Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study

Aims

To determine myopia progression in children who continued to wear the defocus incorporated multiple segments (DIMS) lenses or switched from single vision (SV) to DIMS lenses for a 1-year period following a 2-year myopia control trial.

Methods

128 children participated in this study. The children who had worn DIMS lenses continued to wear DIMS lenses (DIMS group), and children who had worn SV lenses switched to wear DIMS lenses (Control-to-DIMS group). Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at 6-month interval. Historical controls were age matched to the DIMS group at 24 months and used for comparing the third-year changes.

Results

Over 3 years, SER and AL changes in the DIMS group (n=65) were −0.52±0.69D and 0.31±0.26 mm; these changes were not statistically significant over time (repeated measures analysis of variance, p>0.05).

SER (−0.04±0. 38D) and AL (0.08±0.12 mm) changes in the Control-to-DIMS group (n=55) in the third year were less compared with the first (mean difference=0.45 ± 0.30D, 0.21±0.11 mm, p<0.001) and second (0.34±0.30D, 0.12±0.10 mm, p<0.001) years.

Changes in SER and AL in both groups over that period were significantly less than in the historical control group (DIMS vs historical control: mean difference=−0.18±0.42D, p=0.012; 0.08±0.15 mm, p=0.001; Control-to-DIMS versus historical control: adjusted mean differences=−0.30±0.42D, p<0.001; 0.12±0.16 mm, p<0.001).

Conclusions

Myopia control effect was sustained in the third year in children who had used the DIMS spectacles in the previous 2 years and was also shown in the children switching from SV to DIMS lenses.

Case series of children with steroid-Induced glaucoma

Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids, particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent, and children are commonly being prescribed topical anti-inflammatories, including topical steroids, by general practitioners. Furthermore, topical steroids are also available over the counter, and this availability contributes to overuse without proper monitoring by an ophthalmologist. We present a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids among children for vernal keratoconjunctivitis. The medications were prescribed initially by general ophthalmologists and were continually bought over the counter by parents. At the presentation to our center, these patients were already compromised visually, exhibiting glaucomatous optic disc changes and high intraocular pressure. The series highlights the optic nerve damage resulting in irreversible visual compromises among children on long-term, topical steroids and the importance of regular monitoring with a low threshold for ophthalmologist referral.

Clinical Audit on Short Stay Emergency Medical Admission

The growth rate of emergency department visit locally is disproportionate to the population growth. The number of emergency hospital admission has also increased leading to congested ward environment. A retrospective clinical audit on short stay (discharged within 24 hours) emergency medical and geriatric admission was done to look at the appropriateness of our emergency medical and geriatric admission. This study was carried out in April 2000. The Appropriateness Evaluation Protocol was employed as an objective tool for initial assessment. A peer panel, composed of Fellows from the Colleges of Physicians and Emergency Medicine, was formed to check for appropriateness of admission for those cases without objective admission criteria. Thirteen out of the 177 cases (7.3%) available for analysis were considered as “inappropriate” admission. If we assume that those emergency admissions that stayed for longer than 24 hours were appropriately admitted, the “inappropriate” admission rate for medical and geriatric cases would be 0.67% (13 out of 1930). Suggestions for further improvement include: (1) longer and intensive observation for selected patients before admission; (2) access to early specialist outpatient review; (3) ad-hoc clinics to be run by other specialists for selected “old” cases; and (4) strengthening of the primary health care service.

High rate of increased carotid intima-media thickness and atherosclerotic plaques in Chinese asymptomatic subjects with central obesity

Both central obesity and increased carotid intima-media thickness (IMT) are markers of atherosclerosis and associated with cardiovascular diseases (CVD). Information of IMT in Chinese subjects with central obesity is limited. This study was performed to assess the rate of atherosclerosis and abnormal IMT in asymptomatic Chinese subjects with central obesity, and to investigate the association between IMT values and CVD risk factors including hypertension, hyperglycaemia and dyslipidaemia. We studied 122 centrally obese adults who had good past health. IMT measurements on carotid arteries were performed and fasting blood taken for plasma glucose and lipid profiles. Abnormal IMT was defined as > 0.9 mm. Atherosclerosis was defined as the presence of one or more visible plague. Of the 122 subjects, the mean (±SD) age was 59.4 ± 5.8 years (median [range]: 59.0 [45-75] years). The median IMT value was 0.70 mm (range: 0.53-1.19 mm) [men vs. women: 0.74 mm vs. 0.66 mm, P-value: < 0.001]. IMT values and the rate of atherosclerosis increased with age and the number of CVD risk factors (P-value for trend: < 0.05). Using binary logistic regression to predict the presence of atherosclerosis with the presence of abnormal IMT, age, gender, and other CVD risk factors as independent variables, age (OR [95% CI] = 1.13 [1.03, 1.23], P = 0.009) and abnormal IMT (OR [95% CI] = 4.05 [1.09, 15.03], P = 0.037) were independently associated with atherosclerosis. In conclusion, among Hong Kong Chinese asymptomatic subjects with central obesity, there was a high rate of CVD risk factors. We found that 19% of these subjects had carotid atherosclerotic plaques and 10% of them had abnormal IMT (>0.9 mm). Carotid IMT study may serve as an appropriate screening tool to diagnose atherosclerosis in the centrally obese middle-aged population.

