Shirley Chau - Academia.edu (original) (raw)

Papers by Shirley Chau

Canadian Ethnic Studies Journal, Sep 22, 2009

The concept of multiculturalism has become a fixture in Canadian society as part of a nation-buil... more The concept of multiculturalism has become a fixture in Canadian society as part of a nation-building mechanism. In many ways, this suggests a perception that public policies promoting multiculturalism are working. However, this perception is based on assumptions that there is a coherent and shared definition and understanding of the implementation of multiculturalism policies. This paper reports the findings of an exploratory study that examined how multiculturalism policies are actualized at the grassroots level through community organizations. This study involved key informant interviews and focus groups of government staff responsible for the delivery of multiculturalism at the federal, provincial, and municipal levels, as well as discussions with service users and service providers of multiculturalism. Findings of this study show that, first, there is a difference in the understanding of the meaning of the policies among these research participants. Second, there has been a subtle shift of governmental interpretation of multiculturalism policies to an antiracist perspective. Third, although both federal and provincial governments have positioned community organizations as key partners in actualizing multiculturalism policies at the grassroots level, their relationship has been strained, i.e., in order to attain their goals for multiculturalism, community organizations have had to adapt to changing rules and to learn how to maneuver through the funding process. Some policy implications are suggested at the end of the paper.

Canadian Ethnic Studies, 2010

The concept of multiculturalism has become a fixture in Canadian society as part of a nation-buil... more The concept of multiculturalism has become a fixture in Canadian society as part of a nation-building mechanism. In many ways, this suggests a perception that public policies promoting multiculturalism are working. However, this perception is based on assumptions that there is a coherent and shared definition and understanding of the implementation of multiculturalism policies. This paper reports the findings of an exploratory study that examined how multiculturalism policies are actualized at the grassroots level through community organizations. This study involved key informant interviews and focus groups of government staff responsible for the delivery of multiculturalism at the federal, provincial, and municipal levels, as well as discussions with service users and service providers of multiculturalism. Findings of this study show that, first, there is a difference in the understanding of the meaning of the policies among these research participants. Second, there has been a subtle shift of governmental interpretation of multiculturalism policies to an antiracist perspective. Third, although both federal and provincial governments have positioned community organizations as key partners in actualizing multiculturalism policies at the grassroots level, their relationship has been strained, i.e., in order to attain their goals for multiculturalism, community organizations have had to adapt to changing rules and to learn how to maneuver through the funding process. Some policy implications are suggested at the end of the paper.

Thorax, 2007

Background: Community-acquired pneumonia (CAP) is a leading infectious cause of death throughout ... more Background: Community-acquired pneumonia (CAP) is a leading infectious cause of death throughout the world, including Hong Kong. Aim: To compare the ability of three validated prediction rules for CAP to predict mortality in Hong Kong: the 20 variable Pneumonia Severity Index (PSI), the 6-point CURB65 scale adopted by the British Thoracic Society and the simpler CRB65. Methods: A prospective observational study of 1016 consecutive inpatients with CAP (583 men, mean (SD) age 72 (17) years) was performed in a university hospital in the New Territories of Hong Kong in 2004. The patients were classified into three risk groups (low, intermediate and high) according to each rule. The ability of the three rules to predict 30 day mortality was compared. Results: The overall mortality and intensive care unit (ICU) admission rates were 8.6% and 4.0%, respectively. PSI, CURB65 and CRB65 performed similarly, and the areas under the receiver operating characteristic (ROC) curve were 0.736 (95% CI 0.687 to 0.736), 0.733 (95% CI 0.679 to 0.787) and 0.694 (95% CI 0.634 to 0.753), respectively. All three rules had high negative predictive values but relatively low positive predictive values at all cut-off points. Larger proportions of patients were identified as low risk by PSI (47.2%) and CURB65 (43.3%) than by CRB65 (12.6%). Conclusion: All three predictive rules have a similar performance in predicting the severity of CAP, but CURB65 is more suitable than the other two for use in the emergency department because of its simplicity of application and ability to identify low-risk patients.

Respiratory Medicine, 2008

Aim: This study assessed the infectious etiology of patients hospitalized for acute exacerbations... more Aim: This study assessed the infectious etiology of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with concomitant pneumonia. Methods: Patients admitted to medical wards in an acute hospital were recruited prospectively from May 1, 2004 to April 30, 2005. Sputum culture, blood culture, paired serology, and nasopharyngeal aspirates (NPA) viral culture and polymerase chain reaction (PCR) studies were performed. Spirometry was assessed in stable phase at 2e3 months post-hospital discharge. Results: Seventy eight subjects were admitted for AECOPD with concomitant pneumonia. The mean (SD) age was 77.1 (7.5) years, with FEV 1 of 41.5 (20.8)% predicted normal. Overall, an infectious etiology could be established in 48.7% of the subjects. Among the 71 subjects with sputum collected, 40.8% had positive bacterial culture. The commonest bacteria identified were Streptococcus pneumoniae (8[11.3%]), Pseudomonas aeruginosa (7[9.9%]) and Haemophilus influenzae (7[9.9%]). Among the 66 subjects with NPA collected, 9.0 and 12.2% had positive viral culture and PCR results, respectively. The commonest viruses identified by NPA PCR were influenza A (4[6.1%] subjects) and rhinovirus (2[3.0%]). Paired serology was positive in 4.4%. Patients on high dose inhaled corticosteroid (ICS) (>1000 mcg beclomethasone-equivalent/day) had a higher rate of positive sputum bacterial culture than those on low-medium dose of ICS (50.0% vs 18.2%, p Z 0.02). a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2008) 102, 1109e1116

