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Aims: To assess the effect of a structured education intervention, Patient Empowerment Programme (PEP) patient-reported health-related quality of life (HRQOL) among type 2 diabetes mellitus (T2DM) patients, and if positive effect is confirmed, to further explore any association between frequency of sessions attendance and HRQOL. Methods: A total of 298 T2DM patients were recruited when they attended the first session of PEP, between March and September 2010, and were followed over a one-year period from baseline. HRQOL data were assessed using Short Form-12 Health Survey version 2 (SF-12) and Short Form-6 Dimension (SF-6D) at baseline and one-year follow-up. Individuals' anthropometric and biomedical data were extracted from an administrative database in Hong Kong. Unadjusted and adjusted analyses of linear regression models were performed to examine the impact of PEP session attendance on the change in the HRQOL scores, accounting for the socio-demographic and clinical characteristics at baseline. Results: Of the 298 eligible patients, 257 (86.2 %) participated in the baseline assessment and 179 (60.1 %) patients completed the follow-up assessment, respectively. Overall, PEP resulted in a significant improvement in SF-12 bodily pain and role emotional subscales and SF-6D utility scores. These positive changes were not associated with the level of participation as shown in both unadjusted and adjusted analyses. Conclusions: The PEP made significant improvement in bodily pain, role emotional and overall aspects of HRQOL. Higher number of session attendance was not associated with improvement in HRQOL in primary care real-world setting. [ABSTRACT FROM AUTHOR]

Intimate partner violence is a serious social problem and public health issue affecting the well-being of the young adults. However, there is very little epidemiological evidence on the incidence and associated health problems in contemporary Chinese society. Using a representative community sample of 1,223 young adults aged 18 to 27 years conducted by Hong Kong Family Planning Association in 2011, this study aimed to estimate the prevalence, risk factors, and possible health consequences of intimate partner violence among young adults in Hong Kong. It is found that the prevalence of lifetime and preceding 1-year intimate partner violence by former or current partners was 8.6% and 4.9% respectively. Male youths who were older were less likely to experience past-year intimate partner violence (odds ratio [OR] = 0.21, p < .05) and those who had a university degree or were unemployed were more likely to experience past-year intimate partner violence (OR = 8.48, p < .01 and OR = 8.14, p < .05 respectively). Female youths who had a full-time job were less likely to experience the lifetime violence (OR = 0.15, p < .05) and those who were ever pregnant with current partner were more likely to experience both lifetime intimate partner violence (OR = 5.00, p < .05) and past-year violence (OR = 5.63, p < .05). Both female and male victims were more likely to be subjected to mental health problems and only female victims felt fear for the violent partner. [ABSTRACT FROM AUTHOR]

Introduction In Hong Kong, migrants arriving from Mainland China often have multiple roles and responsibilities while adapting to new lives in their host destination. This paper explored the factors that contribute to the inequity in health services utilisation experienced by these migrants; and, identified the elements that could constitute an effective health delivery model to address the service gap. Methods Site visits and a focus group discussion (n = 13) were held with both public and private health providers before a number of innovative health delivery models were formulated. They were then circulated among the panel in two further rounds of Delphi survey (n = 11) from March- April 2012 to systematically collect opinions and select the most endorsed health service models to serve this target population. Results Focus group members perceived that most migrants were unaware of, or even ignored, their own physical and mental health needs, and had low utilisation of healthcare services, because of their pre-occupation with daily chores and hardship as well as differing health values, practices and expectations. They further identified that the structural issues such as the healthcare setting or the operation of current service provisions had failed to meet migrants' health needs. Consequently, four new service models that incorporated professional advice and empowerment, which were identified as the two most important elements, were put forward. Thus, the model of having a nurse with social work training, supported by volunteer groups, was selected as the best option to familiarise and empower patients within the labyrinth of local healthcare services. Conclusion Implementation of a social empowerment model by way of targeted support and specific health information is recommended. Further evaluation of this model is needed to understand its effectiveness for improving health literacy and health status in this disadvantaged group in the long term. [ABSTRACT FROM AUTHOR]

Background Research consistently shows that gaps in health and health care persist, and are even widening. While the strength of a country's primary health care system and its primary care attributes significantly improves populations' health and reduces inequity (differences in health and health care that are unfair and unjust), many areas, such as inequity reduction through the provision of health promotion and preventive services, are not explicitly addressed by general practice. Substantiating the role of primary care in reducing inequity as well as establishing educational training programs geared towards health inequity reduction and improvement of the health and health care of underserved populations are needed. Methods This paper summarizes the work performed at the World WONCA (World Organization of National Colleges and Academies of Family Medicine) 2013 Meetings' Health Equity Workshop which aimed to explore how a better understanding of health inequities could enable primary care providers (PCPs) / general practitioners (GPs) to adopt strategies that could improve health outcomes through the delivery of primary health care. It explored the development of a health equity curriculum and opened a discussion on the future and potential impact of health equity training among GPs. Results A survey completed by workshop participants on the current and expected levels of primary care participation in various inequity reduction activities showed that promoting access (availability and coverage) to primary care services was the most important priority. Assessment of the gaps between current and preferred priorities showed that to bridge expectations and actual performance, the following should be the focus of governments and health care systems: forming cross-national collaborations; incorporating health equity and cultural competency training in medical education; and, engaging in initiation of advocacy programs that involve major stakeholders in equity promotion policy making as well as promoting research on health equity. Conclusions This workshop formed the basis for the establishment of WONCA's Health Equity Special Interest Group, set up in early 2014, aiming to bring the essential experience, skills and perspective of interested GPs around the world to address differences in health that are unfair, unjust, unnecessary but avoidable. [ABSTRACT FROM AUTHOR]