Metabolic syndrome, endothelial injury, and subclinical atherosclerosis in patients with systemic lupus erythematosus

OBJECTIVES

To study the link between metabolic syndrome (MetS), endothelial injury, and atherosclerosis in patients with systemic lupus erythematosus (SLE).

METHODS

Consecutive SLE patients without a history of arterial thrombosis were screened for atherosclerosis at the carotid and coronary arteries by B-mode ultrasound [intima-media thickness (IMT)] and multidetector computed tomography (MDCT) scan (Agatston calcium scores), respectively. Plasma levels of homocysteine, high-sensitivity C-reactive protein (hsCRP), soluble vascular cell adhesion molecule (sVCAM)-1, P-selectin, and soluble thrombomodulin (sTM) were assayed. Patients were stratified according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria for MetS, using the Asian criteria for abdominal obesity. Risk factors for atherosclerosis were studied.

RESULTS

Of the 123 SLE patients (93% women; age 47.9+/-11 years; SLE duration 10.9+/-7.0 years) studied, 20 (16.3%) had MetS. The prevalence of MetS in the SLE patients was significantly higher than in 492 age- and sex-matched healthy controls (9.6%; p=0.03). Coronary calcification and abnormal carotid IMT were detected in 38 (31%) and 72 (59%) of SLE patients, respectively. Patients with MetS had a significantly higher Agatston score (69.5+/-95 vs. 16.4+/-57; p=0.03) and a numerically higher carotid IMT (p=0.43) than those without. In a logistic regression model, the MetS [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.01-9.59, p=0.049] was associated with coronary atherosclerosis after adjustment for age and other risk factors. In addition, patients with MetS had significantly higher levels of hsCRP (p=0.002), homocysteine (p=0.03), and sTM (p=0.01).

CONCLUSIONS

The MetS is more prevalent in SLE patients than the general population and is associated with endothelial injury and coronary atherosclerosis. More aggressive control of risk factors is justified in these patients.

Treatment of Vancomycin-intermediate Staphylcoccus aureus Endocarditis with Linezolid

We report a case of infective endocarditis due to vancomycin-intermediate Staphylococcus aureus that developed after repeated courses of vancomycin. The patient had underlying end stage renal disease and dissecting aortic aneurysm with aortic graft and prosthetic aortic valve replacement. He responded to prolonged combination therapy with linezolid and amikacin without undergoing surgical intervention.

Health services needs and quality of life assessment of individuals with brain injuries: a pilot cross-sectional study

BACKGROUND AND PURPOSE

Quality of Life (QoL) studies have received a substantial amount of attention in medical and rehabilitative practices. However, there is still a paucity of studies in the area, especially on persons with brain injuries (BI). This pilot study, on the QoL of individuals with brain injuries in Hong Kong, attempts to fill this void. It is hoped that the finding of this study will guide the development of programmes and services to people with brain injuries.

METHODS

Through the Self-help Group for People with Brain Damage in Hong Kong, 35 subjects (22 men and 13 women) were successfully recruited to participate in this study by convenience sampling. Demographic data were collected through face-to-face interviews guided by a questionnaire and QoL data were gathered using the Comprehensive Quality of Life Scale--Intellectual/Cognitive Disability--5th edition (ComQol-I5). The general emotional condition of the participants over the past 2 months was measured by a validated Chinese version of the Positive and Negative Affect Scale (PANAS). The participants' ratings on the importance of and their satisfaction with 20 health services areas were also collected.

RESULTS

Preliminary results show that the overall mean quality of life score, as measured by ComQol-I5, was slightly less than two-thirds of the maximum score. Among the seven QoL domains, health and safety received some of the highest scores, while the lowest scores were obtained in the area of material well-being, place in community and productivity. People whose injuries had occurred relatively recently (less than 5 years ago) were found to have higher intimacy QoL scores than their counterparts injured more than 5 years ago. In the domain of safety, persons with a brain injury who were employed scored significantly higher than those who were not. Positive affect scores and the total affect of PANAS scores correlated significantly with the overall QoL scores. Moreover, persons with a brain injury usually felt satisfied with the services they valued as important. The top five most important services were medical services, occupational therapy, physiotherapy, vocational counselling and social work.

