. Conclusions A new classification representing the functional heterogeneity of older adults could effectively stratify the risk of mortality and ADLs limitations. Identifying the clusters of functional decline might be useful in predicting subsequent ageing trends, designing personalized intervention, and delaying the progression of disability and preventing its occurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03081-9.
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Affiliation(s)
- Ying Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361102, PR China
| | - Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361102, PR China.,School of Economics, Xiamen University, 422 Siming South Road, Xiamen, Fujian, 361005, PR China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, 361102, PR China.
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da Silva Dantas BA, Cavalcante ACV, de Miranda JMA, da Silva Toscano GA, Nobre TTX, Mendes FRP, de Miranda FAN, Maia EMC, Torres GDV. Depression and quality of life in Brazilian and Portuguese older people communities: Analysis of association. Medicine (Baltimore) 2021; 100:e27830. [PMID: 34797312 PMCID: PMC8601332 DOI: 10.1097/md.0000000000027830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
We aimed to compare the association of depression with aspects of quality of life (QoL) among older people users of primary health care (PHC) living in Brazil and Portugal.We carried out an observational, cross-sectional and comparative study with a quantitative approach in the PHC scope in Brazil and Portugal, where we obtained a nonrandom sample of 150 participants aged 65 years or older (100 Brazilians and 50 Portuguese). We used the socioeconomic and health data questionnaire, the Medical Outcomes Short-Form Health Survey QoL (SF-36) questionnaire and the Beck Inventory.Among the socioeconomic profiles, most were females aged between 65 and 80 years in both countries. There was a significant difference between groups in the income variable, with 100.0% of Portuguese people earning up to 1 minimum wage (P value <.001), and the presence of chronic diseases in 92.0% of respondents in Portugal (P value = .033). In the association analysis, most aspects of QoL had a higher median score (>50.0) within the categorical variables of "absent" and "mild" depression. The Emotional role functioning, Physical role functioning, Physical functioning, Mental health, Total score domains and the Mental health and Physical health summary measures stood out with this behavior in Brazil and in Portugal, where these latter 2 presented moderate to strong correlation values (ρ > 0.400) in Portugal. Greater associations of depression on QoL were revealed in Portugal than in Brazil. Among their most expressive associations, the Physical role functioning (odds ratio [OR] = 4.776; 95.0% confidence interval [CI]: 2.41-9.43), Physical functioning (OR = 3.037; 95.0% CI: 3.037), Vitality (OR = 6.000; 95.0% CI: 1.56-23.07) and Total score (OR = 3.727; 95.0% CI: 2.24-6.17) domains and the Mental health summary measure (OR = 3.870; 95.0% CI: 2.13-7.02) stood out.Aspects related to the emotional, physical, functional and mental health components stood out. The association and correlation with depression were more expressive in Portugal compared to Brazil. However, similar results were obtained in Brazil but with less relevance.
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Affiliation(s)
| | | | | | | | | | | | | | - Eulália Maria Chaves Maia
- Department of Psychology, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Gilson de Vasconcelos Torres
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal-RN, Brazil
- Department of Nursing, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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12
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Abstract
OBJECTIVES Young adults' physical activity (PA) is a foundation of creating future healthy lifestyles. The purpose of this study was to explore differences in PA, sedentary behaviour, walkability and health beliefs among young adults with different levels of cardiometabolic risks and the influence of moderate-to-vigorous PA. DESIGN A cross-sectional study was conducted using a structured questionnaire. PARTICIPANTS Totally, 1149 valid responses were received for a response rate of 86.32%. According to the self-reported worst health condition, participants were categorised into healthy adults, and adults at levels 1 (overweight), 2 (obese), 3 (hypertensive, hyperlipidaemic, and/or hyperglycaemic), and 4 (with a diagnosis of cardiometabolic diseases) of cardiometabolic risks. PRIMARY OUTCOME MEASURES PA, sedentary time, walkability and health beliefs. RESULTS Significant differences in PA (F=3.78, p<0.01) and sedentary time (F=2.39, p<0.05) among groups with various cardiometabolic risk levels were found. Healthy adults and adults at level 1 risk had significantly higher PA than adults at risk levels 2 and 3. Young adults at risk level 3 were less likely to participate in moderate-to-vigorous PA than were healthy adults (OR=0.64 (95% CI 0.41 to 0.99), p<0.05). Individuals who perceived that there were more recreational facilities (OR=1.27 (1.05 to 1.53), p<0.05), who had higher benefits of exercise (OR=1.73 (1.30 to 2.31), p<0.001), and who had lower barriers to exercise (OR=0.42 (0.32 to 0.55), p<0.001) were more likely to participate in moderate-to-vigorous PA. CONCLUSIONS Being aware of body weight changes could be a danger sign of a lack of PA. Developing environmental and psychological strategies to promote engaging in PA is necessary to promote the cardiometabolic health of young adults.
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Affiliation(s)
- Hsin-Yen Yen
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Ching Li
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei, Taiwan
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13
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Zhang R, Zhang CQ, Lai PC, Cheng W, Schüz B, Kwan MP. Park environment and moderate-to-vigorous physical activity in parks among adolescents in a high-density city: the moderating role of neighbourhood income. Int J Health Geogr 2021; 20:35. [PMID: 34399765 PMCID: PMC8365917 DOI: 10.1186/s12942-021-00289-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Urban parks are critical environmental resources in which adolescents engage in physical activity (PA). Evidence on the associations between park environmental characteristics and park-based PA in adolescents is mixed, particularly for high-density cities. Evidence is also lacking concerning the moderating role of neighbourhood socioeconomic status on the park-PA relationships. The current study aimed to examine the associations between park environmental characteristics and moderate-to-vigorous physical activity (MVPA) in parks among adolescents in Hong Kong and the moderating effect of neighbourhood income on these associations. Methods A cross-sectional study involving direct observations of adolescents was conducted in 32 randomly selected urban parks in Hong Kong. Park environmental characteristics were measured using the Community Park Audit Tool. Park-based MVPA among adolescents was measured using the System for Observation Play and Recreation in Communities. Neighbourhood income was extracted from the 2011 Hong Kong Population Census data on median household income. Results There was a significant positive association between the quality of amenities and park-based MVPA (metabolic equivalents per observation) in adolescents. However, the associations between the diversity of active facilities, greenness and adolescents’ park-based MVPA were not significant. Neighbourhood income moderated the association between adolescents’ park-based MVPA and park safety, where the relationship between park safety and park-based MVPA was significantly positive in low-income neighbourhoods but not significant in high-income neighbourhoods. An income-by-environment interaction was also observed concerning park aesthetics, with a negative relationship between park aesthetics and park-based MVPA in high-income neighbourhoods but not in low-income neighbourhoods. Conclusion Our findings provide evidence regarding how park environment and neighbourhood income impact adolescents’ park-based MVPA in Hong Kong. These findings can inform urban planning and policymakers who seek to improve urban park development in high-density cities. Supplementary Information The online version contains supplementary material available at 10.1186/s12942-021-00289-7.
