OBJECTIVES. To evaluate the efficacy of a birth ball exercise programme conducted by physiotherapists on pain relief, psychological care, and facilitation of the labour process at a labour ward in a regional hospital.

DESIGN. Case series with before-after comparisons.

SETTING. Kwong Wah Hospital, Hong Kong.

PARTICIPANTS. Chinese women admitted to the labour ward for spontaneous vaginal delivery between April and August 2012 were recruited. Physiotherapists taught birth ball exercises in groups or individually for 30 minutes. Labour pain intensity, back pain intensity, frequency of labour pain, stress and anxiety levels, and subjective pressure level over the lower abdomen were captured before and after birth ball exercises. Most of the parameters were measured using self-reported visual analogue scales. After the exercise session, physiotherapists measured the women’s satisfaction level. Midwives recorded pethidine usage.

RESULTS. A total of 203 pregnant women participated in this programme; 181 were in the latent phase group, whereas 22 were categorised into the no-labour-pain group. In both groups, there were statistically and clinically significant differences in back pain level, stress and anxiety levels, as well as pressure level over the lower abdomen before and after the exercise (P<0.05). In the latent phase group, significant decreases in labour pain and frequency of labour pain were demonstrated. Mean satisfaction scores were high, with visual analogue scale scores higher than 8.2 in both groups. Pethidine usage showed a further decreasing trend (6.4%) compared with the past 2 years.

CONCLUSION. Birth ball exercise could be an alternative means of relieving back pain and labour pain in the labour ward, and could decrease pethidine consumption in labouring women.

Key words: Exercise; Labor pain; Pain management; Parturition; Pregnancy

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OBJECTIVES. To explore qualitative and quantitative changes in attitudes and experiences of medical students following a special study suicide prevention module.

DESIGN. Pilot study.

SETTING. The University of Hong Kong, Hong Kong.

PARTICIPANTS. A 2-week intensive special studies module was delivered to third- and fourth-year medical students in June 2011. The module was elective and involved several modes of teaching. All students filled the Chinese Attitude toward Suicide Questionnaire before and after the course. They also provided written feedback about the module experience. Three students participated in in-depth interviews.

RESULTS. In all, 22 students aged 20 to 23 years enrolled in the special studies module; 15 (68%) of whom were male and only one was married. Positive trends were noted in attitudes towards suicide following the participation in the special studies module, namely, reduced negative appraisal of suicide, reduced stigmatisation of the phenomena, and increased sensitivity to suicide-related facts. Feedback of the students suggested inclusion of this module into the main medical curriculum, increased confidence in dealing with issues related to suicide, and appreciation of skills focusing on interviewing in patients. Overall the module was well received by medical students.

CONCLUSIONS. A suicide prevention training module seems to have been valued by students and lead to positive attitudes towards understanding suicide. Adopting this initiative as a suicide prevention strategy warrants further exploration.

Key words: Attitude; Hong Kong; Students, medical; Suicide

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OBJECTIVE. Much attention has recently been focused on the underlying role of circulating inflammatory biomarkers such as high-sensitivity C-reactive protein for predicting cardiovascular disease progression. We therefore set out to assess the relationship between the value of high-sensitivity C-reactive protein and (i) coronary artery disease severity, and (ii) left ventricular end diastolic pressure.

DESIGN. A cross-sectional study.

SETTING. The Shafa hospital in Kerman, Iran.

PATIENTS. A total of 107 consecutive patients referred for coronary angiography from January 2008 to January 2009 were prospectively studied.

INTERVENTION AND MAIN OUTCOME MEASURES. All patients underwent coronary angiography. They all had undergone left ventricular end diastolic pressure measurement, involving a 6-Fr pigtail catheter and a properly zeroed fluid-filled pressure transducer. For each patient, the level of high-sensitivity C-reactive protein was also determined using enzyme-linked immunosorbent assay kits.

RESULTS. The high-sensitivity C-reactive protein levels could strongly predict increased left ventricular end diastolic pressure (standardised beta=1.010; P=0.008), with other patient variables being confounders, but there was no significant association between these levels and Gensini scores. Multiple linear regression analysis showed that among the study parameters, systolic hypertension (standardised beta=1.611; P=0.047) and a family history of coronary artery disease (standardised beta=1.911; P=0.005) were the main predictors of high Gensini scores in study patients.