DISCUSSION AND CONCLUSION

The QoL profile of people with brain injuries in Hong Kong was initially obtained and low scores in the ComQoL were identified in the domains of material well-being, community activities and responsibility and productivity. These might be the consequences of their physical and cognitive limitations due to brain injury. This implies that appropriate interventions to improve their daily life conditions and their social integration would be necessary to improve their QoL. On the other hand, the BI sample also rated relatively high scores in other ComQoL areas such as safety and health, reflecting a good living environment and probably good health care services. Those whose brain injuries had occurred less than 5 years ago tended to have a higher ComQoL intimacy score than those whose injuries occurred more than 5 years ago. In other words, their social relationships may deteriorate with the longer period post-injury so that this group may need more supportive services. In the safety domain, it was found that subjects who were employed after their brain injury scored significantly higher than those who were not, which matched studies about the significant contribution of work towards life satisfaction. The satisfaction of their needs in the services they received, which may affect their QoL, was also investigated. It is clear that they valued the medical and rehabilitation services they received and felt satisfied with them.

Determining horizontal symmetry from neutrino mixing

We argue that the best way to determine horizontal symmetry is from neutrino mixing and proceed to show that the only finite group capable of yielding the tribimaximal mixing for all Yukawa couplings is S4, or any group containing it. The method used is largely group theoretical, but it can be implemented by dynamical schemes in which the Higgs expectation values introduced to break S4 spontaneously are uniquely determined up to an unknown scale for each.

The effect of a job placement and support program for workers with musculoskeletal injuries: a randomized control trial (RCT) study

BACKGROUND

This is a randomized clinical trial (RCT) to investigate the efficacy of a job placement and support program designed for workers with musculoskeletal injuries and having difficulties in resuming the work role. The program was planned to help injured workers to successfully return to work (RTW) by overcoming the difficulties and problems during the process of job seeking and sustaining a job using a case management approach.

METHODOLOGY

A total of 66 injured workers were recruited and randomly assigned into the job placement and support group (PS group) or the self-placement group (SP group). A three-week job placement and support program was given to subjects in the PS group while subjects in the control group (SP group) were only given advice on job placement at a workers' health center. The PS program was comprised of an individual interview, vocational counseling, job preparation training, and assisted placement using the case management approach. The Chinese Lam Assessment of Stages of Employment Readiness (C-LASER), the Chinese State Trait and Anxiety Inventory (C-STAI), and the SF-36 were the outcome measures for the two groups before and after the training program to observe the changes in subjects' work readiness status, emotional status and their health related quality of life pre- and post-training program. The rate of return to work was measured for both groups of subjects after the training program.

RESULTS

The results indicated that the rate of success in RTW (73%) was significantly higher in the job placement (PS) group than that of the self-placement (SP) group (51.6%) with P < 0.05. Significant differences were also found in C-STAI (P < 0.05), SF-36 (P < 0.05) and C-LASER scores on action (P < 0.05) between the two groups.

CONCLUSION

The job placement (PS) program appeared to have enhanced the employability of injured workers. Workers who participated in the program also showed higher levels of work readiness and emotional status in coping with their work injuries.

A 6-month follow-up of the effects of an information and communication technology (ICT) training programme on people with intellectual disabilities

We investigated the long-term effects of an information and communication technology (ICT) training programme for people with intellectual disabilities (ID). A community-based ICT training programme was designed to enhance the computer skills of people with ID and prepare them to make use of ICT in their daily life. Of the 100 who had participated in the original ICT training programme, 59 of them and their caregivers agreed to participate in the follow-up interview. A computer skills checklist was used to assess the ICT competence of the participants before training, after training, and at the 6-month follow-up assessment. All caregivers were interviewed at the 6-month follow-up session to explore the use of ICT by people with ID and their needs for further training. Results from repeated measures ANOVA showed that participants maintained at the 6-month follow-up the basic ICT skills that they acquired during training [F=13.86, p<0.001]. Caregivers reported that participants spent more time in using the computers, but still needed occasional guidance. They also reported a need to advance their ICT skills beyond the basic computer training. We concluded that ICT training for people with ID would help them in maximizing the benefits of information technology via computers.

Psychosocial aspects of injured workers' returning to work (RTW) in Hong Kong

INTRODUCTION

This study was designed to explore the psychosocial aspects of injured workers, their self-perceived capacity and how these factors influence their success in Return To Work (RTW).

METHOD

Seventy-five subjects were recruited from the Hong Kong Workers' Health Centre and were assessed on three occasions consisting of interviews and four self-rated instruments including the Chinese Lam's Assessment of Employment Readiness (C-LASER), the SF-36 health survey, the Chinese State Trait and the Anxiety Inventory (C-STAI).

RESULTS

Results showed that the contemplation and pre-contemplation sub-scores of C-LASER appeared to be the determining factors in predicting subjects' return-to-work status. Subjects who were more "ready for action" (the Actioners) were found to have significantly higher confidence and advocacy in job seeking than the Pre-Contemplators. Their employment readiness was shown to be affected by psychosocial factors such as perceived functioning and bodily pain,

DISCUSSION

From this study, the injured workers' employment readiness appeared to associate with their RTW outcomes. Further studies would be needed to find out how the employment readiness of injured workers could be enhanced.

