Comparative accuracies of automated and manual office blood pressure measurements in a Chinese population.

We aimed to assess the difference in the accuracy of readings from automated office blood pressure machines with each other or with manual office blood pressure measurements in Chinese individuals. We collected awake 48-h ambulatory blood pressure monitoring, two automated office blood pressure device (BpTRU and WatchBP) readings, and manual office blood pressure measurements in Chinese patients (n = 135) with hypertension in a randomized sequence. Differences were compared using paired t-tests and Bland-Altman plots. The sensitivity and specificity of the techniques for detecting elevated blood pressure were calculated using awake ambulatory blood pressure monitoring as the reference standard. The WatchBP device's and awake ambulatory blood pressure readings were similar. The BpTRU device provided significantly lower mean systolic (P < 0.001) and diastolic (P < 0.001) blood pressure readings, while manual office BP provided significantly higher mean systolic (P = 0.008) and diastolic (P < 0.001) blood pressure readings than the awake automated office blood pressure readings. Automated and manual office blood pressure measurements showed similar sensitivity, specificity, and 95% limits of agreement as based on Bland-Altman plots. The mean systolic (P < 0.001) and diastolic (P < 0.02) blood pressure readings of WatchBP and BpTRU differed, and their diagnostic performances were not superior than those of manual office blood pressure measurements in Chinese patients. Therefore, automated office blood pressure measurements cannot be routinely recommended for Chinese individuals in clinical practice. More studies are needed to confirm these results.

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong.

BACKGROUND: The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. METHODS: This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective. RESULTS: A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51-4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47-8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22-3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01-0.73). CONCLUSIONS: While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Incidence of and Risk factors for Mild Cognitive Impairment in Chinese Older Adults with Multimorbidity in Hong Kong.

The aim of our study was to identify the incidence rate of and the risk factors for mild cognitive impairment (MCI) among Chinese older adults with multimorbidity in primary care in Hong Kong. Older adults aged 60 years and above with multimorbidity were recruited from the public primary care clinics in Hong Kong. Incidence rates were calculated with the person-years. Cox proportional hazard regression models were used to predict the risk factors for MCI. Sensitivity analysis was performed using multiple imputation. Among 462 participants included in the main analysis, 45 progressed from normal to MCI with an incidence rate of 80.9 cases per 1000 person-years. Older age (HR 2.82, 95% CI 1.26-6.28) and being single (HR 2.15, 95% CI 1.11-4.19) were risk factors for developing MCI in the multivariable regression model. A total of 660 participants were included in the sensitivity analysis, with an MCI incidence of 114.4 cases per 1000 person-years. Older age and being single remained to be risk factors for MCI among older adults with multimorbidity. There may be a high incidence of MCI among Chinese older adults with multimorbidity in primary care in Hong Kong. Future larger studies need to confirm the prevalence and incidence of MCI among primary care Chinese patients.

A Pilot Cross-Sectional Study of Postpartum Wrist Pain in an Urban Chinese Population: Its Prevalence and Risk Factors.

BACKGROUND: Wrist pain after childbirth is commonly encountered in clinical practice. Little is known about the prevalence of this musculoskeletal disorder which is important to overall maternal health. OBJECTIVE: To examine the prevalence of and risk factors for de novo wrist pain in women after childbirth. STUDY DESIGN: A pilot cross-sectional survey. SETTING: A telephone interview was conducted 2 months after childbirth among women who delivered at a tertiary hospital in Hong Kong. METHODS: The prevalence of de novo wrist pain was recorded; its severity was rated using the numerical rating scale and Patient-Rated Wrist Evaluation (PRWE) with pain and functional subscale scores. RESULTS: In total, 259 women aged 32.8 ± 4.0 years participated; 149 women (57.5%) developed wrist pain after childbirth and 125 (84%) had persistent wrist pain 2 months postpartum. The majority had moderate (43.5%) to severe (21%) wrist pain. Bilateral involvement was common (56.8%), with most of the pain (59.3%) located on the radial side of the wrist. Primiparity was associated with wrist pain development (odds ratio 2.62, 95% confidence interval 1.33 - 5.16, P = 0.01); pain intensity was negatively correlated with the baby's birth weight (beta = -1.059, P = 0.013). Mean PRWE pain and function scores were 22.8 ± 10.3 and 15.6 ± 10.7, respectively. LIMITATIONS: Cross-sectional survey is prone to volunteer bias, though recent literature indicates that the bias may not substantially affect the internal validity of the study. CONCLUSIONS: Wrist pain is prevalent after childbirth; future studies may consider looking into its exact pathology, long-term consequences, and overall effect on maternal health. KEY WORDS: Wrist pain, DeQuervain disease, postpartum, childbirth, mothers, prevalence, cross sectional study, survey.

Primary care physicians' attitudes and beliefs towards chronic low back pain: an Asian study.

