OBJECTIVES. To estimate the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients, and to investigate the difference in retinopathy progression in patients with normal fundi or established retinopathy at baseline and the risk factors implicated in the progression.

DESIGN. Retrospective community-based study.

SETTING. Ten primary care clinics in Hong Kong.

PATIENTS. Type 2 diabetic patients; subsidiary analysis included subjects with more than one screening event.

MAIN OUTCOME MEASURES. Patient demographics, baseline prevalence, and risk factors of diabetic retinopathy; progression of retinopathy in patients with normal fundi and established retinopathy at baseline, and the associated risk factors.

RESULTS. A total of 6165 patients were recruited from January 1998 to May 2004. Primary analysis included 4423 patients with good-quality retinal photographs. The mean age of the patients was 60.36 years (standard deviation, 10.80 years; range, 28-94 years), the mean duration of diabetes was 4.71 years (standard deviation, 4.67 years; range, 0.1-40.6 years), and the mean level of glycated haemoglobin was 7.47% (standard deviation, 1.44%). The prevalence of retinopathy at baseline was 28.4%. Subsidiary analysis showed progression to sight-threatening retinopathy was more common in the group with baseline retinopathy than that without (7.9% vs 0.7%), and occurred at a faster rate (mean, 1.5 [range, 0.5-3.0] vs 2.0 [1.0-4.2] years). Logistic regression revealed that the level of glycated haemoglobin was positively associated with both the onset (P<0.001) and progression of retinopathy (P=0.03).

CONCLUSION. Optimal glycaemic control is important for reducing sight-threatening retinopathy. Close observation is required for patients with established retinopathy as progression occurs more rapidly.

Key words: Diabetic retinopathy; Disease progression; Prevalence; Primary health care; Risk factors

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OBJECTIVES. To examine parent perception of child behaviour problems and parenting stress in Hong Kong, and to assess the extent to which they are related to socio-demographic factors and the availability of social support.

DESIGN. Cross-sectional survey by using a questionnaire.

SETTING. Maternal and Child Health Centres, Hong Kong.

PARTICIPANTS. Parents of children aged 4 years who were registered with Maternal and Child Health Centres and were living in Hong Kong between September 2002 and February 2003.

MAIN OUTCOME MEASURES. Child behaviour problems and parenting stress.

RESULTS. A total of 1009 questionnaires were returned giving a participation rate of 67.0%. About one tenth of parents were experiencing difficulties with their children's behaviour. Parenting stress and children's behaviour problems were associated with presence or absence of social support. Parenting stress was also associated with household income.

CONCLUSIONS. The prevalence of child behaviour problems in Hong Kong is comparable with international figures. Intervention programmes should be targeted at parents who experience difficulties with their children's behaviour and parenting.

Key words: Child behavior; Child health services; Parenting; Social support

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OBJECTIVES. To examine the presentation, workup, and surgical complications of substernal goitre.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Twenty-four mostly elderly patients (mean age, 60.1 years) who underwent thyroidectomy for substernal goitres between 2000 and 2003 (substernal goitres were defined as those having either a caudal mass transgressing the fourth thoracic vertebra or having more than 50% of their overall mass residing within the thorax).

MAIN OUTCOME MEASURES. Symptoms, histopathological diagnoses, morbidities, and complications.

RESULTS. Dyspnoea was the most common symptom (n=8, 33%). Three (12.5%) patients presented with acute airway obstruction; however, 13 (54.2%) were asymptomatic apart from the presence of cervical masses. Computed tomographic scans were performed on all but two patients. Malignancy was present in 12.6% of patients, or 16.8% if occult papillary carcinoma is included. Partial or full sternotomies were performed in two (8.3%) patients. Complications included recurrent laryngeal nerve injury (n=1, 2.7% of nerves at risk), transient hypoparathyroidism (n=2, 13.3% of patients at risk), haematoma (n=1, 2.7%), pneumonia (n=1, 2.7%), and wound infection (n=1, 2.7%). There was no operative mortality or permanent hypoparathyroidism. The complication rate was significantly lower in the asymptomatic patients (P=0.033 by Fisher's exact test); clinicopathological parameters were otherwise statistically comparable between the two groups.

