Association between size at birth, paediatric diarrhoeal incidence and postnatal growth

This study tests the hypothesis that size at birth is associated with diarrhoeal incidence from birth to 24 mo of age, and the hypothesis that diarrhoeal incidence from birth to 24 mo is associated with body size at age 24 mo. This is a longitudinal study of 1476 infants born in Lahore. Pakistan, in 1984-1987. Diarrhoeal incidence was enumerated monthly. A generalized estimating equations approach with Poisson regression showed that birthlength standard deviation score (SDS) and ponderal index at birth (rate ratio = 1.01 and 1.00; each p > 0.05) were not significantly associated with diarrhoeal incidence. Multiple linear regression showed that diarrhoeal incidence was significantly associated with weight SDS and body mass index at 24 mo (regression coefficient or beta = -0.58 and -1.02: each p < 0.05). but not with height SDS (beta = -0.10: p > 0.05). The associations were mainly due to a transient effect of diarrhoea in the period 18-24 mo.

CONCLUSION

Prevention of low birthweight is unlikely to have an impact on diarrhoeal incidence in infants. Control of diarrhoeal incidence may not improve the growth of infants in developing countries.

An epidemiological profile of suicides in Beijing, China

Suicide rates in the Beijing region increase with age. The rural suicide rate is about two to five times of the urban in various age-sex groups. The elderly suicide rate is very serious, especially in the rural area. The average suicide rate for the Beijing region for the period 1987-1996 was 9.8 per 100,000 (6.0 and 17.3 for urban and rural areas, respectively). A low male-to-female ratio was also observed. The female suicide rate for the 15-34 age group was higher than that of its male counterparts, which is unique in other areas of the world. These phenomena can be explained by some of the distinct cultural and economic traits of China. Also, suicides rates in the Beijing region were shown to be on a decreasing trend among the teenaged and the old-age groups. Our findings suggest that the suicide rate in China should not be as high as the estimated rate (31.0 per 100,000), suggested in the Global Health Statistics by Murray and Lopez (1996b, p. 824).

Suicide in response to changing societies

The "medical model" is an insufficient explanation for the high suicide rates, but it does not mean that suicide is a different phenomenon in China. A multidimensional model (Fig. 6) is proposed to appreciate better the complexity of the problem, which can be applied to other countries. As in Figure 6, suicide and suicide attempts are conceptualized as a continuum of behaviors. The suicide method may modify the boundaries (i.e., the availability and choice of a lethal method may expand the size of completed suicides and vice versa). The spectrum of behaviors is also under the influence of individual factors, such as psychiatric disorders and personality, and local factors, such as local cultural norms, resources, and familial problems. All of these factors are subject to the influence of greater social forces. For example, psychiatric disorder increases the risk of suicide but is shaped by global forces. In the case of China, the importing of Western values influences the way Chinese people present their idioms of distress. Chinese people who tend to somatize start to psychologize more, [figure: see text] which in turn affects the rates of depression and subsequently the risk of suicide. The various factors also interact with one another. The diagnosis of disruptive and antisocial disorder illustrates how local factors modulate that of the individual. In Diagnostic and Statistical Manual of Mental Disorders, conduct disorder is defined by a series of "socially unacceptable behaviors," including aggression, destruction of property, theft, and violation of rules. Because biologic validity is lacking, the diagnosis (an individual factor) may vary widely in different cultural settings (a local factor). In China, conformity, self-control, and discipline are emphasized; subthreshold cases in the West already may be unacceptable in the Chinese setting and be labeled "disruptive." On the other hand, the cultural emphasis on conformity in the upbringing may reduce the display of such behaviors and lead to a lower prevalence of disruptive and antisocial disorders in China. With globalization, however, the "Chinese" values are more closely identified with the global culture, and a rising trend of personality disorders has been witnessed. The media are some of the powerful agents in transmitting these forces. The medical model of explaining the phenomenon of suicide with psychiatric disorders is not entirely satisfactory. The association of a high suicide rate with a low prevalence of psychiatric disorders in China challenges this conventional view. Rather than refuting this conventional model, the dynamic interaction with local sociocultural factors and global forces is emphasized. Empirical evidence is lacking, however, and should be the focus for future suicide research.

