Publications (42)147.93 Total impact
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Article: The impact of work nature, lifestyle, and obesity on health-related quality of life in Chinese professional drivers.
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ABSTRACT: To assess the association of work nature, lifestyle and obesity with health-related quality of life (HRQOL) in professional drivers. A total of 3376 Chinese professional drivers aged 18 to 70 years were recruited to assess the HRQOL by SF-12 summary scores (Physical Component Summary [PCS]; Mental Component Summary [MCS]), and collect data for work nature, lifestyle, and body mass index. Factors associated with HRQOL were examined by multiphase regression analyses. Professional drivers reported poorer physical and mental HRQOL than the general population. Shift work and lorry driving had significant negative effect on HRQOL. Obesity was associated with lower PCS but higher MCS. HRQOL of professional drivers tended to be low, especially among lorry drivers and shift drivers. Health intervention programs should promote regular exercise, healthy eating, no smoking, and weight control, which are modifiable factors improving HRQOL.Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 07/2012; 54(8):989-94. · 1.88 Impact Factor -
Article: A new risk classification rule for curve progression in adolescent idiopathic scoliosis.
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ABSTRACT: BACKGROUND CONTEXT: Prognostic factors for curve progression of adolescent idiopathic scoliosis (AIS) have been reported previously. There is only one existing rule that classifies AIS patients into two groups by a curvature of 25°. PURPOSE: This study aimed to develop a more refined risk classification rule for AIS. STUDY DESIGN: This was a retrospective cohort study. PATIENT SAMPLE: We examined 2,308 untreated AIS patients, aged 10 years and older, who had a Risser sign of 2 and lesser and a curvature less than 30° at presentation. OUTCOME MEASURES: Outcome was taken as the time to progression to 30°. METHODS: Patients' clinical parameters were analyzed by Classification and Regression Tree analysis. RESULTS: The new classification rule identified four risk groups of curve progression. Patients with a curvature of 26° and more and less than 18° constituted the highest and lowest risk groups, respectively. The two intermediate groups were identified by the age (11.3 years), menarcheal status, and body height (154 cm). CONCLUSIONS: The risk classification rule only uses information at the first presentation and can aid physicians in deriving an efficient management.The spine journal: official journal of the North American Spine Society 06/2012; · 2.90 Impact Factor -
Article: Violence against pregnant women can increase the risk of child abuse: a longitudinal study.
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ABSTRACT: To assess the impact of intimate partner violence (IPV) against pregnant women on subsequent perpetration of child abuse and neglect (CAN) by parents; and to test the mediation effect of recent IPV on the link between IPV during pregnancy and subsequent CAN. This study was a longitudinal follow-up of a population-based study on pregnancy IPV conducted in antenatal clinics in 7 public hospitals in Hong Kong in 2005. Of all participants in the 2005 study, we recruited 487 women (with 184 having reported pregnancy IPV in the 2005 study) with newborn babies for a follow-up telephone interview in 2008. Participants responded to the Abuse Assessment Screen (AAS), the Parent-Child Conflict Tactics Scale, and some questions assessing demographic information. The most common form of physical violence was corporal punishment, with a prevalence rate of 75.1% in the preceding year and 75.4% over their lifetime. Physical maltreatment was less likely to be reported, accounting for 4.7% in the preceding year and 4.9% over their lifetime. The preceding-year and lifetime prevalence rates of neglect were 11.3% and 11.5%, respectively. Findings from logistic regression analyses showed that IPV experienced by participants during pregnancy was associated with greater odds of both lifetime (aOR=1.74) and preceding-year child physical maltreatment (aOR=1.78). Results of the regression analyses also provided supportive evidence for the mediation effect of recent IPV victimization on the relationship between IPV during pregnancy and recent CAN against children. IPV against women during pregnancy predicted subsequent CAN on newborns in Chinese populations. This underscores the importance of screening pregnant women for IPV in order to prevent CAN at an early stage. Home visitations are suggested to break the cycle of violence within a nuclear family.Child abuse & neglect 05/2012; 36(4):275-84. · 2.34 Impact Factor -
Article: Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese?
