The perils of medical tourism: NDM-1-positive Escherichia coli causing febrile neutropenia in a medical tourist.

NDM-1 is a new metallo-beta-lactamase that readily hydrolyses carbapenems, penicillins and cephalosporins. Its rising incidence has been reported in many countries around the world, with many cases linked to a possible origin from the Indian subcontinent. Due to the lack of effective antibiotic regimes to treat these infections, the increased prevalence of NDM-1 is alarming. We describe a case of NDM-1 infection in an immunocompromised foreign patient, and discuss its implications.

Menopausal transition and changes of body composition: a prospective study in Chinese perimenopausal women.

OBJECTIVES: Whether age or menopause per se influences fat distribution remains controversial. This study aimed to investigate the change of body composition, particularly body fat distribution, in relation to menopausal transition in a 30-month prospective study of perimenopausal women. METHODS: A total of 438 community-based healthy women aged 44-55 years participated in the Hong Kong Perimenopausal Women Osteoporosis Study. Data were obtained at baseline, and at 9-, 18- and 30-month during the follow-up. Soft tissue measurements consisting of fat mass and lean muscle mass of the trunk and whole body were obtained by the dual energy X-ray absorptiometry. Percentage change of body measurements over the follow-up period was compared between women who remained premenopausal, those who went through menopausal transition, and those who were menopausal since baseline. RESULTS: A slight decrease in the lean mass but an increase in the total fat mass and trunk fat mass (TFM) over the follow-up period were noted. Multivariate linear regression analysis showed that age was negatively associated with an increase in central obesity. Adjusted for the important predictors--age, age of menarche and education level, menopausal status was a significant and independent predictor of the decrease in lean mass and the increase in percent of body fat, TFM and trunk-leg fat mass ratio. CONCLUSION: Our 30-month longitudinal study showed that menopause has an independent effect on an increase in fat mass, and an increase in central obesity in perimenopausal Chinese women.

Change in bone mineral density and its determinants in pre- and perimenopausal Chinese women: the Hong Kong Perimenopausal Women Osteoporosis Study.

UNLABELLED: This 30-month study investigating bone change and its determinants in 438 perimenopausal Chinese women revealed that the fastest bone loss occurred in women undergoing menopausal transition but maintenance of body weight and physical fitness were beneficial for bone health. Soy protein intake also seemed to exert a protective effect. INTRODUCTION: This 30-month follow-up study aims to investigate change in bone mineral density and its determinants in Hong Kong Chinese perimenopausal women. METHODS: Four hundred and thirty-eight women aged 45 to 55 years were recruited through random telephone dialing and primary care clinic. Bone mass, body composition, lifestyle measurements were obtained at baseline and at 9-, 18- and 30-month follow-ups. Univariate and stepwise multiple regression analyses were performed with the regression coefficients of BMD/C (derived from baseline and follow-up measurements) as the outcome variables. Menopausal status was classified as pre- or postmenopausal or transitional. RESULTS: Menopausal status was the strongest determinant of bone changes. An annual bone loss of about 0.5% was observed among premenopausal, 2% to 2.5% among transitional, and about 1.5% in postmenopausal women. Multiple regression analyses, revealed that a positive regression slope of body weight was protective for follow-up bone loss at all sites. Number of pregnancy, soy protein intake and walking were protective for total body BMC. Higher baseline LM was also protective for neck of femur BMD. CONCLUSION: Maintenance of body weight and physical fitness were observed to have a protective effect on for bone loss in Chinese perimenopausal women.

Abeta deposits in older non-demented individuals with cognitive decline are indicative of preclinical Alzheimer's disease.

