Mammography screening in general practice - a pilot study

Objectives: To evaluate the acceptability, feasibility and performance of a mammography screening programme for female patients in general practice. Design: A cross sectional study. Setting: A general practice clinic and a resiona/ hospital in Hong Kong. Subjects: 500 Chinese women aged 45 years or older attending a university teaching general practice clinic on Hong Kong Island. Main outcome measures: The rates of uptake of screening, retakes, recall for further evaluation and fine needle aspiration (FNA), and participants' opinion on mammography. Results: The uptake rate of screening was 37%. Mammography was feasible for all participants, 12% had additional films and 7% required retakes. Sixteen percent were recalled for further evaluation, 4% had FNA, one had an excisional biopsy which revealed no cancer. Most women rated pain of mammography mild to moderate and did not find it embarrassing, 98% said that they would recommend it to their friends and 87% indicated that they would do it again. Conclusions: Mammography screening for Chinese women presenting to general practice was technically feasible. Most women found the experience of mammography screening acceptable. The uptake rate of mammography screening was much lower than what would be required to benefit the overall breast cancer mortality. There was also room for improvement in our retake and recall rates. We need to weigh the possible benefit of mammography screening against the stress and resources associated with additional films, retakes, recalls for further evaluation, FNA and excisional biopsy in individuals with false positive results.published_or_final_versio

Hepatic cancer stem cell marker granulin-epithelin precursor and β-catenin expression associate with recurrence in hepatocellular carcinoma

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Comprehensive characterization of the patient-derived xenograft and the paralleled primary hepatocellular carcinoma cell line

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Granulin-epithelin precursor interacts with 78-kDa glucose-regulated protein in hepatocellular carcinoma

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The recording and characteristics of pulmonary rehabilitation in patients with COPD using The Health Information Network (THIN) primary care database

Pulmonary rehabilitation is recommended for patients with COPD to improve physical function, breathlessness and quality of life. Using The Health Information Network (THIN) primary care database in UK, we compared the demographic and clinical parameters of patients with COPD in relation to coding of pulmonary rehabilitation, and to investigate whether there is a survival benefit from pulmonary rehabilitation. We identified patients with COPD, diagnosed from 2004 and extracted information on demographics, pulmonary rehabilitation and clinical parameters using the relevant Read codes. Thirty six thousand one hundred and eighty nine patients diagnosed with COPD were included with a mean (SD) age of 67 (11) years, 53% were male and only 9.8% had a code related to either being assessed, referred, or completing pulmonary rehabilitation ever. Younger age at diagnosis, better socioeconomic status, worse dyspnoea score, current smoking, and higher comorbidities level are more likely to have a record of pulmonary rehabilitation. Of those with a recorded MRC of 3 or worse, only 2057 (21%) had a code of pulmonary rehabilitation. Survival analysis revealed that patients with coding for pulmonary rehabilitation were 22% (95% CI 0.69–0.88) less likely to die than those who had no coding. In UK THIN records, a substantial proportion of eligible patients with COPD have not had a coded pulmonary rehabilitation record. Survival was improved in those with PR record but coding for other COPD treatments were also better in this group. GP practices need to improve the coding for PR to highlight any unmet need locally

Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: a systematic review of qualitative studies

Pulmonary rehabilitation has short-term benefits on dyspnea, exercise capacity and quality of life in COPD, but evidence suggests these do not always translate to increased daily physical activity on a patient level. This is attributed to a limited understanding of the determinants of physical activity maintenance following pulmonary rehabilitation. This systematic review of qualitative research was conducted to understand COPD patients’ perceived facilitators and barriers to physical activity following pulmonary rehabilitation. Electronic databases of published data, non-published data, and trial registers were searched to identify qualitative studies (interviews, focus groups) reporting the facilitators and barriers to physical activity following pulmonary rehabilitation for people with COPD. Thematic synthesis of qualitative data was adopted involving line-by-line coding of the findings of the included studies, development of descriptive themes, and generation of analytical themes. Fourteen studies including 167 COPD patients met the inclusion criteria. Seven sub-themes were identified as influential to physical activity following pulmonary rehabilitation. These included: intentions, self-efficacy, feedback of capabilities and improvements, relationship with health care professionals, peer interaction, opportunities following pulmonary rehabilitation and routine. These encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation and were identified as sub-themes within the three analytical themes, which were beliefs, social support, and the environment. The findings highlight the challenge of promoting physical activity following pulmonary rehabilitation in COPD and provide complementary evidence to aid evaluations of interventions already attempted in this area, but also adds insight into future development of interventions targeting physical activity maintenance in COPD

