SF-6D utility scores of smokers and ex-smokers with or without respiratory symptoms attending primary care clinics

Introduction

The aim of this paper is to find out generic preference-based Short-Form 6 Dimensions (SF-6D) utility scores of smokers and ex-smokers with varying cigarette exposure, with and without respiratory symptoms.

Methods

Seven hundred thirty one people aged ≥30 with a history of smoking who attended 5 public primary care clinics completed a cross-sectional survey using SF-6D utility score, Breathlessness, Cough, and Sputum Scale (BCSS©) and office spirometry.

Results

Most of the subjects were men (92.5%) in an older age group (mean age 62.2 ± 11.7 years). About half of them (48.3%) were current smokers while the other half (51.7%) were ex-smokers. More than half of them (54.2%) reported mild respiratory symptoms (mean BCSS score 0.95 ± 1.12). The most common symptoms were sputum (45.1%), followed by cough (34.2%) and breathlessness (6.0%). The SF-6D overall utility score was 0.850 ± 0.106. The subjects reported significantly lower SF-6D scores when they had breathlessness (0.752 ± 0.138; p = < 0.001), cough (0.836 ± 0.107; p = 0.007), sputum (0.838 ± 0.115; p = 0.004) or any of the above symptom (0.837 ± 0.113; p < 0.001). In both groups of current smokers and ex-smokers, there was no statistically significant difference in the scores among light, moderate or heavy smokers. In the Tobit regression model of factors affecting SF-6D utility score, subjects who reported more respiratory symptoms (i.e. higher BCSS©) had lower SF-6D scores (B = − 0.018 ± 0.007, p < 0.001), while men had higher SF-6D scores than women (B = 0.037 ± 0.031, p = 0.019). Subjects who attended middle or high school had higher SF-6D score than those attended the University or above. The presence of airflow obstruction was not associated with the score.

Conclusions

The study yielded SF-6D utility scores of smokers and ex-smokers with different reported cigarette exposure, which could be useful in future clinical studies and cost-effectiveness analysis.

Effect of a financial incentive on the acceptance of a smoking cessation programme with service charge: a cluster-controlled trial

INTRODUCTION

Frontline health care professionals in Hong Kong may encounter high refusal rates for the Hospital Authority's Smoking Counselling and Cessation Programme (SCCP) when smokers know it is subject to a service charge. We compared SCCP booking and attendance rates among smokers with or without a financial incentive.

METHODS

In this multicentre non-randomised cluster-controlled trial, adult smokers who attended one of six general out-patient clinics between November 2015 and April 2016 were invited to join an SCCP. Attendees in the three intervention-group centres but not the three control-group centres received a supermarket coupon to offset the service charge.

RESULTS

A total of 173 smokers aged 18 years or older (92 in the intervention group and 81 in the control group) were recruited into the study. In the intervention group, 47 smokers (51%) agreed via a questionnaire that they would join the SCCP, compared with only 23 smokers in the control group (28%). The booking rates were 83% (n=39) in the intervention group and 83% (n=19) in the control group. Among those who had booked a place, 19 (49%) intervention-group participants and 11 (58%) control-group participants attended an SCCP session. Multivariable logistic regression revealed that offering a coupon was associated with agreeing to join an SCCP (odds ratio=4.963, 95% confidence interval=2.173-11.334; P<0.001) and booking an SCCP place (odds ratio=4.244, 95% confidence interval=1.838-9.799; P<0.001).

CONCLUSION

Provision of a financial incentive was positively associated with agreement to join an SCCP and booking an SCCP place. Budget holders should consider providing the SCCP free of charge to increase smokers' access to the service.

Manipulation of group-velocity-locked vector dissipative solitons and properties of the generated high-order vector soliton structure

Details of various composites of the projections originated from a fundamental group-velocity-locked vector dissipative soliton (GVLVDS) are both experimentally and numerically explored. By combining the projections from the orthogonal polarization components of the GVLVDS, a high-order vector soliton structure with a double-humped pulse profile along one polarization and a single-humped pulse profile along the orthogonal polarization can be observed. Moreover, by de-chirping the composite double-humped pulse, the time separation between the two humps is reduced from 15.36 ps to 1.28 ps, indicating that the frequency chirp of the GVLVDS contributes significantly to the shaping of the double-humped pulse profile.

Morphomechanical alterations in the medial gastrocnemius muscle in patients with a repaired Achilles tendon: Associations with outcome measures

BACKGROUND

Functional deficits are found in ankles that have sustained an Achilles rupture. This study sought to evaluate and compare the morphomechanical characteristics of the medial gastrocnemius muscle in the legs of participants within six months of a unilateral Achilles repair to determine any correlations between those characteristics and objective outcomes and self-reported functional levels.

