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Objective To assess public knowledge and expectations of the ways to assess doctors' competence to ensure patient safety. Design setting and participants Telephone survey of a random sample of 1000 non-institutionalized Hong Kong residents. Measures and results Only 5% of public were correct that doctors are not required to periodically be assessed, and 9% were correct that the doctors are not required to update knowledge and skills for renewing their license. These results echo international studies showing a low public knowledge of medical regulation. The public overwhelmingly felt a periodic assessment (92%) and requirements for continuous medical education (91%) were important processes for assuring doctors' competence. A high proportion of the public felt that lay representation in the Medical Council was insufficient. Conclusion There is a significant gap between public expectations and understanding of the existing medical regulation and the actual policies and practices. Despite a lack of public knowledge, the public thought it important to have an ongoing structured monitoring and assessment mechanism to assure doctors' competence. The public also expects a greater involvement in the regulatory processes as members of the Medical Council. There is a need to review and enhance the current regulatory system to meet public expectation and ensure accountability for the privilege and trust granted by the State in professional self-regulation. In the context of our complex health system, a thorough understanding on the dynamic interactions between different institutions and their complementary roles in a meta-regulatory framework is required in assuring patient safety.

Background Vouchers are increasingly used as a demand-side subsidy to reduce financial hardship and improve quality of services. Elderly Healthcare Voucher Scheme has been introduced by the Hong Kong Government since 2009 to provide subsidy to elderly aged 65 and above to visit ten different types of private primary care providers for curative, preventive and chronic disease management. Several enhancements have been made over the past few years. This paper (as part of an evaluation study of this unique healthcare voucher scheme) aims to assess the long term impact of the voucher scheme in encouraging the use of primary care services. Methods Two rounds of cross-sectional survey among elderly in Hong Kong were conducted in 2010 and 2016. Propensity score matching and analysis were used to compare changes in perception and usage of vouchers over time. Results 61.5% of respondents in 2016 agreed “the scheme encourages me to use more private primary care services”, a significant increase from 36.2% in 2010. Among those who agreed in 2016, the majority thought the voucher scheme would encourage them to use acute services (90.3%) in the private sector, rather than preventive care (40.3%) and chronic disease management (12.2%). Respondents also reported that their current usual choice of care was visiting “both public and private doctors” (61.9%), representing a significant increase (up from 48.4%) prior to their use of voucher. Conclusions The voucher scheme has encouraged the use of more private care services, particularly acute services rather than disease prevention or management of chronic disease. However, there needs to be caution that the untargeted and open-ended nature of voucher scheme could result in supply-induced demand which would affect long term financial sustainability. The dual utilization of health services in both the public and private sector may also compromise continuity and quality of care. The design of the voucher needs to be more specific, targeting prevention and chronic disease management rather than unspecified care which is mainly acute and episodic in order to maximize service delivery capacity as a whole for equitable access in universal health coverage and to contribute to a sustainable financing system.

To incentivize private primary care utilization and reduce reliance on public healthcare services, Elderly Healthcare Voucher Scheme has been implemented to provide a voucher entitlement to entire older resident population for subsidising their purchase of unspecified primary healthcare services in the private sector. Our study assessed whether voucher usage is associated with reduced utilization of public healthcare services. We retrieved the public healthcare services utilization and voucher transaction data of a survey cohort of 551 participants, who were age eligible for the scheme since 2009, over the period 2009-2015. Our results showed that voucher usage was not associated with reduced utilization of public healthcare services and has encouraged dual utilization of public and private healthcare. It may be due to a generated supply-induced demand and price inflation. The finding suggests the voucher is specifically designed to address the health systems issues to achieve the effective policy objectives. Defining the specific services to be provided and the prices at which they should be offered based on the needs of specified populations is a fundamental design parameter which needs to be incorporated. The alternatives of whether primary care services should be expanded and provided in the public sector or purchased using supply/demand side instruments should be considered taking the context and goals of the health system into account.

During August 2009–July 2010, we conducted 7 longitudinal telephone surveys among 503 adults in Hong Kong, China, to explore changes in their behavioral and psychological responses to the influenza A(H1N1)pdm09 virus epidemic. Trends were examined using generalized estimating equations models. Findings showed that responses varied with the course of the pandemic.

BackgroundLicensure and registration are the traditional approaches to ensure minimally acceptable standards of care for practice. However, due to advances in medical technology and changes in clinical practice, the knowledge and skills obtained from basic education and training may rapidly become out of date. There is no mandated, structured and ongoing mechanism to assess all doctors' competence in Hong Kong. This paper assessed doctors' perceived needs for continuous professional development, and to identify facilitators and barriers that are likely to influence the implementation of compulsory continuous professional development for maintaining professional competence and ensuring patient safety.MethodsAn explanatory sequential mixed method design with two distinct interactive phases was adopted comprising a postal self-administered questionnaire survey among a random sample of 2,459 of doctors (Phase 1), followed by individual interviews of a stratified sample of 30 questionnaire respondents for the subsequent qualitative analysis (Phase 2).ResultsThe majority of doctors (over 90%) agreed the importance of continuous professional development to update knowledge and skills. However, just 30.7% of non-specialists compared with 65.4% of specialists agreed it would be desirable for continuous professional development to be a requirement for renewal of licenses. A relatively higher percentage of non-specialists compared with specialists reported barriers to participation such as accessibility, availability and relevance of the content of the programmes. Facilitators for uptake included more convenient schedule and location, relevant content, and incentives for participation such as making this a pre-condition for enrolling in government-funded services.ConclusionsTo address the needs of individual doctors, the spheres of practice, personal preferences and learning styles should be considered in deciding the content and processes of continuous professional development. Flexibility is also an important principle. A learning model, incentives for participation and a compliance strategy (instead of deterrence) could be effective strategy for continuous professional development.

Introduction This study investigated the associations between the variables of the theory of planned behavior (TPB), influence of significant others, and smoking intentions and behaviors among adolescents living in rural southern China. Methods A cross-sectional study was conducted among 2609 students in two junior high schools in rural Shantou, Guangdong province, using a self-administered questionnaire. Logistic regression models were fitted to estimate univariate and adjusted odds ratios and corresponding 95% confidence intervals. Results Multivariate analyses showed that having favorable attitudes towards smoking on psychological and social aspects, perceived behavioral control, and having most friends who were current smokers were significantly associated with smoking intentions in the next six months and in the next five years. Having most family members who were current smokers was also significantly related to smoking intention in the next five years. Having favorable attitudes towards smoking on psychological aspect and negative attitudes on physical aspect, perceived support from friends on smoking, and having most friends and senior relatives being current smokers were significantly associated with increased likelihood of ever smoking. Perceived behavioral control and having most friends being current smokers were also significantly associated with regular smoking and smoking in the past 30 days. Conclusions Our results suggest that the key constructs of the TPB model and friends' smoking behaviors play important roles in accounting for smoking intentions and behaviors among a sample of rural Chinese adolescents.