Background: Unintended pregnancy (mistimed or unwanted) remains an important health issue for women. The purpose of this study was to determine the prevalence of and factors associated with risk of unintended pregnancy in a sample of Victorian women attending family planning clinics. Methods: This cross-sectional survey of three Family Planning Victoria Clinics from April to July 2011 recruited women aged 16-50 years with a male sexual partner in the last 3 months, and not intending to conceive. The questionnaire asked about contraceptive behaviours and important factors that influence contraception use (identified from a systematic literature review). Univariate analysis was calculated for the variables of interest for associations with contraceptive use. An overall multivariate model for being at risk for unintended pregnancy (due to inconsistent or ineffective contraceptive use or non-use) was calculated through backward elimination with statistical significance set at <0.05. Results: 1006 surveys were analyzed with 96% of women reporting contraception use in the last 3 months. 37% of women were at risk for unintended pregnancy due to imperfect use (61% inconsistent users; 31% ineffective methods) or never using contraception (8%). On multivariate analysis, women at risk for unintended pregnancy compared with women not at risk were <25 years old (OR 1.8, 95% CI 1.2-2.7); had no university/postgraduate degree (OR 1.7, 95% CI 1.2-2.4); and had >1 partner in the last 3 months (OR 3.2, 95% CI 2.3-4.6). These women were dissatisfied with current contraception (OR 2.5, 95% 1.8-3.5); felt "vulnerable" to pregnancy (OR 2.1, 95% CI 1.6-3.0); were not confident in contraceptive knowledge (OR 2.6, 95% CI 1.5-4.8); were unable to stop to use contraception when aroused (OR 2.1, 95% CI 1.5-2.9) but were comfortable in speaking to a doctor about contraception (OR 2.3, 95% CI 1.1-4.1). Conclusion: Despite reported high contraceptive usage, nearly 40% of women were at risk for unintended pregnancy primarily due to inconsistent contraceptive use and use of ineffective contraception. Strategies for improving consistency of effective contraception use or greater emphasis on long-acting contraception may be needed for certain subpopulations at higher risk for unintended pregnancy. [ABSTRACT FROM AUTHOR]

The article presents a study to see if a Mediterranean diet can reduce the effects of lipodystrophy syndrome on people suffering from the human immunodeficiency virus (HIV) infection. It explains how highly active antiretroviral therapies create changes in HIV patients' lipid profiles and fat distribution. It compares the benefits of the Mediterranean diet, or one which includes a high volume of vegetables, fruits and cereals and a moderate intake of fish and red wine, against a low-fat regimen on cardiovascular health. It was shown that although a Mediterranean diet had an advantage over the low-fat diet, it was offset by a rise in cholesterol level. It identified procedural and methodological issues that need to be rectified before conducting a similar trial on a large-scale basis.

Female sex workers (FSW) have been considered reservoirs and vectors of sexually transmitted infections (STI) in the community. This study estimated the prevalence of STI/human immunodeficiency virus (HIV) among FSW of various migration and residential status in Hong Kong and identified possible risk factors. An outreach 'Well-women' clinic was set up at Ziteng, a non-governmental organization working with FSW. Details of their lifestyle and health risk behavior were gathered before screening tests were performed, and the data were analyzed according to their place of origin. A total of 503 FSW were screened for STI/HIV between 2005 and 2007. Syphilis, gonorrhea, chlamydia, and HIV accounted for 1.8, 1.8, 4.6, and 0.2%, respectively. After adjusting for confounders, having ≥2 sexual partners (odds ratio [OR] 8.33, 95%CI: 2.17-33.46), residence status (OR 0.38, 95%CI: 0.17-0.89), and daily frequency of douching (OR 3.02, 95%CI: 1.23-7.35) were identified as significant predictors. This study provides important insights on the screening and associated risk factors of STI among FSW working in Hong Kong. The contextual factors identified reflect the social and geographical context in which these women are operating and how they protect their health using their own means. These findings encourage policymakers and health professionals to redirect their focus and resources to a more holistic approach to sexual health when planning and implementing effective STI/HIV prevention programs. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the concerns and issues specific to sexual behaviors and interests among postmenopausal women in a metropolitan urban city in Southern China. This was a qualitative study using semi-structured focus group discussions (FGDs). Twenty-two informants aged 50 and above recruited through an ongoing research project on early post-menopausal women under the purview of the School of Public Health at the Chinese University of Hong Kong. The main outcome measures were themes identified as health concerns towards sex among postmenopausal women. Contrary to prior expectations and stereotypes, we found that the respondents were very open in discussing their sexual concerns and shared extensively from their personal experiences. Our respondents perceived significant differences in sexual needs between older men and women. Many respondents identified the effects of menopause and general health problems, as well as environmental limitations and communication problems between spouses as barrier to healthy sexual relationships within their marriages. Conversely, sexual disharmony was seen as an important cause of marital strife among older couples. There is a growing need in studying health concerns among the fast-growing, Chinese middle-aged and older population. Our qualitative study revealed a wide gap in the knowledge regarding general and sexual health issues among post-menopausal Chinese women. Raising awareness among health professionals of these issues is essential in addressing health concerns regarding this traditionally taboo subject within the Chinese context. [ABSTRACT FROM AUTHOR]

This article examines factors that relate to psychological health (as measured by the World Health Organization Quality of Life Instrument) as well as suicide attempts among female street sex workers (FSSWs) in Hong Kong. On average, our sampled FSSWs scored significantly lower on the psychological health domain in comparison to the general Hong Kong female population. Factors associated with the working environment in the sex industry were significantly associated with poor psychological health and suicidality. Greater attention is needed to examine the physical and emotional harm intrinsic to certain occupations and the role of financial needs in the experience of psychological stress. [ABSTRACT FROM AUTHOR]