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ABSTRACT: Rationale and objectives The scoring algorithm of the 12-item Short-Form Health Survey (SF-12) was revised in the second version (SF-12v2), but information on its psychometric properties is lacking. This study determined whether the SF-12v2 was a valid and equivalent substitute for the SF-36v2 Health Survey (version 2) for the Chinese. Methods A total of 2410 Chinese adults in Hong Kong completed the SF-36 Health Survey by telephone. The SF-12v2 data were extracted from the SF-36 data. Internal consistency was assessed by Cronbach's alpha, and test-retest reliabilities were evaluated by intraclass correlation. Criterion validity and equivalence were assessed using the SF-36v2 scores as a gold standard. Construct validity and sensitivity were assessed by known-group comparison. Results Internal consistency and test-retest reliabilities were good (range 0.67-0.82) for all except three scales. The SF-12v2 summary scores explained >80% of the total variances of the SF-36v2 summary scores. Construct validity and sensitivity were confirmed by significantly lower SF-12v2 scores in people with chronic diseases than those without. Effect size differences were less than 0.3 and relative validities were greater than 0.7 between SF-12v2 and SF-36v2 scores for different groups. Conclusion The SF-12v2 was valid, reliable and sensitive for the Chinese. It is an equivalent substitute for the SF-36v2 for the summary scales.Journal of Evaluation in Clinical Practice 11/2011; · 1.23 Impact Factor -
Article: Impact of baby-friendly hospital practices on breastfeeding in Hong Kong.
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ABSTRACT: The World Health Organization (WHO) developed the Baby-Friendly Hospital Initiative to improve hospital maternity care practices that support breastfeeding. In Hong Kong, although no hospitals have yet received the Baby-Friendly status, efforts have been made to improve breastfeeding support. The aim of this study was to examine the impact of Baby-Friendly hospital practices on breastfeeding duration. A sample of 1,242 breastfeeding mother-infant pairs was recruited from four public hospitals in Hong Kong and followed up prospectively for up to 12 months. The primary outcome variable was defined as breastfeeding for 8 weeks or less. Predictor variables included six Baby-Friendly practices: breastfeeding initiation within 1 hour of birth, exclusive breastfeeding while in hospital, rooming-in, breastfeeding on demand, no pacifiers or artificial nipples, and information on breastfeeding support groups provided on discharge. Only 46.6 percent of women breastfed for more than 8 weeks, and only 4.8 percent of mothers experienced all six Baby-Friendly practices. After controlling for all other Baby-Friendly practices and possible confounding variables, exclusive breastfeeding while in hospital was protective against early breastfeeding cessation (OR: 0.61; 95% CI: 0.42-0.88). Compared with mothers who experienced all six Baby-Friendly practices, those who experienced one or fewer Baby-Friendly practices were almost three times more likely to discontinue breastfeeding (OR: 3.13; 95% CI: 1.41-6.95). Greater exposure to Baby-Friendly practices would substantially increase new mothers' chances of breastfeeding beyond 8 weeks postpartum. To further improve maternity care practices in hospitals, institutional and administrative support are required to ensure all mothers receive adequate breastfeeding support in accordance with WHO guidelines.Birth 09/2011; 38(3):238-45. · 2.18 Impact Factor -
Article: Childhood sexual abuse associated with dating partner violence and suicidal ideation in a representative household sample in Hong Kong.
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ABSTRACT: This study investigated the prevalence and impact of childhood sexual abuse (CSA) on future intimate partner violence (IPV) in dating relationship in Hong Kong, China. A total of 1,154 Chinese adult respondents engaged in dating relationships were interviewed face-to-face about their CSA histories, childhood witnessing of parental violence, adult sexual victimization (ASV) by others and IPV victimization with their current dating partner. Self-reports also measured levels of suicidal ideation, self-esteem, and demographic details. Overall, 1.7% reported some form of CSA with a higher percentage being women. No gender differences were found in the prevalence of either ASV or IPV. Results showed that CSA had an independent effect on physical IPV and suicidal ideation. The odds of IPV were increased by behavioral and psychological factors of victims such as alcohol and drug abuse, sex with partner, and low self-esteem. The odds of suicidal ideation were also increased by drug abuse, childhood witnessing of parental psychological aggression, and low self-esteem. Clinical implications of results included screening for CSA victims and suicidal victims when treating IPV patients, tailoring treatment according to individual IPV victim's problems, correcting behaviors that are associated with risks of IPV, such as engagement in casual sex and substance abuse, and focusing not only on tangible services but also on the social and psychological aspects that are placing the victims at risk for IPV.Journal of Interpersonal Violence 06/2011; 26(9):1763-84. · 1.64 Impact Factor -
Article: Quitting trajectories of Chinese youth smokers following telephone smoking cessation counseling: a longitudinal study.
