Iris Chi

Rush University Medical Center, Chicago, Illinois, United States

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Publications (229)357.78 Total impact

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    ABSTRACT: Using four-wave panel data of 1,327 older adults in rural China, this study examined potential gender and marital status differences in the relationships between three forms of intergenerational support (monetary, instrumental and emotional support) and the level of depression of the older adults. Results from a pooled time-series fixed-effects model showed that receiving and providing monetary support had a comparable beneficial effect on mothers and fathers, but mothers benefited more psychologically than fathers from closer relationships with their children. Exchanges in instrumental support was not related to either mothers' or fathers' level of depression. Widowhood further affected the gendered relationships between support and depression in that recently widowed fathers had a significantly higher level of depression when they received more monetary support from their children. In contrast, providing monetary support to children was associated with a significantly higher level of depression among recently widowed mothers. We explained the findings in the context of familial and gender norms in the Chinese culture and temporal needs for family support that link with bereavement coping stages among older adults. We argued that the gender and marital status patterns observed in this study are attributive to more fundamental differences in men's and women's social positions in the Chinese society.
    Full-text · Article · Dec 2015 · Ageing and Society
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    ABSTRACT: Aim: The present study aims to describe the prevalence of potential elder abuse, and to examine correlates of abuse screening items among Chinese community-dwelling older adults. Methods: We analyzed the data of 3435 older persons aged ≥60 years who had first applied for the long-term care services in Hong Kong and completed the screening tool (Minimum Data Set-Home Care) in 2006. For each of the five abuse screening items ("fearful of a family member/caregiver," "unexplained injuries/broken bones/burns," "physically restrained," "unusually poor hygiene" and "neglected/abused/mistreated"), we examined its relationship with four types of factors: older person, perpetrator, relationship and environment. Results: The rates of individual abuse screening items ranged from 3.9% for physically restrained to 0.03% for unexplained injures/broken bones/burns. Physically restrained was positively associated with activities of daily living impairments, instrumental activities of daily living impairments, perceived poor health, physically abusive behavior and caregiver mental health. Unusually poor hygiene was positively associated with socially inappropriate behavior and actively resisted care. "Fearful of a family member/caregiver" was positively associated with perceived poor health, conflicting relationship and mental health, and negatively with care activities. Neglected/abused/mistreated was positively associated with age and informal care, and negatively with care activities. Conclusions: We identified a number of associated factors of different abuse screening items among older adults. Our findings could inform healthcare practitioners in identifying those older persons who might be at higher risk of abuse, and provide a knowledge base on which to develop effective preventive measures in the Chinese population. Geriatr Gerontol Int 2015; ●●: ●●-●●.
    No preview · Article · Dec 2015 · Geriatrics & Gerontology International
  • Nan Lu · Vivian W Q Lou · Dongmei Zuo · Iris Chi
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    ABSTRACT: The present study examined trajectory patterns of self-rated health (SRH) among older rural Chinese adults and gender differences in the relationship between intergenerational relationships and SRH trajectories. Using data from four waves of a longitudinal study on the well-being of older adults in Anhui province, a general growth mixture model was estimated to examine the SRH trajectory patterns and antecedents of SRH trajectory class memberships. A two-class model was selected to interpret the SRH trajectory patterns. The two classes were labeled remaining poor and good but declining. Intergenerational relationships were a significant antecedent of SRH trajectory class memberships among men but not women. Gender differences in the cumulative effects of intergenerational relationships on the health of older adults were identified in rural China. Policy implications regarding how to help rural families support their elderly members are discussed.
