Phylodynamics of HIV-1 subtype B among the men-having-sex-with-men (MSM) population in Hong Kong

The men-having-sex-with-men (MSM) population has become one of the major risk groups for HIV-1 infection in the Asia Pacific countries. Hong Kong is located in the centre of Asia and the transmission history of HIV-1 subtype B transmission among MSM remained unclear. The aim of this study was to investigate the transmission dynamics of HIV-1 subtype B virus in the Hong Kong MSM population. Samples of 125 HIV-1 subtype B infected MSM patients were recruited in this study. Through this study, the subtype B epidemic in the Hong Kong MSM population was identified spreading mainly among local Chinese who caught infection locally. On the other hand, HIV-1 subtype B infected Caucasian MSM caught infection mainly outside Hong Kong. The Bayesian phylogenetic analysis also indicated that 3 separate subtype B epidemics with divergence dates in the 1990s had occurred. The first and latest epidemics were comparatively small-scaled; spreading among the local Chinese MSM while sauna-visiting was found to be the major sex partner sourcing reservoir for the first subtype B epidemic. However, the second epidemic was spread in a large-scale among local Chinese MSM with a number of them having sourced their sex partners through the internet. The epidemic virus was estimated to have a divergence date in 1987 and the infected population in Hong Kong had a logistic growth throughout the past 20 years. Our study elucidated the evolutionary and demographic history of HIV-1 subtype B virus in Hong Kong MSM population. The understanding of transmission and growth model of the subtype B epidemic provides more information on the HIV-1 transmission among MSM population in other Asia Pacific high-income countries.     

Conceptualization of psychiatric illness and help-seeking behavior among Chinese

Problem conceptualizations of Chinese psychiatric patients were studied in relation to the patterns of help-seeking and ways of coping. Patients who conceptualized their initial problems in purely psychological terms were more likely to use self-directed psychological coping methods, delay initial professional consultation, and approach mental health professionals. Patients who used only somatic concepts were least likely to approach mental health professionals initially or any time during their previous consultation history, and tended to approach medical resources to cope with their problems. Patients who conceptualized their problems in mixed terms approached professional help early on and reached psychiatric resources soonest. These results provide a clearer perspective to understand the somatization tendency among Chinese patients.     

Konsiliardienste in den Fachgebieten „Psychiatrie und Psychotherapie“ und „Psychosomatische Medizin und Psychotherapie“ im Land Sachsen-Anhalt

Objective To assess the availability and the utilization of specialists for psychiatry, psychotherapy and psychosomatic medicine in somatic hospitals in the German state of Sachsen- Anhalt. Method The “Committee for Issues of Psychiatric Care in Sachsen- Anhalt” sent written questionnaires to the medical chairmen of the 46 hospitals with a somatic department; the return rate was 98% with some information about 48 of 55 hospital locations. Results 17 hospitals use specialists from their own clinical facilities (12 from their own psychiatric department for inpatient care and 4 from their own psychiatric day hospital as well as 9 from their own inpatient psychosomatic unit) for psychiatric consultations on somatic wards and were classified as hospitals with “internal” consultation services. 27 hospitals ask for visits from specialists from another psychiatric hospital (14) and/or call colleagues working in private practice (14) and were classified as “external consultation services”, even if they had psychologists among their own staff (3). In another 4 hospitals, no psychiatric services were offered. Only 16 houses had statistical data regarding the frequency of psychiatric consultations at hand; another 22 hospitals provided estimates. The availability of the consultation service was a strong predictor of its utilization: Hospitals with an “internal” service reported about five times more consultations than those hospitals whose consultation services depended on external specialists. Some formal psychotherapeutic qualification was available in nearly all hospitals with internal and in 37% of the hospitals with external services. Conclusions We were able to gather at least some information regarding psychiatric and/or psychosomatic consultation services in about nearly 90% of the local somatic hospitals of the whole state of Sachsen- Anhalt, which is one of the “new” federal states that emerged from the former “German Democratic Republic” and has to catch up to the standards of medical care of the Federal Republic of Germany. The quality of the data, however, left much room for improvement, as only 36% of the hospitals were able to provide the exact number of psychiatric consultations in the previous year or the last six months. The results, nevertheless, suggest considerable deficits in the care of patients with psychiatric disorders especially in those somatic hospitals with no internal psychiatric consultation service. A service “around the clock” was only available in hospitals with a psychiatric inpatient department of their own. We strongly recommend the implementation of regular reports about the utilization of psychiatric consultations in somatic hospitals as an addition to the current measures of quality assurance. Every somatic hospital should have at least one psychiatrist (with some psychotherapeutic training) on its own staff.     

