Samuel Ys Wong

Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong.

Previous population studies have demonstrated an association between peripheral vascular disease and bone mineral density in women, but not in men. In a large prospective cohort of 3,998 Chinese men and women aged 65 to 92xa0years of age in Hong Kong, the association between peripheral vascular disease and bone mineral density was explored. Demographic and lifestyle information was obtained from face to face interviews using a standardized questionnaire. This included demographic information, medical history and lifestyle factors. Physical examination measurements included anthropometry and tibial and brachial systolic blood pressures. The ratio of the posterior tibial and brachial systolic blood pressures, the ankle/arm index, was used as a measure of peripheral arteriosclerosis in the lower extremities. Bone mineral density (BMD) at the total hip and spine (L1–L4) was measured by Hologic QDR-4500xa0W densitometers (Hologic, Inc., Waltham, Mass.). In this cross-sectional analysis, the ankle brachial index (ABI) was positively correlated with hip BMD (correlation coefficient=0.27; P <0.001). However, after adjustment for confounders, the correlation became much weaker (correlation coefficient=0.03; P <0.05). This showed that much of the relationship between ABI and BMD could be explained by other confounders. In multiple regression analysis, an increase in ABI of 1xa0SD of ABI was associated with an increase of 0.5% (95% CI: 0.02%, 0.9%) in hip BMD after adjusting for age, sex, body weight, smoking status, history of diabetes, cardiovascular diseases, use of thiazide diuretics, grip strength and physical activity. Although our study shows that peripheral vascular disease in the lower extremities may be associated with decreased bone mineral density, the association is weak especially after adjustment was made for confounders. This indicates that other factors may be contributing to the association between peripheral vascular disease and osteoporosis.

The influence of multi-morbidity and self-reported socio-economic standing on the prevalence of depression in an elderly Hong Kong population

BackgroundThere has been an increasing prevalence of both depression and chronic medical conditions globally but the relationship between depression and multi-morbidity is not well understood. The aim of the present study was to investigate the relationship between depression, multi-morbidity (number of chronic medical conditions, and measures of socioeconomic standing (SES) in an elderly Hong Kong population.MethodsCross sectional study. Information on clinically relevant depressive symptoms, measured by the Geriatric Depression Scale (GDS), and demographic and chronic medical conditions were collected using standardized questionnaires. Information collected on SES included educational status (ES), maximum ever income (MEI), and self-perceived social standing in local community (SES-COM) and in Hong Kong generally (SES-HK). Analysis was conducted using multiple logistic regressionResultsDepression rates were similar in men and women (GDS caseness 8.1% vs 8.4%). Multi-morbidity of chronic medical conditions was common (40% of men and 46% of women had three or more). In the overall sample, the prevalence of depression was associated with the number of chronic medical conditions (OR 1.27; CI: 1.16–1.39). In addition, SES-HK and SES-COM were significant independent variables.ConclusionIn this elderly Hong Kong population, depression prevalence rose markedly with number of chronic medical conditions and SES-HK and SES-COM.

Self-perceived social status and health in older Hong Kong Chinese women compared with men.

ABSTRACT Economic and social factors are determinants of health, as are psychosocial factors. The present study compared self-perceived social status and its relation to health, health related quality of life and lifestyle in older women with men, adjusting for age, education level and maximum lifetime income. A cross-sectional study was conducted of 4,000 men and women aged 65 years and over in a community in the North Eastern part of Hong Kong, a Special Administrative Region in China. Participants were asked to rate their community status, education, income and occupation, on two ladders, each with ten rungs. The distributions of the two ladder scores differed, showing that although participants may not have been ranked highly in terms of money, education and job respectability, they may have ranked their community standing highly. Women and older participants tended to rank their community standing highly in spite of lower ratings in the objective measures. A social gradient in self-perceived social status, independent of objective socioeconomic measures, was noted for physical performance and health-related quality of life, rather than related to presence of specific chronic diseases or lifestyle. However, the different ratings of the two ladders suggested that mechanisms by which the gradient operates may differ between women and men. Further studies are needed to explore the health and psychosocial consequences of the gender difference in self-rated social status.

Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis

Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi–randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, pu2009=u20090.012), 0.78 (95% CI: 0.25 to 1.30, pu2009=u20090.001) and 0.62 (95% CI: 0.04 to 1.20, pu2009=u20090.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.

Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

BackgroundThis study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong.MethodsA cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management.Results10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD

The Chinese-version of the CARE Measure reliably differentiates between doctors in primary care: a cross-sectional study in Hong Kong

30,000 (USD

Postgraduate education for Chinese medicine practitioners: a Hong Kong perspective

3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor.ConclusionAbout one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.