    No preview · Article · Oct 2015
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    ABSTRACT: Objectives: To examine the predictive validity of a quick frailty screening tool, the FRAIL-NH, for adverse health outcomes in nursing home residents, using variables from the Minimum Data Set (MDS). The screening items were compiled from the MDS for potential direct application in long-term care facilities using this health information system. Design: Longitudinal follow-up study of nursing home residents with annual clinical assessment using the MDS and mortality data between 2005 and 2013. Setting: Six nursing homes operated by a nongovernmental organization in Hong Kong. Participants: Participants included 2380 nursing home residents aged 65 years or older at study baseline. Measurements: Frailty assessed using the FRAIL-NH model with items from the MDS. The model covers 8 areas: fatigue, resistance, ambulation, incontinence, polypharmacy, weight loss, nutritional approach, and help with dressing. Adverse health outcomes in subsequent years were measured: incident falls, worsening activities of daily living (ADL) function, hospitalization, and death. Results: Using a cutoff score of 5 on the FRAIL-NH, the prevalence of frailty was 58.5% in this nursing home sample. Frailty as identified using the FRAIL-NH predicts incident falls, worsening ADL function, hospitalization, and death (hazard ratios [HR] 2.00-3.73). This remained significant after adjusting for sociodemographic and other clinical characteristics. Each level of increase on the FRAIL-NH has strong distinguishing power on the incidence of adverse outcomes. Intermediate frailty status (score 1-4) also significantly predicts adverse health outcomes (HR 1.57-2.06). Conclusion: The FRAIL-NH is a quick screening tool that can be used to identify frail and prefrail nursing home residents at risk of adverse health outcomes. It can be applied using variables from the MDS, allowing direct adoption in long-term care facilities already using this health information system.
    No preview · Article · Oct 2015 · Journal of the American Medical Directors Association
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    ABSTRACT: Background: Elder mistreatment and suicidal ideation are important public health concerns among aging populations. However, very few studies have been conducted to explore the association between elder mistreatment and suicidal ideation. Objectives: To examine the association between elder mistreatment and suicidal ideation among Chinese older adults in the USA. Methods: Guided by a community-based participatory research approach, in this study we conducted in-person interviews with Chinese older adults aged 60 years and older in the Greater Chicago area from 2011 to 2013. Elder mistreatment was assessed by a 10-item instrument derived from the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) and the Vulnerability to Abuse Screening Scale (VASS). Suicidal ideation was assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9) and the Geriatric Mental State Examination-Version A (GMS-A). Results: Overall, 3,159 Chinese older adults participated in this study, and their mean age was 72.8 years. After controlling for age, gender, education, income, medical comorbidities, depressive symptoms, and social support, elder mistreatment was significantly associated with 2-week suicidal ideation (OR 2.46, 95% CI 1.52-4.01) and 12-month suicidal ideation (OR 2.46, 95% CI 1.62-3.73). With respect to gender differences, the study found that the association remained significant for older women but not for older men after adjusting for all confounding factors. Conclusion: As the largest epidemiological study conducted among Chinese older adults in the USA, this study suggests that elder mistreatment is significantly associated with 2-week and 12-month suicidal ideation in older women but not in older men. Longitudinal studies should be conducted to explore the mechanisms through which elder mistreatment links with suicidal ideation. © 2015 S. Karger AG, Basel.
    No preview · Article · Sep 2015 · Gerontology
  • Weiyu Mao · Bei Wu · Iris Chi
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    ABSTRACT: This study reviewed the existing literature on oral health among older Chinese immigrants and discussed intervention strategies for improving the oral health of older Chinese immigrants in the context of social work practice. A systematic review was conducted of the existing empirical studies on oral health, dental care utilization, and traditional oral health beliefs among older Chinese immigrants. There were very limited studies published in the topic area. The findings showed that older Chinese immigrants had poorer oral health and less dental care use than the general population in their host country. Higher levels of English-language proficiency, stronger social support, and longer length of stay in the host country were positively related to increased dental care utilization. Cultural beliefs and knowledge were related to oral health status and dental care utilization. Overall, the findings support the need to consider the cultural characteristics and background of older Chinese immigrants when strengthening oral health promotion. It is critical to partner with Chinese community agencies to conduct community-based oral health promotion programs and advocate for policy changes.