Preferences in help-seeking among Chinese students

Chinese university students were asked to indicate their inclination to seek help and the resources for consultation on the 22 problems listed on the Langner Scale. Results showed that the Chinese students were generally not inclined to seek help and when they did, would most often seek help from medical doctors. However, when items were grouped in terms of clinical content, it was found that friends were predominantly preferred for psychological problems while the doctor was preferred for psychophysiological, physiological, and ambiguous problems. More female than male students tended to rely on friends and family members while the reverse pattern was found in the preference for doctors. The mental health professional was rarely cited as a resource for any of the problems. The results provide some explanation for observations made in previous studies on symptom presentation and help-seeking behavior among Chinese psychiatric patients.     

Variations in problem conceptualizations and intended solutions among Hong Kong students

Cognitive schema were used to explain health and illness behaviors among Chinese students. University students in Hong Kong were asked to attribute causes and suggest solutions to five health/mental health problems: Weakness/Fatigue, Tension/ Anxiety, Sleep Difficulty, Hollow/Emptiness, and Headache. The patterns of endorsement on the causal and solution categories used for the five problems were compared using a new asymptotic chi-squared test. The response patterns were found to be significantly different across the five problems. Each problem was attributed to multiple causes including psychological, social, situational, somatic, and existential factors. The intended solutions were often related to the nature of the causal attributions especially when the problems were mild. In lay help-seeking, the Hong Kong students would attempt a variety of self-help measures. However, for professional consultation, the medical doctor would be the primary care professional the students would turn to for most of the problems except in the case of Hollow/Emptiness.     

Improving quality of care: focus on liaison old age psychiatry

Introduction Elderly patients occupy up to 65% of acute hospital beds and a significant proportion of them present with a comorbid psychiatric condition such as depression, delirium or dementia. Liaison old age psychiatry (LOAP) services have been developed to provide psychiatric consultation in medical and surgical settings, improving at the same time the knowledge and expertise of general ward staff.Objective The aim of this study is to evaluate clinical characteristics across different psychiatric disorders among elderly patients in medical wards.Method A prospective observational study was developed between October 2011 and January 2013, which involved 107 subjects aged 65 years or older that were hospitalised in the Department of Internal Medicine and referred to the LOAP service. Psychiatric diagnostic was assessed using the Confusion Assessment Method, the Geriatric Depression Scale, the Mini-Mental State Examination and the Clinical Global Impression Scale.Results Delirium (40.6%), depression (22.4%) and dementia (20.4%) were the most common psychiatric diagnoses. Patients with delirium were significantly older, had more severe psychiatric symptomatology (mean CGI = 5.35) and presented infectious processes as acute medical conditions more frequently than the other patients.Conclusion Psychiatric disturbances occurring in elderly inpatients in medical wards are highly prevalent and complex. A LOAP service may play an important role in effectively reducing the overutilisation and consumption of health resources through early recognition of these conditions, effective management and prevention of adverse outcomes, and effective communication with out-patient clinics, community mental health teams and day-care centres.     

The indigenization of neurasthenia in Hong Kong

Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.     

