Search

Abstract: Objective: to identify the antenatal taboos commonly practised by pregnant Hong Kong Chinese women; to explore the health beliefs behind these taboos; and to examine how pregnant women perceived and reacted to the cultural tradition. Design: general ethnography and in-depth interviews, followed by a quantitative self-reported survey. Setting: Antenatal clinic of a university-affiliated hospital in Hong Kong. Participants: consecutive samples of 60 women for in-depth interviews, and 832 women for the survey. Measurements: an inventory on the adherence and attitude towards antenatal taboos, and the Beck Depression Inventory that measures severity of depression. Findings: antenatal taboos were still commonly observed by contemporary Chinese women. Miscarriage, fetus malformation and fetal ill-health were the key cultural fears that drove contemporary Chinese women to observe the traditional taboos. About one-quarter and one-tenth of the women, respectively, felt unhappy and disputed with their families about the taboos. These women had significantly higher levels of depression in late pregnancy and during childbirth. Implications for practice: health-care practitioners should be aware of the benefits and risks of traditional antenatal taboos on maternal health. Although some taboos can be socio-morally protective, the tension created by the observation of cultural tradition in modernity may impair maternal psychological well-being. Health-care providers in Western countries should be vigilant of the complex cultural tension faced by migrant Chinese mothers. [Copyright &y& Elsevier]

Abstract: This study assessed the impact of an information pamphlet on acceptance of human papillomavirus (HPV) vaccine in Chinese women. The pamphlet increased the self-perceived knowledge on cervical cancer and HPV of the study subjects and had a positive influence on women accepting HPV vaccination for their daughters (p < .001). [Copyright &y& Elsevier]

OBJECTIVE: We assessed and compared the quality of life, marital relationship, and sexual function of women who had urodynamic stress incontinence (USI) or detrusor overactivity (DO) diagnosed. STUDY DESIGN: Women with the following urodynamic diagnoses, normal, USI, or DO, were compared by using the psychometric questionnaires: King's Health Questionnaire (KHQ, for quality of life), Dyadic Adjustment Scale (DAS, for marital relationship), and Derogatis Sexual Functioning Inventory (DSFI, for sexual function). RESULTS: Women with DO (n = 29) were younger than healthy women (n = 28) and women with USI (n = 36) (P < .05). Women with USI or DO had a poorer quality of life (P < .05), poorer marital relationship (P < .05), and less sexual satisfaction (P < .05), despite having no change in sexual drive (P > .05). Regression analyses showed that only sexual satisfaction and incontinence-related emotions were associated with marital relationship (P < .05). CONCLUSION: Marital relationship and sexual function were negatively affected in women who had USI or DO. [ABSTRACT FROM AUTHOR]

This research note presents an information quality evaluation model for measuring the performance of hotel websites. The model is developed on the basis of a conceptual framework which consists of five major hotel website dimensions, including facilities information, customer contact information, reservations information, surrounding area information, and management of websites. The dimensions and their associated attributes were obtained and modified from published articles in the hospitality and tourism literature. A preliminary study was performed with Hong Kong hotel managers to rate the level of importance of the dimensions and attributes. The model was then applied to initially measure the performance of the websites of Hong Kong hotels. The performance result of a website is expressed by the total performance score of the site. Experimental findings show significant differences in performance scores for all dimensions among the luxurious, mid-priced, and budget hotel websites. This research should be of interest to hotel practitioners and researchers as the findings shed light on the further development of quantitative measurements for hotel websites. [Copyright &y& Elsevier]

Examines the prevalence of urinary incontinence in women with postpartum urinary retention. Mechanisms involved in postpartum urinary retention; Factors contributing to the incidence of the syndrome; Relationship between nerve damage and urinary incontinence.

