OBJECTIVES. To describe the pattern of infectious diseases among children admitted from a residential child care centre and to identify any unusual clusters of admissions.

DESIGN. Retrospective case review.

SETTING. Regional hospital, Hong Kong.

PATIENTS. All children from a residential child care centre aged over 28 days who were admitted from the Accident and Emergency Department to paediatric wards for infections from 1 January 1999 to 31 December 2003.

MAIN OUTCOME MEASURES. Demographic data, clinical diagnoses, infectious diseases identified, and incidence and seasonal pattern of various infections.

RESULTS. Of 267 children admitted to the hospital over the 5-year period, 221 had infectious diseases. Respiratory tract infections, viral exanthema, and gastroenteritis were present in 83.7%, 7.2%, and 5.9%, respectively. Among those with a respiratory tract infection, 22.7%, 9.2%, and 8.6% had respiratory syncytial virus, parainfluenza virus, and influenza A or B viruses, respectively. Two unusual clusters of respiratory syncytial virus and parainfluenza virus were recognised in late 2003.

CONCLUSION. Children in this residential child care centre were at risk of infectious diseases. Respiratory tract infection is the most common infectious disease in this centre. An outbreak of respiratory tract infection was recognised. Further efforts may be necessary to improve infection control measures in this setting.

Key words: Child care; Disease outbreaks; Infection control; Respiratory syncytial virus infections

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OBJECTIVE. To assess the clinical applicability, efficacy, and safety of coronary angiography and angioplasty via a transradial approach in local Chinese patients.

DESIGN. Prospective case series.

SETTING. Regional hospital, Hong Kong.

PATIENTS. All patients undergoing coronary angiography and coronary angioplasty between 1 January and 30 June 2004.

INTERVENTIONS. Transradial coronary angiography and coronary angioplasty.

MAIN OUTCOME MEASURES. Feasibility, success rate, and complications.

RESULTS. A total of 268 coronary angiographies (62% of all coronary angiographies) and 118 coronary angioplasties (48% of all coronary angioplasties) were performed via a transradial approach. The procedural success rate for coronary angiography was 93.7% with a mean duration of 21.8 (standard deviation, 13.5) minutes compared with 17.9 (10.0) minutes for angiography via a femoral approach. Most (99%) patients were free from any complications. Of those patients who underwent elective transradial coronary angiography in the morning, 64% were discharged on the same day. Comparison of data in the first half of the study period with those in the second half revealed a significant increase in the percentage of coronary angiographies performed via a transradial approach (from 52% to 73%, P<0.0001), and an improved procedural success rate (from 91.5% to 95.3%, P=0.1). For transradial coronary angioplasty, the procedural success rate was 98%. A total of 246 lesions (2.08 lesions per patient) were treated with no procedure-related complications.

CONCLUSIONS. Transradial coronary angiography and angioplasty are feasible in a significant proportion of local Chinese patients and achieve a high success rate and low complication rate. It tends to prolong procedural duration, but improves patients’ comfort and permits earlier ambulation and discharge. The procedural success rate improves with accumulating experience.

Key words: Angioplasty, transluminal, percutaneous coronary; Coronary angiography; Radial artery; Stents

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OBJECTIVE. To verify the usefulness of the BiliCheck transcutaneous bilirubin meter as a screening device for neonatal jaundice in a Chinese population compared with the Minolta bilirubin meter.

DESIGN. A prospective correlation study that compared transcutaneous bilirubin measurements with serum bilirubin levels.

SETTING. Obstetric ward and a neonatal unit of a regional hospital in Hong Kong.

PATIENTS. Neonates with gestation above 32 weeks with neonatal jaundice who were admitted between April 2001 and February 2002.

MAIN OUTCOME MEASURES. Transcutaneous measurements of serum bilirubin obtained from the forehead and the sternum with two instruments: BiliCheck and Minolta Airshields JM 102.