METHODS

Fifteen participants were assessed via measurements of muscle morphologies (fascicle length, pennation angle, and muscle thickness) in a resting state, the mechanical properties of the proximal aponeurosis of the medial gastrocnemius muscle, the pennation angle during ramping maximal voluntary isometric contractions (MVIC), the heel raise test, and the Taiwan Chinese version of the Lower Extremity Functional Scale (LEFS-TC) questionnaire. Findings Compared with the non-injured legs, the repaired legs showed a lower muscle fascicle length (mean 4.4 vs. 5.0cm) and thickness (1.7 vs. 1.9cm), lower stiffness of the GM tendon and aponeurosis (174.1 vs. 375.6N/mm), and a greater GM pennation angle (31.2 vs. 28.9°) during 90% MVIC (all p≤0.05). Correlations were found between the morphomechanical results and maximal heel raise heights or the LEFS-TC score, and between the symmetry ratios of the fascicle lengths and the LEFS-TC score. Interpretation There are decreases in fascicle length, muscle thickness and mechanical properties in the medial gastrocnemius muscles of the participants within the first six months after an Achilles repair. These morphomechanical alterations demonstrate associations with functional levels in the lower extremities and indicated the need for early mobilization of the calf muscles after the repair.

Prevention in primary care is better than cure: The Hong Kong Reference Framework for Preventive Care for Older Adults--translating evidence into practice

An ageing population is posing a great challenge to Hong Kong. Maintaining health and functional independence among older adults is of utmost importance, and requires the collaborative efforts of multiple health care disciplines from both the private and public sectors. The Reference Framework for Preventive Care for Older Adults, developed by the Task Force on Conceptual Model and Preventive Protocols under the auspices of the Working Group on Primary Care, aims to enhance primary care for this population group. The reference framework emphasises a comprehensive, integrated, and collaborative approach that involves providers of primary care from multiple disciplines. In addition to internet-based information, helpful tools in the form of summary charts and Cue Cards are also produced to facilitate incorporation of recommendations by primary care providers into their daily practice. It is anticipated that wide adoption of the reference framework will contribute to improving older adults' health in our community.

Primary hyperaldosteronism among Chinese hypertensive patients: how are we doing in a local district in Hong Kong

OBJECTIVES

To estimate the point prevalence of primary hyperaldosteronism in a government out-patient setting and to compare associated patient characteristics with those having essential hypertension.

DESIGN

Case series with external comparison.

SETTING

A single public hospital (Caritas Medical Centre) and all five associated general out-patient clinics in Sham Shui Po district in Hong Kong.

PATIENTS

All patients with confirmed primary hyperaldosteronism and randomly selected patients with essential hypertension from a medical specialist clinic and general out-patient clinics, retrieved from a computer database for the period January 2007 to December 2008.

MAIN OUTCOME MEASURES

Estimated point prevalence of primary hyperaldosteronism among hypertensive patients treated in the public sector of Sham Shui Po district. Patient age when hypertension was diagnosed, number of antihypertensive drugs used for treatment, and the presence of target organ damage in the patients with primary hyperaldosteronism and those with essential hypertension were compared.

RESULTS

Among the 46 012 patients receiving antihypertensive treatment, 49 were confirmed to have primary hyperaldosteronism. The estimated point prevalence of primary hyperaldosteronism among these hypertensive patients was 0.106% only, which was far smaller than figures from other countries. When compared with the 147 patients with essential hypertension by multivariate analysis, those with primary hyperaldosteronism were: (1) associated with longer durations of hypertension (odds ratio=1.14; 95% confidence interval, 1.06-1.24) despite being younger at the time of study, (2) likely to be taking three or more antihypertensive drugs (odds ratio=2.51; 95% confidence interval, 1.59-3.95), and (3) more likely to have left ventricular hypertrophy (odds ratio=5.01; 95% confidence interval, 1.83-13.69). All primary hyperaldosteronism patients studied presented with hypokalaemia. The need for antihypertensive drugs was markedly reduced after adrenalectomy for adrenal adenoma.

CONCLUSIONS

Primary hyperaldosteronism, which is potentially a surgically curable cause of hypertension, appeared to be underdiagnosed in our locality. Screening by aldosterone-renin ratio of high-risk individuals may help improve patient outcomes.