Approximately 30% of healthy persons aged over 75 years show Abeta deposition at autopsy. It is postulated that this represents preclinical Alzheimer's disease (AD). We evaluated the relationship between Abeta burden as assessed by PiB PET and cognitive decline in a well-characterized, non-demented, elderly cohort. PiB PET studies and cognitive tests were performed on 34 elderly participants (age 73+/-6) from the longitudinal Melbourne Healthy Aging Study (MHAS). Subjects were classified as being cognitively 'stable' or 'declining' by an independent behavioural neurologist based on clinical assessment and serial word-list recall scores from the preceding 6-10 years. Decline was calculated from the slope of the word-list recall scores. Abeta burden was quantified using Standardized Uptake Value normalized to cerebellar cortex. Ten subjects were clinically classified as declining. At the time of the PET scans, three of the declining subjects had mild cognitive impairment, one had AD, and six were declining but remained within the normal range for age on cognitive tests. Declining subjects were much more likely to show cortical PiB binding than stable subjects (70% vs. 17%, respectively). Neocortical Abeta burden correlated with word-list recall slopes (r=-0.78) and memory function (r=-0.85) in the declining group. No correlations were observed in the stable group. Abeta burden correlated with incident memory impairment and the rate of memory decline in the non-demented ageing population. These observations suggest that neither memory decline nor Abeta deposition are part of normal ageing and likely represent preclinical AD. Further longitudinal observations are required to confirm this hypothesis.

Identifying risk factors for low back pain (LBP) in Chinese middle-aged women: a case-control study.

This case-control study was to identify major risk factors, such as natural menopausal transition, physical strain to the lower back, and psychosocial and lifestyle stress, for low back pain (LBP) prevalence among noninstitutional Chinese middle-aged women. A total of 182 cases and 235 controls participated. Data were collected at face-to-face interviews and body measurements were obtained. The data included exclusive criteria: descriptions of their LBP, sociodemographic factors, menopausal status and reproductive factors, physical strain activities, psychosocial stress, lifestyle factors, and anthropometric parameters. Our results indicated that LBP was prevalent among (a) women who experienced stressful life events in the past 12 months; (b) women who had high psychological stress related to housework or work; (c) women who performed some physical strain activities, such as prolonged squatting or moderate physical activities in the previous year; and (d) women who had a low waist-to-hip ratio. Our results reveal that showing women how to reduce physical strain during activity and how to maintain good postures may have great potential in reducing or eliminating LBP. Our findings have important implications for the development of health education or health promotion such as how to take care of their backs and how to handle psychosocial stress in both the home and workplace.

Factors affecting uptake of cervical and breast cancer screening among perimenopausal women in Hong Kong.

OBJECTIVES: To identify factors affecting cervical and breast cancer screening attendance among women aged 44 to 55 years by comparing self-reported uptake of cervical smear and clinical breast examination between patients and a population sample. DESIGN AND SETTING: Telephone survey and audit of clinic records to confirm patients' self-report. PARTICIPANTS: Two thousand and sixty-seven women identified through random telephone dialling from the residence directory and 319 patients ever-registered at a family practice teaching clinic. MAIN OUTCOME MEASURES: Uptake of cervical smear and clinical breast examination. RESULTS: The proportion of women undergoing cervical smear tests and clinical breast examination in the previous 12 months were 35.4% and 22.6%, respectively, for randomly selected women, while the figures were 47.2% and 50.6%, respectively, for patients. Record audit confirmed high rates of screening for patients according to evidence-based protocols (85.1% had had a cervical smear within 3 years). For women in the random sample (mean age, 48.9 years; standard deviation, 3.3 years), those who were older, postmenopausal, not receiving hormone therapy, educated to primary level, and with no chronic diseases were least likely to have had screening. For clinic patients (mean age, 47.9 years; standard deviation, 2.8 years), lower education level was the only variable associated with no recent smears. CONCLUSIONS: Healthy perimenopausal and postmenopausal women in the community with lower educational level and not receiving hormone therapy were more likely to be underscreened. Attendance of 44- to 55-year-old women at a family medicine clinic that actively promotes preventive medicine was associated with high screening uptake.

Socio-psychological stressors as risk factors for low back pain in Chinese middle-aged women.

