Cardiopulmonary response to exercise of 8- and 13-year-old Chinese children in Hong Kong: results of a pilot study

ABSTRACT
Hong Kong Med J 1999;5:121–7 | Number 2, June 1999
ORIGINAL ARTICLE
Cardiopulmonary response to exercise of 8- and 13-year-old Chinese children in Hong Kong: results of a pilot study
RYT Sung, SSF Leung, TK Lee , JCY Cheng, PKW Lam, YY Xu
The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVES. To assess the cardiopulmonary response of healthy Hong Kong Chinese children to the treadmill test, and to identify anthropometric factors that may be related to fitness.
 
DESIGN. Cross-sectional study.
 
SETTING. University teaching hospital, Hong Kong.
 
PARTICIPANTS. Forty-three 8-year-old and fifty-seven 13-year-old healthy Chinese children from middle– or lower–social class families in Shatin and nearby areas.
 
MAIN OUTCOME MEASURES. The forced vital capacity, 1-second forced expiratory volume, pulse rate, and blood pressure were measured before and after undertaking the treadmill test (Bruce protocol). The endurance time until volitional exhaustion, the number of metabolic equivalents of energy used, and the sum of the skinfold thicknesses were also obtained.
 
RESULTS. Multiple regression analysis showed that the sum of the skinfold thicknesses was positively associated with pulse rates and diastolic blood pressure at all stages of exercise and was negatively associated with the endurance time of and number of metabolic equivalents used by the 8-year-old children. The 13-year-old children had a longer cardiopulmonary endurance than the 8-year-old children. In both age-groups, pulmonary function was positively associated with height and weight.
 
CONCLUSION. The study provides useful reference data for Hong Kong Chinese 8- and 13-year-old children when subjected to the treadmill test. A larger study is needed to establish the normal standards for children of all different ages.
 
Key words: Adolescent; Blood pressure; Body mass index; Child; Exercise test/standards; Heart rate; Respiration; Skinfold thickness
 
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Geriatric screening in acute care wardsa novel method of providing care to elderly patients

ABSTRACT
Hong Kong Med J 1999;5:34–8 | Number 1, March 1999
ORIGINAL ARTICLE
Geriatric screening in acute care wards a novel method of providing care to elderly patients
JKH Luk, T Kwok, J Woo
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
OBJECTIVE. To assess a nurse-implemented geriatric screening system.
 
DESIGN. Descriptive study.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. All (5080) elderly patients admitted between 1 January 1996 and 31 December 1996.
 
MAIN OUTCOME MEASURES. Patient characteristics such as disease, prior admission, living quarters, and regular medications; interventions taken; and morbidity and mortality.
 
RESULTS. The most common interventions were referral to a convalescent hospital, patient education, and carer contact. The overall death rate was 8.5% and the diseases with the highest mortality rates were renal failure, liver cirrhosis, and cancer. Approximately one quarter of patients had been admitted to hospital in the previous month. The death rate was higher among women than men (10.8% versus 6.7%, P<0.001; odds ratio=1.68; 95% confidence interval, 1.38-2.05), as was the percentage of those with a history of admission in the previous month (32.8% versus 20.0%, P<0.001; odds ratio=1.95; 95% confidence interval, 1.71-2.21). Patients with multiple pathologies and polypharmacy had a greater frequency of previous 1-month admission compared with those who did not have these features (37.5% versus 20.0%, P<0.001; odds ratio=2.37; 95% confidence interval 2.0-2.7). Patients living in old-age homes had a higher death rate and more previous 1-month admissions than home dwellers, and patients living in private old-age homes had a higher death rate but lower number of previous 1-month admissions than those living in subsidised old-age homes.
 
CONCLUSIONS. This study has collected important data from one form of integrated geriatric practice, which can be used for future service provision.
 
Key words: Aged; Geriatric assessment; Health services for the aged; Hospitalization; Patient care team
 
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Anaesthesia for liver transplantation: experience at a teaching hospital

ABSTRACT
Hong Kong Med J 1999;5:27–33 | Number 1, March 1999
ORIGINAL ARTICLE
Anaesthesia for liver transplantation: experience at a teaching hospital
SKY Fung, TWC Hui, AKY Wong, GMY Lei
Department of Anaesthesiology, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
OBJECTIVE. To assess the anaesthetic aspects of liver transplantation.
 