Lisinopril and perindopril are two commonly used first-line antihypertensive agents. Few studies compared their effectiveness in reducing the incidence of renal diseases and diabetes.Adult patients who received new prescriptions of lisinopril or perindopril from 2001 to 2005 in all public hospitals and clinics in Hong Kong were included, and followed up for at least 2 years. Patients prescribed the angiotensin converting enzyme inhibitors (ACEIs) for1 month were excluded. The incidence of admissions due to renal diseases and diabetes was evaluated. We used Cox proportional hazard regression models to assess hospital admissions as the outcome measures, adjusting for age, sex, socioeconomic status, service types, and the proportion of days covered as a measure of medication adherence. The regression models were constructed with propensity score matching to minimize indication biases.20,252 eligible patients with an average age of 64.5 years (SD 15.0) were included. The admission rates 24 months within the date of index prescription due to renal diseases were 3.1% (lisinopril) and 2.3% (perindopril); and 9.6% (lisinopril) and 7.2% (perindopril) for diabetes. Except for admissions due to diabetes at 6 months, lisinopril users were significantly more likely to be admitted due to renal diseases (adjusted hazard ratios: 1.304 to 1.378) and diabetes (1.146 to 1.231) than perindopril users at all time points.Patients prescribed different ACEIs might have a different incidence of hospital admissions. Future studies should be conducted to evaluate the comparative effectiveness of different ACEIs on various patient-centered outcomes by head-to-head randomized controlled trials.

Objectives Community health centres are the main form of provision of primary care in China. There are three models: government managed, hospital managed and private. Our aim was to describe and compare primary care under the three ownership models. Methods Four aspects of primary care were studied: services, organization, financing and human resources. Interviews were undertaken with 60 managerial and professional staff in 13 community health centres in the Pearl River Delta region in 2010. Three community health centres were selected in the capital city and two were selected from each of the other five cities. Thematic framework analysis was conducted. Results Government-managed community health centres received the largest public funding, followed by hospital-managed community health centres, while private community health centres received the least. Private community health centres were the smallest in scale and provided lower quality public health services compared with the other two models. Patient out-of-pocket costs accounted for the majority of the revenue in all models of community health centres despite improved government funding for preventive services. General challenges such as the shortage of public funding, the exclusion of migrants in the funding for preventive services, low capacity in human resources and the separation of clinical and preventive care in community health centres were identified in all three models of community health centres. Conclusions The ownership and management of a community health centre greatly influence the service it provides. Private community health centres are in a disadvantaged position to deliver high quality clinical and preventive care.

Despite effective treatments, suboptimal medication adherence substantially hinders blood pressure (BP) control among hypertensive patients. This study aimed to evaluate the determinants of medication adherence and BP control among hypertensive patients in Hong Kong.A cross-sectional study was conducted. Adult patients aged18years taking at least one type of antihypertensive drugs were recruited from four clinics in Hong Kong. Each patient completed a self-administered questionnaire, including socio-demographic variables and items related to knowledge, illness perception and medication adherence. Medication adherence was measured by the eight-item Morisky Medication Adherence Scale (MMAS-8), with a score6 defined as "good adherence". BP was measured, and optimal control was defined as systolic BP140mmHg and diastolic BP90mmHg.Among 2445 patients, 55.1% and 52.5% had optimal medication adherence and BP control, respectively. Binary logistic regression analyses were conducted with optimal medication adherence and BP control, respectively, as the outcome variables. Advanced age (adjusted odds ratio [aOR] 1.012, 95% CI 1.002-1.022, p=0.014), unemployment (aOR for employed 0.782, 95% CI 0.628-0.975, p=0.029), and good self-perceived health status (aOR 2.155, 95% CI 1.711-2.714, p0.001) were associated with good adherence; whereas being married (aOR 1.265, 95% CI 1.038-1.542, p=0.020) and having no co-morbidity (aOR for morbidity count 0.713, 95% CI 0.639-0.796, p0.001) were associated with optimal BP control.Evidence-based, adherence-enhancing interventions should be targeted on younger subjects; employed patients; and those with poor self-perceived health status. Patients who are single and those with comorbidities should be closely monitored for their BP control.

Optimal adherence with antihypertensive medications is crucial to prevent hypertension-related complications. This study evaluated whether the duration of initial antihypertensive prescription is associated with better medication adherence in a large sample of Chinese hypertensive patients.From a validated clinical database which consists of all patients in the public healthcare sector in Hong Kong, all patients on their first-ever antihypertensive agent from 2001 to 2005 (N=203,259) were included and followed-up for 12 months (and up to 5 years in separate analyses). The average age was 58.7 years (SD 17.3), and the overall rate of optimal adherence (as measured by having the Proportion of Days Covered≥0.80) was 32.4%. The proportion of patients whose initial prescriptions lasted for ≤6 days; 7-14 days; 15-28 days and ≥29 days was 23.7%, 24.3%, 15.1% and 37.0%, respectively. The corresponding proportion of optimal adherence was 18.1%, 20.1%, 31.0% and 50.3%. The binary logistic regression analysis showed that after controlling for age, sex, socioeconomic status, service type, drug class, and district of residence, those whose initial prescription was 7-14 days (adjusted odds ratio [AOR]=1.17, 95% C.I. 1.12-1.22); 15-28 days (AOR=1.90, 95% C.I. 1.82-1.99) and ≥29 days (AOR=4.13, 95% C.I. 3.96-4.31) were significantly more likely to be adherent than those who were prescribed for ≤6 days (all p0.001). These findings remained significant in separate analyses where the period of follow-up was extended to 5 years.Shorter duration of first antihypertensive prescriptions was associated with poorer medication adherence, and this practice should be avoided if possible.

Current evidence is mixed regarding the association between antihypertensive prescriptions and cancer mortality. We evaluated this association in a large Chinese hypertensive population. We followed for five years all patients who were prescribed their first-ever antihypertensive agents between 2001 and 2005 in a public healthcare sector of Hong Kong. The association between antihypertensive drug class and cancer mortality was evaluated by Cox proportional hazard models with propensity score matching. Age, gender, socioeconomic status, service settings, district of residence, proportion of days covered reflecting medication adherence, and the number of comorbidities were adjusted. From 217,910 eligible patients, 9500 (4.4%) died from cancer within five years after their first-ever antihypertensive prescription. Most cancer deaths occurred in the digestive (38.9%) and respiratory system (30.4%); the breast (6.2%); and the lympho-hematopoietic tissues (5.3%). The proportion of patients who died from cancer was the highest in the calcium channel blocker (CCB) group (6.5%), followed by thiazide diuretics (4.4%), angiotensin converting enzyme inhibitors (4.2%) and β-blockers (2.6%). When compared with β-blockers, patients prescribed CCBs (Adjusted Hazard Ratio [AHR] = 1.406, 95% C.I. 1.334–1.482, p < 0.001) were more likely to die from cancer. Thiazide users were also more likely to suffer from cancer deaths (AHR = 1.364, 95% C.I. 1.255–1.483, p < 0.001), but became insignificant in stratified analysis. The association between cancer mortality and use of CCB, and perhaps thaizide, may alert physicians to the need for more meticulous and comprehensive care of these patients in clinical practice. We recommend prospective studies to evaluate cause-and-effect relationships of these associations.