Objectives: To identify clinical risk factors for dislodgment of vaginal pessary within one year in women with symptomatic pelvic organ prolapse.Study Design: This was a prospective observational study which recruited consecutive women with symptomatic pelvic organ prolapse in a tertiary urogynecology center. Basic demographics, clinical symptoms and staging of pelvic organ prolapse were assessed. A vaginal pessary was offered where appropriate.Main Outcome Measures: Demographics and clinical parameters were compared between women who were able to use a vaginal pessary for one year and those whose pessaries were dislodged within one year.Results: A total of 779 women were recruited and had a vaginal pessary inserted. Of them, 528 women, with a mean age of 64.7 (SD 10.1) years, returned for one-year follow-up; 177 (33.5%) had their pessary dislodged within one year and 351 (66.5%) had been able to retain the pessary. Stage III or IV prolapse (OR 1.76), prolapse predominant at the apical compartment (OR 2.14) and larger genital hiatus (OR 1.63) were factors associated with dislodgment of the vaginal pessary. Age, body mass index, previous hysterectomy and short vagina were not associated with dislodgment. Nevertheless, 47.6% of women with stage III/IV prolapse could still keep the pessary for one year.Conclusion: Higher staging of prolapse, larger genital hiatus and apical compartment prolapse are clinical predictors for dislodgment of a vaginal pessary. Despite this, nearly half of women with stage III/IV prolapse were able to use a vaginal pessary for one year. Therefore, a vaginal pessary should be offered despite their staging of prolapse. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the effects of 4-month treatment of medroxyprogesterone acetate (MPA) and Diane-35 on the clinical and biochemical features of hyperandrogenism and quality of life of adolescent girls with polycystic ovarian syndrome (PCOS). Design: A prospective, randomized, cross-over study. Setting: An accredited pediatric and adolescent gynecology clinic of a university-affiliated tertiary hospital. Participants: 76 adolescents girls aged 14 to 19 years old with PCOS were recruited from July 2007 to July 2010. Interventions: Girls were randomized into 2 groups. Group 1 received oral MPA for 4 months, followed by a washout period of 4 months, and then Diane-35 for another 4 months. Group 2 received the same combination but in the reverse order. Main Outcome Measures: Clinical and biochemical features of hyperandrogenism and quality of life were assessed. Results: There was no significant difference between the 2 groups at baseline. No significant difference was found in the clinical and biochemical parameters of hyperandrogenism before and after treatment with MPA. Significant reduction of the acne score, LH/FSH ratio, and testosterone level was seen after taking Diane-35. Hirsutism was also improved but it did not reach statistical significant. When comparing post-MPA and post-Diane-35, the post-Diane-35 group had significantly improved acne score and LH/FSH ratio. No significant difference was found on quality of life between both groups after treatment. Conclusion: Diane-35 may be a more suitable treatment option in adolescent girls diagnosed with PCOS when compared to MPA. [Copyright &y& Elsevier]

Objectives: One of the long-term consequences of estrogen deficiency in postmenopausal women is an increased risk of osteoporosis. Fractures of the hip and lumbar spine are associated with considerable morbidity and mortality. Estrogen replacement therapy reduces the risk of osteoporosis, but there is no clear agreement on the most appropriate doses to be used. The aim of this study was to compare changes in bone mineral density (BMD) measurements using conventional and lower dose estradiol. Methods: A prospective, randomized, placebo-controlled 12-month study of the effect of 1 and 2 mg estradiol on BMD in 152 hysterectomized postmenopausal Chinese women with no contraindication to the use of estrogen replacement therapy. Results: Over 12 months, spinal BMD in placebo treated patients decreased by a mean of 2% from baseline (−0.02±0.03 g/cm2) while it increased by 2% in the 1 mg (0.02±0.03 g/cm2) and 3% in the 2 mg group (0.03±0.03 g/cm2). Mean changes in BMD over 12 months in the hip were −0.02±0.02 g/cm2 (−2%), 0.01±0.02 g/cm2 (+1%) and 0.01±0.03 g/cm2 (+1%) in the placebo, 1 and 2 mg estradiol groups, respectively (P<0.05). Relative to placebo, increases in BMD in both 1 and 2 mg groups were statistically significant for both spine and hip (P<0.05). However, there was no significant difference in the increase in BMD between the 1 and 2 mg doses for either lumbar spine or hip (P=0.82, 0.53, respectively). Conclusion: The results of our study show that a 1 mg dose of oral estradiol is effective in preventing bone loss in postmenopausal Chinese women. [Copyright &y& Elsevier]

