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While extensive quantitative research has shed light on the cognitive mechanisms of dyslexia, few mixed-methods studies have been conducted to examine the perceptions of and attitudes towards learning in children with dyslexia, especially in Hong Kong, a bilingual context. In addition, the validity of the metaphor elicitation technique, which was adopted in previous interview studies, has not yet been examined in children. Therefore, 30 children with dyslexia (age range: 8-13; 10 females) in Hong Kong were interviewed for metaphors regarding six domains: Chinese reading, Chinese writing, having Chinese lessons, English reading, solving maths problems, and dyslexia. Word reading fluency and parent-rated learning interest and confidence were measured to validate the use of the metaphor elicitation method in assessing children's reading attitudes in both Chinese and English using correlation analyses. Perceptions were examined by way of qualitative analyses based on the metaphor entailments. Results showed that children who expressed more positive attitudes towards English reading performed better in English reading. Moreover, the attitudes also positively correlated with the corresponding parents' ratings. These findings suggested that the metaphor elicitation technique is a valid method for assessing attitudes towards English reading in children with dyslexia. Furthermore, their perceptions of dyslexia and learning generally corresponded to those from previous interview studies despite differences in languages and contexts. Importantly, descriptions related to multiple themes, including metalinguistic awareness, cognitive skills, coping strategies, and dyslexia, were well-aligned with scientific findings, demonstrating that children already have a good understanding of dyslexia and various learning domains.

Social-emotional deficits in school-aged children diagnosed with autism spectrum disorder (ASD) greatly hinder these children from fully participating in various school activities in the inclusive education setting. Previous studies have demonstrated evidence regarding the effectiveness of using virtual reality (VR) for enhancing the children's affective expression and social reciprocity. However, considering the technical and logistical complexity of the enabling hardware and software systems, how such approaches can be effectively and sustainably delivered in the school setting remains underexplored. This paper presents a study that utilised VR headsets to enhance affective expression and social reciprocity for children with ASD and explored how the approach could be effectively and sustainably delivered at schools. A total of eight VR learning scenarios were designed based on Kolb's experiential learning framework. 176 children aged 6-12 with a clinical diagnosis of ASD participated in the study. The statistical analyses showed that the participants who received the intervention significantly improved in affective expression and social reciprocity, compared to those who were in the control group. Moreover, the approaches to enhance long-term sustainability have also been presented and discussed in this paper.

Purpose: We examined the effect of character complexity on early Chinese literacy (word reading and writing). We also investigated whether cognitive skills (phonological awareness, morphological awareness, and rapid automatized naming [RAN]) could moderate the influence of character complexity on literacy outcomes. Method: Our pre-registered study included a sample of 342 Cantonese - speaking Hong Kong Chinese children (162 males, 180 females, mean age = 7.32, SD = 0.87) from Grade 1 to Grade 3. We used a generalized additive mixed model (GAMM) to estimate the main effect of complexity on word recognition and dictation as well as interaction effects with each of the three cognitive skills. Age and nonverbal IQ were also included as controls. Results: Character complexity had a slightly curvilinear but consistently negative association with word reading, with odds ratios ranging from 0.62 to 0.71 per 10% increase in complexity. RAN and morphological awareness buffered the negative influence of character complexity. For writing to dictation, character complexity was more curvilinear, but character complexity and the interactions between cognitive skills and character complexity were not significant. Conclusion: Complex visual input can be a barrier to early reading development in Chinese, and fostering morphological awareness may help mitigate this effect.