DESIGN. Retrospective study.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. The first 55 patients who received liver transplantations between 5 October 1991 and 14 June 1997.
 
MAIN OUTCOME MEASURES. The anaesthetic technique used; indications for liver transplantation and type of graft transplanted; survival rate; duration of anaesthesia and surgical starting time; intra-operative changes associated with major transfusion; frequency of hypothermia, coagulopathy, and reperfusion; frequency of use of cell saver devices, veno-venous bypass, and a rapid infusion system; and associated complications.
 
RESULTS. All patients received general anaesthesia with rapid sequence induction. Most adult recipients had cirrhosis from various causes, whereas biliary atresia was the most common condition in the paediatric population. Both cadaveric and living-related liver transplantations were performed, and the overall 1-year survival rate of patients who received a transplantation before June 1996 was 85%. Veno-venous bypass was used in 84% of adults, but in none of the paediatric patients; a cell saver device was used for all adult patients and 92% of paediatric patients. All transplant recipients had acidosis, hypothermia, and hypotension during the operation.
 
CONCLUSIONS. Liver transplantation is no longer experimental. It is the therapeutic option for patients with chronic liver failure. Good anaesthetic support is an essential element of a liver transplantation service.
 
Key words: Anesthesia; Intraoperative complications; Liver transplantation; Postoperative complications
 
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Parental anxiety associated with participation in anaesthetic induction in children: questionnaire survey

ABSTRACT
Hong Kong Med J 1999;5:21–6 | Number 1, March 1999
ORIGINAL ARTICLE
Parental anxiety associated with participation in anaesthetic induction in children: questionnaire survey
JCZ Lui, KK Wu
Department of Anaesthesia, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Kowloon, Hong Kong
 
 
OBJECTIVE. To determine the reasons why Chinese parents for accompanying their child during anaesthetic induction; to explore the level of anxiety experienced by the parents; and to evaluate the factors that contribute to parental anxiety.
 
DESIGN. Questionnaire study of Chinese parents who had chosen to be present during the anaesthetic induction of their child between January 1997 and July 1997.
 
SETTING. Day Surgery Unit at a public hospital, Hong Kong.
 
PARTICIPANTS. One hundred and fifty-one Chinese parents of 151 children undergoing general anaesthetic for surgery.
 
MAIN OUTCOME MEASURES. Parental anxiety, as evaluated by a self-reporting rating system and the State-Trait Anxiety Scale.
 
RESULTS. More than half (56%) of the participants graded their experience as either "very anxious but tolerable" or "a little anxious", and only 2% graded the situation as "very anxious, intolerable". All participants were either "satisfied" or "very satisfied" with their experience. The type of surgery and any history of previous surgical intervention were found to be factors that determined the level of state anxiety (P<0.05).
 
CONCLUSIONS. Most Chinese parents decide to be present at their child’s anaesthetic induction because of a sense of duty and concern. Parental presence does not provoke further or intolerable parental anxiety. One limitation of this study is that the level of anxiety measured might be due to the combination of anaesthetic induction and surgery rather than to concerns about anaesthetic induction alone.
 
Key words: Anesthesia; Anxiety; Child; Parent-child relations; Preoperative care; Psychology; Questionnaires
 
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A comparison of pregnancy outcome between high-order multiple and twin pregnancies: matched-pair retrospective study

ABSTRACT
Hong Kong Med J 1999;5:16–20 | Number 1, March 1999
ORIGINAL ARTICLE
A comparison of pregnancy outcome between high-order multiple and twin pregnancies: matched-pair retrospective study
H Lam, PC Ho
Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
OBJECTIVE. To compare the pregnancy outcome between high-order multiple and twin pregnancies.
 
DESIGN. Matched-pair retrospective analysis.
 
SETTING. University teaching hospital, Hong Kong.
 
PATIENTS. Patient records from 38 high-order multiple pregnancies that were delivered over a period of 15 years, and those from matched twin pregnancies.
 
MAIN OUTCOME MEASURES. Obstetric and perinatal outcomes.
 
