Choices between Chinese and Western medicine in Hong Kong - interactions of institutional environment, health beliefs and treatment outcomes.

BACKGROUND: About 15-20% of the general public in Hong Kong consult TCM practitioners. This study explored the decision making process involved in Hong Kong Chinese's choice between TCM and western medicine. METHODS: Eight focus group interviews (six to eight participants per group) and four individual interviews were conducted. RESULTS: The participants kept an "old fashioned" concept of TCM. Many saw TCM as a non-scientific practice and had stronger trust on the credibility of western medicine. Some participants, however, preferred the more personalized treatment approach of TCM. While western medicine was usually the initial choice, the participants were pragmatic to adopt TCM when they felt western medicine was not working, or to supplement the treatment. They were often referred by members of their social networks. CONCLUSION: The public' perception of TCM lagged behind its actual development. Many TCM users are pragmatic users who learn through trial and error.

Quality of life (QOL) among community dwelling older people in Taiwan measured by the CASP-19, an index to capture QOL in old age.

There was no existing scale in Mandarin Chinese to specifically measure QOL in old age. We aimed to validate a Chinese Taiwan version of the CASP-19 (control, autonomy, self-realization, pleasure), a QOL questionnaire, in Taiwan. The existing CASP-19 Cantonese version was modified into Chinese Taiwan version and pilot tested. Data were then gathered from 699 older people. Score distribution, exploratory and confirmatory factor structure, reliability and clinical validity of the CASP-19 and its shortened version, the CASP-12, were examined. The mean age of the participants was 75.5 (standard deviation (SD) 6.5), and half (49.5%) were female. The mean CASP-19 score was 38.2 (range 11-56; SD 7.1), lower than that of Western countries. Exploratory factor analysis revealed an additional factor, 'participation' (CASPP-19). There was satisfactory internal consistency (Cronbach's α 0.63-0.85) for the subscales, except for the control domain. For the 19-item scale, the first order five-domain model (CASPP-19) yielded the best fit. For the CASP-12, first and second order original CASP-12 models performed equally well. There was an inverse relationship between the CASP total scores and frailty, chronic diseases, depressive disorders, living alone and fall events in the past 12months, supporting good clinical validity for all versions of the CASP scale (CASP-19, CASPP-19, original and new CASP-12). The original CASP-12 may be presently the best choice for use in China, Taiwan or other Mandarin-speaking populations due to its conciseness and model parsimony.

Against the odds or odds-on chance: pathways of coming back among hand-injured workers in the Chinese context.

In this study, I used a hermeneutic phenomenological approach by means of thematic analysis to examine the lived experiences of hand-injured workers in Hong Kong. Twenty-seven informants with moderate to severe disabilities were interviewed over ten years about how they lived through their disability and their discourses were examined in the cultural context. Three categories (survivors, achievers, strugglers) were synthesized from the informants' life courses. Each category was analyzed under three themes: biographical disruption, working with a disability, and linking family and significant others, but these three categories proved fluid and subject to individual life course and contextual factors. All informants had to work "against the odds." Most returned to work after recovery but some tended to drift within the labor market. Human agency and situated context facilitated achievers to progress through "odds-on chance." Outcome measures of rehabilitative interventions that focus on returning to employment might underestimate the sequelae of being disabled in society.

Excess hospital admissions for pneumonia, chronic obstructive pulmonary disease, and heart failure during influenza seasons in Hong Kong.

It is widely held that Southern China is a hypothetical influenza epicentre for the emergence of pandemic influenza viruses. However, influenza is perceived as a relatively unimportant infection in this part of the world compared with western countries. Hong Kong is situated within the hypothetical epicentre and serves as a sentinel post for the region. In a retrospective study, the influenza-associated excess hospitalisations in a regional hospital for pneumonia, chronic obstructive pulmonary disease (COPD), heart failure, and asthma in persons aged > or = 65 years from 1998 to 2001 were each estimated by a model taking into consideration the confounding effect of other respiratory viral infections, seasonal factors, time trends, and weather and pollution indices. In the regression models, influenza activity is an independent significant factor affecting admission rates for pneumonia, COPD, and heart failure but not that for asthma. The variations in hospital admissions for pneumonia, COPD, and heart failure explained by influenza activity were 38.9, 7.5, and 45.6%, respectively. The adjusted rates of excess influenza-associated hospital admissions for the three diagnoses combined amounted to 58.5, 20.0, 29.2, and 13.4 per 10,000 populations aged > or = 65 years in 1998, 1999, 2000, and 2001, respectively. In conclusion, influenza activity is associated significant excess hospital admissions among elderly aged 65 or above in Hong Kong, comparable to the data reported in Western countries. The findings support a wider application of annual influenza vaccination in this region.

The development and evaluation of an integrated community-based, patient-centred learning activity at the University of Hong Kong.

OBJECTIVE: To develop and evaluate the Patient Care Project (PCP), an integrated patient-centred, community-based learning activity, implemented at the University of Hong Kong since 1992. DESIGN: The PCP, a required course in the first 2 preclinical years, is structured into four learning cycles over 9 months. Each cycle consists of a patient interview followed by a debriefing group tutorial. In-depth interviews with the same patient allow students to explore the impact of disease and patients' illness experience, as well as the contribution of the wider determinants of health to their condition. The debriefing tutorial frames empirical observations into theoretical models and its format reinforces habits of problem-based learning. The programme was evaluated using survey questionnaires completed by students, patients and tutors. PARTICIPANTS: 324 first- and second-year medical students. RESULTS: Students, participating patients and tutors all rated the PCP positively in end-of-course evaluations. Specifically, 68% of students commented that the PCP had met all or most of its stated objectives, while there was nearly unanimous agreement among patients that students demonstrated understanding and empathy in the visits and interviews. Tutor appraisal of student performance also indicated the attainment of all stated aims and objectives overall. CONCLUSIONS: The PCP is a valuable contribution to community-based learning and the promotion of the patient-centred clinical method.