Hip fractures are preventable: a proposal for osteoporosis screening and fall prevention in older people.

Osteoporosis is highly prevalent but underdiagnosed and undertreated in Hong Kong. Fragility fractures associated with osteoporosis often result in loss of independence and increased mortality for home-dwelling patients, imposing a high socio-economic burden on society. This issue requires urgent attention given the rapid growth of the elderly population in Hong Kong by approximately 4.3% each year. To address this situation, a group of experts convened to discuss practical ways to reduce the burden of fractures and formulated three recommendations: first, all men (aged ≥70 years) and women (aged ≥65 years) should receive universal dual-energy X-ray absorptiometry assessment for osteoporosis. Second, all men (aged ≥70 years) and women (aged ≥65 years) with a fracture-risk assessment-derived 10-year risk (hip fracture with bone mineral density) ≥3% should receive ≥3 years of anti-osteoporotic treatment. Third, comprehensive structured assessment (including dual-energy X-ray absorptiometry) should be conducted in older patients with a history of falling. By implementing these recommendations, we estimate that we could prevent 5234 hip fractures in 10 years, an annual incidence reduction of approximately 7%, and save HK$425 million in direct medical costs plus substantial indirect savings. Ample clinical and cost-effectiveness data support these recommendations, and studies in Hong Kong and abroad could serve as models on how to implement them. We are confident that by applying these recommendations rigorously and systematically, a significant reduction in hip fractures in Hong Kong is achievable.

Estimating geriatric patient's body weight using the knee height caliper and mid-arm circumference in Hong Kong Chinese.

The use of the knee height caliper is a convenient way to estimate a patient's body weight. However, the equation devised to estimate an individual's body weight was specifically designed for Caucasians and Blacks. Therefore, this study is to assess the suitability of the knee height caliper among Chinese geriatric patients residing in Hong Kong. Over a six-month period, all geriatric patients from an acute care hospital and private nursing home in the Kwun Tong were recruited into the study. Only patients/residents that were considered unstable with ascites; low blood pressure; on cardiac monitors or had respiratory difficulties were excluded. Measurements from the knee height caliper and mid-arm muscle circumference of the patients were necessary for estimating their body weights. The actual body weights measured with calibrated bed, chair or portable scales was compared with the calculated body weights from the equation. A comparison of the mean and linear regression was performed for analysis of the results. A total of 300 geriatric patients (200 females and 100 males) were recruited. The mean MAC and knee height results were as follows: 25.1 cm (SD 3.9) for females and 26.2 cm (SD 3.2) for males; and 45.75 cm (SD 2.09) for females and 48.98 cm (SD 2.09) for males respectively. The mean difference among the male group was 0.4222 (95% CI: -0.54, 1.39) with a mean estimated body weight of 58.1 kg (SD 10.1) and a mean actual body weight of 57.7 kg (SD 9.9). The mean difference among the female group was 2.9649 (95% CI: 2.30, 3.63) with a mean estimated body weight of 51.6 kg (SD 10.9) and a mean actual body weight of 48.6 kg (SD 10.1). A new equation devised from the data is as follows: Chinese males (over 60 years of age) (R-square -0.81) Weight = [knee height (cm) x 0.928 + mid-arm circumference (cm) x 2.508 - age (years) x 0.144] - 42.543 +/-9.9kg of actual weight for 95% of Chinese males; Chinese females (over 60 years of age) (R-square - 0.82) Weight (kg) = [knee height (cm) x 0.826 + mid-arm circumference (cm) x 2.116 - age (years) x 0.133] - 31.486 +/-10.1kg of actual weight for 95% of Chinese females. The results showed that the mean estimated body weight calculated from the knee height equation (for Caucasians) was significantly larger than the mean actual body weight for the Chinese subjects. This study suggests that the knee height caliper is a useful tool for estimating the body weights. However, a multi-center study is necessary to validate the new equation for the elderly Chinese population.

