Law, FYW

Yang, KCT

Yip, PSF

Hong Kong Medical Journal

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Title Suicides in general hospitals in Hong Kong: Letters to the editorAuthor(s) Yip, PSF; Yang, KCT; Law, FYWCitation Hong Kong Medical Journal, 2005, v. 11 n. 1, p. 70-71Issued Date 2005URL http://hdl.handle.net/10722/45518Rights Creative Commons: Attribution 3.0 Hong Kong License70      Hong Kong Med J Vol 11 No 1 February 2005LETTERS TO THE EDITORTo the Editor—I am writing with reference to the arti-cle by Tam et al1 in the October 2004 issue of the HongKong Medical Journal. The authors are to be congratu-lated for conducting such a comprehensive study on atopic of immense public health and clinical importancethat needs prompt attention and intervention. I wish tocomment more on the importance of early screeningand intervention of microalbuminuria in patients withtype II diabetes, which is never a benign condition.The prevalence of microalbuminuria is as high as53% among diabetics2 and is significantly associatedwith modifiable factors, such as hyperglycaemia andelevated levels of blood pressure.3 Microalbuminuriais a predictor of advanced nephropathy and a risk indi-cator for cardiovascular mortality,3 and is correlatedwith overall deaths4 among patients with type IIdiabetes. Nevertheless, I am concerned about thesubopt imal  survei l lance  and screening ofmicroalbuminuria among type II diabetics by careproviders in different parts of the world. Khuwajaet al,5 for example, recently reported that only 38%of patients with type II diabetes were screened formicroalbuminuria in a multicentre study in Karachi,Pakistan. Moreover, large number of diabetics in thatstudy had modifiable factors (high systolic bloodpressure of 65%, high diastolic blood pressure of 75%,and high glycaemia level of 74%), which were alreadyproven to be strongly associated with microal-buminuria. The literature indicates that intensive dia-betes management with modification of risk factorscan significantly decrease the burden of this condition.3I highly recommend the early detection of micro-albuminuria with aggressive management of modifi-able risk factors by means of lifestyle changes andtherapeutic measures. Thus, the burden of prematuremorbidity and mortality associated with this conditioncan be significantly reduced. In this regard, physiciansshould be trained about more comprehensive andintegrated management protocols for diabetics ingeneral and for diabetics having microalbuminuria inparticular.Ali Khan Khuwaja, MCPS, FCPS(e-mail: ali.khuwaja@aku.edu)Department of Family Medicine and CommunityHealth SciencesAga Khan UniversityKarachi, PakistanReferences1. Tam TK, Cheng LP, Lau DM, et al. The prevalence ofmicroalbuminuria among patients with type II diabetesmellitus in a primary care setting: cross-sectional study.Hong Kong Med J 2004;10:307-11.2. Sobngwi E, Mbanya JC, Moukouri EN, Ngu KB.Microalbuminuria and retinopathy in a diabetic populationof Cameroon. Diabetes Res Clin Pract 1999;44:191-6.3. American Diabetes Association. Standards of medical carein diabetes. Diabetes Care 2004;27(Suppl 1):15S-35S.4. Dinneen SF, Gerstein HC. The association of microalbuminuriaand mortality in non-insulin-dependent diabetes mellitus.A systematic overview of the literature. Arch Intern Med 1997;157:1413-8.5. Khuwaja AK, Rafique G, Azam I, et al. Out-patient careof type 2 diabetes in three settings in Karachi, Pakistan.Proceedings of the 3rd Asia Pacific Conference on Evidence-based Medicine; 2004 Nov 26-28; Hong Kong.Microalbuminuria among patients with type II diabetesmellitus: early screening and intervention requiredTo the Editor—Ho and Tay1 gave a useful descriptionof the characteristics of suicide patients and theirsuicidal acts occurring in general hospitals of HongKong in the October 2004 issue of the Hong KongMedical Journal. It is a retrospective study and focusedon the hospital records of patients who died of suicideor attempted suicide between 2000 and 2002. Resultsindicated that a total of 166 suicidal acts occurred ingeneral wards, consisting of 34 completed suicidesand 132 attempts with a rate of 9.46 on average per100 000 admissions. Among them, 16.9% (28/166)were admitted to the general ward because of theirsuicidal act. Certainly, we agree with the authors thatthere is a particularly high re-attempt risk for thesepatients, and in the meantime the suicidal risk of otherpatients should not be neglected. Increased alertnessSuicides in general hospitals in Hong