    No preview · Article · Aug 2015 · Health & social work
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    ABSTRACT: To investigate whether depressive symptoms and antidepressant use at baseline predict the subsequent decline in physical functioning and number of hospitalizations in nursing home residents. Observational study based on Minimum Data Set (MDS) 2.0. Six nursing homes in Hong Kong. All nursing home residents (n = 1076) assessed with the MDS 2.0 in 2005 followed until 2013. Outcome variables included annual performance in activities of daily living (ADLs) and number of hospitalizations within 90 days before each assessment. The presence of depressive symptoms at baseline was measured by the Resident Assessment Protocol triggered from the MDS 2.0 assessment. Records of antidepressant use and other control variables were exacted directly from the MDS 2.0 assessment. The presence of baseline depressive symptoms did not have significant association with baseline ADLs and number of hospitalizations according to the multilevel mixed-effect model. However, it was associated with a faster deterioration of physical functioning (coefficient 0.03; 95% confidence interval [CI] 0.00-0.07) and an increase in the number of hospitalizations (coefficient 0.05; 95% CI 0.03-0.07). No significant difference between elders using antidepressants and elders who were free from depressive symptoms was observed. If depressive symptoms were presented but antidepressants were not used, a much sharper decline was evident (coefficient 0.06; 95% CI 0.02-0.09). This study provided evidence that the presence of depressive symptoms is associated with more utilization of health care services. However, the use of antidepressants may play a significant role in altering the trajectory. The presence of depressive symptoms is a worrisome but treatable condition. Effective intervention/treatment should be called on. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Jul 2015 · Journal of the American Medical Directors Association
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    Man Guo · Iris Chi · Merril Silverstein
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    ABSTRACT: Using 8-year panel data for 1,355 older adults in rural Anhui province, China, this study examined the trajectories and determinants of elder care provided by adult children to their older parents. The results of two-level latent variable growth models showed that trajectories of elder care differed by the gender of children, with an increase in care from sons but a decrease in care from daughters over time. Children's life stages influenced their care provision but differed by gender. Functional impairment of parents and care provided by siblings in the family also affected the care provided by each child. The findings reflect the patrilineal nature of Chinese family systems and demonstrate the linkages between critical life events and caregiving behaviors of adult children. Findings of this study can inform the formulation of elder care policies that meet the needs of families with different structures and at different life stages. © The Author(s) 2015.
    Full-text · Article · Jun 2015
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    Full-text · Article · Jun 2015 · Journal of Clinical Nursing
  • Hong Li · Ling Xu · Iris Chi
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    ABSTRACT: Guided by the biopsychosocial framework and empirical evidence, this study examined protective and risk factors of older adults' suicidal thoughts and attempts during the previous month, 12 months, and 5 years. The data used in this study were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted in 2006, which included 15,957 older adults from mainland China. Multiple penalized logistic regressions were used to conduct the analyses. During the previous month, 12 months, and 5 years, 5.1‰, 10.0‰, and 17.7‰ of older adults indicated that they thought about suicide, whereas 2.2‰, 3.5‰, and 6.3‰ reported suicidal attempts, respectively. Older adults' age, financial strain, functional limitations, depression, children's filial piety, social network, loneliness, and urban residence were significantly related to suicidal thoughts during the different time periods. In addition, older adults' religious affiliation, depression, loneliness, and urban residence were significantly related to suicidal attempts during the different time periods. Older adults' suicidal thoughts and attempts need to be assessed by mental health care professionals and primary care doctors. Programs addressing these important protective and risk factors may help reduce older adults' suicidal thoughts and attempts.
