Health Disparity Still Exists in an Economically Well-Developed Society in Asia.

BACKGROUND: The socioeconomic inequalities in child health continue to widen despite improved economy. OBJECTIVE: To investigate the correlation between socio-economic factors and health risk behaviors and psychosocial well-being of children in Hong Kong. HYPOTHESIS: The null hypothesis is that for this particular developed region, there exists little or no correlation between social-economic factors and health risk behaviors and psychosocial well-being of children. DESIGN: Cross sectional territory wide survey. PARTICIPANTS: Caregivers of 7,000 children in kindergartens in Hong Kong. MEASURING TOOLS: Youth Risk Behavior Surveillance questionnaire, health-related knowledge and hygienic practice questionnaire, and Children Behavior Checklist (CBCL). RESULTS: Children were less likely to have somatic complaints and anxiety/depression as reflected by CBCL scores coming from families of higher income, not being recipients of social assistance, with fathers in employment, and with higher parental education. Children with only mother or father as caretakers had lower odds ratios (ORs) 0.71 (95% CI 0.58-0.89) and 0.53 (95% CI 0.33-0.84) respectively to have the habit of eating breakfast, whilst parental education at post-secondary level and higher family income had higher ORs 1.91 (95% CI 1.31-2.78), and 1.63 (95% CI 1.11-2.39). Fathers unemployed, relatives as main caretakers and living in districts with low median household inome incurred higher ORs, as 1.46 (95% CI 1.10-1.94),1.52 (95% CI 1.27-1.83) and 1.17 (95% CI 1.02-1.34) respectively, of watching television over two hours daily, whilst children with parental education at secondary level or above incurred lower OR 0.33 (95% CI 0.24-0.45). Children with parental education at post-secondary level and higher family income had lower ORs of 0.32 (95% CI 0.48-0.97) and 0.52 (95% CI 0.34-0.79) respectively, with regard to exposing to passive smoking, and reversed for those living in districts with lower median household income, lower family income and recipient of CSSA with ORs 1.24 (95% CI 1.06-1.44) and 1.6 (95% CI 1.09-2.37) respectively. CONCLUSION: Null hypothesis was not supported. A strong gradient was still found to exist among different socio-economic groups for various health-related behaviors in developed society like Hong Kong.

Facing the threat of influenza pandemic - roles of and implications to general practitioners.

The 2009 pandemic of H1N1 influenza, compounded with seasonal influenza, posed a global challenge. Despite the announcement of post-pandemic period on 10 August 2010 by the WHO, H1N1 (2009) virus would continue to circulate as a seasonal virus for some years and national health authorities should remain vigilant due to unpredictable behaviour of the virus. Majority of the world population is living in countries with inadequate resources to purchase vaccines and stockpile antiviral drugs. Basic hygienic measures such as wearing face masks and the hygienic practice of hand washing could reduce the spread of the respiratory viruses. However, the imminent issue is translating these measures into day-to-day practice. The experience from Severe Acute Respiratory Syndrome (SARS) in Hong Kong has shown that general practitioners (GPs) were willing to discharge their duties despite risks of getting infected themselves. SARS event has highlighted the inadequate interface between primary and secondary care and valuable health care resources were thus inappropriately matched to community needs.There are various ways for GPs to contribute in combating the influenza pandemic. They are prompt in detecting and monitoring epidemics and mini-epidemics of viral illnesses in the community. They can empower and raise the health literacy of the community such as advocating personal hygiene and other precautious measures. GPs could also assist in the development of protocols for primary care management of patients with flu-like illnesses and conduct clinical audits on the standards of preventive and treatment measures. GPs with adequate liaison with public health agencies would facilitate early diagnosis of patients with influenza.In this article, we summarise the primary care actions for phases 4-6 of the pandemic. We shall discuss the novel roles of GPs as alternative source of health care for patients who would otherwise be cared for in the secondary care level. The health care system would thus remain sustainable during the public health crisis.

