Having a family doctor was associated with lower utilization of hospital-based health services

Background: Primary care in the United States and most countries in Asia are provided by a variety of doctors. However, effectiveness of such diversified primary care in gate-keeping secondary medical services is unknown. This study aimed to evaluate health services utilization rates of hospital emergency and admission services among people who used different primary care doctors in Hong Kong. Method: This study was a population-based cross-sectional telephone survey using structured questionnaire on health services utilization rates and pattern in Hong Kong in 2007 to 2008. Information on the choice of primary care doctors, utilization rates and patterns of primary care service were collected. Poisson and logistic regression analyses were used to explore any differences in service utilization rates and patterns among people using different types of primary care doctors. Results: Out of 3148 subjects who completed the survey, 1896 (60.2%) had regular primary care doctors, of whom 1150 (60.7%) regarded their regular doctors as their family doctors (RFD). 1157 (36.8%) of them did not use any regular doctors (NRD). Only 4.3% of the RFD group (vs 7.8% of other regular doctors (ORD) and 9.6% of NRD) visited emergency service and only 1.7% (vs 3.6% of ORD and 4.0% of NRD) were admitted to hospital for their last episode of illness. Regression analyses controlling for sociodemographics and health status confirmed that respondents having RFD were less likely to use emergency service than people who had NRD (OR 0.479) or ORD (OR 0.624) or being admitted to hospital (OR 0.458 vs NRD and 0.514 vs ORD) for their last episode of illness. Conclusion: Primary care is most effective in gate-keeping secondary care among people with regular family doctors. People without any regular primary care doctor were more likely to use emergency service as primary care. The findings supported a family doctor-led primary care model. Trial registration number. ClinicalTrials.gov ID: NCT01422031.published_or_final_versio

Having a Family Doctor is Associated with Some Better Patient-Reported Outcomes of Primary Care Consultations

Background: Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference. Methods: We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient’s concerns. Results: One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient’s concerns. Conclusion: People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations.published_or_final_versio

Correlation of PD-L1 Expression of Tumor Cells with Survival Outcomes after Radical Intensity-Modulated Radiation Therapy for Non-Metastatic Nasopharyngeal Carcinoma

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Prognostication of serial post-intensity-modulated radiation therapy undetectable plasma EBV DNA for nasopharyngeal carcinoma

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The genome and sex-dependent responses to temperature in the common yellow butterfly, Eurema hecabe

This is the final version. Available on open access from BMC via the DOI in this recordAvailability of data and materials: The raw reads generated in this study have been deposited to the NCBI database under the BioProject accession PRJNA664668 [110]. The final chromosome assembly was submitted to NCBI Assembly under accession number JADANM000000000 in NCBI [111]. The genome annotation files were deposited in the Figshare [112].BACKGROUND: Lepidoptera (butterflies and moths) is one of the most geographically widespread insect orders in the world, and its species play important and diverse ecological and applied roles. Climate change is one of the biggest challenges to biodiversity this century, and lepidopterans are vulnerable to climate change. Temperature-dependent gene expression differences are of relevance under the ongoing climate crisis. However, little is known about how climate affects gene expression in lepidopterans and the ecological consequences of this, particularly with respect to genes with biased expression in one of the sexes. The common yellow butterfly, Eurema hecabe (Family Pieridae), is one of the most geographically widespread lepidopterans that can be found in Asia, Africa, and Australia. Nevertheless, what temperature-dependent effects there may be and whether the effects differ between the sexes remain largely unexplored. RESULTS: Here, we generated high-quality genomic resources for E. hecabe along with transcriptomes from eight developmental stages. Male and female butterflies were subjected to varying temperatures to assess sex-specific gene expression responses through mRNA and microRNA transcriptomics. We find that there are more temperature-dependent sex-biased genes in females than males, including genes that are involved in a range of biologically important functions, highlighting potential ecological impacts of increased temperatures. Further, by considering available butterfly data on sex-biased gene expression in a comparative genomic framework, we find that the pattern of sex-biased gene expression identified in E. hecabe is highly species-specific, rather than conserved across butterfly species, suggesting that sex-biased gene expression responses to climate change are complex in butterflies. CONCLUSIONS: Our study lays the foundation for further understanding of differential responses to environmental stress in a widespread lepidopteran model and demonstrates the potential complexity of sex-specific responses of lepidopterans to climate change.Hong Kong Research Grant Council Collaborative Research Fund CRFGeneral Research Fund GRFArea of ExcellenceChinese University of Hong KongBiotechnology and Biological Sciences Research Council (BBSRC

Advances in the clinical management of nasopharyngeal cancer

Celebrating 50 years of Epstein-Barr virus discovery (1964-2014)Session 11: Clinical Aspects of EBV-associated malignanciesNasopharyngeal carcinoma (NPC) is one of the most peculiar cancers with a distinctly skewed geographic and ethnic distribution. Epidemiological studies have unveiled its multifactorial etiology with a dynamic interplay of genetic predisposition, Epstein–Barr virus (EBV) infection and environmental carcinogens. Radiotherapy has been the mainstay of curative treatment. The use of highly precise intensity-modulation radiotherapy technique has achieved excellent locoregional control and reduced treatment toxicities. Combination chemotherapy with cisplatin-based regimen further improves treatment outcome. The refinement of radiotherapy technique, search for more potent systemic agents, contemporary treatment strategies for recurrent or metastatic diseases, biomarkers for prognostification and prediction of treatment response are currently under intense study

Early-stage nasopharyngeal carcinoma

Summary Early-stage nasopharyngeal carcinoma is a highly curable disease. Owing to the high radiosensitivity of nasopharyngeal carcinoma and the small volume of tumor in early-stage disease, definitive radiotherapy alone has been the mainstay of treatment. Modern radiotherapy techniques aim to further improve disease control and reduce toxicities. In this chapter, we discuss the clinical data for radiotherapy in different eras, important prognostic factors and the role of chemotherapy in the treatment of early-stage nasopharyngeal carcinoma

Uncovering insights from healthcare archives to improve operations : an association analysis for cervical cancer screening

202208 bcwwSelf-fundedPublished24 month