Sexual intercourse remains taboo among adolescents in a Chinese society such as Hong Kong. It is not openly discussed and little research has been done on its impact on health, although it carries serious risks of contracting sexually transmitted diseases (STDs)/HIV. In 1999, a cross-sectional, self-report survey on youth risk behaviors was carried out on 8382 students 15–18 years of age from 48 schools in Hong Kong. Three hundred seventy-seven (4.69%) reported that they had had sexual intercourse. Among them, forced sex (16.94%) was common, most often happening to boys (52.38%). They were more likely to have consulted doctors in the last month (odds ration [OR] 1.41 in boys 95% confidence interval [CI] 1.03, 1.94; OR 2.46 in girls 95% CI 1.81, 3.30) and 6 months (OR 1.33 in boys 95% CI 0.98, 1.78; OR 2.66 in girls 95% CI 1.80, 3.91). They also perceived poorer and deteriorating health. The sexually active female students were 6.70 times (95% CI 4.65, 9.66) more likely to attempt suicide than the other group and were more likely to take sick leaves (OR 3.56 in girls 95% CI 2.35, 5.41). Parental education and occupation, place of birth, and type of housing did not correlate in the initiation of sexual intercourse. The sexually experienced group reported worse physical and psychological health as well as health perception. Some of the characteristics and patterns identified in our study were quite different from the findings in the West but further studies are required to determine the reason for this. [ABSTRACT FROM AUTHOR]

The article discusses a study which aimed to evaluate the influence of a structured diabetes education program, Patient Empowerment Programme (PEP) implemented in primary care as compared with the alternative usual clinical practice. Topics covered include the association of PEP with a lower risk of diabetic retinopathy, nephropathy and neuropathy in type 2 diabetes patients and the relation of program completion with reduction in composite microvascular complication events.

A reprint of the article "Mainstreaming HIV Services for Men Who Have Sex With Men: The Role of General Practitioners," which appeared in the 2012 issue of "Sexually Transmitted Infections" is presented. It discusses the strong potential of general practitioners (GPs) and other primary care doctors for providing human immunodeficiency virus (HIV) services. It also cites several challenges to providing high-quality HIV clinical services.

The article discusses the differences between social expectation and practice relative to premarital sex among early school leavers in Hong Kong, China. Although sex education can provide information about safe sex and teach the skills needed, the author notes that the stigma associated with sex in a wider social context prevents this group from practicing it. Strategies aimed to help individuals draw a boundary between others' expectation and personal preference are provided.