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Affiliation(s)
- Ru Zhang
- School of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Chun-Qing Zhang
- Department of Psychology, Sun Yat-Sen University, No. 132 Waihuan East Road, Guangzhou Higher Education Mega Center, Guangzhou, China.
| | - Poh Chin Lai
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Wei Cheng
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Benjamin Schüz
- Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong, China.,Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
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14
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Huang NC, Kung SF, Hu SC. Exploring the role of built environments and depressive symptoms in community-dwelling older adults: A case of Taiwan. Aging Ment Health 2021; 25:1049-1059. [PMID: 32336120 DOI: 10.1080/13607863.2020.1755826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Depression in older adults is a growing public health concern. However, limited research has focused on the issues of physical environments and depression in the elderly in Asia. The purpose of the study is to examine the relationship between the built environments and depressive symptoms in older adults using Taiwan as an example. METHODS Two national datasets were used in this study, including the 2009 National Health Interview Survey and the 2006 National Land Use Investigation in Taiwan. A total of 2,155 older adults were recruited, and eight built environments were examined among 161 townships. Depressive symptoms were measured using a 10-item CES-D scale, and four sophisticated models were built using a multi-level analysis. RESULTS Five types of built environments were found to be significantly associated with depressive symptoms in older adults. Among them, two types of built environments, 'health and medical services' and 'schools' were highly related to a lower CES-D score and lower odds of being depressed, whereas the other three built environments, 'cultural and historical facilities,' 'recreational and amusement areas,' and 'playgrounds and sports venues' were significantly associated with an increasing risk of being depressed. CONCLUSIONS Different built environments had different effects on depression and some even showed a dose-response relationship. These results can help urban planners or city designers reconsider how to facilitate the construction of built environments in neighborhoods that will improve the mental health of older adults.
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Affiliation(s)
- Nuan-Ching Huang
- Healthy Cities Research Center, Research and Services Headquarter, National Cheng Kung University, Tainan City, Taiwan.,Department of Urban Planning, College of Planning & Design, National Cheng Kung University, Tainan City, Taiwan
| | - Shiann-Far Kung
- Healthy Cities Research Center, Research and Services Headquarter, National Cheng Kung University, Tainan City, Taiwan.,Department of Urban Planning, College of Planning & Design, National Cheng Kung University, Tainan City, Taiwan
| | - Susan C Hu
- Healthy Cities Research Center, Research and Services Headquarter, National Cheng Kung University, Tainan City, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Cerin E, Yin S, Choi WK, Ngan W, Tham R, Barnett A. Development of Measures of Perceived Neighborhood Environmental Attributes Influencing, and Perceived Barriers to Engagement in, Healthy Behaviors for Older Chinese Immigrants to Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094531. [PMID: 33923306 PMCID: PMC8123107 DOI: 10.3390/ijerph18094531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants to Australia and similar Western countries. Older Chinese immigrants living in Melbourne (Australia) were recruited from neighborhoods varying in walkability and percentage of Chinese residents. Versions of the Neighborhood Environment for Healthy Aging–Chinese Immigrants to Australia (NEHA-CIA) questionnaire (20 subscales) and the Perceived Barriers to Health-Enhancing Behaviors questionnaire (four subscales) were developed from extant validated scales and information collected in formative qualitative research. Thirty-one participants took part in cognitive interviews aimed to pilot-test and refine the questionnaires. The modified questionnaires were administered to 52 participants twice, two weeks apart. Test-retest reliability (intraclass correlation coefficients), internal consistency (Cronbach’s α), and construct validity (associations with theoretically-relevant constructs) were examined. Most items and subscales of both questionnaires had good test-retest reliability and internal consistency, while the NEHA-CIA also showed good construct validity. Future studies need to further examine the construct validity of the questionnaire of perceived barriers and determine the factorial validity of both measures on large representative samples.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (W.K.C.); (R.T.); (A.B.)
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong, China
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-3-9230-8260
| | - Shiyuan Yin
- School of Exercise and Nutrition Science, Deakin University, Burwood, VIC 3125, Australia; (S.Y.); (W.N.)
| | - Wing Ka Choi
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (W.K.C.); (R.T.); (A.B.)
| | - Winsfred Ngan
- School of Exercise and Nutrition Science, Deakin University, Burwood, VIC 3125, Australia; (S.Y.); (W.N.)
| | - Rachel Tham
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (W.K.C.); (R.T.); (A.B.)
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (W.K.C.); (R.T.); (A.B.)