Background Despite empirical evidence demonstrating the effectiveness of collaborative stepped care program (SCP) in Western countries, such programs have not been evaluated in the east, which has a different services system structure and cultural nuances in seeking help for mental illness. Furthermore, only a few studies have used SCP for depression and anxiety prevention. We conducted a trial to test its effectiveness in preventing major depressive disorder and generalized anxiety disorder among primary care patients with subthreshold depression and/or anxiety in Hong Kong. Methods Subthreshold depression and/or anxiety patients were randomized into the SCP group (n=121) or care as usual (CAU) group (n=119). The SCP included watchful waiting, telephone counseling, problem solving therapy, and family doctor treatment within one year. The primary outcome was the onset of major depressive disorder or generalized anxiety disorder in 15 months. The secondary outcomes were depressive and anxiety symptoms, quality of life and time absent from work due to any illness. Results Survival analysis showed no differences between the SCP and CAU groups (the cumulative probability of onset at 15 month was 23.1% in the SCP group and 20.5% in the CAU group; Hazard Ratio=1.62; 95% Confidence Interval: 0.82–3.18; p=0.16). No significant differences were found in secondary outcomes. Limitations Sample size might not have been large enough. Conclusions SCP did not show beneficial effect on depression/anxiety prevention compared with CAU in Hong Kong primary care. As a large majority of patients improved overtime without any intervention, we are not able to exclude the possibility that the intervention might be effective. Future studies would need to have a larger sample size and conduct on patients with more severe symptoms or perform a second screening.

Aims To examine the patterns of alcohol consumption in Hong Kong Chinese women before and after a period of major alcohol policy amendments. Short summary This study compared alcohol consumption patterns in Hong Kong Chinese women before and after a period of major alcohol policy amendments and found increased drinking among certain subgroups, particularly middle-aged women. These increases are likely due to personal factors (e.g. changing perceptions) as well as environmental influences (e.g. greater marketing). Methods Cross-sectional telephone surveys were conducted on adult Chinese women prior to the 2007-2008 beer and wine tax eliminations in 2006 (n = 4946) and in 2011 (n = 2439). Results Over the study period, only women in the 36-45 year age stratum reported significant increases in all three drinking patterns: past-year drinking (38.1-45.2%), past-month binge drinking (2.3-5.2%) and weekly drinking (4.0-7.3%) (P < 0.05); middle-aged women, unemployed or retired women and those ascribing to alcohol's health benefits emerged as new binge drinking risk groups. In 2011, 3.5% of all drinking-aged women (8.8% of past-year drinkers, 20.7% of binge drinkers and 23.1% of weekly drinkers) reported an increased drinking frequency after the tax policy changes. The main contexts of increased drinking were social events and with restaurant meals; moreover, beliefs of alcohol's health benefits were common to all contexts of increased drinking. Of women who increased their drinking frequency, the largest proportion attributed it to peer effects/social environment conducive to drinking, and brand marketing/advertising influences. Conclusions Increased drinking among certain subgroups of Hong Kong Chinese women may be due to combined influences of: increased societal acceptance of social drinking, aggressive marketing promotions and personal beliefs in the health benefits of drinking that have recently emerged in the region. Hence, multi-prong strategies are required to combat potential drinking harms in these women.

Supplemental Digital Content is available in the text, Ownership of primary care providers varies in different cities in China. Shanghai represented the full public ownership model of primary providers; Shenzhen had public-owned but private-operated providers; and Hong Kong represented the full private ownership. The study aims to assess the association of primary care ownership and patient perceived quality of care in 3 Chinese megacities. We conducted multistage stratified random surveys in 2013 in the 3 cities. Quality scores of primary care were measured using the validated primary care assessment tools. Multivariate linear regression models were used to compare quality scores after controlling potential confounders of patient demographic, socioeconomic, and healthcare utilization factors. Overall, 797 primary care users in Shanghai, 802 in Shenzhen, and 1325 in Hong Kong participated in the study. The mean total quality scores were reported the highest in Shanghai (28.39), followed by Shenzhen (25.82) and then Hong Kong (25.21) (P

Multimorbidity has become the norm worldwide as populations age. It remains, however, infrequently researched. This study evaluated factors associated with multimorbidity in a predominantly Chinese hypertensive population. We included all adult patients prescribed their first antihypertensive agents in the entire public sector in Hong Kong from a validated database. Multimorbidity was defined as having one or more medical conditions (cardiovascular diseases; respiratory diseases; diabetes or impaired fasting glucose; renal disease) in addition to hypertension. We studied the prevalence of multimorbidity and performed multinomial regression analyses to evaluate factors independently associated with multimorbidity. 223,286 hypertensive patients (average age of 59.9 years, SD 17.6) were included. The prevalence of having 0, 1 and ≥ 2 additional conditions was 59.6%, 32.8% and 7.5%, respectively. The most common conditions were cardiovascular disease (24.2%) and diabetes (23.0%), followed by respiratory disorders (14.6%) and renal disease (10.9%). Older age (>50 years), male sex, lower household income, receipt of social security allowance and suboptimal blood pressure control (>140 mmHg or >90 mmHg; >130 mmHg or >80 mmHg for diabetes patients; AOR = 3.38-4.49) were significantly associated with multimorbidity. There exists a synergistic effect among these variables as older (≥ 70 years), male patients receiving security allowance had substantially higher prevalence of multimorbidity (19.9% vs 7.5% among all patients). Multimorbidity is very common in hypertensive patients and its prevalence increased markedly with the presence of risk factors identified in this study. Hypertensive patients with multimorbidities should receive more meticulous clinical care as their blood pressure control tends to be poorer.

