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Background: The surge of positive COVID-19 cases taxed the local health care system and left many older adults initiating home self-care practices. The study aimed to explore the psychological experiences of home-quarantined older women diagnosed with COVID-19 in Hong Kong., Methods: Ten semi-structured telephone interviews were held among older women from March to April 2022. Inductive thematic analysis was used to analyse the data., Results: Older women experienced psychological distress, anxiety and depression after being infected with COVID-19. The source of their psychological difficulties included fear of losing control over one's health and dignity, feeling a burden to one's family, conflict in balancing risks and responsibilities, and being overwhelmed by the tragic news reported in media. Meanwhile, the participants demonstrated resilience following the infection and found meaning in their experiences, and grew mentally., Conclusions: The older women in this study have identified the negative impact having a diagnosis and being home-quarantine means to them and their family. Yet, they were also able to take some positives from this. Importantly, the older women report being able to build greater resilience, optimism and wisdom towards COVID-19 in general and feel better prepared for the potential of future positive diagnoses., (© 2023 John Wiley & Sons Ltd.)

Background: The unprecedented crisis during the fifth wave of the COVID-19 pandemic in Hong Kong placed a significant burden on the health care system. Therefore, the Hong Kong government advocated that individuals with no or mild COVID-19 symptoms should self-care at home. This study aimed to understand intrapersonal and interpersonal level factors that shaped self-care practices among home-quarantined individuals with COVID-19 during the peak of the pandemic., Methods: This study used convenience and snowball sampling whereby a total of 30 semi-structured telephone interviews were conducted between March and April 2022. Inductive content analysis was used to analyze the data., Results: Factors reported at the intrapersonal level included socioeconomic status and housing conditions, information and knowledge about COVID-19, long COVID, and psychological adjustments brought about by home quarantine. Factors identified at the interpersonal level included caregiving responsibilities, family relationships, and social support., Conclusions: Findings from this study identified a combination of intra and interpersonal level factors influenced an individual's self-care practices as a result of pandemic-induced quarantine. It was particularly concerning for those individuals in socially and economically deprived groups, where access to services was challenging. This study also raised awareness of the ineffectual and insufficient knowledge individuals held of self-medication and overall COVID-19 management. A key recommendation is developing family-based resilience programmes to support and empower vulnerable families to better cope with the realities of self-quarantine., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ma, Ma, Ge, Wang, Zhao and Christensen.)

Competing Interests: The authors declare that they have no conflict of interest.

Regional differences in socioeconomic factors are important for assessing the regional development of an area. While much research has focused on the overall patterns of regional differences within independent cities and areas, the hierarchical spatiotemporal structures of megacity regions have seldom been discussed. To fill this gap, this paper investigates the multilevel regional differences within megacity regions. Employing GDP, population and total retail sales as socioeconomic indicators, the spatiotemporal patterns of socioeconomic trends are identified. A hierarchical clustering approach that utilizes socioeconomic similarities is proposed for the identification of the spatiotemporal patterns of individual cities. At the megacity regional level, gravity centers and pathways are constructed to evaluate spatial imbalances and temporal change intensities. Taking the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) as its study area, this research produces results that show diverse spatiotemporal patterns among the individual cities, revealing high/low starting point and high/low growth rate modes in terms of city interactions. From the perspective of the entire GBA, the spatial imbalance of GDP is the highest of the factors, followed by the spatial imbalance of the total retail sales of the region and, finally, by that of its population. Total retail sales exhibit the highest level of temporal change intensity, followed by GDP and population. In terms of the contribution of the various cities to the overall regional changes, Guangzhou, Shenzhen and Hong Kong dominate the spatiotemporal changes in the gravity centers, while Foshan and Dongguan show significant potential to contribute to these socioeconomic patterns. These results provide effective guidance for the sustainable development of megacity regions., Competing Interests: The authors have declared that no competing interests exist.