QJM, 2006

Background: Few reports have described the clinical and microbiological features of cryptococcosi... more Background: Few reports have described the clinical and microbiological features of cryptococcosis in immunocompetent patients. Aim: To compare clinical presentations and outcomes of cryptococcosis in immunocompetent vs. immunocompromised patients. Design: Retrospective case series. Methods: All culture-or histology-confirmed cases (n ¼ 46) of cryptococcosis in two acute hospitals in Hong Kong (1995Kong ( -2005 were included. Clinical presentations, rates of fungaemia, cerebrospinal fluid (CSF) parameters and clinical outcomes were recorded. Results: Twenty patients (43.5%) were apparently immunocompetent, 17 (37.0%) had predisposing factors other than HIV infection, and 9 (19.6%) were HIV-positive. Thirty-one (67.4%) presented with meningitis, four (8.7%) with pulmonary cryptococcosis, and 11 (23.9%) with extraneural, extrapulmonary cryptococcosis. Of the immunocompetent patients with retrievable isolates (n ¼ 8), three (37.5%) were Cryptococcus gattii; all isolates (n ¼ 6) from immunocompromised patients were Cryptococcus neoformans var.

Journal of Immigrant and Minority Health, 2011

The present study investigated the link between the sizes of the Chinese community to the health ... more The present study investigated the link between the sizes of the Chinese community to the health of Chinese seniors in Canada. A secondary data analysis of survey data from a representative sample of 2,272 Chinese older adults aged 55 and over was conducted. Hierarchical regression analyses were performed to assess the effects of the size of Chinese communities in Chinese seniors' health. Chinese seniors residing in the community with a small Chinese population reported better physical and mental health than the Chinese seniors residing in communities with a larger Chinese population. The findings were contrary to expectations that health of Chinese seniors should be higher in cities with large Chinese communities. These findings raise new questions for future investigations into the dynamics and impact of ethnic community size, and the importance of studying intragroup differences within ethno-cultural groups to better understand health disparities in ethnic groups.

Journal of Clinical Microbiology, 2006

A rapid method, using PCR-restriction fragment length and single-strand conformation polymorphism... more A rapid method, using PCR-restriction fragment length and single-strand conformation polymorphism (SSCP), was applied to screen for mutations of the fluoroquinolone resistance determinants in Streptococcus pneumoniae. One hundred nonduplicate Streptococcus pneumoniae isolates with ciprofloxacin MICs of >4.0 g/ml from the Prince of Wales Hospital, Hong Kong, years 2000 to 2003, were examined. For each isolate, PCR amplicons of quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, parC, and parE genes were digested with AluI, HinfI, Sau3AI, and MspI, respectively, and analyzed by SSCP. Each SSCP pattern was given a number, and each isolate obtained a four-digit code, e.g., 1111, that represented the SSCP profile. The SSCP patterns were correlated to mutations characterized from sequence analyses of PCR amplicons. The most common SSCP profile obtained was no. 5232 (40%), which included strains with two amino acid substitutions in the ParC (Lys-137-Asn) and ParE (Ile-460-Val) genes, followed by the SSCP profile 5223 (17%), which included strains with amino acid substitutions in the ParE (Ile-460-Val) gene only. Ten isolates (10%) with amino acid substitutions at GyrA and ParE (؎ParC) genes were resistant to levofloxacin with a MIC of >16 g/ml. Other SSCP profiles were unique in distinguishing the common amino acid substitutions in GyrA (Ser-81-Phe) and ParC (Lys-137-Asn, Ser-79-Phe plus Lys-137-Asn, Asp-83-Asn plus Lys-137-Asn, Ser-79-Phe, and Glu-96-Asp). SSCP analysis of restricted fragments generated patterns that were highly discriminative for mutations present in the QRDRs of gyrA, gyrB, parC, and parE. This method provides a database of high resolution profiles on these mutations and allows rapid screening for new mutations of the fluoroquinolone resistance genes.

International Journal of Antimicrobial Agents, 2010

European Journal of Clinical Microbiology & Infectious Diseases, 2007

This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) a... more This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) and severe non-SARS community-acquired viral respiratory infection (requiring hospitalization) in an emergency department in Hong Kong. In a case-control study, clinical, laboratory and radiological data from 322 patients with laboratory-confirmed SARS from the 2003 SARS outbreak were compared with the data of 253 non-SARS adult patients with confirmed viral respiratory tract infection from 2004 in order to identify discriminatory features. Among the non-SARS patients, 235 (93%) were diagnosed as having influenza infections (primarily H3N2 subtype) and 77 (30%) had radiological evidence of pneumonia. In the early phase of the illness and after adjusting for baseline characteristics, SARS patients were less likely to have lower respiratory symptoms (e.g. sputum production, shortness of breath, chest pain) and more likely to have myalgia (p < 0.001). SARS patients had lower mean leukocyte and neutrophil counts (p < 0.0001) and more commonly had "ground-glass" radiological changes with no pleural effusion. Despite having a younger average age, SARS patients had a more aggressive respiratory course requiring admission to the ICU and a higher mortality rate. The area under the receiver operator characteristic curve for predicting SARS when all variables were considered was 0.983. Using a cutoff score of >99, the sensitivity was 89.1% (95%CI 82.0-94.0) and the specificity was 98.0% (95%CI 95.4-99.3). The area under the receiver operator characteristic curve for predicting SARS when all variables except radiological change were considered was 0.933. Using a cutoff score of…

