Risk factors and outcomes of childhood obesity in Hong Kong: a retrospective cohort study

1. Onset of obesity is related to age, gender, pubertal stage, dietary habits, and parental occupation. Targeting the high riskgroups may help curb obesity in children. 2. Obesity may lead to poor self-esteem and potential psychosocial risk. The psychosocial impact of obesity could be more pronounced in girls than boys. 3. The association between obesity and psychosocial health could be bi-directional. Improving psychosocial health could be beneficial in weight management for normal-weight and obese children. 4. Obesity is associated with higher blood pressures.

Effects of built environment on walking among Hong Kong older adults

1. Reliable and valid interviewer-administered questionnaires were developed to investigate associations of perceived neighbourhood attributes of Hong Kong older adults with their walking for transportation and recreation. 2. Access to and availability of different types of services and destinations, provision of facilities for resting/sitting in the neighbourhood, and easy access to/from residential buildings may help maintain an active lifestyle by facilitating walking for transport in the neighbourhood. 3. Access to services, indoor places for walking, environmental aesthetics, low traffic, and absence of physical barriers may promote recreational walking..

Underage alcohol drinking and medical services use in Hong Kong: a cross-sectional study

OBJECTIVES

To investigate the association of underage alcohol drinking with medical consultation and hospitalisation in Hong Kong.

DESIGN

Cross-sectional study.

SETTING

Secondary schools in Hong Kong.

PARTICIPANTS

A total of 33 300 secondary 1 (US grade 7) to secondary 5 students (47.6% boys; mean age 14.6 years, SD 1.6) in 85 randomly selected schools.

OUTCOME MEASURES

An anonymous questionnaire was used to obtain information about medical consultation in the past 14 days, hospitalisation in the past 12 months, drinking alcohol, smoking, illicit drug use, physical activity, secondhand smoke exposure, feeling depressed, feeling anxious and sociodemographic characteristics. Drinking alcohol was categorised as non-drinking (reference), <1, 1-2 and 3-7 days/week. Logistic regression yielded adjusted ORs (AORs) of medical consultation and hospitalisation for drinking, adjusting for different potential confounders. Subgroup analysis was conducted among adolescents who did not report feeling anxious or depressed.

RESULTS

More than one-fourth (27.6%) of adolescents drank alcohol, 15.9% had medical consultation and 5.1% had been hospitalised. In the fully adjusted model, the AORs (95% CI) for medical consultation were 1.14 (1.06 to 1.23) for <1 day/week, 1.30 (1.13 to 1.50) for 1-2 days/week and 1.70 (1.41 to 2.06) for 3-7 days/week of drinking compared with non-drinking (p for trend <0.001). The corresponding AORs (95% CI) for hospitalisation were 1.14 (1.02 to 1.28), 1.68 (1.32 to 2.14) and 2.38 (1.90 to 2.98) (p for trend <0.001). Similar associations were observed among students who did not feel anxious or depressed.

CONCLUSIONS

Alcohol consumption was associated with medical services use in Chinese adolescents. More rigorous alcohol control policies and health promotion programmes are needed to reduce alcohol drinking and related harms in adolescents.

Secondhand smoke exposure and health services use among adolescent current smokers

Background

To investigate the associations of secondhand smoke (SHS) exposure with medical consultation and hospitalisation among adolescents in Hong Kong.

Methods

A total of 35827 secondary 1 (US grade 7) to secondary 5 students from 85 randomly selected schools completed an anonymous questionnaire on smoking, SHS at home, SHS outside home, medical consultation in the past 14 days, hospitalisation in the past 12 months, and socio-demographic characteristics. Current smoking was defined as any smoking in the past 30 days. SHS exposure was classified as none (reference), 1–4 and 5–7 days/week. Logistic regression yielded adjusted odds ratios (AORs) for medical consultation and hospitalisation in relation to SHS exposure at home and outside home in current smokers. Analyses were also done among never-smokers for comparison.

Results

Among all students, 15.9% had medical consultation and 5.2% had been hospitalised. Any SHS exposure at home was associated with AORs (95% CI) for medical consultation and hospitalisation of 1.69 (1.14–2.51) and 2.85 (1.47–5.52) in current smokers, and 1.03 (0.91–1.15) and 1.25 (1.02–1.54) in never-smokers, respectively, (P<0.01 for interaction between smoking status and SHS exposure at home). SHS exposure outside home was generally not associated with medical consultation and hospitalisation in smokers and never-smokers.

