OBJECTIVE. To describe changes of the epidemiological profile of suicides in Hong Kong, and the burden of suicides in terms of years of life lost between 1981 and 2001.

DESIGN. Retrospective study.

SETTING. Hong Kong.

PARTICIPANTS. Data on registered deaths of the Hong Kong population from 1981 to 2001 were retrieved from records of the Census and Statistics Department of the Government of the Hong Kong Special Administrative Region.

MAIN OUTCOME MEASURES. Crude, standardised, age- and sex-standardised suicide rates; years of life lost; suicide method used; and rank among leading causes of death.

RESULTS. Suicide ranked sixth in the leading cause of deaths and represented about 3% of all deaths each year. The suicide rate has increased from 9.6 per 100 000 to 15 per 100 000 between 1981 and 2001. The total years of life lost due to suicide increased by 96.0%, from about 9900 years in 1981 to 19 400 years in 2001, whereas the figure for all causes of death decreased by 14.0%, from 274 600 years to 236 700 years. The total share of years of life lost attributable to suicide deaths has increased from 3.6% to 8.1% and is still increasing, especially among in the middle age-groups (30-59 years). The use of charcoal burning as a suicide method has increased from 6.0% before 1998 to more than 28.0% in 2001.

CONCLUSION. The burden on the years of life lost due to suicide is underestimated and overlooked. The increase of suicides in recent years has had a significant impact on the years of life lost and can be used as a useful indicator of performance in Hong Kong.

Key words: Hong Kong; Suicide

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OBJECTIVE. To examine the status of obstetric epidural analgesia services in Hong Kong public hospitals in 2001, and to compare findings with those from a similar survey conducted in 1995.

DESIGN. Postal questionnaire survey.

SETTING. Hospital Authority hospitals in Hong Kong offering an obstetric and delivery service.

PARTICIPANTS. Chiefs of Service of departments of anaesthesia and coordinators of obstetric anaesthesia and analgesia service.

MAIN OUTCOME MEASURES. The availability of an obstetric epidural analgesia service, specialist staff allocation to the service, existence of clinical protocols, rate of epidural analgesia, techniques of epidural administration, obstetric outcome or mode of delivery, and the incidence of adverse events associated with the use of epidural analgesia.

RESULTS. Between 1 January and 31 December 2001, all eight Hospital Authority hospitals with an obstetric service provided epidural analgesia for labour pain relief, but only six (75%) offered a 24-hour service. A dedicated anaesthetist provided obstetric anaesthesia and analgesia during office hours in all units, but after hours in only three. This level of service provision compared favourably with that available in 1995, when only 82% of public maternity units provided epidural analgesia and only 36% offered a 24-hour service. The median epidural analgesia rate was 15% (range, 8%-20%) compared with 10% in 1995. The incidence of adverse events and complications was very low. Formal written protocols for the conduct of epidural analgesia for labour were used in six units. All units used mixtures of local anaesthetic combined with opioid, administered as intermittent boluses, continuous epidural infusion, or patient-controlled epidural analgesia.

CONCLUSIONS. Although there has been progress and improvement in the provision of obstetric epidural analgesia services in our public hospitals, the rate is still relatively low and the provision of services after hours is limited. Further progress will likely be hindered by current or future cutbacks in public hospital budgets.

Key words: Analgesia, epidural; Analgesia, obstetric; Health care survey; Hong Kong

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OBJECTIVE. To investigate sleeping energy expenditure in paediatric patients with obstructive sleep apnoea syndrome.

DESIGN. Retrospective study.

SETTING. University teaching hospital, Hong Kong. PATIENTS AND METHODS. A retrospective analysis comparing sleeping energy expenditure in patients with confirmed obstructive sleep apnoea syndrome and control subjects matched for age, sex, and ideal weight for body height. Subjects were recruited from the Paediatric Chest Clinic and all had undergone overnight polysomnography and sleeping energy expenditure measurement by open-circuit indirect calorimetry using a metabolic cart and canopy system. The measurements were taken during slow-wave sleep.