Diagnostic Microbiology and Infectious Disease, 2007

Streptococcus suis was isolated from 6.1% of raw pork meat from 3 of the 6 wet markets in 6 distr... more Streptococcus suis was isolated from 6.1% of raw pork meat from 3 of the 6 wet markets in 6 districts in Hong Kong. S. suis was particularly isolated in sites from the tongue, tonsil, bone, and tail, but not from lean meat/minced pork or internal organs. Isolates were confirmed by polymerase chain reaction using S. suis-specific primers, did not belong to serotype 2 using serotype 2-specific antiserum, and were clustered closely with other known serotypes by phylogenetic analysis. Ten strains from patients admitted to Hong Kong hospitals with sepsis or meningitis in the past 10 years all belonged to type 2, with closely related pulsed-field gel electrophoresis types that were distinct from the S. suis strains isolated from pork in this study. These methods may serve as useful tools in studying and enhancing our understanding of these infections in Hong Kong.

Diagnostic Microbiology and Infectious Disease, 2013

Active surveillance on nasopharygeal carriage of Streptococcus pneumoniae in children was conduct... more Active surveillance on nasopharygeal carriage of Streptococcus pneumoniae in children was conducted in 5581 children under 16 years old admitted with respiratory illness to the pediatric wards in a Hong Kong teaching hospital during 2008-2010. The isolation rate of S. pneumoniae was 14.5%. The most common serotypes/groups from 911 isolates were 19F, 6B, 23F, 14, 6C, 6A, and 3. Considering only children under 2 years old, the percentage serotype belonging to that of the 7-, 10- and 13-valent conjugate pneumococcal vaccines in S. pneumoniae were 56.0% (115/205), 57% (117/205), and 80.5% (165/205), respectively. The prevalence of penicillin-nonsusceptibility (MIC ≥4.0 μg/mL) was 9.1% and for cefotaxime (MIC ≥2.0 μg/mL) was 14.7%. A high prevalence of non-6B serotype, including 6A, 6C, and 6D was noted after the introduction of PCV7 conjugate pneumococcal vaccines in Hong Kong.

Diagnostic Microbiology and Infectious Disease, 2006

Polymerase chain reaction and sequencing of the housekeeping genes, gdh (zwf) and gki, based on t... more Polymerase chain reaction and sequencing of the housekeeping genes, gdh (zwf) and gki, based on the primers and alleles from multilocus sequence typing can be used to delineate and support the identity of clinical isolates of Streptococcus pneumoniae and differentiate from the closely related Streptococcus mitis and Streptococcus oralis.

Diagnostic Microbiology and Infectious Disease, 2007

The values of procalcitonin (PCT), neopterin, and C-reactive protein (CRP) alone and in combinati... more The values of procalcitonin (PCT), neopterin, and C-reactive protein (CRP) alone and in combination to differentiate bacterial from viral etiology in patients with lower respiratory tract infections (LRTIs) were evaluated. Sera obtained on the day of hospitalization for LRTI from 139 patients with confirmed bacterial etiology and 128 patients with viral etiology were examined. A further 146 sera from healthy Chinese subjects with no infection were included as controls. The area under the receiver operating characteristic (ROC) curve (area under curve [AUC]) for distinguishing bacterial from viral infections was 0.838 for CRP and 0.770 for PCT (P b 0.05). The AUC for distinguishing viral from bacterial infections was 0.832 for neopterin (P b 0.05). When the markers were used in combination, AUC of ROC (CRP/neopterin) was 0.857, whereas (CRP × PCT)/neopterin was 0.856. Combination of 2 or all 3 of the biomarkers may improve the discriminatory power in delineating bacterial versus viral etiology in LRTI.

Children and Youth Services Review, 2011

Although the primary aim of child protection services (CPS) is to ensure the well-being and safet... more Although the primary aim of child protection services (CPS) is to ensure the well-being and safety of children, policy decision-makers and service providers are increasingly concerned about the potential harm children encounter when they witness the abuse of their caregivers. Researchers who have conducted reviews of child protection files in both Canada and the United States report that few cases in which intimate partner violence (IPV) is substantiated are referred for additional services. In this article, we question whether this response is appropriate. Through examining the results of a qualitative study with sixty-four women who experienced IPV and were thus involved in the child protection system, we have been able to analyze the impact of CPS practices on those women who received services and those who did not. Our findings suggest that CPS can be an important resource for women who experience IPV, but changes to current practices are necessary to ensure that services offered are beneficial.

Children and Youth Services Review, 2004

U n c o r r e c t e d P r o ARTICLE IN PRESS Children and Youth Services Review xx (2004) xxx-xxx... more U n c o r r e c t e d P r o ARTICLE IN PRESS Children and Youth Services Review xx (2004) xxx-xxx 0190-7409/03/$ -see front matter ᮊ 2004 Published by Elsevier B.V. PII: S 0 1 9 0 -7 4 0 9 Ž 0 4 . 0 0 0 3 0 -1 1 2 3 Predictors of post-traumatic distress in child 4 welfare workers: a linear structural equation 5 model 6 7 Abstract 24 25 Two important bodies of literature explore the issue of stress in social workers, that 26 investigating the impact of burnout and that investigating the impact of traumatic events. 27 This study integrates these two concepts and tests a hypothesized model for predicting post-28 traumatic distress in child welfare workers. In this model, individual, incident and organiza-29 tional factors combined to produce post-traumatic stress distress in child welfare workers. 30 That is, individuals with a greater sense of control over their lives and a better ability to 31 engage in meaningful relationships with others reported lower levels of distress. In addition, 32 those who had less recent and less frequent exposures reported lower levels of distress. 33 However, the strongest predictor was the organizational environment one aspect of which 34 was ongoing, chronic stressors. It thus appears that critical events in child welfare practice 35 are encountered by individuals whose resources may already be taxed through coping on an 36 ongoing basis with high levels of challenge and stress, thereby increasing the intensity of 37 trauma reactions.