BACKGROUND: Chronic low back pain is a serious global health problem. There is substantial evidence that physicians' attitudes towards and beliefs about chronic low back pain can influence their subsequent management of the condition. OBJECTIVES: (1) to evaluate the attitudes and beliefs towards chronic low back pain among primary care physicians in Asia; (2) to study the cultural differences and other factors that are associated with these attitudes and beliefs. METHOD: A cross sectional online survey was sent to primary care physicians who are members of the Hong Kong College of Family Physician (HKCFP). The Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT) was used as the questionnaire to determine the biomedical and biopsychosocial orientation of the participants. RESULTS: The mean Biomedical (BM) score was 34.8+/-6.1; the mean biopsychosocial (BPS) score was 35.6 (+/- 4.8). Both scores were higher than those of European doctors. Family medicine specialists had a lower biomedical score than General practitioners. Physicians working in the public sector tended to have low BM and low BPS scores; whereas physicians working in private practice tended to have high BM and high BPS scores. CONCLUSION: The lack of concordance in the pain explanatory models used by private and public sector may have a detrimental effect on patients who are under the care of both parties. The uncertain treatment orientation may have a negative influence on patients' attitudes and beliefs, thus contributing to the tension and, perhaps, even ailing mental state of a person with chronic LBP.

Prevalence and psychosocial correlates of depressive symptoms in urban Chinese women during midlife.

OBJECTIVE: Depression is common in women with much research focusing on hormonal changes and menopausal symptoms but with little exploration of psychosocial problems in midlife. This study investigates the prevalence of clinically relevant depressive symptoms in midlife Chinese women and its association with psychosocial factors. METHODS: A cross-sectional, community-based household survey of women aged 45 to 64 years of age was conducted in Hong Kong from September 2010 to March 2011. The structured questionnaire included demographic data, educational status, marital status and household income, as well as perceived current stressful events and significant life events in the past 12 months. Information on clinically relevant depressive symptoms was measured by the validated chinese Patient Health Questionnaire (PHQ-9). RESULTS: A total of 402 participants were recruited in the study period. Of the 393 women who completed the questionnaire, the prevalence of clinically relevant depressive symptoms (PHQ-9 score≧10) was 11.0%. In multiple regression analysis, being single/divorced/separated/widowed, having an educational level of primary school level or below, having multiple chronic diseases, loss of hobby or loss of close social support in the past 12 months in midlife were associated with clinically relevant depressive symptoms. CONCLUSIONS: Correlates of clinically relevant depressive symptoms in midlife Chinese women can be used to identify those at increased risk and potentiate further studies to explore early psychosocial and community interventions.

Lower urinary tract symptoms (LUTS) as a risk factor for depressive symptoms in elderly men: results from a large prospective study in Southern Chinese men.

A cross-sectional relationship between lower urinary tract symptoms (LUTS) and depressive symptoms was previously reported among Southern Chinese men; however, the temporal relationship was unclear. Our objective is to evaluate the temporal relationship between moderate to severe lower urinary tract symptoms and clinically significant depressive symptoms in elderly Chinese men aged 65 in a prospective manner. In a prospective cohort of 2,000 Chinese men aged 65 to 92 years in Hong Kong, we studied the association of having moderate to severe LUTS at baseline and having clinically relevant depressive symptoms at year 2 follow-up. After excluding men with prostate or bladder cancer or surgery (n = 20) and lost to follow-up (n = 254), data on 1,726 subjects were analyzed. LUTS were measured by the International Prostate Symptom score; and clinically relevant depressive symptoms were measured by the Geriatric Depression Scale. The multiple logistic regressions showed that the presence of moderate-to-severe LUTS at baseline were significantly associated with increased risk for being depressed at two-year follow-up, with adjustments for demographic, lifestyle, medical factors, weight status and stressful life events (OR = 2.97; CI: 1.70-5.20). Association remained significant with additional adjustments for baseline GDS score (OR = 1.88; CI: 1.03-3.41). LUTS are important risk factors in predicting the presence of clinically relevant depressive symptoms. In elderly men, increased awareness and possible screening are needed to detect the increased risk of clinically relevant depressive symptoms.

Visual functioning and quality of life among the older people in Hong Kong.