Validation of a Chinese version of the Cardiff Acne Disability Index.

OBJECTIVES: To assess the validity (face validity and criterion-related validity) and reliability (test-retest reliability and internal consistency) of a Cantonese (the Chinese dialect predominantly used in Guangdong Province) version of the Cardiff Acne Disability Index. DESIGN: Questionnaire study. SETTING: Two secondary schools in Hong Kong. PARTICIPANTS: The Chinese Cardiff Acne Disability Index was translated according to international guidelines including forward-backward translation, reconciliation, and cognitive debriefing. A questionnaire, which was composed of the resultant Chinese Cardiff Acne Disability Index and the Cantonese Dermatology Life Quality Index (for those aged more than 16 years) or the Cantonese Children's Dermatology Life Quality Index (for those aged 16 years or less) was administered to 85 eligible secondary school students. MAIN OUTCOME MEASURES: Establishing face validity, criterion-related validity, internal consistency, and test-retest reliability by standard testing. RESULTS: The face validity was satisfactory. The strength of the relationship between the Chinese Cardiff Acne Disability Index and Dermatology Life Quality Index was large (gammas=0.58) and significant (P=0.004). The strength of relationship between the Chinese Cardiff Acne Disability Index and Cantonese Dermatology Life Quality Index was also large (gammas=0.72) and significant (P<0.001). Regarding internal consistency, Cronbach's alpha was 0.763. Thirty-three students completed the test-retest reliability test, and the resulting correlation of the first and second administration of the Chinese Cardiff Acne Disability Index was strong (gammas=0.795, P<0.001). The intra-class correlation coefficient was satisfactory (0.784, P<0.001). CONCLUSION: The Chinese Cardiff Acne Disability Index was equivalent to the original English version, and constitutes a valid and reliable tool for day-to-day clinical use.

Sexually transmitted infections--ten common myths.

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.

Unilateral mediothoracic exanthem: a variant of unilateral laterothoracic exanthem.

We report the cases of a 4-year-old Chinese boy and a 33-year-old Chinese man with prodromal constitutional symptoms followed by eruption of small, painless, erythematous, papular lesions on relatively medial aspects of the anterior chest but not as far as the periflexural regions. Spontaneous remission was seen 2 and 3 weeks after rash onset in the child and the adult, respectively. We believe that the terms unilateral mediothoracic exanthem and unilateral thoracic exanthem are appropriate diagnostic labels. Such labels carry clinical significance as the patients can be reassured that although the rash may persist for weeks, final spontaneous remission with no complication is highly likely. Moreover, the risk of contagiousness is low, and we did not insist on isolation for prolonged periods.

Temporal case clustering in pityriasis rosea: a regression analysis on 1379 patients in Minnesota, kuwait, and diyarbakir, Turkey.

OBJECTIVE: To detect temporal case clustering in patients with pityriasis rosea in different geographic locations. DESIGN: Regression analysis of dates on which 1379 patients were diagnosed as having pityriasis rosea in 3 different geographic locations. The control data consisted of dates of diagnosis of patients with psoriasis in the same settings. SETTING: Dermatology clinics in Kuwait, Minnesota, and Diyarbakir, Turkey.Patients Patients with pityriasis rosea and psoriasis seeking care in the clinics. RESULTS: Three significant positive clusters (P = .005, P =.001, and P =.01, respectively) and 1 significant negative cluster (P<.001) were detected in these series of patients. No cluster was detected in 2 corresponding series of patients with psoriasis in Kuwait and Turkey. CONCLUSION: Temporal case clustering exists in pityriasis rosea.

Procedures in primary care dermatology.

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.

Effect on quality of life in patients with pityriasis rosea: is it associated with rash severity?

