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Biomedical subjects

Timothy Kwok

Publications and source records attributed to Timothy Kwok.

15 recordsLinked to original sources
PubMed2006

Risk factors for lower urinary tract symptoms in southern Chinese men.

OBJECTIVES: To study, in a large prospective cohort study of 2000 Chinese men 65 to 92 years of age in Hong Kong, the role of lifestyle and medical risk factors for moderate to severe lower urinary tract symptoms (LUTS). Previous epidemiologic studies evaluating the risk factors for LUTS were mainly conducted in non-Chinese populations. METHODS: After excluding men with prostate or bladder cancer or surgery and those who took alpha-blockers and antiandrogens, 1739 subjects provided responses to a structured interviewer-administered questionnaire and physical examination. RESULTS: A clustered case-control analysis was performed, comparing subjects with moderate to severe LUTS with those with mild or no LUTS. A total of 38.2% of subjects had moderate to severe LUTS. On multiple logistic regression analysis, a history of heart disease was independently associated with an increased risk of moderate to severe LUTS (odds ratio 1.50, 95% confidence interval 1.13 to 1.98). Physical activity was independently associated with reduced risk of moderate to severe LUTS (odds ratio 0.66, 95% confidence interval 0.48 to 0.90). A mild increase in the body mass index (23 to 24.9 kg/m2) was associated with a reduced risk of LUTS (odds ratio 0.72, 95% confidence interval 0.56 to 0.93). CONCLUSIONS: These results have shown that LUTS are a significant health problem in Chinese men and that, similar to results from previous studies, LUTS are associated with medical and lifestyle factors in the Chinese.

Aged↗
PubMed2006

Apolipoprotein E epsilon4 allele is associated with vascular dementia.

BACKGROUND/AIMS: The apolipoprotein E (ApoE) exon 4 polymorphism has been associated with vascular dementia (VaD) risk. Since not all studies confirm this finding, we explored this association in a case-control study. METHODS: We genotyped ApoE in 144 VaD patients and 251 controls. RESULTS: VaD patients were more likely than controls to have ApoE epsilon3/epsilon4 or epsilon4/epsilon4 genotypes: 23.6% versus 15.1%, odds ratio (OR) = 1.7, p = 0.036. This association remained significant after adjustment for age, sex, hypertension and diabetes by multiple logistic regression: OR = 1.9, p = 0.030. The association of epsilon3/epsilon4 or epsilon4/epsilon4 genotypes with VaD was strong among people with hypertension (OR = 2.9, p = 0.007) or diabetes (OR = 6.5, p = 0.011). The association was absent among people without hypertension (OR = 1.1, p = 0.79) or diabetes (OR = 1.3, p = 0.43). CONCLUSION: This interaction with hypertension and diabetes should be examined in other studies to confirm or refute this observation.

Aged↗
PubMed2006

Lower urinary tract symptoms and depressive symptoms in elderly men.

BACKGROUND: To evaluate the impact of moderate to severe lower urinary tract symptoms (LUTS) on clinically significant depressive symptoms in elderly Chinese men aged 65 and above. METHODS: In a large prospective cohort of 2000 Chinese men aged 65 to 92 years of age in Hong Kong, the association between moderate to severe lower urinary tract symptoms and clinically relevant depressive symptoms was studied. After excluding men with prostate or bladder cancer or surgery, 1980 subjects provided response to a structured interviewer-administered questionnaire and physical examination. A case-control analysis was performed, comparing subjects with clinically relevant depressive symptoms (cases) to those without depressive symptoms (controls). RESULTS: In multiple analyses adjusting for all factors that were shown to be significantly associated with having clinically relevant depressive symptoms in the initial bivariate analyses, being widowed, divorced or single were associated with increased risk of having clinically relevant depressive symptoms. Having a history of cardiac disease, being a current smoker and the use of corticosteroid were also associated with increased risk. Having moderate to severe LUTS was significantly associated with increased odds of having clinically relevant depressive symptoms (OR: 2.40; CI: 1.68-3.43) even after adjustment. LIMITATION: This study was cross-sectional and there were no clinician-based diagnostic interviews that were conducted to diagnose clinical depression and thus only clinically relevant depressive symptoms were assessed. CONCLUSIONS: In elderly men, moderate to severe LUTS are important public health problems that are associated with increased risk of having clinically relevant depressive symptoms. These findings suggest that physicians who deal with patients with moderate to severe LUTS should consider the psychological health of their patients as this population is at risk of having clinically relevant depressive symptoms.

Adrenal Cortex Hormones↗
PubMed2006

Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study.