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16
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Sun G, Du Y, Ni MY, Zhao J, Webster C. Metro and elderly health in Hong Kong: protocol for a natural experiment study in a high-density city. BMJ Open 2021; 11:e043983. [PMID: 33737434 PMCID: PMC7978095 DOI: 10.1136/bmjopen-2020-043983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/03/2021] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Public transport accessible to older people may offer a transformative solution to achieving healthy ageing. However, the evidence to support such transport infrastructure modifications is unclear. Previous studies on public transport use and elderly health were mostly observational studies using cross-sectional data. Few studies have examined the before-and-after effects of a new metro, for example, to see if it leads to improved elderly health. METHODS AND ANALYSIS We use a new metro line in Hong Kong as a natural experiment to examine the impact of the metro-led public transport intervention on elderly health. In Hong Kong, more than 90% of daily travels are made by public transport. The public transport modifications consist of the new metro line with eight stations and changes in the walking environment and bus services around the stations. We will look at the before-and-after differences in public transport use and health outcomes between elderly participants living in treatment neighbourhoods (400 m walking buffered areas of the new metro stations) and in control groups (living in comparable areas but unaffected by the new metro). Questionnaire-based baseline data were collected in 2019 before the COVID-19 pandemic, while some qualitative interviews are ongoing. Amid the pandemic, we conducted a quick telephone-based survey of COVID-19's potential impact on public transport use behaviours of our elderly cohort in September 2020. Note there is no lockdown in Hong Kong until the writing of the paper (January 2021). After the new metro opens, we will conduct a follow-up survey, tentatively in late 2022. We aim to investigate if the new metro and the associated changes in the built environment have any effects on public transport use behaviours, physical activity and wider health outcomes among the elderly (eg, social inclusion, quality of life, subjective well-being). ETHICS AND DISSEMINATION The Human Research Ethics Committee of the University of Hong Kong reviewed and approved the study procedures and materials (reference number: EA1710040). Results will be communicated through scientific papers and research reports.
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Affiliation(s)
- Guibo Sun
- Healthy High Density Cities Lab, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Yao Du
- Healthy High Density Cities Lab, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Michael Y Ni
- Healthy High Density Cities Lab, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Jianting Zhao
- Healthy High Density Cities Lab, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Chris Webster
- Healthy High Density Cities Lab, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
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17
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Li Z, Ge J, Feng J, Jiang R, Zhou Q, Xu X, Pan Y, Liu S, Gui B, Wang Z, Zhu B, Hu Y, Yang J, Wang R, Su D, Hashimoto K, Yang M, Yang C, Liu C. Less Social Support for Patients With COVID-19: Comparison With the Experience of Nurses. Front Psychiatry 2021; 12:554435. [PMID: 33633601 PMCID: PMC7901979 DOI: 10.3389/fpsyt.2021.554435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/07/2021] [Indexed: 12/14/2022] Open
Abstract
Context: Since December 2019, more than 80,000 patients have been diagnosed with coronavirus disease 2019 (COVID-19) in China. Social support status of COVID-19 patients, especially the impact of social support on their psychological status and quality of life, needs to be addressed with increasing concern. Objectives: In this study, we used social support rating scale (SSRS) to investigate the social support in COVID-19 patients and nurses. Methods: The present study included 186 COVID-19 patients at a Wuhan mobile cabin hospital and 234 nurses at a Wuhan COVID-19 control center. Responses to a mobile phone app-based questionnaire about social support, anxiety, depression, and quality of life were recorded and evaluated. Results: COVID-19 patients scored significantly lower than nurses did on the Social Support Rating Scale (SSRS). Among these patients, 33.9% had anxiety symptoms, while 23.7% had depression symptoms. Overall SSRS, subjective social support scores and objective support scores of patients with anxiety were lower than those of patients without anxiety. This result was also found in depression. In addition, all dimensions of social support were positively correlated with quality of life. Interestingly, in all dimensions of social support, subjective support was found to be an independent predictive factor for anxiety, depression, and quality of life, whereas objective support was a predictive factor for quality of life, but not for anxiety and depression via regression analysis. Conclusion: Medical staffs should pay attention to the subjective feelings of patients and make COVID-19 patients feel respected, supported, and understood from the perspective of subjective support, which may greatly benefit patients, alleviate their anxiety and depression, and improve their quality of life.
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Affiliation(s)
- Zhenyu Li
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jingwu Ge
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianping Feng
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Riyue Jiang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qin Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaolin Xu
- Department of Anesthesiology, Tongji Medical College, Tongji Hospital, Wuhan, China
| | - Yinbing Pan
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shijiang Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongyun Wang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Suzhou, China
| | - Yimin Hu
- Department of Anesthesiology, The Second Affiliated Changzhou People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jianjun Yang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rong Wang
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongan Su
- Department of Rehabilitation and Pain Medicine, 904th Hospital of The Joint Logistics Support Force, People's Liberation Army, Changzhou, China
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Meiling Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cunming Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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18
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Van Dyck D, Barnett A, Van Cauwenberg J, Zhang CJP, Sit CHP, Cerin E. Main and interacting effects of physical activity and sedentary time on older adults' BMI: The moderating roles of socio-demographic and environmental attributes. PLoS One 2020; 15:e0235833. [PMID: 32645072 PMCID: PMC7347204 DOI: 10.1371/journal.pone.0235833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Our first aim was to examine the main and interacting effects of accelerometer-based sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) with BMI and the likelihood of being overweight/obese in Hong Kong and Ghent (Belgium) older adults. Second, we examined whether these main associations and interactions between MVPA and ST were moderated by socio-demographics (gender, education) and objective neighbourhood attributes supposed to be associated with healthy food intake (food outlet density, neighbourhood-level SES). Finally, we determined whether the associations and interactions were generalisable across study sites. Methods Data from the ALECS (Hong Kong) and BEPAS Seniors studies (Ghent), two comparable observational studies, were used. Older adults (n = 829, 65+) provided self-reported socio-demographic information and objective MVPA and ST data using Actigraph accelerometers. Annual household income data and GIS software were used to assess neighbourhood-level SES and food outlet density. Generalised additive mixed models were conducted in R. Results ST was linearly and positively related to both weight outcomes in the overall sample, while MVPA was not. The overall-sample analyses including the two-way interaction between MVPA and ST showed no interactions between these behaviours on weight outcomes. Three site-specific findings were identified, showing distinct associations in Hong Kong compared to Ghent. Study site moderated the interaction between ST and MVPA on both weight outcomes, the interaction between education and ST on both weight outcomes and the interaction between the number of food outlets and ST on being overweight/obese. Conclusions The country-specific effects confirm the cultural dependency and complexity of the associations between PA, ST and weight outcomes. Future longitudinal international studies including older adults from multiple regions assessing PA, ST, weight outcomes and dietary intake should be encouraged. Such studies are needed to refine the recommendations regarding ST and PA in older adults in light of preventing overweight and obesity.