RESULTS. The incidence of high-order multiple pregnancies increased over the study period in association with the more frequent practice of ovulation induction and other assisted reproductive techniques. High-order multiple pregnancies were associated with a higher incidence of maternal complications and a significantly higher perinatal mortality rate than were twin pregnancies.
 
CONCLUSION. Efforts should be made to prevent multiple pregnancies by carefully monitoring ovulation treatment and by limiting the number of embryos transferred.
 
Key words: Comparative study; Fertilization in vitro; Ovulation induction; Pregnancy, multiple; Pregnancy outcome
 
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The effects of different dosages of oestrogen on the bone mineral density of postmenopausal Hong Kong Chinese women: randomised controlled trial

ABSTRACT
Hong Kong Med J 1999;5:9–14 | Number 1, March 1999
ORIGINAL ARTICLE
The effects of different dosages of oestrogen on the bone mineral density of postmenopausal Hong Kong Chinese women: randomised controlled trial
KY Leung, TK Lee, CN Lee, TK Sum, MYM Chan, CM Tong
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
OBJECTIVE. To determine the effects of different dosages of conjugated equine oestrogen on the bone mineral density of postmenopausal Hong Kong Chinese women.
 
DESIGN. A 1-year three-arm randomised controlled trial.
 
SETTING. Out-patient setting at a governmental hospital in Hong Kong.
 
PARTICIPANTS. One hundred and five women aged 45 years or older, in whom menopause had occurred not more than 2 years previously.
 
INTERVENTION. Women were assigned randomly to treatment with conjugated equine oestrogen 0.625 mg/d or 0.3 mg/d, or no oestrogen.
 
MAIN OUTCOME MEASURES. Bone mineral density.
 
RESULTS. Women who were assigned to the control group showed a significant reduction in bone mineral density in both the femoral neck and the lumbar spine (3.6%; P=0.001 and 4.0%; P<0.001, respectively). Those who received oestrogen 0.3 mg/d showed a significant reduction (3.9%; P=0.010) and a non-significant reduction (2.2%; P=0.141) in their lumbar spine and femoral neck bone mineral densities, respectively. In contrast, there was little change in the spinal and femoral neck bone mineral densities in women who received estrogen 0.625 mg/d.
 
CONCLUSION. The minimum effective dosage of conjugated equine oestrogen to prevent osteoporosis in postmenopausal Hong Kong Chinese women is 0.625 mg/d. The bone mineral density, however, was maintained but not increased.
 
Key words: Bone density; Estrogen replacement therapy; Hong Kong; Osteoporosis, postmenopausal
 
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Translation and calibration of a Chinese version of the Sickness Impact Profile for use in Hong Kong

ABSTRACT
Hong Kong Med J 1998;4:375-81 | Number 4, December 1998
ORIGINAL ARTICLE
Translation and calibration of a Chinese version of the Sickness Impact Profile for use in Hong Kong
TG Short, MY Rowbottom, JPF Lau, GWY Lau, TA Buckley, TE Oh
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
Because of the lack of suitable generic health status measures in Hong Kong that reflect the value structure and culture of the society, we have translated and calibrated the Sickness Impact Profile, which was originally developed in the United States. Translation consisted of a sequence of forward translations into Chinese, back translations into English and, when there was a loss of meaning or conceptual equivalence, retranslation into Chinese. Sixty Hong Kong Chinese people, including health professionals, patients, and members of the public were then recruited to determine item and dimension weights for the Hong Kong population. Individual ratings were averaged to obtain a consensus value for each item. Within-category reliability analysis for scores varied from 0.70 to 0.92 (Cronbach's alpha values) and overall internal consistency was 0.98. There were only small differences between this version and the original American English version in the ratings given to individual questions (Pearson's product moment correlation coefficient, r=0.8). We have developed a Chinese translation of the Sickness Impact Profile, which can now be used to evaluate health outcomes in Hong Kong and to compare outcomes with studies in other populations where the Sickness Impact Profile was used.
 