Disseminated strongyloidiasis: a retrospective study of clinical course and outcome

A retrospective study was carried out to evaluate the clinical course and outcome of disseminated strongyloidiasis treated in a regional hospital in Hong Kong over a 10-year period. Seven cases were identified, and the case history of each patient was analysed. The most common presenting symptom was fever (100%). Five (71%) patients had gastrointestinal symptoms, the most common being abdominal pain and diarrhoea. Three (42%) patients had a significant drop in haemoglobin. Six (85%) patients had bronchoalveolar infiltrates on chest radiographs. Most patients were immunosuppressed by means of steroid treatment for their underlying primary disease. One patient was diabetic, and another had lymphoma and was receiving chemotherapy. Strongyloides larvae were identified in stool specimens in two patients, in sputum smears in two patients, and in gastric biopsies in three patients. Five (71%) of the patients with lung involvement progressed to respiratory failure and died. Two (29%) cases were complicated by gram-negative bacterial infection. No patient had eosinophilia on presentation. All patients received antihelminthic treatment of variable duration. The case fatality rate in the cohort was 71% despite aggressive supportive therapy. Pulmonary and bowel symptoms were prominent in our series. In conclusion, the diagnosis of disseminated strongyloidiasis is often delayed because of nonspecific presenting symptoms. Early diagnosis relies on a high index of clinical suspicion, especially in immunocompromised hosts. Screening for Strongyloides infection before the initiation of immunosuppressive therapy should be considered, especially in endemic areas.

The effect of a "training on work readiness" program for workers with musculoskeletal injuries: a randomized control trial (RCT) study

BACKGROUND

This is a clinical randomized trail (RCT) to investigate the effects of a three-week training program on work readiness designed for musculoskeletal injured workers with long-term sick leave who had difficulties resuming their work role. The program was planned to help injured workers overcome the psychological and psychosocial problems and to facilitate their Work Readiness on Return to Work (RTW) based on the Employment readiness model.

METHODOLOGY

A total of 64 injured workers were recruited and randomly assigned into the training (T) and control (C) groups. Observations were blinded between service providers and evaluators. A three-week intensive training on work readiness program was given to the T group while subjects in the C group were given advice on job placement by social workers in a community work health center. The training program was comprised of individual vocational counseling and group therapy using cognitive behavioral approach to alleviate symptoms of stress, pain and anxiety. The Chinese Lam Assessment of Stages of Employment Readiness (C-LASER), the Chinese State Trait and Anxiety Inventory (C-STAI) and the Short form of Health Survey (SF-36) were used to evaluate all subjects' psychological health status and behavioral changes on job readiness before and after the intervention.

RESULTS

Subjects in the T group showed significant improvement in their work readiness (p < 0.05), level of anxiety (p < 0.05) and their self perception of health status measured by SF-36 (p < 0.02) when compared with subjects in the C group. Control of chronic pain, negative motivation, and anxiety level were some of the key behavioral changes found from the study.

CONCLUSION

The TWR program appeared to improve injured workers' motivation and employment readiness. Further study on the employment outcomes of subjects is recommended.

Distribution of cannabinoid receptor 1 in the CNS of zebrafish

The cannabinoid receptor 1 (Cb1) mediates the psychoactive effect of marijuana. In mammals, there is abundant evidence advocating the importance of cannabinoid signaling; activation of Cb1 exerts diverse functions, chiefly by its ability to modulate neurotransmission. Thus, much attention has been devoted to understand its role in health and disease and to evaluate its therapeutic potential. Here, we have cloned zebrafish cb1 and investigated its expression in developing and adult zebrafish brain. Sequence analysis showed that there is a high degree of conservation, especially in residues demonstrated to be critical for function in mammals. In situ hybridization revealed that zebrafish cb1 appears first in the preoptic area at 24 hours post-fertilization. Subsequently, transcripts are detected in the dorsal telencephalon, hypothalamus, pretectum and torus longitudinalis. A similar pattern of expression is recapitulated in the adult brain. While cb1 is intensively stained in the medial zone of the dorsal telencephalon, expression elsewhere is weak by comparison. In particular, localization of cb1 in the telencephalic periventricular matrix is suggestive of the involvement of Cb1 in neurogenesis, bearing strong resemblance in terms of expression and function to the proliferative mammalian hippocampal formation. In addition, a gradient-like expression of cb1 is detected in the torus longitudinalis, a teleost specific neural tissue. In relation to dopaminergic neurons in the diencephalic posterior tuberculum (considered to be the teleostean homologue of the mammalian midbrain dopaminergic system), both cb1 and tyrosine hydroxylase-expressing cells occupy non-overlapping domains. However there is evidence that they are co-localized in the caudal zone of the hypothalamus, implying a direct modulation of dopamine release in this particular region. Collectively, our data indicate the propensity of zebrafish cb1 to participate in multiple neurological processes.