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Affiliation(s)
- Delfien Van Dyck
- Faculty of Medicine and Health Sciences, Department of Movement and Sports Science, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
- * E-mail:
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Jelle Van Cauwenberg
- Research Foundation Flanders, Brussels, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Cindy H. P. Sit
- Faculty of Education, Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, China
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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19
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Cerin E, Van Dyck D, Zhang CJP, Van Cauwenberg J, Lai PC, Barnett A. Urban environments and objectively-assessed physical activity and sedentary time in older Belgian and Chinese community dwellers: potential pathways of influence and the moderating role of physical function. Int J Behav Nutr Phys Act 2020; 17:73. [PMID: 32517790 PMCID: PMC7285720 DOI: 10.1186/s12966-020-00979-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/04/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Many studies have examined neighbourhood environmental correlates of older adults' physical activity (PA) but only a few focused on sedentary time (ST). Only a small proportion of these studies used objective measures of PA/ST, such as accelerometer-assessed PA/ST, and only a couple employed accelerometer cut-points appropriate for older adults. Furthermore, although older adults experience declines in physical function as they age, there is a dearth of information on the impact of the neighbourhood environment on PA/ST in individuals with different levels of physical function. METHODS We used data from two extant cross-sectional studies conducted in Hong Kong (China) and Ghent (Belgium) (N = 829). Participants were recruited from pre-selected administrative units stratified by socio-economic status and walkability. Moderate-to-vigorous PA (MVPA) and ST were assessed for 7 days using accelerometers and cut-points developed for older adults. Objective neighbourhood environmental attributes within 400 m and 1 km buffers surrounding participants' homes were quantified using Geographic Information Systems data. Lower extremity physical function was objectively assessed. Socio-demographic information was collected via interviews. Total, direct and indirect (mediated) effects of environmental attributes on MVPA and ST were estimated using generalised additive mixed models and the joint-significant test. RESULTS Commercial/civic destination density and number of parks within 1 km from home showed positive total and direct effects on MVPA, and public transport density showed negative total and direct effects on ST, which were consistent across cities and physical function levels. The total and direct effects of residential density on MVPA depended on physical function, and those of residential density on ST differed by city. A complex network of potential inconsistent pathways linking all environmental attributes to MVPA and ST in the whole sample or in subgroups of participants was revealed. DISCUSSION Access to parks and commercial/civic destinations appear to support older adults' MVPA in different geographical and cultural contexts and irrespective of their physical function level. By supporting MVPA, these characteristics also contribute to a reduction in ST. The potential effects of public transport, recreational facilities and residential density are less straightforward and point at inconsistent effects that may depend on the geographical context and level of physical function.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. .,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China. .,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jelle Van Cauwenberg
- Research Foundation Flanders (FWO), Brussels, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Poh-Chin Lai
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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20
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Cerin E, Barnett A, Zhang CJP, Lai PC, Sit CHP, Lee RSY. How urban densification shapes walking behaviours in older community dwellers: a cross-sectional analysis of potential pathways of influence. Int J Health Geogr 2020; 19:14. [PMID: 32299439 PMCID: PMC7164360 DOI: 10.1186/s12942-020-00210-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Population growth, population ageing, and urbanisation are major global demographic trends that call for an examination of the impact of urban densification on older adults' health-enhancing behaviours, such as walking. No studies have examined the pathways through which urban densification may affect older adults' walking. This information is key to evidence-based, health-oriented urban and transport planning. This study aimed to identify neighbourhood environment characteristics potentially responsible for the effects of neighbourhood densification on older adults' frequency and amount of transportation and recreation walking within and outside the neighbourhood. METHODS The Active Lifestyle and the Environment in Chinese Seniors (ALECS) project collected self-reported data from 909 older adults (≥ 65 years) living in 128 physically and socially diverse neighbourhoods in Hong Kong (71% response rate). Walking was measured using the Neighbourhood Walking Questionnaire for Chinese Seniors. Objective residential density and other neighbourhood environmental attributes were assessed using Geographic Information Systems. Generalised additive mixed models examined the total effects of neighbourhood residential density on walking and the mediating role of other environmental attributes and car ownership. RESULTS A complex network of potential pathways of positive and negative influences of neighbourhood residential density on different aspects of walking was revealed. While residential density was positively related to within-neighbourhood transportation and outside-neighbourhood recreation walking only, it exhibited positive and/or negative nonlinear indirect effects on all examined aspects of walking via recreation, public transport, food/retail and street intersection densities, and/or car ownership. CONCLUSIONS High-density environments appear to support within-neighbourhood walking by providing access to food and retail outlets via well-connected street networks and discouraging car ownership. However, extreme density may lead to reductions in walking. Public transport density accompanying high-density areas may facilitate outside-neighbourhood walking but deter within-neighbourhood walking. The development of activity-friendly communities for ageing populations need to consider these opposing influences.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Poh-Chin Lai
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong SAR, Hong Kong, Hong Kong SAR, China