Background: Hong Kong has gained a good reputation for its quality public health care services. However, there is a growing recognition that social stigma is a potential obstacle when female sex workers (FSWs) access health care services. There are a lack of studies focusing on how FSWs experience and cope with stigma when accessing health care services in Hong Kong., Objective: This study aims to explore how FSWs experience stigma and develop coping strategies when accessing health care services in Hong Kong., Methods: This is a qualitative interview study. Staff of non-governmental organizations (NGOs) that serve sex workers in Hong Kong facilitated the process of recruiting the participants. In-depth individual interviews were conducted with 22 FSWs, focusing on their experiences of stigma and coping strategies when accessing health care services. A directed content analysis approach was adopted to analyze the data., Results: The interview data can be grouped into three themes: experience of stigma in the health care setting; coping with the stigma of sex work; and the call for non-judgmental holistic health care., Conclusion: This study contributes to an understanding of the experience of stigma and stigma coping strategies of FSWs when accessing health care services in Hong Kong. stigma remains an important issue for a large proportion of FSWs when they seek timely professional help, openly disclose their sex work identity, and receive comprehensive health care services. The study also highlights the need to address multiple healthcare needs of FSWs beyond STDs. Moreover, the study contributes to increasing awareness of, and respect for, the human right of FSWs to receive non-discriminatory health services.

We describe the dissemination of a multidrug-resistant (MDR) serogroup 19 pneumococcal clone of representative multilocus sequence type 271 (ST271) with high-level resistance to cefotaxime in Hong Kong and penicillin binding protein (pbp) genes and its relationships to Taiwan(19F)-14 and the prevalent multidrug-resistant 19A clone (MDR19A-ST320). A total of 472 nonduplicate isolates from 2006 and 2011 were analyzed. Significant increases in the rates of nonsusceptibility to penicillin (PEN) (MIC ≥ 4.0 μg/ml; 9.9 versus 23.3%; P = 0.0005), cefotaxime (CTX) (MIC ≥ 2.0 μg/ml; 12.2 versus 30.3%; P < 0.0001 [meningitis MIC ≥ 1.0 μg/ml; 30.2 versus 48.7%; P = 0.0001]), and erythromycin (ERY) (69.2 versus 84.0%; P = 0.0003) were noted when rates from 2006 and 2011 were compared. The CTX-resistant isolates with MICs of 8 μg/ml in 2011 were of serotype 19F, belonging to ST271. Analyses of the penicillin binding protein 2x (PBP2x) amino acid sequences in relation to the corresponding sequences of the R6 strain revealed M339F, E378A, M400T, and Y595F substitutions found within the ST271 clone but not present in Taiwan(19F)-14 or MDR19A. In addition, PBP2bs of ST271 strains and that of the Taiwan(19F)-14 clone were characterized by a unique amino acid substitution, E369D, while ST320 possessed the unique amino acid substitution K366N, as does that of MDR19A in the United States. We hypothesize that ST271 originated from the Taiwan(19F)-14 lineage, which had disseminated in Hong Kong in the early 2000s, and conferred higher-level β-lactam and cefotaxime resistance through acquisitions of 19 additional amino acid substitutions in PBP2b (amino acid [aa] positions 538 to 641) and altered PBP2x via recombination events. The serogroup 19 MDR CC320/271 clone warrants close monitoring to evaluate its effect after the switch to expanded conjugate vaccines., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)

Serogroup 15 pneumococcal isolates from nasopharyngeal carriage of hospitalized children admitted to a teaching hospital in Hong Kong from April 2009 to September 2013 were characterized by pulse-field gel electrophoresis (PFGE), multilocus sequence typing, and antimicrobial non-susceptibility testing. The overall proportion of serogroup 15 isolates in the pre-PCV7 and post-PCV13 periods rose from 5.7% to 20.0%. The increase in trend for serotype 15B/C was statistically significant among children presented with pneumonia; bronchiolitis; upper respiratory tract infection; and febrile, non-respiratory diseases and for serotype 15A/F, among children with bronchiolitis and febrile, non-respiratory diseases. The predominant PFGE cluster of serotype 15B/C belonged to sequence type (ST) 199. Replacement of this more susceptible cluster (Ery and Tet non-susceptibilities of 32.2% and 25.4%) with the non-susceptible cluster, ST8859 (Ery and Tet non-susceptibilities of 91.7% and 87.5%) was noted. ST63 was the predominant serotype 15A cluster (Ery and Tet non-susceptibilities of 97.4% and 92.3%). Serogroup 15 subtypes have emerged in the post-PCV13 era, and these non-susceptible clusters warrant closer monitoring as candidates for incorporation to future pneumococcal vaccines., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A novel stichotrich ciliate, Strongylidium orientale sp. nov., was discovered from a mangrove river in Hong Kong, southern China, and its morphology was investigated through observations in vivo and after protargol impregnation. Cells are 80-120 × 35-50 µm in vivo and fusiform in shape, with rounded anterior and tapered posterior ends. It is characterized by its brackish habitat and by the presence of two types of cortical granules arranged irregularly throughout the cortex. Morphogenetic events of cell division and physiological reorganization are described. The main ontogenetic features were: (i) only the posterior portion of the parental adoral zone of membranelles was renewed by dedifferentiation of the old structures; (ii) the oral primordium in the opisthe occurred apokinetally; (iii) the left and right ventral rows originated intrakinetally and the final left ventral row was spliced from two cirri from the frontoventral cirral anlage, a short cirral row from the anlage for the right ventral row and a long cirral row which was formed from the whole anlage of the left ventral row; (iv) the marginal rows developed intrakinetally; (v) the dorsal kineties replicated entirely de novo and did not fragment; and (vi) the two macronuclear nodules fused into a mass and then divided. Based on small-subunit rRNA gene sequences, phylogenetic analyses showed a close relationship with its congener Strongylidium pseudocrassum and with the genus Pseudouroleptus.