BACKGROUND: Previous studies have confirmed the contribution of various medications towards falls in the older population. Recently questions were raised as to whether the chronic illnesses or drug use was more important. OBJECTIVE: We attempt to test the hypothesis that underlying medical illnesses are the cause of falls rather than medications. DESIGN: Cross-sectional. SETTING: Urban community in Hong Kong. SUBJECTS: 4,000 Ambulatory community-dwelling men and women aged 65 years or over. METHODS: Demographic data, fall history in the previous 12 months, medical diagnoses, current medications and self-rated health were recorded. Body measurements and neuromuscular function tests were performed. Medical diagnoses and their corresponding medications were tested simultaneously in a multivariate model. RESULTS: 789 (19.7%) Subjects reported at least one fall and 235 (5.9%) experienced two or more falls. After adjustment for age and sex, medications associated with any falls were aspirin, diabetic drugs, nitrates, NSAIDs, and paracetamol, and those associated with recurrent falls were calcium channel blockers, diabetic drugs, nitrates, NSAIDs, aspirin and statins. Only anti-diabetics and nitrate showed moderate and borderline significance in multivariate analyses for recurrent and any falls respectively (OR 2.9, P = 0.01; OR 1.5, P = 0.027). Other medications failed to show significant relationship with falls, while eye diseases, heart diseases and musculoskeletal pain showed variable associations. CONCLUSION: The apparent association between many medications and falls was mediated through the underlying medical diagnoses and neuromuscular impairment. Anti-diabetics agents were associated with falls.

Accidental Falls↗
PubMed2006

Quality of life of stroke survivors: a 1-year follow-up study.

OBJECTIVES: To examine the changes in and to identify determinants of health-related quality of life (HRQOL) during the first year after stroke. DESIGN: Prospective cohort study. SETTING: Regional university teaching hospital in China. PARTICIPANTS: Chinese survivors of stroke (N=303). Patients who were previously physically handicapped were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Barthel Index, Lawton Instrumental Activities of Daily Living (IADL), Chinese Mini-Mental State Examination, Geriatric Depression Scale (GDS), and the abbreviated Hong Kong Chinese version of the World Health Organization Quality of Life measure domain scores at 3, 6, and 12 months after the stroke. RESULTS: A total of 268 (88%) subjects completed the study. HRQOL data were available in 247 (82%) subjects at 3 months. Between 3 and 12 months, there was no significant change in Barthel Index and IADL scores, but there was significant increase in GDS scores. On multivariate analysis and multilevel modeling, there was a small but significant decrease in social interaction and environment HRQOL domain scores with time. GDS score was negatively associated with all 4 domains of HRQOL, whereas the Barthel Index score was associated with physical and psychological HRQOL domains only. Female sex, nursing home residence, welfare assistance, pain in affected limbs, soft diet or tube feeding, and lack of physical exercise were associated with poorer HRQOL. CONCLUSIONS: Environment and social interaction HRQOL may decrease after 1 year of stroke among Chinese stroke patients. Depression has a more generalized adverse effect on HRQOL than basic functional disabilities. Health care professionals should focus on treating depression; group exercises and self-help group activities may help in promoting socialization and reintegration into community life.

Activities of Daily Living↗
PubMed2006

Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting?

BACKGROUND: The common use of physical restraints in older people in hospitals and nursing homes has been associated with injurious falls, decreased mobility and disorientation. By offering access to bed-chair pressure sensors in hospitalized patients with perceived fall risk, nurses may be less inclined to resort to physical restraints, thereby improving clinical outcomes. AIMS AND OBJECTIVES: To investigate whether the access of bed-chair pressure sensors reduces physical restraint use in geriatric rehabilitation wards. DESIGN: Randomized controlled trial. METHODS: Consecutively, patients admitted to two geriatric wards specialized in stroke rehabilitation in a convalescent hospital in Hong Kong, and who were perceived by nurses to be at risk of falls were randomly assigned to intervention and control groups. For the intervention group subjects, nurses were given access to bed-chair pressure sensors. These sensors were not available to control group subjects, as in usual practice. The trial continued until discharge. The primary outcomes were the proportion of subjects restrained by trunk restraint, bedrails or chair-board and the proportion of trial days in which each type of physical restraint was applied. The secondary outcomes were the proportions of those who improved in the mobility and transfer domains of modified Barthel index on discharge and of those who fell. RESULTS: One hundred and eighty subjects were randomized. Fifty (55.6%) out of the 90 intervention group subjects received the intervention. There was no significant difference between the intervention and control groups in the proportions and duration of having the three types of physical restraints. There was also no group difference in the chance of improving in mobility and transfer ability, and of having a fall. CONCLUSION: Access to bed-chair pressure sensor device neither reduced the use of physical restraints nor improved the clinical outcomes of older patients with perceived fall risk. RELEVANCE TO CLINICAL PRACTICE: The provision of bed-chair pressure sensors may only be effective in reducing physical restraints when it is combined with an organized physical restraint reduction programme.