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Cerin E, Barnett A, Chaix B, Nieuwenhuijsen MJ, Caeyenberghs K, Jalaludin B, Sugiyama T, Sallis JF, Lautenschlager NT, Ni MY, Poudel G, Donaire-Gonzalez D, Tham R, Wheeler AJ, Knibbs L, Tian L, Chan YK, Dunstan DW, Carver A, Anstey KJ. International Mind, Activities and Urban Places (iMAP) study: methods of a cohort study on environmental and lifestyle influences on brain and cognitive health. BMJ Open 2020; 10:e036607. [PMID: 32193278 PMCID: PMC7202706 DOI: 10.1136/bmjopen-2019-036607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Numerous studies have found associations between characteristics of urban environments and risk factors for dementia and cognitive decline, such as physical inactivity and obesity. However, the contribution of urban environments to brain and cognitive health has been seldom examined directly. This cohort study investigates the extent to which and how a wide range of characteristics of urban environments influence brain and cognitive health via lifestyle behaviours in mid-aged and older adults in three cities across three continents. METHODS AND ANALYSIS Participants aged 50-79 years and living in preselected areas stratified by walkability, air pollution and socioeconomic status are being recruited in Melbourne (Australia), Barcelona (Spain) and Hong Kong (China) (n=1800 total; 600 per site). Two assessments taken 24 months apart will capture changes in brain and cognitive health. Cognitive function is gauged with a battery of eight standardised tests. Brain health is assessed using MRI scans in a subset of participants. Information on participants' visited locations is collected via an interactive web-based mapping application and smartphone geolocation data. Environmental characteristics of visited locations, including the built and natural environments and their by-products (e.g., air pollution), are assessed using geographical information systems, online environmental audits and self-reports. Data on travel and lifestyle behaviours (e.g., physical and social activities) and participants' characteristics (e.g., sociodemographics) are collected using objective and/or self-report measures. ETHICS AND DISSEMINATION The study has been approved by the Human Research Ethics Committee of the Australian Catholic University, the Institutional Review Board of the University of Hong Kong and the Parc de Salut Mar Clinical Research Ethics Committee of the Government of Catalonia. Results will be communicated through standard scientific channels. Methods will be made freely available via a study-dedicated website. TRIAL REGISTRATION NUMBER ACTRN12619000817145.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Barnett
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
| | - Basile Chaix
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, Île-de-France, France
| | | | - Karen Caeyenberghs
- Cognitive Neurosciences Unit, Deakin University, Burwood, Victoria, Australia
| | - Bin Jalaludin
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Takemi Sugiyama
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - James F Sallis
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | | | - Michael Y Ni
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Govinda Poudel
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
| | - David Donaire-Gonzalez
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
| | - Rachel Tham
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
| | - Amanda J Wheeler
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
| | - Luke Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Linwei Tian
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yih-Kai Chan
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alison Carver
- Mary MacKillop Inst Health Res, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute and School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
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Dantas BADS, de Miranda JMA, Cavalcante ACV, Toscano GADS, Torres LSS, Rossignolo SCDO, Nobre TTX, Maia EMC, de Miranda FAN, Torres GDV. Impact of multidimensional interventions on quality of life and depression among older adults in a primary care setting in Brazil: a quasi-experimental study. ACTA ACUST UNITED AC 2019; 42:201-208. [PMID: 31826082 PMCID: PMC7115439 DOI: 10.1590/1516-4446-2019-0577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/26/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the impact of multidimensional interventions on quality of life (QoL) and depressive symptoms in Brazilian older adults living in the community. METHODS Longitudinal, quasi-experimental study of older adults receiving conventional primary health care (PHC). The interventions were designed in response to a first round of data collection and validated through pilot testing in groups of older adults from another community. The validated interventions were then applied to an intervention group (IG). To measure their effect, we used the Medical Outcomes Short-Form Health Survey (SF-36) quality of life scale and the Geriatric Depression Scale (GDS-30). RESULTS The sample comprised 118 participants. IG participants exhibited significant improvement in several QoL domains (SF-36): mental health (p = 0.010), general health perceptions (p = 0.016), and physical functioning (p = 0.045). No such improvement occurred in controls (p > 0.050). The prevalence of depression (GDS-30) fell from 36.7 to 23.3% in the IG, despite no significant difference (p = 0.272). Controls also reported a reduction in depressive symptoms, but only from 44.8 to 41.4% (p = 0.112). CONCLUSIONS This multidimensional intervention was associated with significant improvement in mental health, general health perceptions, and physical functioning in a sample of Brazilian older adults. CLINICAL TRIAL REGISTRATION RBR-92dbtx.
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Affiliation(s)
- Bruno A da S Dantas
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Jessica M A de Miranda
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Anna C V Cavalcante
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Gislani A da S Toscano
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | | | | | - Thaiza T X Nobre
- Faculdade de Ciências da Saúde do Trairi, UFRN, Santa Cruz, RN, Brazil
| | - Eulália M C Maia
- Departamento de Psicologia, Centro de Ciências da Saúde, UFRN, Natal, RN, Brazil
| | | | - Gilson de V Torres
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
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Guo Y, Chang SS, Chan CH, Chang Q, Hsu CY, Yip PSF. Association of neighbourhood social and physical attributes with depression in older adults in Hong Kong: a multilevel analysis. J Epidemiol Community Health 2019; 74:120-129. [DOI: 10.1136/jech-2019-212977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 11/04/2022]
Abstract
BackgroundPrevious studies investigating the independent effects of neighbourhood-level factors on depression are rare within the Asian context, especially in the elderly population.MethodsData for 29 099 older adults aged 65 years or above who have received health examinations at elderly health centres in Hong Kong in 2008–2011 were analysed. Using multilevel regression modelling, the cross-sectional associations of neighbourhood social attributes (neighbourhood poverty, ethnic minority, residential stability and elderly concentration) and physical (built) attributes (recreational services and walkability) with depression outcomes (depressive symptoms and depression) after adjusting for individual-level characteristics were investigated. Gender interaction effects were also examined.ResultsNeighbourhood poverty was associated with both depressive symptoms and depression in the elderly. Neighbourhood elderly concentration, recreational services and walkability were associated with fewer depressive symptoms. The association between neighbourhood poverty and elderly depressive symptoms was found in women only and not in men.ConclusionPolicies aimed at reducing neighbourhood poverty, increasing access to recreational services and enhancing walkability might be effective strategies to prevent depression in older adults in the urban settings.