OBJECTIVES: This study aimed to examine the association of visual functioning and health-related quality of life (HRQOL) among the older community in Hong Kong. DESIGN: This study used the baseline examination of a cohort study MrOs and MsOs (a large study for osteoporosis in men and women). SETTING: This study was set in the Hong Kong community. PARTICIPANTS: A total of 4000 ambulatory community-dwelling Chinese men and women aged 65 years or above participated in this study. MEASUREMENTS: Health-related quality of life was assessed by Medical Outcomes Study Short Form-12 (SF-12), with physical component summary (PCS) and mental component summary (MCS) scores. Demographics, medical history, mental status, and quality of life were obtained from face-to-face interviews, using standard structured questionnaire. Visual functions (i.e., binocular visual acuity, contrast sensitivity, and stereopsis) were assessed by different visual tests after refraction corrections. Different visual functions were tested simultaneously in multiple ordinal logistic regression models. RESULTS: Better binocular visual acuity, contrast sensitivity, and stereopsis were associated with higher PCS. Visual acuity and contrast sensitivity was associated with PCS after adjustment of different visual functions and sex, age, education level, cognitive status, and history of diabetes in multivariate analysis, (OR = 0.73, 95% CI = 0.54 0.98) for low vision (≤6/24) compared with ≥6/9 in visual acuity and (OR = 1.34, 95% CI = 1.09 1.64) for contrast sensitivity row b 5-8 (best) compared with 0-1 (worst). MCS was only associated with visual acuity and contrast sensitivity, but no association was found after adjustment. CONCLUSION: Apparent association was found between visual functions and HRQOL among older community in Hong Kong. In addition to visual acuity, contrast sensitivity is also important, so eye care should also cover.

Characteristics of age-related changes in bone compared between male and female reference Chinese populations in Hong Kong: a pQCT study.

There have been few comprehensive studies on the age-related changes in bone mineral density (BMD) and bone structure in Chinese people. Using peripheral quantitative computed tomography (pQCT), we assessed volumetric BMD of both trabecular and cortical bone and their geometry at both radius and tibia in 620 Chinese men and 638 women, aged 20­98 years, in Hong Kong. Cortical BMD did not start declining until after the age of 50 years in women and the age of 60 years in men. In contrast, trabecular BMD declined with age starting from adulthood in both sexes, and the rates of decline accelerated after the age of 50 years only in women. The integral and trabecular bone area expanded with age in older men and women, primarily at the tibia. Cortical bone area decreased significantly in older women, particularly at the tibia, while it decreased only slightly with aging in men. The moment of inertia decreased with age at the radius in older men and women. At the tibia, age-related decline accelerated in older women, but not in older men. It was concluded that trabecularization of bone in response to declining BMD and mechanical loading may be maladaptive by reducing cortical bone area, if periosteal apposition cannot keep pace with it.

Bone mineral status and its relation with dietary estimates of net endogenous acid production in Hong Kong Chinese adolescents.

Diet composition influences net endogenous acid production (NEAP), which may affect bone health. No studies are available to relate dietary estimate of NEAP to bone health in Chinese adolescents. This study examined the association of dietary estimates of NEAP with bone mineral status in Hong Kong Chinese adolescents. Baseline data on 171 boys and 180 girls aged 10-12 years from the Hong Kong Adolescent Bone Health Cohort Study were presented. Weight, height, Tanner stage and dietary intakes by FFQ were collected. NEAP was estimated from diet using Frassetto's method. Bone area (BA), bone mineral content (BMC) and bone mineral apparent density (BMAD) of total hip, lumbar (L1-L4) spine and whole body were estimated by dual-energy X-ray absorptiometry (DXA). No significant association was observed between BMC or BMAD and energy-adjusted NEAP or other nutrients. BA was significantly and positively associated with BMC at all sites in both sexes. Weight was significantly and positively associated with BMC in hip and spine in both sexes. Height was negatively correlated with hip BMC for boys and whole body BMC for girls. Pubertal stage was significantly and positively associated with BMC in all sites in both sexes. Weight and height contributed most of the variability in BMAD at different sites. The results suggest that anthropometric characteristics and pubertal stage are more influential than dietary NEAP in determining bone mineral status of Hong Kong Chinese adolescents. However, the methodological weaknesses regarding the use of DXA and FFQ in the present sample require attention.

Prevalence of and risk factors for androgen deficiency in middle-aged men in Hong Kong.

The purpose of this investigation was to study the prevalence of and risk factors for androgen deficiency in middle-aged men in Hong Kong. A community-based, cross-sectional household survey was performed in Hong Kong on men aged 45 to 64 years. Demographics, lifestyle information (cigarette smoking, alcohol consumption, and physical activity), and symptoms previously defined for identifying those with androgen deficiency were measured by using standardized questionnaires. Blood samples were collected in the morning, and total, free, and bioavailable testosterone levels were assessed. Data on androgen deficiency were available for 252 men aged 45 to 64 years. Crude prevalence of androgen deficiency was 9.52%. Prevalence increased significantly with age. For risk factors, having a lower personal income and having a history of hypertension were independently associated with increased risk of having androgen deficiency (odds ratio, 3.72; confidence interval, 1.01-13.61; and odds ratio, 2.89; confidence interval, 1.06-7.91, respectively). The prevalence of androgen deficiency in Hong Kong Chinese is similar to that found in Caucasians by using a similar definition. From this age-specific prevalence cross-sectional data, it is estimated that there are approximately 68,775 Hong Kong Chinese men aged 45-64 years with androgen deficiency. Future studies with large sample size are needed to evaluate the risk factors for androgen deficiency in men.