AIM(S) OF THE STUDY: This study aims to explore the relationship between socio-psychological stress and low back pain (LBP) prevalence among Chinese middle-aged women. BACKGROUND: Women in mid-life experience increasing socio-psychological stress because of midlife transitions, stressful life events and housework or work factors. Encountering socio-psychological stress itself may result in the manifestation of LBP. DESIGN: A case-control study of Hong Kong community-based middle-aged women was conducted. The study subjects were either from the University Family Medicine Clinic or from a previous population-based cross-sectional study of middle-aged women conducted by Department of Community and Family Medicine. Among the 928 potential eligible subjects from both sources, a total of 182 cases and 235 controls participated in this study. Data were collected from face-to-face interviews and included demographic factors, menopausal status, socio-psychological stress and occurrence of LBP. Socio-psychological stress covered social factors, self-reported nature of housework/work, housework/work stress and stressful life events. RESULTS: Among the 182 cases who entered this study, 83 women (45.6%) had experienced 1-<14 days of LBP, and 99 women (54.4%) had at least 14 days of LBP in the previous 12 months. Those who reported that 'their family members, relatives or friends were very sick, died, needed her to take care of them or who they worried about in the past 12 months' had an increased risk of LBP of 67% (95% confidence interval (CI) 1.09-2.55). In addition women with a bad or ordinary relationship with cohabitants had an increased risk of LBP of 70% (95% CI 1.00-3.04). Lastly, women with a high housework or work stress had an increased risk of suffering both types of LBP of nearly two- and half-fold (95% CI 1.61-3.85). CONCLUSIONS: The results indicate that an association exists between high socio-psychological stress and LBP prevalence. Alleviating the impact of housework or work related factors would, however, involve improving both the work and home environment.

Tall stature, overweight and the prevalence of low back pain in Chinese middle-aged women.

OBJECTIVES: First, to estimate the rate and characteristic of low back pain (LBP) among Hong Kong middle-aged women. Second, to explore the relationship between being overweight, having tall stature and LBP prevalence. DESIGN: A case-control study of Hong Kong community-based middle-aged women was conducted. SUBJECTS: The study subjects were either from the University Family Medicine Clinic or from a population-based cross-sectional study on health in middle-aged women conducted by the Department of Community and Family Medicine (based on a randomized sample of telephone numbers from the Hong Kong residential telephone directory in 1991). Among the 928 potential eligible subjects from both sources, a total of 182 cases and 235 controls participated in this study. MEASUREMENTS: Data were collected from personal interviews and anthropometric measurements. Participants were asked about exclusion criteria, the occurrence of LBP and demographics factors. The anthropometric measurements included measures of body height, body weight, waist and hip circumferences. RESULTS: Among the 182 cases who entered this study, 83 women (45.6%) had 1-<14 days of LBP, and 99 women (54.4%) had at least 14 days of LBP in the previous 12 months. Having tall stature and being overweight were found to have no association with LBP prevalence. Conversely, high waist-to-hip ratio (> or =0.8) was noted to be inversely associated with the risk of severe (at least 14 days) LBP (adjusted odds ratio=0.43, 95% confidence interval 0.26-0.70) even when controlling for other risk factors together, but not for the overall (at least one day) LBP. CONCLUSION: This case-control study found no association between excessive weight, tall stature and an increased risk of LBP prevalence in Hong Kong Chinese middle-aged women. Conversely, the results indicate that a high waist to hip ratio was associated with a lower risk of severe LBP. Prospective studies are needed to further evaluate the association between underweight/obesity, bone mass density and LBP.

Soy intake and the maintenance of peak bone mass in Hong Kong Chinese women.