RESULTS. Twenty-four cases with obstructive sleep apnoea syndrome (apnoea hypopnoea index >5) and 23 control subjects were studied. Mean age and ideal weight for body height were 9.4 (standard deviation, 3.9) years and 152.5% (27.2%), respectively. Mean sleeping energy expenditure corrected for body weight for the cases and the control group were 44.83 (standard deviation, 10.49) Kcal/day and 40.71 (10.60) Kcal/day, respectively. Sleeping energy expenditure was not found to be associated with the severity of obstructive sleep apnoea syndrome (r=0.34, P=0.27).

CONCLUSION. A trend towards greater sleeping energy expenditure was found in patients with obstructive sleep apnoea syndrome. Further studies on the metabolic aspects of this condition are required.

Key words: Energy expenditure; Sleep apnea, obstructive

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OBJECTIVE. To determine the prognostic factors associated with successful outcome following controlled ovarian stimulation and intrauterine insemination.

DESIGN. Retrospective analysis.

SETTING. University-based assisted reproductive technology centre, Hong Kong.

PATIENTS AND METHODS. Patients included 292 couples undergoing 600 treatment cycles, following a standard protocol of human menopausal gonadotrophin injections. Multiple logistic regression analysis was performed to determine which demographic and sperm parameters gave the maximum discrimination to predict pregnancy.

RESULTS. One hundred and eleven pregnancies resulted from treatment. The pregnancy rates were 18.5% per cycle and 37.9% per couple. The age of the women was significantly lower for pregnant cycles, and the serum oestradiol levels and number of follicles greater than 16 mm in diameter were significantly higher, compared with non-pregnant cycles. The sperm concentration and number of motile spermatozoa were also significantly increased in pregnant cycles. Pregnancy rate was significantly increased when the raw semen sample contained 20 million/mL or more spermatozoa, normal forms comprised 7% or more, and when the number of motile spermatozoa in inseminated samples was 1 million or greater.

CONCLUSION. Using multiple logistic regression analysis, age of the women and serum oestradiol level had the maximum power to predict pregnancy following ovarian stimulation and intrauterine insemination.

Key words: Insenmination; Ovarian stimulation; Prognosis; Semen

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OBJECTIVE. To describe demographic characteristics, patterns of use, reported symptoms, and laboratory results associated with mercury exposure among people who used a beauty cream containing mercury.

DESIGN. Descriptive study of a case series.

SETTING. The Hong Kong community.

PARTICIPANTS. Users of a cream cosmetic who contacted the Department of Health following a public announcement.

MAIN OUTCOME MEASURES. Urine and blood mercury concentrations, cream mercury content, self-reported symptoms, duration of cream use, and duration since last cream use.

RESULTS. We interviewed 314 cream users, 99% of whom were women. The mean urine and blood mercury concentrations of 286 users, who submitted a urine or blood sample, were 45.2 µg/L (reference level, <20µg/L) and 17.1 µg/L (reference level, <10 µg/L), respectively; 65% of these participants had elevated mercury concentrations. The mercury content of the cream cosmetic ranged from 660 to 57 000 ppm. Seventy-eight percent of all cream users reported no symptoms, but absence of symptoms was not predictive of low urine and blood mercury concentrations. Urine mercury concentrations were significantly higher among people who last used the cream within 45 days. Blood mercury concentrations were elevated following cream use for as short as 2 days.

CONCLUSIONS. The majority of cream users had increased urine or blood mercury concentrations but remained asymptomatic, implying that the incidence of overt symptomatic mercury poisoning resulting from dermal application of creams with mercury content lower than 57 000 ppm is low. Doctors should take a history of the use of cosmetics if patients have clinical or laboratory evidence of mercury exposure; such cases should be reported to public health authorities.

Key words: Cosmetics/adverse effects; Female; Mercury poisoning

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