Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry

Kidney transplant recipients have increased risk of cancers when compared with the general population. Hepatocellular carcinoma (HCC) is extremely important in Asia where hepatitis B virus (HBV) infection is endemic. The aim is to study the epidemiological and clinical aspects of all de novo HCC in our kidney transplant recipients. Moreover, various preventive strategies which may help to optimize the outcome will also be discussed. A retrospective review of all patients who developed HCC after kidney transplantation between May 1972 and December 2011 in Hong Kong, based on the data from Hong Kong Renal Registry. After a follow-up period of 40,246 person-years, 20 patients (males 15: females 5) developed HCC. The annual incidence was 49.7/100,000 persons per year. Among them, 16 were HBV carriers, 2 were hepatitis C (HCV) carriers and 2 had HBV and HCV co-infection. Presence of HBV infection was associated with 78-fold higher risk for HCC development. Majority (85%) were asymptomatic when HCC was diagnosed by ultrasound or alpha-fetoprotein surveillance. All patients diagnosed by surveillance received active treatment while 2/3 of symptomatic patients could only receive symptomatic care and died rapidly. In conclusion, HBV infection is the major etiological factor for HCC development in kidney transplant recipients in HBV endemic areas. Regular HCC surveillance appeared to be able to detect early stage cancers which are amenable to treatment and offer the best hope of cure.     

Modeling cumulative incidence function for competing risks data

A frequent occurrence in medical research is that a patient is subject to different causes of failure, where each cause is known as a competing risk. The cumulative incidence curve is a proper summary curve, showing the cumulative failure rates over time due to a particular cause. A common question in medical research is to assess the covariate effects on a cumulative incidence function. The standard approach is to construct regression models for all cause-specific hazard rate functions and then model a covariate-adjusted cumulative incidence curve as a function of all cause-specific hazards for a given set of covariates. New methods have been proposed in recent years, emphasizing direct assessment of covariate effects on cumulative incidence function. Fine and Gray proposed modeling the effects of covariates on a subdistribution hazard function. A different approach is to directly model a covariate-adjusted cumulative incidence function, including a pseudovalue approach by Andersen and Klein and a direct binomial regression by Scheike, Zhang and Gerds. In this paper, we review the standard and new regression methods for modeling a cumulative incidence function, and give the sources of computer packages/programs that implement these regression models. A real bone marrow transplant data set is analyzed to illustrate various regression methods.     

广州天河区2001-2010年传染病流行概况分析

目的探讨10年来传染病发生趋势,为制定防控措施提供参考依据。方法采用描述性流行病学方法对本辖区2001-2010年间各类法定传染病疫情报告资料进行统计学分析。结果 10年来共报告法定传染病31种93 566例,其中甲类1种7例,乙类22种49289例,丙类8种44 270例。10年间传染病构成比主要以肠道传染病和呼吸道传染病为主。虫媒和自然疫源性疾病构成比波动较小。结论由于本辖区人口构成比较复杂,流动人口较多,规范性预防接种难以实现,经常有输入性传染病病例的发生,导致传染病防控难度加大。需要政府加大对传染病防控机构人力和财力的投入。     

2012咸宁市手足口病疫情分析

目的了解咸宁市手足口病的流行特点,为制定手足口病防治措施提供依据。方法对2012年咸宁市区（咸宁市中心医院、咸宁市第一人民医院咸安区妇幼保健院咸安桂花镇卫生院、马桥镇卫生院、汀泗镇卫生院、浮山大幕卫生院）手足口病疫情资料进行分析。结果 2012年咸宁市区报告手足口病1 480人,同期总人口28.15万人,发病率525.75/10万,男性患者961例,女性患者519例,男女比例是1.85∶1,男性患者高于女性患者（P〈0.01）;温泉城区592人（40.0%）,咸安城区656人（44.32%）,咸安妇幼保健院71人（4.79%）,永安社区61人（4.12%）,马桥镇卫生院62人（4.18%）,桂花镇卫生院15人（1.01%）,咸安浮山社区12人（0.81%）,汀泗桥卫生院4人,大幕乡卫生院3人,向阳湖1人。1480例中4~7月发病848例（57.29%）,10~12月发病428例（28.91%）;五岁及以下儿童1467例（99.12%）,散居儿童1201例（81.14%）,幼托儿童259例（17.5%）,学生18例（1.21%）。结论 2012年咸宁市手足口病发病率相对较高,防控工作的重点为散居儿童和幼托机构儿童。     