Children and Youth Services Review, 2013

ABSTRACT

CHEST Journal, 2007

obstructive pulmonary disease in Hong Kong Viral etiology of acute exacerbations of chronic http:... more obstructive pulmonary disease in Hong Kong Viral etiology of acute exacerbations of chronic http://chestjournal.org/cgi/content/abstract/chest.07-0530v1 services can be found online on the World Wide Web at: The online version of this article, along with updated information and is available. publications. Readers are advised to refer to the final, typeset version when it print version apply with full force and effect to CHEST Papers In Press online or in the http://www.chestjournal.org/ publication. Any disclaimers set forth at must include the digital object identifier (DOI) and date of initial online PubMed from initial publication. Citations to CHEST Papers In Press articles In Press are citable and establish publication priority; they are indexed by Papers non-substantive) that do not appear in this manuscript version. CHEST form may contain changes and corrections (substantive and/or formatted, or typeset, and the version that will subsequently appear in typeset printed or online issues of the Journal. These papers are not yet copyedited, peer reviewed and accepted for publication but have not yet appeared in the CHEST Papers In Press contains articles in manuscript form that have been ). Abstract Introduction: Viral respiratory infections may precipitate acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, little is known about viral etiology related to AECOPD in Asia. We aimed to study the viral etiology of AECOPD in Hong Kong. Methods: Patients admitted to an acute hospital in Hong Kong with AECOPD were recruited prospectively from May 1, 2004 to April 30, 2005. Nasopharyngeal aspirates (NPA) were collected and assessed by polymerase chain reaction (PCR) and viral culture. Spirometry was performed in the stable phase at 2-3 months post hospital discharge. Results(mean[SD]): There were 262 episodes of AECOPD among 196 patients. Their age was 75.7[7.7]yrs with 160 males. The FEV 1 was 39.6[18.9]% predicted normal and FEV 1 /FVC ratio was 58.0[15.2]%. Fifty-eight episodes (22.1%) yielded positive viral

Canadian Journal on Aging / La Revue canadienne du vieillissement, 2007

La présente étude examine les relations entre la culture et l'état de santé des aînés chinois au ... more La présente étude examine les relations entre la culture et l'état de santé des aînés chinois au Canada. Les données ont été recueillies lors d'entretiens face à face avec un échantillon transversal de 2 272 aînés chinois de 55 à 101 ans sélectionnés au hasard dans sept villes canadiennes. Leur état de santé a été évalué en fonction du nombre de maladies chroniques, des limites de l'AVQ et de l'AIVQ, et de la Medical Outcome Study Short Form SF-36. Bien que les variables culturelles n'expliquent qu'une petite partie de la variance dans l'état de santé, être davantage au courant des modèles traditionnels de croyance à la santé des Chinois est important si l'on veut prévoir la santé physique, le nombre de maladies, et les limites associées aux activités instrumentales de la vie quotidienne. D'autres variables culturelles, notamment la religion, le pays d'origine, et la période de résidence au Canada étaient aussi importantes afin de prévoir certaines variables associées à la santé. Les interventions visant à améliorer la santé devraient porter sur des stratégies permettant d'améliorer la compatibilité culturelle entre les utilisateurs et le système de distribution des soins.

Antimicrobial Agents and Chemotherapy, 2007

Atypical strains, presumed to be pneumococcus, with ciprofloxacin MICs of >4.0 g/ml and unique se... more Atypical strains, presumed to be pneumococcus, with ciprofloxacin MICs of >4.0 g/ml and unique sequence variations within the quinolone resistance-determining regions (QRDRs) of the gyrase and topoisomerase genes in comparison with the Streptococcus pneumoniae R6 strain, were examined. These strains were reidentified using phenotypic methods, including detection of optochin susceptibility, bile solubility, and agglutination by serotype-specific antisera, and genotypic methods, including detection of pneumolysin and autolysin genes by PCR, 16S rRNA sequencing, and multilocus sequence typing (MLST). The analysis based on concatenated sequences of the six MLST loci distinguished the "atypical" strains from pneumococci, and these strains clustered closely with S. mitis. However, all these strains and five of nine strains from the viridans streptococcal group possessed one to three gyrA, gyrB, parC, and parE genes whose QRDR sequences clustered with those of S. pneumoniae, providing evidence of horizontal transfer of the QRDRs of the gyrase and topoisomerase genes from pneumococci into viridans streptococci. These genes also conferred fluoroquinolone resistance to viridans streptococci. In addition, the fluoroquinolone resistance determinants of 32 well-characterized Streptococcus mitis and Streptococcus oralis strains from bacteremic patients were also compared. These strains have unique amino acid substitutions in GyrA and ParC that were distinguishable from those in fluoroquinolone-resistant pneumococci and the "atypical" isolates. Both recombinational events and de novo mutations play an important role in the development of fluoroquinolone resistance.