Conclusions

SHS exposure at home was associated with health services use among adolescent current smokers. Adolescent smokers should be aware of the harm of SHS in addition to that from their own smoking. The evidence helps health care professionals to advise adolescent smokers to avoid SHS exposure and stop smoking.

Smoking family, secondhand smoke exposure at home, and quitting in adolescent smokers

INTRODUCTION

This study investigated the associations of smoking family and secondhand smoke (SHS) exposure at home with quit attempts and smoking cessation among adolescents.

METHODS

Students from 85 randomly selected secondary schools in Hong Kong were surveyed using an anonymous self-administered questionnaire on SHS exposure at home and outside the home in the past 7 days, quit attempts, smoking cessation, sociodemographic characteristics, and smoking status of family members and peers. Families with 1 or more smoking members (excluding the subject) were classified as smoking families and otherwise as nonsmoking families. Logistic regression yielded adjusted odds ratios (AORs) for quit attempts and smoking cessation in smoking families with or without SHS exposure at home compared with nonsmoking families.

RESULTS

Of 4,361 students who had smoked in the past 12 months, 70.3% were living with smokers and 52.8% were exposed to SHS at home. Compared with nonsmoking families, the AORs (95% CI) for making at least 1 quit attempt in the past 12 months were 0.80 (0.61-1.05) for 0 day, 0.80 (0.63-1.04) for 1-3 days, and 0.65 (0.50-0.86) for 4-7 days of SHS exposure at home. The corresponding AORs (95% CI) for smoking cessation were 0.58 (0.48-0.70), 0.45 (0.35-0.58), and 0.49 (0.41-0.60) (p for trend <.001). Any SHS exposure at home was associated with 28% and 53% lower odds of quit attempts and smoking cessation, respectively.

CONCLUSIONS

Living with smoker(s) and especially being exposed to SHS at home may hinder quit attempts and smoking cessation among Chinese adolescent smokers.

Quality of diabetes care in public primary care clinics in Hong Kong

BACKGROUND

Little is known about the quality of care for patients with Type 2 diabetes in primary care setting in Hong Kong.

OBJECTIVES

To investigate the quality of care for patients with Type 2 diabetes in Hong Kong primary care setting and potential disparities by patient characteristics and clinics.

METHODS

Cross-sectional study in three general outpatient clinics (GOPCs; public primary care clinics) in Hong Kong involving 1970 patients. Main outcome measures were achievement rates of seven process measures and three intermediate outcome targets and adjusted odds ratios of age, sex, socio-economic status and clinic on the quality measures.

RESULTS

The achievement rates for the recording of HbA1c, blood pressure (BP), cholesterol, body mass index, smoking status, nephropathy screening and retinopathy screening in the previous 12 months were 92.8%, 99.9%, 91.0%, 47.9%, 91.3%, 69.0% and 38.0%, respectively. A total of 58.0%, 38.2% and 36.4% of patients achieved the glycaemic, BP and cholesterol targets, respectively. Older patients were less likely to have records of process measures and more likely to achieve the HbA1c target. Women were less likely to have smoking status recorded and to achieve the HbA1c target. Patients of lower socio-economic status were less likely to have records of process measures and to achieve the BP target. Family medicine training practices had better achievements of the quality measures.

CONCLUSIONS

There is scope for improvement in the quality of diabetes care in the GOPCs. Variations in the quality of care were observed. Family medicine training may enhance the health care quality.

Comparison of ex-vivo high-resolution episcopic microscopy with in-vivo four-dimensional high-resolution transvaginal sonography of the first-trimester fetal heart

OBJECTIVE

To compare the capability of three-dimensional (3D) reconstructed images produced by high-resolution episcopic microscopy (HREM) with that of in-vivo four-dimensional high-resolution transvaginal sonography (4D-HRTVS) to discern morphological features of the first-trimester human fetal heart.