Non-communicable diseases dominate the public health arena in China, yet neglected tropical diseases (NTDs) are still widespread and create a substantial burden. We review the geographical distribution, prevalence, and epidemic characteristics of NTDs identifi ed in China caused by helminths, protozoa, bacteria, and viruses. Lymphatic fi lariasis was eliminated in 2007, but schistosomiasis still aff ects up to 5% of local village residents in some endemic counties with around 300 000 people infected. China harbours more than 90% of the world’s burden of alveolar echinococcosis and food-borne zoonoses are emerging. In 2010, the overall prevalence of soil-transmitted helminth infections caused by Ascaris lumbricoides, Trichuris trichiura, and hookworm was 11·4%, with 6·8% of these infections caused by A lumbricoides. Corresponding fi gures for food-borne trematodiasis, echinococcosis, and cysticercosis are more than 5%. Dengue, leishmaniasis, leprosy, rabies, and trachoma exist in many areas and should not be overlooked. Transmission of vector-borne diseases can be interrupted; nevertheless, epidemics occur in remote areas, creating a challenge for surveillance and control. Rigorous surveillance, followed by immediate and integrated response packages tailored to specifi c social and ecological systems, is essential for progress towards the elimination of NTDs in China.

Timely and appropriate care for children with autism spectrum conditions is affected by the interaction between healthcare professionals and parents. Despite the importance of the parent–professional partnership, there is a dearth of cultural-specific data on parent–professional partnership in the Chinese context. We conducted 10 in-depth life-history interviews with parents of children with autism spectrum conditions in Hong Kong who were diagnosed during preschool years. Using an interpretative phenomenological analytic method, five themes were constructed to represent the context of parent–professional partnership in Hong Kong along the pathway of seeking a diagnosis: (a) access to the assessment and diagnosis of autism spectrum conditions, (b) multiple procedures of assessment, (c) consultation prior to diagnosis and assessment, (d) communication of diagnosis and assessment result and (e) post-assessment isolation. Parental narratives highlight the important domains of parent–professional partnership and reflect the complexity of diagnosis and the lack of a cohesive system. For many parents, the assessment procedure was marred by a series of obstacles, which were further exacerbated by a poorly developed parent–professional partnership. Suggestions for parent–professional partnership development include establishing an evidence-based best practice guideline for Hong Kong, creating pre-assessment information workshops for parents to attend and equipping professionals with knowledge about autism spectrum conditions and enhanced communication skills.

Aim : In an effort to promote Hong Kong as a global wine hub, the government eliminated duties on wine and beer in 2008. The changes in alcohol consumption patterns are examined. Methods : Anonymous, cross-sectional telephone surveys on a random sample of Chinese male and female residents aged 18–70 were carried out in 2011 ( n = 4800) and 2012 ( n = 1001). These data were compared with those of a 2006 ( n = 9896) baseline survey conducted before the excise tax elimination. Results : Prevalence of those ever drinking alcohol significantly increased from the 2006 baseline level of 66.6% to 82.0% in 2011 and to 85.2% in 2012. Of note, 10.2% of ever drinkers within the 2012 sample reported consuming alcohol for the first time in or after 2008. Younger, more educated or more affluent parts of the population are more likely to be ever drinkers. Unexpectedly, prevalence of binge drinking in the population decreased slightly from the 2006 baseline of 9.0% to 7.1% in 2011 and to 7.3% in 2012. Quantity of alcohol reportedly consumed by individuals did not change, while alcohol abuse and alcohol dependence levels decreased. However, binge drinking prevalence among the unemployed has increased. Logistic regression showed that those with lower educational achievement and the unemployed have higher likelihood of binge drinking. Conclusion : The government appears to have achieved its objective of making Hong Kong a world center for alcohol trade. However, the resulting access locally to cheaper alcohol has been associated with an increase in the numbers of those drinking alcohol. There has been a trend toward more adults drinking alcohol and greater risk of harm to some disadvantaged groups.

SUMMARYCase report data and a matched case-control study were used to investigate the epidemiological characteristics of hand, foot and mouth disease (HFMD) in children in Shenzhen, China between 2008 and 2011. Multivariate analyses were used to evaluate factors associated with severity of infection. Laboratory tests were performed to determine aetiological identification for samples from 163 severe and fatal cases as well as an outpatient-based HFMD sentinel surveillance system (n = 446). All identified EV71 belonged to sub-genotype C4a. No major changes in the CA16 and EV71 viruses were found until the end of 2011. Annual attack rates and the case-severity ratios (CSRs) rose from 0·82/1000 and 0·56/1000, respectively, in 2008 to 2·12/1000 and 6·13/1000 in 2011. The CSR was higher in migrants than in local residents. The adjusted odds ratio (OR) of having a severe attack for being a migrant was 2·45, having a fever >39°C (OR 5·77), visiting a private clinic (OR 2·65), longer time from symptom onset to diagnosis (OR 1·49), visiting a doctor (OR 1·51), early use of intramuscular pyrazolone (OR 3·36), early use of intravenous glucocorticoids (OR 2·28), or the combination of both (OR 3·75). The mortality and increasing case severity appears to be associated with socioeconomic factors including migration and is of worldwide concern.

Socioeconomic transformation in China at the beginning of the twenty-first century has led to rapid urbanization and accelerated rural-urban migration. As a result, the concerns about public health problems triggered by increasing internal population mobility have been more widely studied in recent years.Published data in Chinese and English on health of migrants and their families in mainland China from 2000 to 2012.The shifting patterns of disease distribution due to rural-urban migration, health equity and health reform strategies that cater for this specific yet substantial subpopulation are outstanding concerns. Infectious diseases, mental health, occupational health and women's health are emerging public health priorities related to migration.The high mobility and large numbers of Chinese rural-urban migrants pose challenges to research methods and the reliability of evidence gained.While the theme of working migrants is common in the literature, there have also been some studies of health of those left behind but who often remain unregistered. Migration within China is not a single entity and understanding the dynamics of new and emerging societies will need further study.Social, economic, emotional, environmental and behavioural risk factors that impact on health of migrants and their families call for more attention from health policy-makers and researchers in contemporary China.

• This is the first Chinese study to show that parental alcohol dependence is a risk factor for practicing child maltreatment.

Background China is facing the challenges of an expanding ageing population and the impact of rapid urbanization, cancer rates are subsequently increasing. This study focuses on the changes of the ageing population and projects the incidence of common ageing-related cancers in the urban regions in China up to 2030. Sources of data Cancer incidence data and population statistics in China were extracted from the International Agency for Research on Cancer. Areas of agreement Due to improving longevity in China, continuous and remarkable increasing trends for the lung, colorectal and prostate cancers are expected. Growing points The rate of expanding ageing population was taken into account when predicting the trend of cancer incidence; the estimations of ageing-related cancers were more factual and significant than using the conventional approach of age standardization. Areas timely for developing research The incidence rates of lung, colorectal and prostate cancers will continue to rise in the future decades due to the rise of ageing population. Lifestyle modification such as cutting tobacco smoking rates and promoting healthier diets as well as cancer screening programs should be a health system priority in order to decrease the growing burden of cancer-related mortality and morbidity.

