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Background: Intradermal (ID) injection is an alternative route for influenza vaccine administration in elderly with potential improvement of vaccine coverage. This study aimed to investigate the cost-effectiveness of an influenza vaccination program offering ID vaccine to elderly who had declined intramuscular (IM) vaccine from the perspective of Hong Kong public healthcare provider., Methods: A decision analytic model was used to simulate outcomes of two programs: IM vaccine alone (IM program), and IM or ID vaccine (IM/ID program) in a hypothetic cohort of elderly aged 65 years. Outcome measures included influenza-related direct medical cost, infection rate, mortality rate, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model inputs were derived from literature. Sensitivity analyses evaluated the impact of uncertainty of model variables., Results: In base-case analysis, the IM/ID program was more costly (USD52.82 versus USD47.59 per individual to whom vaccine was offered) with lower influenza infection rate (8.71% versus 9.65%), mortality rate (0.021% versus 0.024%) and QALYs loss (0.00336 versus 0.00372) than the IM program. ICER of IM/ID program was USD14,528 per QALY saved. One-way sensitivity analysis found ICER of IM/ID program to exceed willingness-to-pay threshold (USD39,933) when probability of influenza infection in unvaccinated elderly decreased from 10.6% to 5.4%. In 10,000 Monte Carlo simulations of elderly populations of Hong Kong, the IM/ID program was the preferred option in 94.7% of time., Conclusions: An influenza vaccination program offering ID vaccine to elderly who had declined IM vaccine appears to be a highly cost-effective option., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the efficacy of a birth ball exercise programme conducted by physiotherapists on pain relief, psychological care, and facilitation of the labour process at a labour ward in a regional hospital., Design: Case series with before-after comparisons., Setting: Kwong Wah Hospital, Hong Kong., Participants: Chinese women admitted to the labour ward for spontaneous vaginal delivery between April and August 2012 were recruited. Physiotherapists taught birth ball exercises in groups or individually for 30 minutes. Labour pain intensity, back pain intensity, frequency of labour pain, stress and anxiety levels, and subjective pressure level over the lower abdomen were captured before and after birth ball exercises. Most of the parameters were measured using self-reported visual analogue scales. After the exercise session, physiotherapists measured the women's satisfaction level. Midwives recorded pethidine usage., Results: A total of 203 pregnant women participated in this programme; 181 were in the latent phase group, whereas 22 were categorised into the no-labour-pain group. In both groups, there were statistically and clinically significant differences in back pain level, stress and anxiety levels, as well as pressure level over the lower abdomen before and after the exercise (P<0.05). In the latent phase group, significant decreases in labour pain and frequency of labour pain were demonstrated. Mean satisfaction scores were high, with visual analogue scale scores higher than 8.2 in both groups. Pethidine usage showed a further decreasing trend (6.4%) compared with the past 2 years., Conclusion: Birth ball exercise could be an alternative means of relieving back pain and labour pain in the labour ward, and could decrease pethidine consumption in labouring women.

The extensive use of multiple organic solvents in offset lithographic printing causing high emissions of volatile organic compounds (VOCs) indeed poses a serious risk to printing workers' health. In this study, indoor air quality (IAQ) assessments were carried out in seven printing plants and the main objectives were to understand the effect of VOC emissions on IAQ and develop effective mitigation measures to protect workers. The thorough gas chromatography/mass spectrometry (GC/MS) measurements showed that although a variety of VOCs were presented in the indoor air, none of them was found close to individual 8-h time-weighted average (TWA) of the occupational exposure limit (OEL). The additive effect was also found below the critical value of unity. However, short-term personal exposure to total volatile organic compounds (TVOCs) was exceedingly high when a print worker carried out blanket and ink roller cleaning procedures. Therefore, the occupational health risk was mainly due to repeated short-term exposures during intermittent VOC-emitting procedures rather than long-term exposure to background VOCs. Push-pull local exhaust ventilation (LEV) was identified as an effective mitigation measure. Computational fluid dynamics (CFD) analysis was conducted to study the push-pull LEV operation. It was found that there existed a threshold LEV air flow rate for an abrupt reduction in the worker's exposure to VOCs. The reduction was less sensitive when the LEV airflow was further increased beyond the threshold. These phenomena, consistent with experimental results reported by other investigators, were explained by detailed CFD analysis showing the competition between the general ventilation and the push-pull LEV to become the dominating driving force for the resultant local flow pattern.