Our previous study on bone health among premenopausal women showed that bone mass consolidation is attained by the early 30s, and small loss of spinal bone mineral density (SBMD) occurs soon after peak bone mass attainment. Recent interest has been shown in the potential beneficial effects of phytoestrogens on bone health. However, data are lacking, particularly in Asian women. This study aims to investigate the effect of soy isoflavones intake on the maintenance of peak bone mass in a cohort of 132 women aged 30-40 years who were followed up for 3 years. Baseline measurements of SBMD (L2-L4) were obtained using dual-energy X-ray densitometry, and dietary intake of soy foods and other key nutrients, including dietary calcium, were obtained through a quantitative food frequency method. Information on body measurements; physical activity (PA), weight-bearing activity in particular; age of menarche; and number of pregnancies were obtained at baseline. Repeated measurements of SBMD were obtained yearly for a further 3 years with an average follow-up time of 38 months. Analyses were performed on 116 subjects with at least three SBMD measurements (at baseline, 3-year follow-up, and at least one measurement during follow-up). The individual SBMD regression slope was computed for each of the subjects. Soy isoflavones consumption was categorized as quartiles of intake. We observed a significant difference in the SBMD individual regression slopes between women belonging to the fourth and first soy isoflavones intake quartiles. The positive effect of soy isoflavones on SBMD remained after adjusting for age and body size (height, weight, and bone area). Multiple linear regression analysis including the other known covariates (lean body mass, PA, energy adjusted calcium, and follow-up time) showed that soy isoflavones, together with these variables, accounted for 24% of the variances of the SBMD individual regression slope. This longitudinal study shows that soy intake had a significant effect on the maintenance of SBMD in women aged 30-40 years. The effects of phytoestrogens on bone health should be explored further in a population with habitual dietary soy but low calcium intake.

A 3-year follow-up study of social, lifestyle and health predictors of cognitive impairment in a Chinese older cohort.

BACKGROUND: Longitudinal data on the older population in the Asian setting are limited. This paper reports the factors associated with the development of cognitive impairment (CI) in a cohort of Chinese elderly aged > or =70 years. METHODS: The study cohort comprising 2030 subjects aged > or =70 years was assembled in 1991-1992 and followed for 36 months. Baseline information on cognitive function, as well as a number of social and health variables were obtained through face-to-face interview at the respondent's place of residence. The outcome variable was the development of CI among 988 cohort members who were initially free from CI, and who could be contacted at the 36-month follow-up. The instrument used to assess CI was based on the information/orientation part of the Clifton Assessment Procedure for the elderly (CAPE), using a cut-off point of 7. RESULTS: Of the men, 6.7%, but 22.2% of women had CI at 3-year follow-up. The age-adjusted annual incidence of CI was 1.52% in men, and 6.37% in women. Multivariate logistic regression analysis showed that women had a 2.5-fold increased risk of having CI, compared with men. The risk increased by about 1.5-fold with every 5-year increase in age. Slow gait time, as assessed by the 16-foot walk, was a predictor of CI in both sexes (odds ratio [OR] = 1.03 per second increase, 95% CI : 1.0-1.07). Men residing in institutions had a 4.4-fold increased risk of having CI (95% CI : 1.7-11.1) compared with those residing in community, while the OR among women was 2.5 (95% CI : 1.3-4.9). Among women, no formal education increased the risk of having CI by 3.2-fold (95% CI : 1.8-5.5). Income dependency also increased the risk of CI by about fourfold, and no exercise at baseline was associated with a twofold increased risk of CI. Incident stroke during follow-up also increased the risk of CI (OR = 8.4, 95% CI : 1.2-59.4). CONCLUSIONS: Older age and female sex were independent factors associated with CI. No formal education, slow gait time and institutionalization increased the risk of CI in both sexes. While education had a stronger effect in women, institutionalization had a stronger effect in men. Financial dependency, lack of exercise and incident stroke played a significant role in women.

Smoking and mortality in an older Chinese cohort.

