Qualitative study of Chinese widows in Hong Kong: Insights for psycho-social care in hospice settings

In an exploratory, phenomenological study of seven Chinese widows in Hong Kong, five major themes are identified: relationship with the deceased, relationship with others, grief reactions, coping and emotional expression. This paper focuses on the first theme: the widows' relationship with the deceased husband along a timeline from the time of diagnosis to after death. The experiences in the final days with the deceased were frequently referred to when the informants talked about this theme. This paper aims to give added voice, based on the experience of Chinese widows, to the possible role of hospice and palliative care on influencing the bereavement experience. Issues of awareness and acceptance of death, the supportive environment and support for family carers, the moment of death, creation of legacies, and sensitivity towards cultural embedded practices, are discussed. It is hoped that the experiences of these bereaved widows will stimulate new research to elucidate and verify the findings reported in this paper. © 2006 Edward Arnold (Publishers) Ltd.postprin

Dignity amidst liminality: Healing within suffering among Chinese terminal cancer patients

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Viral Replication in the Nasopharynx Is Associated with Diarrhea in Patients with Severe Acute Respiratory Syndrome

The role of severe acute respiratory syndrome (SARS) coronavirus as an enteric pathogen was investigated in a cohort of 142 patients with SARS who were treated with a standard treatment protocol. Data from daily hematological, biochemical, radiological, and microbiological investigations were prospectively collected, and the correlation of these findings with diarrhea was retrospectively analyzed. Sixty-nine patients (48.6%) developed diarrhea at a mean (± standard deviation [SD]) of 7.6 ± 2.6 days after the onset of symptoms. The diarrhea was most severe at a mean (± SD) of 8.8 ± 2.4 days after onset, with a maximum frequency of 24 episodes per day (median, 5 episodes; range, 3-24 episodes). A higher mean virus load in nasopharyngeal specimens obtained on day 10 after the onset of symptoms was significantly associated with the occurrence of diarrhea (3.1 log 10 vs. 1.8 log 10 copies/mL; P = .01) and mortality (6.2 vs. 1.7 log 10 copies/mL; P<.01). However, diarrhea was not associated with mortality. The lung and the gastrointestinal tract may react differently to SARS coronavirus infection. Additional investigation of the role of SARS coronavirus in the pathogenesis of diarrhea in patients with SARS should be conducted.published_or_final_versio

The Blessings and the Curses of Filial Piety on Dignity at the End-of-Life: Lived Experience of Hong Kong Chinese Adult Children Caregivers

This study critically examines the evolving nature of filial piety and the role that it plays in the contemporary experience of "living and dying with dignity" among Hong Kong Chinese families facing the end of life. Meaning-oriented interviews were conducted with a purposive sample of 15 adult-children caregivers, ages 30 to 62, to elicit their narratives and stories in caring for a dying elderly parent. Qualitative content analysis reveals that although traditional filial beliefs provided motivation for family caregiving, the regrets of unfulfilled filial responsibilities create emotional distance between parents and adult children, which acts as a cultural barrier for reconciliation and contentment at life's final margin. These findings underscore the importance of intergenerational dynamics and interactions in the transformation of filial attitudes and behaviors, highlighting the importance of reciprocal relationships (versus authority relationship), mutual support (versus complete obedience), compassionate duty (versus obligatory duty), emotional connection (versus task fulfillment), and appreciation and forgiveness (versus guilt and shame) in the promotion of dignity at the end of life. Policy and clinical implications are discussed.School of Nursin

"Streptococcus milleri" endocarditis caused by Streptococcus anginosus

Unlike other viridans streptococci, members of the "Streptococcus milleri group" are often associated with abscess formation, but are only rare causes of infective endocarditis. Although it has been shown that almost all S. intermedius isolates and most S. constellatus isolates, but only 19% of S. anginosus isolates, were associated with abscess formation, no report has addressed the relative importance of the 3 species of the "S. milleri group" in infective endocarditis. During a 5-year period (April 1997 through March 2002), 6 cases of "S. milleri" endocarditis (out of 377 cases of infective endocarditis), that fulfil the Duke's criteria for the diagnosis of infective endocarditis, were encountered. All 6 "S. milleri" isolates were identified as S. anginosus by 16S ribosomal RNA (rRNA) gene sequencing. Three patients had underlying chronic rheumatic heart disease and 1 was an IV drug abuser. Five had monomicrobial bacteremia, and 1 had polymicrobial (S. anginosus, S. mitis, Granulicatella adiacens, and Slackia exigua) bacteremia. Two patients died. None of the 6 isolates were identified by the Vitek system (GPI) or the API system (20 STREP) at >95% confidence. All 6 isolates were sensitive to penicillin G (MIC 0.008-0.064 μg/mL), cefalothin, erythromycin, clindamycin, and vancomycin. Accurate identification to the species level, by 16S rRNA gene sequencing, in cases of bacteremia caused by members of the "S. milleri group", would have direct implication on the underlying disease process, hence guiding diagnosis and treatment. Infective endocarditis should be actively looked for in cases of monomicrobial S. anginosus bacteremia, especially if the organism is recovered in multiple blood cultures. © 2004 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

Development of a multi-locus sequence typing scheme for Laribacter hongkongensis, a novel bacterium associated with freshwater fish-borne gastroenteritis and traveler's diarrhea, revealed 'pathogenic' strains

Background: In 2001, we discovered Laribacter hongkongensis, a novel genus and species, facultative anaerobic, Gram-negative, motile, urease-positive, S-shaped rod that belongs to the Neisseriaceae family. In a multi-centered prospective study, we showed that L. hongkongensis was associated with community-acquired gastroenteritis and traveler's diarrhea, with freshwater fish as the reservoir of the bacterium. L. hongkongensis is globally distributed, as travel histories from patients suggested that it is present in at least four continents, including Asia, Europe, Africa and Central America.link_to_subscribed_fulltex