Introduction:On 08 October 2005, an earthquake measuring 7.6 on the Richter scale, struck Pakistan's autonomous state of Kashmir and part of Indian-administrated Kashmir. The official death toll in Pakistan was 79,000, and nearly 1,400 in Kashmir. This study reports the findings of a three-week health needs assessment to understand the needs of rural, older people post-earthquake. This study was conducted in February 2006 in the Neelum Valley of Kashmir, Pakistan, four months after the earthquake.Hypothesis:During emergency relief, the vulnerability and health needs of older people in rural settings are different than are those in of urban areas.Methods:A comparative, descriptive study was performed using health information to compare the differences between rural and urban health needs and the utilization of services of older people after the earthquake. Semi-structured interviews were conducted to collect information regarding demographic background, medical and drug history, self-reported health status, healthcare access and utilization, and social/financial concerns. Clinical records were reviewed and physical indicators for older patients also were collected on-site.Results:The health profile, access to health care, service availability, and prevalence of non-communicable diseases differ between urban and rural settings. The greatest gap in health services at all sites was that non-communicable disease management was inadequate during non-acute, post-earthquake medical care. Health service utilization varied by gender, as in conservative rural areas, older, traditional women were less likely to receive medical services while older men were less likely to access psychological services in all sites.Conclusions:This is the first study to compare the post-earthquake healthcare needs of older people in urban and rural settings. Findings highlight specific health needs and issues related to long-term, chronic disease management. Given the global pattern of aging of the population, it is important to strengthen the capacity to respond appropriately to medical disasters, which includes preparedness for treating the health needs of older people.

BACKGROUND: Overweight and obesity pose a challenge to public health in China. According to Chinese definition, 303 million Chinese are overweight (body mass index, BMI >or= 24 kg m(-2)). Among them, 73 million are clinically obese (BMI >or= 28 kg m(-2)). In line with the global trend, the rate of obesity in China continues to increase, with associated morbidity and mortality. This study was to identify interventions, which are effective in Mainland Chinese society. METHODS: All non-drug-controlled interventions (>or=3 months) in Mainland China, which used anthropometric outcome measures, were selected from three Chinese and nine international electronic databases (before May 2006) and included in this systematic review. RESULTS: A total of 20 studies met the selection criteria and were included in the review. Among them only one was published in an international journal. Most studies combined at least physical activity, dietary intervention and health education. Seventeen studies (85%) reported significant effects in anthropometric measurement outcomes. CONCLUSIONS: Comprehensive interventions with at least physical activity, dietary intervention and health education may be effective in reducing obesity in Chinese children. The role of grandparents as carers in the one-child society is worth considering further. Current evidence of effective interventions for adults is limited. Publication bias in Chinese databases should be taken into account.

Background & Aims Population growth and changes in demographic structure are linked to trends in colorectal cancer (CRC) incidence. The aim of this study is to estimate future CRC incidence in the ageing population, and compare trends across developing and developed regions. Methods Cancer and population data were extracted from the International Agency for Research on Cancer. Annual incidence rates for the major types of cancer in 118 selected populations were extracted from 102 cancer registries in 39 countries worldwide. We selected 8 jurisdictions (from the United States, Europe, and Asia) that reported 20-year cancer incidence rates since 1988. Time series models were constructed to project cancer incidence, by sex and age, to 2030. Incidence rates for persons older than 65 years were combined and further adjusted for change of ageing population. We compared age-adjusted incidence rates among the jurisdictions. Results The total population older than 65 years old was 12,917,794 in 1988, and the number increased by almost 40% to 17,950,115 in 2007. In developed countries in the West CRC incidence is predicted to decrease by 16.3% in the United States, increase by 4.8% in the United Kingdom, and increase by 4.7% in Sweden by 2030. In developing countries, such as China (Shanghai), Croatia, and Costa Rica, CRC incidence is predicted to increase in a steep curve by 2030 because of the growing population and ageing effect; in 2030, the incidence increases were 60.5% for China, 47.0% for Croatia, and 18.5% for Costa Rica. We also predict CRC incidence will increase greatly by 2030 in Japan and Hong Kong, which are developed regions. Conclusions With the exception of the United States, the incidence of CRC is expected to continue to rise in most regions in the coming decades, due to population growth and changes in demographic structure. The predicted increases are more marked in developing regions with limited health care resources.

Background: \ud \ud The Dietary Approaches to Stop Hypertension (DASH) has been shown to lower blood pressure in the West. However, the real-life impact of DASH on reducing cardiovascular (CV) risk in routine clinical setting has not been studied.\ud \ud Methods: \ud \ud A parallel-group, open-labelled, physician-blinded, randomised controlled trial was conducted in January–June 2013 and followed up for 6- and 12-months in primary care settings in Hong Kong. Patients newly diagnosed with grade 1 hypertension (aged 40–70 years) who had no concomitant medical conditions requiring dietary modifications were consecutively recruited. Subjects were randomised to standard education (usual care) (n = 275), or usual care plus dietitian-delivered DASH-based dietary counselling in a single one-to-one session (intervention) (n = 281). Primary outcomes were the changes in estimated 10-year CV risk.\ud \ud Results: \ud \ud Outcome data were available for 504 (90.6%) and 485 (87.2%) patients at 6 and 12 months, respectively. There was no difference in the reduction of 10-year CV risk between the two groups at 6 months (− 0.13%, 95% confidence interval [95% CI] − 0.50% to 0.23%, p = 0.477) and 12 months (− 0.08%, 95% CI − 0.33% to 0.18%, p = 0.568). Multivariate regression analyses showed that male subjects, younger patients, current smokers, subjects with lower educational level, and those who dined out for main meals for ≥ 4 times in a typical week were significantly associated with no improvements in CV risk.\ud \ud Conclusions: \ud \ud The findings may not support automatic referral of newly diagnosed grade 1 hypertensive patients for further one-to-one dietitian counselling on top of primary care physician's usual care. Patients with those risk factors identified should receive more clinical attention to reduce their CV risk.\ud \ud Clinical trial registration: \ud \ud ChiCTR-TRC-13003014 (http://www.chictr.org.cn/enindex.aspx).