OBJECTIVES: Only limited data are available regarding smoking and health in later life and, in particular, in the older Chinese population. This paper reports the relationship between smoking and mortality in a Chinese cohort aged 70 years and older. SETTING: A population-based study conducted in Hong Kong. PARTICIPANTS: A cohort comprising 2030 subjects aged 70 and older were assembled in 1991-1992 and followed for 36 months. DESIGN: A prospective cohort study. MEASUREMENTS: Baseline information regarding smoking status as well as several social and health variables were obtained through face-to-face interview at the respondent's place of residence. The outcome variables were mortality from all causes as well as from cancer and cardiovascular and respiratory diseases. Causes of death were ascertained from death certificates. RESULTS: The prevalence rates of smoking at baseline were 24.9% in men and 8.2% in women. A total of 534 deaths occurred during the 36-month follow-up period. Of these, 447 were attributable to three main causes: cancer, cardiovascular disease, and respiratory disease. Elevated mortality risks from all causes were observed among both male (RR = 1.4; 95% CI, 0.9-1.9) and female (RR = 1.6; 95% CI, 1.0-2.5) current smokers, but the 95% confidence intervals overlapped. Significant association between current smoking and combined mortality from these three major causes was found in men; it was also found in women after excluding those with these diseases at baseline. More than a 3-fold increased risk of cancer mortality was found in current smokers of both sexes. Although nonsignificant associations were found between former smokers and mortality risks in men, women who were former smokers had increased mortality risks from all causes as well as from cancer and respiratory diseases. CONCLUSIONS: This 3-year prospective study of an older Chinese cohort reveals the impact of smoking on health during later life, especially in women. Smoking cessation, particularly in older men, should be beneficial in reducing mortality. Smoking cessation should begin as early as possible for women.

Menopausal symptoms and symptom clustering in Chinese women.

OBJECTIVES: this paper aims to report the prevalence of symptoms in the Hong Kong Chinese perimenopausal women; to construct reported symptoms into symptom groupings; and to clarify whether the symptom groups are associated with menopausal status. METHODS: a random telephone survey of perimenopausal women aged 44-55 years was conducted in 1996. Eligible subjects were identified through telephone dialing of a random sample of the numbers listed in the residents' telephone directory. Standardized questionnaire, including a 22-item symptom check list, was administered over the telephone. The principal component analysis method followed by varimax rotation was used to examine the relations among the symptoms. RESULTS: differences in the prevalence of menstrual problems across the menopausal status were noted with perimenopausal women having the most complaints. Musculoskeletal conditions were the top complaints reported by the respondents, followed by headaches and psychological symptoms. About 10% of the women complained of hot flushes, and less than 5% of cold sweats. Five symptom clusters, namely psychological, musculoskeletal/gastrointestinal, non-specific somatic, respiratory, and vasomotor, have been identified. After adjustment for age, the analysis of variance showed that psychological, non-specific somatic and vasomotor symptoms were significantly associated with menopausal status, while musculoskeletal and respiratory were of borderline statistical significance. CONCLUSIONS: compared with pre- and post-menopausal women, perimenopausal women had the highest reports of symptom complaints. Musculoskeletal complaints were the most prevalent complaints, followed by psychological symptoms. While vasomotor symptoms were significantly associated with menopausal status, their prevalence was comparatively lower than that reported in Caucasian populations.

Predictors of mobility decline: the Hong Kong old-old study.

BACKGROUND: Old age is often accompanied by functional decline and loss of autonomy. This longitudinal study examines the factors associated with mobility decline among a Chinese elderly cohort aged 70 years and above. METHODS: Analyses were carried out on data collected from 1,483 elderly subjects who were functionally mobile at baseline and survived the 18-month follow-up period. The outcome variable "mobility decline" was measured using the Barthel Activities of Daily Living Scale, which accesses subjects' ability to be independent in walking a distance of 50 meters and/or moving up and downstairs during the 18-month follow-up interview. RESULTS: Multivariate backward stepwise logistic regression analysis revealed that the following baseline characteristics were independently associated with mobility decline during the follow-up period: increasing age (OR 1.4, 95% CI 1.2-1.6 for every 5-year increase in age), no formal level of education (OR 1.9, 95% CI 1.0-3.9), no current practice of exercise (OR 2.1, 95% CI 1.4-3.1), symptoms of palpitation (OR 1.7, 95% CI 1.1-2.8), body mass index [weight (kg)/height (m)2] below 20 (OR 1.7, 95% CI 1.1-2.6), and slow gait velocity (OR 1.12, 95% CI 1.09-1.16 per second increase in gait time). There was also significant association between the experience of falls during follow-up and mobility decline (OR = 2.9, 95% CI = 1.9-4.5). CONCLUSION: Low body weight, lack of exercise, and falls during the follow-up period might serve as markers as to which subjects are at risk for mobility decline.