Key words: Health status; Health surveys; Sickness Impact Profile; Translations
 
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Epidemiology of severe childhood eye injuries that required hospitalisation

ABSTRACT
Hong Kong Med J 1998;4:371-4 | Number 4, December 1998
ORIGINAL ARTICLE
Epidemiology of severe childhood eye injuries that required hospitalisation
ASY Poon, JSK Ng, DSC Lam, DSP Fan, ATS Leung
Eye Unit, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
We conducted a retrospective study of all paediatric ocular injuries that were treated at the Prince of Wales Hospital between October 1991 and January 1997. Of the 60 injuries reviewed, eight (13.3%) resulted in some degree of visual deficit. The mean age was 5.5 years and the average male to female ratio was 2.75:1. The distribution of injuries was as follows: contusions, 29 (48.3%); non-penetrating lacerations, 14 (23.3%); penetrating lacerations, six (10.0%); chemical burns, six (10%) and superficial foreign bodies, five (8.3%). Thirteen (21.7%) ocular injuries were associated with common household items, seven (11.7%) injuries were due to toy gun pellets, and five (8.3%) injuries were sports-related. A total of 28 operations were performed on 21 patients, and the mean duration of hospital stay was 3.6 days. The visual outcome depended mainly on the type and severity of the injury. Some childhood eye injuries are preventable by means of more public education, improved safety measures, and closer adult supervision.
 
Key words: Eye injuries, epidemiology; Child
 
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Effectiveness of non-mydriatic retinal photography and direct ophthalmoscopy in detecting diabetic retinopathy

ABSTRACT
Hong Kong Med J 1998;4:367-70 | Number 4, December 1998
ORIGINAL ARTICLE
Effectiveness of non-mydriatic retinal photography and direct ophthalmoscopy in detecting diabetic retinopathy
SC Siu, TC Ko, KW Wong, WN Chan
Diabetes Centre, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
 
 
This is a prospective study to compare the effectiveness of non-mydriatic photography with that of direct ophthalmoscopy in screening for diabetic retinopathy in 153 patients attending a hospital clinic in Hong Kong. Retinal photography under physiological mydriasis and direct ophthalmoscopy of patients with dilated pupils were compared with the ophthalmologists' examination results as a reference standard. The prevalence of diabetic retinopathy in this sample population was 15%. The sensitivity of detecting diabetic retinopathy by retinal photography was higher than that of direct ophthalmoscopy (64% versus 41%; 95% confidence interval of difference, 1.2%-44.3%). Of five patients who had serious retinopathy, retinal photography failed to detect the disease in two; direct ophthalmoscopy failed to detect the disease in all five patients. Specificities of retinal photography and direct ophthalmoscopy were 90% (95% confidence interval, 84%-96%) and 93% (95% confidence interval, 88%-97%), respectively. We conclude that retinal photography is significantly more effective than direct ophthalmoscopy in detecting diabetic retinopathy. In addition, the non-mydriatic camera is easy to use and is the preferred method of screening.
 
Key words: Diabetic retinopathy; Mass screening; Photography; Sensitivity and specificity
 
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Current practice in preventing blood-borne diseases during organ/tissue transplantation in Hong Kong

ABSTRACT
Hong Kong Med J 1998;4:361-6 | Number 4, December 1998
ORIGINAL ARTICLE
Current practice in preventing blood-borne diseases during organ/tissue transplantation in Hong Kong
Scientific Committee of the Advisory Council on AIDS and the Hong Kong Society of Transplantation
5/F Yaumatei Jockey Club Clinic, 145 Battery Street, Yaumatei, Kowloon, Hong Kong
 
 
A questionnaire survey was conducted in late September 1996 to study the current practice in preventing blood-borne diseases during organ/tissue transplantation at local institutions. Twenty-five (83%) of 30 public transplantation institutions responded. Kidney and cornea/sclera transplantations were the most commonly practised procedures. Some institutions performed bone, skin, liver, heart and lung, and bone marrow transplantations. A variety of measures have been taken by most of the institutions to uphold safety during transplantation. Nevertheless, a lack of protocol standardisation and inadequate awareness to communicable diseases during transplantation are apparent. The establishment of local guidelines and the implementation of an effective monitoring mechanism might minimise the transmission risk of communicable diseases that are associated with transplantation.
 
Key words: Blood-borne pathogens; Organ transplantation; Risk; Virus diseases/prevention & control
 
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