Introduction: This study aimed to construct consolidated and updated ultrasonographic fetal biometry and estimated fetal weight (EFW) references for the Hong Kong Chinese population and evaluate the extent of under- and overdiagnosis of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) using these new references., Methods: Fetal biometry and EFW references were constructed using the Generalised Additive Model for Location, Scale, and Shape, based on data from 1679 singleton pregnancies in non-smoking Chinese women. Ultrasound scans were performed at 12 to 40 weeks of gestation to measure biparietal diameter, head circumference, abdominal circumference (AC), and femur length, following standardised protocols. The rates of SGA and LGA diagnoses using the existing and updated Hong Kong fetal biometry references were compared in an independent cohort of 10 229 pregnancies., Results: The median number of scans per gestational week between 20 and 39 weeks was 75 (interquartile range=67-83). Compared with existing references, the new AC reference would significantly (P<0.001) increase the proportions of SGA fetuses with AC measurements at <3rd and <10th percentiles from 1.7% and 6.1% to 3.4% and 10.0%, respectively. Conversely, it would significantly decrease (P<0.001) the proportions of LGA fetuses with AC at >90th and >97th percentiles from 15.0% and 4.9% to 11.5% and 3.5%, respectively., Conclusion: Adoption of the new references, particularly for AC, may lead to increased identification of SGA cases and decreased identification of LGA cases. The proportions of these cases will be more consistent with their intended diagnostic thresholds. Further studies are needed to determine how these references impact pregnancy outcomes., Competing Interests: All authors have disclosed no conflicts of interest.

Competing Interests: All authors have disclosed no conflicts of interest.

Introduction: Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision-to-delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia-to-delivery or decision-to-delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse., Material and Methods: This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia-to-delivery, deceleration-to-delivery, and decision-to-delivery were performed for the different groups with Spearman test., Results: There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision-to-delivery interval in any of the groups, but they were inversely correlated with bradycardia-to-delivery interval in Group 1 (Spearman's ρ = -.349; P = .043 and Spearman's ρ = -.558; P = .001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia-to-delivery interval in Group 1 (95% CI 0.0180-0.0003). The risk of significant acidosis (pH < 7) was 80% when bradycardia-to-delivery interval was >20 minutes, and 17.2% when the interval was <20 minutes., Conclusions: There is significant correlation between bradycardia-to-delivery interval and cord arterial pH in umbilical cord prolapse with fetal bradycardia but not in cases with decelerations or normal heart rate. The drop of cord arterial pH is rapid and urgent delivery is essential in such situations., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.)

Background: Adolescent idiopathic scoliosis (AIS) is the most common spine deformity in adolescent patients. Although structural deformity may affect spinal biomechanics of patients with AIS, little is known regarding various period prevalence proportions of back pain and chronic back pain and factors associated with back pain in such patients., Questions/purposes: (1) What are the period prevalence rates of back pain among teenagers with AIS? (2) Is back pain in patients with AIS associated with curve severity?, Methods: A total of 987 patients with AIS who were treated without surgery were recruited from a single center's scoliosis clinic. Between December 2016 and July 2017, this center treated 1116 patients with suspected AIS. During that time, patients were offered surgery when their Cobb angle was at least 50° and had evidence of curve progression between two visits, and most of the patients who were offered surgery underwent it; other patients with AIS were managed nonsurgically with regular observation, brace prescription, posture training, and reassurance. To be included in this prospective, cross-sectional study, a patient needed to be aged between 10 and 18 years with a Cobb angle > 10°. No followup data were required. A total of 1097 patients with AIS were managed nonsurgically (98.3% of the group seen during the period in question). After obtaining parental consent, patients provided data related to their demographics; physical activity levels; lifetime, 12-month, 30-day, 7-day, and current thoracic pain and low back pain (LBP); chronic back pain (thoracic pain/LBP); brace use; and treatments for scoliosis/back pain. Pain was rated on a 10-point numeric rating scale for pain. The Insomnia Severity Index, Epworth Sleepiness Scale, and Depression Anxiety Stress Scales were also assessed. These features and radiologic study parameters between patients with and without back pain were also compared. Factors associated with current and 12-month back pain as well as chronic back pain were analyzed by multivariate analyses., Results: Depending on the types of period prevalence, the prevalence of thoracic pain ranged from 6% (55 of 987) within 12 months to 14% (139 of 987) within 7 days, whereas that of LBP ranged from 6% (54 of 987) to 29% (289 of 987). Specifically, chronic thoracic pain or LBP had the lowest prevalence. Compared with the no pain group, patients with current back pain had more severe insomnia (odds ratio [OR], 1.80; p = 0.02; 95% confidence interval [CI], 1.10-2.93) and daytime sleepiness (OR, 2.41; p < 0.001, 95% CI, 1.43-4.07). Those with chronic back pain had the same problems along with moderate depression (OR, 2.49; p = 0.03; 95% CI, 1.08-5.71). Older age (OR range, 1.17-1.42; all p values ≤ 0.030) and Cobb angle > 40° (OR range, 2.38-3.74; all p values ≤ 0.015), daytime sleepiness (OR range, 2.39-2.41; all p values ≤ 0.011), and insomnia (OR range, 1.76-2.31; all p values ≤ 0.001) were associated with episodic and/or chronic back pain. Females were more likely to experience back pain in the last 12 months than males. Moderate depression (OR, 3.29; 1.45-7.47; p = 0.004) and wearing a brace (OR, 3.00; 1.47-6.15; p = 0.003) were independently associated with chronic back pain., Conclusions: Biopsychosocial factors are associated with the presence and severity of back pain in the AIS population. Our results highlight the importance of considering back pain screening/management for patients with AIS with their psychosocial profile in addition to curve magnitude monitoring. In particular, sleep quality should be routinely assessed. Longitudinal changes and effects of psychotherapy should be determined in future studies., Level of Evidence: Level II, prognostic study.