Background: The COVID-19 pandemic has reshaped healthcare delivery worldwide., Objective: To explore potential changes in the reasons for visits and modality of care in primary care settings through the International Consortium of Primary Care Big Data Researchers (INTRePID)., Methods: We conducted a cross-sectional, retrospective study from 2018-2021. We examined visit volume, modality, and reasons for visits to primary care in Argentina, Australia, Canada, China, Peru, Norway, Singapore, Sweden, and the USA. The analysis involved a comparison between the pre-pandemic and pandemic periods., Results: There were more than 215 million visits from over 38 million patients during the study period in INTRePID primary care settings. Most INTRePID countries experienced a decline in monthly visit rates during the first year of the pandemic, with rate ratios (RR) and 95% confidence intervals (CI) ranging from RR:0.57 (95%CI:0.49-0.66) to RR:0.90 (95%CI:0.83-0.98), except for in Canada (RR:0.99, 95%CI:0.94-1.05) and Norway (RR:1.00, 95%CI:0.92-1.10), where rates remained stable and in Australia where rates increased (RR:1.19, 95%CI:1.11-1.28). Argentina, China, and Singapore had limited or no adoption of virtual care, whereas the remaining INTRePID countries varied in the extent of virtual care utilization. In Peru, virtual visits accounted for 7.34% (95%CI:7.33%-7.35%) of all interactions in the initial year of the pandemic, dipping to 5.22% (95%CI:5.21%-5.23%) in the subsequent year. However, in Canada 75.30% (95%CI:75.20%-75.40%) of the visits in the first year were virtual, decreasing to 62.77% (95%CI:62.66%-62.88%) in the second year. Diabetes, hypertension and/or hyperlipidemia and general health exams were in the top 10 reasons for visits in 2019 for all countries. Anxiety, depression and/or other mental health related reasons were among the top 10 reasons for virtual visits in all countries that had virtual care., Conclusions: The pandemic resulted in changes in reasons for visits to primary care, with virtual care mitigating visit volume disruptions in many countries., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: KT receives a Chair in Family and Community Medicine Research in Primary Care at UHN and a Research Scholar award from the Department of Family and Community University of Toronto. She has received grants from the following organizations in the past 3 years: The Canadian Institutes of Health Research, Rathlyn Foundation Primary Care EMR Research and Discovery Fund, College of Family Physicians of Canada/Foundation for Advancing Family Medicine/CMA Foundation Heart and Stroke Foundation of Ontario, Department of Defense United States of America, St. Michael’s Hospital Foundation, Ontario Health Data Platform First Movers Fund, Queen’s University CSPC Research Initiation Grant, Diabetes Canada, Heart and Stroke Foundation and Brain Canada Heart-Brain IMPACT Award, CANSSI ICES Data Access Grant, North York General Hospital Exploration Fund, CFPC Janus Grant. MSCF receives honoraria and stocks from the Peruvian Cayetano Heredia University (Universidad Peruana Cayetano Heredia). SDL research group receives payments from the University of Oxford and the University of Surrey for conducting health services and primary care research. Moreover, they receive payments from pharmaceutical companies AstraZeneca, GSK, Sanofi, Seqirus, and Takeda for vaccine-related research. Additionally, SDL receives payments for membership on advisory boards for AstraZeneca, Sanofi, and Seqirus. RSK teaches at the Swedish advanced training program in quality improvement, Jonkoping Academy, and owns stocks in the Swedish healthcare company Ambea. AL received datasets and software from the University of Melbourne for data analysis in the present manuscript. He received remuneration as part of contracted wages from the University of Melbourne as part of his existing employment. JMN has received funding from the following organizations in the past 3 years: National Health and Medical Council, Medical Research Future Fund, Paul Ramsay Foundation, RACGP Foundation, and Astra Zeneca. This funding has all been provided to institutions, not personally. Related to use of general practice data, she holds shares in Torch Recruit, clinical trial recruitment software which is a spin off company from The University of Melbourne. WDP sits on the AT Still Research Advisory Board, for which he receives $1000 per year when meetings occur, although these meetings are irregular. He also serves voluntarily on the CO Aca. Fam Med. Leg. Com, Colorado Medicaid Provider Rate Review Com, and NAEPPCC Expert WG #4. He holds stocks in Johnson and Johnson, Eli Lilly, Novo Nordisk, Pfizer, Stryker, Amgen, Moderna, and Novartis, managed by independent advisors. Additionally, he receives supplies from Boehringer Ingelheim and AstraZeneca for COPD quality improvement studies and data analysis using secondary data. JMW was Past President at NAPCRG, an international primary care research organization holding an unpaid position. All other authors have declared that no competing interests exist. No funding sources were involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and the decision to submit the article for publication. The researchers are all independent of funders, and KT, AOB, MCL had full access to all the data and authors from each country had full access to the country-specific data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis., (Copyright: © 2024 Tu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background & Aims: Globally, one-third of individuals infected with HBV live in China. Eliminating HBV in China would therefore be paramount in achieving the World Health Organization's (WHO's) targets of viral hepatitis elimination as a worldwide public health threat., Methods: We constructed a dynamic HBV transmission model in China, structured by age and sex. We calibrated the model by HBsAg prevalence, acute HBV incidence, and nationally reported HBV-related cancer mortality. We investigated seven intervention scenarios (A-G) based on assumptions in diagnostic, linkage-to-care, and treatment coverages in achieving the WHO's HBV elimination goals., Results: With the status quo , HBsAg prevalence among children 1-4 years would reduce to 0.09% (95% CI 0.09-0.10%) by 2025; acute HBV incidence would drop to <2/100,000 person-years by 2024, achieving the elimination target of 90% incidence reduction. Nonetheless, China would not achieve a 65% reduction target in HBV-related mortality until 2059 with 9.98 (95% CI 9.27-10.70) million HBV-related deaths occurred by 2100. If China achieves 90% diagnostic and 80% treatment coverages (scenario E), HBV elimination would be achieved 8 years earlier, potentially saving 1.98 (95% CI 1.83-2.12) million lives. With more effective therapies for HBV control in preventing cirrhosis and hepatocellular carcinoma, elimination targets could be achieved in 2048 (scenario F) and 2038 (scenario G), additionally saving 3.59 (95% CI 3.37-3.82) and 5.19 (95% CI 4.83-5.55) million lives, respectively., Conclusions: Eliminating HBV will require interventional strategies to improve diagnostic, linkage-to-care, and treatment coverages. Developing novel therapies will be crucial in further reducing HBV-related mortality and removing HBV as a public health threat., Impact and Implications: This study explores the key developments and optimal intervention strategies needed to achieve WHO hepatitis B elimination targets by 2030 in China. It highlights that China can realise the HBV elimination targets in the incidence by 2025, and by upscaling diagnostic, linkage-to-care, and treatment coverages, up to 2 million lives could potentially be saved from HBV-related deaths., (© 2023 The Author(s).)

Background: We evaluate the impact and cost-effectiveness of shared primary-specialty chronic hepatitis B (CHB) care models in China., Methods: We constructed a decision-tree Markov model to simulate hepatitis B virus (HBV) disease progression in a cohort of 100,000 CHB individuals aged ≥18 years over their lifetime (aged 80). We evaluated the population impacts and cost-effectiveness in three scenarios: (1) status quo ; (2) shared-care model with HBV testing and routine CHB follow-ups in primary care and antiviral treatment initiation in specialty care; and (3) shared-care model with HBV testing, treatment initiation and routine CHB follow-up in primary care and treatment for predetermined conditions in specialty care. We evaluated from a healthcare provider's perspective with 3% discounting rate and a willingness-to-pay (WTP) threshold of 1-time China's GDP., Findings: Compared with status quo , scenario 2 would result in an incremental cost of US$5.79-132.43m but a net gain of 328-16,993 quality-adjusted life years (QALYs) and prevention of 39-1935 HBV-related deaths over cohort's lifetime. Scenario 2 was not cost-effective with a WTP of 1-time GDP per capita, but became cost-effective when treatment initiation rate increased to 70%. In contrast, compared with status quo , secnario 3 would save US$144.59-192.93m in investment and achieve a net gain of 23,814-30,476 QALYs and prevention of 3074-3802 HBV-related deaths. Improving HBV antiviral treatment initiation among eligible CHB individuals substantially improved the cost-effectiveness of the shared-care models., Interpretation: Shared-care models with HBV testing, follow up and referring of predetermined conditions to specialty care at an appropriate time, especially antiviral treatment initiation in primary care, are highly effective and cost-effective in China., Funding: National Natural Science Foundation of China., Competing Interests: W.-K.S. received speaker's fees from Mylan and AstraZeneca, is an advisory board member of Abbott, is an advisory board member and received speaker's fees from AbbVie, and is an advisory board member, received speaker's fees and researching funding from Gilead Sciences. F.J. received lecture fees from Gilead Sciences, MSD and Ascletis; is aconsultant for Gilead, MSD. The remaining authors declare that they have no competing interests., (© 2023 Published by Elsevier Ltd.)

