Diagnostic screening for mucopolysaccharidoses by the dimethylmethylene blue method and two dimensional electrophoresis.

BACKGROUND: The diagnosis of a mucopolysaccharidosis (MPS) can be achieved by non-enzymatic screening methods, including two-dimensional electrophoresis (2-D EP), and the dimethylmethylene blue (DMB) method. However, the confirmation of MPS diagnosis is difficult to achieve in Taiwan due to the shortage of a well-established MPS diagnostic service. In this article, we introduce the MPS screening protocols we have already established, and also illustrate the interpretation of 2-D EP result for MPS typing determination. METHODS: Thirty-seven patients with different types of MPS were analyzed by 2-D EP and the DMB method. They were 4 with MPS I (Hurler), 15 with MPS II (Hunter), 10 with MPS III (Sanfilippo), 5 with MPS IV (Morquio), and 3 with MPS VI (Maroteaux-Lamy). RESULTS: The electrophoretic patterns of the affected glycosaminoglycans (GAGs) in different MPS were illustrated, which were the basis of MPS diagnosis. The DMB results showed a significant difference between these diseases, and the dimethylmethylene blue/creatinine (DMB/CRE) ratio of Hunter Syndrome was markedly greater than those of the Sanfilippo, Hurler, and Maroteaux-Lamy Syndrome, successively. The 2-D EP is also applicable for MPS prenatal diagnosis. One cell-free amniotic fluid with suspected Hunter Syndrome was analyzed by 2-D EP, and the results excluded the possibility of MPS which was confirmed by enzymatic study. CONCLUSIONS: The 2-D EP provides a good separation of urinary GAG, and the DMB method gives an estimation of the GAG concentration in the urine. Both of the methods are specific, sensitive, and easy to perform for MPS screening and diagnosis.

Suicide ideation and its relationship to depressed mood in a community sample of adolescents in Hong Kong.

A sample of 996 Chinese adolescents in Hong Kong provided information about their suicide ideation. Their depressive symptoms were measured by the Chinese Beck Depression Inventory (C-BDI), and a broad range of stressors were also assessed as potential predictors to level of suicide ideation. The stressors and C-BDI scores predicted 33% of the variance in suicide ideation. In boys, most of the prediction was attributable to C-BDI scores, suggesting that depression mediated the effects of stressors. In girls, C-BDI scores, perceptions of low parental caring, and high conflict with parents had additive effects in predicting level of suicide ideation. This study contributes needed information about a non-Western population and highlights gender differences.

The correlates of depressed mood in adolescents in Hong Kong.

PURPOSE: Most studies of depressed mood and its correlates in adolescents have been conducted in Western countries. This study examined the relationship between a broad range of stressors and depressed mood in a community sample of Hong Kong adolescents. METHODS: Secondary school students (n = 996) completed the Chinese Beck Depression Inventory (C-BDI), provided demographic information, and indicated their perceptions of family and peer relationships, school function and pressures, and subjective health, and some measures salient to the Hong Kong environment: triad gang pressure, religiosity, and intent to emigrate. The correlation between C-BDI and these variables was assessed in bivariate and multivariate analyses. RESULTS: Hong Kong adolescents reported higher levels of depressive symptoms than a comparison group of Western teenagers. Girls showed more symptoms than boys. All stressors correlated in bivariate analyses with C-BDI, indicating similar influences on depressed mood in Western and Hong Kong teenagers. In multivariate analyses, the stressors contributed cumulatively to the C-BDI score. Perceptions of a lack of parental understanding and peer acceptance appeared as the strongest variables in predicting depressed mood. CONCLUSIONS: Depressed mood is highly prevalent among Hong Kong teenagers. Stressors play a cumulative role in their relationship to mood. Our findings point to the importance of broad screening of this vulnerable population.

Passive smoking and respiratory symptoms in primary school children in Hong Kong. Child Health and Activity Research Group (CHARG).