Development and application of the Family Empowerment Questionnaire in brain injury

BACKGROUND

The present study was an ongoing development of a previous study of the Family Empowerment Questionnaire, which had already indicated a four-factor solution (Skill, Knowledge, Support and Aspiration) empowerment process among family caretakers for their family members with traumatic brain injury (TBI).

OBJECTIVE

The Family Empowerment Questionnaire was used to further explore its applicability to rehabilitation professionals through investigating differences between rehabilitation professionals' and family members' perceptions of empowerment in the rehabilitation process of persons with TBI.

METHOD AND PROCEDURES

The present study compared the 52-item Family Empowerment Questionnaire scores between 65 rehabilitation professionals with the results obtained from 211 family caretakers.

MAIN OUTCOME

Statistical analyses using the factor-based scores of the four sub-scales revealed that professionals and family members differ significantly in their perceptions regarding family empowerment in TBI rehabilitation in any of the four empowerment factors and within individual items of each factor.

CONCLUSIONS

Specific activities in which families and professionals' perceptions differed significantly should be explored further and clinical implications of the study are discussed.

White spot syndrome virus (WSSV) infects specific hemocytes of the shrimp Penaeus merguiensis

White spot syndrome virus (WSSV) was specifically detected by PCR in Penaeus merguiensis hemocytes, hemolymph and plasma. This suggested a close association between the shrimp hemolymph and the virus. Three types of hemocyte from shrimp were isolated using flow cytometry. Dynamic changes of the hemocyte subpopulations in P. merguiensis at different times after infection were observed, indicating that the WSSV infection selectively affected specific subpopulations. Immunofluorescence assay (IFA) and a Wright-Giemsa double staining study of hemocyte types further confirmed the cellular localization of the virus in the infected hemocytes. Electron microscopy revealed virus particles in both vacuoles and the nucleus of the semigranular cells (SGC), as well as in the vacuoles of the granular cells (GC). However, no virus could be detected in the hyaline cells (HC). Our results suggest that the virus infects 2 types of shrimp hemocytes--GCs and SGCs. The SGC type contains higher virus loads and exhibits faster infection rates, and is apparently more susceptible to WSSV infection.

Traveling through the cancer trajectory: social support perceived by women with gynecologic cancer in Hong Kong

A qualitative research design was selected to gather data on the experiences of social support for Chinese women with gynecologic cancer. Eighteen women were recruited and interviewed at an oncology unit of a teaching hospital in Hong Kong. Content analysis of the interview data showed Chinese women with gynecologic cancer placed enormous emphasis on their human relationships. Family members were especially significant to them although not all identified their family relations as satisfactory or helpful. Their social network comprised 4 major sources, including family and friends, work and colleagues, health professionals, and religion and spiritual beliefs. Each network offered significant reciprocal relations, authoritative relations, or entrusting relations. The positive appraisal of the support function was linked to the Chinese value of food, work ethics, the Confucian and religious philosophy, whereas negative aspects of support, such as the stress of maintaining relationships and inadequate information, conjoined with the Chinese suppression of emotion and the busyness of health professionals. Future studies, including social relations as a determinant, should ensure a broad and multifunctional view of social support and acknowledge the cultural influences on the perspective of support.

The development of myopia in Hong Kong children

PURPOSE

The purpose of this two and one-half year follow-up study is to evaluate the relationship between early academic activities and the development of myopia.

METHODS

128 children randomly selected from 51 pre-schools completed an education and vision assessment study. At the end of the period, the children were 8.5 years old. Data were collected on developmental performance in the areas of cognition, language, social, academic and motor skills. The prevalence of myopia, mean refraction and change of refraction over this period were described in terms of the gender, geographical areas, type of pre-schools and type of primary schools.

RESULTS

The prevalence of myopia shifted towards a higher proportion of myopia in all the above categories. The mean refraction at the initial visit was 0.5 D and became about -0.50 D at the follow-up visit. There was no difference in the changes of refraction in relation to the type of pre-school or primary school. The change of refraction was also not related to the educational scores. However, there was a statistically significant difference in the academic scores, in particular the reading scores, between the activity and conventional primary schools. There was also gender difference in language scores between the girls and the boys of the activity schools. There was no difference in all scores between the myopes and non-myopes.

CONCLUSION

The present study did not demonstrate a relationship between early academic activities and development of myopia. However, the higher reading scores and the slightly faster progression rate in the conventional schools may indicate an influence of the curriculum on the refractive development. A longer follow-up study may elucidate a clearer trend.

Fatal chemotherapy associated Clostridium difficile infection--a case report

Clostridium difficile associated diarrhoea or Pseudomembranous colitis occasionally occurs without prior antibiotic usage. While the association of chemotherapy and Clostridium difficile infection has previously been well recorded, the true incidence is unknown. We report a case of Clostridium difficile associated diarrhoea after chemotherapy for lung cancer. The fatal outcome in this case and the increasing use of chemotherapy in this country highlights the need to have a high index of suspicion in any case of unexplained diarrhoea post chemotherapy. A review of the literature is presented.