Hypertension is a typical example of long-term disease posing formidable challenges to health care. One goal of antihypertensive therapy is to achieve optimal blood pressure (BP) control and reduce co-occurring chronic conditions (multimorbidity). This study aimed to assess the influence of multimorbidity on medication adherence, and to explore the association between poor BP control and multimorbidity, with implications for hypertension management.\ud \ud A cross-sectional design with multistage sampling was adopted to recruit Chinese hypertensive patients attending general out-patient clinics from 3 geographic regions in Hong Kong. A modified systemic sampling methodology with 1 patient as a sampling unit was used to recruit consecutive samples in each general out-patient clinic. Data were collected by face-to-face interviews using a standardized protocol. Poor BP control was defined as having systolic BP/diastolic BP ≥130/80 mm Hg for those with diabetes or chronic kidney disease; and ≥140/90 mm Hg for others. Medication adherence was assessed by a validated Chinese version of the Morisky Medication Adherence Scale. A simple unweighted enumeration was adopted to measure the combinations of coexisting long-term conditions. Binary logistic regression analysis was conducted with medication adherence and multimorbidity as outcome variables, respectively, after controlling for effects of patient-level covariates.\ud \ud The prevalence of multimorbidity was 47.4% (95% confidence interval [CI] 45.4%–49.4%) among a total of 2445 hypertensive patients. The proportion of subjects having 0, 1, and ≥2 additional long-term conditions was 52.6%, 29.1%, and 18.3%, respectively. The overall rate of poor adherence to medication was 46.6%, whereas the rate of suboptimal BP control was 48.7%. Albeit the influence of multimorbidity on medication adherence was not found to be statistically significant, patients with poorly controlled BP were more likely to have multimorbidity (adjusted odds ratio 2.07, 95% CI 1.70–2.53, P < 0.001). Diabetes was the most prevalent concomitant long-term condition among hypertensive patients with poor BP control (38.6%, 95% CI 35.8–41.4 vs 19.7%, 95% CI 17.5–21.9 for patients with good BP control, P < 0.001).\ud \ud Multimorbidity was common among hypertensive patients, and was associated with poor BP control. Subjects with coexisting diabetes, heart disease, or chronic kidney disorder should receive more clinical attention to achieve better clinical outcomes.

Background Randomized trials have shown that optimal adherence to antihypertensive agents could protect against cardiovascular diseases, but whether adherence reduces cardiovascular deaths in community settings has not been explored so fully. This study evaluates the association between antihypertensive adherence and cardiovascular (coronary heart disease and stroke) mortality in the primary care settings. Methods From a territory-wide database in Hong Kong, we included all patients who were prescribed their first-ever antihypertensive agents in the years between 2001 and 2005 from the public healthcare sector. All patients were followed up for five years, and assigned as having poor (Proportion of Days Covered [PDC]

This study examined the rates of discontinuation of Oral Hypoglycemic Agents (OHAs) in diabetes patients, and to evaluate the associations between discontinuation of OHAs, socioeconomic status and the number of comorbidities.A cohort study from January 2004 to June 2007 was conducted and followed up through December 2007. We included all primary care clinics in one large territories of Hong Kong involving 28,773 Chinese diabetes patients. Multivariate regression analyses controlled for age, gender, payment status (fee-payers vs. fee waivers; fee-waivers represented those less able to pay for consultation fees and were regarded as having lower socioeconomic status), service type delivered by the clinics, district of residence, visit type (new vs. follow-up), the number of comorbidities and the drug class (sulphonylureas vs. biguanide vs. combination therapy).9.9% discontinued their medications within 180 days of their prescriptions. Fee waivers (adjusted odds ratio [AOR] for fee payers=0.81, 95% C.I. 0.73-0.89, p0.001) and the absence of comorbidities (AOR for ≥one morbidity=0.59-0.62, p0.001) were associated with medication discontinuation.Diabetes patients with lower ability to pay and without comorbidities were significantly associated with OHAs discontinuation. They should be the target groups for medication counseling programmes.

To examine the Eastern-Western difference in the interpretation of Integrative Medicine Attitude Questionnaire (IMAQ) by assessing the psychometric properties of a revised Chinese medicine (CM)-specific version of IMAQ (CM-IMAQ). Factor and Rasch analysis were performed with data collected from a mail survey of 165 Hong Kong Western medical doctors (WMD) randomly sampled from the official registry. The structural validity, unidimensionality, item fit, and differential item functioning (DIF) of the Hong Kong CM-IMAQ were evaluated. Confirmatory factor analysis (CFA) demonstrated that the original IMAQ factor structure was not concordant with our data on Chinese WMD, and subsequent explanatory factor analysis (EFA) validated a new three-factor model for CM-IMAQ: (1) attitude towards “tonification”, (2) attitude towards the effectiveness of CM, and (3) attitude towards CM knowledge. The original IMAQ factor on holism and doctor-patient relationship disappeared. Rasch analysis confirmed the unidimensionality of “tonification” and the effectiveness domains, but further refinement of the knowledge domain is needed. Cultural adaptation of the IMAQ has demonstrated differences between Eastern and Western doctors trained in allopathic medicine in their interpretations of holism in healthcare. For Chinese WMD, the emphasis of holistic care is placed on “tonifying” the body rather than on nurturing the mind and spirit. Confucian and Taoist conceptualizations of mental health as well as the persistent stigma towards mental illness within modern Chinese culture may explain why Chinese WMD do not regard mental health promotion as part of routine healthcare.

Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care” and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

Introduction This review outlines the development of China's primary care system, with implications for improving equitable health care.\ud \ud Sources of data Government documents, official statistics, and recent literature identified through systematic searches performed on NCBI PubMed.\ud \ud Areas of agreement Community health centres (CHCs) are being developed as the major primary care provider in urban China, with laudable achievements. The road towards a strong primary care-led system is promising but challenging.\ud \ud Areas of controversy The effectiveness in improving equitable care through the expansion of primary care workforce and redesign of the social medical insurance system warrants further exploration.\ud \ud Growing points Healthcare disparities exist in the health system wherein universal health coverage and gatekeepers have not yet been established.\ud \ud Areas timely for developing research Future prospective studies should aim to provide solutions for strengthening the leading role of CHCs in providing equitable care in response to population ageing and multimorbidity challenges.

Satisfaction with hospitalization may lead to both better health outcomes for patients and create better working environment and relationship between staff and patients. The objective of this study is to explore the relationship between the experiences of inpatients with specific aspects of care and satisfaction with the hospitalization experience.A secondary data analysis based on the Thematic Household Survey which was regularly conducted by the Census and Statistic Department.This survey covered the land-based non-institutional population of the Hong Kong Special Administrative Region (HKSAR), China, and representing 99% of the total population of HKSAR of 6.8 million.Totally 1264 respondents aged ≥15 who had ever been admitted to local hospital in 12 months prior enumeration were recruited.The Picker Patient Experience Questionnaire-15 (PPE-15) was adopted for measuring patient-perceived quality of hospitalization; and one global rating of the overall quality of hospital service was included.The mean global satisfaction scores for public and private hospital care were 7.3/10 and 7.8/10, respectively. By adjusting patient demographics, the regression models show that 'want to be more involved in decision made about the care and treatment', 'respect for patient's dignity', 'patients' family have enough opportunity to talk to doctor' and 'tell about danger signals regarding illness/treatment after went home' are major determinants of the global satisfaction scores.Communication, respect and patient engagement in provider-patient relationship are important in determining patient's satisfaction. Training and healthcare education curriculum could take this into account for ensuring the quality of patient-centered care.