1. We aimed to study whether passive smoking is associated with respiratory ill health in primary school children in Hong Kong. 2. In this cross-sectional study, a standardised structured questionnaire was used to obtain information on respiratory symptoms, smokers in the household and smoking habit of the children. A random sample of 30 primary schools was included. Four classes were randomly selected for each school, one class each from each school year of primary 3-6. A total of 3964 children aged 8 - 13 years completed the questionnaire during October 1995-May 1996. The response rate was over 94%. 3. In 3480 children who had never smoked, after adjusting for gender, age, place of birth and living district, the odds ratios (95% confidence interval) were: (a) throat problems, 1.35 (1.08-1.68); (b) cough, 1.54 (1.28-1.84); (c) phlegm, 1.43 (1.21-1.70); (d) wheezing, 1.21 (0.89-1.41); (e) nose problems, 1.17 (1.02-1.35). The odds ratios increased with increasing number of smokers at home (P for trend < 0.001; except for wheezing, P=0.3). The odds ratios for having any of the above symptoms for one, two and three smokers at home were respectively 1.15 (0.99-1.34), 1.48 (1.16-1.88) and 2.03 (1.47 - 2.81); P for trend < 0.001. 4. We conclude that the results provide further evidence that passive smoking is a cause of respiratory ill health in school children in Hong Kong.

Respiratory symptoms due to active and passive smoking in junior secondary school students in Hong Kong.

BACKGROUND: Evidence on respiratory symptoms due to smoking and passive smoking in children is mainly derived from studies in Western countries. Evidence from the East was required to support stronger tobacco control policy in Asia. This study aimed to analyse the relationship between respiratory symptoms and smoking status in junior secondary students and between respiratory symptoms and family smoking in never-smoking students. METHODS: In a cross-sectional survey in 1994, anonymous questionnaires were administered to a two-stage cluster probability sample of 6304 students, aged mostly 12-15 years, from 172 classes of 61 schools in Hong Kong. RESULTS: Significant linear trends were found between smoking and the prevalence of throat and nose problems, cough and phlegm, and wheezing. The odds ratio (OR), after adjustment for age, gender, area of residence, type of housing and correlation within schools and classes (cluster effects), for smoking at least weekly ranged from 1.35 to 4.84. In never-smoking children, significant trends were found between the number of smokers living with the children and throat and nose problems, cough and phlegm, and recent wheezing. The adjusted OR and 95% confidence interval (CI) for any cough or phlegm symptoms was 1.19 (95% CI: 1.01-1.47) for one smoking household member, 1.38 (95% CI: 1.07-1.79) for two and 1.85 (95% CI: 1.19-2.85) for three (P for trend <0.001). Increased OR were found for father and mother smoking. CONCLUSIONS: This study provides strong evidence that both active and passive smoking can cause respiratory ill health in Chinese children in Hong Kong. Urgent measures are needed to protect children from the health hazards of active and passive smoking in Asia.

Tobacco advertisements: one of the strongest risk factors for smoking in Hong Kong students.

STUDY OBJECTIVE: To describe the prevalence of smoking in junior secondary school students in Hong Kong and to analyse the relationship between a range of risk factors and ever-smoking experience, including tobacco advertisements. METHODS: Cross-sectional survey using an anonymous standardised self-administered questionnaire. SETTING: 61 randomly selected secondary schools in Hong Kong. PARTICIPANTS: 6,304 form 1 to 3 Chinese students from 172 classes (51% girls and 49% boys; 90% were aged 12 to 15 years). RESULTS: The smoking status (95% confidence interval) was: (1) never smoker, 71.1% (70.0%-72.2%), (2) tried only, 15.5% (14.6%-16.4%), (3) used to smoke but not now, 4.2% (3.7%-4.7%), (4) smoked < 1 cigarette per week, 2.9% (2.5%-3.4%), (5) smoked 1-6 per week, 1.7% (1.4%-2.0%), and (6) smoked > 6 per week, 4.5% (4.0%-5.0%). In a backward stepwise logistic regression model, ever-smoking (including categories 2 to 6 above) was independently associated with thirteen factors, including gender (boys), increasing age, place of birth (outside Hong Kong, mainly China), poor knowledge of the hazards of smoking, positive attitudes to smoking, smoking in family members, participation in tobacco promotional activities, and perception of cigarette advertisements as attractive. Among the strongest associations observed was the youth's perception of cigarette advertisements as attractive, with the adjusted odds ratio (95% confidence interval) of 2.68 (2.33-3.07). CONCLUSIONS: Smoking among young people is an important public health problem. Although the causes are multifactorial, in Hong Kong environmental tobacco advertising is an important risk factor that can be removed by banning all forms of tobacco promotion to young people.

