Vaccine hesitancy is among the major threats to the effectiveness of vaccination programmes. This study aimed to report the trend in response to willingness to accept the COVID-19 vaccine between two waves of the local epidemic and examine differences among occupations. Two cross-sectional surveys were conducted online during the first wave (February) and third wave (August to September) of the local epidemic in 2020. Acceptance of the COVID-19 vaccine was measured along with personal protection behaviours and occupations. A total of 2047 participants provided valid responses. The willingness to accept the COVID-19 vaccine among the participants was lower in the third wave (34.8%) than the first wave (44.2%). There were more concerns over vaccine safety in the third wave. Clerical/service/sales workers were less likely to accept the vaccine (adjusted odds ratio: 0.62, 95% confidence interval: 0.43–0.91). A high-level compliance of facemask wearing was found, and more people maintained social distancing and used alcohol hand rub in the third wave. Decreasing willingness to accept the COVID-19 vaccine may be associated with increasing concerns about vaccine safety and growing compliance of personal protection behaviours. The rush of vaccine development with higher risks of safety issues may jeopardize the public’s trust and lower uptake rates. Education and favourable policy should be provided to the general working population for the vaccination, especially for those who are not professional and are frequently exposed to crowds.

Importance: Although poorly controlled diabetes is associated with a higher incidence of dementia, few studies have examined the association of diabetes management interventions with dementia incidence.Objective: To examine the association of receiving a multidisciplinary diabetes management program (the Risk Assessment and Management Program-Diabetes Mellitus [RAMP-DM]) that enables better glycemic control with subsequent risk of dementia incidence and the association of dementia with glycemic control.Design, Setting, and Participants: This territory-wide, retrospective, matched cohort study with more than 8 years of follow-up was conducted using electronic health care records from all the patients who used public health care services in Hong Kong from 2011 to 2019. Eligible participants included all patients with type 2 diabetes (T2D) who were managed in primary care settings. Patients who received RAMP-DM were matched in a 1:1 ratio with patients who received usual care only. Data analysis occurred from April 2023 to July 2023.Exposures: Diagnosis of T2D, hemoglobin A_1C (HbA_1C) level, and attendance at a general outpatient clinic or family medicine clinic. Patients received either RAMP-DM or usual care.Main Outcomes and Measures: Incidence of all-cause dementia and subtypes of dementia were compared between the RAMP-DM and usual care participants using a Cox proportional hazard model with other baseline characteristics, biomarkers, and medication history adjusted. HbA_1C levels were measured as a secondary outcome.Results: Among the 55 618 matched participants (mean [SD] age, 62.28 [11.90] years; 28 561 female [51.4%]; 27 057 male [48.6%]), including the 27 809 patients in the RAMP-DM group and 27 809 patients in the usual care group, patients had been diagnosed with T2D for a mean (SD) of 5.90 (4.20) years. During a median (IQR) follow-up period of 8.4 (6.8-8.8) years, 1938 patients in the RAMP-DM group (6.97%) and 2728 patients in the usual care group (9.81%) received a diagnosis of dementia. Compared with those receiving usual care, RAMP-DM participants had a lower risk of developing all-cause dementia (adjusted hazard ratio [aHR], 0.72; 95% CI, 0.68-0.77; P < .001), Alzheimer disease (aHR, 0.85; 95% CI, 0.76-0.96; P = .009), vascular dementia (aHR, 0.61; 95% CI, 0.51-0.73; P < .001), and other or unspecified dementia (aHR, 0.71; 95% CI, 0.66-0.77; P < .001). Compared with having a mean HbA_1C level during the first 3 years after cohort entry between 6.5% and 7.5%, a higher risk of dementia incidence was detected for patients with a 3-year mean HbA_1C level greater than 8.5% (aHR, 1.54; 95% CI, 1.31-1.80]), between 7.5% and 8.5% (aHR, 1.33; 95% CI, 1.19-1.48), between 6% and 6.5% (aHR, 1.17; 95% CI, 1.07-1.29), and 6% or less (aHR, 1.39; 95% CI, 1.24-1.57).Conclusions and Relevance: In this cohort study of patients with T2D, the findings strengthened evidence of an association of glycemic control with dementia incidence, and revealed that a multidisciplinary primary care diabetes management program was associated with beneficial outcomes for T2D patients against dementia and its major subtypes. A moderate glycemic control target of HbA_1C between 6.5% and 7.5% was associated with lower dementia incidence.

