Cynthia Chan

Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers

BACKGROUND Helicobacter pylori infection is common in patients with peptic ulcers caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs). But the pathogenic role of H pylori in this disease is controversial. We studied the efficacy of eradication of H pylori in the prevention of NSAID-induced peptic ulcers. METHODS We recruited patients with musculoskeletal pain who required NSAID treatment. None of the patients had previous exposure to NSAID therapy. Patients who had H pylori infection but no pre-existing ulcers on endoscopy were randomly allocated naproxen alone (750 mg daily) for 8 weeks or a 1-week course of triple therapy (bismuth subcitrate 120 mg, tetracycline 500 mg, metronidazole 400 mg, each given orally four times daily) before administration of naproxen (750 mg daily). Endoscopy was repeated after 8 weeks of naproxen treatment or when naproxen treatment was stopped early because of bleeding or intractable dyspepsia. All endoscopic examinations were done by one endoscopist who was unaware of treatment assignment. The primary endpoint was the cumulative rate of gastric and duodenal ulcers. FINDINGS 202 patients underwent endoscopic screening for enrolment in the trial, and 100 eligible patients were randomly assigned treatment. 92 patients completed the trial (47 in the naproxen group, 45 in the triple-therapy group). At 8 weeks, H pylori had been eradicated from no patients in the naproxen group and 40 (89%) in the triple-therapy group (p < 0.001). 12 (26%) naproxen-group patients developed ulcers: five had ulcer pain and one developed ulcer bleeding. Only three (7%) patients on triple therapy had ulcers, and two of these patients had failure of H pylori eradication (p = 0.01). Thus, 12 (26%) patients with persistent H pylori infection but only one (3%) with successful H pylori eradication developed ulcers with naproxen (p = 0.002). INTERPRETATION Eradication of H pylori before NSAID therapy reduces the occurrence of NSAID-induced peptic ulcers.

Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial.

BACKGROUND Whether Helicobacter pylori increases the risk of ulcers in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) is controversial. We hypothesised that eradication of H pylori infection would reduce the risk of ulcers for patients starting long-term NSAID treatment. METHODS Patients were enrolled if they were NSAID naïve, had a positive urea breath test, had dyspepsia or an ulcer history, and required long-term NSAID treatment. They were randomly assigned omeprazole triple therapy (eradication group) or omeprazole with placebo antibiotics (placebo group) for 1 week. All patients were given diclofenac slow release 100 mg daily for 6 months from randomisation. Endoscopy was done at 6 months or if severe dyspepsia or gastrointestinal bleeding occurred. The primary endpoint was the probability of ulcers within 6 months. Analyses were by intention to treat. FINDINGS Of 210 arthritis patients screened, 128 (61%) were positive for H pylori. 102 patients were enrolled, and 100 were included in the intention-to-treat analysis. H pylori was eradicated in 90% of the eradication group and 6% of the placebo group. Five of 51 eradication-group patients and 15 of 49 placebo-group patients had ulcers. The 6-month probability of ulcers was 12.1% (95% CI 3.1-21.1) in the eradication group and 34.4% (21.1-47.7) in the placebo group (p=0.0085). The corresponding 6-month probabilities of complicated ulcers were 4.2% (1.3-9.7) and 27.1% (14.7-39.5; p=0.0026). INTERPRETATION Screening and treatment for H pylori infection significantly reduces the risk of ulcers for patients starting long-term NSAID treatment.