Early unplanned readmission of patients with newly diagnosed tuberculosis discharged from acute hospital to ambulatory treatment.

OBJECTIVE: The aim of this study was to examine whether patients with newly diagnosed tuberculosis (TB) discharged to ambulatory treatment are at risk of unplanned readmission through the emergency department within 28 days of discharge, and the risk factors associated with such readmission. METHODOLOGY: A cohort of 134 patients admitted to an acute medical department with TB, who were subsequently discharged to ambulatory treatment of TB, were studied by a retrospective record review for unplanned readmission in 28 days. Potential risk factors associated with the readmission were recorded during hospital stay and follow-up visits, including age, sex, length of stay, substance abuse, need of assistance in the activities of daily living (ADL), comorbidities, non-compliance, drug complications and use of non-standard drug regimen. RESULTS: Up to 20.1% of patients were readmitted. Factors independently associated with early unplanned readmission were need of assistance in ADL, drug complications, the need to use a non-standard drug regimen and more than three non-chest comorbidities. CONCLUSIONS: A significant readmission rate was found in these patients and potential risk factors were identified. Ambulatory treatment for TB may not be appropriate for selected patients. Local guidelines for the management of TB patients at high risk of readmission is needed.

Changing needs and changing service delivery for long-term care in Hong Kong.

Both the need for and delivery of long-term care in Hong Kong are shaped by the interaction of the traditional and modern. Rapid social change is affecting traditional family structures and roles in care of the elderly, resulting in increased demand for formal care, which to date has been provided mainly by way of residential care. This growth of demand will escalate with rapid population aging in coming decades. In response to this burgeoning demand, current planning is seeking to reshape the established service system and tackle problems in service delivery in ways that will address the bias towards residential care and improve quality of care.

Predicting traditional Chinese medicine's use and the marginalization of medical care in Hong Kong.

The study examined the importance of socio-demographic factors, health conditions, health beliefs and health seeking behaviors in predicting the use of Traditional Chinese Medicine (TCM) in Hong Kong. A sample of 4,339 respondents was randomly selected and interviewed. Among the 1,651 respondents who had consulted a doctor in the three months prior to the survey, 8.6% consulted a TCM doctor. Besides, 13.5% of the entire sample reported that they had been using TCM drugs frequently or occasionally. Socio-demographic factors, health conditions, health beliefs and health seeking behaviors were all found predictive of the use of TCM. In particular, those who were older, female, new immigrants, unemployed, retired, had chronic disease such as rheumatism, bronchitis, asthma, and those taking non-prescribed medication and not seeking treatment when falling ill were more likely to use TCM. Perceived difficulty in obtaining medical services and high medical cost also predicted TCM use. In sum, the findings suggest that TCM users are likely to be those who have been marginalized in obtaining medical care.

The compression of spheres coated with an aqueous ethylcellulose dispersion.

Tablets were compressed from commercial samples of Sugar Spheres NF, Sucrose NF, Corn Starch NF, as well as ground spheres and a physical mixture of ground sucrose plus cornstarch. Additional tablets were compressed from spheres that had been coated with a water-soluble cellulosic polymer solution followed by an aqueous ethylcellulose dispersion. Tableting parameters measured "in-die" included work of compression, peak offset time, tablet density, and Young's modulus. Following ejection, tensile strength was determined under diametrical loading. Dissolution of a marker contained in the water-soluble layer was determined for both compressed and uncompressed spheres. Porosities at peak pressure and peak offset times or tensile strength as functions of peak pressure did not differ between tablets compressed from pristine spheres or from ground spheres. Tablets compressed from spheres had higher values for porosity, tensile strength, and peak offset time than those compressed from sucrose or the sucrose: starch mixture. Values for work of compression were higher for tablets compressed from pristine spheres or from starch. This was attributed to the work required for particle deformation and for breaking of the spheres. The greatest elastic recovery during decompression was observed for tablets compressed from pristine spheres or starch. More brittle behavior was observed for tablets compressed from sucrose or the sucrose: starch mixture. Tablets compressed from ground spheres were more brittle than those compressed from the pristine spheres, indicating an effect due to grinding. Most mechanical properties of tablets compressed from the coated spheres were comparable to those of tablets compressed from uncoated spheres. An exception was diametric strain for tablets compressed from spheres coated with the aqueous ethylcellulose dispersion. These values increased since the plasticized ethylcellulose allowed greater distortion of the tablet before failure occurred. The dye marker was released more rapidly from tablets compressed from spheres coated with the aqueous ethylcellulose dispersion than from comparable uncompressed spheres. At both the 5% and 10% coating levels, spheres coated with the aqueous ethylcellulose dispersion fused into nondisintegrating matrices during compression. Little difference in release rates was seen between the two tablets.