Strongyloidiasis as a possible cause of nephrotic syndrome

Chronic strongyloidiasis is a mild disease and has never been reported to be associated with nephrotic syndrome. Disseminated strongyloidiasis is known to have high mortality, but it frequently is not diagnosed until autopsy. We report a patient with nephrotic syndrome developing disseminated strongyloidiasis after steroid therapy. The findings in renal biopsy, the time course of the development, and resolution of nephrotic syndrome after thiabendazole treatment suggested a possible causal relationship between chronic strongyloidiasis and nephrotic syndrome. The case also demonstrated the importance of early diagnosis in disseminated strongyloidiasis and the good clinical outcome of early treatment before the development of organ failure.

A 2-year longitudinal study of myopia progression and optical component changes among Hong Kong schoolchildren

This study investigated refractive error and optical component changes in a group of 142 Hong Kong schoolchildren from age 6 to 17 years over a 2-year period between 1991 and 1993. Subjects were refracted subjectively and corneal curvatures and ocular dimensions were measured. At the end of the 2-year study, the mean spherical equivalent refraction (SER) was -1.86 D (SD 1.99 D) and 62% of the schoolchildren were myopic. The annual incidence of myopia was 11.8%. Children aged 10 years and under had a greater change in SER toward myopia than older children. The annual rate of myopia progression for the myopic children was -0.46 D (SD 0.40 D) and the rate of progression was greatest between age 6 and 10 years old. Vitreous depth/axial length elongation was the main component contributing to the progression of myopia. Hong Kong schoolchildren develop myopia as early as 6 years old and myopia progresses at a greater rate compared with children of European extraction.

Standardized memory tests and the appraisal of everyday memory

Although ecological validity of traditional tests of memory has been questioned, use of these tests remains the standard in clinical practice. More recently, however, standardized measures with more emphasis on ecological relevance have been developed. One hundred and nineteen adults with diagnosed brain injuries completed traditional instruments of memory assessment, the Luria Nebraska Neuropsychological Battery Memory Scale (LNNB-M) and the Wechsler Memory Scale-Revised (WMS-R). Subjects also completed the Rivermead Behavioural Memory Test (RBMT), an instrument designed to measure everyday memory. Additionally, clinicians rated subjects' day-to-day memory functioning at the rehabilitation facility. Results suggest that RBMT is most accurate in classifying severity of memory impairment as rated by clinicians. The LNNB-M and WMS-R were relatively accurate at classifying severely impaired and unimpaired subjects, but were much less accurate at classifying subjects in the mild and moderate impairment ranges. Implications for interpretation and use of these instruments in rehabilitation settings are discussed.

Neuropsychological testing and functional outcome for individuals with traumatic brain injury

The relationship between performance on neuropsychological measures and the vocational and independent living functioning of individuals with traumatic brain injury was examined. The Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQ and Stroop Color and Word Test scores differentiated individuals who required no assistance with activities of daily living from those requiring some level of assistance. Only the Stroop Color and Word Test scores differentiated individuals who were competitively employed or engaged in degree-oriented education from those who were unemployed or in sheltered or supported employment. Wechsler Memory Scale-Revised (WMS-R) scores did not differentiate these groups.

Methods for the Hong Kong Vision Study: a pilot assessment of visual impairment in adults

INTRODUCTION

The Hong Kong Vision Study (HKVS) was a pilot study to collect data on the prevalence of eye diseases and risk factors in Hong Kong using methodology comparable to that developed in America and Australia.

AIM

The main goal was: to evaluate the application of the methodology in a different culture and language; and to determine the prevalence and risk factors of eye diseases in order to design a larger study of an ethnic Chinese population.

METHOD

This study was patterned after the Melbourne Visual Impairment Project using the Chinese language in data collection and examinations.

CONCLUSION

Well-designed methodology is transferable to different cultures, languages and continents. Use of similar methodology will enable better comparisons and analyses to be made from population-based data.

Development and application of the Family Involvement Questionnaire in brain injury rehabilitation

This article reports the development and implementation of a new instrument, the Family Involvement Questionnaire (FIQ), for determining perceptions about family involvement needs in the rehabilitation process of traumatically brain-injured (TBI) clients. Factor analysis results indicate a four-factor solution to be optimal both in terms of parsimony and psychological meaningfulness, providing empirical evidence for the factorial structure of the FIQ. Additional statistical analyses using the factor-based scores of the four FIQ subscales revealed that professionals and family members differ significantly in their perceptions regarding family involvement in TBI rehabilitation in three of the four subscales. Specific activities where family members and professionals differed significantly are explored and implications of the study are discussed.

A rare complication of oesophageal sclerotherapy

Endoscopic sclerotherapy is a standard procedure for the treatment of oesphageal varices. It is generally regarded as a safe procedure with low morbidity and mortality. However, there are a number of rare and fatal complications associated with this procedure. We report a case of pericardial effusion developing after oesophageal sclerotherapy. The patient developed cardiac tamponade requiring pericardiocentesis. This complication is uncommon, but its true incidence may be underestimated. When pericardial effusion is diagnosed early, this potentially fatal complication can be treated without serious sequelae.