Several adolescent developmental problems in Hong Kong are briefly reviewed in this paper. First, rising adolescent substance abuse trends are described. Second, Internet use problems and Internet addiction among young people are examined. Third, worrying trends in adolescent sexuality are identified. Fourth, phenomena on bullying among young people are reviewed. Finally, phenomena related to adolescent materialistic orientation are focused upon. With reference to these adolescent developmental problems, possible solutions are briefly discussed particularly with reference to the ecological perspective. It is argued that the related scientific literature provides useful pointers for designing the curriculum in the extension phase of the Project P.A.T.H.S. in Hong Kong.

Of 1,388 Streptococcus pneumoniae isolates collected from 2000 to 2005, 10.5% had a ciprofloxacin MIC of >/=4.0 mug/ml and 1.6% (range, 0.8% to 4.3% per year) had a levofloxacin MIC of >/=4.0 mug/ml. Molecular characterization indicated that fluoroquinolone resistance occurred independently in our prevalent Spain(23F)-1 clone, expressing serotypes 23F, 19F, and 14. Rates of resistance to levofloxacin in S. pneumoniae have remained stable at a Hong Kong hospital.

Five hundred nineteen Streptococcus pneumoniae isolates from nasopharyngeal aspirates of 3,157 children (age, <16 years) participating in a respiratory surveillance study in Hong Kong in 2005 and 2006 indicated that 64.9% and 37.2% of the isolates were not susceptible to penicillin and cefotaxime, respectively. The rate of potential coverage by the seven-valent conjugate vaccine was 72.3%, and the rate increased to 74.6% for serogroup-specific types.

This longitudinal study examined the relationships between parent-adolescent conflict and antisocial and prosocial behavior in Chinese adolescents. Results showed that father-adolescent conflict and mother-adolescent conflict were concurrently related to adolescent antisocial and prosocial behavior. Longitudinal analyses showed that parent-adolescent conflict predicted antisocial behavior but not prosocial behavior. Adolescent antisocial and prosocial behavior was also found to be related to father-adolescent conflict across time. The findings suggest that the linkage between father-adolescent conflict and adolescent social behavior is stronger than that between mother-adolescent conflict and adolescent social behavior.

The prosocial and antisocial behaviors of 2,862 Hong Kong Chinese adolescents were investigated. The major findings were as follows: (a) boys were more antisocial than girls: (b) negative peer influences were significantly stronger in boys than in girls, whereas positive peer influences were significantly stronger in girls than in boys; (c) antisocial adolescents tended to perceive their best friend as antisocial and exerting more negative influences on them, whereas prosocial adolescents tended to perceive their best friend as prosocial and exerting more positive influences on them; (d) antisocial behavior was positively associated with psychoticism and neuroticism; and (e) academic achievement tended to have a positive relation with prosocial behavior and a negative relation with antisocial behavior.

