OBJECTIVES. To determine the epidemiology of human immunodeficiency virus infection among pregnant women and the neonatal outcomes in Hong Kong.

DESIGN. Retrospective observational study composed of two parts: record review of pregnant women and unlinked anonymous screening of cord blood from neonates.

SETTING. Two human immunodeficiency virus clinics and the Government Virus Unit.

PARTICIPANTS. Female patients attending the two clinics who became pregnant and neonates who underwent routine metabolic screening by the Government Virus Unit between 1992 and 1999.

MAIN OUTCOME MEASURES. The outcomes of neonates born to women who had human immunodeficiency virus infection during pregnancy.

RESULTS. Forty-one human immunodeficiency virus–related pregnancies were recorded among 32 infected women. Fifteen pregnancies were terminated, of which 14 were in women who knew their infection status before conception. Twenty-six pregnancies continued to term, resulting in 26 live births. Twelve babies were born to women who knew their infection status before delivery. One baby was confirmed to be infected. Six women were given zidovudine for prophylaxis against vertical transmission and none of the babies were infected at birth. Of the remaining 14 human immunodeficiency virus–related pregnancies, the mothers’ status became known only at a later date and nine (64.3%) babies were confirmed to be infected at the age of 18 months or older. The rate ratio of giving birth to an infected baby was 8.18 from mothers who did not know their status antenatally. Unlinked anonymous screening showed that the seroprevalence rate for human immunodeficiency virus in pregnant women was 0.032% (1/3125) in Hong Kong in 1999.

CONCLUSIONS. Human immunodeficiency virus–related pregnancy is not rare in Hong Kong and the majority of infected mothers were not identified and treated. Detection of these pregnancies will be invaluable for the prevention of mother-to-child transmission. Universal antenatal screening of human immunodeficiency virus antibody is proposed as an effective strategy.

Key words: Disease transmission, vertical; HIV infections/transmission; Hong Kong; Neonatal screening; Prenatal diagnosis

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OBJECTIVES. To assess the quality of anaesthetic services as defined in the six anaesthetic clinical indicators against preset standards and to identify risk factors for adverse events in the recovery room.

DESIGN. Prospective study.

SETTING. All public hospitals providing anaesthetic care in Hong Kong.

PATIENTS. Eighteen thousand, seven hundred and fifty-nine patients receiving elective or emergency anaesthesia administered by anaesthetists from June 1998 to July 1998.

MAIN OUTCOME MEASURES. Patient demographics, American Society of Anesthesiologists status, category and nature of operation, presence of preoperative anaesthetic visit in ward, type of anaesthesia, reasons for a recovery room stay of more than a 2-hour duration, intubation to relieve respiratory distress in the recovery room, presence of hypothermia in the recovery room for operations lasting more than 2 hours, and dental or ocular injuries attributable to anaesthesia.

RESULTS. There are two major findings from this study. Firstly, a high incidence of hypothermia in the recovery room was reported. Secondly, a greater risk of prolonged stay in the recovery room was identified for patients older than 65 years, major operations, and anaesthetic techniques using combined general and regional anaesthesia.

CONCLUSION. The six anaesthetic clinical indicators reflected the provision of anaesthetic care in public hospitals in Hong Kong. Good compliance to the preset standard of the anaesthetic clinical indicators was achieved during the study period.

Key words: Anesthesia; Anesthesia recovery period; Quality assurance, health care; Risk management

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OBJECTIVE. To estimate how axial rotation of lumbar vertebrae quantitatively affects bone mineral density, as measured by dual energy X-ray absorptiometry in the anteroposterior plane.

DESIGN. Observational study. Setting. University teaching hospital, Hong Kong.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Cadaver lumbar vertebrae (L2 to L4) were removed from four adults.

MAIN OUTCOME MEASURES. Using dual energy X-ray absorptiometry, the bone mineral content, bone area, and bone mineral density were measured in the neutral position and with vertebral axial rotation in increments of 7.5 degrees, up to a maximum of 45 degrees.

RESULTS. Correlation analysis showed a significant positive correlation between the degree of rotation and measured bone area, a significant negative correlation between degree of rotation and bone mineral density measurements, but no significant correlation between degree of rotation and measured bone mineral content. The measured bone area increased approximately 24% and the bone mineral density decreased approximately 19% when the vertebrae were rotated by 45 degrees.

CONCLUSIONS. These results suggest that for patients with rotational deformity of the spine, such as scoliosis, measurements of lumbar spine bone mineral content by dual energy X-ray absorptiometry is not affected, while bone mineral density measurements are not reliable.

Key words: Absorptiometry, Bone density; Densitometry, X-ray; Lumbar vertebrae; Scoliosis

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OBJECTIVES. To examine the demographics, professional background, progress, and aspirations of anaesthesia trainees in Hong Kong.

DESIGN. Anonymous questionnaire consisting of 56 items grouped into the areas of demographics, and anaesthetic and postanaesthetic training. Eight of the items were open questions. Descriptive analyses were undertaken for the closed items.

SETTING. Hong Kong College of Anaesthesiologists, Hong Kong.

PARTICIPANTS. All trainees.

MAIN OUTCOME MEASURES. Demographic data, aspects of training, supervision, working environment, career aspirations, job satisfaction, and morale.

RESULTS. The response rate was 77%. The various problems highlighted by respondents included the need for more input and feedback into individual training programmes, the lack of senior support, and the need for more relevant and examination-orientated courses and workshops. Unsatisfactory aspects of the specialty reported were the lack of control over work routines, relationships with surgeons, boredom, and the poor public image of the specialty. Eighty-four percent of respondents reported having reasonable to good job satisfaction.

CONCLUSIONS. Ongoing benefits could be derived from enhancing communication between trainees and the Hong Kong College of Anaesthesiologists, through appropriate channels for trainee feedback.

Key words: Anesthesiology, education; Career choice; Decision making; Education, medical, graduate

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OBJECTIVE. To analyse the pattern of acute pelvic fractures, prognostic indicators, and intermediate-term functional outcome among elderly patients.

DESIGN. Retrospective study.

SETTING. Community-based hospital, Hong Kong.

PATIENTS. Sixty patients older than 60 years who were admitted to hospital with acute pelvic fracture between 1 November 1993 and 31 December 1996.

MAIN OUTCOME MEASURES. Review of medical records and X-ray assessment to determine the patients' demographic data, medical comorbidities, aetiology and mechanism of injury, associated injuries, and clinical outcome indicators such as complications, duration of hospital stay, ambulatory status, and 1- and 2-year mortality rates.

RESULTS. The mean follow-up period was 29 months (range, 12 to 65 months). Eighty-seven percent of patients were women and the predominant fracture pattern was Tile A2. The leading cause of injury was low-energy fall injury (75%). The 1-year mortality rate was nearly 12%. Thirty-six percent of patients experienced a decline in ambulatory status. Twenty-five percent of superior rami fractures involved the low anterior column of the acetabulum. There was a high incidence of associated cardiovascular disorders.

CONCLUSIONS. Pre-existing medical conditions and acetabular involvement are important adverse factors affecting postinjury ambulatory status. A significant decline in ambulatory status and a significant mortality rate at 1 year were found following pelvic fracture in elderly patients.

Key words: Aged; Fractures/complications; Multiple trauma/etiology; Pelvic bones/injuries

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