A Preliminary Study Of The Sub-health Condition Of The Working Population In Hong Kong

ObjectiveThe study of sub-health condition has been actively pursued in China for the past ten years or so. The scope of study is very wide, encompassing the sub-health concept study, diagnosis criteria study, cause and mechanism study, epidemiological study on the sub-health condition of area population and working population, and intervention method study, including the use of Traditional Chinese Medicine (TCM).Among these various streams of studies, the study on the sub-health condition of working population, the contributing factors and the corresponding intervention strategy and measures are of particular significance to the society. The reason is that if people are inflicted with such health problems, their production capacity as well as working efficiency will be adversely affected. This will in turn have a negative impact on the social economy. Hence this kind of study will not only help upgrade the physical and mental health of the working population, but also help improve the social economy and its stable development.Scholars on the Mainland have carried out epidemiological surveys on sub-health for the working population engaged in different occupations. In the recent ten years, studies have often been carried out on teachers, medical personnel and government officers. However, the targeted groups in the studies were all from the Mainland:very few sub-health condition studies have been carried out for the people of Hong Kong.At the time of writing, no sub-health condition study or epidemiological survey has been carried out for the working population in Hong Kong, and no article on the subject has been published. Therefore the objectives of this research are:(1)to carry out a pilot study to investigate the sub-health condition of the working population in Hong Kong, including the prevalence rate, the symptoms, the TCM syndromes and the contributing factors;(2)to collect relevant information with subsequent statistical analysis to provide the basis for formulating the intervention strategy and measures of sub-health using TCM;(3) to lay the foundation for more comprehensive sub-health condition studies and epidemiological surveys on the working population in Hong Kong.MethodsThis study is divided into two parts. The first part is literature review. Relevant articles, books and information on the internet have been studied with a view to understanding the current situation and deficiencies about sub-health researches. This review provides background information and helps determine the direction and objective of the preliminary study. The second part is the epidemiological survey. In this survey, the target sample of the working population came from an engineering works department of the Government of the Hong Kong Special Administration Region (SAR), together with consulting and contracting firms which implement projects of the department. This study sample has covered both government and non-government staff as well as staff of various ranks including construction workers, clerical staff, technical staff, and professional and managerial staff.When the questionnaires were designed, reference has been made to those frequently used by scholars in recent years. Questionnaires used by the scholars were modified so that they were more suitable for use in this study. The information collected covered physiological, psychological and social adaptation symptoms. It could also be used on the working population as the study targets, and was relevant for TCM studies. The scope of the questions covered all common symptoms of sub-health, as well as those living conditions closely related to the contributing factors of sub-health.The questionnaire was divided into four sections. The first to third sections were to be answered and filled in by the study targets. The fourth section, which covered the TCM diagnosis involving inspection, listening and olfaction, inquiry and pulse-taking (the four methods), as well as syndrome differentiation, was to be completed by the examining doctor. The diagnosis criteria for sub-health status, which involved two conditions, were those which are more commonly used by scholars. The first was:"though there is no affirmation diagnosis as being sick, discomfort or weakness in adaptation have repeatedly occur in the recent three months." The second was:"though there is affirmation diagnosis as being sick, the discomfort or weakness in adaptation being suffered is not directly caused by the current sickness." These two conditions, together with the information collected from the questionnaires, were used to determine whether a target person was in a sub-health state and the associated TCM syndrome as appropriate.A database of the survey results was created and frequency analysis was carried out with the aid of Excel software. Chi-square analysis and Logistic regression were also carried out using the SPSS18software. From these statistical analysis results, the prevalence rates, the common symptoms, the TCM syndromes and the contributing factors of the sub-health state of the sample group were identified.Comparisons were made among the results obtained in this study, and those of the relevant researches carried out in the Mainland, Hong Kong and Taiwan. Their differences and similarities were discussed which helped formulate further study proposals. Based on the TCM syndromes and contributing factors found out from the study, corresponding intervention strategy, intervention measure, treatment method as well as prescription were proposed. All these research records and outcomes served as useful references not only for conducting future similar studies, but also for formulating measures of prevention and treatment of sub-health.ResultsA total of305employees have participated in this survey. Among them,176were diagnosed to be in the sub-health state resulting in a prevalence rate of57.7%.98were diagnosed to be in a healthy state, and31were diagnosed to be sick, amounting to32.1%and10.2%respectively of the total.The survey results revealed that among the working people who were in the sub-health state, the ten most common body symptoms were tiredness, pain in the