METHODS

This was a prospective study of fetal hearts between 9 and 14 weeks' gestation. For ex-vivo 3D analysis, 30 human fetal hearts (at 9 + 0 to 14 + 6 weeks) were retrieved from surgical terminations of pregnancy. The specimens were embedded in resin and episcopic ('block-face') imaging was used to obtain a digital volume dataset (HREM) using 3-micron slicing. 4D-HRTVS was performed in 28 separate pregnancies at 10 + 2 to 14 + 0 weeks using a Voluson E8 ultrasound machine with volumetric transvaginal RIC 6-12-MHz transducers. Heart volumes obtained by both methods were compared to assess their ability to demonstrate first-trimester cardiac morphology. Comparisons were made in the transverse and sagittal planes, and using volume rendering.

RESULTS

All hearts were structurally normal, although abdominal situs was not examined in the isolated hearts that underwent HREM. 4D-HRTVS demonstrated each of the complete five transverse cardiac views in 32-86% of cases. HREM showed four features unique to the first-trimester human heart: prominent atrial appendages, spiral ventricular arrangement, prominent coronary arteries and thickened arterial walls. 4D-HRTVS could demonstrate the first two, but ultrasound resolution was too poor to quantify wall thickness and demonstrate coronary arteries in the 3-5-mm diameter heart.

CONCLUSIONS

4D-HRTVS showed limited morphological features of the first-trimester fetal heart compared with HREM. HREM provides a gold standard of ex-vivo imaging against which developments in ultrasound resolution could be compared.

Smoking is associated with poor self-rated health among adolescents in Hong Kong

INTRODUCTION

To investigate the association between smoking and self-rated health (SRH) among adolescents in Hong Kong.

METHODS

Form 1 (U.S. Grade 7) to 5 students (N = 36,225) from 85 randomly selected secondary schools were surveyed using anonymous, self-administered questionnaires to collect information about smoking, SRH, secondhand smoke exposure, drinking, illicit drug use, physical activities, medical services use, health complaints, and sociodemographic characteristics. Logistic regression yielded adjusted odds ratios (AORs) for poor SRH due to smoking in boys and girls.

RESULTS

Compared with never-smoking, smoking experimentation, ex-smoking, and current smoking were associated with AORs (95% CI) for poor SRH of 1.22 (1.07-1.40), 1.43 (1.12-1.83), and 1.31 (1.13-1.53), p for trend <.001, in boys and 1.26 (1.10-1.39), 1.42 (1.08-1.85), and 1.75 (1.53-2.00, p for trend <.001, in girls. The AOR of poor SRH for current smoking was higher in girls than boys, p for interaction <.001. Current and experimental smoking but not ex-smoking were significantly associated with poor SRH among healthy students who had no health complaints or recent medical consultations. Increasing cigarette consumption, years of smoking, and smoking urge were also significantly associated with poor SRH.

CONCLUSIONS

Smoking was associated with poor SRH among Chinese adolescents, especially girls. This finding is useful for discouraging smoking initiation and motivating quitting in adolescent smokers.

Who wants a slimmer body? The relationship between body weight status, education level and body shape dissatisfaction among young adults in Hong Kong

Background

Body shape dissatisfaction has been thought to have an indispensable impact on weight control behaviors. We investigated the prevalence of body shape dissatisfaction (BSD) and explored its association with weight status, education level and other determinants among young adults in Hong Kong.

Methods

Information on anthropometry, BSD, and socio-demographics was collected from a random sample of 1205 young adults (611 men and 594 women) aged 18-27 in a community-based household survey. BSD was defined as a discrepancy between current and ideal body shape based on a figure rating scale. Cross-tabulations, homogeneity tests and logistic regression models were applied.

Results

The percentages of underweight men and women were 16.5% and 34.9% respectively, and the corresponding percentages of being overweight or obese were 26.7% and 13.2% for men and women respectively. Three-quarters of young adults had BSD. Among women, 30.9% of those underweight and 75.5% of those with normal weight desired a slimmer body shape. Overweight men and underweight women with lower education level were more likely to have a mismatch between weight status and BSD than those with higher education level. After controlling for other determinants, underweight women were found to have a higher likelihood to maintain their current body shapes than other women. Men were found to be less likely to have a mismatch between weight status and BSD than women.