    No preview · Article · Apr 2015 · Aging and Mental Health
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    ABSTRACT: Although the prevalence of depressive disorders among North Korean (NK) refugees living in South Korea has been reported to be twice the rate of their South Korean counterparts, little is known about the correlates of depressive symptoms among this population. Despite their escape from a politically and economically repressive setting, NK refugees continue to face multidimensional hardships during their adaptation process in South Korea, which can adversely affect their mental health. However, to our knowledge, no empirical research exists to date on depressive symptoms in the context of adaptation or perceived discrimination among NK refugees. To fill this gap, this study used a sample of 261 NK refugees in South Korea from the 2010 National Survey on Family Violence to examine associations between sociocultural adaptation, perceived discrimination, and depressive symptoms, as well as the moderation effect of discrimination on adaptation to depressive symptoms. We found that poor sociocultural adaptation and perception of discrimination were associated with increased levels of depressive symptoms. Perception of discrimination attenuated the association between better adaptation and fewer depressive symptoms, when compared to no perception of discrimination. These findings highlight the need to improve NK refugees' adaptation and integration as well as their psychological well-being in a culturally sensitive and comprehensive manner. They also underscore the importance of educating South Koreans to become accepting hosts who value diversity, yet in a homogeneous society. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Feb 2015 · Social Science & Medicine
  • Yura Lee · Iris Chi
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    ABSTRACT: Objectives: Increasing demand for early detection and prevention of dementia has shifted recent attention toward cognitive impairment with no dementia (CIND), which is often considered a possible risk path to dementia. Education and cognitive leisure activities are major predictors featured in dementia studies. However, the definition of cognitive leisure activities often has been inconsistent and diverse. This study explored different domains of these activities and their moderating roles on the relationship between education and cognition. Method: A sample of 704 participants aged 70 or older was drawn from the national Aging, Demographics, and Memory Study. Exploratory factor analysis was conducted to assess two domains from cognitive leisure activities: literacy and visuospatial activities. Multinomial logistic regression tested the main and moderating roles of each domain on cognition categorized as no impairment, CIND, and dementia. Results: Individuals with greater engagement in both literacy and visuospatial activities were more likely to have no cognitive impairment than CIND. Individuals with greater engagement in literacy activities were less likely to have dementia compared to CIND. Literacy activities and education years had a significant interaction effect. Individuals with higher education seem to benefit more by engaging in literacy activities, as evidenced by decreased odds of having dementia. Conclusion: Engagement in cognitive leisure activities for both cognitively intact and impaired older adults is suggested, with more focus on literacy activities for cognitively impaired and highly educated older adults.
    No preview · Article · Feb 2015 · Aging and Mental Health
  • Z Bai · J Chang · C Chen · P Li · K Yang · I Chi
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    ABSTRACT: Some evidence from previous randomized controlled trials and systematic reviews has demonstrated a positive association between hypertension and transcendental meditation (TM). However, other trials and reviews showed the effect of TM on blood pressure (BP) was unclear but did not use subgroup analysis to rigorously investigate this relationship. The American Heart Association has stated that TM is potentially beneficial but did not give a standard indication. The present study explored several subgroup analyses in systematic reviews to investigate the effect of TM on BP. Medline, Embase, Cochrane Library, Web of Science and Chinese BioMedical Literature Database were searched through August 2014. Randomized controlled trials of TM as a primary intervention for BP were included. Two reviewers independently used the Cochrane Collaboration's quality assessment tool to assess each study's quality. Twelve studies with 996 participants indicated an approximate reduction of systolic and diastolic BP of -4.26 mm Hg (95% CI=-6.06, -2.23) and -2.33 mm Hg (95% CI=-3.70, -0.97), respectively, in TM groups compared with control groups. Results from subgroup analysis suggested that TM had a greater effect on systolic BP among older participants, those with higher initial BP levels, and women, respectively. In terms of diastolic BP, it appears that TM might be more efficient in a short-term intervention and with individuals experiencing higher BP levels. However, some biases may have influenced the results, primarily a lack of information about study design and methods of BP measurement in primary studies.Journal of Human Hypertension advance online publication, 12 February 2015; doi:10.1038/jhh.2015.6.