Canadian Ethnic Studies Journal, Sep 22, 2009

The concept of multiculturalism has become a fixture in Canadian society as part of a nation-buil... more The concept of multiculturalism has become a fixture in Canadian society as part of a nation-building mechanism. In many ways, this suggests a perception that public policies promoting multiculturalism are working. However, this perception is based on assumptions that there is a coherent and shared definition and understanding of the implementation of multiculturalism policies. This paper reports the findings of an exploratory study that examined how multiculturalism policies are actualized at the grassroots level through community organizations. This study involved key informant interviews and focus groups of government staff responsible for the delivery of multiculturalism at the federal, provincial, and municipal levels, as well as discussions with service users and service providers of multiculturalism. Findings of this study show that, first, there is a difference in the understanding of the meaning of the policies among these research participants. Second, there has been a subtle shift of governmental interpretation of multiculturalism policies to an antiracist perspective. Third, although both federal and provincial governments have positioned community organizations as key partners in actualizing multiculturalism policies at the grassroots level, their relationship has been strained, i.e., in order to attain their goals for multiculturalism, community organizations have had to adapt to changing rules and to learn how to maneuver through the funding process. Some policy implications are suggested at the end of the paper.

Canadian Ethnic Studies, 2010

The concept of multiculturalism has become a fixture in Canadian society as part of a nation-buil... more The concept of multiculturalism has become a fixture in Canadian society as part of a nation-building mechanism. In many ways, this suggests a perception that public policies promoting multiculturalism are working. However, this perception is based on assumptions that there is a coherent and shared definition and understanding of the implementation of multiculturalism policies. This paper reports the findings of an exploratory study that examined how multiculturalism policies are actualized at the grassroots level through community organizations. This study involved key informant interviews and focus groups of government staff responsible for the delivery of multiculturalism at the federal, provincial, and municipal levels, as well as discussions with service users and service providers of multiculturalism. Findings of this study show that, first, there is a difference in the understanding of the meaning of the policies among these research participants. Second, there has been a subtle shift of governmental interpretation of multiculturalism policies to an antiracist perspective. Third, although both federal and provincial governments have positioned community organizations as key partners in actualizing multiculturalism policies at the grassroots level, their relationship has been strained, i.e., in order to attain their goals for multiculturalism, community organizations have had to adapt to changing rules and to learn how to maneuver through the funding process. Some policy implications are suggested at the end of the paper.

Thorax, 2007

Background: Community-acquired pneumonia (CAP) is a leading infectious cause of death throughout ... more Background: Community-acquired pneumonia (CAP) is a leading infectious cause of death throughout the world, including Hong Kong. Aim: To compare the ability of three validated prediction rules for CAP to predict mortality in Hong Kong: the 20 variable Pneumonia Severity Index (PSI), the 6-point CURB65 scale adopted by the British Thoracic Society and the simpler CRB65. Methods: A prospective observational study of 1016 consecutive inpatients with CAP (583 men, mean (SD) age 72 (17) years) was performed in a university hospital in the New Territories of Hong Kong in 2004. The patients were classified into three risk groups (low, intermediate and high) according to each rule. The ability of the three rules to predict 30 day mortality was compared. Results: The overall mortality and intensive care unit (ICU) admission rates were 8.6% and 4.0%, respectively. PSI, CURB65 and CRB65 performed similarly, and the areas under the receiver operating characteristic (ROC) curve were 0.736 (95% CI 0.687 to 0.736), 0.733 (95% CI 0.679 to 0.787) and 0.694 (95% CI 0.634 to 0.753), respectively. All three rules had high negative predictive values but relatively low positive predictive values at all cut-off points. Larger proportions of patients were identified as low risk by PSI (47.2%) and CURB65 (43.3%) than by CRB65 (12.6%). Conclusion: All three predictive rules have a similar performance in predicting the severity of CAP, but CURB65 is more suitable than the other two for use in the emergency department because of its simplicity of application and ability to identify low-risk patients.

Respiratory Medicine, 2008

Aim: This study assessed the infectious etiology of patients hospitalized for acute exacerbations... more Aim: This study assessed the infectious etiology of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with concomitant pneumonia. Methods: Patients admitted to medical wards in an acute hospital were recruited prospectively from May 1, 2004 to April 30, 2005. Sputum culture, blood culture, paired serology, and nasopharyngeal aspirates (NPA) viral culture and polymerase chain reaction (PCR) studies were performed. Spirometry was assessed in stable phase at 2e3 months post-hospital discharge. Results: Seventy eight subjects were admitted for AECOPD with concomitant pneumonia. The mean (SD) age was 77.1 (7.5) years, with FEV 1 of 41.5 (20.8)% predicted normal. Overall, an infectious etiology could be established in 48.7% of the subjects. Among the 71 subjects with sputum collected, 40.8% had positive bacterial culture. The commonest bacteria identified were Streptococcus pneumoniae (8[11.3%]), Pseudomonas aeruginosa (7[9.9%]) and Haemophilus influenzae (7[9.9%]). Among the 66 subjects with NPA collected, 9.0 and 12.2% had positive viral culture and PCR results, respectively. The commonest viruses identified by NPA PCR were influenza A (4[6.1%] subjects) and rhinovirus (2[3.0%]). Paired serology was positive in 4.4%. Patients on high dose inhaled corticosteroid (ICS) (>1000 mcg beclomethasone-equivalent/day) had a higher rate of positive sputum bacterial culture than those on low-medium dose of ICS (50.0% vs 18.2%, p Z 0.02). a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2008) 102, 1109e1116