BACKGROUND: It is unknown how the quality of life (QOL) is affected in patients with pityriasis rosea (PR), and whether it is related to rash severity. METHODS: We constructed a valid and reliable Cantonese version of the Dermatology Life Quality Index (DLQI). We recruited patients with PR, with atopic dermatitis and with acne vulgaris, and controls of the same sex and comparable age. We applied the DLQI and the Pityriasis Rosea Severity Score (PRSS) to the patients with PR, the DLQI and the SCORing Atopic Dermatitis Index (SCORAD) to the controls with atopic dermatitis, and the DLQI and the Leeds Acne Grading System (LAGS) to the controls with acne vulgaris. RESULTS: Total DLQI scores of the 22 patients with PR (mean: 6.36, SD: 5.79) were significantly lower than those of the 22 controls with atopic dermatitis (mean: 12.00, SD: 5.38) (P = 0.021), but were insignificantly different from those of the 22 controls with acne vulgaris (mean: 6.86, SD: 4.53) (P = 0.57). Correlation between the total DLQI and PRSS scores was weak (gamma(s) = +0.19) and insignificant (P = 0.40). All six DLQI parameters were insignificantly correlated with the PRSS scores. In contrast, the total DLQI scores and most of the DLQI parameters were strongly correlated with the rash severity scores for the control subjects. Significantly more patients with PR have concerns regarding disease etiology and infectivity. CONCLUSIONS: The QOL of the patients with PR was significantly less affected than that for the patients with atopic dermatitis, but was insignificantly different from the patients with acne vulgaris. Unlike atopic dermatitis and acne vulgaris, the effects on the QOL in PR are insignificantly correlated with rash severity. These results bear important implications on clinical management.

Is human herpesvirus 7 the causative agent of pityriasis rosea?--A critical review.

BACKGROUND: Conflicting results on the association of pityriasis rosea and human herpesvirus 7 infection have been reported by different investigators. AIM: To review the level of evidence for such an association. METHODS: Medline was searched with unlimited data entry and 13 reports were retrieved. The data were analyzed for a causative association according to the criteria of Fredericks and Relman, which take into consideration latent infection and the reactivation of viruses characteristic of herpesviruses, and the roles of sequence-based detection methods. RESULTS: None of the criteria was substantiated by the findings of most investigators. Factors leading to the discrepancies of the results were discussed. CONCLUSION: There is currently insufficient evidence that human herpesvirus 7 infection is causally related to pityriasis rosea.

Demonstration of residual perifollicular pigmentation in localized vitiligo--a reverse and novel application of digital epiluminescence dermoscopy.

Digital epiluminescence dermoscopy (microscopy) is usually employed to examine melanomas and other pigmented lesions. We report its reverse application in assisting the early diagnosis of a depigmentation condition-localized vitiligo. A pattern of depigmentation with residual reservoirs of perifollicular pigments is clearly visualized. This pattern is not seen in other disorders of depigmentation. Such pattern signifies focally active or repigmenting vitiligo and thus, clearly serves as a useful guide for the cases wherein there exists a doubt about the possible diagnosis. Further studies are warranted to affirm the specificity and applicability of our observations.

Quality of life in children with pityriasis rosea: a prospective case control study.

Our aim was to investigate the effects on quality of life of pityriasis rosea (PR) in children and the concerns of their parents. We recruited all children ages 5-16 years with a diagnosis of PR in a primary care setting over a period of 30 months. Controls were the next child of the same sex and comparable age consulting for atopic dermatitis or for conditions unrelated to the skin. Information on parental concerns was also gathered. Ten children with PR and 20 control subjects were recruited. Total Children's Dermatology Life Quality Index (CDLQI) scores of children with PR (mean 3.50; 95% confidence interval [CI] 2.66-4.34) were significantly lower than those of children with atopic dermatitis (mean 7.70; 95% CI 5.59-9.81). Children with PR had significantly lower scores for symptoms and feelings, personal relationships, and sleep. Total CDLQI scores of children with PR were significantly higher than those of children with no active skin problem (mean 0.30; 95% CI -0.18 to 0.78). Significantly more parents of children with PR had concerns regarding the etiology, infectivity, relapse, and complications or dangers of the disease. We concluded that quality of life (QOL) of children with PR is significantly less affected than that of children with atopic dermatitis and significantly more affected than in children with no active skin problem. The major concerns of parents of children with PR are the etiology, infectivity, relapse, and complications or dangers. These results have important implications on whether active intervention is worthwhile for this disease.

