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This study was performed to examine the effects of primary granulocyte-colony stimulating factor (G-CSF) prophylaxis on neutropenic toxicity, chemotherapy delivery, and hospitalisation among Chinese patients with breast cancer in Hong Kong.This retrospective study included patients with breast cancer who received adjuvant docetaxel plus cyclophosphamide chemotherapy from November 2007 to October 2013 at Princess Margaret Hospital. Data were collected regarding the usage of G-CSF prophylaxis; incidences of grade 3 or 4 neutropenia, febrile neutropenia, non-neutropenic fever, and infection; hospital admissions, and chemotherapy dose delivery. Patients who began to receive G-CSF prophylaxis during the first cycle of chemotherapy and continued such prophylaxis in subsequent cycles were regarded as the primary G-CSF prophylaxis group.In total, 231 female Chinese patients with breast cancer were included in the analysis. Overall, 193 (83.5%) patients received primary G-CSF prophylaxis. The demographics and tumour characteristics were comparable between patients with and without primary G-CSF prophylaxis. Primary G-CSF prophylaxis significantly reduced febrile neutropenia incidence from 31.6% to 14.5% (relative risk=0.45, 95% confidence interval=0.25-0.81). Primary G-CSF prophylaxis also significantly reduced the incidence of grade 3 or 4 neutropenia from 57.9% to 24.7% (relative risk=0.43, 95% confidence interval=0.30-0.62) and the incidence of febrile neutropenia-related hospital admission from 31.6% to 12.4% (P=0.025). Finally, it enabled more patients to receive adequate chemotherapy dose delivery.Primary G-CSF prophylaxis effectively reduced the incidences of grade 3 or 4 neutropenia and febrile neutropenia, while enabling adequate chemotherapy dose delivery and reducing hospital admissions among Chinese patients with breast cancer who received adjuvant docetaxel plus cyclophosphamide chemotherapy.

We look at the effect of the WTO on stabilizing international trade using both a fixed-effects and an event study approach. Our results show that WTO members experience lower trade volatilties in a predictable and integrated system. In addition, we focus on the trade volatility comovement among countries in a multilateral framework. Previous research has mainly focused on WTO membership in a bilateral trade framework, which only allows interactions between two trade partners without considering any possible influence from other countries. A bilateral trade framework does not fully capture the effect of WTO membership, nor does it investigate why the multilateral platform of the WTO should exist. With a unique setup estimating interactions among multiple trading dyads, we find strong evidence supporting positive correlation or comovement of trade volatilities across trading pairs. Such a comovement appears much stronger among WTO members than between WTO and non-WTO members. Due to the feedback mechanism among dyads in a multilateral framework, such as the WTO, bilateral trade stability may further stabilize the global trade. Our results remain robust to a battery of sensitivity checks.

Breast cancer (BC) is the most common cancer among women in Hong Kong. The Food and Health Bureau commissioned The University of Hong Kong (HKU) to conduct the Hong Kong Breast Cancer Study (HKBCS) with the aim of identifying relevant risk factors for BC in Hong Kong and developing a locally validated BC risk assessment tool for Hong Kong Chinese women. After consideration of the most recent international and local scientific evidence including findings of the HKBCS, the Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) has reviewed and updated its BC screening recommendations. Existing recommendations were preserved for women at high risk and slightly changed for women at moderate risk. The following major updates have been made concerning recommendations for other women in the general population: Women aged 44 to 69 with certain combinations of personalised risk factors (including presence of history of BC among first-degree relative, a prior diagnosis of benign breast disease, nulliparity and late age of first live birth, early age of menarche, high body mass index and physical inactivity) putting them at increased risk of BC are recommended to consider mammography screening every 2 years. They should discuss with their doctors on the potential benefits and harms before undergoing mammography screening. A risk assessment tool for local women (eg, one developed by HKU) is recommended to be used for estimating the risk of developing BC with regard to the personalised risk factors described above.

The Centre for Health Protection of the Department of Health has convened the Advisory Group on Antibiotic Stewardship Programme in Primary Care (the Advisory Group) to formulate guidance notes and strategies for optimising judicious use of antibiotics and enhancing the Antibiotic Stewardship Programme in Primary Care. Acute pharyngitis is one of the most common conditions among out-patients in primary care in Hong Kong. Practical recommendations on the diagnosis and antibiotic treatment of acute streptococcal pharyngitis are made by the Advisory Group based on the best available clinical evidence, local prevalence of pathogens and associated antibiotic susceptibility profiles, and common local practice.