Objectives: Hypoestrogenism occurring in association with the menopause may result in the development of vasomotor symptoms and it may also have a detrimental effect on psychological well being and quality of life (QOL). The aims of this study were to measure menopausal symptoms, mood and QOL in postmenopausal Chinese women and to assess the effect of different doses of oestrogen on these outcome indicators.Methods: A prospective, randomized, placebo-controlled study of the effect of 1 and 2 mg oestradiol on menopausal symptoms, anxiety and depressive symptoms, and QOL in 152 postmenopausal women over a 12 month study period. Menopausal symptoms were measured using a modified Kupperman's scale. Anxiety and depressive symptoms and QOL were measured using the Hospital Anxiety and Depression Scales and a modification of the World Health Organization Quality of Life questionnaire, respectively.Results: Baseline scoring of vasomotor symptoms in our population was low whilst QOL scoring was relatively high. Over 12 months, after adjustment for differences in baseline scoring, there was a significant reduction in menopausal symptom scores in the 2 mg oestradiol group compared with placebo but not in the 1 mg group. There were no statistically significant changes in levels of anxiety and depression or QOL in either the 1 or the 2 mg group compared with placebo.Conclusions: These results suggest that relatively few Chinese women will be expected to benefit from hormone replacement in terms of either QOL or mood. In addition, the overall benefit of treatment for vasomotor symptoms will be less for a given number of Chinese women than for Caucasians. Therefore, when considering the reasons for prescribing hormone replacement therapy in this population, protection against osteoporosis will for most women be the prime consideration. [ABSTRACT FROM AUTHOR]

Abstract: During recent decades there have been remarkable advances in biology, in which one of the most important discoveries is RNA interference (RNAi). RNAi is a specific post-transcriptional regulatory pathway that can result in silencing gene functions. Efforts have been done to translate this new discovery into clinical applications for disease treatment. However, technical difficulties restrict the development of RNAi, including stability, off-target effects, immunostimulation and delivery problems. Researchers have attempted to surmount these barriers and improve the bioavailability and safety of RNAi-based therapeutics by optimizing the chemistry and structure of these molecules. This paper aimed to describe the principles of RNA interference, review the therapeutic potential in various diseases and discuss the new strategies for in vivo delivery of RNAi to overcome the challenges. [Copyright &y& Elsevier]

Abstract: Postnatal depression affects both men and women. The detection of postnatal depression is important, yet there are few validated screening tools on Chinese men. The goals of the present study were to compare the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), and the Patient Health Questionnaire — Depression Module (PHQ-9) in screening for postnatal depression among Chinese fathers in Hong Kong. The prevalence of depression at 8 weeks postpartum was also estimated. A prospective cohort of 551 men completed the EPDS, BDI, and PHQ-9 at 8 weeks postpartum. Clinical diagnosis of depression was established with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), non-patient version (SCID-NP). The criterion validity of the instruments was evaluated against this clinical diagnosis. The EPDS was significantly more accurate than the BDI and PHQ-9 in detecting postnatal depression among Chinese men. With a cut-off score of 10 or more, the EPDS has a sensitivity of 91%, specificity of 97%, positive predictive value of 57%, and negative predictive value of 99%. Approximately 3.1% men met the DSM-IV criteria for depression at 8 weeks postpartum. The prevalence rate of postnatal depression in Chinese men is comparable to their Western counterparts. The Chinese EPDS is a valid instrument for detecting postnatal depression in men. It could be applied as a supplementary assessment tool in Chinese fathers who may be reluctant to disclose their depressive symptoms in face-to-face interviews. [ABSTRACT FROM AUTHOR]