Accidental Falls↗
PubMed2005

Cognitive intervention for community-dwelling older persons with memory problems: telemedicine versus face-to-face treatment.

BACKGROUND: Memory complaints and decline in cognitive function are common in the elderly. Cognitive intervention has been shown to be beneficial in Alzheimer's disease (AD). However, few community-based cognitive intervention programs are available in Hong Kong. The aim of this project is to examine and compare the feasibility, acceptability, and clinical outcome of a cognitive intervention program for older patients with mild cognitive impairment and mild dementia using telemedicine versus a conventional face-to-face method. METHODS: Community-dwelling older subjects with mild dementia or mild cognitive impairments were recruited from a community center. A total of 12 sessions of assessment and cognitive intervention were conducted via videoconferencing or by face-to-face method. Assessment included: Cantonese version of Mini Mental State Examination (C-MMSE), Cantonese version of Rivermead Behavioural Memory test (C-RBMT) and Hierarchic Dementia Scale (HDS). RESULTS: Twenty-two clients were recruited. There was significant and comparable cognitive improvement in clients in both treatment arms. The videoconference arm was highly accepted by the clients and the community center. Overall compliance rate of participants was above 95%. CONCLUSIONS: Telemedicine was a feasible, effective and acceptable means in providing cognitive assessment and intervention to older persons with mild cognitive deficits. Promoting such a program to other community settings would further enhance the accessibility of dementia service to the community.

Aged↗
PubMed2004

A randomized, controlled trial of an intensive community nurse-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease.

OBJECTIVES: To evaluate the effectiveness of an intensive community nurse (CN)-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease (CLD). DESIGN: Randomized, controlled trial. SETTING: Two acute hospitals in the same health region in Hong Kong. PARTICIPANTS: One hundred fifty-seven hospitalized patients aged 60 and older with a primary diagnosis of CLD and at least one hospital admission in the previous 6 months. INTERVENTION: CNs made home visits within 7 days of discharge, then weekly for 4 weeks and monthly until 6 months. CNs coordinated closely with a geriatric or respiratory specialist in hospital. Subjects had telephone access to CNs during normal working hours from Monday to Saturday. MEASUREMENTS: The primary outcome was the rate of unplanned readmission within 6 months. The secondary outcomes were the rate of unplanned readmission within 28 days, number of unplanned readmissions, hospital bed days, accident and emergency room attendance, functional and psychosocial status, and caregiver burden. RESULTS: One hundred forty hospitalized patients completed the trial. Intervention group subjects had a higher rate of unplanned readmission within 6 months than control group subjects (76% vs 62%, P=.080, chi2 test). There was no significant group difference in any of the secondary outcomes except that intervention group subjects did better on social handicap scores. CONCLUSION: There was no evidence that an intensive CN-supported discharge program can prevent hospital readmissions in older patients with CLD.

Aged↗
PubMed2004

Association between functional dental state and dietary intake of Chinese vegetarian old age home residents.

OBJECTIVE: To examine the association between dental functional status and dietary intakes of Chinese vegetarian old age home residents. SUBJECTS AND METHODS: A cross-sectional survey was performed in a group of 76 older vegetarian Chinese women living in an old age home. Oral examination was performed by a dental surgeon. Sixty-eight of them had a 24-hour food record by direct observation, analysed by a Chinese food composition table. Nutritional status was measured by Body Mass Index (BMI), and the functional status by modified Barthel Index (BI). RESULTS: Forty-two subjects (55.3%) were edentulous; 59 subjects (77.6%) had chewing difficulties; 35 subjects (46%) had poor dental functional status defined by having five or less functional teeth unit (FTU). When compared with those older people with better dental functional status, the poor dental functional status group was more likely to have chewing difficulties, tolerate soft diet only, and be functionally dependent (BI < 15/20). Poor dental functional status was associated with lower mean daily fibre intake, but not with intakes of macronutrients and micronutrients, after adjustment by BI categories. CONCLUSION: Poor dental functional status is associated with impaired chewing and lower fibre intake in Chinese vegetarian old age home residents, but it is not associated with reduced intakes of macronutrients or micronutrients.