Conclusions

Overweight and obesity in men and underweight in women were prevalent among Hong Kong young adults. Inappropriate body shape desire might predispose individuals to unhealthy weight loss or gain behaviors. Careful consideration of actual weight status in body shape desire is needed in health promotion and education, especially for underweight and normal weight women and those with a low education level.

Overestimation of peer smoking prevalence predicts smoking initiation among primary school students in Hong Kong

PURPOSE

To investigate the relationship between perceived prevalence of smoking and smoking initiation among Hong Kong primary second- to fourth-grade-students.

METHODS

A cohort of 2,171 students was surveyed in 2006 and again in 2008. Students who perceived ever-smoking prevalence in peers as "none" or "some" were considered as correct (reference group), whereas those who perceived it as "half" (overestimation) or "most/all" (gross overestimation) were considered as incorrect.

RESULTS

At baseline, overestimation was found to be cross-sectionally associated with ever-smoking (p < .01). At follow-up, 7.2% of never-smoking students with incorrect estimation at baseline had started smoking, which was 79% (95% confidence interval: 3%-213%), greater than that of 3.7% for those with correct estimation. Among the never-smoking students with incorrect estimation, subsequent correct estimation was associated with 70% (95% confidence interval: 47%-83%) lower risk of smoking initiation compared with persistent incorrect estimation.

CONCLUSION

Overestimation of the prevalence of peer smoking predicted smoking initiation among children. Interventions should be carried out to evaluate whether correcting children's overestimation of peer smoking could reduce smoking initiation.

Lifestyle and socioeconomic correlates of breakfast skipping in Hong Kong primary 4 schoolchildren

OBJECTIVE

Although breakfast is associated with different benefits, breakfast skipping is increasingly common among children. This study aimed to identify lifestyle and socioeconomic correlates of breakfast skipping in Hong Kong schoolchildren.

METHODS

68,606 primary 4 participants of the Department of Health Student Health Service in 1998-2000 reported breakfast habit and other lifestyle characteristics using a standardized questionnaire. Height and weight were measured by trained SHS nurses. Socioeconomic data were reported by parents. In cross-sectional analysis, multivariate logistic regression was used to identify lifestyle and socioeconomic correlates of breakfast skipping.

RESULTS

3,598 subjects (5.2%) usually skipped breakfast. Breakfast skipping was associated with being overweight (Odds ratio=1.59, 95% CI: 1.46 to 1.73) and obese (2.06, 1.80 to 2.36), and unhealthy dietary habits including more frequent junk food (1.23, 1.14 to 1.33) but less frequent fruit/vegetable (1.23, 1.13 to 1.34) and milk (1.98, 1.80 to 2.16) intake. Breakfast skippers tended to skip lunch, do less extra-curricular physical activity, watch more television and have less educated parents.

CONCLUSIONS

Breakfast skipping was significantly related to various health-compromising lifestyle characteristics and lower parental education. Breakfast habit can be a potential lifestyle indicator. Education programmes aimed at specific target groups should encourage regular breakfast consumption.

The use of waist-to-stature ratio to identify underweight and overweight in adolescents

OBJECTIVES

To examine the percentile distribution of waist-to-stature ratio (WSR) and derive WSR cut-offs for underweight, normal weight, and overweight based on the International Obesity Task Force (IOTF) and local weight-for-height standards in Hong Kong Chinese adolescents.

METHODS

In the Hong Kong Student Obesity Surveillance project in 2006-2007, height, weight and waist circumference of 13 568 (40.3% boys) Chinese adolescents aged 12-18 were measured. Smoothed percentile distributions of WSR by age and sex were examined using Lambda-Mu-Sigma (LMS) regression. The sex- and age-specific WSR values corresponding to underweight and overweight, as defined by the IOTF and local weight-for-height standards, were determined using receiver operating characteristic curves.

RESULTS

The percentile values of WSR were stable across age in both sexes. In general, WSR values of 0.40 and 0.46 corresponded to underweight and overweight, respectively, as defined by both IOTF and local weight-for-height standards. As a reference for normal weight status, the median weight-for-height values corresponded to a WSR value of 0.42 in most sex-age subgroups.

