Ageing in Hong Kong

Abstract. Hong Kong has experienced a steady and significant growth in its elderly population. Being essentially a Chinese community, the traditional virtue of filial piety has been upheld and the family is expected to be the prime source of care for its members. However, there has been a gradual increase in the number of nuclear families and a gradual dwindling of the positive image of the elderly person, which threatens the basis for community care for the elderly. About half of the elderly population are living in government rental housing and are receiving public primary medical care. Community support services are not in-home support in nature and are of low levels of care. The professional and social organisations unanimously urge the government to take a more proactive stance in providing services to the elderly and encourage the community to revitalise its traditional Chinese cultural heritage in caring for the elderly.     

Temporal arteritis in Hong Kong

Objective: To evaluate Chinese patients with biopsy‐proven temporal arteritis in Hong Kong, focusing on clinical presentation, frequency of occurrence, treatment regimen and complications, management and outcome of these patients. Design: A retrospective study. Method: A retrospective study was undertaken in which patients with biopsy‐proven temporal arteritis were identified from: (i) Statistical records of Hospital Authority (1996–1999); (ii) pathology records of regional hospitals in Hong Kong (1996–2000); and (iii) case records from rheumatologists in two university hospitals. Indexed hospital and out‐patient records were reviewed and analysed. Results: Nineteen patients with biopsy‐proven temporal arteritis were identified from 1996 to 2000 and the calculated annual incidence was 0.34 patients in 100,000 people aged 50 and above per year. There were six male and 13 female patients (male : female ratio 1:2.2). Sixteen (84%) patients were older than 70 years. The common presentations were similar to overseas studies and included headache (79%), muscular symptoms (42%), constitutional symptoms (37%), scalp tenderness (37%), visual loss (32%), jaw claudication (32%), abnormal temporal artery (32%), and fever (26%). The mean erythrocyte sedimentation rate before treatment was 104 mm/h (SD = 30 mm/h). Anemia (Hb < 12 g/dL) was present in 79% of patients. The mean duration of symptoms before diagnosis was 8.4 weeks. Seventeen (89%) patients received high‐dose steroid therapy but none received steroid‐sparing agents. Only 33% of patients reached a physiological dose of steroid (prednisolone 5 mg/day) after 1 year. Conclusion: Temporal arteritis is rare among Hong Kong Chinese. A rough estimate of annual incidence yielded less than one per 100,000 people aged ≥ 50. Overall clinical presentation was similar to overseas studies but there were: (i) longer duration of steroid therapy given; and (ii) more complications from steroid use. Steroid‐sparing agents should be considered early in difficult‐to‐control cases.     

Malignant mesothelioma in Hong Kong

Malignant mesothelioma (mesothelioma) is rare. We conducted the first systematic study of the epidemiology of mesothelioma in Hong Kong from 1988 to May 2002 by reviewing medical records. Mesothelioma patients were identified from the database of 12 out of 20 hospitals that would have admitted mesothelioma patients territory-wide. These 12 hospitals served 73% of the total hospital bed-years of the 20 hospitals. We identified 67 mesothelioma patients. The estimated annual incidence was one per million, which was similar to the background incidence of one to two per million among Caucasians. Occupational history was available in 43 subjects. Three quarters of mesothelioma patients with available occupational history had occupational asbestos exposure. Restricting analysis to 48 patients with accessible medical records and using 67 occupational asbestosis patients for comparison, the epidemiology of mesothelioma in Hong Kong shares similarities with the literature: mean age of 63 years upon diagnosis, mean latency of 46 years, median survival of 9.5 months, male predominance, selective presentation among women, high prevalence among workers in ships and dockyards, predominantly epithelioid type, lower prevalence of asbestos bodies, and negative association with pleural plaques. Asbestos consumption in Hong Kong rose in the 1970s and peaked in early 1980s and late 1990s. Hong Kong may encounter an epidemic of mesothelioma in the 2010s if effective occupational asbestos control measures are not in place.     

