Tp Lam

Clinical effectiveness of school screening for adolescent idiopathic scoliosis: A large population-based retrospective cohort study

Study Design. Retrospective cohort study. Objective. To evaluate the clinical effectiveness of school scoliosis screening using a large and long–term-followed cohort of students in Hong Kong. Summary of Background Data. School screening for adolescent idiopathic scoliosis has been criticized as resulting in over-referrals for radiography and having low predictive values. Indeed, all but one previous retrospective cohort studies had no follow-up assessments of students until their skeletal maturity, leaving any late-developed curves undetected. The one study that completed this follow-up was well conducted but had low precisions due to its small sample size. Methods. A total of 157,444 students were eligible for a biennial scoliosis screening, and their screening results and medical records up to 19 years of age were available. Students first had forward bending test and angle of trunk rotation (ATR) performed. Those with ATR between 5° and 14° or signs of adolescent idiopathic scoliosis were assessed by moiré topography regularly. Students with an ATR ≥15°, ≥2 moiré lines, or significant clinical signs were referred for radiography and had their Cobb angle measured. Results. Of the 115,190 screened students in the cohort, 3228 (2.8%, 95% confidence interval [CI] = 2.7%–2.9%) were referred for radiography. At the final follow-up, the positive predictive values were 43.6% (41.8%–45.3%) for a Cobb angle ≥20° and 9.4% (8.4%–10.5%) for needing treatment, while the sensitivities were 88.1% (86.4%–89.6%) and 80.0% (75.6%–83.9%), respectively. Conclusion. This is the largest study that has demonstrated that school scoliosis screening in Hong Kong is predictive and sensitive with a low referral rate. Screening should thus be continued in order to facilitate early administration of conservative treatments.

Validation of Minimum Data Set for Home Care Assessment Instrument (MDS-HC) for Hong Kong Chinese Elders

ABSTRACT The objective of this study was to validate the Chinese version of Minimum Data Set -Home Care (MDS-HC) in Hong Kong Chinese elders. The respondents were 179 people aged 60 years or older who attend an outpatient clinic in Hong Kong. Firstly, inter-rater reliability was examined and we found acceptable inter-rater reliability. Internal consistency was also obtained for all the composite outcome measures in MDS-HC and most of the Cronbach coefficients were in the range from 0.6 to 0.8. Finally, the concurrent validity of the Chinese version of MDS-HC was assessed by comparing the MDS-HC triggered CAPs and a clinicians diagnoses. We found that high consistency between the results from MDS-HC and clinical judgement in 20 out of 30 CAPs.

Current perspectives on medical education in China

Context  China has a long tradition of education and medicine. However, limited economic conditions and a huge population mean that further development of medical education in China must be tailored to meet the countrys needs.

Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study

BACKGROUND The World Health Organization is revising the primary care classification of mental and behavioural disorders for the International Classification of Diseases (ICD-11-Primary Health Care (PHC)) aiming to reduce the disease burden associated with mental disorders among member countries. OBJECTIVE To explore the opinions of primary care professionals on proposed new diagnostic entities in draft ICD-11-PHC, namely anxious depression and bodily stress syndrome (BSS). METHODS Qualitative study with focus groups of primary health-care workers, using standard interview schedule after draft ICD-11-PHC criteria for each proposed entity was introduced to the participants. RESULTS Nine focus groups with 4-15 participants each were held at seven locations: Austria, Brazil, Hong Kong, New Zealand, Pakistan, Tanzania and United Kingdom. There was overwhelming support for the inclusion of anxious depression, which was considered to be very common in primary care settings. However, there were concerns about the 2-week duration of symptoms being too short to make a reliable diagnosis. BSS was considered to be a better term than medically unexplained symptoms but there were disagreements about the diagnostic criteria in the number of symptoms required. CONCLUSION Anxious depression is well received by primary care professionals, but BSS requires further modification. International field trials will be held to further test these new diagnoses in draft ICD-11-PHC.

A meta-analysis identifies adolescent idiopathic scoliosis association with LBX1 locus in multiple ethnic groups

Background Adolescent idiopathic scoliosis (AIS) is a common rotational deformity of the spine that presents in children worldwide, yet its etiology is poorly understood. Recent genome-wide association studies (GWAS) have identified a few candidate risk loci. One locus near the chromosome 10q24.31 LBX1 gene (OMIM #604255) was originally identified by a GWAS of Japanese subjects and replicated in additional Asian populations. To extend this result, and to create larger AIS cohorts for the purpose of large-scale meta-analyses in multiple ethnicities, we formed a collaborative group called the International Consortium for Scoliosis Genetics (ICSG). Methods Here, we report the first ICSG study, a meta-analysis of the LBX1 locus in six Asian and three non-Asian cohorts. Results We find significant evidence for association of this locus with AIS susceptibility in all nine cohorts. Results for seven cohorts containing both genders yielded P=1.22×10–43 for rs11190870, and P=2.94×10–48 for females in all nine cohorts. Comparing the regional haplotype structures for three populations, we refined the boundaries of association to a ∼25 kb block encompassing the LBX1 gene. The LBX1 protein, a homeobox transcription factor that is orthologous to the Drosophila ladybird late gene, is involved in proper migration of muscle precursor cells, specification of cardiac neural crest cells, and neuronal determination in developing neural tubes. Conclusions Our results firmly establish the LBX1 region as the first major susceptibility locus for AIS in Asian and non-Hispanic white groups, and provide a platform for larger studies in additional ancestral groups.

