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The dominance of Asian communities in international league tables such as those produced by The Program for International Student Assessment, which monitors competence in literacy and numeracy, has resulted in a policy discourse from the English government of failing schools, deficit curricular and ineffective teachers. This in turn has led to a re-defining of the National Curriculum framework for pupils educated in England with greater focus given in the Early Years curriculum to Mathematical functions particularly those associated with skills in counting; understanding and using number; calculating simple addition and subtraction problems and the understanding of shape, space and measure. Drawing on research carried out in Hong Kong and England this article offers a cross-cultural comparison of the expectations of Early Years Teachers in terms of the capabilities of early learners in achieving elements of number competency. The study of teachers' expectation is a neglected field in research when applied to compare intercultural achievement. In identifying divergent national expectations, the current panic over what constitutes an appropriate maths curriculum is critiqued and recommendations made for further exploration into teachers' expectations as to the age and stage at which elements of the maths curriculum are introduced in English schools.

In the present study, the mediating roles of syllable awareness, orthographic knowledge, and vocabulary skills and the moderating role of morpheme family size in the association between morphological awareness and Chinese character reading were investigated with 176 second-grade Hong Kong Chinese children. In the path analyses, the results indicated significant partial mediating effects of semantic radical function knowledge and vocabulary skills but not of syllable awareness and pseudocharacter identification. A significant moderating effect of morpheme family size was also observed. Children with relatively poor compounding structure awareness performed much more poorly in reading Chinese characters that had a small family size. The mediating and moderating effects documented in the present study can help us understand the mechanism involved in the relationship between morphological awareness and Chinese character reading and provide evidence as a basis for modifying current instruction strategies for improving Chinese children's reading performance.

There is little consensus among different early childhood education stakeholders in Hong Kong on whether it is beneficial or detrimental for children to receive an English bilingual education before the age of 6. This longitudinal study investigated the issue of potential "detrimental effects of learning English" on Hong Kong kindergarten children's performance in L1 (Cantonese) and L2 (English) over a six-month period. The sample consisted of 53 children, 29 of whom went to international schools and received 90 minutes of daily in-class English instruction, and 24 of whom went to local schools, and received 20 minutes of daily in-class English instruction. Analyses of the relationship between L1 and L2 development showed "no" evidence that learning a second language is detrimental to the learning of the first. This was despite the large difference in the amount of in-school instruction time the children who went to local vs. international schools received. Children in the international schools vastly outperformed those in the local schools in English. We found no evidence that learning a second language is detrimental to learning more general cognitive skills. The results provided very weak evidence for the opposite. Thus, learning English as a second language in Hong Kong before the age of 6 did not harm children's learning in any way.

Practitioners as well as language approach and language development scholars need to work together to create an environment in which research-based learning methods can be put into practice with developmentally appropriate content. Inadequate attention has been given to the crucial language skills that underpin children's language and literacy development because of a traditional focus on method of teaching. Critical language skills include early vocabulary knowledge, narrative skills and phonological awareness. Highlights of why these skills are important (with reference to research findings from the fields of language acquisition and developmental psychology) are followed by an illustration of how these skills can be incorporated into preschool English lessons.

The primary objective of this study was to examine, based on a model of spurned helpers' reactions: (a) the degrees to which kindergarten teachers in Hong Kong, China, experienced recurrent rejections of their offers of help (being spurned) by peer teachers; (b) whether being spurned by peers would induce depersonalization; (c) the ways teachers with higher or lower self-esteem coped with recurrent rejection; and (d) effects of coping in reducing depersonalization. A sample of serving kindergarten teachers in Hong Kong participated in the study. Their levels of self-esteem were first measured. Five months afterwards the extent to which they were spurned by their peers and the way they coped with such rejections were assessed. Another 5 months later the degrees to which they experienced depersonalization were measured. The results showed (a) that the teachers were fairly spurned; (b) that the more spurned the teachers were, the more depersonalized they were towards their peers; and (c) teachers with higher self-esteem and teachers with lower self-esteem coped with being spurned in different ways. The findings suggest that kindergarten teachers should be aware of recurrent rejection of their offers of help by peer workers and also the adverse effects of such rejection, and that administrators should provide training to teachers to assist them to deal with recurrent rejection of help by peers.