Objectives: For diagnosing neuropathic pain, a simple 6-item patient-completed identification pain questionnaire has been validated among Caucasians. We aimed to study the validity and reliability of this questionnaire among Hong Kong Chinese patients., Design: Questionnaire survey., Setting: Two pain clinics and two neurology clinics in Hong Kong., Patients: Patients with either neuropathic pain or nociceptive pain were recruited randomly from the four clinics. The patients completed the questionnaire themselves and the diagnosis of neuropathic pain and nociceptive pain was made by the pain specialists. We determined the optimal cutoff, positive and negative predictive values, sensitivity, specificity, the area under the receiver operating characteristic curve, and test-retest reliability of the translated version., Results: Among the 92 participants, 60 (65%) had neuropathic pain and 32 (35%) had nociceptive pain. At an optimal cutoff score of 3 or higher, the positive predictive value was 87% while the negative predictive value was 55%, and it correctly classified 71% of cases. The specificity and sensitivity were 81% and 65%, respectively. The area under the curve was 0.78 (P<0.001). Test-retest reliability in the 10 randomly selected patients showed a good intraclass correlation of 0.72., Conclusion: The Chinese Identification Pain Questionnaire is a valid and reliable scale that may be used as an initial diagnostic tool for neuropathic pain among Hong Kong Chinese patients.

Objective: To evaluate the influence of meteorological factors on the onset of aneurysmal subarachnoid haemorrhage in Hong Kong., Design: Retrospective review of prospectively collected data., Setting: University teaching hospital, Hong Kong., Patients: A total of 135 consecutive patients with acute aneurysmal subarachnoid haemorrhage presenting to the hospital within 48 hours after ictus from October 2002 to October 2006., Main Outcome Measures: Occurrence of aneurysmal subarachnoid haemorrhage in relation to daily changes in atmospheric pressure, temperature, and humidity., Results: The peak incidence of aneurysmal subarachnoid haemorrhage occurred in winter (December to February), especially January. The mean (+/-standard deviation) daily atmospheric pressure change was significantly higher on days with aneurysmal subarachnoid haemorrhage onset as opposed to days without (1.75+/-1.47 hPa vs 1.48+/-1.28 hPa; P=0.032)., Conclusions: A seasonal variation and relationship to atmospheric pressure change in aneurysmal subarachnoid haemorrhage was noted in the current study carried out in Hong Kong. The mechanism linking atmospheric pressure change and aneurysmal rupture remained to be explored.

We conducted a 31-month retrospective review of all laboratory-confirmed Streptococcus suis infections admitted to public hospitals in Hong Kong. Strain identification, serotyping and antibiotic susceptibility tests were conducted on S. suis isolates. Twenty-one sporadic cases were identified, comprising 18 (86%) males and 3 (14%) females. About half were patients aged 65 years. More cases occurred during summer. Occupational exposure was documented in five (24%) cases. The estimated annual incidence was 0.09/100 000 in the general population and 32/100 000 in people with occupational exposure to pigs and raw pork. The primary clinical manifestations were meningitis (48%), septicaemia (38%) and endocarditis (14%). The case-fatality rate was 5%. All available isolates from 15 patients were serotype 2, sensitive to penicillin, ampicillin, ceftriaxone, but resistant to tetracycline. Injury prevention and proper handling of pigs or raw pork should be advocated to both at-risk occupational groups and the general population.