Changes in refractive trends and optical components of Hong Kong Chinese aged 19-39 years

The distribution of refractive errors and its relationship to the optical components in 105 Hong Kong Chinese aged 19-39 years was studied. Myopia was most frequent (71%) in this population. The mean spherical equivalent was -3.00 DS. The trend of changes of the direction of refractive and corneal astigmatism from with-the-rule to against-the-rule with increasing age was shown. Significant correlations were found between age and anterior segment distance. Ultrasound examination showed that an increasing axial length was associated with higher myopia. Men had flatter corneal radii, but longer axial length. The prevalence of myopia in the Chinese population seems to be a new trend for the younger Hong Kong Chinese when compared with adults aged over 40 years. Thus the importance of genetics in determination of myopia is called into question by these findings.

Changes in refractive trends and optical components of Hong Kong Chinese aged over 40 years

The age trends of refractive errors, astigmatism and optical components were studied in 220 Chinese subjects aged over 40 years. Myopia did not dominate in this age group. With increasing age, the prevalence of hyperopia increases from 2% at age 40-45 years to 66% at age > 65 years. Against-the-rule astigmatism was more prevalent than the other types. Significant correlations were found between age and spherical equivalent power, age and vitreous depth and axial length. Sex differences were found among the optical components but not in the refractive error. Myopia appears to be more prevalent among the younger age groups than the older age groups of the Hong Kong Chinese population, and the importance of genetics in determination of refractive error is called into question by these findings.

Cancer pain management: a recent experience by anaesthesiologists in a teaching hospital in Hong Kong

More than 60% of cancer patients suffers from unbearable pain, especially towards their terminal stages. Anaesthesiologists are involved in cancer pain management because of their expertise in analgesic pharmacology and neurolytic procedures. This manuscript reported on the experience of treating cancer pain in Chinese patient in Hong Kong with reference to current literature in other parts of the world. One hundred and sixty two Chinese patients were referred from other specialists to the Department of Anaesthesiology, Queen Mary Hospital for further management because of their cancer pain control were considered difficult. Upon referral, the mean visual analogue scale of pain (VAS) was 5.8 +/- 2.7. The pain caused insomnia (66.7%) and appetite loss (45%) as well. By far most (80%) patients' pain were successively controlled with oral systemic analgesics. These were prescribed in form of a combination of NSAID (72.2%), potent opioids (76.5%) and co-analgesics (21.6%). In our series, the mean oral morphine (MS Continus) requirements was 96.0 +/- 68.3 mg on discharge. Frequent nausea and constipation persisted in 16.0% and 8.0% respectively despite active treatment with anti-emetics and laxatives. Twenty eight neurolytic blocks was performed in 22 (13.6%) patients. Good pain relief was achieved in 78.6%. Overall speaking most patients (90.7%) were able to achieve adequate analgesia before death.

A study of treatment compliance following kidney transplantation

Kidney transplantation is a successful treatment for end-stage renal disease. We studied demographic and psychosocial variables that relate to compliance behaviors following renal transplant. One hundred and five renal allograft recipients, with a minimum of 18 months follow-up, were studied. A biographical questionnaire, the Center for Epidemiologic Studies Depression Scale, the Multidimensional Health Locus of Control Scale, and the Social Support Appraisals Questionnaire were used as measuring instruments. Specifically for this study, we designed a Health Belief Model Questionnaire, a Patient and Provider Relationship Questionnaire, a Compliance Self-Report Questionnaire, and a Self-Efficacy Questionnaire. Compliance was determined by cyclosporine whole blood levels > 30 ng/ml, maintenance of ideal body weight (< 20% gain), and percentage of missed clinic visits (< 20%). Data was analyzed using discriminant analysis, Pearson's correlation, and chi-square. Four groups were identified, i.e., overall compliant (n = 25), noncompliant with diet (n = 29), noncompliant with medication (n = 27), and overall noncompliant (n = 29). No patient missed > 20% of clinic visits. Discriminant function analysis distinguished patients who were compliant from those who were not. Males were more likely to be noncompliant with medication, whereas females were more likely to be noncompliant with diet. Noncompliance was also associated with increased numbers of prescribed medications, depression, black race, locus of control attributed to powerful others, unemployment, as well as the perceived amount of social and family support. Patients with failed grafts (n = 14) were more depressed (P < 0.05), perceived less benefit from the treatment regimen (P < 0.01), and had less confidence in their care providers (P < 0.05) than those recipients of successful grafts (n = 91). In conclusion, this study identifies a number of psychosocial and demographic variables that impact on patient compliance behaviors after renal transplant. Interventional strategies to obviate noncompliance will need to consider these heterogeneous variables in order to maximize long-term renal allograft survival.