Informed by knowledge of linguistics, research findings in the areas of monolingual and bilingual acquisition, dyslexia and speech therapy clinical practice, five factors are proposed to argue that the acquisition of English by young non-native learners can be enhanced by learning activities which take into account factors of developmental sequence in language acquisition, language-specific properties, the relationship between oral and written language, the what-to-learn-first issue and the quality of the language input. Proper language goals can be set and appropriate activities designed, only if the language input provider interacts with a learner in a concrete activity while being sensitive to the developmental trajectory of monolingual speaking children, the development of the less dominant language in a bilingual child, the prosodic and phonological differences between the learner's mother tongue and the target language, the importance of phonological awareness which defines dyslexia, the use of non-abstract language structures grounded in concrete lexical items in the early stage of language acquisition and the strategy of expanding learners' utterance by one element as used in speech therapy.

Extends a model of rejected helpers' reactions to the experience of secondary-school teachers by examining (1) effects of being spurned on burnout; (2) whether problem-focused coping styles are more effective than emotion-focused styles in reducing negative impacts; and (3) whether preparedness for job stress prevents the experience of being spurned. (DSK)

Purpose: Malnutrition is highly prevalent in head and neck cancer (HNC) patients, with weight loss being one of the major nutritional indicators. The objective of this study was to investigate the impact of weight loss on treatment interruptions and unplanned hospital admissions in HNC patients undergoing radiotherapy (RT) with or without chemotherapy., Methods: In this retrospective cohort study, consecutive HNC patients who started RT between January 2011 and December 2019 were included. Data from a total of 1086 subjects with 747 (68.8%) nasopharyngeal carcinomas (NPCs) and 31.2% (N=339) non-NPC patients were analysed. Body weight (BW) was measured before, during, and after RT treatment. Factors associated with ≥10% weight loss, treatment interruption, and unplanned admissions were analysed using multivariate logistic regression., Results: The prevalence of ≥10% weight loss was 26.8% (N=288), with 32.7% (N=243) in NPC and 13.5% (N=45) in non-NPC patients. The prevalence of RT delay in patients with ≥10% vs. <10% weight loss was 6.2% vs. 7.0% (p=0.668) in NPC patients and 42.2% vs. 50.5% (p=0.300) in non-NPC patients. The prevalence of unplanned admissions in patients with ≥10% vs. <10% weight loss was 51.9% vs. 25.3% (p<0.001) in NPC patients and 68.9% vs. 27.0% (p<0.001) in non-NPC patients., Conclusion: In our study, ≥10% weight loss was found to be associated with a higher rate of unplanned admissions but not with RT delay or chemotherapy interruption., Clinical Implications: With the knowledge of the impact of weight loss on hospital admissions and the characteristics of patients with weight loss, nutritional intervention can be effectively focused on the stratification of patients for intensive nutritional support to reduce weight loss., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To determine the prevalence of mitochondrial diseases (MD) in Hong Kong (HK) and to evaluate the clinical characteristics and genetic landscape of MD patients in the region., Methods: This study retrospectively reviewed the phenotypic and molecular characteristics of MD patients from participating public hospitals in HK between January 1985 to October 2020. Molecularly and/or enzymatically confirmed MD cases of any age were recruited via the Clinical Analysis and Reporting System (CDARS) using relevant keywords and/or International Classification of Disease (ICD) codes under the HK Hospital Authority or through the personal recollection of treating clinicians among the investigators., Results: A total of 119 MD patients were recruited and analyzed in the study. The point prevalence of MD in HK was 1.02 in 100,000 people (95% confidence interval 0.81-1.28 in 100,000). 110 patients had molecularly proven MD and the other nine were diagnosed by OXPHOS enzymology analysis or mitochondrial DNA depletion analysis with unknown molecular basis. Pathogenic variants in the mitochondrial genome (72 patients) were more prevalent than those in the nuclear genome (38 patients) in our cohort. The most commonly involved organ system at disease onset was the neurological system, in which developmental delay, seizures or epilepsy, and stroke-like episodes were the most frequently reported presentations. The mortality rate in our cohort was 37%., Conclusion: This study is a territory-wide overview of the clinical and genetic characteristics of MD patients in a Chinese population, providing the first available prevalence rate of MD in Hong Kong. The findings of this study aim to facilitate future in-depth evaluation of MD and lay the foundation to establish a local MD registry., (© 2023. The Author(s).)