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Hossain S, Anjum A, Uddin ME, Rahman MA, Hossain MF. Impacts of socio-cultural environment and lifestyle factors on the psychological health of university students in Bangladesh: A longitudinal study. J Affect Disord 2019; 256:393-403. [PMID: 31226611 DOI: 10.1016/j.jad.2019.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/06/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The psychological health of university students is an issue of utmost concern worldwide. Its consequences include multifaceted outcomes from complex interactions of sociocultural, environmental, and individual lifestyle factors. This research explores the impacts of socio-cultural environment and lifestyle factors on the psychological health of university students in Dhaka, Bangladesh. METHODS A 15-month follow-up was carried out among 1140 university students from April 2016 to November 2017. Data were collected by using a pre-developed questionnaire, consisting of socio-demographic information, comprehensive lifestyle information, and psychological health information including a nine-item scale, the Patient Health Questionnaire-9 (PHQ-9) for assessing the level of depression, and a 7-item scale, the Generalized Anxiety Disorder-7 (GAD-7) for assessing the level of anxiety. The collected data were analyzed by using the Statistical Package for Social Sciences (SPSS) software, version 22. RESULTS With time, there was a 22.5% increase in the prevalence of provisional depression and a 27.1% increase in the prevalence of anxiety. In terms of demographic factors, findings revealed that students dissatisfied with university culture were significantly more likely to experience depression (B = 5.13, p<0.01, β=0.33) and anxiety (B = 4.69, p<0.01, β=0.34). 'Being female', 'being students of social sciences faculty', 'dissatisfaction with current education, financial condition and future career' were found to be significant predictors of students' psychological disorders. In terms of lifestyle factors, participants with high and excessive recreational screen time were significantly more vulnerable to depression (B = 1.25, p<0.01, β=0.097 and B = 1.75, p<0.01, β=0.12) and anxiety (B = 0.86, p = 0.02, β=0.08 and B = 1.22, p<0.01, β=0.096). Additionally, 'weekly physical inactivity', 'dissatisfaction with daily sleep', 'short and long sleep duration', 'low and high daily meal intake frequency' and 'alcohol consumption' were inextricably linked with students' depression and anxiety. CONCLUSION The prevalence of provisional as well as major depressive and anxiety disorders among university students in Bangladesh is significantly high and augmented in nature. This study provides significant information about the adverse impacts of university socio-cultural environment and students' lifestyle factors on their psychological health conditions.
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Affiliation(s)
- Sahadat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh; Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68, Shahid Tajuddin Sarani, Mohakhali, Dhaka 1212, Bangladesh.
| | - Afifa Anjum
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Md Elias Uddin
- Department of English, University of Dhaka, Dhaka 1000, Bangladesh
| | - Md Abdur Rahman
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Md Forhad Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
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Gan DRY, Fung JC, Cho IS. Neighborhood Experiences of People Over Age 50: Factor Structure and Validity of a Scale. THE GERONTOLOGIST 2019; 60:559-571. [DOI: 10.1093/geront/gnz111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background and Objectives
Various aspects of the neighborhood environment have been shown to correlate with older adults’ health. Socio-ecological models of health posit that interventions in the living environment can influence population health. Yet, there are no scales to comprehensively measure older people’s experiences of their neighborhoods especially in dense urban contexts. This study analyzes the psychometric properties and factor structure of a holistic measure of Older People’s Neighborhood Experience (OpenX) to understand constituent factors of residential satisfaction and well-being in dense urban contexts.
Research Design and Methods
Participants were 1,011 community-dwelling older adults aged 50 and older in Singapore. Face-to-face interviews were conducted. Questions were drawn to measure physical and social aspects of the neighborhood as well as sociodemographic variables. Exploratory and confirmatory factor analyses were conducted to obtain a shorter version; content validity, internal consistency, and external validity were assessed.
Results
The OpenX has a 4-dimensional structure, explaining 45.5% of the variance of neighborhood experience. They are communal affordance, embeddedness, environment pleasantness, and time outdoors. Good reliability and validity were found, including Cronbach’s alpha of 0.827. The correlation between neighborhood experience and objectively measured proximity to parks and fitness corners approached significance (p = .082).
Discussion and Implications
The 16-item OpenX demonstrated good psychometric properties. With reference to the transdisciplinary neighborhood health framework, it is useful for assessing older adults’ neighborhood environment, identifying neighborhoods for pilot population health interventions, and understanding how the neighborhood environment affects older adults’ health.
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Affiliation(s)
- Daniel Rong Yao Gan
- Centre for Ageing Research in the Environment, School of Design and Environment, and, National University of Singapore, Singapore
- Department of Architecture, National University of Singapore, Singapore
| | - John Chye Fung
- Centre for Ageing Research in the Environment, School of Design and Environment, and, National University of Singapore, Singapore
- Department of Architecture, National University of Singapore, Singapore
| | - Im Sik Cho
- Centre for Ageing Research in the Environment, School of Design and Environment, and, National University of Singapore, Singapore
- Department of Architecture, National University of Singapore, Singapore
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Association of the built environments and health-related quality of life in community-dwelling older adults: a cross-sectional study. Qual Life Res 2019; 28:2393-2407. [PMID: 31073818 DOI: 10.1007/s11136-019-02199-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE The relationship between built environments and the quality of life (QoL) of the elderly has gained great attention in recent years. However, most QoL studies have been conducted in western countries; thus, limited research was found in Asia, in which the population density, urban forms, narrow roadways, and land use patterns are more compact and highly mixed in terms of use. Therefore, the purpose of this study was an interdisciplinary analysis of two national datasets, the National Land Use Investigation and the National Health Interview Survey, to explore the relationship between built environments and the health-related quality of life of older adults in Taiwan. METHODS Eight types of built environments at the township level were calculated, and 1222 nationally representative older adults aged 65 and older were recruited. The outcome variable was health-related QoL as measured using the EQ-5D, including utility score and the EQ-VAS. Statistical methods included descriptive analysis, bivariate analysis, and mixed-effects logistic regression analysis, which were conducted using SAS 9.4 software. RESULTS The results showed that a significant relationship exists between cultural and historical facilities and low EQ-VAS; none of the built environments were found to be related to the EQ-5D. Individual factors are the main determinants of the EQ-5D of older adults in Taiwan. Positive relationships were found if older adults were engaging in physical activities and social participation. CONCLUSIONS We suggest that building a supportive environment in which elderly people could consistently engage in physical activities and social participation is another potential approach that might contribute to active aging.