CONCLUSIONS. There is rarely any mortality in thyroidectomy for substernal goitre, and the morbidity is also very low, especially in asymptomatic patients. In the absence of contra-indications, substernal goitre should be treated with early surgery rather than having it run the risk of acute airway distress or cancer.

Key words: Goiter, substernal; Hong Kong; Tomography, X-ray computed

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OBJECTIVES. To study children with cerebral palsy in Hong Kong, their neuroimpairment, activity limitation, and participation restriction in society. Parents' opinion on current medical and rehabilitation services was also sought.

DESIGN. Systematic survey using questionnaires.

SETTING. Four associations in Hong Kong: Child Assessment Service, Hong Kong Association for Parents of Children with Physical Disabilities, Association of Parents of the Severely Mentally Handicapped, and Hong Kong Physically Handicapped and Able-Bodied Association.

PARTICIPANTS. Parents of children with cerebral palsy.

MAIN OUTCOME MEASURES. Neuroimpairment, activity limitation, and participation restriction.

RESULTS. Information from 181 children with cerebral palsy was analysed. Among them, 56% were boys. The mean age was 7 years 6 months (standard deviation, 3 years 11 months). The most common diagnostic type was spastic cerebral palsy. Co-morbidities in children with cerebral palsy were common. Limitation in daily activities including mobility and self-care tasks was considerable and this posed great stress to parents when taking care of their children. Children's participation in both social and leisure activities was regarded as a low priority. A high percentage (70%) of parents reported difficulty in travelling. The reasons involved problems in transportation, building access (entry and exit), and attitudes of the general public. These environmental factors restricted the social participation of the children and their families. Over 75% of parents were satisfied with the current medical and rehabilitation services.

CONCLUSIONS. Children with cerebral palsy have multiple and complex needs. The findings of this study may serve as a reference for parents, service providers, and policy makers to work in partnership to achieve a more comprehensive health-care service for children with cerebral palsy and to facilitate better integration into the community.

Key words: Activities of daily living; Cerebral palsy; Developmental disabilities; Disability evaluation; Learning disorders

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OBJECTIVE. To describe the epidemiology, clinical characteristics, and management of Kawasaki disease in children in Hong Kong.

DESIGN. Retrospective survey of medical records from July 1994 to June 1997, and prospective data collection from July 1997 to June 2000.

SETTING. Hospitals with a paediatric unit in Hong Kong.

PATIENTS. Patients diagnosed with Kawasaki disease between July 1994 and June 2000 in public hospitals in Hong Kong.

MAIN OUTCOME MEASURES. Incidence of Kawasaki disease and coronary artery aneurysm rates.

RESULTS. A total of 696 cases of Kawasaki disease were reported. There were 435 (62.5%) boys and 261 (37.5%) girls giving a male to female ratio of 1.7:1. The age ranged from 1 month to 15 years 5 months with a median of 1.7 years. Infants (<1 year) constituted the largest group of patients (223,32.0%) and overall, 638 (91.7%) were younger than 5 years. Skin rash, conjunctivitis, and oral signs were among the principal clinical features present in over 80% of cases. Prominent cervical lymph nodes larger than 1.5 cm were less commonly found (24%). Coronary artery aneurysms or ectasia were present in 15.7% (109/696), 8.5% (59/696), and 5.0% (35/696) of patients at 2, 4, and 8 weeks, respectively. The incidence of Kawasaki disease per 100 000 children under 5 years was significantly higher in the prospective study period than in the retrospective period (39 vs 26, <0.001).

CONCLUSION. The incidence of Kawasaki disease is high in Hong Kong and is 39 per 100 000 children below 5 years of age. The coronary artery aneurysm prevalence is 5%. Intravenous gamma-globulin and high-dose aspirin is the mainstay of treatment.

Key words: Child; Coronary aneurysms; Incidence; Mucocutaneous lymph node syndrome

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