Competing Interests: Conflict of Interest and Sources of Funding: None declared.

Objectives: A review of cost-effectiveness studies on self-management education programmes for Type 2 diabetes mellitus., Methods: Cochrane, PubMed and PsycINFO databases were searched for papers published from January 2003 through September 2015. Further hand searching using the reference lists of included papers was carried out., Results: In total, 777 papers were identified and 12 papers were finally included. We found eight programmes whose effectiveness analyses were based on randomised controlled trials and whose costs were comprehensively estimated from the stated perspective. Among these eight, four studies showed a cost per unit reduction in clinical risk factors (HbA1c or BMI) of US$491 to US$7723 or cost per glycaemic symptom day avoided of US$39. In three studies the cost per QALY gained, as estimated from a life-time model, was less than US$50,000. However, one study found the programme was not cost-effective despite a gain in QALYs at the one-year follow up., Conclusion: A small number of cost-effectiveness studies were identified with only eight of sufficiently good quality. The cost of a self-management education programme achieving reduction in clinical risk factors seems to be modest and is likely to be cost-effective in the long-term., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This study aimed to examine the association between sexual orientation and health disparities among a stratified random sample of 3776 secondary students in Hong Kong. The prevalence of homosexuality and bisexuality were 1.5% and 2.6% in boys and 1.8% and 3.7% in girls, respectively. A total of 10.7% of boys and 8.8% of girls were unsure of their sexual orientation. Homosexual and bisexual boys reported poorer physical and mental health than their heterosexual peers. Homosexual and bisexual boys were more likely to engage in smoking, frequent drinking, and vaginal sex and be subjected to sexually transmitted disease and sexual victimization. However, lesbian and bisexual girls were less likely to engage in risky health behaviors except for smoking and being subjected to sexual victimization. There is a gender-specific problem that may warrant prevention and intervention programs to address the unique health issues facing homosexual and bisexual adolescents in Hong Kong.

Objectives: This study aims to determine the efficacy and safety of soy isoflavones in controlling the symptoms and signs of lower urinary tract symptoms due to benign prostate hyperplasia (BPH)., Design: This was a prospective, randomized, double-blind, placebo-controlled pilot study., Setting: This trial was conducted at two hospitals in Hong Kong between May 2006 and September 2007., Participants: One hundred and seventy-six (176) participants diagnosed with BPH were recruited from outpatient clinics. Participants with lower urinary tract symptoms were recruited through newspaper and radio interviews, posters placed at government outpatient clinics, and a public seminar offered by the investigators., Interventions: Participants were randomly assigned to either intervention (40 mg of isoflavones daily from Soylife 40) or placebo groups in a double-blind fashion., Main Outcome Measures: The primary outcome parameter of peak urine flow rate and the second outcome parameters of postresidual urine volume, lower urinary tract symptoms, testosterone, prostate-specific antigen, quality of life, diet, and safety profile (liver and renal function) were collected. All parameters were assessed at baseline, 6 months, and 12 months in a 12-month study period except testosterone, prostate-specific antigen, and safety profile, which were assessed at baseline and at 12 months., Results: The peak urine flow rate (Qmax), postresidual urine volume, International Prostate Symptoms Scores (IPSS), and 36-Item Short Form Health Survey (SF-36) significantly improved from baseline to the 12th month within both groups. However, when compared between groups, Qmax (p=0.055) and incomplete emptying subscore in IPSS (p=0.05) were marginally/statistically different between the two groups from the 6th to the 12th months, in addition to the general health domain of SF-36 from the baseline to 12th month (p=0.02) and from the 6th month to the 12th month (p=0.055). Isoflavones were generally safe and well tolerated., Conclusions: This randomized control pilot study showed only slight superiority of isoflavones over placebo over 12 months with otherwise surprising beneficial effects in both groups. Tolerability of isoflavones was excellent; thus it has laid foundations for further studies of isoflavones in BPH with focus on dosage and possible specificity of the effect.

Male sex workers are a highly marginalised group in Hong Kong and it is increasingly so with an influx of them travelling from mainland China to work as "freelance" sex workers. This study aimed to measure important work environment variables that might affect the likelihood of condom use among male sex workers working in Hong Kong. A cross-sectional survey of 161 participants recruited by snowball and convenience sampling methods through outreach workers of a local non-governmental organization was conducted in 2007-2008. Only 27.4%, 54.7% and 42.6% reported consistent condom use when engaging in oral, anal and vaginal sex, respectively. Logistic regression shows unsafe sex was nearly four times (OR=3.41; 95%CI 1.51-7.69) as common in institutionalised male sex workers as among their independent counterparts. Lack of condoms provided at workplaces was a major barrier in this socio-legal context and was strongly associated with condom non-use amongst institutionalised sex workers (OR= 10.86; 95%CI 2.94-40.17). The present study finds that when compared with independent Male sex workers (MSWs), institutionalised MSWs were older, less educated, earned a higher income but more likely to engage in unsafe sex with their clients and their partners. Public health physicians must work with law-enforcing authorities to provide clear guidelines to remove these HIV prevention barriers.

This study examined the influence of immediate social environment on health compromising behaviors (HCB) among 6564 high school students in China. Results showed that physical abuse by parents was a major risk factor that accounted for high rates of HCB. Perceived positive school experience and social support were protective factors associated with low rates of HCB. These two protective factors also buffered the adverse influence of abuse on the practice of individual HCB. In particular, parental abuse was associated with sexual experimentation, non-fatal self-harm, and suicide behaviors only at low levels of protective factors.