Objective: To examine the 1-year longitudinal course of psychological outcomes after miscarriage. Design: Longitudinal observational study. Setting: University-affiliated teaching hospital. Patient(s): 280 miscarrying women and 150 nonpregnant women. Intervention(s): Psychological outcomes were assessed using the 12-item General Health Questionnaire (GHQ-12) and Beck Depression Inventory (BDI) immediately, 3 months, 6 months, and 12 months after miscarriage. Main Outcome Measure(s): Scores on GHQ-12 and BDI. Result(s): Half (55%) of the miscarrying women scored high (≥4) on the GHQ-12 immediately, 25% at 3 months; 17.8% at 6 months, and 10.8% at 1 year after miscarriage; 26.8% of the patients scored high on the BDI (≥12) immediately, 18.4% at 3 months, 16.4% at 6 months, and 9.3% at 1 year after miscarriage. Patients who were initially more distressed continued to score higher on both the GHQ-12 and the BDI along the 1-year course when compared with those who were initially less distressed. When compared with the nonpregnant controls, the miscarrying women scored statistically significantly higher on the GHQ-12 and BDI; the differences became not statistically significant only 1 year after miscarriage. Conclusion(s): A statistically significant proportion of patients reported psychological morbidity shortly after miscarriage, but their level of distress reduced over time until they were comparable with the controls 1 year later. Patients who were initially more distressed continued to be throughout the 1-year course. [Copyright &y& Elsevier]

Abstract: Study Objective: The objective of the study was to assess the attitudes of adolescent girls on Human papillomavirus (HPV) vaccination and the impact of an information pamphlet on their attitude. Other factors that may affect their attitude were also studied. Design: Questionnaire survey. Setting: Pediatric and adolescent gynecology clinic. Participants: 250 adolescents aged 12 to 19 years. Interventions: Participants completed a questionnaire regarding their knowledge and attitudes towards HPV vaccination. Immediately following this, they read an information pamphlet on HPV vaccination. They then completed the same questionnaire again. Main Outcome Measures: The attitude of the adolescents towards HPV vaccination. Results: Initially, 35% intended to receive the vaccination but after reading the information pamphlet, it rose to 69%. Their intention was positively correlated with their knowledge (P = 0.003), health belief (P < 0.001) and belief in who should receive the vaccine (P < 0.001) but negatively correlated with their belief that other people would approve of their vaccination (normative belief) (P < 0.001). There was a significant increase in their knowledge score (P < 0.001) after reading the pamphlet. Their health belief and belief in who should receive vaccine became more positive (P < 0.001), but the normative belief was more negative (P = 0.002) after reading. Conclusion: 69% of adolescent girls intended to receive HPV vaccination and their intention was improved by reading an information pamphlet. It was positively correlated with their knowledge, health belief, and belief in who should receive the vaccine, but negatively correlated with their normative belief. [Copyright &y& Elsevier]

