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The formation of a pseudoaneurysm or ‘false’ aneurysm is a rare vascular complication of arthroscopic surgery. Its occurrence is even more uncommon in the background of a clotting disorder. We present a case of a recreational athlete with a history of haemophilia, who developed a pseudoaneurysm over an arthroscopic portal site following arthroscopic-assisted anterior cruciate ligament reconstruction. The lesion was treated successfully with image-guided thrombin injection. We discuss the association between haemophilia and pseudoaneurym formation as well as prevention methods and treatment options.

Background Many chronic diseases are characterised by low-grade systemic inflammation. Oestrogens may promote immune response consistent with sex-specific patterns of diseases. In vitro culture and animal experiments suggest oestrogens are anti-inflammatory and might thereby protect against low-grade systemic inflammation. Evidence from epidemiological studies is limited. Using a Mendelian randomisation analysis with a separate-sample instrumental variable (SSIV) estimator, we examined the association of genetically predicted 17β-estradiol with well-established systemic inflammatory markers (total white cell count, granulocyte and lymphocyte count). Methods A genetic score predicting 17β-estradiol was developed in 237 young Chinese women (university students) from Hong Kong based on a parsimonious set of genetic polymorphisms (ESR1 (rs2175898) and CYP19A1 (rs1008805)). Multivariable linear regression was used to examine the association of genetically predicted 17β-estradiol with systemic inflammatory markers among 3096 older (50+ years) Chinese women from the Guangzhou Biobank Cohort Study. Results Predicted 17β-estradiol was negatively associated with white blood cell count (−6.3 103/mL, 95% CI −11.4 to −1.3) and granulocyte count (−4.5 103/mL, 95% CI −8.5 to −0.4) but not lymphocyte count (−1.5 103/mL, 95% CI −3.4 to 0.4) adjusted for age only. Results were similar further adjusted for education, smoking, use of alcohol, physical activity, Body Mass Index, waist-hip ratio, age of menarche, age at menopause, use of hormonal contraceptives and hormone replacement therapy. Conclusions Endogenous genetically predicted 17β-estradiol reduced low-grade systemic inflammatory markers (white blood cell count and granulocyte count), consistent with experimental and ecological evidence of 17β-estradiol promoting immune response. Replication in a larger sample is required. [ABSTRACT FROM AUTHOR]

Both case-ascertained household studies, in which households are recruited after an ‘index case’ is identified, and household cohort studies, where a household is enrolled before the start of the epidemic, may be used to test and estimate the protective effect of interventions used to prevent influenza transmission. A simulation approach parameterized with empirical data from household studies was used to evaluate and compare the statistical power of four study designs: a cohort study with routine virological testing of household contacts of infected index case, a cohort study where only household contacts with acute respiratory illness (ARI) are sampled for virological testing, a case-ascertained study with routine virological testing of household contacts, and a case-ascertained study where only household contacts with ARI are sampled for virological testing. We found that a case-ascertained study with ARI-triggered testing would be the most powerful design while a cohort design only testing household contacts with ARI was the least powerful. Sensitivity analysis demonstrated that these conclusions varied by model parameters including the serial interval and the risk of influenza virus infection from outside the household. [ABSTRACT FROM PUBLISHER]

Background Western observational studies show moderate alcohol use, compared with never use, positively associated with health. Moderate users differ systematically from others, making these observations vulnerable to confounding. Observations from other contexts may help distinguish whether these associations are confounded. To assess whether southern Chinese would provide a more suitable setting to examine the association of moderate alcohol use with health, we compared never alcohol users with moderate alcohol users and occasional users in this setting. Methods We used age-adjusted multinomial regression to assess sex-stratified associations of alcohol use (never, occasional (<1 occasion/week), moderate (≤140 g ethanol/week for women and ≤210 g for men)) with health attributes and indicators in the Guangzhou Biobank Cohort Study (2003-2008) (n=26 361). Results Among men, moderate alcohol users, when compared with never users, had slightly lower socioeconomic position and unhealthier lifestyle. Conversely, occasional alcohol users, when compared with never users, had higher socioeconomic position and healthier lifestyle. Among women, when compared with never users, both occasional and moderate users had higher socioeconomic position and healthier lifestyle. However, all alcohol users for both sexes, when compared with never users, were more likely to be ever smokers and to be exposed to secondhand smoke. Conclusions Observations in alcohol epidemiology may be affected by confounding due to contextually specific systematic differences. Results from a particular setting should not be interpreted as causal unless they are verified in different populations and, preferably, in nonobservational studies. [ABSTRACT FROM AUTHOR]