This study tested the hypothesis that younger, male patients or new clinic visitors, who were prescribed thiazide diuretics were more likely to have drug discontinuation and switching. All adult patients who visited any primary care clinic in one territory of Hong Kong, and who were prescribed a thiazide diuretic from January 2004 to June 2007 were included. The rates of discontinuation and switching, separately, 180 days after thiazide prescriptions were measured. Factors associated with discontinuation and switching were evaluated by multiple regression analyses. Among 9398 patients, 12.5% discontinued and 10.8% switched their prescriptions, whereas prescriptions of other patients remained the same. Younger patients (

Objectives The perception and understanding of health professionals of the role of sub-acute care in the health system will have an impact on the potential effectiveness in preventing unnecessary hospitalization. This study aims to explore the perceived role and quality of sub-acute care services in the context of Hong Kong from the perspective of health service providers and to identify barriers to effectiveness. Methods Seven focus groups were conducted and the discussion was led by a guide covering three main areas: definition/component/role of sub-acute, difficulties in the sub-acute care services provision, and suggestion for further improvement in the provision of sub-acute care. Results The participants highlighted the positive role of sub-acute to promote patient's health and quality of life so as to reduce unnecessary hospitalization. The potential barriers in the sub-acute care identified were interrelated and focused mainly on systemic issues including lack of service coordination, specialist input and resources. The participants also suggested a number of practical ways to improve the quality of sub-acute care services. Conclusions The findings showed a need for further improvement in the process of sub-acute care by developing operation guideline and re-evaluating the allocation of resources to support the sub-acute care provision.

China has experienced dramatic industrialization, urbanization, and economic growth over the last 3 decades. The rapid transformation and dramatic prosperity of industries in rural areas have, in turn, created tremendous challenges for occupational health and safety (OHS). This article was prepared to address occupational health and safety issues in township- and village-owned enterprises (TVEs) from several aspects, including working conditions and workplace hazards, major recognized OHS problems, implications of TVE industries to environmental health, and migrant workers. Among the major recognized OHS problems, pneumoconiosis, chemical poisoning, and workplace accidents, especially in small-scale coal mines, are highlighted. It is suggested that the national polices and regulations that specifically target TVEs are indispensable and a more powerful administrative structure should be established to ensure that the pertinent polices, regulations, and OHS standards can be enforced widely and effectively in practice.

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong’s TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.

Summary As one of the fastest growing cities in Pearl River Delta of southern China, Shenzhen accommodates a higher percentage and increasing number of internal migrants, mainly coming from the inland areas. The public health issues that challenge its local government include the special population structure, high incidence of infectious diseases, high prevalence of mental problems, rising chronic disease burdens, and maternal and children’s health issues, although progress has been made in the past years. The health authority of Shenzhen has realized that provision of high quality equitable public health services to its residents, including migrants is of high priority, and should be supported by innovations in the health insurance system and establishment of community-based primary care networks. Making changes within the national-level health reform framework and learning from international experiences are necessary and important.

Background. Little is known about the community psychological and behavioral responses to influenza pandemics. Methods. Using random digit dialing, we sampled 12,965 Hong Kong residents in 13 cross-sectional telephone surveys between April and November 2009, covering the entire first wave of the 2009 influenza A(H1N1) pandemic. We examined trends in anxiety, risk perception, knowledge on modes of transmission, and preventive behaviors. Results. Respondents reported low anxiety levels throughout the epidemic. Perceived susceptibility to infection and perceived severity of H1N1 were initially high but declined early in the epidemic and remained stable thereafter. As the epidemic grew, knowledge on modes of transmission did not improve, the adoption of hygiene measures and use of face masks did not change, and social distancing declined. Greater anxiety was associated with lower reported use of hygiene measures but greater social distancing. Knowledge that H1N1 could be spread by indirect contact was associated with greater use of hygiene measures and social distancing. Conclusions. The lack of substantial change in preventive measures or knowledge about the modes of H1N1 transmission in the general population suggests that community mitigation measures played little role in mitigating the impact of the first wave of 2009 influenza A(H1N1) pandemic in Hong Kong.

Few studies address the profiles of antihypertensive compliance among ethnic Chinese. The levels of and factors associated with antihypertensive drug compliance among Chinese patients were evaluated in this study.All Chinese hypertensive patients who paid at least two consecutive visits in any government primary care clinics for antihypertensive drug refill in a large territory of Hong Kong from January 2004 to June 2007 were included. Medication possession ratio (MPR), defined as the ratio of total days of medication supplied (not including the last prescription) to total days in a period of time, was used a measure of drug compliance.From 83,884 eligible patients, 71,685 (85.5%) had good compliance to antihypertensive drugs (MPRor=80%). Binary logistic regression analysis was conducted, with good compliance as the outcome variable while controlling for potential confounders. Advanced age (adjusted ORs (aOR) 1.36-1.55, p0.001), female gender (aOR for male patients 0.84, 95% CI 0.80 to 0.87, p0.001), payment of fees (aOR 1.14, 95% CI 1.09 to 1.19, p0.001), attendance in family medicine specialist clinic (aOR 1.52, 95% CI 1.40 to 1.66, p0.001), follow-up visits (aOR 3.21, 95% CI 3.06 to 3.36, p0.001) and use of drugs acting on the renin-angiotensin system (aOR 1.18, 95% CI 1.07 to 1.30, p=0.001) were positively associated with good compliance to drugs. Use of β-blockers was negatively associated with drug compliance (aOR 0.78, 95% CI 0.73 to 0.84, p0.001).Physicians should practice caution when prescribing antihypertensive drugs to patients with these factors where closer monitoring of their compliance patterns is warranted.

To examine the prevalence and correlates of drinking and driving in Hong Kong, an anonymous, random telephone survey was conducted on 9860 Chinese adults (18-70 years of age) from April to June 2006. Trained interviewers administered a structured interview consisting of questions on socio-demographic information, drinking pattern, drink-driving, and motor vehicle accidents. The census age-standardized past-year prevalence of driving within 2h of drinking was 5.2% among males and 0.8% among females. The prevalence across age showed an inverted U-shaped trend for males peaking at 8.2% between 41 and 45 years. For females the prevalence was fairly stable between the ages of 20 and 55. The past-year prevalence of alcohol-related motor vehicle accidents was 0.1%, with the majority being in the 26-30 age group. For males who drank, the prevalence of drinking and driving was 5.0% among those without problem drinking, 14.8% among binge drinkers, 37.1% among alcohol abusers and 22.4% among the alcohol dependent. For females who drank, the corresponding figures were all lower at 1.2%, 6.9%, 12.1% and 12.5%, respectively. Higher socio-economic status, weekly drinking, binge drinking and alcohol abuse were independently associated with higher likelihood of drinking and driving in both genders. Among drinking drivers, having a job that required drinking was the only predictor of having had a motor vehicle accident. The elevated prevalence of drinking and driving among alcohol abusers, binge drinkers and the alcohol dependent may portend higher population-level rates of alcohol-related motor accidents in the future since the prevalence of problem drinking has previously been noted to be increasing rapidly in Hong Kong.