An unexpected increase in positive sputum cultures of non-tuberculous mycobacteria (NTM) was noted in Hong Kong in 1990 compared to previous years, in contrast to a steady decline in the number of positive cultures of Mycobacterium tuberculosis. A retrospective case note study was therefore undertaken to ascertain the clinical importance of the rise in NTM isolates. A representative sample of 183 of the 675 patients with NTM isolates from sputum during 1990 was identified. Cases were assigned to groups according to whether there was evidence of progressive pulmonary disease due to NTM (group 1), persisting colonization without evidence of progressive disease (group 2) or transient isolation of NTM without evidence of progressive disease (group 3). Of 168 cases with adequate clinical and radiological records, 28 (16.7%) represented progressive disease due to NTM and 6 (3.6%) represented persisting colonization. The remainder were both transient and clinically insignificant. Most patients (71%) with progressive pulmonary disease due to NTM had pre-existing lung damage, and 50% had received anti-tuberculous therapy for documented M. tuberculosis previously. The commonest organism involved was the M avium complex. Eighty-six percent of patients with progressive disease and 83% of those with persisting colonization had at least one smear positive sputum specimen, whereas only 2% of patients with sputum contamination had a smear positive sputum sample (P < 0.0001). M. malmoense, M. xenopi and M. fortuitum all appear to be rare causes of significant NTM disease in Hong Kong. However, M. chelonei caused four cases of progressive disease within the study population, two of which were fatal.(ABSTRACT TRUNCATED AT 250 WORDS)

Four thousand four hundred and seventy-two patients were recruited into a project to test the efficacy of a Shared Care System in the management of low risk antenatal patients. The patients were scored according to a simple point scoring system. Three thousand three hundred and fourty-seven (74.8%) were scored as low risk. Fifty point two percent (1,682) of these low risk patients received the conventional system of care and acted as controls; while 49.8% (1,665) received shared care, where they were seen jointly by midwives, general doctors and hospital specialists. It was found that with the use of shared care, there was a significant decrease in workload to the hospital specialty clinics. Not only was the antenatal diagnostic rate of intrauterine growth retardation (IUGR) significantly improved, but the mean gestations at which IUGR, malpresentations, and pregnancy induced hypertension were diagnosed were also significantly earlier. The number of antenatal cardiotocographs performed, as well as the number of hospital admissions and mean duration of stay were decreased in the study group. The overall cost savings to the hospital was calculated if the shared care system was generally adopted.

A retrospective case controlled study was carried out on 51 Chinese gravidas who had abused narcotics and who were delivered in a teaching hospital in Hong Kong. Heroin was the most commonly abused drug. The number of patients who changed from heroin to methadone was small. The major antenatal complications were late antenatal booking (average 28 weeks), prematurity (41%), small for gestational age baby (27.5%), antepartum haemorrhage (13.7%) and high prevalence of venereal disease (23.5%). The babies born to drug addicted mothers were on average 629 g lighter at birth, 5 cm smaller in head circumference and 7 cm shorter in body length. Neonatal withdrawal symptoms occurred in 83% of all drug exposed neonates. The perinatal mortality rate was 19.6 per 1,000 total birth which was 2.5 times that of the control group. There was one maternal death in our series. Drug addiction in pregnancy poses a major risk to both mother and child.

In a retrospective case controlled study the demographic background and outcome of 193 mothers whose babies were born before arrival at hospital was compared to that of a control group who delivered within the maternity units of 2 teaching hospitals in Hong Kong. Mothers who delivered before arrival at hospital were significantly more likely to be single, to have received no antenatal care, to have an unplanned pregnancy, low family income and to come from a socially disadvantaged group such as Vietnamese refugees and illegal immigrants from China. Lacerations to the genital tract, postnatal anaemia and blood transfusions were more common in the study group. Results of cervical cytology and rubella status were available in significantly fewer of these mothers. They were more likely to be ambivalent about contraception and less likely to attend the postnatal clinic. The perinatal mortality and morbidity was significantly increased.

An excellent maternal and perinatal outcome is reported in a group of grand multipara of low socioeconomic status. These observations on a group of patients who are traditionally considered to be high risk show that in a healthy population with access to modern medical care and hospital delivery, a favorable outcome can be achieved despite a low socioeconomic or refugee status.

The perinatal outcome of 96 patients who had an antenatal haemoglobin value of less than 8.0 g/dl was compared with that of a similar number of controls who were matched for age and parity. Sixty-one patients (63%) had iron deficiency anaemia, 25 (26%) had alpha or beta thalassaemia minor, 7 (7.3%) had iron deficiency and thalassaemia trait, 2 had idiopathic pancytopenia and 1 had haemolytic anaemia due to systemic lupus erythematosus. Patients in the study group attended the antenatal booking clinic later, had less weight gain during pregnancy and their babies had lower birth-weights (2,984 g versus 3,177 g p less than 0.01) although there was no significant difference in the period of gestation at delivery. Six patients in the study group had placental abruption and another 2 patients had stillbirths but neither of these complications occurred in the control group. Although 37 patients (39%) in the study group received an antenatal blood transfusion, 53 (55%) of this group also had postnatal anaemia.

