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.

Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial.

AIM: This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers. BACKGROUND: Osteoarthritis of the knee is a major source of loss of function in older people. Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice. METHOD: A randomized control trial was carried out from December 2002 to May 2003 and 120 participants (65.9%, including 67 in intervention group and 53 in control group) completed the 16-week postintervention assessments. Outcome measures included arthritis self-efficacy, use of self-management techniques, pain intensity and daily activity. FINDINGS: At 16 weeks, there was a 'statistically' significant improvement in the arthritis self-efficacy level (P

An experimental study comparing the effects of combined transcutaneous acupoint electrical stimulation and electromagnetic millimeter waves for spinal pain in Hong Kong.

OBJECTIVES: To compare the efficacy of combined transcutaneous acupoint electrical stimulation (TAES) and electromagnetic millimeter wave (EMMW) therapy as an add-on treatment for pain relief and physical functional activity enhancement among adults with sub-acute non-specific spinal pain in either the low back or neck. DESIGN: A non-blinded study with data obtained before, immediate, one week and three months after intervention. SETTING: The Telehealth Clinic and Community Centre, Hong Kong. PARTICIPANTS: Forty-seven subjects with either sub-acute neck or low back pain. INTERVENTION: Subjects were randomly allocated to either an intervention group (n=23) or a control group (n=24). These groups were then divided into subgroups according to the site of their spinal pain-neck or back. The intervention group had eight treatments over a three-week period of TAES and EMMW. OUTCOME MEASURES: Changes from baseline to the end of treatment were assessed at intervals of one week and three months on either neck or low back pain intensity [by Visual Analogue Scale (VAS)]; stiffness level; stress level; neck or low back lateral flexion and forward flexion in cm, and interference with daily activities. RESULTS: The baseline VAS scores for the intervention and control groups were 5.34 and 5.18 out of 10, respectively (P value=0.77). At the one week and three month assessments, there were no significant differences between the groups-VAS (P value=0.09 and 0.27, respectively). A further subgroup of chronic pain sufferers (n=31) was identified and these had significantly reduced pain intensity at the one week assessment (P value=0.04) but this was not sustained at post three months after treatment (P value=0.15). Improvements in stiffness level, stress level, and functional disability level in the intervention group were not significant. CONCLUSIONS: Our study shows that there was a reduction in pain intensity, stress and stiffness level immediately after the eight sessions of treatment (TAES and EMMW), though the effect is not sustained after a week. No pain relief was found with the neck pain subgroup. However, the reduction in subjective average pain intensity among the chronic pain subgroup was sustained at the post one week assessment for the intervention group but not at the post three month assessment.

Impact of an Arthritis Self-Management Programme with an added exercise component for osteoarthritic knee sufferers on improving pain, functional outcomes, and use of health care services: An experimental study.

OBJECTIVE: The aim of this study was to assess the effect of an adopted Arthritis Self-Management Programme (ASMP) with an added exercise component among osteoarthritic knee sufferers in Hong Kong. METHODS: An experimental study with 88 participants assigned to an intervention group and 94 participants to a control group. One hundred and forty-nine participants (81.9%) completed the 1 week and 120 participants (65.6%) the 16 week post-intervention assessments. Participants in the intervention group received a 6-week ASMP with an added exercise component. Outcome measures included arthritic pain and fatigue rating, practice of light exercise routines, functional status, and number of unplanned arthritis-related medical consultations. To assess the programme's effect on outcome measures, the between-groups and within-group mean changes were compared using Mann-Whitney U-test and Friedman test. RESULTS: At 16 weeks, there were significant mean changes between groups in four outcome measures: reduction in arthritis pain (p=0.0001) and fatigue (p=0.008), and increased duration of weekly light exercise practice (p=0.0001) and knee flexion (p=0.004). The ability to perform daily activities and the number of unplanned arthritis-related medical consultations show statistically significant improvements between three time-points within the intervention group only (p=0.0001 and p=0.005, respectively), but not between-groups (p=0.14 and p=0.86, respectively). Both groups apparently had no changes in muscle strength. CONCLUSION: Our findings suggest that the intervention had a positive effect in reducing pain, fatigue, knee range of motion, the practice of exercise routines, the number of medical consultations and in improving functional status and over a 16-week period. PRACTICE IMPLICATIONS: The self-management programme we applied took into account the local context and the ethnicity of the group. This process is worth further exploration and testing in different groups.

An experimental study on the effectiveness of acupressure with aromatic lavender essential oil for sub-acute, non-specific neck pain in Hong Kong.