Practice of breast self-examination among high risk Chinese women in Hong Kong

Background The incidence of breast cancer in Hong Kong is increasing and breast self-examination (BSE) as a screening tool is becoming more popular, especially among first-degree relatives (FDR) of breast cancer victims. BSE may be more applicable to Chinese women as their breast size is smaller. This study explores the BSE practice in this group of women. Methods: A cross sectional study was conducted by sending questionnaires to 330 FDR of breast cancer patients treated in the Department of Surgery, University of Hong Kong. BSE behavior was studied with respect to its frequency, awareness, completeness and confidence of practice. Results: 110 subjects returned the questionnaires with a response rate of 33% . The mean age of the respondent was 37 years. Only 57 women (52%) were practicers. The practicers have a stronger BSE awareness (P < 0.01) and a lower mean score on thought barriers (P = 0.002) than the non-practicers. 40% of the practicers gain their BSE knowledge through clinicians and their mean period of practice was 3.2 years. 68% of the practicers performed BSE completely. The overall confidence rate was 35%, but the rate was 43% among those who performed complete BSE. Thirteen factors possibly related to the completeness and rate of confidence of BSE examination were studied. The only factor that significantly determined completeness was the time spent for each examination (P = 0.002) . The complete practicers required a longer time than the incomplete practicers (6.60 and 2.96 min, respectively) . Women with a stronger BSE intention (P = 0.001) and a lower mean score on thought barriers (P = 0.001) performed the examination confidently. Conclusions: Slightly over half of the FDR practice BSE. The majority perform a complete BSE but they are not confident in finding abnormalities. Women spending more time on BSE are associated with a higher rate of completeness. However, only those with a stronger BSE intention and lesser thought barriers are more confident in their practice.link_to_subscribed_fulltex

A Coasian Approach to Planning and Sustainable Development by Communicative Planning

Influenced by the growing popularity of the Coase Theorem, less formal expressions are often used interchangeably, such as 'Coasian approaches', 'Coasian paradigm', 'Coasian solutions', and 'Coasian framework', and have proliferated in the planning and related sustainable development literature. The diversity of the meanings of these expressions has grown, thereby causing some confusion. This short article examines these expressions with a view to explaining what exactly may or may not be properly described as a 'Coasian approach' and explores the idea that the Coasian approach, taken with innovations brought along through communicative planning, can foster sustainable development. This is demonstrated by reference to a model built of elementary neo-classical economic and ecological concepts but given a new interpretation

When to be vaccinated? What to consider? Modelling decision-making and time preference for COVID-19 vaccine through a conjoint experiment

How do citizens choose COVID-19 vaccines, and when do they wish to be vaccinated? A choice-based conjoint experiment was conducted in Hong Kong to examine factors that shape citizens’ preference toward COVID-19 vaccines and their time preference to be vaccinated, which is overlooked in extant literature. Results suggest people are most concerned about vaccines’ efficacy and severe side-effects, and that cash incentives are not useful in enhancing vaccine appeal. The majority of respondents show low intention for immediate vaccination, and many of them want to delay their vaccination. Further analysis shows that their time preference is shaped more by respondent characteristics than vaccine attributes. In particular, confidence in the vaccine, trust in government, and working in high-risk professions are associated with earlier timing for vaccine uptake. Meanwhile, forced COVID testing would delay vaccination. The findings offer a novel view in understanding how people decide whether and when to receive new vaccines, which have pivotal implications for a head start of any mass vaccination programs