Attributes of primary care in community health centres in China and implications for equitable care: a cross-sectional measurement of patients' experiences

BackgroundThe Consultation and Relational Empathy (CARE) Measure is a widely used patient-rated experience measure which has recently been translated into Chinese and has undergone preliminary qualitative and quantitative validation. The objective of this study was to determine the reliability of the Chinese-version of the CARE Measure in reliably differentiating between doctors in a primary care setting in Hong KongMethodsData were collected from 984 primary care patients attending 20 doctors with differing levels of training in family medicine in 5 public clinics in Hong Kong. The acceptability of the Chinese-CARE measure to patients was assessed. The reliability of the measure in discriminating effectively between doctors was analysed by Generalisability-theory (G-Theory)ResultsThe items in the Chinese-CARE measure were regarded as important by patients and there were few not applicable responses. The measure showed high internal reliability (coefficient 0.95) and effectively differentiated between doctors with only 15-20 patient ratings per doctor (inter-rater reliability > 0.8). Doctors mean CARE measure scores varied widely, ranging from 24.1 to 45.9 (maximum possible score 50) with a mean of 34.6. CARE Measure scores were positively correlated with level of training in family medicine (Spearmans rho 0.493, p < 0.05).ConclusionThese data demonstrate the acceptability, feasibility and reliability of using the Chinese-CARE Measure in primary care in Hong Kong to differentiate between doctors interpersonal competencies. Training in family medicine appears to enhance these key interpersonal skills.

The relationship between clinically relevant depressive symptoms and episodes and duration of all cause hospitalization in Southern Chinese elderly.

BackgroundDespite Hong Kong governments official commitment to the development of traditional Chinese medicine (TCM) over the last ten years, there appears to have been limited progress in public sector initiated career development and postgraduate training (PGT) for public university trained TCM practitioners. Instead, the private TCM sector is expected to play a major role in nurturing the next generation of TCM practitioners. In the present study we evaluated TCM graduates perspectives on their career prospects and their views regarding PGT.MethodThree focus group discussions with 19 local TCM graduates who had worked full time in a clinical setting for fewer than 5 years.ResultsGraduates were generally uncertain about how to develop their career pathways in Hong Kong with few postgraduate development opportunities; because of this some were planning to leave the profession altogether. Despite their expressed needs, they were dissatisfied with the current quality of local PGT and suggested various ways for improvement including supervised practice-based learning, competency-based training, and accreditation of training with trainee involvement in design and evaluation. In addition they identified educational needs beyond TCM, in particular a better understanding of western medicine and team working so that primary care provision might be more integrated in the future.ConclusionTCM graduates in Hong Kong feel let down by the lack of public PGT opportunities which is hindering career development. To develop a new generation of TCM practitioners with the capacity to provide quality and comprehensive care, a stronger role for the government, including sufficient public funding, in promoting TCM graduates careers and training development is suggested. Recent British and Australian experiences in prevocational western medicine training reform may serve as a source of references when relevant program for TCM graduates is planned in the future.

Low DHEAS levels are associated with depressive symptoms in elderly Chinese men: results from a large study

BACKGROUNDnChina has been undergoing a health-care reform, and community health centres (CHCs) are being established as primary care provider across urban areas.nnnAIMnTo evaluate primary care attributes in CHCs by measuring patients experiences.nnnDESIGNnCross-sectional surveys of 3360 adult service users with multistage cluster sampling.nnnMETHODSnWe developed a short assessment tool consisting of 33 items derived from the short version of the original Primary Care Assessment Tool-Adult Edition (PCAT-AE). The reliability and validity of the instrument were evaluated. Score distributions were assessed using descriptive statistics with 95% confidence interval (CI). The overall PCAT scores were categorized into three quantile groups (lower score, medium score and optimal score). Ordinal logistic regression analysis was performed to explore patient characteristics associated with optimal score after controlling for demographic, socio-economic, health conditions and health-care utilization characteristics.nnnRESULTSnOne-third (33.4%, 95% CI: 31.0-35.9%) of subjects had optimal overall PCAT scores, while the majority (83.4%) reported medium-to-lower score in the community orientation scale. Patients characteristics with respect to health-care utilization had major effects on PCAT scores. Subjects with the presence of social medical insurance had higher odds of having greater experience in most primary care attributes and tended to report optimal primary care experience (aOR 2.30, 95% CI: 1.92-2.75) compared with those without social medical insurance.nnnCONCLUSIONSnEquitable primary care is yet to be strengthened with regard to the community orientation attribute, and particularly among patients without social medical insurance, as they tend to have inferior experiences in the primary care sector.