Intrahepatic cholangiocarcinoma in Hong Kong

We retrospectively analyzed the results of hepatic resection for patients with intrahepatic cholangiocarcinoma managed between December 1966 and January 1998 at the University of Hong Kong Medical Center, Queen Mary Hospital. There were 61 men and 40 women (mean age, 61.8 years). The clinical records of these patients were reviewed. A survival analysis was performed on the group of patients who had undergone hepatic resection. Twenty-one patients were treated conservatively. Non-resective (palliative) operations were performed in 32 patients. The median survivals after conservative management and palliative operation were 2.5 and 3.3 months, respectively. The remaining 48 patients underwent hepatic resection. The overall operative morbidity and mortality rates after hepatic resection were 41.7% and 16.7%, respectively. The median survival after hepatic resection was 16.4 months. The overall 1-, 3-, and 5-year survival rates after hepatic resection were 60.3%, 29.4% and 22.0%, respectively. Lymphatic permeation (P = 0.007) and hilar nodal metastases (P = 0.009) were found to be significantly associated with poor survival after hepatic resection. Hepatic resection is the treatment of choice for intrahepatic cholangiocarcinoma when it is resectable.     

Lupus in Hong Kong Chinese

Systemic lupus erythematosus (SLE) is a fairly common rheumatic disease among southern Chinese in Hong Kong, with an estimated point prevalence of 0.06% (0.1% among women). Compared with the Caucasians, renal disease and the anti-Ro antibody appear to be more common in our SLE patients. Whether these are related to certain genetic or environment factors remains speculative. Nephritis and its treatment are the major causes of organ damage in our lupus population. With early diagnosis of the disease and its complications, judicious use of immunosuppressive therapy to achieve prompt control of disease activity, and better supportive care for disease- or treatment-related morbidity, the survival of our Chinese SLE patients has improved. In the past decade, considerable effort has been spent on lupus education, medical training and research in Hong Kong, aiming to improve the quality of care of patients with SLE. More grants and funding are being sought for basic and clinical researches in SLE and subsidising patients to receive newer and less toxic treatment options.     

Scrub typhus in Hong Kong

A retrospective analysis of cases of scrub typhus in military personnel in Hong Kong during the years 1979-1989 is presented. Fifty-nine cases were identified, most occurring during the hot humid season between May and October. Few civilian cases of scrub typhus are notified to the Hong Kong Medical and Health Department and possible reasons for the disparity in case numbers between military and civilian personnel are discussed. Reports from other areas of South-east Asia have documented a previously unrecognized high incidence of scrub typhus in the indigenous population. It is suggested that a prospective study utilizing specific serological diagnostic techniques would be of value in assessing the importance of scrub typhus as a cause of 'fever of undetermined origin' in the civilian population of Hong Kong.     

The case in Hong Kong

Hong Kong experienced a massive increase in its elderly population in recent decades with an average life expectation of 80 years and a majority of them being widows the need for elder care services has risen considerably. A variety of services are being provided to them. This article examines the demographic pictures of the elderly in Hong Kong and the variety of services made available to them.     

Management of osteoporosis in Hong Kong

Osteoporosis is among the top 3 medical conditions that are associated with greatest morbidity and reduction of quality of life of Hong Kong elderly subjects. The genetic and environmental risk factors for osteoporosis in southern Chinese as well as the current approach towards managing this growing health problem in Hong Kong are presented.     

Distribution of enterococci in Hong Kong

OBJECTIVES: To examine the epidemiology, clinical and hematological characteristics, complications and treatment outcome of childhood brucellosis in central Greece. METHODS: Retrospective record review of all patients 0-14 years of age with brucellosis admitted during a 16-year period between 1984 and 1999. RESULTS: A total of 39 cases (23 males, median age 132 months) were recorded in which the diagnosis was confirmed by a positive culture (n=30) or detection of IgM antibodies with ELISA (n=9). About 38% of these patients came from families of farmers or shepherds who owned a few domestic animals or small herds of goats or sheep and another 43% had consumed dairy products bought from shepherds. In 41% of the cases another family member developed symptomatic infection. Most of the patients presented with fever (61%) and musculoskeletal symptoms (69%). Splenomegaly was recorded in 38% and hepatomegaly in 28% of the cases. Anemia (39%) and monocytosis (31%) were the most common hematological manifestations, followed by lymphopenia (18%). Unusual complications were detected in two patients who developed thrombocytopenic purpura and acute facial nerve palsy, respectively, but recovered without long-term sequelae. None of the 22 patients who received a combination of two or three antibiotics for > or =6 weeks and had adequate follow-up had a relapse. CONCLUSION: Childhood brucellosis remains an important public health problem in central Greece. It usually occurs in families that raise small ruminants and the development of symptomatic infection in more than one family member is common. It may cause serious complications in children and treatment with at least two antibiotics for not less than six weeks appears to be effective.     