Toothache with a multifactorial etiology: a case report.

A case report of orofacial pain originating from both dental and nondental conditions is presented. The spontaneous throbbing pain initiated from the left maxillary second premolar and spread throughout the entire upper part of the face to the frontoparietal area. Root canal treatment of the maxillary second premolar did not resolve the chief complaint. Magnetic resonance imaging examination revealed hypertrophy of the left inferior turbinate and soft tissue haziness in the left maxillary sinus floor. After antrostomy, submucosal turbinectomy, and endodontic treatment, the patient was free from pain. The final diagnosis of this case, in addition to pulpitis, was maxillary sinusitis with chronic rhinitis. The multiple factors associated with the etiology made the diagnosis difficult. The mechanism of referred pain from the maxillary sinus and paranasal mucosa to the maxillary teeth and face is discussed.

Evaluation of two videotape instruction programmes on how to break bad news--for Cantonese-speaking medical students in Hong Kong.

OBJECTIVES: To evaluate a culture-specific videotape on how to 'break bad news' and another videotape produced by a western university, and to determine if the language of presentation influenced the students' perceived abilities to execute basic skills. SUBJECTS: Third year medical students at the Faculty of Medicine, the University of Hong Kong. DESIGN: Longitudinal study with experimental design. INTERVENTION: Two instructional tapes on breaking bad news; one using Chinese speaking role models and one using English. RESULTS: In both groups, self-efficacy summed scores increased from 26.8 (95% CI = 25.9-27.7) at the pre-test to 29.0 (95% CI = 28.4-29.6). The biggest changes occurred in perceived self-efficacy regarding specific skills. However, students using the Chinese tape rated skills as more useful than those using the English tape. CONCLUSION: The videotapes were useful in teaching communication skills. Culturally relevant audiovisual materials were more effective.

Stopping drinking and risk of oesophageal cancer.

OBJECTIVE: To examine the effect of stopping drinking on the risk of oesophageal cancer. DESIGN: Hospital based case-control study. SETTING: Surgical departments of four district general hospitals and general practices in Hong Kong. SUBJECTS: Cases were 400 consecutive admissions of patients with histologically confirmed diagnosis of oesophageal cancer during a 21 month period in 1989-90 (87% response rate). Controls were 1598 patients selected from the same surgical departments as the cases and from the general practices from which the cases were originally referred (95% response rate). MAIN OUTCOME MEASURE: Relative risk of developing oesophageal cancer after stopping drinking (adjusted for age, education, place of birth, smoking, and diet). RESULTS: Current light drinking (< 200g ethanol/week) was not associated with significant increase in risk. Among former drinkers risk fell more quickly in moderate (200-599 g/week) than heavy (> or = 600 g/week) drinkers. Even among heavy drinkers, however, risk had dropped substantially after five to nine years of not drinking. The results suggest that the time taken for risk to return to that in subjects who never drink was 10-14 years for moderate drinkers and 15 years or more, if ever, for heavy drinkers. CONCLUSION: Risk of oesophageal cancer decreases fairly rapidly with time after abstaining from drinking. This new finding could be used in health promotion to encourage behavioural changes, especially in heavy drinkers, who have a very high risk of developing oesophageal cancer. It also suggests that alcoholic beverages have a strong effect on the late stage of carcinogenesis.