Immunoglobulin G4-related aortitis mimicking an intramural hematoma.

Immunoglobulin G4-related systemic disease is a rare entity with various presenting symptoms. We report the case of a 34-year-old Chinese male who presented with immunoglobulin G4-related aortitis and the unusual symptom of hoarseness of voice. He underwent distal ascending aorta and total aortic arch replacement.

Does being bilingual in English and Chinese influence changes in quality of life scale scores? Evidence from a prospective, population based study.

BACKGROUND: Bilinguals differ from monolinguals in language use, but the influence of bilingualism on changes in Health-Related Quality of Life (HRQoL) scores is not known. OBJECTIVE: To determine the influence of bilingualism on changes in HRQoL scores. RESEARCH DESIGN: A prospective cohort study of a population-based, disproportionately stratified random sample of monolingual or bilingual ethnic Chinese who completed the Short-Form 36 Health Survey (SF-36) in English or Chinese twice in 2 years. Least squares regression models were used to assess the influence of bilingualism on SF-36 scores, while adjusting for the influence of questionnaire language and determinants of HRQoL. RESULTS: Usable English and Chinese questionnaires were returned by 1013 and 910 subjects respectively (aged 21-65 years, 48.5% female, 52.8% bilingual). Bilinguals differed from monolinguals in known determinants of HRQoL (being younger and better educated), changes in determinants of HRQoL over 2 years (more bilinguals had changes in work or marital status) and had mean SF-36 scores that were up to 10 points higher than monolinguals. After adjusting for these differences, bilingualism did not influence 2 year change scores for any of 8 SF-36 scales. CONCLUSION: Bilingualism did not influence changes in HRQoL scores over 2 years in this large, population-based study of subjects fluent in English and/or Chinese (representing an alphabet and/or pictogram based language respectively).

Quality of life in an urban Asian population: the impact of ethnicity and socio-economic status.

The relationships between ethnicity, socio-economic status (SES) and health-related quality of life (HRQoL) have not been well characterised in most Asian populations. We therefore studied the influence of ethnicity and SES on HRQoL in a multi-ethnic urban Asian population, adjusting for the influence of other known determinants of HRQoL. In a disproportionately stratified, cross-sectional, population-based survey, Chinese, Malay and Indian subjects in Singapore completed the Short Form 36 Health Survey (SF-36) HRQoL measure and were assessed to determine demographic, socio-economic, psychosocial and other characteristics. Multiple linear regression models were used to study the influence of ethnicity and SES on SF-36 scores while adjusting for the influence of other determinants of HRQoL. The survey participation rate was 92.8%. Ethnic differences in HRQoL were present for all 8 SF-36 scales (p<0.001 for all scales except General Health) among the 4122 Chinese, Malays and Indians surveyed. These ethnic groups also differed in several known determinants of HRQoL (e.g., Chinese had more years of education and Indians had more chronic medical conditions). After adjusting for the influence of these factors, ethnicity and SES independently influenced HRQoL, with mean differences in SF-36 scores due to ethnicity ranging from 1.4 to 13.1 points. Educational level and housing type (markers of SES) were also associated with SF-36 scores (0.5-0.6 point increase per year of education and 3.5-4.0 point increase with better housing type, respectively). Better HRQoL was also associated with better family support, and poorer HRQoL with acute and chronic medical conditions and sick days. The study concludes that ethnicity and SES are associated with clinically important differences in HRQoL in a multi-ethnic, urban Asian population.

The equivalence of English and Chinese SF-36 versions in bilingual Singapore Chinese.

OBJECTIVE: To assess the equivalence of English and Chinese versions of the SF-36. METHODS: Using a crossover design with block randomisation and stratification by age, identical English or Chinese questionnaires containing the English (UK) and Chinese (HK) SF-36 versions were administered 3-16 days apart to 168 free-living, bilingual, ethnic Chinese volunteers in Singapore. Item level equivalence of both versions was assessed by comparing item means and orderings within each scale. Scale level equivalence was assessed by comparing internal consistency (Cronbach's alpha), results of factor analysis and mean scale scores (using paired t-tests and intra-class correlations). RESULTS: Item and scale level comparisons supported the equivalence of both versions. For both the versions, item means, item ordering and Cronbach's alpha were similar, and factor analysis yielded two factors with similar factor loadings. There was no clinically important difference in mean scale scores for seven of eight scales, and intra-class correlations were excellent/good for five scales (0.69-0.77) and moderate for three scales (0.55-0.57). CONCLUSION: English (UK) and Chinese (HK) SF-36 versions are equivalent in bilingual Singapore Chinese. Our data suggest that SF-36 scores from English- and Chinese-speaking subjects may be combined in studies using the SF-36, increasing the power and representativeness of such studies.

Does being bilingual in English and Chinese influence responses to Quality-of-Life scales?

BACKGROUND: It is not known if the inclusion of bilinguals affects the results of research using Quality-of-Life (QoL) scales. OBJECTIVE: To determine the influence of bilingualism on responses to a QoL scale. RESEARCH DESIGN: In this cross sectional study, a population-based, disproportionately stratified random sample of monolingual and bilingual ethnic Chinese completed the Short-Form 36 Health Survey (SF-36) in English or Chinese (representing an alphabet and pictogram based language respectively). Cumulative logit regression models were used to assess the influence of bilingualism on SF-36 scores, while adjusting for the influence of questionnaire language and known determinants of QoL. RESULTS: English or Chinese SF-36 versions were completed by 1331 and 1380 subjects respectively (49% female, aged 21-65 years, 1366 bilingual, 501 English monolingual, 844 Chinese monolingual), with response rates exceeding 85%. Fifty percent of subjects were bilingual. Bilinguals differed from monolinguals in known determinants of QoL, being younger, better educated, and having fewer chronic medical conditions, and had SF-36 scores up to 8 points higher than monolinguals. After adjusting for these differences, bilingualism did not influence scores for any of eight SF-36 scales, whereas questionnaire language influenced scores for four scales. Use of the English SF-36 was associated with higher scores for General Health, Vitality, Role Emotional and Mental Health Scales (odds ratios 1.35-1.41), though the magnitude of these odds ratios suggests this association may not be clinically important. CONCLUSION: Bilingualism did not influence responses to a QoL scale in this large, population-based study of subjects fluent in an alphabet and/or pictogram based language.