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Background: The Children's Response Styles Questionnaire (CRSQ) is a widely-adopted inventory that assesses response styles in youths. It is useful in examining how coping styles (particularly rumination) may relate to depressive vulnerability in youths. Despite its utility, little is known about its applicability in non-Western cultures and CRSQ has not been evaluated using current psychometric methods including item response theory (IRT). The present study assessed the properties using IRT methods in a Chinese youth sample., Methods: Students in Grades 4-6 were recruited from seven public primary schools in Hong Kong, and a total of 581 children (280 boys and 301 girls) between 8 and 14 years of age participated in the study. A Chinese version of CRSQ was administered to them in groups at school after receiving written parental consent as well as students' assent., Results: Confirmatory factor analysis revealed a two-factor structure that was comparable to that identified in Western samples, namely, the rumination and distraction/problem-solving subscales. IRT analysis suggested that items varied in levels of item discrimination and item severity, and in precision/usefulness for assessing the underlying latent trait levels. Test information analysis indicated that rumination subscale was more useful than the distraction and problem-solving subscale in assessing the latent trait over a broader range of levels. For gender-based Differential Item Functioning (DIF) analysis, item 1 "When I am sad, I think about how alone I feel" was found to exhibit higher discriminating power for girls than boys., Conclusions: The study presents the first attempt to examine CRSQ item properties using IRT analysis and supports its validity beyond the Western cultures. The factor structure of CRSQ was found to be comparable to the West in our Chinese sample. Differential Item Functioning (DIF) evaluation suggested all but one item in the rumination subscale of the CRSQ apply equally well to both boys and girls.

Background: Congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency (21OHD) is an autosomal recessive disorder due to mutation in the CYP21A2 gene., Objective: To elucidate the genetic basis of 21-hydroxylase-deficient CAH in Hong Kong Chinese patients., Patients and Methods: Mutational analysis of the CYP21A2 gene was performed on 35 Hong Kong Chinese patients with 21OHD using direct DNA sequencing and multiplex ligation-dependent probe amplification (MLPA)., Results: The genetic findings of 21 male and 14 female patients are the following: c.293-13A/C>G (intron 2 splice site; 20 alleles), p.I172N (13), p.R356W (7), p.Q318X (4). A total of 20 mutant alleles contained gross deletion/conversion of all or part of the CYP21A2 gene. A novel mutation, c.1367delA (p.D456fs), was detected in one patient. One patient had only a heterozygous mutation detected. Out of 35 patients, 16 would have been incorrectly genotyped if either DNA sequencing or MLPA alone was used for molecular analysis., Conclusions: The frequency of various mutations in the studied patients differs from those reported in other Asian populations. Gross deletion/conversion accounts for nearly one-third of the genetic defects. Therefore, laboratories must include methods for detecting point mutations as well as gross deletions/conversions to avoid misinterpretation of genotype. Genotyping has increasingly been proven to be a useful tool for supplementing, if not replacing, hormonal profiling for the diagnosis of 21OHD., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To delineate the epidemiology of Charcot foot in Hong Kong Chinese diabetic patients, and to provide baseline data for benchmarking the clinic service for this special group of patients., Design: Retrospective cohort study., Setting: Regional hospital, Hong Kong., Patients: Diabetic patients with Charcot foot and age- and sex-matched diabetic foot clinic attendees between 1995 and 2007., Main Outcome Measures: Clinical presentations were compared in patients with Charcot foot and the controls., Results: Twenty-five patients were diagnosed with Charcot foot over 12 years; 60% were male. At the time of diagnosis, the mean age was 59 (standard deviation, 14; range, 38-85) years, with diabetes being diagnosed for a mean of 11 (standard deviation, 8; range, 0-30) years. Retinopathy was noted in 36% (n=9) and nephropathy in 20% (n=5) of the Charcot foot patients. No patient had peripheral vascular disease. This finding was statistically significant. Delayed presentation occurred in 11 patients. Presentation was usually unilateral. In the minority (n=3, 12%) with bilateral involvement, presentation was sequential. Charcot arthropathy affected the mid-foot in 64% of the patients. Superimposed infection was common (61%). Recurrent ulceration occurred in 11%, all of whom presented late. Only one patient underwent major amputation, but the 5-year mortality of Charcot foot patients could be up to 33%., Conclusion: Charcot foot was uncommon in this population. Late presentation was common and might be related to superimposed infection; such patients were prone to recurrent ulcers.

Objectives: To study the relationship between hospitalisation for diabetic foot complications, non-traumatic major lower limb amputations, and seasonal variation in humidity and temperature., Design: Retrospective study., Setting: Regional hospital, Hong Kong., Patients: Diabetic patients hospitalised for lower limbs infection during the inclusive period 1995 to 2004., Main Outcome Measures: Monthly incidence of admissions for diabetic foot sepsis and non-traumatic non-neoplastic major lower limb amputations correlated with the monthly average humidity and temperature., Results: During the study period, a total of 770 patients contributed to 1285 episodes of hospitalisation and ensued 208 corresponding major lower limb amputations. Poisson regression study showed that the monthly incidences of hospitalisation as well as amputations were related to the monthly average temperature (P<0.001 and =0.0012, respectively) but not the monthly average humidity (P=0.1560 and 0.6332, respectively)., Conclusion: The warm and humid weather of Hong Kong exerts a seasonal variation on the diabetic foot infection presentations. Warm temperature aggravates the severity of infection and precipitates amputation. More intensive patient education and clustering of medical services in late winter and spring might reduce the incidence of diabetic foot amputation, which is a preventable complication.

Objectives: To compare the memory function of older adults who regularly practiced mind-body (MB) or cardiovascular (CV) exercises with that of those who did not engage in regular exercise. Older adults who engaged in both types of exercise were also included to examine the combined effects., Design: Cross-sectional study between 2002 and 2003., Setting: Older adults from a local community in Hong Kong., Participants: One hundred forty adults aged 56 and older., Measurements: The Hong Kong List Learning Test was used to assess the memory of all participants. It is a clinically validated Chinese verbal-memory test that measures various aspects of memory processing, including learning, retention, and retrieval abilities. MB and CV exercises were defined using three dimensions: motion speed, emphasis on relaxing the mind, and conscious control of movement., Results: Older adults who practiced MB or CV exercises demonstrated a similar level of memory function, and their learning and memory was better than that of individuals who did not exercise regularly. Those who practiced both types of exercises outperformed all other groups, even after corrected for the total hours of exercise. Although memory change across age was found in older adults who did not exercise, this trend was not observed in individuals who practiced MB exercises., Conclusion: Practicing both MB and CV exercises appears to have a combined effect that might help to preserve memory in older adults. In addition, MB exercises may be considered as an alternative training for older adults who cannot practice strenuous physical exercise.

Objective: To assess the predictive power of various parameters on the final outcome of ulcerated diabetic feet among the Hong Kong Chinese population., Design: Retrospective cohort study., Setting: Regional public hospital, Hong Kong., Patients: Medical records of 340 diabetic patients with foot ulcers (535) who were referred to the Diabetic Foot Clinic between July 1995 and June 2000 were reviewed., Main Outcome Measures: Demographic and clinical data, including assessment of the foot and blood parameters., Results: Increasing age, wound depth, the presence of ischaemia, a low albumin level, and the lack of simultaneous ulceration were determined by stepwise logistic regression analysis to be the most significant independent predictors of an unfavourable outcome., Conclusions: Major amputation is more likely to occur in elderly patients, with progressive wound depth, and in the presence of ischaemia. A low albumin level was also noted to be an independent predictor of major amputation in the population studied.