CONCLUSION

Sex and age independent WSR cut-off values for underweight, median weight and overweight in Hong Kong adolescents were identified. WSR is potentially a practical indicator for adolescents to monitor their weight status.

Subjective health and fibrinogen in a healthy Chinese cohort

OBJECTIVES

This study explores standard cardiovascular (CVD) risk factors in a healthy population sample, with low CVD prevalence and presumed higher social connectedness as potential mechanisms linking subjective health (SH) and physical health.

METHOD

A population-based, telephone-sampled, cross-sectional study recruited a healthy subset of 2280 Chinese adults who subsequently underwent a free medical examination. Serum total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, fibrinogen, fasting glucose, 2-hour post-load glucose, blood pressure and adiposity were compared between respondents reporting good SH and those reporting poor SH over the past 3 months, on a 4-point, single-item measure.

RESULTS

After adjustment for age, gender, education, exercise, marital and smoking status, only serum fibrinogen significantly differentiated the two groups. Respondents reporting Very poor or Poor SH had a significantly greater likelihood of raised mean fibrinogen levels compared with those reporting Good or Very good SH (Adjusted Odds Ratio 1.37, 95% CL 1.002-1.84, p < .05).

CONCLUSIONS

There is a small but robust association between SH and fibrinogen in this low CVD prevalent population unexplained by known pre-existing disease.

Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?

BACKGROUND

Age is associated with both impaired glucose and insulin metabolism. To what extent the age-related changes in insulin resistance (IR) and beta-cell function contribute to the increase in prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is less known, and this is investigated in this study.

METHODS

This study included 6610 men and 7664 women of different ethnic groups aged 30-69 years. IR and beta-cell function were examined by the homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-B). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis adjusting for body mass index and study.

RESULTS

In Chinese men, the ORs (95% CIs) for IFG were 2.69 (1.70, 4.26), 2.51 (1.49, 4.21) and 2.89 (1.68, 4.97), respectively, in age groups of 40-49, 50-59 and 60-69 years compared with 30-39 years (p < 0.001 for trend); the corresponding figures for IGT were 1.73 (1.25, 2.38), 2.54 (1.78, 3.63) and 3.57 (2.46, 5.19) (p < 0.001 for trend). Similar trends for IGT were observed also in Chinese women and other ethnic groups, but not for IFG in Mauritius Indian and Creole men. Adjustment for HOMA-IR and HOMA-B reduced the ORs in all age groups of all ethnicities for both IFG and IGT, but the risk gradient between age groups remained particularly for the IGT.

CONCLUSIONS

The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

Evaluation of internal reliability in the presence of inconsistent responses

BACKGROUND

We aimed to assess the impact of inconsistent responses on the internal reliability of a multi-item scale by developing a procedure to adjust Cronbach's alpha.

METHODS

A procedure for adjusting Cronbach's alpha when there are inconsistent responses was developed and used to assess the impact of inconsistent responses on internal reliability by evaluating the standard Chinese 12-item Short Form Health Survey in adolescents.

RESULTS

Contrary to common belief, random responses may inflate Cronbach's alpha when their mean differ from that of the true responses. Fixed responses inflate Cronbach's alpha except in scales with both positive and negative polarity items. In general, the bias in Cronbach's alpha due to inconsistent responses may change from negative to positive with an increasing number of items in a scale, but the effect of additional items beyond around 10 becomes small. The number of response categories does not have much influence on the impact of inconsistent responses.

CONCLUSIONS

Cronbach's alpha can be biased when there are inconsistent responses, and an adjustment is recommended for better assessment of the internal reliability of a multi-item scale.

The Short Form-12 Health Survey was a valid instrument in Chinese adolescents

OBJECTIVE

To evaluate the construct validity of the standard Chinese Short Form (SF)-12v2 in adolescents.

STUDY DESIGN AND SETTING

Data collected from the Hong Kong Student Obesity Surveillance project conducted in 2006-2007 were used. The standard Chinese SF-12v2 was first evaluated against clinical criteria previously used for the evaluation of SF-12 or SF-36. The data were then randomly split into training and validation halves for exploratory and confirmatory factor analyses, respectively.

