Should adolescents be vaccinated against hepatitis A: the Hong Kong experience.

Hong Kong is a well developed city in the center of an endemic region for hepatitis A. The age at which hepatitis A occurs has shifted from childhood and adolescence to adults like many western countries. There is a high chance of outbreaks with the introduction of infection from neighbouring countries. Reducing the susceptibility of a population by vaccination can eliminate the diseases but updated sero-epidemiological data is needed to analyse the level of natural immunity, and identify those susceptible to infection for preventive measures. This study conducted amongst secondary school children seeks to identify those who are at risk and to obtain data on the present sero-prevalence of anti-HAV. Overall prevalence of anti-HAV in this age group was 7% increasing with age. Analysed by multiple regression model, those students living in mainland China over 3 years had odds ratio of 31.6 (95% c. i. 17.4-57.3) compared with those born in Hong Kong. Students with a father in a skilled occupation and an education level of secondary school or above, and both parents with secondary education or above, had an odds ratio of 0.22 (95% c.i. 0.07-0.7) and 0.35 (95% c.i. 0. 17-0.72) associated with presence of anti-HAV, respectively. Improved socio-economic state exposes higher proportion of the population at risk. Immunisation is worthwhile to be considered for the adolescents in Hong Kong. Prevaccination screening is cost effective only for those adolescents who are most likely to have natural immunity.

Changing hepatitis A epidemiology among Hong Kong Chinese adolescents: what are the implications?

OBJECTIVE: To study the sero-epidemiology of hepatitis A virus (HAV) among adolescents in Hong Kong and analyse the changing patterns of the infection rates. DESIGN: Cross sectional study. SETTING: Secondary school students. SUBJECTS: One thousand, five hundred and eighty students were randomly selected from 12 schools in four regions of Hong Kong. MAIN OUTCOME MEASURES: Anti-HAV status. RESULTS: The overall prevalence of anti-HAV is 7%. The sero-prevalence for age group 11-20 y has fallen compared with 44.8% in 1978, 17.1% in 1987 and 11.2% in 1989. Those adolescents born in mainland China, who are frequent travellers and had a longer period of residence in mainland China were shown to have a higher prevalence of anti-HAV. CONCLUSION: The changing epidemiology of HAV indicates that Hong Kong will have a large proportion of susceptible young adults. Because of its geographic situation and import of most its food supplies from less developed countries, for epidemiological purposes the inhabitants can be compared to western travellers staying in a five star hotel in a less developed country. The risk of an outbreak of HAV is to be expected. Vaccination has the potential to serve as an effective prevention for adolescents living in countries whose circumstances are similar to Hong Kong.

The trouble with family medicine.

BACKGROUND: The trouble with family medicine is that the perceptual framework it uses to view the phenomena of health and illness is at variance with the frameworks traditionally used by medicine generally. This creates difficulties in communication between those in family medicine and those in other disciplines, and sometimes leads to misunderstanding of the nature of the discipline of family medicine and its place in the health care system. Those who practise family medicine need to be 'multilingual', able to understand and speak the language and use the metaphors of family medicine, yet equally able to use the language and metaphors of other disciplines. OBJECTIVES: This paper, which begins with a clinical scenario, reviews the contemporary biomedical paradigm, proposes an alternative, and examines the conceptual frameworks which underpin the discipline of family medicine.

Longitudinal reliability of the Royal Australian College of General Practitioners certification examination.

The examination for Fellowship of the Royal Australian College of General Practitioners is a long-standing examination that is regarded as a valid and comprehensive assessment of competence for general practice in Australia. Income and employment opportunities now depend on passing this battery of eight subtests. This paper describes the structures of the examination and reports an analysis of the reliability and efficiency of the examinations, based on data from five consecutive examinations. Results indicate that the examination achieves acceptable overall reliability, although suggestions for changes to improve reliability are made. A decision on implementing any changes must take into consideration any consequent changes in validity.

An analysis of the FRACGP exam.

This paper reports briefly on an analysis of data from five consecutive FRACGP examinations. Using new measurement technology, this study sought to investigate the reliability and efficiency of the exam, which has long been regarded as a valid and comprehensive assessment of competence for general practice in Australia. Results indicate that the examination achieves acceptable overall reliability, although some segments contribute more to the reliability than others. Suggestions for changes to improve reliability are made. A decision on implementing these changes must take into consideration any consequent changes in validity.

Practice audit-blessing or threat?

The purpose of this paper is to define the elements of quality assurance in health care, to outline ways in which quality care may be assured, to focus on practice audit as a specific method, and to suggest how we might prepare our graduates more adequately to assure that they deliver quality care throughout their professional life.