Medical students are vulnerable to sleep disorders, which could be further exaggerated by poor dormitory environment and roommate behaviour. However, there is little evidence of whether dormitory environment intervention is effective in improving the sleep quality of medical college students in developing countries. The present study aimed to evaluate the effects of a comprehensive multidomain intervention on dormitory environment and roommate behaviour among medical college students in China. In this cluster randomised controlled trial, a total of 106 dormitories (364 students) were randomly allocated into an intervention group (55 dormitories, 193 students) and a control group (51 dormitories, 171 students). The intervention group received a three-month intervention with multiple components to improve or adapt to sleep environments in dormitories; the control group received no intervention. Primary and secondary outcomes were measured at study enrolment and three months later for both groups. The linear mixed-effects models showed that, compared with the control group, the intervention was associated with a significantly decreased Pittsburgh Sleep Quality Index (β = −0.67, p = 0.012), and a marginally significant effect on reducing roommates’ influence on sleep schedule (β = −0.21, p = 0.066). Students in the intervention group rated “making dormitory sleep rules” and “wearing eye masks” as the most effective intervention measures. These findings could contribute to the limited body of scientific evidence about sleep intervention in Chinese medical students and highlight the importance of dormitory sleep environments in maintaining sleep quality.

Background: The small-area deprivation indices are varied across countries due to different social context and data availability. Due to lack of chronic disease-related social deprivation index (SDI) in Hong Kong, China, this study aimed to develop a new SDI and examine its association with cancer mortality. Methods: A total of 14 socio-economic variables of 154 large Tertiary Planning Unit groups (LTPUGs) in Hong Kong were obtained from 2016 population by-census. LTPUG-specific all-cause and chronic condition-related mortality and chronic condition inpatient episodes were calculated as health outcomes. Association of socio-economic variables with health outcomes was estimated for variable selection. Candidates for SDI were constructed with selected socio-economic variables and tested for criterion validity using health outcomes. Ecological association between the selected SDI and cancer mortality were examined using zero-inflated negative binomial regression. Results: A chronic disease-related SDI constructed by six area-level socio-economic variables was selected based on its criterion validity with health outcomes in Hong Kong. It was found that social deprivation was associated with higher cancer mortality during 2011–2016 (most deprived areas: incidence relative risk [IRR] = 1.40, 95% confidence interval [CI]: 1.27–1.55; second most deprived areas: IRR = 1.34, 95%CI: 1.21–1.48; least deprived areas as reference), and the cancer mortality gap became larger in more recent years. Excess cancer death related to social deprivation was found to have increased through 2011–2016. Conclusions: Our newly developed SDI is a valid and routinely available measurement of social deprivation in small areas and is useful in resource allocation and policy-making for public health purpose in communities. There is a potential large improvement in cancer mortality by offering relevant policies and interventions to reduce health-related deprivation. Further studies can be done to design strategies to reduce the expanding health inequalities between more and less deprived areas.

This study aimed to test the influence of vaccination characteristics and gain/loss-framing of information, on parental acceptance of the coronavirus disease 2019 (COVID-19) vaccination for their minor children. A discrete choice experiment was conducted among parents of children aged 0–17 years from September to October 2021 in Hong Kong. Respondents were randomly assigned to four groups with different framing of information and asked to choose hypothetical vaccination alternatives, described by seven attributes that were derived from prior qualitative interviews. A mixed logit model was adopted to analyze the effect of attributes and information framing on parental vaccination acceptance. The vaccine acceptance rates under different scenarios were also estimated. A total of 298 valid responses were obtained. It was found that the BioNTech brand, higher efficacy, less serious adverse events and more vaccination coverage in children significantly improved parental acceptance. Additionally, loss-framing increased parental acceptance compared with gain-framing, while the presentation of mortality information did not make a difference. Acceptance was also associated with parental uptake of the COVID-19 vaccine and the children’s age.Conclusion: The findings imply that factors including gain/loss information framing, importance of vaccine characteristics, and peer influence have a significant effect on parents’ decisions to get their children vaccinated. Parents with younger children had greater vaccine hesitancy, and information framing techniques should be considered in vaccination promotion for combating such vaccine hesitancy. Future studies could be conducted to identify the moderators and mediators of information framing to facilitate its implementation. What is Known:• Parental acceptance of COVID-19 vaccine was found to be associated with various socio-economic and psychosocial factors, while the evidence on impact of vaccination characteristics was limited.• Behavioral interventions, including information framing, have been used to promote various health behaviors. What is New:• Loss-framing of information on vaccine effectiveness improves vaccine acceptance, while additional information on how the vaccine reduces death does not make a difference, which can be used to inform communication with the public in vaccination promotion.• The social norm (i.e., the vaccine uptake amongst other people) is important for increasing the parental vaccine acceptance rate.