Objective: The aim of the present study was to examine the behavioral and psychological responses of pregnant women during the 2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong.Methods: Ethnographic interviews were first conducted to identify the common psychological and behavioral responses to the outbreak. This was followed by a case-control study of 235 consecutive pregnant women recruited during the SARS epidemic, and a historical cohort of 939 pregnant women recruited a year before the outbreak. Both cohorts completed standardized rating scales on depression, anxiety, and social support.Results: Women in the SARS cohort adopted behavioral strategies to mitigate their risk of contracting infection. However, pregnant women tended to overestimate the risk of contracting SARS and nearly a third of the women were homebound. The anxiety level of the SARS cohort was slightly higher than that of the pre-SARS control. No statistical difference was found between the depression levels of the two cohorts.Conclusion: The improved social support experienced by pregnant women during SARS might have buffered the stress associated with an outbreak. However, clinicians should monitor for overestimation of infectious risk among pregnant women. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the pregnancy outcomes of two policies of timing of induction of labor for post-term pregnancies. Study design: It is a retrospective study in a University obstetric unit from 1997 to 2002. Five thousand eight hundred and ninety-two singleton, cephalic pregnancies with gestational age at delivery at or more than 41 completed weeks were studied. They were divided into two groups. Group A included women who delivered from January 1997 to February 1999 when the policy of the department was to induce labor for post-maturity at 42 weeks of gestation. Group B included those delivered between March 1999 and December 2002 when the timing of induction for post-term was advanced to 41 weeks. The intrapartum characteristics, delivery and perinatal outcomes were analyzed by Student''s t-test and Chi-square test for continuous and categorical variables, respectively. Results: Two thousand one hundred and seventy-six women were studied in Group A and 3716 in Group B. Twenty-nine percent of these pregnancies in Group A required induction of labor whereas 20.3% were for post-term. In Group B, 58% of pregnancies had labor induction and 55% for post-maturity. For the pregnancies undergoing induction of labor for post-term, both the duration of labor (P <0.001) and the need of intrapartum epidural analgesia were increased (OR 1.3, 95% CI: 1.0–1.6) in Group B. However, there was no significant difference in the mode of delivery, apgar scores and stillbirths between the two study periods. Conclusion: Compared to routine induction at 42 weeks, induction at 41 weeks is associated with a significantly higher risk of use of medical interventions and associated complications, with no observable benefits. [Copyright &y& Elsevier]

Abstract: The combined oral contraceptive (COC) pills, injectables, intrauterine contraceptive device (IUCD) and female sterilization are the most common contraceptive methods used by women. Women''s choice, compliance and satisfaction with specific contraceptive methods are influenced by any impact of the method on their quality of life and sexual function. Anxiety regarding possible adverse effects of the contraceptive methods on their quality of life and sexual function is one of the common concerns. The aim of this prospective observational study was to determine the impact of the abovementioned contraceptive methods on the quality of life and sexual function of the users. A sample of 361 Hong Kong Chinese women who were first-time users of the following contraceptive methods completed the study: COC pills (n=87), injectables (n=67), IUCD (n=96) and female sterilization (n=111). Quality of life and sexual function of the subjects were assessed before and 3–4 months after use of the method by a standardized questionnaire. The questions were adopted from the validated Chinese versions of the World Health Organization Quality of Life (WHOQOL) questionnaire and the Derogatis Sexual Functioning Inventory (DSFI). In the female sterilization group, we found a significantly higher score for sexual satisfaction (p=.004) and sexual drive (p=.003) 3–4 months after sterilization, as well as an improved WHOQOL social domain score (p=.009). However, the other DSFI subscale scores and WHOQOL domain scores were not significantly different (p>.05). No significant difference was demonstrated in all the WHOQOL domain scores and DSFI subscale scores after use of COC pills, injectables and IUCD (p>.05). We conclude that the COC pills, injectables, IUCD and female sterilization all do not have significant adverse impact on quality of life and sexual function. After female sterilization, there is a significant improvement in sexual satisfaction and sexual drive. [Copyright &y& Elsevier]

Ovarian carcinoma is a leading cause of gynecologic cancer death in women. Despite treatment, a large number of women with ovarian cancer eventually relapse and die of the disease. Hence, recurrent ovarian cancer continues to be a therapeutic dilemma, possibly a result of the emergence of drug resistance during relapse. Recent advances in expression genomics enable global transcript analysis that leads to molecular classification of cancers and prediction of outcome and treatment response. We did a cDNA microarray examination of the expression profiles of eight primary ovarian cancers stratified into two groups based on their chemotherapeutic response. We applied a voice–speech–pattern recognition algorithm for microarray data analysis and were able to model and predict the response of these patients to chemotherapy from their expression profiles. Hence, gene expression profiling by means of DNA microarray may be applied diagnostically for predicting treatment response in ovarian cancer. [Copyright &y& Elsevier]