Incidence and predictors of depression after stroke (DAS)

Objective. Depression after stroke (DAS) poses a treble burden to patients, families and health care system. The purpose of this paper is to estimate the incidence of depression among first-ever ischemic stroke patients and identify the predictors of DAS. Methods. A longitudinal study design was undertaken. Of 836 patients admitted to the stroke unit of two regional hospitals in Hong Kong during the period 1 June 2004 to 31 May 2005, 295 patients fulfilled the inclusion and exclusion criteria. A total of 260 patients had given their consents and were interviewed at 1 month after stroke onset. Results. Nearly one-quarter of the first ischemic stroke patients, who were known to be free of personal and family history of psychiatric illnesses, were found to satisfy the criteria of depression using Diagnostic and Statistical Manual IV (24%, 48 out of 200 participants; 95% CI: 18.6%, 30.4%). This result was close to that assessed by the Geriatric Depression Scale (GDS) – 15 items. The psycho-emotional factor and level of dependency were found to be most significant predictors for DAS onset. Conclusion. The high incidence of DAS and low rate of accessibility to treatment indicate timely action to be undertaken.     

Professional Burnout:

This paper attempts to answer the question of why social caseworkers have ongoing supervision by exploring the historical evolution of social work supervision. Supervision has withstood the many changes in the field since its beginning in the late 1800s and has been reinterpreted to fit the prevailing theories guiding practice, thus avoiding obsolescence. Supervision began as an educational device, then evolved into a practice tool, later became a therapeutic method, and then became a separate entity from therapy.     

Acute Appendicitis in Pediatric Patients With Sickle Cell Disease: Lower Incidence,More Imaging,and More False-Positives

ObjectivePatients with sickle cell disease (SCD) experience recurrent pain crises, which may mimic appendicitis. A prior study found a significantly lower rate of appendicitis in patients with SCD compared with national averages. We investigate the incidence of appendicitis and number of imaging studies for appendicitis in pediatric patients with SCD.MethodsUsing a retrospective study design from a single institution, SCD and control cohorts were created. Inclusion criteria included age 0 to 21years and at least one follow-up appointment within 24 months. Length of observation was calculated from initial presentation to either inpatient admission for appendicitis or last clinic visit. Analysis of an SCD subgroup and a control subset (n = 1,596) was used to compare the number of imaging studies. Incidence rates of appendicitis and number of appendicitis studies were determined. Z-tests, binomial enumeration exact tests, and Fischer’s exact tests were used.ResultsThe SCD cohort included 1,064 patients between January 1, 2001, to December 31, 2014, and the control cohort included 115,109 patients without SCD between January 1, 2011, and December 31, 2011. Incidence rate of appendicitis per 10,000 patient-years was significantly lower in the SCD group compared with controls (2.9 cases versus 10.7 cases per 10,000 patient-years; P = .044). Additionally, the SCD group received significantly more ultrasounds (148 versus 60 per 10,000 patient-years; P < .0001) and CTs (94 versus 27 per 10,000 patient-years; P < .0001) for appendicitis, which remained significant when controlling for race. Patients with SCD also received more false-positive scans.DiscussionPatients with SCD had a significantly lower incidence of appendicitis than controls, yet had a higher number of imaging tests performed for appendicitis. Appendicitis should be viewed as a less common cause of acute abdominal pain in SCD. This consideration should help guide imaging strategy.