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In summary, imaging diagnosis of femoral hernia can be potentially difficult and radiologists must be cognizant of this possible differential diagnosis whenever a cystic lesion is encountered at its characteristic location. Thus, femoral hernia should be considered in the differential diagnoses whenever a cystic groin mass is encountered at or near the femoral ring or canal, inferior to the inguinal ligament between the pubic tubercle and the femoral vein. While the diagnosis of larger femoral hernias containing bowel or peritoneal fat is relatively straightforward, early femoral hernias may contain only peritoneal fluid and can be difficult to distinguish from other cystic lesions on imaging. [Extracted from the article]

Background: Healthcare workers in many countries are recommended to receive influenza vaccine to protect themselves as well as patients. A monovalent H1N1 vaccine became available in Hong Kong in December 2009 and around 10% of local healthcare workers had received the vaccine by February 2010. Methods: We conducted a cross-sectional study of the prevalence of antibody to pandemic (H1N1) 2009 among HCWs in Hong Kong in February-March 2010 following the first pandemic wave and the pH1N1 vaccination campaign. In this study we focus on the subset of healthcare workers who reported receipt of non-adjuvanted monovalent 2009 H1N1 vaccine (Panenza, Sanofi Pasteur). Sera collected from HCWs were tested for antibody against the pH1N1 virus by hemagglutination inhibition (HI) and viral neutralization (VN) assays. Results: We enrolled 703 HCWs. Among 104 HCWs who reported receipt of pH1N1 vaccine, 54% (95% confidence interval (CI): 44%-63%) had antibody titer ≥1:40 by HI and 42% (95% CI: 33%-52%) had antibody titer ≥1:40 by VN. The proportion of HCWs with antibody titer ≥1:40 by HI and VN significantly decreased with age, and the proportion with antibody titer ≥1:40 by VN was marginally significantly lower among HCWs who reported prior receipt of 2007-08 seasonal influenza vaccine (odds ratio: 0.43; 95% CI: 0.19-1.00). After adjustment for age, the effect of prior seasonal vaccine receipt was not statistically significant. Conclusions: Our findings suggest that monovalent H1N1 vaccine may have had suboptimal immunogenicity in HCWs in Hong Kong. Larger studies are required to confirm whether influenza vaccine maintains high efficacy and effectiveness in HCWs. [ABSTRACT FROM AUTHOR]

Although "intellectual disability" has widely replaced the term "mental retardation", the debate as to whether this entity should be conceptualized as a health condition or as a disability has intensified as the revision of the World Health Organization (WHO)'s International Classification of Diseases (ICD) advances. Defining intellectual disability as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. This paper presents the consensus reached to date by the WHO ICD Working Group on the Classification of Intellectual Disabilities. Literature reviews were conducted and a mixed qualitative approach was followed in a series of meetings to produce consensus-based recommendations combining prior expert knowledge and available evidence. The Working Group proposes replacing mental retardation with intellectual developmental disorders, defined as "a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The Working Group further advises that intellectual developmental disorders be incorporated in the larger grouping (parent category) of neurodevelopmental disorders, that current subcategories based on clinical severity (i.e., mild, moderate, severe, profound) be continued, and that problem behaviours be removed from the core classification structure of intellectual developmental disorders and instead described as associated features.

Psychotropic medications are used regularly to manage problem behaviours among people with intellectual disabilities. This causes concern because often these medications are used out of their licensed indications in this context. The WPA Section on Psychiatry of Intellectual Disability has recently developed an evidence and consensus-based international guide for practitioners for the use of psychotropic medications for problem behaviours among adults with intellectual disabilities. This guide advises on assessment of behaviours, producing a formulation, initiation of treatment, assessment of out-come and adverse effects, follow-up arrangements, and possibility of discontinuation of treatment.

Following the movement from institutionalization to community care, there has been a transformation of services for people with intellectual disability over the past few decades. Kwai Chung Hospital in Hong Kong is a pioneer in Asia that took the initiative of improving the mental health care for this underserved population by setting up a specialist unit called the Psychiatric Unit for Learning Difficulties (PULD) 10 years ago. This new service was established through re-engineering of existing resources and re-distribution of manpower within the psychiatric hospital. This paper reviews the work of PULD and examines its achievements. By sharing the experiences of PULD, it is hoped that health providers currently without such a specialist service can make similar reforms to enhance their provisions for people with intellectual disability and mental health problems.