One-week ranitidine bismuth citrate versus colloidal bismuth subcitrate-based anti-Helicobacter triple therapy: a prospective randomized controlled trial.

OBJECTIVE: The efficacy of 1 wk bismuth triple therapy is adversely influenced by the presence of metronidazole resistance. In vitro studies suggest that ranitidine bismuth citrate (RBC) plus metronidazole exhibit synergistic activity against metronidazole resistant strains of Helicobacter pylori (H. pylori). Whether this confers a superior clinical efficacy remains unproven. This study compared the efficacy of RBC-based triple therapy with bismuth triple therapy in eradication of H. pylori. METHODS: Patients with H. pylori-related ulcer disease or gastritis were randomized to receive either 400/mg of RBC twice daily plus 400/mg of metronidazole and 500/mg of tetracycline four times daily for 1 wk (RMT) or 120/mg of colloidal bismuth subcitrate, 400/mg of metronidazole, and 500/mg of tetracycline, all given four times daily for 1 wk (BMT). Metronidazole susceptibility was determined by the E-test and pretreatment resistance was defined as minimum inhibitory concentration > or = 32/mg/L. RESULTS: Of 100 consecutive patients randomized, two patients were lost to follow-up in each group. Forty-three of 85 (51%) H. pylori isolates were metronidazole resistant. Per-protocol cure rate for RMT and BMT was 40 of 41 (98%) and 37 of 44 (84%), respectively (p = 0.058). Intent-to-treat cure rate for RMT and BMT was 46 of 50 and 41 of 50, respectively (92% vs 82%, p = 0.23). A significantly higher eradication of metronidazole resistant H. pylori was observed in the RMT group (25 of 25, 100%) than in the BMT group (12 of 16, 75%), (p = 0.018). Side effects observed in the two treatment groups were comparable. CONCLUSIONS: One week of RBC triple therapy with metronidazole and tetracycline is an effective anti-Helicobacter therapy. This regimen is more appropriate in areas of high prevalence of metronidazole resistance.

Health promotion for the elderly persons in Hong Kong.

By the year 2000, there will be one million elderly persons in Hong Kong. With the rise of an older population, the cost of health care is likely to increase. Studies conducted in Hong Kong have shown that over 30% of health care expenditure is spent on the elderly. Unless steps are taken to slow the onset of chronic illnesses in elderly people, health care expenditure will increase rapidly in the future. The present paper describes strategies that have been adopted for promoting a healthier elderly population in Hong Kong. The paper also reports the results of an evaluative study on the largest health promotion program for older people in Hong Kong. It seems to show that health promotion activities may have the potential to save lives, delay institutionalization, and improve life satisfaction.

Geriatric day hospital in Hong Kong: a three-year follow-up study.

In this study, 477 elderly patients who attended the day hospital at Princess Margaret Hospital, Hong Kong in the years 1979-81 are reviewed. Our patients are on the whole younger than those in the UK, with an approximately equal sex ratio. The day hospital has an important function for the rehabilitation of stroke patients. A longer stay of patients has reflected the lack of day hospital places. A low New Patient Index resulted from the lack of day care centres.