The frequency of LRRK2 Gly2385Arg mutation in Hong Kong Chinese with early-onset (age < or =45 years) Parkinson's disease was identified and compared with late-onset patients (age >50 years) and controls. The mutation prevalence were 8.8, 8.3, and 0% for early-onset, late-onset, and controls, respectively. The mean age of onset among LRRK2 G2385R carriers was 42.7 years old for early-onset compared to 74.3 for late-onset patients. LRRK2 G2385R mutation appears to be as prevalent among early-onset as late-onset patients.

Our aim was to characterise PARK2 mutations and clinical features in Hong Kong Chinese with early-onset Parkinson's disease. Subjects were recruited from two major hospitals. Detailed data included demographics, age of onset, duration of disease, neurological manifestations, complications and disease severity. Genetic analysis for PARK2 mutations was performed. Thirty-four patients were recruited (mean age of onset = 39 years; mean duration of disease = 10 years). Seven patients reported a family history. The salient clinical manifestations were resting tremor (33/34), bradykinesia (33/34), rigidity (30/34), postural instability (20/34), good response to L-dopa (33/34), asymmetry at onset (31/34) and sleep benefit (12/34). Motor complications were reported in a significant number of patients, and depression was the most common nonmotor complication. Five patients were identified to have PARK2 mutations. Two sisters were compound heterozygotes for an insertion and a deletion, a novel and rare 1 bp insertion/nonsense mutation c1378&#95;1379insG (exon 12) and the entire deletion of exon 7. Another patient was homozygous for the entire deletion of exon 6. Two carriers were identified, one with a T1321C (Cys441Arg) missense mutation in exon 12 and another with a snp within intron 4. Our study reviewed a higher prevalence of PARK2 mutations in Chinese than that previously documented. A compound heterozygous mutation within two sisters with significant differences in age of onset and phenotypic manifestations suggest that modifier affects may be present in this family.

This study is set to examine the British (in England) and Chinese (in China and Hong Kong) beliefs about the causes, behaviour manifestations and treatments of schizophrenia. It was hypothesised that first the Chinese would hold more religious and superstitious beliefs towards the causation and treatment of schizophrenia and would prefer the use of alternative medicine; second, the British would emphasise more on internal (biological and psychological) and external (sociological) beliefs for the causes and treatments. It was also predicted that the Chinese would possess more negative attitudes and beliefs about the behaviour manifestations of schizophrenia than the British. All three hypotheses were confirmed after factor analysing the internal structure of the questionnaire. The relevance between investigating beliefs of schizophrenia and treatment of psychiatric disorders for clinical practice is also highlighted.

Purpose: This paper aims to examine the management strategies adopted by older people living with HIV/AIDS (PHAs) to conceal their positive status in healthcare settings, and their responses taken and means used to cope with the stigmatizing and exclusionary effects as a result of the disclosure of their status by/to healthcare workers., Design/methodology/approach: Under the auspices of a local NGO in Hong Kong, a total of seven male older PHAs aged 55 or above from pre-existing HIV/AIDS self-help groups were recruited for two separate focus groups. A thematic approach was adopted for data analysis and specific themes identification., Findings: An analysis of the data revealed that older PHAs did exercise their own agency in preventing against and managing stigma in their access to and use of health care services. Two more specific themes around "sign of disapproval" and "discriminatory practice" as barriers to access were also identified., Research Limitations/implications: Because of the small sample size, the pattern of stigmatization experiences and coping strategies cannot claim to be representative of the complete picture of the stigma associated with HIV/AIDS., Originality/value: This is the first exploratory study of the stigmatization and devaluation suffered by older PHAs in healthcare settings in the context of Hong Kong. It also explored in details the pros and cons of the stigma management strategies employed by this vulnerable group of patients. The implications for practice both on the side of healthcare workers and policy makers and that of PHAs were discussed.