QJM, 2006

Background: Few reports have described the clinical and microbiological features of cryptococcosi... more Background: Few reports have described the clinical and microbiological features of cryptococcosis in immunocompetent patients. Aim: To compare clinical presentations and outcomes of cryptococcosis in immunocompetent vs. immunocompromised patients. Design: Retrospective case series. Methods: All culture-or histology-confirmed cases (n ¼ 46) of cryptococcosis in two acute hospitals in Hong Kong (1995Kong ( -2005 were included. Clinical presentations, rates of fungaemia, cerebrospinal fluid (CSF) parameters and clinical outcomes were recorded. Results: Twenty patients (43.5%) were apparently immunocompetent, 17 (37.0%) had predisposing factors other than HIV infection, and 9 (19.6%) were HIV-positive. Thirty-one (67.4%) presented with meningitis, four (8.7%) with pulmonary cryptococcosis, and 11 (23.9%) with extraneural, extrapulmonary cryptococcosis. Of the immunocompetent patients with retrievable isolates (n ¼ 8), three (37.5%) were Cryptococcus gattii; all isolates (n ¼ 6) from immunocompromised patients were Cryptococcus neoformans var.

Journal of Immigrant and Minority Health, 2011

The present study investigated the link between the sizes of the Chinese community to the health ... more The present study investigated the link between the sizes of the Chinese community to the health of Chinese seniors in Canada. A secondary data analysis of survey data from a representative sample of 2,272 Chinese older adults aged 55 and over was conducted. Hierarchical regression analyses were performed to assess the effects of the size of Chinese communities in Chinese seniors' health. Chinese seniors residing in the community with a small Chinese population reported better physical and mental health than the Chinese seniors residing in communities with a larger Chinese population. The findings were contrary to expectations that health of Chinese seniors should be higher in cities with large Chinese communities. These findings raise new questions for future investigations into the dynamics and impact of ethnic community size, and the importance of studying intragroup differences within ethno-cultural groups to better understand health disparities in ethnic groups.

Journal of Clinical Microbiology, 2006

A rapid method, using PCR-restriction fragment length and single-strand conformation polymorphism... more A rapid method, using PCR-restriction fragment length and single-strand conformation polymorphism (SSCP), was applied to screen for mutations of the fluoroquinolone resistance determinants in Streptococcus pneumoniae. One hundred nonduplicate Streptococcus pneumoniae isolates with ciprofloxacin MICs of >4.0 g/ml from the Prince of Wales Hospital, Hong Kong, years 2000 to 2003, were examined. For each isolate, PCR amplicons of quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, parC, and parE genes were digested with AluI, HinfI, Sau3AI, and MspI, respectively, and analyzed by SSCP. Each SSCP pattern was given a number, and each isolate obtained a four-digit code, e.g., 1111, that represented the SSCP profile. The SSCP patterns were correlated to mutations characterized from sequence analyses of PCR amplicons. The most common SSCP profile obtained was no. 5232 (40%), which included strains with two amino acid substitutions in the ParC (Lys-137-Asn) and ParE (Ile-460-Val) genes, followed by the SSCP profile 5223 (17%), which included strains with amino acid substitutions in the ParE (Ile-460-Val) gene only. Ten isolates (10%) with amino acid substitutions at GyrA and ParE (؎ParC) genes were resistant to levofloxacin with a MIC of >16 g/ml. Other SSCP profiles were unique in distinguishing the common amino acid substitutions in GyrA (Ser-81-Phe) and ParC (Lys-137-Asn, Ser-79-Phe plus Lys-137-Asn, Asp-83-Asn plus Lys-137-Asn, Ser-79-Phe, and Glu-96-Asp). SSCP analysis of restricted fragments generated patterns that were highly discriminative for mutations present in the QRDRs of gyrA, gyrB, parC, and parE. This method provides a database of high resolution profiles on these mutations and allows rapid screening for new mutations of the fluoroquinolone resistance genes.

International Journal of Antimicrobial Agents, 2010

European Journal of Clinical Microbiology & Infectious Diseases, 2007

This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) a... more This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) and severe non-SARS community-acquired viral respiratory infection (requiring hospitalization) in an emergency department in Hong Kong. In a case-control study, clinical, laboratory and radiological data from 322 patients with laboratory-confirmed SARS from the 2003 SARS outbreak were compared with the data of 253 non-SARS adult patients with confirmed viral respiratory tract infection from 2004 in order to identify discriminatory features. Among the non-SARS patients, 235 (93%) were diagnosed as having influenza infections (primarily H3N2 subtype) and 77 (30%) had radiological evidence of pneumonia. In the early phase of the illness and after adjusting for baseline characteristics, SARS patients were less likely to have lower respiratory symptoms (e.g. sputum production, shortness of breath, chest pain) and more likely to have myalgia (p < 0.001). SARS patients had lower mean leukocyte and neutrophil counts (p < 0.0001) and more commonly had "ground-glass" radiological changes with no pleural effusion. Despite having a younger average age, SARS patients had a more aggressive respiratory course requiring admission to the ICU and a higher mortality rate. The area under the receiver operator characteristic curve for predicting SARS when all variables were considered was 0.983. Using a cutoff score of >99, the sensitivity was 89.1% (95%CI 82.0-94.0) and the specificity was 98.0% (95%CI 95.4-99.3). The area under the receiver operator characteristic curve for predicting SARS when all variables except radiological change were considered was 0.933. Using a cutoff score of…