Background and Objectives Heart and lung transplantation is a high-risk procedure requiring intensive immunosuppressive therapy for preventing organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is increasingly used for induction therapy compared with conventional agents. However, there has been no systematic review comparing its efficacy with traditional therapeutic drugs. Methods PubMed and EMBASE were searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic transplant surgery. Of the 433 studies retrieved, 8 were included in the final meta-analysis. Results In lung transplantation, alemtuzumab use was associated with lower odds of acute cellular rejection compared with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11–0.40; P Conclusions Alemtuzumab use was associated with lower rejection rates when compared with conventional induction therapy agents (antithymocyte globulin, basiliximab, and tacrolimus) in heart and lung transplantation. However, this was based on observational studies. Randomized controlled trials are needed to verify its clinical use.

We study the importance of individual characteristics and national factors influencing individual attitudes towards the impact of multinational corporations on local businesses. Our sample includes more than 40 000 respondents in 29 countries from the 2003 National Identity Survey conducted by the International Social Survey Programme. We find that individual demographic factors and socioeconomic status, such as gender, age, income and education, are strong predictors of their attitudes. For example, income and education are positively associated with favourable attitudes towards the impact of multinational corporations (MNCs) on local businesses while age is negatively associated with individual attitudes towards MNCs. In addition, hierarchical ordered logit model results show that approximately 8% of total variations in individual attitudes around our sample mean are not explained by differences in personal traits. Instead, they are due to country-level heterogeneity such as, but not limited to,...

Summary Background: Published literature addressing the efficacy of different antihypertensive drug classes among Asian patients is scarce. Methods: This cohort study included all patients prescribed their first-ever antihypertensive monotherapy without concomitant use of chronic medications in two primary care clinics in Hong Kong during 1990–2002. The incidence of add-on therapy within 48 weeks because of suboptimal blood pressure control was evaluated and compared among different age and gender groups. Results and discussion: Among the 2531 patients, the incidence of add-on therapy among users of angiotensin converting enzyme inhibitors (ACEI) was highest in young females (31·1%, 95% CI 22·2%, 40·0%, P 0·50) and elderly males (12·5%, 95% CI 3·8%, 21·2%) was also highest with the ACEI than other drug classes although statistical significance was not reached. Conclusion: The incidence of add-on therapy among first-time antiypertensives appear to be significantly different between drug classes. This deserves further investigation.

This study aims to quantitatively summarize the association between night shift work and the risk of metabolic syndrome (MetS), with special reference to the dose-response relationship with years of night shift work. We systematically searched all observational studies published in English on PubMed and Embase from 1971 to 2013. We extracted effect measures (relative risk, RR; or odd ratio, OR) with 95% confidence interval (CI) from individual studies to generate pooled results using meta-analysis approach. Pooled RR was calculated using random- or fixed-effect model. Downs and Black scale was applied to assess the methodological quality of included studies. A total of 13 studies were included. The pooled RR for the association between 'ever exposed to night shift work' and MetS risk was 1.57 (95% CI = 1.24-1.98, pheterogeneity = 0.001), while a higher risk was indicated in workers with longer exposure to night shifts (RR = 1.77, 95% CI = 1.32-2.36, pheterogeneity = 0.936). Further stratification analysis demonstrated a higher pooled effect of 1.84 (95% CI = 1.45-2.34) for studies using the NCEP-ATPIII criteria, among female workers (RR = 1.61, 95% CI = 1.10-2.34) and the countries other than Asia (RR = 1.65, 95% CI = 1.39-1.95). Sensitivity analysis confirmed the robustness of the results. No evidence of publication bias was detected. The present meta-analysis suggested that night shift work is significantly associated with the risk of MetS, and a positive dose-response relationship with duration of exposure was indicated.

Angiotensin-converting enzyme inhibitors (ACEI) are among the most commonly used antihypertensive agents worldwide. Factors associated with their discontinuation in clinical practice are not well defined as studies undertaken in different ethnic populations have yielded conflicting result. We aimed to identify predictors of ACEI discontinuation among Chinese patients.We used a validated clinical database for this cohort study. We included all adult patients aged ≥ 18 years who visited any primary care clinic in one Territory of Hong Kong and who were prescribed an ACEI from January 2004 to June 2007. The cumulative incidence of discontinuation 180 days after prescription of an ACEI was measured. Factors associated with discontinuation were evaluated by multiple regression analyses.Among 9398 eligible patients, 14·0% discontinued their prescriptions. After controlling for patient's age, gender, socio-economic status, service type, district of residence, visit type and number of comorbidities, patients aged 70 or above [adjusted odds ratio (AOR) = 1·27, 95% CI 1·04-1·56, P = 0·022], male subjects (AOR = 1·21, 95% CI 1·05-1·40, P = 0·008), new visitors (AOR = 0·64, 95% CI 0·55-0·75, P0·001), patients who obtained their prescriptions in Family Medicine Specialist Clinic (FMSC) (AOR = 1·43, 95% CI 1·14-1·79, P = 0·002), patients who lived in the less urbanized district (AOR = 1·96, 95% CI 1·55-2·48, P0·001) and the most rural district (AOR = 1·24, 95% CI 1·03-1·49, P = 0·027), and patients with no comorbidity, were more likely to discontinue their medications.Physicians should pay attention to adherence problems particularly when prescribing ACEI to male patients, those who are older than 70 years, have no comorbidity, live in less urbanized or more rural areas, qualify for fee-waiver, are new attendees of consultations or obtain their ACEI prescriptions in FMSC. Future research should evaluate the reasons for ACEI discontinuation among these higher-risk groups.