    No preview · Article · Feb 2015 · Journal of Human Hypertension
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    ABSTRACT: Abstract Objectives: Mental health providers are the major resource families rely on when experiencing the effects of dementia. However, mental health resources and manpower are inadequate and unevenly distributed between cities and towns in China. The present study was conducted to examine similarities and differences in knowledge, attitudes, and clinical practices concerning dementia and working with family caregivers from mental health providers' perspectives in city versus town settings. Method: Data were collected during focus group discussions with 40 mental health providers in the Xicheng (city) and Daxing (town) districts in Beijing, China in 2011. Results: Regional disparities between providers' knowledge of early diagnosis of dementia and related counseling skills were identified. Regional similarities included training needs, dementia-related stigma, and low awareness of dementia among family caregivers. Conclusion: Culturally sensitive education specific to dementia for mental health providers and a specialized dementia care model for people with dementia and their family caregivers are urgently needed. Implications for geriatric practitioners and educators are discussed.
    No preview · Article · Jan 2015 · Gerontology & Geriatrics Education
  • S.-T. Cheng · I. Chi · H.H. Fung · L.W. Li · J. Woo
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    ABSTRACT: This book brings together state-of-the-art research on successful aging in Asian populations and highlights how the factors that contribute to successful aging differ from those in the West. It examines the differences between the Asian and Western contexts in which the aging process unfolds, including cultural values, lifestyles, physical environments and family structures. In addition, it examines the question of how to add quality to longer years of life. Specifically, it looks at ways to promote health, preserve cognition, maximize functioning with social support and maintain emotional well-being despite inevitable declines and losses. Compared to other parts of the world, Asia will age more quickly as a result of the rapid socioeconomic developments leading to rising longevity and historically low fertility rates in some countries. These demographic forces in vast populations such as China are expected to make Asia the main driver of global aging in the coming decades. As a result, researchers, professionals, policymakers, as well as the commercial sector, in both East and West, are increasingly interested in gaining a deeper understanding of aging in Asia.
    No preview · Article · Jan 2015
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    ABSTRACT: This chapter reviews the conceptual underpinnings of successful aging and related concepts including productive aging, healthy aging, and active aging. Specific focus was placed on Rowe and Kahn's model of successful aging and the controversies around the concept, with particular emphasis on the model's limitations when being applied to developing countries where access to healthcare is often limited, and Asian cultures which tend to espouse a more holistic view of health and wellness. We argue that successful aging needs to be viewed within the broader social and cultural contexts and has to incorporate psychological, social, and physical dimensions. Finally, we discuss the organization of the book and provide a sketch of the four parts to follow.
    No preview · Article · Jan 2015
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    ABSTRACT: In contrast to mainstream and Western models of successful aging with an emphasis on individual responsibility and agency, Asian cultures have strong collectivistic values and models of successful aging need to move away from purely individualistic paradigms. The family has been playing a major role in supporting individuals to age successfully. Nevertheless, demographic changes have put strains on the family system, which has been undergoing changes as industrialization and modernization progress in this region. We discuss changing relationships among the State, the family, and the individual in Asia, and the demand for greater state involvement to meet the needs of older persons and support families to continue their traditional role. Finally, we highlight key research and policy directions that are urgently needed in the region.
    No preview · Article · Jan 2015
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    ABSTRACT: Objective: This study compared urban and rural factors associated with life satisfaction among older adults in mainland China. Method: Study data were extracted at random from 10% of the Sample Survey on Aged Population in urban/rural China in 2006 for 1980 participants aged 60 and older, including 997 from urban cities and 983 from rural villages. Results: In this study, 54.6% of urban older adults and 44.1% of rural older adults reported satisfaction with their lives. Binary logistic regression analysis showed that financial strain, depressive symptoms, filial piety, and accessibility of health services were significantly associated with life satisfaction for both urban and rural participants, but age and financial exchange with children were only associated with life satisfaction among urban older adults. Conclusion: Findings are consistent with some previous studies that indicated the importance of financial strain, depressive symptoms, filial piety, and accessibility of health services to life satisfaction among the older adults in both urban and rural areas. This study also demonstrated the importance of age and family financial exchange to the life satisfaction of urban older adults.