Medical education reform: the Asian experience.

Medical education reform is taking place all over the world including Asia, which has 60% of the world’s population. Confronted with diverse social and cultural needs as well as resource constraints, various regions in Asia have carried out medical education reform at different levels and directions. In this article, the authors describe the application of Western-inspired reforms and localization and adaptation of Western models to fit the cultural and community needs in the five different subregions of Asia: (1) Eastern Asia, (2) Southern Asia, (3) Southeastern Asia, (4) Central Asia, and (5) Western Asia. The article reviews whether the medical education reforms brought improvement to the medical curricula and effectively fulfilled the cultural and social needs of Asian countries. The authors also explore the establishment of medical education departments in many Asian medical schools and the incorporation of research findings into medical practice. Departments of medical education will facilitate localization and promote further development of medical education reform in Asia despite the challenges ahead.

Referral criteria for school scoliosis screening: assessment and recommendations based on a large longitudinally followed cohort.

Study Design. This study was a retrospective cohort study. Objective. To examine the criteria recommended in the literature for the school-based scoliosis screening program in Hong Kong. Summary of Background Data. School-based screening for scoliosis has been a controversy. Objectors to the policy were concerned about the high over-referral and false-positive rates. Recommendations were then made for improvement, but the feasibility of these recommendations has not been studied. Methods. The cohort consisted of students in Grade 5 in 1995/1996 or 1996/1997 who underwent scoliosis screening in Hong Kong. Participants who had an angle of trunk rotation (ATR) ≥15°, 2 or more moiré lines, or presented significant clinical signs were referred for radiography. Screening histories and radiography records before the age of 19 years were extracted. The accuracy measures for different combinations of screening tests were examined. Results. There were 115,178 students in the cohort, of which 3228 (2.8%) were referred for radiography. Among the 1406 students who displayed a curve ≥20° during screening, 257 (18.3%) were boys and 336 (23.9%) were identified as 16 years or older, ruling out the suggestion of screening only 10-year-old girls. The sensitivity and positive predictive value for the current referral criteria were 88.1% and 43.6%, respectively. The sensitivity would drop substantially if the use of moiré topography (39.8%) or clinical signs (55.5%) were discarded. With the inclusion of these 2 tests, the clinical effectiveness measures were robust to the cutoff for ATR, unless it was set below 10°. Conclusion. Selectively screening only premenarche girls was not feasible, as this screen would have missed a significant proportion of children with significant curvature. No refinement of the current protocol was necessary, although boys could be screened beginning at 12 years of age. The tandem use of ATR, moiré topography, and clinical signs was recommended for future studies.

How do patients choose their doctors for primary care in a free market

AIMS A recent trend in health care system is to provide more choices to the patients. This study surveyed the general publics choices for primary care in Hong Kong which has the setting of free choices for private or public service and also direct access to specialists. METHODS We used a combined qualitative and quantitative approach. We held five focus group interviews with participants of different socio-economic categories. Information from the focus groups helped to design a questionnaire for random telephone interviews with members of the public aged 18 or above. RESULTS There were 37 participants in the focus groups and 1647 respondents in the telephone survey. The most important factor for choosing a doctor was proximity to home or workplace, followed by quick relief from the illness. Once continuity of care had been established, distance was of less importance but comprehensive care was valued. Nearly 70% of the public had regular doctors. About 93% of the public would consult specialists directly when they thought they needed a specialists opinion. Nearly 30% chose specialists for any medical care and 38% preferred specialists to also look after their primary care problems. CONCLUSION Convenient accessibility was the most important factor for the initial choice of primary care doctors by the general public. The perceived clinical proficiency of the doctor determined future continuity of care. Patients liked to have direct access to specialists. Though some chose to see the specialists even for primary care problems, most people had regular doctors who were likely to have the attributes of family doctors.

What are the non-biomedical reasons which make family doctors over-prescribe antibiotics for upper respiratory tract infection in a mixed private/public Asian setting?

Objectives: To examine the non‐biomedical reasons which make family doctors over‐prescribe antibiotics for upper respiratory tract infection (URTI) in a mixed private/public Asian setting.

The public's perspectives on antibiotic resistance and abuse among Chinese in Hong Kong

Antibiotic abuse and resistance impose a continuing threat to the world. The awareness of antibiotic resistance is said to be inversely associated with the prevalence of abuse. We examined the publics perspectives on antibiotic resistance in our study of the publics knowledge, attitude and practice with antibiotics.