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ABSTRACT: The smoking patterns of youth remain unknown after they have received smoking cessation counseling. This study aims to examine the quitting trajectories of Chinese youth smokers after they have received quitline services and to examine factors to predict their quitting trajectories. A total of 402 Chinese youth smokers (aged 12-25 years) called a quitline and participated in telephone follow-ups at 1 week, 1 month, and 3 and 6 months after initial telephone counseling. Finite mixture modeling was employed to examine the quitting trajectories by the SAS Proc Traj group-based modeling procedure. Hierarchical multinomial logistic regression was used to compare the baseline intention to quit smoking, prosmoking attitudes, social influences, self-efficacy to quit, smoking profile, quitting history, and demographic characteristics among the trajectory groups. Three distinct quitting trajectory groups were identified: quitters, reducers, and persistent smokers. Both quitters and reducers dramatically reduced the level of their cigarette consumption immediately after initial counseling. Youth smokers who were intended to quit at baseline, perceived confidence to quit, and perceived importance of quitting were more likely to have successfully quit smoking at six-month follow-up. Those who had prosmoking attitudes were less likely to quit smoking. Conclusion: The findings reveal the profiles of youth smokers who can quit successfully and can guide the development of better and relevant interventions based on the psychosocial characteristics of youth smokers. Short-term goals such as an abrupt quit attempt or immediately reducing cigarette consumption by half may be the key to help youth smokers quit successfully.Nicotine & Tobacco Research 05/2011; 13(9):848-59. · 2.58 Impact Factor -
Article: Associating pregnancy with partner violence against Chinese women.
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ABSTRACT: The present study discusses if pregnancy is a risk factor for intimate partner violence using a large, representative sample containing detailed information on partner violence including physical and sexual abuse as well as perpetrator-related risk factors. Data from a representative sample of 2,225 men were analyzed. The self-reported prevalence of men's violence against their female partners was computed and compared in terms of demographic, behavioral, and relationship characteristics. The preceding-year prevalence of physical assault, sexual violence, and "any violence or injury" among the group whose partners were pregnant was 11.9%, 9.1%, and 18.8%, respectively. This is significantly higher than the nonpregnant group. Pregnancy was significantly associated with increased odds of violence, including physical assault, sexual violence, and "any violence or injury" (ORs = 2.42, 2.42, and 2.60, respectively). Having controlled for relationship characteristics including social desirability, social support, in-law conflict, dominance, and jealousy of male perpetrators, pregnancy was significantly associated with "any violence or injury." Demographic and behavioral variables accounted for pregnant women's significantly higher odds of having been abused in the year preceding the data collection. This study provides preliminary findings on the association between pregnancy and partner violence. Our findings underscore the need to screen for violence among pregnant women in clinical health care settings as well as in communities. Perpetrator-related risk factors should be included in the assessment of risk for partner violence against pregnant women. For the prevention of intimate partner violence, family-based intervention is needed to work with victims as well as perpetrators.Journal of Interpersonal Violence 05/2011; 26(7):1478-500. · 1.64 Impact Factor -
Article: A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status.