RESULTS

A total of 31,357 adolescents with mean age of 14.8 years (standard deviation=1.9; range=11.0-18.9) were included. The standard Chinese SF-12v2 effectively distinguished groups differing in doctor-diagnosed health problems, self-reported illnesses in the past 30 days, gender, perceived health in the past 3 months, and health compared with that 12 months back. The mental health scale had low internal consistency (Cronbach's alpha=0.34). The exploratory factor analysis was influenced by method effects, but confirmatory factor analysis confirmed the hypothesized latent structure and the one-factor structure of the SF-12v2, providing fit indices within acceptable limits.

CONCLUSION

The two components and a single general health component of the standard Chinese SF-12v2 are appropriate health indicators for Chinese adolescents.

Community psycho-behavioural surveillance and related impact on outbreak control in Hong Kong and Singapore during the SARS epidemic

1. The promotion of personal protective health practices must take into account background perceptions of risk and psychological responses in the community-at-large. 2. Population psycho-behavioural factors in Hong Kong and Singapore are shown to be an important potential vector for the transmission of an infectious agent. 3. Comparative psycho-behavioural surveillance and analysis can yield important insights into generic versus population-specific issues that could be used to inform, design and benchmark public health infection control measures.

The importance of atrial structure and fibers

Atrial structures are important in the current era of cardiac interventions using percutaneous transcatheter procedures. Understanding their locations and component parts helps to reduce risks of procedural-related damage. The general arrangement of the myofibers that make up the atrial walls is reviewed to provide a morphologic basis for atrial conduction and potential substrates of arrhythmias. The right atrium, dominated by its appendage, is characterized by having an extensive array of pectinate muscles. These extend almost perpendicularly from the terminal crest. The left atrium has relatively smooth walls and a small tubular-shaped appendage. The myofibers show changes in orientations when traced through the thickness of the walls. Extensions of atrial myocardium onto the pulmonary veins and the superior caval vein are common. Apart from Bachmann's bundle, there are other muscular bridges of variable numbers and sizes that provide interatrial connections, connections between the left atrium and the coronary sinus, and connections between the muscular sleeves of the right pulmonary veins and the right atrium. The purpose of this review is to summarize the three-dimensional arrangement of gross atrial structures, the myoarchitecture and variations in muscular interatrial connections. These are important features in intra- and interatrial conduction.

Alcohol and cardio-respiratory deaths in Chinese: a population-based case-control study of 32,462 older Hong Kong adults

BACKGROUND

In observational studies moderate alcohol use reduces cardio-respiratory mortality. However observational studies may be biased by many factors including residual confounding by unmeasured differences between moderate alcohol users and other groups or by changes in alcohol use with ill-health and aging. We used two different analytic strategies in an under-studied population, i.e. southern Chinese, to provide an assessment of the specific impact of moderate alcohol use on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary diseases (COPD).

METHODS

In a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998, we used adjusted logistic regression to compare alcohol use in decedents aged > or = 60 years from IHD (2270) and COPD (1441) with 10,320 living and 9043 dead controls (all non-alcohol related deaths). We also examined whether the association of alcohol use with death from IHD or COPD varied with sex or smoking status.

RESULTS

Using living controls and adjusted for age, socio-economic status and lifestyle, occasional and moderate alcohol use were generally associated with lower mortality from IHD and COPD. However, using dead controls the protection of occasional and moderate alcohol use appeared to be limited to ever-smokers for IHD (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.46 to 0.73 for moderate compared to never-use in ever-smokers, but OR 1.07, 95% CI 0.76 to 1.50 in never-smokers), and possibly to men for COPD. High alcohol use was associated with lower IHD mortality and possibly with lower COPD mortality.

CONCLUSION

High levels of alcohol use in an older Chinese population were associated with lower IHD mortality. Moderate alcohol use was less consistently protective against IHD mortality. Alcohol use was associated with lower COPD mortality particularly in men, either due to some yet to be clarified properties of alcohol or as the artefactual result of genetic selection into alcohol use in a Chinese population. Given the increasing use of alcohol in China with economic development, other designs and analytic strategies are needed to assess the impact of alcohol in this population, so that an evidence-based public health policy can be formulated.