Perceptions and uses of Chinese medicine among the chinese in Hong Kong

The present paper was based on both qualitative observations and quantitative survey data. Major findings are as follows: (1) The sacred or magical-religious tradition of Chinese medicine is accepted by a relatively small portion (roughly one-fifth) of the ordinary Chinese people in urban Hong Kong, and is relatively more popular among women or less educated people. (2) Both the classical-professional and the local-empirical traditions of secular medicine are resorted to by many Chinese people (over one half) either for treating diseases or for strengthening their constitution. The acceptance of secular Chinese medicine does not vary significantly among different sex, age, education, or income groups. It should be noted that secular Chinese medicine is often used in addition to or in combination with modern Western medicine. (3) It appears that most people are more confident in the Chinese medical tradition than in Chinese-style practitioners in Hong Kong, and that people's confidence in secular Chinese medicine has been increasing in recent years. (4) There are reasons for the confidence in secular Chinese medicine. Chinese medicine is generally perceived to be better than or as good as Western, scientific medicine in some ways, such as for tonic care, for fewer side effects, for curing the cause (not symptoms) of diseases, and for treating certain diseases. Therefore, to ordinary Chinese people, Chinese and Western medicine may perform either equivalent or complementary functions. (5) As regards the process of seeking medical care, most people seem to follow the pattern of moving from self-medication, using Chinese and/or Western home remedies, to Western-style doctors, to Chinese-style practitioners, and finally to a Western medical hospital. Policy and theoretical implications of these findings are discussed.     

Cross-Sectional Study on Attitudes among General Practitioners towards Pneumococcal Vaccination for Middle-Aged and Elderly Population in Hong Kong

Objective

To study the attitudes among general practitioners towards pneumococcal vaccination for middle-aged (50–64) and elderly population (over 65) in Hong Kong and the factors affecting their decision to advise pneumococcal vaccination for those age groups.

Design

Cross-sectional study of general practitioners in private practice in Hong Kong.

Participants

Members of Hong Kong Medical Association delivering general practice services in private sector.

Measuring Tool

Self-administered questionnaire.

Main Outcome Measures

Intention to recommend pneumococcal vaccination, barriers against pneumococcal vaccination.

Results

53.4% of the respondents would actively recommend pneumococcal vaccination to elderly patients but only 18.8% would recommend for middle-aged patients. Consultation not related to pneumococcal vaccine was the main reason for not recommending pneumococcal vaccine (43.6%). Rarity of pneumonia in their daily practice was another reason with 68.4% of respondents attending five or less patients with pneumonia each year. In multivariate analysis, factors such as respondents would get vaccination when reaching age 50 (OR_m 10.1), and attending 6 pneumonia cases or more per year (OR_m 2.28) were found to be associated with increasing likelihood for recommending vaccination to the middle-aged. While concerns of marketing a product (OR_m 0.41), consultation not related to vaccination (OR_m 0.45) and limited time (OR_m 0.38) were factors that reduced the likelihood.

Conclusion

Public policy is needed to increase the awareness of impact of pneumococcal pneumonia and the availability of preventive measures.     

Psychiatric consultation in the nursing home. An inquiry among Amsterdam nursing home physicians

Psychiatric disorders are common among nursing home residents. However, little is known about psychiatric consultation in Dutch nursing homes. As an exploration of the topic, Amsterdam-based nursing home physicians were asked to rate a number of aspects of psychiatric consultation as performed in their nursing home. Striking differences are reported between 14 participating nursing homes with regard to the intensity of psychiatric consultation and the number of consultation requests, which seems low compared with the perceived psychiatric problems. Somatically ill and psychogeriatric residents are estimated to generate an equal number of consultation requests. Psychiatric consultation appears to be characterized by diagnostic clarification, medication recommendations and behavioral management advice whereas staff-directed activities are scarce. Physicians report shortcomings in psychiatric skills among care staff. Research is necessary concerning the psychiatric care delivered to nursing home residents, as well as with regard to the optimal model for psychiatric consultation services. Integration of psychiatric care in nursing homes with mental health care services appears to be desirable.     

Homosexuality in chinese culture

Reviewing a book from the Pink Triangle Press of Hong Kong, and drawing upon other professional and personal resources, the authors of this review essay, both psychiatrists and graduates of the University of Hong Kong, present a digest and synopsis of material relating to homosexuality in Chinese culture. With illustrations from the royal palaces, upper class households, entertainment companies, scholars' conclaves, novels and fiction, seaboard populations, travellers, emigrants, socially marginal groups, closed institutions, and folk literature and dialects, a wide variety of homophilic relations is described. A section on the modern scene reviews clinical studies, legal and sociological data, seminar and commission reports, and news items. Although many Chinese names have been applied to the condition, homosexuality is not a culture-bound phenomenon. A basic question which emerges from this review is the extent to which human behavior is genderbound. History of Homosexuality in China (Chinese ed.). Xiaomingxiong. Hong Kong: Samashasha and Pink Triangle Press, 1984. 373 pp., U.S. $9.00, Hong Kong $55.00     