Validation of a Cantonese version of the Children's Dermatology Life Quality Index.

My goal was to assess the validity and reliability of a Cantonese version of the Children's Dermatology Life Quality Index (CDLQI). To do so, I invited four translators to produce a proper Cantonese translation of the CDLQI. I asked five children to complete this version and made adjustments as necessary. I then requested 30 children with skin problems and 30 children consulting for problems unrelated to the skin in a primary care setting to complete the questionnaire before their consultation. A physician assessed the severity of the skin problem using a visual analog scale. Some children from both groups completed the questionnaire again 7 days later. The CDLQI scores are strongly (gammas = 0.850) and significantly (p < 0.01) correlated with physician-rated disease severity. The Cantonese CDLQI scores were similar to those of the English version for individual skin problems. Correlation of test-retest results is strong (gammas = 0.958, p < 0.01). Cronbach's alpha is 0.83. I concluded that the Cantonese CDLQI is a valid and reliable tool for assessing the effects of skin problems on quality of life in children.

Truncal lesions do not exclude a diagnosis of Gianotti-Crosti syndrome.

A boy aged 2 years and 10 months had a pruritic eruption and low-grade fever for 1 week. Examination revealed discrete erythematous papules and papulovesicles on his buttocks and extensor surfaces of four limbs. Several papules were also present on his back. No lymphadenopathy and no hepatosplenomegaly were noted. Investigations failed to identify a single viral aetiology. Topical calamine lotion and a sedating oral antihistamine to be taken at night were prescribed. The truncal lesions subsided in 3 weeks. Complete remission of all lesions was seen after 6 weeks. Although most patients with Gianotti-Crosti syndrome only have the typical acrally distributed eruption, additional truncal lesions, if few in number, do not exclude the diagnosis.

Case clustering in pityriasis rosea: a multicenter epidemiologic study in primary care settings in Hong Kong.

OBJECTIVES: To investigate the epidemiology of pityriasis rosea in primary care settings in Hong Kong and to analyze for temporal clustering. DESIGN: Retrospective epidemiologic study. SETTING: Six primary care teaching practices affiliated with a university. Patients Forty-one patients with pityriasis rosea, 564 patients with atopic dermatitis (negative control condition), and 35 patients with scabies (positive control condition). METHODS: We retrieved all records of patients with pityriasis rosea, atopic dermatitis, or scabies diagnosed in 3 years. We analyzed temporal clustering by a method based on a regression model. RESULTS: The monthly incidence of pityriasis rosea is negatively but insignificantly correlated with mean air temperature (gamma s = -0.41, P =.19) and mean total rainfall (gamma s = -0.34, P =.27). Three statistically significant clusters with 7, 6, and 7 cases were identified (P =.03), occurring in the second coldest month in the year (February), the second hottest month (July), and a temperate month (April), respectively. For atopic dermatitis (negative control condition), the nonclustering regression model was selected by Akaike information criteria. For scabies (positive control condition), 1 cluster of 20 cases was detected (P =.03). CONCLUSIONS: Significant temporal clustering independent of seasonal variation occurred in our series of patients with pityriasis rosea. This may be indicative of an infectious cause.

The association of pityriasis rosea with cytomegalovirus, Epstein-Barr virus and parvovirus B19 infections - a prospective case control study by polymerase chain reaction and serology.