Epidemiology of Irritable Bowel Syndrome in Chinese

Irritable bowel syndrome (IBS) is common in Caucasians and Japanese, but its epidemiology has not been studied in urbanized Chinese populations. Our aim was to compare diagnostic criteria and study the epidemiology of IBS in Hong Kong Chinese. In all, 964 subjects from public housing and 334 subjects from private housing were recruited for face-to-face interviews in Shatin, Hong Kong. A structured questionnaire was used to measure the prevalence of IBS according to the Manning, Rome I, and Rome II criteria. The SF-36 scale was used to measure quality of life (QOL) in subjects with IBS and in normal controls. The results were compared by the analysis of covariance (ANCOVA). Relevant medical consultations and absence from work were recorded. There was fair agreement between the Manning and Rome II criteria (κ = 0.23; P < 0.001), but good agreement between the Rome I and Rome II criteria (κ = 0.5; P < 0.001). The prevalence of IBS, based on the Rome II criteria, was 3.6% (95% CI = 2.0–5.2) in men and 3.8% (95% CI = 2.5–5.2) in women. Men with IBS had significantly lower vitality scores on the SF-36 scale than the controls (P < 0.05 by ANCOVA), and women with IBS had significantly lower mental health scores than controls (P < 0.05 by ANCOVA). In conclusion, IBS is quite prevalent in Hong Kong Chinese, and the QOL of subjects with IBS was significantly affected.

Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause.

ObjectivePueraria lobata (PL) is used as a traditional Chinese herbal remedy for menopausal symptoms, as well as an ingredient in preparations for conditions affecting menopausal women, such as osteoporosis, coronary heart disease, and some hormone-dependent cancers. The scientific basis for its action may be its action as a phytoestrogen. DesignTo examine the effects of PL in comparison with hormone replacement therapy (HRT) on lipid profile, sex hormone levels, bone turnover markers, and indices of cognitive function. For the study, 127 community-living, postmenopausal women aged 50 to 65 years were randomized to receive HRT (n = 43), PL (equivalent to 100 mg isoflavone; n = 45), or no treatment (n = 39) for 3 months. The following measurements were carried out at baseline and after 3 months for all participants: menopausal symptoms questionnaire; neuropsychological tests covering memory, attention, motor speed, and word-finding ability; quality of life (SF36); lipid profile; urinary deoxypyridinoline; dietary phytoestrogen intake and urinary phytoestrogen; estradiol; follicle-stimulating hormone; and luteinizing hormone. ResultsOnly participants in the HRT group showed a mean reduction in cholesterol and low-density lipoprotein cholesterol that was significantly different from that of the control group. No significant changes in lipid profile or follicle-stimulating hormone and luteinizing hormone were observed in the PL group compared with the controls. However, both the HRT and PL groups showed an improvement in Mini-Mental State Examination score and attention span compared with the case of participants receiving no treatment. HRT and PL had different effects on cognitive function; HRT improved delayed recall, whereas flexible thinking seemed improved in the PL group. ConclusionsThis study was unable to demonstrate a scientific basis for the use of PL for improving the health of postmenopausal women in general. However, the effect of PL on cognitive function deserves further study.

Determinants of peak bone mass in Chinese women aged 21-40 years. III. Physical activity and bone mineral density

Previous studies on the relation between moderate physical activity and bone mass have observed conflicting results. Many of these studies have not dissociated the role of physical activity by age groups and in relation to the period of peak bone mass formation. Our cross‐sectional analysis of the baseline data of a longitudinal study of 273 women aged 21–40 attempted to evaluate the role of moderate physical activity on bone mass around the period of peak bone mass attainment. The analyses were carried out separately for the two age groups—21–30 and 31–40—and had also taken into account the effects of age, dietary calcium intake, and lean body mass on bone mineral density (BMD). The total metabolic equivalent values (MET) of leisure time physical activity was based on the MET values for each activity and the reported time spent on each activity in the past year. The results indicated that among the younger group of women, high level of leisure time physical activity was associated with higher bone mass at both the spine and the hip. Additive effects of physical activity and dietary calcium intake on the spine and the hip BMD were observed. Together with age and lean body mass, physical activity and dietary calcium intake accounted for 19% of the variances of bone mineral at the spine and 9–11% at the hip. Among women aged 31–40, presumably after the peak bone mass formation, lean body mass as well as fat mass have independent strong association with BMD. Physical activity was not associated with bone mass in this age group.

Determinants of bone mass in Chinese women aged 21-40 years. II. Pattern of dietary calcium intake and association with bone mineral density.