Good compliance to anti-hypertensive medications has been recognized as a crucial factor to achieve optimal blood pressure control, but there were few studies addressing this issue among ethnic Chinese patients. This study aims to evaluate the factors associated with compliance to thiazide diuretics in a Chinese hypertensive population.From a clinical database, all adult Chinese patients aged ≥ 18 years who were prescribed a thiazide diuretic from the public health care sector in one large Territory of Hong Kong during January 2004 to June 2007 and attended at least twice for anti-hypertensive drug refill were included. Medication Possession Ratios were used to measure drug compliance for each patient, with a level ≥ 80% defined as compliant. We used binary logistic regression analysis to evaluate the factors associated with good compliance.From 8551 eligible patients, 84·5% were compliant (defined as MPR ≥ 80%). Fee payers (adjusted odds ratio [aOR] 1·28; 95% CI 1·12-1·46, P0·001) and follow-up visitors (aOR 2·47, 95% CI 2·13-2·87, P0·001) were significantly associated with better anti-hypertensive compliance. Patients who were newly prescribed thiazide diuretics and those with poorer socioeconomic status were more likely to be non-compliant to anti-hypertensive therapies. Patients' age, gender and number of co-morbidities were not significant associated factors.Among Chinese patients, those who were newly prescribed thiazide diuretics and those with poorer socioeconomic status were more likely to be non-compliant to anti-hypertensive therapies. Closer monitoring and more intensive compliance-enhancing strategies had to be targeted towards these patients to enhance clinical outcomes.

Published literature addressing the efficacy of different antihypertensive drug classes among Asian patients is scarce.This cohort study included all patients prescribed their first-ever antihypertensive monotherapy without concomitant use of chronic medications in two primary care clinics in Hong Kong during 1990-2002. The incidence of add-on therapy within 48 weeks because of suboptimal blood pressure control was evaluated and compared among different age and gender groups.Among the 2531 patients, the incidence of add-on therapy among users of angiotensin converting enzyme inhibitors (ACEI) was highest in young females (31.1%, 95% CI 22.2%, 40.0%, P0.001) and elderly females (18.0%, 95% CI 11.3%, 24.7%, P = 0.049) as compared with thiazide diuretics, beta-blockers and calcium channel blockers. The incidence of add-on therapy among young males (20.3%, 95% CI 11.1%, 29.5%; P0.50) and elderly males (12.5%, 95% CI 3.8%, 21.2%) was also highest with the ACEI than other drug classes although statistical significance was not reached.The incidence of add-on therapy among first-time antihypertensives appear to be significantly different between drug classes. This deserves further investigation.

Preferences to choose immunochemical faecal occult blood test (FIT) and colonoscopy as colorectal cancer (CRC) screening modalities among asymptomatic Chinese subjects remain unknown.To evaluate the preference of choosing colonoscopy vs. FIT among CRC screening participants.From a community-based CRC screening programme for asymptomatic Hong Kong Chinese aged 50-70 years, participants attended standardized educational sessions and chose the options of annual FIT for 5 years or direct colonoscopy once. Factors associated with choosing colonoscopy were evaluated by multivariate regression analysis.Among 3430 participants [mean age 56.8 years (s.d. 5.0); female 55.1%, male 44.9%], 51.3% chose colonoscopy and 48.7% chose FIT. Older participants (65-70 years) were less likely to choose colonoscopy [adjusted odds ratio (aOR) 0.731, P = 0.041]. Subjects who chose colonoscopy were those disagreed screening would lead to discomfort (aOR 1.356, P0.001), had relatives or friends who had CRC (first degree relatives aOR 1.679, P0.001; second degree relatives aOR 1.304, P = 0.019; friends or others aOR 1.252, P = 0.026) and those who self-perceived their health as poor (aOR 1.529, P = 0.025).Faecal occult blood test and direct colonoscopy were equally preferable to Chinese. Colonoscopy was preferred among the younger subjects, those with positive family history of CRC and self-perceived poor health status.