A viral aetiology is suspected for pityriasis rosea (PR). The objective was to investigate the association of PR with cytomegalovirus (CMV), Epstein Barr virus (EBV) and parvovirus B19 infections. Patients with PR were recruited in a primary care setting over 18 months. Blood was collected at initial presentation and four weeks later. Controls were the next age-and-sex-matched patients requiring blood collection for non-dermatological disease. Polymerase chain reaction was performed for EBV and parvovirus B19 DNA. Serology was done for CMV, EBV and parvovirus B19. 12 patients with PR and 12 control subjects were recruited. No patient had viral DNA or significant antibody rise against any of the viruses investigated. The seroprevalence of all three viruses and Ab titres in the patients with PR were insignificantly different from those of control subjects. Two patients had IgM detectable against CMV and EBV respectively. Based on other investigation results, we believe that both IgM results were caused by cross reactivity. PR is not associated with CMV, EBV or parvovirus B19 infections.

Rash orientation in pityriasis rosea: a qualitative study.

Rash orientation in pityriasis rosea (PR) has been described as Christmas-tree pattern, inverted Christmas-tree pattern, fir tree pattern, parallel to the ribs or along skin cleavage lines. We retrieved clinical photographs of 11 patients diagnosed as having PR over a two-year period for qualitative study of rash orientation. We found that Langer's cleavage lines are the most appropriate description. All three components of these lines on the trunk, i.e. V-shaped pattern on upper chest and upper back, circumferential pattern around the shoulders and hips, and transverse pattern on the lower anterior trunk and lower back, are demonstrated by most patients. We believe with the present state of knowledge, the mechanism for PR following Langer's lines is best considered unknown. We advocate abandoning other descriptions which might cause confusion to students and trainee physicians.

Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea.

A double-blind placebo-controlled trial reported the benefit of erythromycin in treating pityriasis rosea (PR), a postulated mechanism being the eradication of bacteria susceptible to erythromycin. The aim of this study was to investigate the association between PR and Chlamydia pneumoniae, C. trachomatis, Legionella longbeachae, L. micdadei, L. pneumophila, and Mycoplasma pneumoniae infections. We recruited 13 patients aged seven to 46 years (mean: 26.8 years) diagnosed to have PR in a primary care setting in 18 months. Lesional histopathology was arranged for atypical cases. Clotted blood was collected at initial presentation and four weeks later. Controls were 13 paired age-and-sex-matched patients requiring blood collection for non-dermatological diseases. Serology tests were performed in parallel but were read "blinded" on the acute and convalescent specimens of patients and the control subjects. The serology profiles were not diagnostic of active infection by any of the bacteria studied for all 13 patients. Two patients had four-fold increase in IgG titres against C. pneumoniae, with IgM being negative. Two patients had IgM detectable against L. pneumophila serotype 6 and M. pneumoniae respectively, with no significant rise of the specific IgG. These patients had no symptom or sign of chest infection. The seroprevalence and IgG titres of the study patients for the bacteria investigated were insignificantly different from those of control subjects. We conclude that the bacteria investigated in this study do not play a significant role in the pathogenesis of PR. We believe that anti-inflammatory and immunomodulatary effects might contribute towards the action of erythromycin, if any, in PR.

The use of digital epiluminescence dermatoscopy to identify peripheral scaling in pityriasis rosea.

Non-digital epiluminescence dermatoscope (ED) is a skin surface microscope utilizing oil immersion. Digital ED achieves epiluminescence by cross-polarization, with real-time images shown on computer screen.Non-digital and digital ED can assist to identify peripheral scaling in pityriasis rosea (PR). Additional advantages of digital ED include higher magnifications, a dry and convenient procedure, direct patient involvement, and easy appreciation of the relationship between microscopic changes and macroscopic clinical signs. PR is a particularly good teaching model as the histopathological changes almost exactly mirror changes seen under digital ED. Digital ED also allows easy image storage for record keeping, teaching and research.