Introduction: Undergraduate education in medical schools plays an important role in promoting patient safety. Medical students from different backgrounds may have different perceptions and attitudes toward issues concerning safety. This study aimed to investigate whether patient safety cultures differed between students from two Asian countries, and if they did, to find out how they differed. This study also aimed to identify the educational needs of these students.Methods: A voluntary, cross-sectional and self-administered questionnaire survey was conducted on 259 students from two medical schools - one in Hong Kong and the other in Singapore. None of the students had received any formal teaching on patient safety. We used a validated survey instrument, the Attitudes to Patient Safety Questionnaire III (APSQ-III), which was designed specifically for students and covered nine key factors of patient safety culture.Results: Of the 259 students, 81 (31.3%) were from Hong Kong and 178 (68.7%) were from Singapore. The overall response rate was 66.4%. Significant differences between the two groups of students were found for two key factors - 'patient safety training', with Hong Kong students being more likely to report having received more of such training (p = 0.007); and 'error reporting confidence', which Singapore students reported having less of (p < 0.001). Both groups considered medical errors as inevitable, and that long working hours and professional incompetence were important causes of medical errors. The importance of patient involvement and team functioning were ranked relatively lower by the students.Conclusion: Students from different countries with no prior teaching on patient safety may differ in their baseline patient safety cultures and educational needs. Our findings serve as a reference for future longitudinal studies on the effects of different teaching and healthcare development programmes. [ABSTRACT FROM AUTHOR]

Introduction: The pipeline embolization device (PED) is a new endovascular stent designed for the treatment of challenging intracranial aneurysms (IAs). Its use has been extended to nonruptured and ruptured IAs of a variety of configurations and etiologies in both the anterior and posterior circulations. Methods: We conducted a systematic review of ten eligible reports on its clinical efficacy and safety. Results: There were 414 patients with 448 IAs. The majority of the IAs were large (40.2 %), saccular or blister-like (78.3 %), and were located mostly in the anterior circulation (83.5 %). The regimens of antiplatelet therapy varied greatly between and within studies. The mean number of the PED used was 2.0 per IA. Deployment was successful in around 95 % of procedures. Aneurysm obliteration was achieved in 82.9 % of IAs at 6-month. The overall incidences of periprocedural intracranial vascular complication rate and mortality rate were 6.3 and 1.5 %, respectively. Conclusion: The PED is a safe and effective treatment for nonruptured IAs. Its use in the context of acute subarachnoid hemorrhage (SAH) should be cautioned. Its main limitations include the need for prolonged antiplatelet therapy, as well as the potential risks of IA rupture and non-IA-related intracerebral hemorrhages (ICH). Future studies should aim at identifying factors that predispose to incomplete obliteration, delayed rupture, and thromboembolic complications. [ABSTRACT FROM AUTHOR]

Family harmony, an important Confucian ideal in Chinese society is believed to determine family happiness and therefore health, but is this accurate? This is a qualitative study of 41 Hong Kong Chinese family members. Individual recorded interviews were thematically analysed describing perceived interactions between harmony, happiness and health. Family harmony comprised four components: communication, mutual respect, lack of conflict and family time [notably ‘Gou tong’ (in Cantonese 溝通)—opportunity and willingness to spend time together—requiring good interpersonal communication, emphasized by female respondents]. Lack of conflict was emphasized, while diverse values, parenting styles and financial difficulties were common causes of conflict. Respect required reciprocity. Family happiness comprised four elements: family harmony, an important pre-requisite; mutual caring and supportive orientation; sense of security emphasizing financial security in middle-class versus sense of togetherness in lower social class groups and contentment. Healthy families were harmonious; ‘typical’ (children/two-parent/two-grandparent); happy; caring and respectful, with individual health and healthy behaviours. Family harmony, happiness and health are interrelated and built on a communicative, respectful, caring and contented set of attitudes, in particular allowing for family time. Harmony is apparently a core element of good family functioning. [ABSTRACT FROM PUBLISHER]

With economic development, non-communicable diseases replace infectious diseases as the leading cause of death; how such transition occurs for infectious diseases with long latency has rarely been considered. We took advantage of a Chinese population with rapid economic development in the mid-20th century to study changing patterns of infection-related cancers. We used sex-specific Poisson regression to estimate age, period and cohort effects on adult deaths 1976–2005 from eight infection-related cancers in Hong Kong. Cervical, head and neck, and oesophageal cancers, associated with sexually transmitted infections, decreased for the first birth cohorts with sexual debut in a more developed environment. Leukaemia and non-Hodgkin's lymphoma, associated with vertically transmitted infections, decreased for the first cohorts born into a more developed environment. Birth cohort patterns were unclear for nasopharyngeal, stomach and liver cancers. Mortality rates for cancers related to early infections may depend on population history, with delayed reductions for some infection-related cancers. [ABSTRACT FROM PUBLISHER]