Competing Interests: Competing interests: Francis Chan reports personal fees from Pfizer, AstraZeneca, Eisai, Takeda Pharmaceuticals, EA Pharma and the Japan Gastroenterological Endoscopy Society, and reports grants from Pfizer, AstraZeneca and Takeda (China) Holdings. No other competing interests were declared.

Background: Improvement of health literacy, health behavioural change, creating a supportive physical and social environment to be more conducive to health should be the focus of child and adolescent public health. The concept of Health Promoting School initiated by World Health Organization aims to move beyond individual behavioural change and to consider organisational structure change such as improvement of the school's physical and social environment. The aim of this study is identification of the key indicators for successful implementation of Health Promoting School by analysing the findings of the school health profile based on the structured framework of Hong Kong Healthy School Award Scheme and the health status of students investigated by the Hong Kong Student Health Survey., Methods: This is a retrospective correlation study. Analysis of variance (ANOVA) was utilised to analyse for significant improvement of school health profile measured at baseline (n = 104) and among those schools implemented the Hong Kong Healthy School Award Scheme (n = 54). Those indicators showing statistical significance were chosen to be part of the core indicators reflecting effective Health Promoting School. Each of those selected core indicators was then correlated with the related student health outcomes measured by the Hong Kong Student Health Survey Questionnaire to further identify the core indicators., Results: A total of 20 core indicators among all the six Key Areas of Health Promoting School (6 indicators under action competencies, 2 under community link, 2 under physical environment, 2 under social environment, 4 under healthy school policies, 1 under services of school health protection) have been identified with the method mentioned above., Conclusions: This study has identified the indicators with most significant impact on a wide range of health related outcomes. Those are key indicators for motivating positive change of the schools and students. They can be considered as school performance indicators to help schools embarking their Health Promoting School journey as another key education objective.