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ABSTRACT: Little is known regarding juvenile disc degeneration in individuals with normal spinal alignment. Consequently, the purpose of this study was to assess the prevalence, determinants, and clinical relevance associated with juvenile disc degeneration of the lumbar spine in individuals without spinal deformities. A cross-sectional assessment of disc degeneration in juveniles was performed as part of a population-based study of 1989 Southern Chinese volunteers. Adolescents and young adults from thirteen to twenty years of age were defined as "juveniles." Juvenile subjects with no spinal deformity (n = 83) were stratified into two groups, those with and those without juvenile disc degeneration. Sagittal T2-weighted magnetic resonance images (MRI) were evaluated for the presence and extent of disc degeneration as well as other spinal findings. Demographics were assessed and clinical profiles were collected with use of standardized questionnaires. Juvenile disc degeneration was present in 35% (twenty-nine) of the juveniles without spinal deformity. Disc bulging or extrusion (p < 0.001), high-intensity zones on MRI (p = 0.040), and greater weight (p < 0.001) and height (p = 0.002) were significantly more prevalent in subjects with juvenile disc degeneration. Adjusted multivariate logistic regression modeling demonstrated that Asian-modified body-mass index (BMI) values in the overweight or obese range had a significant association with juvenile disc degeneration (odds ratio = 14.19; 95% confidence interval = 1.44 to 140.40; p = 0.023). Overweight and obese individuals had greater severity of disc degeneration than underweight and normal-weight individuals (p = 0.036). Furthermore, individuals with juvenile disc degeneration had an increased prevalence of low back pain and/or sciatica (p = 0.002), greater low back pain intensity (p < 0.001), diminished social functioning (p = 0.049), and greater physical disability (p < 0.05) than individuals without disc degeneration. The p value of <0.05 for physical disability represents both the physical function (p = 0.006) and the physical component (p = 0.032) of the SF-36. This study demonstrated that the presence of juvenile disc degeneration was strongly associated with overweight and obesity, low back pain, increased low back pain intensity, and diminished physical and social functioning. Furthermore, an elevated BMI was significantly associated with increased severity of disc degeneration. This study has public health implications regarding overweight and obesity and the development of lumbar disc disease.The Journal of Bone and Joint Surgery 04/2011; 93(7):662-70. · 3.27 Impact Factor -
Article: Child maltreatment polyvictimization: Rates and short-term effects on adjustment in a representative Hong Kong sample.
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ABSTRACT: Objective: This article examines the unique effects of multiple forms of victimization, namely child abuse and neglect (CAN) and exposure to parental intimate partner violence (IPV), on children's self-blame, feelings of being threatened, self-esteem, and ability to control anger. Method: The cross-sectional study recruited a population-based sample of 2,062 children aged 12–17 years in Hong Kong. Structured questionnaires were used to collect data from the children. The prevalence rate of the co-occurrence of exposure to IPV and CAN in the Chinese population, and the unique impacts of exposure to IPV and CAN on children were examined. Results: The results show that 13.1% of the children had experienced CAN, and 6.5% had witnessed parental IPV. Among those families characterized by IPV, 61.1% were involved in child abuse in the preceding year of the study. Participants who had experienced both CAN and exposure to parental IPV reported lower levels of self-esteem and higher rates of being aggressive and violent, and feeling threatened. These children also reported the highest levels of feeling that their well-being was threatened and of blaming themselves for parental violence and parental discipline. Conclusions: The findings reemphasize the important need for public policy on child and youth victimization that encourages social workers and Child Protective Services to screen for child polyvictimization in cases of suspected/reported child abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)Psychology of Violence. 12/2010; 1(1):4-15. -
Article: Costs of school scoliosis screening: a large, population-based study.
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ABSTRACT: This was a population-based retrospective study. To fully estimate the costs of the Hong Kong scoliosis screening program through a large, population-based study. School screening for scoliosis has often been criticized for having high costs. In fact, the screening cost that has reported varied widely, from less than 1 to more than 30 US dollars (USD) per child screened. This variation is mainly due to the incomplete inclusion of cost items. We examined the screening and medical histories of a cohort of 115,190 screened students who were in Grade 5 in 1995/96 or 1996/97. The average costs spent on screening, diagnosing, following, and treating this cohort of students were calculated. The total expenses in the screening centers increased steadily from USD 380,930 in 1995/96 to USD 2,417,824 in 2005/06. Based on the 115,190 students who were followed up until they were 19 years old or they left school, the costs of screening and diagnosing 1 student during adolescence were USD 17.94 and USD 2.08, respectively. Of the 1311 referrals who attended the specialist hospitals for diagnosis, 264 and 39 had been braced and operated on, respectively. The medical care cost averaged USD 34.61 per student screened. The cost of finding 1 student with a curvature ≥20° and 1 treated case were USD 4475.67 and USD 20,768.29 respectively. This was the largest study that has evaluated school scoliosis screening on students who were followed during their adolescence and accounted for all relevant costs. The cost per student screened in the scoliosis screening program in Hong Kong was comparable to that in Rochester, which had a similar protocol and was evaluated in a similar manner. The estimated costs can help the policy makers when they allocate healthcare resources.Spine 12/2010; 35(26):2266-72. · 2.08 Impact Factor -
Article: Referral criteria for school scoliosis screening: assessment and recommendations based on a large longitudinally followed cohort.