RESULTS. A total of 77 term and six near-term babies (gestation, 32-37 weeks) were recruited. The mean age at the time of data collection was 3.96 days (range, 2-9 days). The correlations between serum bilirubin and transcutaneous bilirubin measurements of the two devices at the two sites were high, with a coefficient of 0.718 (95% confidence interval, 0.610-0.800; n=100) for forehead measurements, and 0.814 (95% confidence interval, 0.740-0.870; n=99) for sternum using the Minolta Airshields JM 102; and a coefficient of 0.757 (95% confidence interval, 0.657-0.827; n=98) for forehead measurements, and 0.794 (95% confidence interval, 0.700-0.862; n=92) for sternum using the BiliCheck. For BiliCheck, a cut-off point of 250 micromol/L at the forehead and 260 micromol/L at the sternum had a specificity of 61.9% and 70.0%, respectively with a sensitivity of 100% for the detection of serum bilirubin concentrations of 250 micromol/L or higher. This level is commonly used as the level for initiation of treatment such as phototherapy.

CONCLUSION. BiliCheck is a useful screening tool for neonatal jaundice in the Chinese population and is comparable with the Minolta Airshields JM 102.

Key words: Bilirubin/blood; Comparative study; Infant, newborn; Jaundice, neonatal; Neonatal screening

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OBJECTIVE. To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time.

METHODS. The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted.

RESULTS. Total domestic health expenditure was $68 620 million in the fiscal year 2001/02. In real terms, expenditure grew at an average rate of 7% while gross domestic product increased by 4% during the same period. This indicates a growing share of health spending relative to gross domestic product, from 3.8% in 1989/90 to 5.5% in 2001/02. This upward trend was largely driven by increased public spending that rose 208% in real terms over the period, compared with 76% for private spending. Out-of-pocket payments by households accounted for about 70% of private spending while employers and insurance accounted for 28%. Private insurance plays an increasingly important role in financing private spending whereas household expenditure has shown a corresponding decrease during the period. Expenditure incurred at providers of ambulatory services and hospitals accounted for more than 70% of total health expenditure during the observed period. Hospitals’ share of total spending increased by 18%, reaching 45% of total expenditure in 2001/02, whilst the share of providers of ambulatory services reduced to 30% in 2001/02. The two largest functional components of total health expenditure were ambulatory care (35-41%) and in-patient curative care (20-27%). Public spending generally financed in-patient curative care and ambulatory services; private spending was concentrated on ambulatory services and medical goods outside the patient care setting.

CONCLUSION. These data provide important information for the public, policymakers, and researchers to assess the performance of the health care system longitudinally, and to evaluate health expenditure-related policies.

Key words: Delivery of health care; Health expenditures; Hong Kong

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OBJECTIVE. To study the outcome of children with acute lymphoblastic leukaemia who were treated using a protocol including one or two delayed intensifications.

DESIGN. Prospective single-arm multicentre study.

SETTING. Five designated children cancer units of the Hospital Authority of Hong Kong.

PATIENTS. Children aged between 1 and 17.9 years with newly diagnosed acute lymphoblastic leukaemia seen from November 1997 to December 2002.

INTERVENTION. Chemotherapy was modified from a German Berlin-Frankfurt-Muenster 95 (BFM95) protocol that included a delayed intensification similar to the induction phase repeated 5 months after diagnosis. High-risk patients were given double delayed intensification.

MAIN OUTCOME MEASURES. Overall survival and event-free survival of the whole group and the three risk groups (standard-, intermediate-, and high-risk groups), and comparison with historical controls.

RESULTS. A total of 171 patients were recruited with a median age at diagnosis of 5.57 years (range, 1.15-17.85 years). The induction remission rate was 95.3% and non-leukaemia mortality during remission was 2.3%. At 4 years, the relapse rate of this (HKALL97) study was significantly lower than that of the HKALL93 study (15.7 vs 37.3%; P<0.001). The 4-year overall survival of HKALL97 and HKALL93 studies were 86.5% and 81.8%, respectively (P=0.51). The 4-year event-free survival for HKALL97 and HKALL93 studies were 79% and 65%, respectively (P=0.007). Nonetheless the difference of event-free survival was most remarkable in the intermediate-risk group: 75.6% and 53.1% for HKALL97 and HKALL93 studies, respectively (P=0.06).

CONCLUSION. A more intensive delayed consolidation phase improved the outcome for children with acute lymphoblastic leukaemia by reducing relapses at 4 years. The early treatment complications were manageable and non-leukaemia mortality during remission remained low.

Key words: Immunophenotyping; Leukemia, lymphocytic, acute; Methotrexate; Prognosis; Treatment outcome

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