The objective of the study is to evaluate the management outcomes of ruptured cerebral arteriovenous malformations (bAVMs) in the paediatric population in a regional hospital in Hong Kong. We performed a retrospective review between 1 January 1999 and 31 December 2017 for ruptured bAVM in a regional neurosurgical centre in Hong Kong. All other vascular pathologies and unruptured cases were excluded. Thirty-three eligible patients were included for analysis. The median age at presentation was 12 (3-18), with a slight male preponderance. Presenting complaints included headache (60.6%), motor deficits (24.2%), and seizure (6.1%). Glasgow coma scale (GCS) on presentation (median, IQR) was 15 (13-15). bAVMs were lobar in 57.6%, infratentorial in 27.3%, and basal ganglia in 9.1%. Follow-up was 101 ± 61 months and ranged from 24 to 229 months. 12 (36.4%) patients underwent emergency haematoma evacuation with or without bAVM excision because of neurological deterioration in the acute phase. 7 (21.2%) patients underwent interval excision and 11(33.3%) patients underwent stereotactic radiosurgery (SRS). There was no residual bAVM and no Clavien-Dindo complications greater than grade II in interval surgery group. Those who underwent SRS had a significantly higher Spetzler-Martin grade; bAVM obliteration was achieved at 73.3%, without any major symptomatic post-radiosurgery complications. There was 1 (3%) mortality and 30 (90.9%) patients recovered well with minor non-disabling deficits (GOS 5). For paediatric patients with ruptured bAVM, a satisfactory management outcome can be achieved with careful patient selection for surgery and radiosurgery., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Purpose: Cerebral microbleeds (CMBs), which predict future intracerebral haemorrhage (ICH), may guide anticoagulant decisions for atrial fibrillation (AF). We aimed to evaluate the risk of warfarin-associated ICH in Chinese patients with AF with CMBs., Methods: In this prospective, observational, multicentre study, we recruited Chinese patients with AF who were on or intended to start anticoagulation with warfarin from six hospitals in Hong Kong. CMBs were evaluated with 3T MRI brain at baseline. Primary outcome was clinical ICH at 2-year follow-up. Secondary outcomes were ischaemic stroke, systemic embolism, mortality of all causes and modified Rankin Scale ≥3. Outcome events were compared between patients with and without CMBs., Results: A total of 290 patients were recruited; 53 patients were excluded by predefined criteria. Among the 237 patients included in the final analysis, CMBs were observed in 84 (35.4%) patients, and 11 had ≥5 CMBs. The mean follow-up period was 22.4±10.3 months. Compared with patients without CMBs, patients with CMBs had numerically higher rate of ICH (3.6% vs 0.7%, p=0.129). The rate of ICH was lower than ischaemic stroke for patients with 0 to 4 CMBs, but higher for those with ≥5 CMBs. CMB count (C-index 0.82) was more sensitive than HAS-BLED (C-index 0.55) and CHA2DS2-VASc (C-index 0.63) scores in predicting ICH., Conclusions: In Chinese patients with AF on warfarin, presence of multiple CMBs may be associated with higher rate of ICH than ischaemic stroke. Larger studies through international collaboration are needed to determine the risk:benefit ratio of oral anticoagulants in patients with AF of different ethnic origins., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Community determinants of antibiotics nonadherence, an important contributor of antibiotics resistance, remained unclear., Objectives: Our objective was to investigate whether deficient antibiotics knowledge could contribute to nonadherence in a community with high prevalence of antibiotics resistance., Methods: We recruited 465 people by random sampling from 5 urban areas in Hong Kong. A structured questionnaire was used to assess antibiotics knowledge and adherence. Adherence was defined as completing the most recent course of antibiotics entirely according to physicians' instructions. An antibiotics knowledge score ranging from 0 to 3 (highest) was composed based on the number of correctly answered questions., Results: Of the 465 participants interviewed, 96.3% had heard of the term "antibiotics," and 80.6% recalled having previously received antibiotics prescription. Among the eligible 369 subjects, 32.9% showed nonadherence. Percentages of participants with antibiotics knowledge scores of 0, 1, 2, and 3 were 11%, 27%, 33%, and 29%, respectively. There was a higher prevalence of nonadherence among people with lower antibiotics knowledge score (P < .001). Furthermore, people with nonadherence had a significantly lower mean antibiotics knowledge score (1.3 ± 1.0 versus 2.0 ± 0.9, P < .001), with no interaction with education (P < .05). Adjusted for potential confounders, antibiotics knowledge scores of 2, 1, and 0 independently predicted increased risk of nonadherence by 1-fold (odds ratio [OR], 2.00; 95% confidence interval [CI]: 1.01-3.94; P = .047), 4-fold (OR, 4.77; 95% CI: 2.30-9.92; P < .001), and 17-fold (OR, 18.41; 95% CI: 6.92-48.97; P < .001) respectively, compared with the maximum score of 3., Conclusion: Lack of antibiotics knowledge is a critical determinant of nonadherence independent of education in the community., (Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: The International Diabetes Attitudes, Wishes, and Needs (DAWN) programmes have shown the existence of a critical gap in self management support and access to the support system. This study aims to evaluate the effectiveness of the diabetes mellitus (DM) self management programme, with partnership between general practice and social work, on clinical outcomes, patient self efficacy and lifestyle behaviours., Methods: In this is single blind randomised controlled trial, subjects were recruited from patients attending general outpatient clinics in the Hospital Authority New Territory East Cluster of Hong Kong. 157 subjects meeting the inclusion criteria completed the study and were randomly assigned to the experimental or control group. The experimental group underwent the six sessions of weekly DM self management course with emphasis on self efficacy and participatory approach. The outcome measurements included HbA1c concentration, DM self efficacy scale, dietary behaviours, body mass index (BMI), and waist: hip ratio., Results: Baseline assessment observed no significant differences between experimental and control groups for the variables related to outcomes. For the experimental group, the proportion of subjects with normal HbA1c increased from 4.5% (3/66) at baseline to 28.6% (19/66) at week 28 (p<0.001), but there was insignificant improvement in the control group (3.9% to 11.8%, p=0.13). Repeated measure of analysis of variance showed pronounced improvement in DM self efficacy scale and BMI among the experimental group with significant interaction. Dietary behaviours also improved significantly in the experimental group., Conclusion: The DM care model with partnership between general practice and social work demonstrated better diabetic control with improvement of self efficacy and minimisation of risk behaviours., Trial Registration: Current Controlled Trials ISRCTN78882965.