The obstetric outcome of 285 women with a history of previous multiple induced abortions is compared to that of 285 age matched primigravidas. In the study group, 219 women had 2 previous induced abortions and 66 had 3 or more, the maximum number being 8. There was a higher incidence of unmarried women and smokers in this group but a lower incidence of uneducated women. There was no difference in the incidence of antenatal complications between the 2 groups. The mean gestation at delivery, duration of labour and mode of delivery were comparable. There was an increased incidence (p less than 0.01) of retained placenta in the subgroup of women with 3 or more previous induced abortions. There were no maternal or perinatal deaths. The mean birth-weight was comparable and there were no infants weighing less than 1,500 g in either group. We conclude that multiple previous induced abortions appear to have minimal impact on the obstetric outcome of subsequent pregnancy in this population, and in the absence of other risk factors there is no need to alter standard obstetric management in this group of women.

The obstetric performance of 308 Vietnamese refugees is compared with that of 308 age-matched Hong Kong Chinese patients. Vietnamese women were of higher parity and had an increased incidence of late booking and unreliable dates. Significant differences were found in the incidence of previous termination of pregnancy, iron-deficiency anemia, parasitic infestation, tuberculosis (TB) and syphilis. There was no significant difference in the mean birthweight between the two groups. However, there were twice as many low birthweight (less than 2500 g) infants amongst the Vietnamese whereas the Chinese patients had a higher incidence of macrosomic (greater than 4 kg) infants. There were no perinatal deaths and no significant perinatal morbidity.

In a prospective study the prevalence of syphilis amongst a group of pregnant Vietnamese refugees in Hong Kong was found to be 3.4%. No cases of gonorrhoea, genital warts or genital ulcers were found in the same group of patients. The implications of these results are discussed and the importance of adequate screening, treatment, contact tracing and health education amongst this group are emphasised.

Between 1984 and 1988 inclusive 34 patients with syphilis during pregnancy were identified in this unit by routine serological screening. There were 2 stillbirths in this group of patients giving a perinatal mortality rate of 59 per 1,000 total births. Analysis of the patients' history and physical examination findings did not reveal any predictive factors for sexually transmitted diseases in most cases. Despite the dramatic fall in the prevalence of syphilis both during pregnancy and the general population in Hong Kong, routine serological screening for syphilis during pregnancy must continue.

Routine cytological examination and HPV-DNA probing were performed on cervical cells obtained from 215 pregnant Chinese females. The procedure utilized the specific binding of a mixture of complementary [32P]-labelled RNA probes to membrane-bound target HPV DNA types 6, 11, 16, 18, 31, 33 and 35. Positive results for HPV-DNA were obtained in 11/215 (5%) of the cases. The cervical smears were routinely processed and in 3/215 (1.5%) cases a cytological diagnosis of wart virus infection was made. All three were included in the 11 probe-positive cases. Using similar molecular biological techniques, pregnant Western females have an incidence of HPV infection of the cervix which is up to five times that of the present series. This is an unexpected finding in view of the fact that the incidence of cervical cancer is higher in Chinese women than American women.

Of 154 Chinese patients who underwent gynaecological operations, four showed a positive 125I fibrinogen leg scan for venous thrombosis, and overall incidence of 2 . 6%. In those who were on oral contraceptives and had major pelvic surgery for benign conditions, the incidence was 10 . 5%; in those who had Wertheim hysterectomy for carcinoma of cervix, it was 6 . 7%. This confirms the rarity of post-operative thromboembolism in the Chinese. Fragment E showed a biphasic rise after major operation due to tissue injury and venous thrombosis. In patients with malignancy, the postoperative 'fibrinolytic shutdown', represented by decreased plasminogen activator together with increased alpha 1 antitrypsin and C1- inhibitor levels, was more marked. In addition, alpha 2 macroglobulin level was lower and fell significantly after operation. In patients on oral contraceptives, fragment E levels were higher after surgery and there was no decrease in plasminogen activator levels. Antithrombin III levels did not fall except in three of the four patients with venous thrombosis. A marked increase in fragment E level and a decrease in antithrombin III level might be useful diagnostic markers for postoperative venous thrombosis.