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Objectively-Measured Neighbourhood Attributes as Correlates and Moderators of Quality of Life in Older Adults with Different Living Arrangements: The ALECS Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050876. [PMID: 30857372 PMCID: PMC6427272 DOI: 10.3390/ijerph16050876] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 12/15/2022]
Abstract
With an ageing world population, preservation of older adults’ health and quality of life (QoL) is paramount. Due to lower levels of physical functionality, older adults are particularly susceptible to local environment influences, especially those living alone and lacking family support. Using generalised additive mixed models, we examined associations and confounder-adjusted associations between objectively-measured neighbourhood attributes and QoL domains in 909 Hong Kong Chinese elderly community dwellers. Most examined neighbourhood attributes were not associated with QoL in the whole sample. Neighbourhood residential and entertainment density was curvilinearly and/or linearly related to specific QoL domains. Number of parks was negatively associated with social QoL and having well-treed parks with higher levels of social QoL. Older adults living alone in neighbourhoods with poor access to destinations and few activities in parks showed lower environmental and/or social QoL than their counterparts. Neighbourhood built environment characteristics do not seem to impact Hong Kong older adults’ physical and psychological QoL. Medium-to-high density, well-ordered neighbourhoods with optimal mixes of well-treed public open spaces and services meeting their daily needs may significantly contribute to social and environmental QoL in this population and appear particularly important to those living alone.
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Zhu Y, Liu J, Qu B, Yi Z. Quality of life, loneliness and health-related characteristics among older people in Liaoning province, China: a cross-sectional study. BMJ Open 2018; 8:e021822. [PMID: 30429143 PMCID: PMC6252650 DOI: 10.1136/bmjopen-2018-021822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/09/2018] [Accepted: 10/02/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The aim of the study was to examine the relations among quality of life (QOL), loneliness and health-related characteristics in a sample of Chinese older people. DESIGN Cross-sectional study. SETTING Communities in Dandong city, Liaoning province, China. PARTICIPANTS Sample of 732 older people aged 60 and older who were living in Dandong, Liaoning province, China. METHODS A questionnaire was administered to the participants face-to-face. The questionnaire contained four sections: demographic characteristics, health-related characteristics, the EQ-5D Scale and the UCLA Loneliness Scale. The t-test, F-test and multivariable linear regression analyses were performed to individually test associations between the demographic data, health-related characteristics, loneliness and QOL. RESULTS Chronic diseases, loneliness, age and smoking status were negatively associated with QOL (p<0.05). Satisfaction with health services, income and physical activity were positively associated with QOL (p<0.05). CONCLUSIONS Loneliness, chronic diseases and health service satisfaction were important factors related to low QOL among older people in China. The findings indicate that reducing loneliness, managing chronic diseases and improving the health service may help to improve the QOL for older people.
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Affiliation(s)
- Yaxin Zhu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, People’s Republic of China
| | - Jie Liu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, People’s Republic of China
| | - Bo Qu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, People’s Republic of China
| | - Zhe Yi
- Department of Prothodontics, School of Stomatology, China Medical University, Shenyang, People’s Republic of China
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Ferreira LK, Meireles JFF, Ferreira MEC. Evaluation of lifestyle and quality of life in the elderly: a literature review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to analyze Brazilian and non-Brazilian scientific production that considers the relationship between the lifestyle and quality of life of the elderly. Method: an integrative review of literature was performed in the Scopus, PubMed, Virtual Health Library and PsycINFO databases. Four cross-searches were adopted: the English synonyms of the word "elderly" ("Aged", "Aging", "Old age" and "Elderly") with the terms "Quality of life" and "Lifestyle". Results: after the adoption of the inclusion and exclusion criteria, 21 articles were analyzed. Physical activity, diet, body composition, alcohol intake, smoking and social relations were the main components of lifestyle investigated. The studies show that these factors influence the perception of the quality of life of the elderly. In addition to these factors, sociodemographic characteristics, functional capacity, sleep quality and comorbidities are also factors that influence the quality of life of the elderly. Conclusion: interest in the relationship between the lifestyle and quality of life of the elderly has increased in recent years. It was observed that the lifestyle of the elderly has been investigated in several ways, however no qualitative studies were found using the search criteria adopted in this review. As future perspectives, it is hoped that tools for evaluating the lifestyle of the elderly will be developed and qualitative investigations will be carried out in order to obtain a deeper understanding of the specificities that exist in the relationship between the lifestyle and levels of quality of life in old age.
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Zhang CJP, Barnett A, Sit CHP, Lai PC, Johnston JM, Lee RSY, Cerin E. Cross-sectional associations of objectively assessed neighbourhood attributes with depressive symptoms in older adults of an ultra-dense urban environment: the Hong Kong ALECS study. BMJ Open 2018; 8:e020480. [PMID: 29581207 PMCID: PMC5875633 DOI: 10.1136/bmjopen-2017-020480] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES This study aimed to examine the associations between objectively assessed neighbourhood environmental attributes and depressive symptoms in Hong Kong Chinese older adults and the moderating effects of neighbourhood environmental attributes on the associations between living arrangements and depressive symptoms. DESIGN Cross-sectional observational study. SETTING Hong Kong. PARTICIPANTS 909 Hong Kong Chinese community dwellers aged 65+ years residing in preselected areas stratified by walkability and socioeconomic status. EXPOSURE AND OUTCOME MEASURES Attributes of participants' neighbourhood environment were objectively assessed using geographic information systems and environmental audits. Depressive symptoms were measured using the Geriatric Depression Scale. RESULTS Overall, pedestrian infrastructure (OR=1.025; P=0.008), connectivity (OR=1.039; P=0.002) and prevalence of public transport stops (OR=1.056; P=0.012) were positively associated with the odds of reporting depressive symptoms. Older adults living alone were at higher risk of reporting any depressive symptoms than those living with others (OR=1.497; P=0.039). This association was moderated by neighbourhood crowdedness, perceptible pollution, access to destinations and presence of people. Residing in neighbourhoods with lower levels of these attributes was associated with increased deleterious effects of living alone. Living in neighbourhoods with lower public transport density also increased the deleterious effects of living alone on the number of depressive symptoms. Those living alone and residing in neighbourhoods with higher levels of connectivity tended to report more depressive symptoms than their counterparts. CONCLUSIONS The level of access to destinations and social networks across Hong Kong may be sufficiently high to reduce the risk of depressive symptoms in older adults. Yet, exposure to extreme levels of public transport density and associated traffic volumes may increase the risk of depressive symptoms. The provision of good access to a variety of destinations, public transport and public open spaces for socialising in the neighbourhood may help reduce the risk of depressive symptoms in older adults who live alone.
