OBJECTIVE. To evaluate the epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong.

DESIGN. Retrospective study.

SETTING. Tuberculosis and Chest Service and Special Preventive Programme, Public Health Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region.

PATIENTS. Cases reported to the TB/HIV Registry jointly kept by the Tuberculosis and Chest Service and Special Preventive Programme from 1996 to 2006 were reviewed. The Registry includes cases of human immunodeficiency virus-associated tuberculosis diagnosed in the two services, and cases referred from regional hospitals under the Hong Kong Hospital Authority and the private sector.

RESULTS. Tuberculosis has become an increasingly important acquired immunodeficiency syndrome-defining illness in Hong Kong, and overtook Pneumocystis jiroveci pneumonia for the first time as the most common primary acquired immunodeficiency syndrome-defining illness in 2005 (accounting for 39% and 31% of all such illnesses, respectively in that year). The presentation of human immunodeficiency virus-associated tuberculosis is often atypical. In these patients moreover, there was a slightly higher rate of multidrug-resistant tuberculosis (2%) than in the general population (range, 0.7-1.5%).

CONCLUSIONS. Programmes for the provider-initiated human immunodeficiency virus testing policy to reduce diagnostic delays should continue and be enhanced. Continual surveillance of both conditions is imperative, especially in view of a possible link between human immunodeficiency virus and multidrug-resistant tuberculosis.

Key words: AIDS-related opportunistic infections; Anti-HIV agents; HIV infections; Tuberculosis, multidrug-resistant

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OBJECTIVE. To examine whether sleep hygiene-related factors are associated with sleep quality among university students.

DESIGN. Cross-sectional survey.

SETTING. A university in Hong Kong.

PARTICIPANTS. Full-time university students recruited by convenience sampling.

MAIN OUTCOME MEASURES. Responses to a sleep questionnaire containing the Pittsburgh Sleep Quality Index and obtaining sleep hygiene knowledge and practice, as well as knowledge on caffeine were used for data collection.

RESULTS. Regression analysis with stepwise selection procedure revealed that sleep hygiene practice was significantly associated with the Pittsburgh Sleep Quality Index score after adjusting for age, gender, year of study, and type of residence (b= -0.08, P<0.001).

CONCLUSIONS. Our study's results indicated that sleep hygiene practice was significantly associated with sleep quality. Appropriate measures and sleep hygiene education need to be emphasised among university students in order to increase their awareness on the importance of adopting healthy sleep hygiene practices.

Key words: Questionnaires; Sleep; Sleep deprivation; Sleep disorders; Students

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OBJECTIVE. To determine whether in the local lay Hong Kong population, video self-instruction about cardiopulmonary resuscitation has comparable results to traditional classroom instructions.

DESIGN. Prospective randomised single-blind controlled trial.

SETTING. A first-aid training organisation in Hong Kong.

PARTICIPANTS. Cantonese applicants for cardiopulmonary resuscitation courses aged between 18 and 70 years were recruited into the study. They were randomised into two groups. Those selected for self-learning were given a kit (consisting of a mini-manikin, a video compact disc, and an instruction manual) and sent home. The other group underwent usual classroom training. Both groups were examined together; the examiners remained blinded to the background training of the subjects. Those who passed were asked to come back for re-examination after 1 year.

MAIN OUTCOME MEASURES. The examination passing rates initially and after 1 year.

RESULTS. During a 1-year period between 1 April 2007 to 31 March 2008, 256 subjects were recruited into this study, 124 for self-learning and 132 for classroom training. The age range was 18 to 62 (mean, 39; standard deviation, 10) years. There was no significant difference in passing rate between the two groups at the initial examination or at the re-examination after 1 year. Notably, 28 (23%) of the participants of the self-learning group taught cardiopulmonary resuscitation to relatives and friends.

CONCLUSION. Video self-learning resulted in cardiopulmonary resuscitation performance as good as traditional classroom training.

Key words: Education; Heart arrest; Learning; Public sector; Teaching

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OBJECTIVE. To study the efficacy and safety of endoscopic ultrasonography–guided fine-needle aspiration in the management of mediastinal diseases in Hong Kong.

DESIGN. Retrospective review of prospectively collected data.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. A total of 125 consecutive patients with various mediastinal and pulmonary lesions that underwent trans-oesophageal endoscopic ultrasonography–guided fine-needle aspiration from July 1998 to June 2007.

MAIN OUTCOME MEASURES. The diagnostic accuracy and safety of the procedure and its influence in patient management.

RESULTS. Malignancy was confirmed in 62 (50%) of the patients and excluded in 42 (34%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic ultrasonography–guided fine-needle aspiration in diagnosing mediastinal malignancies were 75% (95% confidence interval, 64-83%), 100% (90-100%), 100% (93-100%), 67% (54-78%), and 83%, respectively. Eighty-six (69%) of the patients had their initial plan of invasive investigations changed. Only one (0.8%) patient developed a septic complication in a mediastinal cyst after puncturing, and was treated surgically.

CONCLUSIONS. Trans-oesophageal endoscopic ultrasonography–guided fineneedle aspiration is a minimally invasive, effective, and safe method of diagnosing malignant mediastinal disease. It may reduce the need for other invasive investigations.

Key words: Biopsy, needle; Carcinoma, non–small-cell lung; Endosonography; Lung neoplasms; Mediastinum

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OBJECTIVES. To identify concepts including misconceptions among the community members regarding family doctors, and determine factors affecting decisions on which doctor to consult in different clinical scenarios.

DESIGN. Household telephone survey conducted between 4 and 13 September 2006.

SETTING. Hong Kong community.

PARTICIPANTS. Cantonese-speaking Hong Kong residents aged 18 years or more were targeted. Randomly selected participants were asked to complete a questionnaire, which was designed based on a literature search and subsequent focus group discussions.

RESULTS. Among the 1811 households with eligible subjects to survey, 1204 completed the questionnaire (response rate, 67%). More than 85% considered a family doctor to be the first doctor they wanted to see even if it was inconvenient. "Clearly knowing my physical conditions", "fast-acting and effective treatment", and "doctor with friendly and sincere attitude" were the three most important factors influencing the choice of a family doctor. When affected by flu-like symptoms, 65% would go to a private clinic, 20% to a general out-patient clinic, 6% to a designated clinic with staff approved by their respective medical insurance/ medical benefit scheme, and 5% to a private hospital outpatient clinic. Among the latter two groups, 65% consulted the same doctor every time when they felt sick. More than 50% of those willing to have regular follow-up by a family doctor for hypertension and diabetes paid more than HK$300 per month. Approximately 64% might consider having regular follow-up at a general out-patient clinic by a nurse specialist.

CONCLUSION. Hong Kong inhabitants already have their own ideas regarding how to care for their own health, and what kind of family doctors they prefer. This survey should help both doctors and health care policy makers to realign their current thinking, and thus provide a platform for the development of a primary care model unique to Hong Kong.

Key words: Clinical competence; Patient satisfaction; Physician-patient relations; Physicians, family; Quality indicators, health care

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