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ABSTRACT: This study was a retrospective cohort study. To examine the criteria recommended in the literature for the school-based scoliosis screening program in Hong Kong. School-based screening for scoliosis has been a controversy. Objectors to the policy were concerned about the high over-referral and false-positive rates. Recommendations were then made for improvement, but the feasibility of these recommendations has not been studied. The cohort consisted of students in Grade 5 in 1995/1996 or 1996/1997 who underwent scoliosis screening in Hong Kong. Participants who had an angle of trunk rotation (ATR) ≥15°, 2 or more moiré lines, or presented significant clinical signs were referred for radiography. Screening histories and radiography records before the age of 19 years were extracted. The accuracy measures for different combinations of screening tests were examined. There were 115,178 students in the cohort, of which 3228 (2.8%) were referred for radiography. Among the 1406 students who displayed a curve ≥20° during screening, 257 (18.3%) were boys and 336 (23.9%) were identified as 16 years or older, ruling out the suggestion of screening only 10-year-old girls. The sensitivity and positive predictive value for the current referral criteria were 88.1% and 43.6%, respectively. The sensitivity would drop substantially if the use of moiré topography (39.8%) or clinical signs (55.5%) were discarded. With the inclusion of these 2 tests, the clinical effectiveness measures were robust to the cutoff for ATR, unless it was set below 10°. Selectively screening only premenarche girls was not feasible, as this screen would have missed a significant proportion of children with significant curvature. No refinement of the current protocol was necessary, although boys could be screened beginning at 12 years of age. The tandem use of ATR, moiré topography, and clinical signs was recommended for future studies.Spine 12/2010; 35(25):E1492-8. · 2.08 Impact Factor -
Article: Patterns and predictors of quitting among youth quitline callers in Hong Kong.
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ABSTRACT: To examine the time patterns and predictors of initiating a quit attempt and subsequent sustained abstinence among youth smokers after receiving a telephone smoking cessation intervention. This was a longitudinal study of 408 current youth smokers aged 12-25 years who called a smoking cessation hotline in Hong Kong. Telephone surveys were conducted at baseline; 1 week; and 1, 3, and 6 months to assess smoking status and other risk factors. Nonparametric Kaplan-Meier methods and hierarchical Cox's proportional odds models were applied to explore the time patterns and predictors of the quitting process. Half of the youth smokers initiated a quit attempt within 1 month after receiving the baseline telephone intervention, while the likelihood of further quit attempts decreased over time. Two thirds relapsed within the first 7 days after starting a quit attempt. Intention to quit, previous quit attempts, perceived physical unfitness, and other factors could predict the initiation of a quit attempt. Sustained abstinence was facilitated by making an immediate attempt to quit, adopting self-help strategies, and a perceived improvement in physical health. Our findings support the "catastrophic" pathway of youth smokers initiating a quit attempt. Counselors should capture the quitting momentum and motivate youth smokers to quit immediately. Interventions should include a health assessment and discussion of smokers' physical fitness. During the first week of abstinence, intensive monitoring of withdrawal symptoms, together with booster counseling, is helpful in preventing smoking relapse and could remotivate those who fail to sustain their quit attempt.Nicotine & Tobacco Research 11/2010; 13(1):7-14. · 2.58 Impact Factor -
Article: ISSLS prize winner: prevalence, determinants, and association of Schmorl nodes of the lumbar spine with disc degeneration: a population-based study of 2449 individuals.