Diagnostic Microbiology and Infectious Disease, 2007

Streptococcus suis was isolated from 6.1% of raw pork meat from 3 of the 6 wet markets in 6 distr... more Streptococcus suis was isolated from 6.1% of raw pork meat from 3 of the 6 wet markets in 6 districts in Hong Kong. S. suis was particularly isolated in sites from the tongue, tonsil, bone, and tail, but not from lean meat/minced pork or internal organs. Isolates were confirmed by polymerase chain reaction using S. suis-specific primers, did not belong to serotype 2 using serotype 2-specific antiserum, and were clustered closely with other known serotypes by phylogenetic analysis. Ten strains from patients admitted to Hong Kong hospitals with sepsis or meningitis in the past 10 years all belonged to type 2, with closely related pulsed-field gel electrophoresis types that were distinct from the S. suis strains isolated from pork in this study. These methods may serve as useful tools in studying and enhancing our understanding of these infections in Hong Kong.

Diagnostic Microbiology and Infectious Disease, 2013

Active surveillance on nasopharygeal carriage of Streptococcus pneumoniae in children was conduct... more Active surveillance on nasopharygeal carriage of Streptococcus pneumoniae in children was conducted in 5581 children under 16 years old admitted with respiratory illness to the pediatric wards in a Hong Kong teaching hospital during 2008-2010. The isolation rate of S. pneumoniae was 14.5%. The most common serotypes/groups from 911 isolates were 19F, 6B, 23F, 14, 6C, 6A, and 3. Considering only children under 2 years old, the percentage serotype belonging to that of the 7-, 10- and 13-valent conjugate pneumococcal vaccines in S. pneumoniae were 56.0% (115/205), 57% (117/205), and 80.5% (165/205), respectively. The prevalence of penicillin-nonsusceptibility (MIC ≥4.0 μg/mL) was 9.1% and for cefotaxime (MIC ≥2.0 μg/mL) was 14.7%. A high prevalence of non-6B serotype, including 6A, 6C, and 6D was noted after the introduction of PCV7 conjugate pneumococcal vaccines in Hong Kong.

Diagnostic Microbiology and Infectious Disease, 2006

Polymerase chain reaction and sequencing of the housekeeping genes, gdh (zwf) and gki, based on t... more Polymerase chain reaction and sequencing of the housekeeping genes, gdh (zwf) and gki, based on the primers and alleles from multilocus sequence typing can be used to delineate and support the identity of clinical isolates of Streptococcus pneumoniae and differentiate from the closely related Streptococcus mitis and Streptococcus oralis.

Diagnostic Microbiology and Infectious Disease, 2007

The values of procalcitonin (PCT), neopterin, and C-reactive protein (CRP) alone and in combinati... more The values of procalcitonin (PCT), neopterin, and C-reactive protein (CRP) alone and in combination to differentiate bacterial from viral etiology in patients with lower respiratory tract infections (LRTIs) were evaluated. Sera obtained on the day of hospitalization for LRTI from 139 patients with confirmed bacterial etiology and 128 patients with viral etiology were examined. A further 146 sera from healthy Chinese subjects with no infection were included as controls. The area under the receiver operating characteristic (ROC) curve (area under curve [AUC]) for distinguishing bacterial from viral infections was 0.838 for CRP and 0.770 for PCT (P b 0.05). The AUC for distinguishing viral from bacterial infections was 0.832 for neopterin (P b 0.05). When the markers were used in combination, AUC of ROC (CRP/neopterin) was 0.857, whereas (CRP × PCT)/neopterin was 0.856. Combination of 2 or all 3 of the biomarkers may improve the discriminatory power in delineating bacterial versus viral etiology in LRTI.

Children and Youth Services Review, 2011

Although the primary aim of child protection services (CPS) is to ensure the well-being and safet... more Although the primary aim of child protection services (CPS) is to ensure the well-being and safety of children, policy decision-makers and service providers are increasingly concerned about the potential harm children encounter when they witness the abuse of their caregivers. Researchers who have conducted reviews of child protection files in both Canada and the United States report that few cases in which intimate partner violence (IPV) is substantiated are referred for additional services. In this article, we question whether this response is appropriate. Through examining the results of a qualitative study with sixty-four women who experienced IPV and were thus involved in the child protection system, we have been able to analyze the impact of CPS practices on those women who received services and those who did not. Our findings suggest that CPS can be an important resource for women who experience IPV, but changes to current practices are necessary to ensure that services offered are beneficial.

Children and Youth Services Review, 2004

U n c o r r e c t e d P r o ARTICLE IN PRESS Children and Youth Services Review xx (2004) xxx-xxx... more U n c o r r e c t e d P r o ARTICLE IN PRESS Children and Youth Services Review xx (2004) xxx-xxx 0190-7409/03/$ -see front matter ᮊ 2004 Published by Elsevier B.V. PII: S 0 1 9 0 -7 4 0 9 Ž 0 4 . 0 0 0 3 0 -1 1 2 3 Predictors of post-traumatic distress in child 4 welfare workers: a linear structural equation 5 model 6 7 Abstract 24 25 Two important bodies of literature explore the issue of stress in social workers, that 26 investigating the impact of burnout and that investigating the impact of traumatic events. 27 This study integrates these two concepts and tests a hypothesized model for predicting post-28 traumatic distress in child welfare workers. In this model, individual, incident and organiza-29 tional factors combined to produce post-traumatic stress distress in child welfare workers. 30 That is, individuals with a greater sense of control over their lives and a better ability to 31 engage in meaningful relationships with others reported lower levels of distress. In addition, 32 those who had less recent and less frequent exposures reported lower levels of distress. 33 However, the strongest predictor was the organizational environment one aspect of which 34 was ongoing, chronic stressors. It thus appears that critical events in child welfare practice 35 are encountered by individuals whose resources may already be taxed through coping on an 36 ongoing basis with high levels of challenge and stress, thereby increasing the intensity of 37 trauma reactions.