Objective: This study investigated the prevalence of child maltreatment as perpetrated by parents, its associated health outcomes, and its resilient factors among high school students in China., Methods: A multi-level stratified random school-based survey was conducted in 2005. Twenty four high schools were randomly chosen from eight districts in Guangzhou, South China (three from each district). Two classes were randomly selected from each of Form 1 to Form 3 (aged 12-16) in each selected school. Data from 6,593 students were analyzed. A number of locally validated tools were used to measure various types of maltreatment as well as physical and psychological conditions of students., Results: The half-year prevalence of psychological aggression, minor physical maltreatment, severe physical maltreatment, and very severe physical maltreatment were 78.3%, 23.2%, 15.1%, and 2.8% respectively; while the half-year prevalence of sexual abuse was .6%. Maltreated students were more likely to report physical and psychological problems, and a positive relationship was also found between the severity of maltreatment and the likelihood of negative health outcomes. Male gender or having higher levels of social support and life satisfaction were identified as resilient factors to physical health of maltreated students., Conclusions: Child maltreatment as perpetrated by parents is common among high school students in Guangzhou, China. More public education programs are needed to raise public awareness of this problem. Intervention programs that target at improving social support and life satisfaction of students are potentially beneficial.

The current study investigated potential associations between working conditions of truck drivers crossing the Hong Kong-China border, family relationships, extramarital affairs, and the attitudes that these male drivers held toward extramarital relationships. A cross-sectional survey of 193 male cross-border truck drivers from Hong Kong was conducted in 2004 using a 47-item multi-faceted questionnaire. No statistical significance was found between family relationship and many work parameters. However, extramarital relationships were related to poor marital relationships. Further study may help to nourish information and opinions regarding the interaction between the job nature and the family relationship.

Background: Under the "two countries, one system" policy implemented by China to manage the return of Hong Kong's sovereignty, Hong Kong has maintained a comparatively prosperous economy within the Asian region. This has resulted in an environment which fosters migration from the mainland to Hong Kong, due largely to proximity, higher earning potential, common language, and a relaxing of border control measures. However not all mainland China citizens are equally able to access these new migration schemes and indeed a number of women such as sex workers are either migrating and/or working illegally and without occupational, legal and health protection within Hong Kong., Discussion: Female migrant sex workers are exposed to a number of significant threats to their health, however their illegal status contributes to even greater vulnerability. The prevailing discourses which view these women as either "trafficked women" or as "illegal immigrants" do not adequately account for the complex situations which result in such women's employment in Hong Kong's sex industry. Rather, their position can best be understood within the broader frameworks provided by migration literature and the concept of "structural violence". This allows for a greater understanding of the socio-political issues which are systematically denying migrant sex workers adequate access to health care and other opportunities for social advancement. When these issues are taken into account, it becomes clear that the current relevant legislation regarding both immigration and sex work is perpetuating the marginalised and vulnerable status of migrant sex workers. Unless changes are made, structural barriers will remain in place which impede the ability of migrant sex workers to manage their own health needs and status., Conclusion: Female migrant sex workers in Hong Kong are extremely vulnerable to a number of occupational health and safety hazards which have significantly detrimental effects on their health. These risks can best be understood within a broad framework of socio-political factors contributing to their vulnerability. Ensuring that migrant sex workers have adequate support for their health and legal rights requires require structural interventions such as decriminalisation and providing open and inclusive access to health service to counteract such factors.

Background: Systematic reviews based on the critical appraisal of observational and analytic studies on HIV prevalence and risk factors for HIV transmission among men having sex with men are very useful for health care decisions and planning. Such appraisal is particularly difficult, however, as the quality assessment tools available for use with observational and analytic studies are poorly established., Methods: We reviewed the existing quality assessment tools for systematic reviews of observational studies and developed a concise quality assessment checklist to help standardise decisions regarding the quality of studies, with careful consideration of issues such as external and internal validity., Results: A pilot version of the checklist was developed based on epidemiological principles, reviews of study designs, and existing checklists for the assessment of observational studies. The Quality Assessment Tool for Systematic Reviews of Observational Studies (QATSO) Score consists of five items: External validity (1 item), reporting (2 items), bias (1 item) and confounding factors (1 item). Expert opinions were sought and it was tested on manuscripts that fulfil the inclusion criteria of a systematic review. Like all assessment scales, QATSO may oversimplify and generalise information yet it is inclusive, simple and practical to use, and allows comparability between papers., Conclusion: A specific tool that allows researchers to appraise and guide study quality of observational studies is developed and can be modified for similar studies in the future.

Background: Child maltreatment can cause significant physical and psychological problems. The present study aimed to investigate the prevalence and determinants of child maltreatment in Guangzhou, China, where such issues are often considered a taboo subject., Methods: A school-based survey was conducted in southern China in 2005. 24 high schools were selected using stratified random sampling strategy based on their districts and bandings. The self-administered validated Chinese version of parent-child Conflict Tactics Scale (CTSPC) was used as the main assessment tool to measure the abusive experiences encountered by students in the previous six months., Results: The response rate of this survey was 99.7%. Among the 6592 responding students, the mean age was 14.68. Prevalence of parental psychological aggression, corporal punishment, severe and very serve physical maltreatment in the past 6 months were 78.3%, 23.2%, 15.1% and 2.8% respectively. The prevalence of sexual abuse is 0.6%. The most commonly cited reasons for maltreatment included 'disobedience to parents', 'poor academic performance', and 'quarrelling between parents'. Age, parental education, places of origins and types of housing were found to be associated with physical maltreatments whereas gender and fathers' education level were associated with sexual abuse., Conclusion: Though largely unspoken, child maltreatment is a common problem in China. Identification of significant determinants in this study can provide valuable information for teachers and health professionals so as to pay special attention to those at-risk children.