Constructing transnational identities? Mass media and the Malaysian Chinese audience

This article examines the influence of Chinese transnational mass media, in particular television, videos, and films, on the creation of transnational Chinese identities among Malaysian Chinese. Drawing on ethnographic research and surveys of adults and high school students in four Malaysian cities, it argues that local audiences distinguish clearly between the various forms of transnational Chinese media produced in Hong Kong, Taiwan, and China. Although preferences for different types of transnational media vary among viewers in terms of age, gender, educational background, and place of residence in Malaysia, Hong Kong productions are clearly the most popular. Similarities between the experiences and perspectives of Hong Kong and Malaysian Chinese are examined as possible explanations for this preference.     

Review of evolution of clinical,training and educational services and research program for autism spectrum disorders in Hong Kong

The evolution of a local fragmented model of services for children with autism in Hong Kong emerged gradually over the past three decades with lack of government funding or support. This had been due to increasing number of children with autism being detected and referred for earlier assessment. With increasing pressure from parents due to long waiting time for assessment and training services and the increasing polarization by mass media there had been a gradual increasing public awareness over the past five years. Though still highly fragmented in the availability of services, there is a growing "business model" available in the community due to increasing need and lack of public funding for support. There is a lack of strategic planning for medical diagnostic and management issues in Hong Kong. Our University of Hong Kong based Autism Research Program was pioneered in 1985 based on the increasing load of autism cases referred for assessment for other developmental problems and diagnosed as Autism in the Duchess of Kent Children's Hospital. As the first author has been the staff of the University of Hong Kong, this program flourished as a research based program. The benefits of early identification and intervention of autism spectrum disorder(ASD) had been increasingly recognized, and with the increased public awareness and increasing trend of earlier diagnosis, there has been a continuously high demand from parents for earlier assessment and training for children suspected to have ASD. This model had not received extra funding for this integrated program for research, teaching and training in autism. We had to apply for various donations and grants to support the development of this pioneer program. The research output and organization of forums for public education and awareness are reviewed. The latter part of the paper reports the summary of clinical profile of autism cases(N=1441) assessed from 1985 to 2010 June under the University of Hong Kong. As the waiting time for initial developmental assessment for any children in Hong Kong is 12?24 months, we also report our preliminary experience with a newly launched triaging service provision for children suspected to be ASD since 2009, including multi-disciplinary assessment and parallel interim training in our university affiliated child assessment centre in Hong(N=89).     

Evaluation of the development of psychosomatic medicine in a large university hospital in Turkey

The purpose of this study was to evaluate the development of psychosomatic medicine at our university hospital in Istanbul, which has an inpatient capacity of 3,000. Changing patterns of utilization of psychiatric service were analyzed in two 1-year surveys five-year intervals (1998, n=888) - (2003, n=1609). Psychiatric referrals were analyzed with regard to rate of consultation, demographic characteristics, departments making referrals, reasons for referral, psychiatric diagnoses and patterns of psychiatric intervention. Psychiatric consultation request, consultation reply and medical psychiatric examination forms were used. In evaluating the data, consultation rate was seen to have doubled over the five intervening years. Significant changes were also noted in the demographic characteristics of patients (e.g., more men, older mean age). The most prevalent disorders in both groups were depressive disorder and adjustment disorders. Alcohol and substance abuse remained as a small group. The gradual increase in the utilization of psychiatric services can be attributed to service and education-related variables.     

Prevalence of excessive or problem drinkers among patients attending somatic outpatient clinics: a study of alcohol related medical care.

