Glycaemic control and microvascular complications among paediatric type 2 diabetes mellitus patients in Hong Kong at 2 years after diagnosis.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is becoming increasingly common among children and adolescents worldwide, including those in Hong Kong. This study analysed the characteristics and prevalence of microvascular complications among paediatric T2DM patients in Hong Kong at diagnosis and 2 years after diagnosis. METHODS: All patients aged <18 years who had been diagnosed with DM at public hospitals in Hong Kong were recruited into the Hong Kong Childhood Diabetes Registry. Data collected at diagnosis and 2 years after diagnosis were retrospectively retrieved from the Registry for patients diagnosed from 2014 to 2018. RESULTS: Median haemoglobin A1c (HbA1c) levels were 7.5% (n=203) at diagnosis and 6.5% (n=135) 2 years after diagnosis; 59.3% of patients achieved optimal glycaemic control (HbA1c level <7%) at 2 years. A higher HbA1c level at diagnosis was associated with worse glycaemic control at 2 years (correlation coefficient=0.39; P<0.001). The presence of dyslipidaemia (adjusted odds ratio [aOR]=3.19; P=0.033) and fatty liver (aOR=2.50; P=0.021) at 2 years were associated with suboptimal glycaemic control. Diabetic neuropathy and retinopathy were rare in our cohort, but 18.6% of patients developed microalbuminuria (MA) within 2 years after diagnosis. Patients with MA had a higher HbA1c level at 2 years (median: 7.2% vs 6.4%; P=0.037). Hypertension was a risk factor for MA at 2 years, independent of glycaemic control (aOR=4.61; P=0.008). CONCLUSION: These results highlight the importance of early diagnosis and holistic management (including co-morbidity management) for paediatric T2DM patients.

Change in bone mineral density and its determinants in pre- and perimenopausal Chinese women: the Hong Kong Perimenopausal Women Osteoporosis Study.

UNLABELLED: This 30-month study investigating bone change and its determinants in 438 perimenopausal Chinese women revealed that the fastest bone loss occurred in women undergoing menopausal transition but maintenance of body weight and physical fitness were beneficial for bone health. Soy protein intake also seemed to exert a protective effect. INTRODUCTION: This 30-month follow-up study aims to investigate change in bone mineral density and its determinants in Hong Kong Chinese perimenopausal women. METHODS: Four hundred and thirty-eight women aged 45 to 55 years were recruited through random telephone dialing and primary care clinic. Bone mass, body composition, lifestyle measurements were obtained at baseline and at 9-, 18- and 30-month follow-ups. Univariate and stepwise multiple regression analyses were performed with the regression coefficients of BMD/C (derived from baseline and follow-up measurements) as the outcome variables. Menopausal status was classified as pre- or postmenopausal or transitional. RESULTS: Menopausal status was the strongest determinant of bone changes. An annual bone loss of about 0.5% was observed among premenopausal, 2% to 2.5% among transitional, and about 1.5% in postmenopausal women. Multiple regression analyses, revealed that a positive regression slope of body weight was protective for follow-up bone loss at all sites. Number of pregnancy, soy protein intake and walking were protective for total body BMC. Higher baseline LM was also protective for neck of femur BMD. CONCLUSION: Maintenance of body weight and physical fitness were observed to have a protective effect on for bone loss in Chinese perimenopausal women.

Primary care physicians in public and private sectors perceive different learning needs.

We compared the perceived learning needs of primary care physicians from the public and private sectors who responded to a questionnaire before taking educational courses in Family Medicine. They rated their perceived learning needs on 71 items of clinical practices and practice management on a scale of 1-10. The ratings of their learning needs were closely related to the perceived needs of their daily work. The private physicians gave higher ratings to most items. Both groups of physicians shared similar least-preferred items (e.g. suturing, plastering, taking Pap smears) but had very different most-preferred ones. Public physicians wished to improve their care of individual patients (e.g. skin, eye, ear-nose-throat problems). Private physicians were more concerned with professional development to improve their practice (e.g. audits, counselling, adult learning). Organizers of educational programmes should assess and discuss with physicians their expected learning needs at the planning stage of a programme.

Graduates' evaluation of a postgraduate diploma course in family medicine.