A study on the determinants of bone mass in young women is being carried out among 287 young Chinese women aged 21–40 years. The baseline cross-sectional data show that the mean dietary calcium intake, estimated from the quantitative food frequency method, was 448 mg/day (standard deviation = 219). About 50% of the calcium source was from vegetables and 22% from dairy products. Among women aged 21–30 years, those with a dietary calcium intake of at least 600 mg/day had a 4%–7% higher mean bone mineral density at the spine and femur when compared with those with a mean intake below 300 mg/day. In women aged 31–40 years, subjects belonging to the highest quartile of calcium density (⩾35 mg/420 kJ) had a 3%–8% higher mean bone mineral density at the spine and femur when compared with those in the lowest quartile (<20.8 mg/420 kJ). Favorable calcium intake is beneficial in this population of young women with habitual low dietary calcium intake.

Communication skill of general practitioners: any room for improvement? how much can it be improved?

Objective To measure any changes in the communication skills of primary care physicians before and after a part‐time Diploma course in Family Medicine.

Sero-epidemiology and risk factors of positive hepatitis B surface antigen amongst Chinese adolescents.

This paper reports the prevalence rate of hepatitis B antigen (HBsAg) amongst the Hong Kong Chinese adolescents (age 11 to 19), and the risk factors associated with HBsAg positive. The study is cross sectional and 1,580 students were randomly selected from 12 secondary schools in four regions of Hong Kong. For those subjects who agreed to participate and were randomly selected, their blood was tested for HBsAg and anti-HBs. The overall prevalence of HBsAg positive was reported to be 5.8% (7.9% in male and 4.1% in female), lower than 8.1% in 1978. Males, those born in Mainland China and family history of carriers had higher prevalence of HBsAg positive (7.9% vs 4.1%, 12.2% vs 4.7%, 52.9% vs 3.8% respectively) with statistical significance. Males and those born in mainland China were found to have significantly higher odds ratio 1.8 (95% CI. 0.98-3.52) and 4.4 (95% CI. 2.2-8.8) respectively of HBsAg positive by multivariate analysis. Findings suggest that family history of carriers and those born in endemic area are at a higher risk. Therefore it is worthwhile to consider vaccination programme for adolescents to reduce the carrier rate, and to also reduce the infection amongst the adults by horizontal transmission. Asia Pac J Public Health 2001;13(1): 30-35

A longitudinal study of the determinants of bone mass in Chinese women aged 21 to 40. I. Baseline association of anthropometric measurements with bone mineral density.

The bone mineral density of the lumbar spine (L2 to L4) and neck of the femur of 293 Chinese women aged 21 to 40 years was measured using a dual x-ray densitometer. The participants were recruited from subjects registered with the University Family Medicine Clinic in Hong Kong. Our cross-sectional data showed that maximal bone mass occurs in the early 30s. Both the spine and hip bone masses were observed to decline at a rate of around 1% per annum from the early 30s onward. Body weight, lean body mass, and body fatness were significantly associated with the mineral density of the spinal and femoral bones after or around the attainment of peak bone mass, while no correlation of these data was observed in the younger age group (20 to 28 years). Other factors may play a more important role than body mass in influencing bone mineral density before attainment of peak bone mass.

Role Occupancy, Role Quality, and Psychological Distress in Chinese Women

ABSTRACT This study explored the associations between role occupancy, role quality, and psychological distress in 897 Chinese women in Hong Kong. Results showed that employed as compared to nonemployed women reported a lower level of psychological distress. Never married as compared to married women, and mothers as compared to childless women, did not differ in their levels of psychological symptoms. Correlation results indicated that a net gain of rewards over concerns about social roles was negatively related to psychological distress. The number of social roles was related to the balance between rewards and concerns between social roles, but had no significant association with mental health status of women. Results of the hierarchical regression analyses showed that good mother role quality and the occupancy of the paid worker role were significant predictors of a low level of psychological distress. Findings based on a subsample of employed mothers failed to support the compensatory and spillover hypotheses. Limitations and implications for future studies were discussed.