Correlation between computerised findings and Newman's scaling on vascularity using power Doppler ultrasonography imaging and its predictive value in patients with plantar fasciitis

OBJECTIVES

The purpose of this study was to correlate findings on small vessel vascularity between computerised findings and Newman's scaling using power Doppler ultrasonography (PDU) imaging and its predictive value in patients with plantar fasciitis.

METHODS

PDU was performed on 44 patients (age range 30-66 years; mean age 48 years) with plantar fasciitis and 46 healthy subjects (age range 18-61 years; mean age 36 years). The vascularity was quantified using ultrasound images by a customised software program and graded by Newman's grading scale. Vascular index (VI) was calculated from the software program as the ratio of the number of colour pixels to the total number of pixels within a standardised selected area of proximal plantar fascia. The 46 healthy subjects were examined on 2 occasions 7-10 days apart, and 18 of them were assessed by 2 examiners. Statistical analyses were performed using intraclass correlation coefficient and linear regression analysis.

RESULTS

Good correlation was found between the averaged VI ratios and Newman's qualitative scale (ρ=0.70; p<0.001). Intratester and intertester reliability were 0.89 and 0.61, respectively. Furthermore, higher VI was correlated with less reduction in pain after physiotherapeutic intervention.

CONCLUSIONS

The computerised VI not only has a high level of concordance with the Newman grading scale but is also reliable in reflecting the vascularity of proximal plantar fascia, and can predict pain reduction after intervention. This index can be used to characterise the changes in vascularity of patients with plantar fasciitis, and it may also be helpful for evaluating treatment and monitoring the progress after intervention in future studies.

Treatment of patients with chronic obstructive pulmonary disease as practised in a defined Hong Kong community: a cross-sectional pilot survey

OBJECTIVES

To examine the characteristics of chronic obstructive pulmonary disease patients of the Kwai-Tsing area, Hong Kong, and the chronic treatments they received. DESIGN. Cross-sectional survey.

SETTING

Four clinic settings in Hong Kong: Respiratory Specialist Clinic, Princess Margaret Hospital (group 1); Medical Specialist Clinics, Princess Margaret Hospital (group 2); General Outpatient Clinics, Princess Margaret Hospital (group 3); South Kwai Chung Chest Clinic, Department of Health (group 4).

PATIENTS

Thirty physician-diagnosed chronic obstructive pulmonary disease patients in each of the above groups with post-bronchodilator 1-second forced expiratory volume/forced vital capacity ratios of less than 70% predicted values, who had been followed up at any of the participating clinics for at least 6 months.

RESULTS

There were 111 male and nine female patients. The median age was 72.5 years and 79% had at least one medical co-morbidity. The mean duration of their chronic obstructive pulmonary disease was 9.8 years, and their mean post-bronchodilator 1-second forced expiratory volumes were 45% (for males) and 58% (for females) of predicted values. There were significantly fewer stage I and more stage IV patients in group 1. Influenza vaccination coverage within the previous 1 year was 54% and did not differ significantly between groups. Chronic obstructive pulmonary disease education was given significantly more often to group 1 patients. Short-acting beta agonists were used to treat all patients but long-acting bronchodilators and pulmonary rehabilitation were used almost exclusively in group 1. Overall, long-acting bronchodilators and pulmonary rehabilitation were offered to 16% and 5%, respectively, of those for whom these were indicated (according to international guidelines).

CONCLUSION

In general there was insufficient education and under-treatment for chronic obstructive pulmonary disease patients. Management of such patients warrants improvements by way of increased accessibility to structured education programmes, pulmonary rehabilitation programmes, long-acting bronchodilator drugs, and respiratory specialist care.

Mental set can modulate response onset in the lower limb muscles to falls in humans

The objective of this study was to investigate the modulation of the ankle muscle electromyographic (EMG) response as a function of mental set. Thirteen young healthy subjects underwent 40 unexpected and self-initiated drops from 30 cm above two separate force-plates. Following unexpected drops, reflex activities were observed in the medial gastrocnemius (MG) and tibialis anterior (TA) at mean latencies (+/- SD) of 83.59 +/- 10.1 and 99.43 +/- 21.82 ms, respectively. Following self-initiated drops, the response latency of the MG was significantly shortened (to 71.98 +/- 10 ms, P<0.05), and the TA was significantly lengthened (to 183.33 +/- 45 ms, P<0.05) when compared with unexpected drops. Such a modulation was associated with a significant reduction of the impact force on landing as compared with unexpected drops (by 17%, P<0.05). Interestingly, a negative correlation was found between the onset of the TA EMG response and the magnitude of the impact force on landing during expected (r= -0.66, P<0.05) but not unexpected drops.