BACKGROUND: Postgraduate programmes offer an opportunity to learn family medicine for physicians in practice who were unable to obtain formal training in the immediate postgraduate phase of their career. Since 1985, the Chinese University of Hong Kong has provided a part-time 1-year diploma course at hours convenient for private practitioners. The curriculum has evolved, reducing public health components and increasing family medicine concepts. Between six and 16 students took the course each year until 1999, when formal recognition led to increased popularity. OBJECTIVE: The aim of this study was to evaluate the components and outcomes of the course as a prelude to further development. METHODS: Evaluation comprised a structured telephone interview conducted with two enrollees from each year of the course (total 28), selected randomly from class lists. RESULTS: Participants were mostly young doctors, with an average of 5 years in general practice. Many graduates are now prominent in training and development of family medicine in Hong Kong. Graduates rated most components favourably, but found the original research components too demanding, and not useful subsequently for most. Counselling, family dynamics, consultation and practice organization skills were valued. Conventional continuing education components, such as lectures by specialists, were evaluated poorly. CONCLUSIONS: This course has proved useful in the Hong Kong context, being practical for physicians, and allowing them to study ideas they would not otherwise encounter. Critical appraisal and evidence-based medicine exercises now replace the former research components.

Determinants of physicians' attitude towards prescribing.

OBJECTIVE: To identify the primary care physicians' (PCP) characteristics that are associated with their prescribing attitude. METHODS: A validated questionnaire was sent to randomly selected PCPs stratified in three groups according to any higher qualification in family medicine. RESULT: The best predictor for orientation of quality of care in prescribing was the country of qualification. Duration after qualification was negatively associated with PCP's belief in the use of drugs. Physicians who were female, with higher qualification, sooner after qualification, and working in group practice were less likely to perceive pressure from patients to prescribe, with group practice being the most significant determinant. CONCLUSION: Different physician factors affect different aspects of PCPs' prescribing attitude. As duration after qualification was an important but negative attribute, quality use of medication should be emphasized in continuing medical education.

Epidemiology of irritable bowel syndrome in Chinese.

Irritable bowel syndrome (IBS) is common in Caucasians and Japanese, but its epidemiology has not been studied in urbanized Chinese populations. Our aim was to compare diagnostic criteria and study the epidemiology of IBS in Hong Kong Chinese. In all, 964 subjects from public housing and 334 subjects from private housing were recruited for face-to-face interviews in Shatin, Hong Kong. A structured questionnaire was used to measure the prevalence of IBS according to the Manning, Rome I, and Rome II criteria. The SF-36 scale was used to measure quality of life (QOL) in subjects with IBS and in normal controls. The results were compared by the analysis of covariance (ANCOVA). Relevant medical consultations and absence from work were recorded. There was fair agreement between the Manning and Rome II criteria (K = 0.23; P < 0.001), but good agreement between the Rome I and Rome II criteria (kappa = 0.5; P < 0.001). The prevalence of IBS, based on the Rome II criteria, was 3.6% (95% CI = 2.0-5.2) in men and 3.8% (95% CI = 2.5-5.2) in women. Men with IBS had significantly lower vitality scores on the SF-36 scale than the controls (P < 0.05 by ANCOVA), and women with IBS had significantly lower mental health scores than controls (P < 0.05 by ANCOVA). In conclusion, IBS is quite prevalent in Hong Kong Chinese, and the QOL of subjects with IBS was significantly affected.

Communication skill of general practitioners: any room for improvement? How much can it be improved?

OBJECTIVE: To measure any changes in the communication skills of primary care physicians before and after a part-time Diploma course in Family Medicine. SUBJECTS: 79 Hong Kong Chinese doctors (46 of whom were local graduates, with an average of 7 years in general practice). METHODS: Over the 10-month course in 2000-01, participants had 11 2.5-hour lecture/demonstrations in communication skills, 2 sessions of role play practice in groups of 20, self-analysis of a videotaped interview and skills evaluation. A before-after design measured scores in videotaped simulated patient interviews (rated by a research assistant using a structured observation guide, after standardisation by a psychologist) and scores in Objective Structured Clinical Examinations (OSCE) (rated by experienced family physician examiners with standardised checklists). RESULTS: There were wide variations in baseline skills, with scores ranging between 24-78 (out of 100) for video and 18-68 for OSCE, which were related to prior training and inversely associated with years after graduation. Significant improvements occurred in both video (from 53 to 61) and OSCE (from 46 to 56) post-course (P < 0.001). The group in the lowest quartile improved from 36 to 54 for video and from 29 to 48 for OSCE, while those in the second lowest quartile improved from 50 to 61 for video and from 44 to 56 for OSCE (F = 12.2, P < 0.001). Doctors who graduated more than 20 years ago made as much improvement as more recent graduates. CONCLUSIONS: Communication skills can be effectively taught to, and improved among experienced Chinese doctors by a combination of large-class teaching and medium-sized group practice with feedback, and without intensive individual supervision.