Background The aim of this study was to monitor changes in behavioral and emotional responses to human H5N1 in the community over a 28-month period (from November 2005 to February 2008). Methods A total of 3,527 Hong Kong Chinese adults were interviewed by telephone within the framework of six identical cross-sectional surveys carried out during the 28-month study period. Given a hypothetical scenario that two to three new human-to-human H5N1 cases had been reported in Hong Kong, the trends of the respondents in various H5N1-related risk perceptions, anticipated personal psychological responses, and anticipated personal preventive behaviors were investigated. Results Over time, a decreased proportion of the respondents (1) felt susceptible to contracting H5N1, (2) expected a large outbreak would eventually occur, (3) believed that the impacts of H5N1 were worse than those of severe acute respiratory syndrome (SARS), and (4) anticipated adopting more types of preventive measures and experiencing mental distress in the case of a small-scale outbreak in Hong Kong (AOR from 0.27 to 0.43, p

A random population-based telephone survey (n = 301) was conducted among the Hong Kong general population in July 2009. Past history of seasonal influenza vaccination (OR = 2.59–3.13) was associated with intention to take up A/H1N1 vaccination under three hypothetical scenarios (provided at HK$200). Adjusting background variables, other significant factors were identified by stepwise models: perceived side effects (OR = 0.33), family members’ recommendations and friends’ acceptability toward the vaccine (OR = 2.80–4.74). In contrast to other studies on seasonal influenza and A/H1N1 vaccination, perceived susceptibility and perceived severity related to influenza A/H1N1 were non-significant. Cultural differences may therefore exist.

Few studies have addressed the profile of adherence among ethnic Chinese patients. This study evaluated the factors associated with adherence with angiotensin-converting enzyme inhibitors (ACEIs), an increasingly common antihypertensive drug of choice. The authors included all adult patients who were prescribed an ACEI and paid at least 2 consecutive visits to any primary care clinics of one large territory of Hong Kong from January 2004 to June 2007. The determinants of good adherence to ACEI, as defined by a medication possession ratio > or = 80%, were evaluated by multivariate regression analysis. From 6408 eligible patients, 88.0% were adherent. Patients attending family medicine specialist clinics (adjusted odds ratio [AOR] = 1.46, 95% confidence interval [CI]: 1.12-1.91, P = .005) and follow-up visitors (AOR = 2.98, 95% CI: 2.49-3.55, P < .001) were significantly more likely and attendees of staff clinics (AOR = 0.48, 95% CI: 0.25-0.94, P = .033) were less likely to be adherent to ACEIs. Patients' age, gender, socioeconomic status, district of residence, and the number of comorbidities were not found to be associated with good adherence. Adherence-enhancing strategies should therefore be particularly focused on the new visitors (likely to be drug naive), and future research directions should delineate the best health service setting that could facilitate adherence to ACEIs.

Discontinuation of antihypertensive combination therapy imposes a substantial public health burden, but few studies have addressed the factors associated with their discontinuation in Chinese patients. This study evaluated the association between patient age, gender, and number of comorbidities with discontinuation of combination therapies. From clinical databases, we included all adult patients prescribed an antihypertensive fixed-dose combination therapy during January 2004 to June 2007 in any government primary care clinics in one large Territory of Hong Kong. We studied the factors associated with drug discontinuation within 180 days after the first prescription date by multivariable regression analysis, controlling for age, gender, socioeconomic status, service setting, district of residence, visit types (new vs. follow-up), and the number of comorbidities. From 29 253 eligible patients, 7.1% discontinued their antihypertensive prescriptions. Younger (

Antihypertensive drug switching induces substantial public health costs. This cohort study evaluated factors associated with switching of antihypertensive agents 180 days after the first date of prescription among ethnic Chinese patients. We included all adult patients agedor =18 years, who had paid at least two consecutive visits to all public primary care clinics in one large territory of Hong Kong during the study period from January 2004 to June 2007. Binary logistic regression analyses were carried out with antihypertensive drug switching as an outcome variable, while controlling for age, gender, payment status, service types, district of residence, visit types and the number of comorbidities. Among 93,286 eligible patients, 5281 (5.7%) switched their antihypertensive prescriptions to another drug class within 180 days. Patients agedor =70 years (adjusted odds ratio (aOR) 0.88, P=0.005), male subjects (aOR 0.87, P0.001) and follow-up visitors (aOR 0.67, P0.001) were less likely to have their drugs switched. When compared with thaizide diuretics, all other antihypertensive drug classes were associated with a lower likelihood of drug switching (aOR 0.27-0.69, all P0.001). Closer observations of drug utilization profiles among these patient groups are recommended, and future studies should evaluate the reasons for drug switching.

Objectives : Primary care physicians (PCPs) are influential in colorectal cancer (CRC) screening uptake in the community. This study aims to evaluate the factors associated with PCPs' practice of CRC screening among asymptomatic patients in a Chinese population. Methods : A validated postal questionnaire was sent to all practicing PCPs who were members of a community-based network in Hong Kong. Three separate rounds of reminder letters were sent to non-respondents. Binary logistic regression analysis was used with ever-referral for CRC screening in the past 12 months as the outcome variable. Predictor variables include physicians' gender, clinical experience, types of practice, and attitudes towards CRC screening. Results : Of 428 eligible physicians, 263 (61.4%) responded. A total of 187 physicians (71.1%) had referred patients for CRC screening in the past 1 year. Among all asymptomatic patients aged 50 years or older, physicians reported referring only 3.0% (1.0–10.0%) [median (interquartile range)] of patients. Colonoscopy (57.0%) and fecal occult blood testing (FOBT) (46.4%) were the most commonly recommended tests for these asymptomatic patients. Family history of CRC (58.6%) and patients' concern about CRC (50.2%) were major reasons for referral. PCPs in private practice (adjusted odds ratio [aOR] 2.60, 95% C.I. 1.21–5.59) and those with positive attitude towards CRC screening (aOR 2.27, 95% C.I. 1.15–4.48) were more likely to recommend CRC screening. Conclusions : PCPs' attitude towards CRC screening is a significant determinant of its practice. Future studies should identify and strengthen the influencers of PCPs' attitude to enhance CRC screening rates.