Case-ascertained household transmission studies, in which households including an ‘index case’ are recruited and followed up, are invaluable to understanding the epidemiology of influenza. We used a simulation approach parameterized with data from household transmission studies to evaluate alternative study designs. We compared studies that relied on self-reported illness in household contacts vs. studies that used home visits to collect swab specimens for virological confirmation of secondary infections, allowing for the trade-off between sample size vs. intensity of follow-up given a fixed budget. For studies estimating the secondary attack proportion, 2–3 follow-up visits with specimens collected from all members regardless of illness were optimal. However, for studies comparing secondary attack proportions between two or more groups, such as controlled intervention studies, designs with reactive home visits following illness reports in contacts were most powerful, while a design with one home visit optimally timed also performed well. [ABSTRACT FROM AUTHOR]

Objectives: Most studies examining factors contributing to cognitive impairments and dementia in late life focused on risks. In this study, we aimed to evaluate factors that might help preserve cognition in healthy Hong Kong elders. Methods: This was a 2-year prospective study of 476 cognitively healthy community dwellers (aged 60-92 years) recruited in Hong Kong. Participants were assessed with a battery of cognitive tests and questionnaires on their sense of loneliness and leisure activities. Results: A high level of cognitive activity participation (r = 0.13, p = 0.03) and a low level of loneliness (r = -0.15, p = 0.01) were associated with better cognitive test performance. Participants with more years of education (odds ratio = 1.27, p < 0.001) and a higher frequency of drinking (odds ratio = 1.17, p = 0.05) were associated with high cognitive function, while those with a high level of loneliness (odds ratio = 0.79, p = 0.01) were associated with low cognitive function. The correlation with cognitive activity participation remained significant in participants with very good cognitive function (r = 0.20, p = 0.04). Conclusions: These results suggested that social engagement and moderate drinking may be modulating factors for cognition. Further studies should explore the interactions between lifestyle factors and cognition in older adults with no significant cognitive impairment. [ABSTRACT FROM AUTHOR]

This paper examines the views of Hong Kong community leaders on the underlying issues that affect family health, happiness and harmony (3Hs) in Hong Kong. Using a community reconnaissance method, a series of individual in-depth interviews with 26 leaders that represent neighbourhoods of diverse socio-economic status (SES) from June to August 2008 were conducted. Participants considered that changing family structure, economic situation and strong work ethic are the most salient factors that affect family 3Hs. The deprived comprehensive social security assistance recipients, single-parent families and migrant women were considered to be the most vulnerable groups to breakdown in family 3Hs and particularly, they lack family resources. Families from different SES have to overcome different challenges in order to achieve and sustain family 3Hs. Leaders from low SES neighbourhood were concerned more about providing tangible help such as child care facilities to improve family resources, whereas leaders from high SES neighbourhood focused more on preventive interventions such as education on relationship skills to achieve better family well-being. The findings offer insights in designing effective social marketing education campaigns and family-friendly workplace policy to promote social harmony through the maintenance of 3Hs families. [ABSTRACT FROM PUBLISHER]

Both central obesity and increased carotid intima-media thickness (IMT) are markers of atherosclerosis and associated with cardiovascular diseases (CVD). Information of IMT in Chinese subjects with central obesity is limited. This study was performed to assess the rate of atherosclerosis and abnormal IMT in asymptomatic Chinese subjects with central obesity, and to investigate the association between IMT values and CVD risk factors including hypertension, hyperglycaemia and dyslipidaemia. We studied 122 centrally obese adults who had good past health. IMT measurements on carotid arteries were performed and fasting blood taken for plasma glucose and lipid profiles. Abnormal IMT was defined as > 0.9 mm. Atherosclerosis was defined as the presence of one or more visible plague. Of the 122 subjects, the mean (±SD) age was 59.4 ± 5.8 years (median [range]: 59.0 [45-75] years). The median IMT value was 0.70 mm (range: 0.53-1.19 mm) [men vs. women: 0.74 mm vs. 0.66 mm, P-value: < 0.001]. IMT values and the rate of atherosclerosis increased with age and the number of CVD risk factors ( P-value for trend: < 0.05). Using binary logistic regression to predict the presence of atherosclerosis with the presence of abnormal IMT, age, gender, and other CVD risk factors as independent variables, age (OR [95% CI] = 1.13 [1.03, 1.23], P = 0.009) and abnormal IMT (OR [95% CI] = 4.05 [1.09, 15.03], P = 0.037) were independently associated with atherosclerosis. In conclusion, among Hong Kong Chinese asymptomatic subjects with central obesity, there was a high rate of CVD risk factors. We found that 19% of these subjects had carotid atherosclerotic plaques and 10% of them had abnormal IMT (>0.9 mm). Carotid IMT study may serve as an appropriate screening tool to diagnose atherosclerosis in the centrally obese middle-aged population. [ABSTRACT FROM AUTHOR]