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Affiliation(s)
- Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Poh-chin Lai
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Janice M Johnston
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong Special Administration Region, Hong Kong, China
| | - Ester Cerin
- School of Public Health, The University of Hong Kong, Hong Kong, China
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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Jung S, Lee S, Lee S, Bae S, Imaoka M, Harada K, Shimada H. Relationship between physical activity levels and depressive symptoms in community-dwelling older Japanese adults. Geriatr Gerontol Int 2017; 18:421-427. [PMID: 29052928 DOI: 10.1111/ggi.13195] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/17/2017] [Accepted: 08/27/2017] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to investigate the relationship between physical activity (PA) and depressive symptoms in community-dwelling older Japanese adults. METHODS A cross-sectional study design was used to obtain data from 3191 community-dwelling older Japanese adults aged 70-95 years. Depressive symptoms were assessed using self-reported scores on the Geriatric Depression Scale-15. PA was objectively measured using an accelerometer worn for a maximum of 40 days, and average daily durations of light-intensity PA (LPA), moderate-to-vigorous intensity PA (MVPA) and step count were calculated. PA was compared between participants with and without depressive symptoms by carrying out analysis of covariance and multivariable logistic regression analysis adjusted for all covariates by using propensity scores. RESULTS Depressive symptoms were present in 598 participants (19.6%). A comparison of propensity-score adjusted PA showed that step count (5059.6 ± 53.7 vs 5003.0 ± 112.1 count/day; P = 0.652) and moderate-to-vigorous intensity PA duration (23.0 ± 0.4 vs 23.8 ± 0.7 min/day; P = 0.358) were not significantly different between participants with and without depressive symptoms, respectively. However, participants without depressive symptoms had a significantly higher LPA duration than those with depressive symptoms (39.4 ± 0.3 vs 37.3 ± 0.7 min/day, respectively; P < 0.01). CONCLUSIONS The present results suggest that individuals with lower LPA have a higher risk of depressive symptoms. These findings imply that PA recommendations, especially for older adults, should emphasize LPA, which appears to be especially effective at preventing depressive symptoms. Geriatr Gerontol Int 2018; 18: 421-427.
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Affiliation(s)
- Songee Jung
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sungchul Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masakazu Imaoka
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuhiro Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
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Effects of Perceived Neighbourhood Environments on Self-Rated Health among Community-Dwelling Older Chinese. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060614. [PMID: 28590435 PMCID: PMC5486300 DOI: 10.3390/ijerph14060614] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/24/2017] [Accepted: 06/02/2017] [Indexed: 02/06/2023]
Abstract
In response to the growing number of older people living in cities, the World Health Organization (WHO) introduced the concept of “Age-Friendly Cities” (AFC) to guide the way in designing physical and social environments to encourage active ageing. Limited research has studied the effects of neighbourhood age-friendliness on elderly health outcomes. Using the example of a highly urbanized city in Asia, this study examined the effects of perceived age-friendliness of neighbourhood environments on self-rated health (SRH) among community-dwelling older Chinese. A multi-stage sampling method was used to collect views of community-dwelling older people from two local districts of Hong Kong. A structured questionnaire covering the WHO’s eight AFC domains was developed to collect information on the perceived neighbourhood environments, SRH and individual characteristics. Age-friendliness of neighbourhood was assessed by mean scores of AFC domains, which was used to predict SRH with adjustment for individual and objective neighbourhood characteristics. Furthermore, 719 respondents aged ≥60 years completed the questionnaire, of which 44.5% reported good SRH. Independent of individual and objective neighbourhood characteristics, multiple logistics regressions showed that higher satisfaction on outdoor spaces and buildings, transportation, housing, social participation, and respect and social inclusion was significantly associated with increased odds of reporting good SRH by more than 20% (p < 0.05). Individuals aged 70–79 years, being female, lower education and residents of public or subsidized housing were less likely to report good SRH, after controlling for individual and neighbourhood characteristics. In addition to age, gender, education and housing type, AFC environments have important contributive influence on SRH, after controlling for individual and objective neighbourhood characteristics.
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Barnett A, Cerin E, Zhang CJP, Sit CHP, Johnston JM, Cheung MMC, Lee RSY. Associations between the neighbourhood environment characteristics and physical activity in older adults with specific types of chronic conditions: the ALECS cross-sectional study. Int J Behav Nutr Phys Act 2016; 13:53. [PMID: 27105954 PMCID: PMC5477845 DOI: 10.1186/s12966-016-0377-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/14/2016] [Indexed: 12/14/2022] Open
Abstract
Background Neighbourhood characteristics may influence physical activity (PA), which has positive effects on the health of older adults. Older adults with chronic conditions are less active and possibly more affected by environmental factors than their peers. Understanding neighbourhood characteristics associated with PA specific to older adults with chronic conditions is currently lacking. This cross-sectional study aimed to assess the associations between the neighbourhood environment and various forms of PA in older adults with and without visual impairment, hearing impairment, musculoskeletal disease and/or genitourinary disease. Methods Neighbourhood environment and PA data were collected in Hong Kong older adults (N = 909) from 124 preselected neighbourhoods stratified for walkability and socioeconomic status. Generalized linear models and zero-inflated negative binomial models with robust standard errors were used to examine associations of perceived neighbourhood environment characteristics, and the moderating effects of having specific chronic conditions, with PA outcomes. Results Thirteen perceived neighbourhood characteristics were associated with older adults’ PA in the expected direction irrespective of their health condition. Nine neighbourhood characteristics had associations with PA that were dependent on hearing impairment, vision impairment, musculoskeletal disease or genitourinary disease. In general, they were stronger in participants with than without a specific chronic condition. Conclusions Maximizing the potential for PA in older adults who have lower levels of physical functionality due to chronic conditions may require neighbourhood characteristics specific to these groups.
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Affiliation(s)
- Anthony Barnett
- Institute of Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia.
| | - Ester Cerin
- Institute of Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia.,School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Janice M Johnston
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Martin M C Cheung
- Elderly Health Service, Department of Health, The Government of Hong Kong Special Administrative Region, Hong Kong, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong Special Administrative Region, Hong Kong, China
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