There is little information available on strategies of information disclosure used by doctors in the care of patients with cancer. This report focuses on the style of disclosure used by doctors when giving diagnostic and prognostic information to patients with cancer. Among 46% of 133 surgeons and radiotherapists interviewed, disclosure of diagnosis involved a sudden approach (information given outright at one sitting). Less commonly used (19%) was a gradual disclosure style. Of the remainder who disclosed, more than half did so through the family or left it to the family to tell the patient. Doctors' specialty and patients' requests for prognostic information dictated disclosure style most frequently. Single people were more likely to have information disclosed to their families than were married people. While anecdotal accounts indicate negative reactions on the part of patients are a major reason for withholding such information, different disclosure style had little effect on doctors' reports of patient reactions to the bad news. Doctors perceived 25% of patients appeared to react 'with depression' but the remaining 75% appeared 'calm'. These results suggest patients are more likely to be told bad news suddenly, and that doctors do not perceive that this impacts too negatively on patients. The high levels of reported preference for information about cancer in Hong Kong (Fielding and Hung, 1996) conflict with actual prevalence patterns. It seems that commonly cited anecdotal reasons for withholding information from cancer patients in Hong Kong are not sustained by the data produced in these studies.

The antiglobulin gel test (DiaMed) was compared with conventional IAT methods in pretransfusion antibody screening in a tertiary hospital in Hong Kong. Antibody titrations showed that the gel system was more sensitive than the tube IAT method in detecting anti-D, anti-S, anti-s, but slightly less sensitive with anti-E. The gel tests detected all clinically significant warm reacting allo-antibodies detected by conventional IAT methods except one case of weak anti-E. It detected a case of anti-C missed in conventional screening. The number of serological investigations due to false positive screens, non-specific antibodies and clinically insignificant cold antibodies (anti-P, and anti-Lewis) were reduced. The gel system was fast and easy to use. It would reduce delays and inconvenience caused to patients due to false positive screens and non-specific antibodies without compromising detection of clinically significant antibodies. However, of concern was the failure to detect several cases of anti-Le(a) and anti-P1 that were reactive at 37 degrees C by conventional IAT and one case of anti-H in a patient with Parabombay A.

Study Objective: The aim was to assess the influence of childhood reading on the development of myopia after allowance for familial differences in susceptibility., Design: The study was a cross sectional survey., Setting: Four fishing harbours in Hong Kong in 1989., Subjects: Participants were 408 men and women aged 15-39 years old from 159 families., Main Results: Histories of school attendance and reading habits in childhood were obtained at interview. Myopia was assessed by retinoscopy. Associations between myopia (defined as a refractive error of at least -1.0D in one or both eyes) and indices of reading in childhood were explored. Myopia was more common in subjects who had attended school (odds ratio = 1.7, 95% CI 1.0-3.0), with the highest risks in those who had started school at the earliest ages and who had spent the most time reading and writing while at primary school. Allowance for familial tendency to myopia produced no diminution in the risks associated with reading., Conclusions: These data support the hypothesis that reading in childhood is a cause of short sight.

Study Objectives: The aim was to test whether cataract is associated with higher lifetime exposure to sunlight, and whether antioxidants protect against cataract., Design: This was a cross sectional survey of eye disease, with assessment of antioxidant status in a subgroup., Setting: Hong Kong fishing communities in 1989., Participants: 685 men and women aged 55 to 74 years old were included in the study, of whom 367 (54%) attended hospital for detailed examination., Measurements and Main Results: At a mobile clinic visual acuity and lens opacities were assessed, and using a questionnaire, occupational history and lifetime exposure to sunlight. At hospital ophthalmic measurements were repeated and blood was taken for measurement of plasma vitamin C, vitamin E, and total carotenoids, and red cell activities of glucose-6-phosphate dehydrogenase, glutathione peroxidase, superoxide dismutase, and catalase. Higher grades of cataract (particularly nuclear cataract) tended to be more common in subjects with the most sun exposure, although not to the point of statistical significance. In contrast to earlier studies, no association was found with antioxidant status., Conclusions: The findings give some support to the hypothesis that sunlight causes cataract. The absence of a relation to antioxidant status may be because blood levels of antioxidants at one point in time do not adequately reflect a subject's past metabolic state, and particularly the past activity of antioxidants in the lens.