KongHong Kong Med J Vol 11 No 1 February 2005      71to the possibility of depression and suicidal riskamong general ward patients is required. Generalpractitioners and nurses should improve their careand awareness to patients who have not previouslyattempted suicide but who have suicidal risk in gen-eral wards during their normal daily practice.However, we would like to add some observationson the re-attempt suicidal risk of in-patients in localhospital setting. The suicide rate for the generalpopulation and the attempt rate were 16.4 and 37.3per 100 000, respectively, in 2002.2 The suicide andattempt rates in hospital wards were actually lowerthan that of the general population. Also, based on theHospital Authority’s data warehouse system, there wasa record of 4289 cases of in-patients with suicidalattempts who were admitted via Accident and Emer-gency Department during the captioned period (1 April2000 to 31 March 2002). The rate of re-attempt of thesesuicidal patients in general ward was about 652.8 per100 000 admissions (28/4289). The odds ratio (OR)of these two groups, ie (i) patients admitted to generalwards primarily due to their suicidal acts and (ii)general ward patients as a whole, was estimated tobe about 69 (OR= [28/166]/[4289/1 754 500]) with a95% confidence interval (46-103), which shows thatthose admitted to general wards because of attemptedsuicides are exposed to a significantly higher risk ofattempt than that of other patients. Those who areadmitted to general ward due to suicidal attempt havethe highest risk of re-attempt and they should be moni-tored closely. Many long-term follow-up studies ondeliberate self-harm patients have already concludedthat an unexpectedly high risk of re-attempt is presentwithin the first-year follow-up and its impact lastsseveral years afterwards.3-5 Also, focusing on suicidalattempts has been identified as one of the coreinterventions in suicide prevention programmes in anumber of national programmes, for example, in theUnited States, United Kingdom, and Australia. In viewof this, our Centre is currently collaborating with twolocal hospitals to study suicidal attempts and how toimprove on the existing service (including the follow-up) for suicide attempters.Given the importance of Accident and EmergencyDepartment as the first point of contact for a majorproportion of people who attempt suicide, a system-atic surveillance and monitoring of deliberate self-harmpatients presented to this department is essential forany suicide prevention programme.PSF Yip, PhD(e-mail: sfpyip@hku.hk)KCT Yang, MPhilFYW Law, MSWThe Hong Kong Jockey Club Centre for Suicide Re-search and Prevention, University of Hong Kong,Pokfulam, Hong KongReferences1. Ho TP, Tay MS. Suicides in general hospitals in Hong Kong:retrospective study. Hong Kong Med J 2004;10:319-24.2. The Hong Kong Jockey Club for Suicide Research andPrevention website: http://csrp1.hku.hk. Accessed 1 Nov 2004.3. Hawton K, Zahl D, Weatherall R. Suicide following deliberateself-harm: long-term follow-up of patients who presented to ageneral hospital. Br J Psychiatry 2003;182:537-42.4. Hawton K, Fagg J, Simkin S. Deliberate self-poisoning andself-injury in children and adolescents under 16 years of agein Oxford, 1976-1993. Br J Psychiatry 1996;169:202-8.5. Yim PH, Yip PS, Li RH, Dunn EL, Yeung WS, Miao YK.Suicide after discharge from psychiatric inpatient care: acase-control study in Hong Kong. Aust NZJ Psychiatry2004;38:65-72.To the Editor—We read with interest the article ‘Theaetiology and treatment of oral halitosis: an update’by Lee et al.1 The authors rightly pointed out mouthbreathing as a cause of halitosis but they failed to dis-cuss the important issue of causes of mouth breathing.Only by tackling the aetiologies of mouth breathingcan we treat halitosis effectively. Nasal breathing isusually the preferred route of breathing at rest, andmouth breathing occurs when there is nasal obstruction.The most common cause of persistent nasal obstruc-tion in Hong Kong would be allergic rhinitis whichhas been reported to affect 52% of 13- to 14-year-olds2and 37% of 6- to 7-year-olds.3 Hence, prescription oftopical nasal corticosteroid and avoidance of allergenswould be important in halitosis due to mouth breath-ing secondary to allergic rhinitis.Another important cause of halitosis is subacuterhinosinusitis. We found halitosis in 29 of 41 childrenwith subacute rhinosinusitis.4 Hence, appropriate an-Halitosis and the nose

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