OBJECTIVES: To assess the efficacy of acupressure using an aromatic essential oil (lavender) as an add-on treatment for pain relief and enhancing physical functional activities among adults with sub-acute non-specific neck pain. DESIGN: Experimental study design. SETTING: The Telehealth clinic and the community centre, Hong Kong. INTERVENTION: A course of 8-session manual acupressure with lavender oil over a 3 week period. OUTCOME MEASURES: Changes from baseline to the end of treatment were assessed on neck pain intensity [by Visual Analogue Scale (VAS)]; stiffness level; stress level; neck lateral flexion, forward flexion and extension in cm, and interference with daily activities. RESULTS: The baseline VAS score for the intervention and control groups were 5.12 and 4.91 out of 10, respectively (P = 0.72). One month after the end of treatment, compared to the control group, the manual acupressure group had 23% reduced pain intensity (P = 0.02), 23% reduced neck stiffness (P = 0.001), 39% reduced stress level (P = 0.0001), improved neck flexion (P = 0.02), neck lateral flexion (P = 0.02), and neck extension (P = 0.01). However, improvements in functional disability level were found in both the manual acupressure group (P = 0.001) and control group (P = 0.02). CONCLUSIONS: Our results show that eight sessions of acupressure with aromatic lavender oil were an effective method for short-term neck pain relief.

Cardiovascular disease: application of a composite risk index from the Telehealth System in a district community.

Assessing a combination of cardiovascular disease (CVD)-risk factors may be a practical tool for risk assessment and for finding the high-risk group among local community members. This study examines the association between the number of CVD-risk factors, regardless of any specific combination with the CVD ambit, using data from 1,570 residents in Tsing Yi community (Hong Kong) who registered with the Telehealth System. A quantitative composite CVD Risk Index (CVDRI) with scores ranging from 0 to 6 included rankings for high systolic and diastolic blood pressure, presence of diabetes, body mass index (BMI), smoking, and age. Multivariate logistic regression was used to estimate odds ratios for the prevalence of CVD. Those with a CVDRI of 1, 2, or 3 and above were 1.7 [95% confidence interval (CI) = 1.34-3.99], 5.3 (95% CI = 3.60-7.90), and 10 times (95% CI = 6.41-15.50) more likely to have CVD, respectively, than those with a risk index of 0. Among the CVDRI components, high blood pressure had the greatest influence on CVD risk, followed by presence of diabetes and high BMI. In conclusion, a CVDRI based on existing health data from a Telehealth System was developed and used to identify local community members at risk of CVD. Nurse intervention may achieve greater reduction of CVD morbidity and mortality if multiple risk factors for the high-risk group are addressed at the same time.

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.

The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomised controlled trial.

OBJECTIVES: To assess the effect of acupoint stimulation with electrodes combined with acupressure using an aromatic essential oil (lavender) as an add-on-treatment on pain relief and enhancing the physical functional activities among adults with sub-acute or chronic non-specific low back pain. DESIGN: Randomised controlled trial. SETTING: The community centre, Old-Aged Home and Women Workers Association, Hong Kong. INTERVENTION: 8-session relaxation acupoint stimulation followed by acupressure with lavender oil over a 3-week period. The control group received usual care only. OUTCOME MEASURES: Changes from baseline to the end of treatment were assessed in pain intensity (by Visual Analogue Scale) and duration; lateral fingertip-to-ground distance in centimetres; walking time and interference on daily activities. RESULTS: The baseline VAS scores for the intervention and control groups were 6.38 (S.E.M. = 0.22) and 5.70 (S.E.M. = 0.37) out of 10, respectively ( P=0.24 ). One week after the end of treatment, the intervention group had 39% greater reduction in VAS pain intensity than the control group ( P=0.0001 ), improved walking time ( P=0.05 ) and greater lateral spine flexion range ( P=0.01 ). CONCLUSIONS: Our results show that 8-sessions of acupoint stimulation followed by acupressure with aromatic lavender oil were an effective method for short-term LBP relief. No adverse effects were reported. To complement mainstream medical treatment for sub-acute LBP, the combined therapy of acupoint stimulation followed by acupressure with aromatic lavender oil may be one of the choices as an add-on therapy for short-term reduction of LBP.

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.

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.

The association between medications and falls in Australian nursing-home residents.

OBJECTIVE: To determine whether commonly used medications increase the risk of falling in elderly Australians living in nursing homes. DESIGN: Case-control study. SETTING: A 104-bed nursing home in western Sydney during 1990-1991. SUBJECTS: The cases comprised 71 people who had at least one fall during the 12-month study period; 55 people with no falls over the same period served as the control group. The mean age of subjects was 82 years. MEASURES: Data included medication use in the 24 hours prior to a fall, and assessments of ambulatory status, and gait and balance problems. All data were abstracted from medical records. RESULTS: After adjusting for potential confounders (age, sex, health status, depression, dementia, incontinence, ambulatory status, gait and balance problems, length of stay and use of other medications), the use of antipsychotics was found to be an important risk factor for falls (odds ratio 4.4, 95% confidence interval 1.2-16.5). CONCLUSIONS: Our results support the conclusion that antipsychotic medications increase the risk of falls among elderly Australians living in nursing homes. Health professionals should minimise the use of these medications.