Occluding the left atrial appendage: anatomical considerations

BACKGROUND

Occlusion of the left atrial appendage (LAA) is thought to reduce the risk of thromboembolic events in patients with atrial fibrillation.

OBJECTIVE

To examine the LAA and its relationship to neighbouring structures that may be put at risk when intervening to occlude its os.

METHODS

31 heart specimens were examined grossly. Four of the LAAs were processed for histological examination and endocasts were made from 11 appendages. The diameters of the LAA os and proximity to the left superior pulmonary vein, mitral valve and left anterior descending artery were measured and areas of thin atrial wall in the vicinity were noted.

RESULTS

The LAA orifice was oval shaped in all cases with a mean (SD) diameter of 17.4 (4) mm (range 10-24.1). The mean (SD) distances of the LAA orifice to the left superior pulmonary vein and mitral valve were 11.1 (4.1) mm and 10.7 (2.4) mm, respectively. The left anterior descending, circumflex artery and, in 6 cases, the sinus node artery, were in close proximity to the LAA. Pits or troughs and areas of thin atrial wall were found in 57.7% of hearts within a 20.9 mm radius from the os. Histology showed small crevices and areas of very thin wall within the trabeculated appendage.

CONCLUSIONS

The LAA orifice is oval shaped and thin areas of appendage wall and atrial wall are common. Potentially, the left superior pulmonary vein, mitral valve and anterior descending coronary artery can be at risk during occlusion of the os.

BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians

OBJECTIVE

To compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) in association with diabetes or hypertension.

METHODS AND PROCEDURES

Cross-sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged 35-74 years, of different ethnicities were included in this meta-analysis.

RESULTS

Age-adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three) adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P=0.001) in men but with WC and WSR than BMI (both P<0.05) in women. Hypertension had stronger association with BMI than WHR in men (P<0.001) and had the strongest with BMI than the others (WHR P<0.001; WSR P<0.01; and WC P<0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742) while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped.

DISCUSSION

WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly associated with hypertension in Asians.

Factor structure of the Center for Epidemiological Studies Depression Scale in Hong Kong adolescents

We present data from the Center for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977) for 2 samples of Hong Kong community adolescents (combined N = 1,385). The 4 positive affect items related poorly to the remainder of the scale. Using 16 items, the data were consistent with 2 models with highly correlated factors: (a) a 2-factor model, 1 of which merged somatic and affective items, and (b) a 3-factor model separating somatic, depressed, and interpersonal items. Correlations with related constructs provide preliminary support of validity. Hong Kong adolescents are influenced both by traditional concepts of mind-body holism and Western psychological models separating psychological and somatic symptoms.

Moderate alcohol use and mortality from ischaemic heart disease: a prospective study in older Chinese people

BACKGROUND

Moderate alcohol use is generally associated with lower ischaemic heart disease (IHD) mortality but it is difficult to ascertain whether this is due to attributes of moderate alcohol users or the properties of alcohol itself. Evidence from populations with different patterns of alcohol use and IHD can provide crucial evidence. We assessed the association of moderate alcohol use with IHD mortality in older Chinese people from Hong Kong.

METHODOLOGY

We used Cox regression to determine whether moderate alcohol use was associated with IHD mortality in a prospective, population-based cohort study of all 56,167 attendees, aged 65 years or over, from July 1998 to December 2000 at all 18 Elderly Health Centers operated by the Department of Health in Hong Kong.

PRINCIPAL FINDINGS

After a median follow-up of 4.2 years, there were 406 (188 in men, 218 in women) deaths from IHD in 54,090 subjects (96.3% successful follow-up). Moderate alcohol use in men was not associated with IHD mortality adjusted only for age [Hazard Ratio, HR 1.01 (95% CI 0.55 to 1.84) compared with never drinkers] or additionally adjusted for socio-economic status and lifestyle. Almost all women were occasional drinkers and their current alcohol use was not significantly associated with IHD mortality [HR 0.88, (95% CI 0.51 to 1.53)].

CONCLUSIONS

Moderate alcohol use had no effect on IHD mortality in older Chinese men. Lack of replication of the usual protective effect of moderate alcohol use in a setting with a different pattern of alcohol use and IHD could be due to chance or could suggest that the protective effect of alcohol on IHD does not extend to all populations.