Aim: This paper presents a Hong Kong (HK) data on the effect that sex work has on women's environmental health and safety. An outreach role that highlights safety and human rights is suggested for nurses working with female sex workers (FSWs) as clients., Background: In HK it was estimated that there were at least 200,000 FSWs in 2002 and the total population involved as workers, support staff, clients and partners of the clients exceeded half a million in a city of 6.8 million people. Despite these numbers, both locally and internationally there are very limited outreach nursing services that address the FSW's occupational health needs., Method: A cross-sectional survey, was undertaken over a 5 month period commencing in October 2003. A validated Chinese version of the World Health Organisation Quality of Life Measure was administered to a convenience sample of 89 female street sex workers. A focus group interview was later conducted to gain contextual information., Results: The predominantly mainland Chinese FSWs had a mean age of 36.1 years. These women tended to be less educated and older than the general population of FSWs. They worked long hours with most of their income sent back home to China. Many lived in sub-optimal conditions and risked being abused while at work. The women scored significantly lower in the environmental domains when compared to the general female population., Conclusion: Highlighted is the critical importance of developing a new role, both international and within the Asian region, for community nurses working in an outreach capacity. This role should be visible, affordable and accessible, for at risk populations such as FSWs. The primary focus of the new role would be to establish a close working relationship between sex workers, sex industry owner/operators, health agencies and local authorities. Risk awareness programs developed and conducted by community nurses should embrace the complexity of occupational health issues. Such programs would also have the benefit of affirming the health rights of sex workers and public health.

Objectives: This study was designed to compare the response and management of severe acute respiratory syndrome (SARS) by the family physicians of the Hong Kong and the Toronto health systems, and to provide evidence to improve health policy and practices in a newly emerging infectious disease., Methods: A questionnaire was sent to family medicine tutors affiliated with either the Chinese University of Hong Kong or the University of Toronto in 2003. The survey questions covered training for SARS, the use of screening tools, an anxiety scale, clinical practices, and demographic data., Results: 137 (74.8%) and 51 (34%) doctors from Hong Kong and Toronto replied to the questionnaire, respectively. Most (80-84.6%) had no training in infectious disease control and were not confident in dealing with SARS (68.1-73.5%). In Hong Kong, the screening tools provided by international agencies did not meet the local needs. In Toronto, lack of a centralized hospital admission policy and fully public laboratory probably resulted in appointment cancellation and dissatisfaction. There may be a need for deployment of personnel between institutions but loss of income was not a major concern., Conclusions: Sharing the "lessons learned" in different regions during a SARS outbreak will help prepare for the next epidemic.

Background: Due to their job nature, cross-border truck drivers working between Hong Kong and China are exposed to many health risks. The aim of this study was to find out the impact of their occupation on their psychological health and sexual dysfunction and to assess their sexual risk behaviors., Methods: A cross-sectional survey of 193 male cross-border truck drivers was conducted in 2004 using a 47-item multifaceted questionnaire. Data were analyzed using descriptive statistics, chi-square tests, and odds ratio (OR)., Results: One third of the respondents (31.2%) experienced crashes (road traffic accidents), and those who had "driving and drinking" were much more likely to have experienced accidents [OR 4.7, 95% confidence interval (CI) 2.3-9.4]. About 14.5 and 25.9% of respondents reported feeling depressed and anxious, respectively, while 24.1% reported sexual dysfunction. They were strongly related to smoking (OR 2.8, 95% CI 1.4-5.7) and drinking habits (OR 2.3, 95% CI 1.2-4.5), which was common in this group of men: about half of them had smoking (53.1%) and drinking habits (45.3%). Over half (51.0%) admitted risky sexual behaviors. Those engaged in these behaviors were more likely to feel depressed (OR 7.4, 95% CI 2.4-22.4) and be worried about contracting sexually transmitted infections (STIs) (OR 5.3, 95% CI 2.7-10.3) or human immunodeficiency virus (HIV) (OR 3.8, 95% CI 2.0-7.3)., Conclusion: The problems of poor psychological health, sexual dysfunction, and sexual risk behaviors are common among cross-border truck drivers in Hong Kong. These problems are also found to be interrelated. Community programs to promote psychological health and proper sexual values, reduce smoking and drinking, and educate on STIs/HIV are urgently needed.

Objective: To describe the current use of health services by the street-based female sex workers (FSWs) and to explore beliefs behind these health behaviors., Study Setting: Community outreach approach in a few red-light districts in Hong Kong., Study Design: A 30 min face-to-face interview was carried out in 89 women by direct approach and snowballing, followed by a focus group discussion drawn from the participants of the questionnaire., Results: While these FSWs' perception of personal health was good, a considerable proportion suffered from illnesses but the consultation rate was a third of the mean rate of the general population in Hong Kong. Many street workers experienced difficulty in utilizing health service in Hong Kong and even when they did, it was mainly for acute problems. Affordable access to health public services was excluded and many found private services unaffordable due to the high price charged by the practitioners. It was common for these women to self-medicate, delay in seeking medical help, or travel back to China for treatment., Conclusion: The current empirical understanding of the health and health service utilization by sex workers is unbalanced. In order to reduce sexually transmitted infections (STIs) and HIV among the street sex workers, it is essential to address the fundamental issue of health care access.