Postoperative analgesia for oesophageal surgery: a comparison of three analgesic regimens

Sixty-four patients undergoing oesophageal surgery were randomly allocated to receive either a continuous lumbar epidural infusion of morphine or fentanyl, or, intramuscular morphine for postoperative analgesia. There was no statistical difference in analgesic requirements between the patients who underwent a thoracotomy for their procedure (n = 50) and those who did not (n = 14), as assessed by the total dose of opioid administered, visual analogue scale (VAS) and pain score (PS) comparison. However, by these criteria, epidural morphine infusion provided the most satisfactory analgesia (P less than 0.05). Despite the variable quality of analgesia achieved with the three regimens, the postoperative lung function tests were similar for all groups, and we conclude that routine lung function tests are not an appropriate method of comparing analgesic efficacy. Prophylactic administration of loratadine to 15% of our patients was not shown to be effective in diminishing the incidence of pruritus.

A comparison of two-lung high frequency positive pressure ventilation and one-lung ventilation plus 5 cm H2O non-ventilated lung CPAP, in patients undergoing anaesthesia for oesophagectomy

A randomised prospective controlled study was conducted during a one-year period on patients scheduled for oesophagectomy via a right thoracotomy approach. Twenty-two patients received one-lung ventilation (OLV group) and twenty patients received high frequency positive pressure ventilation (HFPPV group). Episodic hypoxaemia (SaO2 less than 90% for greater than 30 seconds, FiO2 1.0) occurred in eleven patients in the OLV group and six patients in the HFPPV group. No patient in the HFPPV group had a severe desaturation episode (SaO2 less than 80%, FiO2 1.0) compared with nine patients in the OLV group (P less than 0.05). The mean peak inspiratory pressure and average mean airway pressure were significantly lower in the HFPPV group 28.8 (SD 7.7) and 7.2 (SD 2.4) cm H2O respectively, compared with the OLV group, 40.0 (SD 9.9) and 11.9 (SD 4.9) cm H2O (P less than 0.05). Two-lung high frequency positive pressure ventilation has some advantages over one-lung ventilation during the thoracotomy phase of oesophagectomy because it is easy to administer, does not significantly compromise the surgical exposure and is associated with fewer severe undesirable physiological disturbances.

Driving after a severe head injury

The driving activities of 50 head-injury survivors were surveyed 6 months or more post-discharge. Of these, 21 (42%) possessed a valid drivers licence, but only 19 (38%) were actually operating motor vehicles at follow-up. Only measures of spatial/perceptual deficits were found to discriminate between groups of drivers and non-drivers. The recommendations of rehabilitation staff did not appear to have much influence on the final decision whether or not the survivor resumed driving activities. Most of the drivers did not report post-injury accidents or traffic violations, perhaps because several participants were restricting their driving activities. The willingness voluntarily to restrict driving behaviours may offer some head-injury survivors the opportunity to continue to enjoy this important daily living activity under selected circumstances.

A comprehensive alcohol abuse treatment programme for persons with traumatic brain injury

The concerns of dual disability problems of substance abuse and traumatic brain injury have been documented and well recognized by rehabilitation professionals. Substance abuse treatment programmes for TBI, however, have been lacking. The purpose of this paper is to suggest both the framework and the content of interventions designed to prevent and treat alcohol abuse in traumatic brain injury clients.

Reliability of self report among non-oriented head-injured adults

Two groups of head injury clients (oriented and non-oriented) and a group of non-disabled participants were compared on response consistency to a MMPI test. Over three testing sessions it was found that the non-oriented head injury group had the most inconsistent responses followed by the oriented head injury group and the control group. Though six of the 21 MMPI profiles from the non-oriented clients were identified as invalid, MMPI validity scales did not effectively detect unreliable responders. Results suggest that caution is needed when using self-report personal assessments with non-oriented head injury clients.

Deficit awareness and treatment performance among traumatic head injury adults

Among a group of 45 severely head-injured clients in a post-acute rehabilitation programme, the clients' awareness of deficits and readiness to change are examined in relation to performance in treatment. Results lend qualified support to the hypothesis that head-injured clients who are aware of their deficits tend to have better treatment performance as rated by their therapists. Implications for measuring these constructs, matching treatment strategies to specific stages of change, and future investigation of the full application of these findings, are discussed.

Differential attitudes of Chinese students toward people with disabilities: a cross-cultural perspective

The purpose of this study was to examine the attitudes of 338 Chinese secondary school students toward three major disability groups (people who are physically disabled, emotionally disturbed, and mentally retarded) using an adaptation of the American Scale of Attitudes toward Disabled Persons (SADP). We found that physically disabled persons were rated higher across the three subscales of the SADP compared to either emotionally disturbed and mentally retarded individuals, who were rated similarly low by the students. The lack of differentiation between the two mental handicapping conditions is at variance with contemporary western findings. The overall negative attitudes toward people with mental disabilities may have significant implications for community rehabilitation programming for this population.