Background: There has thus far been no empirical research on the occurrence of antenatal psychiatric morbidity in Chinese population. Epidemiological studies in western societies generally show that depressive episodes occur in 10–20% of pregnant women. Longitudinal studies have demonstrated that antenatal depression is one of the most powerful predictors of postnatal depression. There is also a growing literature that shows that antenatal psychological distress can adversely affect maternal and foetal well being. Methods: At 38 weeks of pregnancy, 238 consecutive women were invited to return for psychiatric assessment. The participants were interviewed using the non-patient version of the Structured Clinical Interview for DSM-IV (SCID-NP). Results: Seventy women (29%) declined to participate, and another 11 (5%) defaulted the SCID interview. Among the 157 women interviewed, the 1-month prevalence of antenatal depression was 4.4%. The 1-month prevalence of all psychiatric diagnoses was 6.4%. The prevalence of antenatal depression and all psychiatric diagnoses for the entire pregnancy was 6.4% and 8.3%, respectively. Limitations: About a third of eligible subjects did not participate in the study. Conclusions: A significant proportion of Chinese women suffer from psychiatric morbidity during pregnancy. Depressive disorders are by far the commonest morbidity in the study population. Given the scope of the morbidity and the potential impact on obstetric and neonatal outcomes, early screening and treatment are warranted. [Copyright &y& Elsevier]

: ObjectiveTo determine whether raloxifene has an effect on serum vascular endothelial growth factor (VEGF) concentration in postmenopausal women.: DesignA randomized, placebo-controlled trial.: SettingUniversity-based obstetrics and gynecology unit.: Patient(s)Fifty postmenopausal women who did not receive any hormone therapy in the 6 months preceding the study.: Intervention(s)The participants were randomly assigned on a one-to-one basis to receive either raloxifene (60 mg daily) or placebo for 36 weeks.: Main outcome measure(s)Serum VEGF concentrations at baseline and at 12 weeks and 36 weeks after the commencement of intervention.: Result(s)The serum VEGF concentrations in the raloxifene group were significantly reduced from 247 ± 16 pg/mL at baseline to 195 ± 11 pg/mL at 36 weeks after starting raloxifene. The placebo group showed no significant change in the serum VEGF concentrations throughout the intervention period.: Conclusion(s)Raloxifene therapy in postmenopausal women is associated with a significant reduction in serum VEGF concentration. [Copyright &y& Elsevier]

Objectives: To evaluate the use of hormone replacement therapy (HRT), the prevalence of climacteric symptoms, and the knowledge about HRT. Methods: A prospective study was conducted by telephone interview among a randomly selected population-based sample of 978 Hong Kong Chinese women aged 40–60 years. Results: Of 414 women with a history of either natural or surgical menopause, 22 (5.3%) and 17 (4.1%), respectively, were either past or current users of HRT. The climacteric symptom scores of premenopausal women were significantly lower than those of perimenopausal women, but were comparable with those of postmenopausal women. The commonest climacteric symptom was ‘muscle and joint pains’ which was reported in 553 (56.6%) women, while only 228 (23.3%) and 151 (15.4%) women reported hot flushes and night sweating, respectively. Moreover, only 230 (23.5%) women realized that HRT could relieve menopausal symptoms and only 33 (3.4%) women were aware that HRT was protective against osteoporosis. In general, women with more climacteric symptoms, who had ever used HRT, and those with higher education level and higher family income, had better knowledge about HRT. Conclusions: Postmenopausal Hong Kong Chinese women have a low HRT usage rate and the majority of them are lacking of the knowledge about HRT. [Copyright &y& Elsevier]