Background: For many years, the sex industry in Hong Kong has appeared to be an integral and ever-expanding component of the city's sociocultural and economic structure. Accordingly, the physical and psychological health of sex workers is becoming an increasing concern for the workers themselves, the public, and government policy., Methods: A cross-sectional survey on the quality of life (World Health Organization Quality of Life [WHOQOL]) of female sex workers (FSWs) in Hong Kong was used to investigate the physical and psychological well-being of street FSWs, and the results were compared with those of non-sex-working Hong Kong women after adjusting for age, educational level, marital status, and health status., Results: The 89 FSWs surveyed scored significantly lower on QOL--WHOQOL-BREF (HK)--measures compared with the non-sex-working women. One common aspect among these sex workers was their negative view of themselves and of life. Many sex workers were at risk of being abused while at work, and many women worked without legal protection. Most of the women surveyed engaged in sex work to support their families. Because their income was often insufficient, some of their needs, especially those concerning health, were often neglected., Conclusions: The low WHOQOL-BREF (HK) scores in FSWs indicate feelings of helplessness and entrapment, which may well result in detrimental effects on sex workers' health, self-esteem, and confidence when asserting their basic rights, such as access to healthcare and safety. The conclusion highlights the vulnerability of this population to apparent weaknesses in Hong Kong's current healthcare system.

Five focus group discussions were conducted with 28 (fourth-year) medical students from the Chinese University of Hong Kong (CUHK) to explore attitudes to Traditional Chinese Medicine (TCM) and its impact on the future of medical training. Most students perceived that TCM was a good alternative for certain health problems but lack of scientific evidence and the absence of regulation were major barriers. Students were concerned about the limitations of TCM, but identified their need to understand TCM to effectively communicate with their patients. Paralleled with the experience in the United Kingdom and other countries, if traditional and conventional doctors are to work effectively side by side, current medical education and health service arrangements need to change.

Unlabelled: BACKGROUND The management of sexually transmitted infections serves as a good example of how medical practitioners should offer continuous and 'whole person' care to patients and their contacts., Objective: This article discusses 10 myths commonly held by patients with sexually transmitted infections consulting their general practitioners., Discussion: We stress the importance of risk assessment, patient education, pre- and post-test counselling, assessment of associated diseases, contact tracing, and modification of health related behaviour in managing patients with sexually transmitted infections.

Despite the rapid increases of HIV and sexually transmitted infections (STIs) in East Asia, the sex-related knowledge among Chinese adolescents is limited and the standard of sex education is both variable and inconsistent in Hong Kong. The aim of this study is to review the overall effectiveness of the school-based or doctor-based sexual health education currently provided for Hong Kong adolescents. In 1999 - 2000, a large survey on youth risk behaviours was carried out among 15 - 18-year-old students from 21 secondary schools. Of the 8,039 questionnaires, 377 students (4.7%) admitted sexual experience. Multiple logistic regression showed that students who had received school AIDS education were found to be less likely to have sexual intercourse in the past 3 months (odds ratio, OR 0.5; 95% confidence interval, CI 0.3 - 0.9) or use drugs or alcohol before the previous intercourse (OR 0.5; 95% CI 0.3 - 0.9). They were twice as likely to discuss emotional (95% CI 1.4 - 4.0) or puberty issues (95% CI 1.1 - 3.0). Although not statistically significant, sex education by family doctors showed a similar pattern. This result provides the strongest available evidence that school-based sex education programmes can modify sexual behaviour, which, in turn, reduces risk among Chinese students.

Objectives: To investigate the extent and how cough mixtures are prescribed, and what conditions or specific groups of people would contribute to its prescription in Hong Kong., Methods: Using diagnosis and drug data obtained from logbooks submitted by participants in the diploma in family medicine course between 1999 and 2003, we selected and analysed all patients with a diagnosis of cough or cough-related illnesses as well as cough mixtures that were used to treat them., Results: This study confirmed that cough-related illnesses were common in the Hong Kong primary care setting and cough mixtures were used quite liberally irrespective of the patients' age and sex. Combination preparations accounted for over half of the prescriptions and cough mixture was used less in severe cases when antibiotics were given. Private doctors working in the public sector., Conclusion: Given the current health care system, inappropriate and over-prescribing of cough mixtures can be improved by promoting health education and awareness among patients seeking medical help for this common medical condition.

Background: General practitioners can provide a range of diagnostic and treatment procedures for patients with dermatological problems., Objective: This article reviews the use of Wood's light, diascopy, skin scrapings for microscopy, skin biopsy, cauterisation, doppler measurement of ankle-brachial pressure index, and multi-layer compression bandages for venous ulcers., Discussion: Adequate training and proper equipment is essential for commonly neglected areas including informed written consent, good communication with the histopathologist, a system for handling specimens and reports, action plans for laboratory results, and adequate training and protection for auxiliary staff.

Ruili is a small border town between China and Myanmar where drugs and commercial sex are common, and rates of sexually transmitted diseases (STDs) including HIV, are high. A qualitative study was carried out on 89 commercial sex workers there in 2001 to understand more about their HIV awareness, medical-seeking behaviors and needs. We found that the sex workers were young and the turnover rates were high. Contrary to common belief, many came from nearby villages or cities, but were probably reluctant to participate in organized activities. Their medical knowledge was very limited, often acquired from peers and self-medication was common. The contraception they used was inappropriate and screening for cervical cancer was nonexistent. They were very stigma conscious. Condoms were purchased in small quantities when required and used only if the clients were agreeable. These findings have strong implications for the future planning of services and HIV/STD prevention.

A charitable clinic was set up to provide HIV/STD education and care to commercial sex workers in Ruili. Despite regular promotion of the clinic, few people had utilised the service. Therefore, a qualitative study was carried out among 89 sex workers between March and April 2001 to look at the background of our target group, their medical-seeking behaviours and the range of services expected. The turnover rates of sex workers were high. They had good awareness but poor knowledge of STD/HIV. Many self-medicated or sought advice from peers. They had a serious concern for private practitioners or the quality of drugs from pharmacy stores. They found our clinic inconvenient and did not meet their needs. Subsequently, we refurbished the clinic, implemented changes and retrained our staff. The number of patients treated three weeks after re-opening of the clinic has increased by three folds, with many of them still sex workers, and the clinic's income increased by 58%. Our experience has important implications for policymakers and other NGOs working with sex workers.