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ABSTRACT: A cross-sectional population-based magnetic resonance imaging study of Schmorl nodes (SN) in the lumbar spine. To determine the prevalence and potential determinants of SN, and their association with intervertebral disc degeneration. SN represent intravertebral disc herniation and are commonly seen in the spine. Their reported prevalence and determinants vary, and their association with disc degeneration remains uncertain. Data based on this large scale population-based study of intervertebral disc degeneration would provide important information for understanding SN and their pathomechanism. Sagittal T2-weighted magnetic resonance imagings of the lumbar spine were analyzed in 2449 volunteers. Two independent observers assessed the images for the presence of SN, and scored for additional radiologic features (e.g., severity of degeneration, presence of disc bulge/extrusion). Subject demographics were assessed by standardized questionnaire. SN were found in 16.4% (n = 401; 219 males, 182 females; mean age = 42.3) of our study population (981 males, 1468 females; mean age = 40.4), being most common at L1/2 and L2/3 (54.1%). Multivariate logistic regression revealed that males, taller and heavier individuals had an increased likelihood of SN (P < 0.005), but association between SN and age were not discerned. Overall presence of SN was associated with disc degeneration (P < 0.001), and linearly correlated (R = 0.97) with increase in severity of degeneration. SN were particularly associated with severe disc degeneration at L1/2 and L2/3 with 22- to 15-fold increased odds, respectively (P < 0.0001), but less than 5-fold increased odds (P < 0.001) were noted in the lower lumbar spine. In a population-based cohort, 16.4% of Southern Chinese subjects had SN at 1 or more lumbar levels. Males, taller and heavier individuals had increased likelihood of SN. Interestingly, SN were highly associated with severity of disc degeneration.Spine 10/2010; 35(21):1944-52. · 2.08 Impact Factor -
Article: Brief problem-solving treatment in primary care (PST-PC) was not more effective than placebo for elderly patients screened positive of psychological problems.
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ABSTRACT: To evaluate whether screening followed by brief problem-solving treatment by primary care doctors (PST-PC) could improve health-related quality of life (HRQOL) and reduce consultation rates in the elderly. A single-blind randomized placebo controlled trial (RCT). Two government funded primary care clinics in Hong Kong. Two hundred and ninety nine Chinese patients aged 60 years or over, with positive screening scores for psychological problems by the Hospital Anxiety and Depression Scale (HADS). One hundred and forty nine subjects were randomized to receive brief PST-PC from primary care doctors (treatment) and 150 to group video-viewing (placebo). All subjects were followed up by telephone at 6, 12, 26 and 52 weeks. Changes in SF-36 HRQOL scores, HADS scores and monthly consultation rates were compared within and between groups. Study completion rates were 69-71%. There was significant improvement in the SF-36 role-emotional (RE) and mental component summary (MCS) scores at week 6 in the PST-PC group but not in the placebo group. Several SF-36 scores improved significantly in the placebo (video) group at week 6-52. Mixed effects analysis adjusting for baseline values and cofounders did not show any difference in any of the outcomes between the PST-PC and placebo (video) groups. Screening followed by brief PST-PC was associated with a short-term improvement in HRQOL in Chinese elderly patients screened positive of psychological problems, but the HRQOL benefit was not greater than those found in the placebo group who participated in group-viewings of health education videos.International Journal of Geriatric Psychiatry 10/2010; 25(10):968-80. · 2.42 Impact Factor -
Article: Erratum: Intervertebral disc degeneration: New insights based on "skipped" level disc pathology.
Arthritis & Rheumatism 09/2010; 62(9):2830. · 7.87 Impact Factor -
Article: Predictors of intention to quit smoking in Hong Kong secondary school children.
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ABSTRACT: Behavioral theories suggest that a past quit attempt influences psycho-social determinants to predict smokers' intention to quit, although no study has tested the hypothesis among youth smokers. A sample of 1561 Chinese secondary students, who were current smokers, were collected in a cross-sectional school-based survey in Hong Kong. For the 943 students with past quit attempts, those with lower daily cigarette consumption; who perceived smoking would not elicit positive social responses from others; who had one parent/teacher who prohibited them to smoke; who were aware of the health hazards of smoking and being male smokers, were more likely to have an intention to quit smoking. For the 618 students without a past quit attempt, those who did not perceive any benefit from smoking; who had parents and teachers to prohibit them to smoke and who received social support to quit, were more likely to have an intention to quit smoking. Strengthening the prohibition of smoking and providing social support may help initiate the intention to quit among youth smokers without a past quit attempt, while de-normalizing social images of smoking, providing information about the health hazards of smoking and relieving nicotine addiction may sustain quitting intentions among youth smokers with past quit attempts.Journal of Public Health 09/2010; 32(3):360-71. · 2.06 Impact Factor -
Article: Intervertebral disc degeneration: new insights based on "skipped" level disc pathology.