Objective: The study investigated whether Massachusetts beneficiaries of Medicare, Medicaid, or both programs who have behavioral disorders have higher rates of diabetes-related complications and hospitalizations.Methods: This was a retrospective study using merged Medicare and Medicaid claims data from Massachusetts in 2004 and 2005. The study included beneficiaries who had type 2 diabetes, who stayed in nursing homes for fewer than 90 days, and who were enrolled in Medicare or Medicaid (or both) for at least ten months during the study period. ICD-9-CM and Current Procedural Terminology codes were used to identify diabetes complications (eye complications, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, lower-limb amputations, and diabetes-related hospitalizations). The rates of adverse diabetes outcomes were compared across behavioral disorders as identified by ICD-9-CM diagnoses. While adjusting for case mix, multivariate logistic regressions were performed to compare the odds of adverse diabetes outcomes among people with mental or substance use disorders with those without these disorders.Results: A total of 106,174 individuals met inclusion criteria. Results from adjusted analysis showed a mixed picture of the relationships between behavioral disorders and adverse diabetes outcomes. Although substance use disorders were associated with higher odds of lower-limb amputations and diabetes-related hospitalizations, beneficiaries with schizophrenia or paranoid states had lower odds of adverse diabetes outcomes.Conclusions: Medicaid and Medicare beneficiaries with alcohol or drug use disorders had higher rates of adverse diabetes outcomes than other groups, whereas beneficiaries with mental disorders had lower rates of diabetes-related complications. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that socio-economic development could, via nutritionally driven levels of pubertal sex-steroids, promote a pro-inflammatory state among men but not women in developing countries. We tested this hypothesis, using recalled childhood meat eating as a proxy for childhood nutrition, in southern China. Methods: We used multivariable linear regression in the Guangzhou Biobank Cohort Study phase 3 (2006-8) to examine the adjusted associations of recalled childhood meat eating, <1/week (n = 5,023), about once per week (n = 3,592) and almost daily (n = 1,252), with white blood cell count and its differentials among older (=50 years) men (n = 2,498) and women (n = 7,369). Results: Adjusted for age, childhood socio-economic position, education and smoking, childhood meat eating had sex-specific associations with white blood cell count and lymphocyte count, but not granulocyte count. Men with childhood meat eating almost daily compared to <1/week had higher white blood cell count (0.33 109/L, 95% confidence interval (CI) 0.10 to 0.56) and higher lymphocyte count (0.16 109/L, 95% CI 0.07 to 0.25). Adjustment for obesity slightly attenuated these associations. Conclusion: If confirmed, this hypothesis implies that economic development and the associated improvements in nutrition at puberty may be less beneficial among men than women; consistent with the widening sex differentials in life expectancy with economic development. [ABSTRACT FROM AUTHOR]

Ethnic foods and ethnic-style cuisines have long had a presence in the UK and are becoming increasingly popular for a number of reasons, including growing immigrant and expatriate populations, increased long-haul travel and globalisation of the food market, all of which have resulted in the tastes of UK consumers becoming more cosmopolitan. There are different forms of classification for ethnic foods; however, they are usually defined as the commercially available products in the host country, including ready meals, cooking sauces, condiments, accompaniments and snacks (with the favourite cuisines being Indian and Chinese). Cost has been found to be a significant factor in whether people decide to consume ethnic foods, while other major factors include authenticity and familiarity. With increasing awareness of healthy eating, there is also a demand for healthier options and the need for delivery of appropriate portion sizes. With an increased demand for convenience and concerns over costs, the ethnic catering industry faces tough competition from ethnic foods sold in supermarkets, such as ready meals. With eating out now becoming more common rather than being an occasional treat, there are schemes in the UK to support the provision of healthier catering, which also include ethnic-style restaurants and takeaways. However, these have cost implications for businesses, so it is important to address the individual needs of caterers and have a good understanding of the business culture to enhance the implementation of these schemes. Providing consistent, consumer-friendly nutrition information is also vital to help the public make informed choices about the foods they are eating. [ABSTRACT FROM AUTHOR]