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.

An estimate of chronic disease burden and some economic consequences among the elderly Hong Kong population.

OBJECTIVES: To estimate the burden of chronic disease for an elderly Chinese population aged 70 years and over, and to illustrate the use of this information in estimating the economic consequences of disease burden using stroke as an example. PARTICIPANTS: A total of 1902 subjects recruited by random sampling of the old age and disability allowance schemes, which cover over 90% of the Hong Kong elderly population, stratified by sex and five year age groups from age 70 years onwards. METHOD: Information was collected on 10 medical conditions at baseline: arthritis, hypertension, cardiac disease, stroke, chronic obstructive airways disease, peptic ulcer, diabetes mellitus, osteoporotic fracture, malignancy, and dementia. A follow up survey was carried out after 18 months to determine the occurrence of new disease and the number with disease who had died. Disease burden is calculated as the number with disease at baseline plus the number developing new disease minus the number who had died. RESULTS: Disease burden figures were highest for arthritis, hypertension, cardiac disease, and peptic ulcer, and were higher in the 70-79 age group than the 80+ age group for some diseases. For stroke, the economic cost based on a population projection for 2001 was estimated to be around HK$1,900,000,000, or US$250 million. CONCLUSION: Information on the burden of chronic disease is important. It enables the economic consequences to be estimated so that strategies can be developed to prevent diseases with high costs and known effective preventive methods.

Life satisfaction and associated factors in older Hong Kong Chinese.

OBJECTIVE: To determine life satisfaction and its association with physical, functional, socioeconomic, psychological, and social support characteristics in Hong Kong Chinese aged 70 years and older. DESIGN: Cross-sectional study. SETTING: Territory-wide random sample of persons aged 70 years and older. SUBJECTS: A total of 843 men and 714 women were selected by random sampling, stratified by age and sex, from the Old age and Disability Allowance Register, after exclusion of subjects with cognitive impairment. MEASUREMENTS: Life satisfaction was assessed by the subjects' response to the question "Are you satisfied with life", using a 0 to 10-point linear scale. They were also asked to name the most important factor contributing to life satisfaction. Information was also obtained regarding physical health, functional ability, depressive symptoms, and socioeconomic factors. RESULTS: There was a weak association between score and age. Health, adequate income to meet living expenses, and caring relatives were rated the most important factors (> 65%). Some of these factors were also those associated with a high life satisfaction score. Factors associated with a life satisfaction score greater than 6 points were higher social class and educational attainment, adequate income to meet living expenses, satisfactory living arrangement, Christianity, good social support, participation in social activities, functional independence, good self-perceived health, good hearing and vision, daily exercise, absence of recurrent falls, and low depressive symptom score. Multiple logistic regression identified having two or more relatives and tertiary education as positive associated factors, whereas inadequate income to meet expenses, dissatisfaction with living arrangement, nonparticipation in religious group activities, and a high depressive symptom score were negative associated factors. CONCLUSION: In older Chinese, social factors such as the support provided by family members, as well as adequate income to meet living expenses, play a role equal to that of physical factors in contributing to life satisfaction.

Age-associated gait changes in the elderly: pathological or physiological?

AIM: To examine the role of disease-related factors and age-related physiological changes in affecting gait speed and stride length in the elderly. SUBJECTS: 925 men and 890 women aged 70 years and above who were ambulant, recruited by random sampling stratified according to age and sex, from all recipients of Old Age and Disability Allowance in Hong Kong. DESIGN: Gait was assessed by measuring the time taken and the number of steps required to complete a 16-foot walk. Information on health and functional status, cognitive function, and depressive symptoms was collected, and anthropometric indices obtained. Factors affecting walking speed and stride were examined in the overall population and also after excluding those with physical disability or diseases. RESULTS: Results were analyzed separately for men and women since mean walking speed was slower in women, who also took a larger number of steps. Age, coexisting disease, leg or back pain, poor vision, low level of physical activity, functional and cognitive impairment, high depressive symptom score, and anthropometric indices were all negatively associated with walking speed. Fallers also had slower speed. After excluding those with diseases or physical impairment, multivariate analysis showed that the only factors affecting speed were age in men, and age, height, and level of physical activity in women. Age and height were factors associated with stride length in men, and height only for women. CONCLUSION: Both disease-related factors as well as age-related physiological changes contribute to the decline in walking speed and stride length.