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ABSTRACT: Typically, age and abnormal physical loading ("wear and tear") have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, "skipped" level (nonconsecutive) disc degeneration (SLDD). As part of a large genetics-based study in southern Chinese individuals (n = 1,989), a cross-sectional analysis was performed in subjects exhibiting disc degeneration in > or = 2 levels (n = 838) who were then categorized as having SLDD (n = 174) or non-SLDD (contiguous, multilevel; n = 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed. Overall, 8.7% of the whole population (n = 1,989) had SLDD, while it was present in 20.8% of subjects with multilevel disc degeneration (n = 838). SLDD was more prevalent in male subjects (adjusted odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.04-2.10, P = 0.028). SLDD was significantly associated with the presence of Schmorl's nodes (adjusted OR 2.72, 95% CI 1.78-4.15, P < 0.001), which also presented in levels with no disc degeneration. A history of disc bulge/extrusion (P = 0.004) and/or a history of back injury (P = 0.010) was significantly associated with non-SLDD, and a greater degree of overall severity of disc degeneration was also associated with non-SLDD. Other demographic and MRI findings did not significantly differ between groups. To our knowledge, this report is the first to describe the prevalence and risk factors associated with SLDD. Our study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, our novel findings of SLDD patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration.Arthritis & Rheumatism 08/2010; 62(8):2392-400. · 7.87 Impact Factor -
Article: Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study.
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ABSTRACT: Retrospective cohort study. To evaluate the clinical effectiveness of school scoliosis screening using a large and long-term-followed cohort of students in Hong Kong. School screening for adolescent idiopathic scoliosis has been criticized as resulting in over-referrals for radiography and having low predictive values. Indeed, all but one previous retrospective cohort studies had no follow-up assessments of students until their skeletal maturity, leaving any late-developed curves undetected. The one study that completed this follow-up was well conducted but had low precisions due to its small sample size. A total of 157,444 students were eligible for a biennial scoliosis screening, and their screening results and medical records up to 19 years of age were available. Students first had forward bending test and angle of trunk rotation (ATR) performed. Those with ATR between 5 degrees and 14 degrees or signs of adolescent idiopathic scoliosis were assessed by moiré topography regularly. Students with an ATR >or=15 degrees , >or=2 moiré lines, or significant clinical signs were referred for radiography and had their Cobb angle measured. Of the 115,190 screened students in the cohort, 3228 (2.8%, 95% confidence interval [CI] = 2.7%-2.9%) were referred for radiography. At the final follow-up, the positive predictive values were 43.6% (41.8%-45.3%) for a Cobb angle >or=20 degrees and 9.4% (8.4%-10.5%) for needing treatment, while the sensitivities were 88.1% (86.4%-89.6%) and 80.0% (75.6%-83.9%), respectively. This is the largest study that has demonstrated that school scoliosis screening in Hong Kong is predictive and sensitive with a low referral rate. Screening should thus be continued in order to facilitate early administration of conservative treatments.Spine 05/2010; 35(17):1607-14. · 2.08 Impact Factor -
Article: Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong.
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ABSTRACT: The Hospital Anxiety and Depression Scale (HADS) is widely used in adult populations; however, its usefulness with adolescents has been explored less. This study sought to evaluate the reliability, validity, and factor structure of the Chinese version of HADS in a community sample of adolescents residing in Hong Kong. A prospective cohort of 5,857 students recruited from 17 secondary schools completed the HADS. Internal consistency and concurrent validity were examined. Confirmatory factor analysis was applied to test the relative fits of six factor structures of the HADS. The best fitting model was further cross-validated by male, female, split-half samples, and age subgroups. The HADS possessed adequate internal consistency, especially for the anxiety subscale. Significant concurrent intercorrelations with self-reported suicidal thoughts and the Youth Self Report Anxious/Depressed subscale were discovered and found to be stronger for females. The cross-validation supported a two-factor model, where anxiety item 7, "I can sit at ease and feel relaxed", was placed in the depression subscale. The HADS showed satisfactory psychometric properties as a screening instrument in assessing anxious and depressive states as two correlated but distinct factors in adolescents. Study implications and recommendations for future research were discussed.Quality of Life Research 04/2010; 19(6):865-73. · 2.30 Impact Factor
Top co-authors
Top Journals
Institutions
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1993–2010
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The University of Hong Kong
- • School of Nursing
- • Department of Nursing Studies
Hong Kong, Hong Kong
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1995
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University of Waterloo
- Department of Statistics and Actuarial Science
Waterloo, Ontario, Canada
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