Models of preconception care implementation in selected countries.

Globally, maternal and child health faces diverse challenges depending on the status of the development of the country. Some countries have introduced or explored preconception care for various reasons. Falling birth rates and increasing knowledge about risk factors for adverse pregnancy outcomes led to the introduction of preconception care in Hong Kong in 1998, and South Korea in 2004. In Hong Kong, comprehensive preconception care including laboratory tests are provided to over 4000 women each year at a cost of $75 per person. In Korea, about 60$12) for preconception health care services. These case studies illustrate programmatic feasibility of preconception care services to address maternal and child health and other public health challenges in developed and emerging economies

Prevalence and Risk Factors of Human Papillomavirus (HPV) Infection in Southern Chinese Women – A Population-Based Study

Background: Persistent high-risk type Human papillomavirus (HPV) infection is recognized as a necessary cause of cervical cancer. This study aimed to compare the HPV prevalence and risk factors between women residing in Hong Kong (HK) and Guangzhou (GZ) region of China. Methodology/Principal Findings: A total of 1,570 and 1,369 women were recruited from HK and GZ, respectively. The cytology samples were collected and tested for HPV infection. The overall and type-specific HPV prevalence and the potential risk factors for acquisition of HPV infection were studied. Women with normal cytology in the GZ cohort had significantly higher HPV prevalence (10%) than those in the HK cohort (6.2%, p<0.001). The patterns of the age-specific HPV prevalence were also different between the two cohorts. In the HK cohort, women at the age of 20-29 years old had the highest prevalence and a second peak was observed in the age of ≥60 years old. In the GZ cohort, the highest HPV prevalence was also observed in 20-29 years old but declined as the age increased and a second peak was not seen. HPV16 and HPV52 were the most common high-risk types found in the HK and GZ cohorts, respectively. Age was the most consistently observed independent risk factor for HPV infection in the HK, while the number of sexual partners had association in the GZ cohort. Conclusions/Significance: Our study provides the current status and the epidemiological characteristics of HPV prevalence in Southern Chinese women. The results strongly suggested that population education and the effective cervical cancer screening would be vital in the prevention of cervical cancer. © 2011 Liu et al.published_or_final_versio

A study on the policy options for the HKSAR Government to tackle the low fertility rate in Hong Kong

published_or_final_versionPublic AdministrationMasterMaster of Public Administratio

Novel use of emergency contraceptive pills in Hong Kong

Emergency contraception is an effective backup for contraceptive failure. In Hong Kong, levonorgestrel emergency contraceptive pill is a prescription drug. In most developed countries, it is provided in advance or over-the-counter to eliminate the barrier to access. The objective of this thesis is to evaluate the feasibility and acceptability of these novel delivery modes in Hong Kong. Four studies were conducted to study pertinent subject matters. A retrospective review on 11014 clinical records of The Family Planning Association of Hong Kong on emergency contraception prescription between 2006 and 2008 was performed to delineate the characteristics of emergency contraceptive users. One-year follow-up data was available in 4728 records, with 89.4% used emergency contraception once and 8.5% used it twice. The proportion of subjects not using ongoing contraceptives reduced from 20.6% at the emergency contraception visit to 4.5% at post-treatment follow-up, 3.9% at 6th month and 3.3% at 12th month. Young age was not associated with not using ongoing contraceptives and repeat use of emergency contraceptives. A randomized controlled trial with 1030 women was conducted to compare the behavior of those given three courses of levonorgestrel emergency contraceptive pills in advance against those who had to get them from clinics when needed. After one year, 29.9% of women in the advanced provision group had used the pills versus 12.9% in the control group (odds ratio 2.87, 95% confidence interval 2.07-3.97). The advanced provision group used three times more pills than the control group (278 versus 95 courses, p<0.001). The median coitus-treatment interval in the advanced provision group was significantly shorter than the control group (11 h versus 20 h; p<0.001). Most women used condoms before (90%) and during (89%) the study. In both groups, consistency of use was higher after emergency contraception (65%) than before (60%) (p<0.001). This study confirmed that advanced provision increased the utilization of emergency contraceptive pill, facilitated its early use and did not hamper ongoing contraceptive use. A questionnaire survey was conducted to evaluate the acceptability of novel use of emergency contraceptive pill among women practicing contraception. Of the 1405 questionnaires analyzed, 46.3% of women supported more advertising on emergency contraception; 48.7% supported advanced provision of emergency contraceptive pill and 25.7% supported over-the-counter provision. Another questionnaire survey assessed the attitude of physicians who provide family planning services. Half (54.2%) of them supported advanced provision of emergency contraceptive pill; 32.5% supported advanced provision to girls aged 16 and below and 40.2% supported over-thecounter provision. Among 352 physicians who provided emergency contraception, only 21.7% of private family physicians and 15.9% of private obstetrician-gynaecologists prescribed emergency contraceptive pills in advance. In conclusion, local women used emergency contraception responsibly and remained vigilant with ongoing contraception even when they got pills in advance. Minority of physicians practice advanced provision. The acceptance of advanced provision, among women and physicians who do not know much about it, is around 50%. It is thus possible to improve when more education on advanced provision is provided. The support for over-the-counter provision was too weak to boost.published_or_final_versionMedicineMasterDoctor of Medicin

The prevalence of type-specific HPV infection in women with normal cytology in the HK and GZ cohorts.

<p>*Statistically significant at 0.05 level of significance by Holm's procedure that accounts for the multiple comparisons.</p><p>**Adjusted for the stratified sampling design.</p>†<p>The seven commonest HPV high-risk types in the HK cohort.</p>‡<p>The seven commonest HPV high-risk types in the GZ cohort.</p

Potential risk factors in relation to HPV infection in the HK and GZ cohorts.

1<p>:Tolerance >0.4 for all variables, Naglekerke R² = 7.8%, Hosmer-Lemeshow test p = 0.793.</p>2<p>:Tolerance >0.4 for all variables, Naglekerke R² = 3.5%, Hosmer-Lemeshow test p = 0.750.</p>3<p>:OR and P-value were obtained using multivariate logistic regression analysis model of which included all of the variables listed in this table. Bold type indicated statistically significant values.</p><p>N: Total number of cases.</p

Comparison of the age-specific overall and high-risk HPV prevalence in five age-groups in the HK and GZ cohorts.

<p>(A) Overall HPV prevalence: significant difference in the overall HPV prevalence between the two cohorts in age-groups of 30–39, 40–49 and 50–59 (p<0.001, p<0.001 and p = 0.007, respectively, z test). (B) High-risk HPV prevalence: significant difference in the high-risk HPV prevalence between the two cohorts in age-groups of 30–39 and 40–49 (p<0.001 and p<0.001, respectively, z test). The error bar indicates 95% confidence interval.</p