    No preview · Article · Nov 2014 · Aging and Mental Health
  • Yura Lee · Iris Chi
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    ABSTRACT: Objectives: Based on the cognitive reserve theory, relationships among education, employment status, and cognition have been found in many studies. However, there are only few studies specifically investigating the influence of late-life verbal activities (reading, writing, and discussing) on cognition, comparing those who are yet impaired with cognition vs. who are already in the process of cognitive deterioration. This study aims to examine aforementioned predictors on cognition; categorized into normal, cognitively impaired not demented (CIND) and demented given by the expert consensus panel. Methods: The study employed a national sample of American older adults (70+) from the ‘Aging, Demographics, and Memory Study’. 702 respondents (Normal: 270, CIND: 190, Demented: 242) were included in the final analysis using multinomial logistic regression, controlling for age, sex, race, employment status, depression, perceived health, and ApoE genotype. CIND was treated as a reference group. Results: Results showed that longer education years (OR=1.10, CI=1.02-1.17), current employment (OR=4.30, CI=1.55-11.94), and more engagement in verbal activities (OR=1.20, CI=1.11-1.31) increased the odds to be diagnosed with normal cognition than with CIND. On the other hand, education years and employment status were not significant predictor when comparing CIND vs. demented group. Only engagement in verbal activities decreased the odds (OR=0.70, CI=0.64-0.76) to be diagnosed with dementia than with CIND. Conclusions: Findings suggest that late-life verbal activities are important for both normal and cognitively impaired group to prevent any or further deterioration while education and employment status were only significant for normal vs. CIND group. Different approaches will be required for implementation purposes on two groups.
    No preview · Conference Paper · Nov 2014
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    ABSTRACT: To investigate why first-generation Chinese immigrants with diabetes have difficulty obtaining, processing and understanding diabetes related information despite the existence of translated materials and translators. This qualitative study employed purposive sampling. Six focus groups and two individual interviews were conducted. Each group discussion lasted approximately 90 min and was guided by semistructured and open-ended questions. Data were collected in two community health centres and one elderly retirement village in Los Angeles, California. 29 Chinese immigrants aged ≥45 years and diagnosed with type 2 diabetes for at least 1 year. Eight key themes were found to potentially affect Chinese immigrants' capacity to obtain, communicate, process and understand diabetes related health information and consequently alter their decision making in self-care. Among the themes, three major categories emerged: cultural factors, structural barriers, and personal barriers. Findings highlight the importance of cultural sensitivity when working with first-generation Chinese immigrants with diabetes. Implications for health professionals, local community centres and other potential service providers are discussed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Full-text · Article · Nov 2014 · BMJ Open

Publication Stats

4k Citations
357.78 Total Impact Points


  • 2015
    • Rush University Medical Center
      Chicago, Illinois, United States
  • 2004-2015
    • University of Southern California
      • School of Social Work
      Los Ángeles, California, United States
  • 1989-2015
    • The University of Hong Kong
      • • Sau Po Centre on Aging
      • • Department of Psychology
      • • Department of Social Work and Social Administration
      Hong Kong, Hong Kong
    • University of California, Davis
      • School of Medicine
      Davis, California, United States
  • 1988-2015
    • University of California, Los Angeles
      • • Department of Community Health Sciences
      • • Department of Social Welfare
      Los Ángeles, California, United States
  • 2013
    • National Taiwan University
      T’ai-pei, Taipei, Taiwan
  • 2010
    • Lanzhou University
      Kao-lan-hsien, Gansu Sheng, China
  • 2009
    • The Hong Kong Polytechnic University
      • School of Nursing
      Hong Kong, Hong Kong
  • 2008
    • University of South Carolina
      Columbia, South Carolina, United States
  • 2007
    • The Ohio State University
      • College of Social Work
      Columbus, Ohio, United States
  • 2001
    • University of Macau
      • Faculty of Social Sciences and Humanities
      Macao, Macau, Macao
  • 1994-1999
    • Prince of Wales Hospital, Hong Kong
      Chiu-lung, Kowloon City, Hong Kong