loins and back, dryness in the throat, poor memory, insomnia or sleep with frequent dreams, irregular menstrual cycles, abdominal distention, dryness in the eyes, weakness in knees and legs, and alopecia. These symptoms occurred in50%or more of people who were diagnosed as sub-healthy. The most common one was tiredness, with a prevalence rate of83.5%. The five most common psychological symptoms were nervousness, dispiritedness, emotional depression, irritability and susceptibility to rage, and frequent sighing. These symptoms occurred in45%or more of sub-healthy people. The most common one was nervousness, with a prevalence rate of67.6%. The three most common social adaptation symptoms were low working efficiency, low social communication frequency and boredom. These symptoms occurred in23%or more of sub-healthy people. The most common one was low working efficiency, with a prevalence rate of23.9%. The survey results also revealed that the twelve most commonly found symptoms on sub-healthy working people, beginning with the most frequent one were: tiredness, pain the loins and back, dryness in the throat, nervousness, dispiritedness, poor memory, insomnia or sleep with frequent dreams, irregular menstrual cycles, abdominal distention, dryness in the eyes, weakness in knees and legs, and alopecia, with a prevalence rate of50%or more.The ten most commonly found TCM syndromes on sub-healthy working people were:liver qi stagnation, deficiency of qi and yin, liver qi stagnation and asthenia of splenic qi, deficiency of liver and kidney yin, deficiency of heart blood and splenic qi, deficiency of qi and blood, liver fire hyperactivity, asthenia of splenic qi and stagnation of qi, asthenia of splenic qi, and deficiency of liver yin. The first three syndromes occurred in10%or more of sub-healthy people. The most common one was liver qi stagnation, with a prevalence rate of17.05%.The living condition survey results and subsequent statistical analyses revealed that the reason for the liver qi stagnation syndrome to occur in sub-healthy working people was probably due to the living problems encountered which included work stress, children problem and job promotion problem. These have resulted in symptoms like nervousness, dispiritedness and emotional depression etc. Other living problems such as frequent working overtime, heavy workload, long working hours and poor sleep quality would exhaust the qi and yin of the body. This would lead to the development of the deficiency of qi and yin syndrome and result in symptom like tiredness, dry throat etc. People with liver qi stagnation, together with improper functioning of the spleen due to an imbalanced diet, would lead to the liver qi stagnation and asthenia of splenic qi syndrome. This would result in symptoms like emotional depression, abdominal distention etc. In this study, comparisons have been made among the research results regarding the common sub-health TCM syndromes in the Mainland, Hong Kong and Taiwan. It was found that they were not similar. This was probably due to the differences in people's constitution as well as the differences in key sub-health contributing factors which included the social environment, living environment, natural environment, extent of pollution, life style, work pace, human relationship etc.The study results also revealed that sex, education, occupation, government or non-government employment and marital status apparently had no correlation with sub-health. Age might be a possible contributing factor, but more local studies would be required to confirm. Other factors such as education, occupation and marital status would also require further investigation. The statistical analysis results suggested that the major contributing factor leading to the sub-health condition of the working population included lack of leisure activities, encountering living problems, poor sleep quality and poor living conditions. The other probable factors included lack of physical exercise, poor living environment, frequent overtime work, worrying character, severe noise pollution in living environment, severe air pollution in living environment, poor health care service, financial problem and family conflicts.ConelusionThe study results revealed that probably more than half of the working population showed various symptoms of discomfort or distress though the study targets have not been diagnosed as being sick. These symptoms might affect the study targets'work efficiency and production capacity. Therefore the problem of sub-health should be accorded serious attention by the Government of the HKSAR, the employers and the employees in Hong Kong.Some intervention strategies have been proposed in the light of the survey results obtained from this study. These included eradicating unhealthy living styles, managing stress, improving the environment with the concerted efforts of parties concerned, and increasing awareness of the society towards sub-health problem. The Government of the HKSAR should actively monitor the sub-health condition of the working population and provide support to assist sub-healthy people to recover, or prevent them from becoming sick. The intervention measures recommended included TCM prescription methods and non-prescription methods, appropriate counseling service, advice on healthy living styles,, stress management etc.This was a pilot study to investigate the sub-health condition of the working population in Hong Kong. No similar study results were available for comparison. In view of the small sample size adopted, the results obtained in this pilot study might not be representative of the entire working population. In other words, the results might not wholly reflect the sub-health condition of the working population in Hong Kong. Hence it was proposed to carry out more surveys with a larger sample size and also more comprehensive epidemiological surveys. Such surveys could be designed to focus on certain particular contributing factors such as work pressure or financial problem. These studies could provide a more thorough understanding of the sub-health condition of the working population and the contributing factors, which would help determine appropriate intervention strategies and measures.