Influence of age, disease and disability on anthropometric indices in elderly Chinese aged 70 years and above.

To determine the influence of age, disease and other factors on anthropometric indices in elderly subjects aged 70 years and above, body mass index (BMI), arm muscle circumference (AMC), corrected arm muscle area (CAMA), fat-free mass (FFM) and total body fat (TBF) were determined in a random sample of 990 Chinese men and 1,021 women aged 70 years and over stratified by age and sex. Old age, presence of disease, poor self-perceived health, poor functional ability, lower level of physical activity, lack of dentures, depression and cognitive impairment were all factors associated with lower anthropometric values. Haemoglobin, total cholesterol and walking speed were also associated factors, although the latter two factors became insignificant after adjusting for age. When subjects with a history of disease or cognitive impairment were excluded, an age-related decline in BMI, AMC, CAMA and TBF was still observed in men although FFM remained unchanged. However, in women, only TBF showed an age-related decline. It is concluded that in the old-old population, both age and disease affect anthropometric indices, the change being more marked in men.

Cardiovascular symptoms, electrocardiographic abnormalities, and associated risk factors in an elderly Chinese population.

The aim of this study was to determine the prevalence of angina and possible infarct (WHO cardiovascular questionnaire) and electrocardiographic abnormalities (Minnesota Coding) in elderly Chinese subjects aged 70+ years living in Hong Kong, and the association with some cardiovascular risk factors. A subsample of 197 subjects (96 men, 101 women) selected according to geographical area from a territory-wide health survey consisting of 2032 elderly subjects selected by an age and sex stratified random sampling method was studied. Overall, 7% of men and 9% of women had symptoms suggestive of angina, while 6% of men and 4% of women had symptoms suggestive of possible infarct. There were fewer symptoms in the 80+ age group. Forty-two percent of men and 35% of women had normal electrocardiograms. The prevalence of probable ischaemic heart disease (using the Whitehall Criteria) was 6% for men and 7% for women, while the figures for possible disease were 23% and 25%, respectively. The percentage with abnormalities increased with age. The prevalence of coronary heart disease defined by the presence of symptoms, a history of known disease plus use of medication, and electrocardiographic abnormalities suggestive of probable disease, was 26% for men and 27% for women. These findings were comparable with studies in elderly Caucasian populations. Only a higher socioeconomic grouping and lower HDL cholesterol were identified as associated risk factors. It is concluded that the prevalence of coronary heart disease in the elderly Chinese population in Hong Kong is at least as high in Caucasian populations, and few modifiable risk factors were identified in the elderly aged 70 years and over.

Lipid profile in the Chinese old-old: comparison with younger age groups and relationship with some cardiovascular risk factors and presence of diseases.

In a health survey of 2,032 elderly Hong Kong Chinese aged 70 years and over selected by stratified random sampling, a subset of 199 subjects (96 M, 103 F) were selected for a study of their lipid profile. No age and sex differences were observed in mean total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations in this subgroup. Compared with values from younger Chinese subjects from a previous survey, TC and LDL-C showed an age-related rise up till about 60 years, followed by a gradual decline. HDL-C concentrations showed little variation with age. Nonagenarians had a LDL/HDL ratio similar to subjects in the < 24 age group and lower than male subjects in the age 35-64 age group. HDL-C was lower in those with heart disease or hypertension. Other lipid parameters were not influenced by the presence of other chronic diseases, self-perceived health status, or cognitive impairment. TC was positively associated with the Barthel Index, a measure of functional ability. Positive associations between obesity indices and diastolic blood pressure, and TC, LDL-C, and triglycerides were present.(ABSTRACT TRUNCATED AT 250 WORDS)