The prevalence of alcohol related morbidity was studied among 2038 patients attending somatic outpatient clinics. A further 76 patients had refused the study, giving an overall drop out rate of 3.6%. Several methods were combined so as to detect as many patients with problem drinking as possible. According to the criteria and definitions employed 17% of men (confidence interval 15% to 19%) and 4% of women (confidence interval 3% to 5%) were excessive consumers of alcohol or problem drinkers. The highest proportion of such patients--that is, 17%--was noted in the emergency rooms (27% of men, 8% of women). At other clinics the proportions varied from 11% to 17% of men and from 2% to 4% of women. The strongest relations between overconsumption of alcohol and consultation at the clinic were among patients attending the medical outpatient clinic and the emergency rooms; in 86% (confidence interval 75% to 97%) and 88% (confidence interval 81% to 95%) of problem drinkers attending these clinics, respectively, alcohol was related to the consultation. Consultations were related to alcohol in 82% of women with excessive or problem drinking and 73% of men defined in this way. There was a tendency to a higher proportion of men with excessive or problem drinking in the age group 40-49 years. These findings show that among patients classified as excessive or problem drinkers attending somatic outpatient clinics there was a close relation between alcohol consumption and utilisation of medical resources, especially in women.     

Clara Law's Floating Life and Hong Kong-Australian 'flexible citizenship'

Clara Law's film Floating Life was the first Australian film to be nominated for an Oscar for Best Foreign Film, and the first Australian film to deal with migrant Hong Kong Chinese identities 'from inside'. From perspectives of transnational Chinese migration and flexible citizenship, this article looks at Floating Life as a Hong Kong Chinese migrant reading of Australia, which defamiliarizes and recontextualizes familiar Australian localities and geopolitical formations, contrasting them with the film's other principal loci of Hong Kong and Germany. It also interprets the film as a neo-Confucian study of family disintegration in a migrant context, and an exploration of notions of home and identity.     

Chinatown UK v. Colonial Hong Kong: An early exercise in transnational militancy and manipulation, 1967–1969

In the late 1960s, Hong Kong was hit by a wave of social and political unrest, an echo in the colony of China's Cultural Revolution of 1966–69. The unrest spread to parts of Britain's Chinatown, where a leftist movement emerged in sympathy with the Hong Kong agitation. Among the Chinatown leftists were former supporters of the Communist anti-Japanese guerrillas in Hong Kong's rural New Territories. The colonial authorities reacted to these developments in Britain by drawing up plans to protect and assist overseas Hong Kong residents in an attempt to win their political approval and stymie the pro-Communists. The Hong Kong Government Office [HKGO] in London started providing materials for Chinese-language schools and set up various other communal services. Later, it launched a campaign to foster the emigrants’ “Hong Kong identity”. The scheme was in many ways successful. Chinatowners were usually happy to make use of the facilities on offer. However, there is little evidence that the HKGO succeeded in winning their political allegiance.     

Molecular Coordinated Regulation of Gene Expression During Ovarian Development in the Penaeid Shrimp

To understand the molecular events of ovarian development in penaeid shrimp, RNA arbitrarily primed polymerase chain reaction (RAP-PCR) was used to identify differentially expressed genes during ovarian maturation in Metapenaeus ensis. From a screening of 700 clones in a cDNA library of the shrimp ovary by the products of RAP-PCR of different maturation stages, 91 fragments with differentially expressed pattern as revealed by dot-blot hybridization were isolated and sequenced. Forty-two of these fragments show significant sequence similarity to known gene products and the differentially expressed pattern of 10 putative genes were further characterized via Northern hybridization. Putative glyceraldehyde–3–phosphate dehydrogenase and arginine kinase are related to provision of energy for active cellular function in oocyte development. Translationally controlled tumor protein, actin, and keratin are related to the organization of cytoskeleton to accomplish growth and development of oocytes. High mobility group protein DSP1, heat shock protein 70, and nucleoside diphosphate kinase may act as repressors before the onset of ovarian maturation. Peptidyl-prolyl cis-trans isomerase and glutathione peroxidase are related to the stabilization of proteins and oocytes. This study provides new insights on the molecular events in the ovarian development in the shrimp. Present addresses: T.S. Lo, Department of Applied Science, Hong Kong Institute of Vocational Education, Chai Wan, Hong Kong, China J.L.Y. Mong, Department of Biochemistry, The Chinese University of Hong Kong, Shatin, Hong Kong, China Q.W.L. Wong, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China