Causes of perinatal mortality at Tsan Yuk Hospital, Hong Kong, were classified into 14 categories from the "P" list of stillbirths and neonatal mortality in the International Statistical Classification of Diseases, Injuries and Causes of Death. Trends for each category over the period 1970-1979 were examined by regression analysis. Overall perinatal mortality fell from 17.80 in 1970 to 10.94 in 1979. A low incidence of deaths from congenital abnormality and medical complication in the mother was observed. Significant statistical correlations were obtained in the trends in mortality associated with placental hemorrhage, pre-eclampsia, difficult labor, hemolytic disease of the newborn, and prematurity. Improvements in perinatal mortality in these areas as well as inadequacies in perinatal care in other areas, are discussed.

Fifteen years' experience in a Menstrual Disorder Clinic revealed that gonadal dysgenesis was the commonest cause of primary amenorrhoea. Investigations using Barr Body study and laparoscopic examination were unsatisfactory and inaccurate. The invasive nature of laparoscopy was the likely principal cause for the high default rate in the early years of the Clinic. The availability of hormone radioimmunoassay and cytogenetic study has improved the diagnostic acuity. Gonadal malignancy associated with the "Y" chromosome could also be identified at its early stage. Oestrogen replacement therapy has been found to be beneficial and is associated with little side effects and no endometrial pathology has been identified.

Newborn infants of Chinese HBeAg-carrier mothers in Hong Kong were randomly assigned to one of four study groups. Group I was treated with 3 micrograms heat-inactivated hepatitis B (HB) vaccine at birth and at 1, 2, and 6 months thereafter, in conjunction with seven monthly HBIg injections; group II was treated according to the same vaccine schedule but received only one HBIg injection at birth; group III received only the vaccine, at months 0, 1, 2, and 6; and group IV received placebos for both vaccine and HBIg. The first set of injections was given within 1 h after birth. Comparisons were made in the 140 children who were at least six months old at the close of the trial (495 days). In all three treatment groups development of the persistent carrier state was significantly (p less than or equal to 0.0001) less frequent than in controls (2.9%, 6.8%, and 21.0% versus 73.2%). Although vaccination alone was significantly less protective than vaccination plus multiple HBIg injections (p = 0.03), the degree of protection was still remarkable. 12 months after the first set of injections 96-100% of the infants in the three treatment groups were anti-HBs positive; the geometric mean titres of anti-HBs in the three groups did not differ significantly. This indicates that even high doses of HBIg do not interfere with the anti-HBs response to the vaccine. Probable intra-uterine HB infections were observed in 3 infants. No serious side-effects were observed from the interventions, even in the babies with intra-uterine infections who had received HBIg and HB-vaccine at birth. To prevent development of the persistent HBsAg carrier state, and thereby the consequent chronic liver disease and/or primary carcinoma of the liver, HB vaccine and HBIg should be administered as soon as possible after birth to all newborn infants at risk of perinatal hepatitis B infection.

Intrauterine growth standards for Hong Kong Chinese were derived from birth-weight data between 28 and 42 weeks' gestation in 15,815 livebirths delivered in 1982 to 1984 at 2 maternity teaching hospitals in Hong Kong. Normal distribution of birth-weights was noted in each of the gestational weeks studied. The mean birth-weight was 3,237g at 40 weeks which was similar to the mean weights reported in other populations for this gestation. The trend of the median weight curve was also similar to that in other Caucasian and Asian reports. The growth pattern for males and females were similar and males were on the whole heavier than females throughout the gestational period studied. At 40 weeks, the 10th percentile weight also showed wide variations between reports, which would have important bearing on the studying of intrauterine growth retardation. When the mean weight at term as derived from the present study was compared to a previous report on birth-weight data in 1970-1972 in the same hospital, a significant increase in birth-weight was observed over the 12-year period. The importance of having up-to-date intrauterine weight standards for a specific population is discussed.