Distribution of Enterococci in Hong Kong

Objectives: To study the distribution of hospital isolates of enterococci from urines, bile, blood and body fluids and to evaluate different methods for the identification of enterococci.Methods: Enterococci isolated from urine, bile, blood and body fluids collected during 1997 and 1998 were identified by polymerase chain reaction (PCR), API 20 Strep and conventional biochemical tests.Results: A total of 498 non-duplicate enterococci were studied: 398 and 43 isolates from urine and bile, respectively, 49 from blood, two from cerebrospinal fluid and six from body fluids. Both API 20 Strep and PCR gave the same identification results for 240 Enterococcus faecalis isolates, 45 E. faecium isolates and one isolate each of E. gallinarum and E. Casseliflavus. These isolates were re-defined by conventional biochemical tests. PCR could correctly identify 303 (98%) isolates while API 20 Strep could only correctly identify 287 (93%) isolates (99% of E. faecalis and 57–87% of the other Enterococcus sp.). Thus, PCR was used in the identification of the remaining isolates and the identity of isolates other than E. faecalis was subsequently confirmed by biochemical tests.Conclusions: The majority of enterococci isolated wasE. faecalis (81%) while only 15% were E. faecium and 4% the other enterococcal species. PCR could correctly identify E. faecalis while the identity of other enterococcal species had to be confirmed by biochemical tests.     

Colonoscopy in Hong Kong Chinese children

AIM:To investigate the safety and diagnostic yield of colonoscopy in Chinese children in whom the procedure is not often done.METHODS:We conducted a retrospective review of all colonoscopies in consecutive children who underwent their fi rst diagnostic colonoscopy from Jan 2003 to 2008.RESULTS:Seventy-nine children (48 boys,31 girls;mean age 9.2 ± 4.2 years) were identified and reviewed with a total of 82 colonoscopies performed.Successful caecal and ileal intubation rates were 97.6% and 75.6% respectively.Forty patients (50.6%) had a positive diagnosis made in colonoscopy and that included colonic polyps (23),Crohn’s disease (12),ulcerative colitis (1),and miscellaneous causes (4).80% of polyps were in the rectosigmoid colon.All but one were juvenile hamartomatous polyps.The exceptionwas an adenomatous polyp.The mean ages for children with inflammatory bowel disease (IBD) and polyps were 11.3 and 4.3 years respectively.There was no procedure-related complication.CONCLUSION:Colonoscopy is a safe procedure in our Chinese children.The increasing diagnosis of IBD in recent decades may reflect a rising incidence of the disease in our children.     

Review of vector-borne diseases in Hong Kong

The epidemiology of vector-borne diseases in Hong Kong has changed over the past decade but still poses a significant public health risk. We provided a comprehensive review of the epidemiological information and analysed the trends of major vector-borne diseases, including the vector situation in Hong Kong. The incidence of malaria has dropped dramatically in the past few decades and is now mainly an imported disease acquired from malaria endemic countries. Locally acquired dengue fever occurred in 2002 and 2003, and thereafter all cases were imported, mainly from Southeast Asia areas. Only a few local cases of Japanese encephalitis were reported in the past decade. In contrast, there is a notable increase in scrub typhus and spotted fever cases. The emergence of chikungunya fever in Asia and Indian Ocean countries also resulted in importation of human cases. Given the heavy traffic between this international city and other parts of the world, as well as the presence of vectors in this densely populated area, vigilance should be maintained against these infections. Comprehensive public health measures encompassing disease surveillance, vector surveillance and control measures with support from all sectors of the community are required to combat the old and newly emerging vector-borne diseases in Hong Kong.     

HIV antibody testing among the Hong Kong mainland Chinese cross-border sex networking population in Hong Kong

The present study reports the results of 2 surveys examining the likelihood of performing HIV antibody test among the Hong Kong mainland China traveller population. The 2 studies interviewed 1325 and 2074 male adult Hong Kong residents. Among those who had had sexual intercourse with a female sex worker (FSW) in the past 6 months, 31.1% in the first sample indicated that they intended to take an HIV antibody test in the future, whereas 16.4% in the second sample reported they had actually taken a blood test for HIV antibody. In both samples, no association was found between demographic variables, attitudinal/knowledge-related variables and intention to do a blood test for HIV antibody and actual testing behaviour. Moreover, in both samples, those who had more female sexual partners in the past 6 months were more likely to report an intention for HIV test or to have taken an HIV test.