CONCLUSION. High-sensitivity C-reactive protein level is a clinical parameter that could predict left ventricular end diastolic pressure and left ventricular dysfunction, but was not associated with the severity of coronary artery disease.

Key words: Coronary artery disease; C-reactive protein; Heart ventricles

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OBJECTIVE. To evaluate the clinical efficacy of percutaneous cementoplasty with respect to pain relief in patients with refractory painful bone metastases.

DESIGN. Case series.

SETTING. Regional hospital, Hong Kong.

PATIENTS. All oncological patients with painful bone metastases despite conventional treatment seen between October 2006 and May 2010 were recruited.

INTERVENTIONS. Cementoplasty with or without radiofrequency ablation.

MAIN OUTCOME MEASURES. Pain score before and after the procedure.

RESULTS. In all, 12 patients with 13 lesions received cementoplasty. Two patients were excluded from the analysis because of inadequate documentation of pain score due to rapid disease progression. For the remaining 10 patients with 11 metastases, the primary sites were the lung (n=3), renal cell carcinoma (n=2), rectum (n=2), pancreas (n=1), multiple myeloma (n=1), and soft tissue sarcoma (n=1). The locations of the metastatic lesions were scapula (n=1), thoracic vertebrae (n=1), lumbar vertebrae (n=3), and pelvic bones (n=6). Eight lesions were treated by cementoplasty alone, whereas the other three associated with large soft tissue components had radiofrequency ablation followed by cementoplasty in a single setting. Immediate or near-immediate pain relief after treatment was achieved in 10 out of 11 lesions; the median pain score was 5 before treatment and decreased to 2 a week after treatment (P=0.039). In all lesions for which the pain was successfully controlled in the first week, the palliation effect persisted at subsequent follow-ups. The median follow-up period for these patients was 16 weeks, and the longest pain-relieving effect was at least 9 months.

CONCLUSION. In our experience, cementoplasty with or without radiofrequency ablation achieves satisfactory and long-lasting pain control in oncological patients with bone metastases. This is the first local study to describe the effect of cementoplasty for pain relief. Patients with painful bone metastases that are refractory to conventional treatments can benefit from cementoplasty, which should therefore be considered when conservative treatments fail.

Key words: Bone neoplasms; Cementoplasty; Pain management

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OBJECTIVES. To identify factors affecting the sex ratio at birth.

DESIGN. Cross-sectional study.

SETTING. Obstetric department of a public hospital in Hong Kong.

PARTICIPANTS. All pregnant women delivered between 2001 and 2010.

MAIN OUTCOME MEASURES. Sex ratio at birth versus women’s eligibility status, age, parity, number of miscarriages or terminations of pregnancy, and number of fetuses were analysed using the Chi squared test. Multivariate regression was used to determine the effects of multiple factors on the sex of the newborn.

RESULTS. A total of 54 039 cases were reviewed. The sex ratio at birth changed since 2003, and became unbalanced (>107 males per 100 females) since 2006 revealed by a significant increase in males per 100 females, from 106.6 in 2001-2005 to 111.4 in 2006-2010. From 2001 to 2010, the sex ratio at birth increased from being balanced to becoming unbalanced in eligible persons, and became more unbalanced in non-eligible persons. The ratio increased in eligible persons after having two children, but in non-eligible persons after having one child. The sex ratio at birth was unbalanced (1.095) in singleton pregnancies, but balanced (1.019) in multiple pregnancies. Based on logistic regression, the chance of a male baby being born increased with parity of 2 or above (odds ratio=1.1; P<0.001), non-eligible person status (odds ratio=1.05; P=0.034), and delivery in the period 2006-2010 (odds ratio=1.04; P=0.019). The ratio was not increased with advanced maternal age, the number of miscarriages/terminations of pregnancy, and number of fetuses.

CONCLUSION. Compared with 2001-2005, the sex ratio at birth became unbalanced in 2006-2010. An unbalanced ratio ensued in the latter period in both eligible and non-eligible persons, but to a greater extent and even after having one child in the latter group.

Key words: Birth rate; Hong Kong; Pregnancy; Sex ratio

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