Activities of Daily Living↗
PubMed2004

Impact of osteoarthritis on quality of life in a Hong Kong Chinese population.

OBJECTIVE: To measure the impact of osteoarthritis (OA) on quality of life in the Hong Kong Chinese population. METHODS: This was a cross sectional, retrospective, non-random, cohort design stratifying disease severity and presence or absence of joint prostheses. Patients with OA (n = 574; 136 men and 438 women) were recruited from rheumatology, family medicine, orthopedics, and geriatric medicine clinics. They were divided into 2 equal groups based upon disease severity (either American College of Rheumatology functional classes I and II, or III and IV). The 36-item Medical Outcomes Study Short-Form Health Survey (SF-36) and Western Ontario and McMaster Universities (WOMAC) OA Index were used. RESULTS: Patients with severe disease had lower mean scores in all SF-36 domains and higher mean scores in all WOMAC domains, indicating poorer quality of life. Scores in patients who had had arthroplasty were better than those with severe disease only in certain domains: role physical, general health, vitality, and mental health (SF-36); and pain (WOMAC). Women with OA had poorer scores compared to men for bodily pain, general health, and mental health after adjusting for age and disease severity. Low educational attainment was independently associated with poorer scores when disease severity was taken into account. CONCLUSION: OA has a significant impact on quality of life, only partly ameliorated by arthroplasty, as assessed by the SF-36 and WOMAC in this population.

Adult↗
PubMed2003

Socioeconomic impact of osteoarthritis in Hong Kong: utilization of health and social services, and direct and indirect costs.

OBJECTIVE: To determine the direct and indirect cost of osteoarthritis (OA) according to disease severity, and to estimate the total cost of the disease in Hong Kong. METHODS: This study is a retrospective, cross-sectional, nonrandom, cohort design, with subjects stratified according to disease severity based on functional limitation and the presence or absence of joint prosthesis. Subjects were recruited from primary care, geriatric medicine, rheumatology, and orthopedic clinics. There were 219 patients in the mild disease category, 290 patients in the severe category, and 65 patients with joint replacement. A questionnaire gathered information on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. Costs were calculated as direct and indirect. RESULTS: Low education and socioeconomic class were associated with more severe disease. OA affected family or close relationships in 44%. The average cost incurred as a result of side effects of medication is similar to the average cost of medication itself. Excluding joint replacement, the direct costs ranged from Hong Kong (HK) dollar $11,690 to $40,180 per person per year and indirect costs, HK $3,300-$6,640. The direct costs are comparable to those reported in Western countries; however, the ratio of direct to indirect costs is much higher than 1, in contrast to the greater indirect versus direct costs reported in whites. The total cost expressed as a percentage of gross national product is also much lower in Hong Kong. CONCLUSIONS: The socioeconomic impact of OA in the Hong Kong population is comparable to Western countries, but the economic burden is largely placed on the government, with patients having relatively low out-of-pocket expenditures.

Costs and Cost Analysis↗
PubMed2002

Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial.

BACKGROUND: Whether Helicobacter pylori increases the risk of ulcers in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) is controversial. We hypothesised that eradication of H pylori infection would reduce the risk of ulcers for patients starting long-term NSAID treatment. METHODS: Patients were enrolled if they were NSAID naïve, had a positive urea breath test, had dyspepsia or an ulcer history, and required long-term NSAID treatment. They were randomly assigned omeprazole triple therapy (eradication group) or omeprazole with placebo antibiotics (placebo group) for 1 week. All patients were given diclofenac slow release 100 mg daily for 6 months from randomisation. Endoscopy was done at 6 months or if severe dyspepsia or gastrointestinal bleeding occurred. The primary endpoint was the probability of ulcers within 6 months. Analyses were by intention to treat. FINDINGS: Of 210 arthritis patients screened, 128 (61%) were positive for H pylori. 102 patients were enrolled, and 100 were included in the intention-to-treat analysis. H pylori was eradicated in 90% of the eradication group and 6% of the placebo group. Five of 51 eradication-group patients and 15 of 49 placebo-group patients had ulcers. The 6-month probability of ulcers was 12.1% (95% CI 3.1-21.1) in the eradication group and 34.4% (21.1-47.7) in the placebo group (p=0.0085). The corresponding 6-month probabilities of complicated ulcers were 4.2% (1.3-9.7) and 27.1% (14.7-39.5; p=0.0026). INTERPRETATION: Screening and treatment for H pylori infection significantly reduces the risk of ulcers for patients starting long-term NSAID treatment.

Anti-Inflammatory Agents, Non-Steroidal↗