Eighty-three cases of secondary postpartum haemorrhage managed in this teaching unit over a 3-year period are described. Bleeding occurred most frequently between the 8th and 14th day of the puerperium; 73% of the patients had already been discharged from hospital and required readmission. Suction evacuation was performed in 72 patients and was successful in arresting haemorrhage whether retained placental tissue could be demonstrated on histology or not. There was histological confirmation of retained gestational products in only 30 (42%) of the patients treated surgically. No predictive factors for secondary postpartum haemorrhage could be identified in the obstetric profiles or antenatal course of most of these patients. Patients with retained gestational products could not be distinguished from those without on the basis of history or examination alone apart from 4 patients noted to have incomplete membranes at delivery.

Testicular size, semen characteristics and serum reproductive hormone levels were studied in 1239 normal Chinese men. The mean testicular size of 17 ml in this group of subjects was similar to other reports in Orientals but was smaller than that reported in Caucasians. Semen volume, and the sperm count, motility and morphology were comparable to those described for Caucasian subjects. The cervical mucus penetration test (Kremer's test) and the zona-free hamster egg penetration test were also studied in some of the subjects. Age showed a positive correlation with the serum levels of FSH and LH, which were highly correlated with each other. Sperm concentration and the total sperm count were positively correlated with testicular volume, the length of abstinence, the % of sperm with an oval head, and the zona-free hamster egg penetration test, but were negatively correlated with serum FSH. Sperm motility was negatively correlated with the duration of abstinence but was positively correlated with the % normal sperm. The results constitute a normal data base from Chinese men for comparison with studies in male infertility and fertility regulation.

The reproductive performance of 110 patients who had had gestational trophoblastic disease was reviewed. There were 160 pregnancies and their outcomes were similar to that of the general population. The subfertility rate was also comparable to the general population. The high rate of failure of contraception resulting in a high rate of conception during the first year of follow-up warrants special attention. Reasons for the high failure rate and ways of prevention are discussed. Reasons for the deliberate delay in attempts to conceive in patients after the full year of postmolar human chorionic gonadotropin (hCG) surveillance were explored.

The incidence of alpha-thalassemia trait (alpha-thal-1 and alpha-thal-2) among Southern Chinese in Hong Kong is about 3%. From June 1983 to September 1987, prenatal diagnosis for homozygous alpha-thal-1 was performed in 88 pregnancies at risk, using direct DNA analysis of amniotic fluid cells or chorionic villi. Twenty-one homozygous alpha-thal-1 fetuses were aborted and confirmed as Hb Bart's hydrops fetalis, and two were "Hb H" hydrops fetalis. Of 47 pregnancies delivered, 26 were alpha-thal-1 heterozygotes, 10 normal, eight alpha-thal-1/normal. Twenty-one pregnancies, diagnosed as alpha-thal-1/normal, await delivery. Based on a 6% incidence of beta-thalassemia minor among pregnant women in Hong Kong, the number of pregnancies at risk for beta-thalassemia major should be 288 per annum. However, since February 1984, only 25 diagnoses were performed. Comprehensive screening and education programs need to be implemented. The majority of beta-thalassemia defects in Southern Chinese are point mutations, single nucleotide insertions or minor deletions, not detectable by standard gene mapping techniques. With linkage analysis of the defective gene to polymorphic restriction sites, a definitive diagnosis can be obtained in 50% of the families, while in the remaining there is a 50% exclusion rate. We routinely use the Hind III-3' beta, Bam HI-3' beta, Ava II-beta, and Hinc II-psi beta sites for linkage analysis. For first pregnancies, the marked linkage disequilibrium of the Bam HI polymorphism can be applied in 29% of the cases. In nonconclusive cases, fetal blood beta/gamma globin chain synthetic ratio was used.(ABSTRACT TRUNCATED AT 250 WORDS)

The maternal mortality rate in Hong Kong fell from 0.45/1000 total births in 1961 to 0.05/1000 total births in 1985. During the period between 1961 and 1985 there were a total of 438 maternal deaths and 2,193,012 births. Of the 438 deaths 150 (34%) were due to haemorrhage during pregnancy and childbirth (ICD 640, 641, 666), 89 (20%) were due to pre-eclampsia (ICD 642, 643) and 60 (13.7%) were due to ectopic pregnancy (ICD 633). Comparison of maternal deaths by cause between the periods 1961-1965 and 1981-1985 showed an 86% reduction in deaths due to haemorrhage and pre-eclampsia and a 72% reduction in deaths due to ectopic pregnancy. Pulmonary embolism was not a major cause of maternal mortality.