Children and Youth Services Review, 2013

ABSTRACT

CHEST Journal, 2007

obstructive pulmonary disease in Hong Kong Viral etiology of acute exacerbations of chronic http:... more obstructive pulmonary disease in Hong Kong Viral etiology of acute exacerbations of chronic http://chestjournal.org/cgi/content/abstract/chest.07-0530v1 services can be found online on the World Wide Web at: The online version of this article, along with updated information and is available. publications. Readers are advised to refer to the final, typeset version when it print version apply with full force and effect to CHEST Papers In Press online or in the http://www.chestjournal.org/ publication. Any disclaimers set forth at must include the digital object identifier (DOI) and date of initial online PubMed from initial publication. Citations to CHEST Papers In Press articles In Press are citable and establish publication priority; they are indexed by Papers non-substantive) that do not appear in this manuscript version. CHEST form may contain changes and corrections (substantive and/or formatted, or typeset, and the version that will subsequently appear in typeset printed or online issues of the Journal. These papers are not yet copyedited, peer reviewed and accepted for publication but have not yet appeared in the CHEST Papers In Press contains articles in manuscript form that have been ). Abstract Introduction: Viral respiratory infections may precipitate acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, little is known about viral etiology related to AECOPD in Asia. We aimed to study the viral etiology of AECOPD in Hong Kong. Methods: Patients admitted to an acute hospital in Hong Kong with AECOPD were recruited prospectively from May 1, 2004 to April 30, 2005. Nasopharyngeal aspirates (NPA) were collected and assessed by polymerase chain reaction (PCR) and viral culture. Spirometry was performed in the stable phase at 2-3 months post hospital discharge. Results(mean[SD]): There were 262 episodes of AECOPD among 196 patients. Their age was 75.7[7.7]yrs with 160 males. The FEV 1 was 39.6[18.9]% predicted normal and FEV 1 /FVC ratio was 58.0[15.2]%. Fifty-eight episodes (22.1%) yielded positive viral

Canadian Journal on Aging / La Revue canadienne du vieillissement, 2007

La présente étude examine les relations entre la culture et l'état de santé des aînés chinois au ... more La présente étude examine les relations entre la culture et l'état de santé des aînés chinois au Canada. Les données ont été recueillies lors d'entretiens face à face avec un échantillon transversal de 2 272 aînés chinois de 55 à 101 ans sélectionnés au hasard dans sept villes canadiennes. Leur état de santé a été évalué en fonction du nombre de maladies chroniques, des limites de l'AVQ et de l'AIVQ, et de la Medical Outcome Study Short Form SF-36. Bien que les variables culturelles n'expliquent qu'une petite partie de la variance dans l'état de santé, être davantage au courant des modèles traditionnels de croyance à la santé des Chinois est important si l'on veut prévoir la santé physique, le nombre de maladies, et les limites associées aux activités instrumentales de la vie quotidienne. D'autres variables culturelles, notamment la religion, le pays d'origine, et la période de résidence au Canada étaient aussi importantes afin de prévoir certaines variables associées à la santé. Les interventions visant à améliorer la santé devraient porter sur des stratégies permettant d'améliorer la compatibilité culturelle entre les utilisateurs et le système de distribution des soins.

Antimicrobial Agents and Chemotherapy, 2007

Atypical strains, presumed to be pneumococcus, with ciprofloxacin MICs of >4.0 g/ml and unique se... more Atypical strains, presumed to be pneumococcus, with ciprofloxacin MICs of >4.0 g/ml and unique sequence variations within the quinolone resistance-determining regions (QRDRs) of the gyrase and topoisomerase genes in comparison with the Streptococcus pneumoniae R6 strain, were examined. These strains were reidentified using phenotypic methods, including detection of optochin susceptibility, bile solubility, and agglutination by serotype-specific antisera, and genotypic methods, including detection of pneumolysin and autolysin genes by PCR, 16S rRNA sequencing, and multilocus sequence typing (MLST). The analysis based on concatenated sequences of the six MLST loci distinguished the "atypical" strains from pneumococci, and these strains clustered closely with S. mitis. However, all these strains and five of nine strains from the viridans streptococcal group possessed one to three gyrA, gyrB, parC, and parE genes whose QRDR sequences clustered with those of S. pneumoniae, providing evidence of horizontal transfer of the QRDRs of the gyrase and topoisomerase genes from pneumococci into viridans streptococci. These genes also conferred fluoroquinolone resistance to viridans streptococci. In addition, the fluoroquinolone resistance determinants of 32 well-characterized Streptococcus mitis and Streptococcus oralis strains from bacteremic patients were also compared. These strains have unique amino acid substitutions in GyrA and ParC that were distinguishable from those in fluoroquinolone-resistant pneumococci and the "atypical" isolates. Both recombinational events and de novo mutations play an important role in the development of fluoroquinolone resistance.