A study of demographic changes under sustained below-replacement fertility in Hong Kong SAR

The total fertility in Hong Kong SAR fell continuously below replacement in the past two decades and reached a level of 0.98 in 1998. The rate in 1981 was close to replacement at 1.93. In this paper the theoretical outcomes of long-lasting below-replacement fertility are identified with a view to gaining some analytical insight into the situation, where the population is experiencing such a striking demographic trend. In the absence of migration, Hong Kong SAR will see its population start to decline between 2008 and 2038, if the future course of fertility falls within these 'bounds'. Concurrently, the aging of population will be reaching unprecedented proportions. Should fertility remain at the present below-replacement level, i.e. the worse-case scenario, the proportion of population aged 65 years or older would increase to 44 per cent, and those aged under 15 years would decrease to six per cent, by 2048. As a result, the potential labour supply (those aged 15-64 years) would dwindle to only 50 per cent of the population, suggesting that there would be less than one person potentially working to support one dependent (who is likely to be a person aged 65 years or older). The socio-economic consequences of population aging are discussed. By analysing net immigration in the demographic process in the past, the way in which replacement migration would help alleviate the problem of population decline and population aging is also discussed.

A longitudinal study on quality of life after gynecologic cancer treatment

OBJECTIVE

The objective was to describe the pattern of quality of life (QOL) over time and to assess the impact of age, symptoms, disease parameters, and treatment on the overall QOL.

METHODS

A longitudinal study on patients with newly diagnosed gynecologic cancer using individual patients as their own control was performed. The 33-item EORTC QLQ-C30(+3) was used as the QOL measure. Patients were assessed before treatment, after completion of treatment, and at 6, 12, and 24 months. Spearman's correlation analyses were performed. A mixed effect model was fitted to the data. Bonferroni pairwise comparisons were used to analyze the different variables.

RESULTS

One hundred forty-four women completed the study. Overall QOL improved after the completion of treatment but remained the same throughout the 2 years after treatment. The individual patient's QOL before treatment was insignificant while the impact of treatment on the individual patient was significant in determining QOL after treatment. There was a strong correlation for all time points in most factors, indicating that the global health status, functional scales, and symptom scales exhibit a dependent change over time. Relief in symptoms was associated with improvements in functional scales. The scores on overall QOL were lower for younger patients and for patients treated with chemotherapy than for patients treated with surgery.

CONCLUSIONS

Strategies for supportive care need to focus on symptom management. Psychosocial interventions, to be effective, should include all patients and should aim to reduce the impact of treatment on the individual patient.

Parametric modelling of neonatal mortality in relation to size at birth

We use a richly parameterized model to analyse the effects of shortness and thinness at birth on neonatal mortality in Swedish live-born singletons. The model captures the hazard of neonatal mortality according to the function alpha x exp(-gamma x t) + delta, where t represents age. Covariates are allowed to simultaneously influence the initial excess hazard, the rate of decay, and the long-term hazard. Among term newborns, birth length for gestational age had a stronger effect on the long-term hazard and a weaker effect on the initial excess hazard than the Ponderal index. The initial excess hazard associated with a low Ponderal index tended to decay quickly. Among preterm newborns, a higher birth length for gestational age was associated with lower initial and long-term hazards, and with a faster rate of decay of the initial excess hazard. In contrast, the Ponderal index was not associated with the long-term hazard. We discuss the interpretability of the model and its potential use in neonatology and medical demography. We also compare the model to a Cox model with time-dependent covariates.

Social patterns of birth weight in Hong Kong, 1984-1997

Fetal growth is an indicator of social inequalities in health that may have a long-term impact persisting into later life. Little is known about the social patterns of birth weight in Hong Kong. This is a study of live-born singletons from 1984 to 1997 in a Hong Kong birth registry. Ordinary least-squares regression and logistic regression are used to analyse birth weight and low birth weight (< 2500 g), respectively. A gradient of birth weight and prevalence of low birth weight is demonstrated according to mothers' educational attainment. In relation to babies of the most educated mothers, babies of the least educated mothers had a mean deficit of 46g in birth weight and an odds ratio of 1.56 of low birth weight (each P<0.05). This social gradient was hidden unless parity was adjusted for. Unexpectedly, migrants from mainland China delivered heavier rather than lighter babies (each P<0.05). Type of living quarters and parental relation were also related to birth weight and low birth weight (each P<0.05). Continuous monitoring of the social patterns of birth weight is recommended.

Psychosocial adjustment in gynecologic cancer survivors: a longitudinal study on risk factors for maladjustment

OBJECTIVE

The objective was to describe the change in psychosocial state over time and to identify risk factors for maladjustment in gynecologic cancer survivors. Awareness of these issues is important for planning supportive care services for cancer patients.

METHODS

A longitudinal prospective study of patients with newly diagnosed gynecologic cancer using individual patients as their own control was performed. Patients were interviewed after confirmation of the diagnosis and were reassessed at 6 and 18 months after completion of treatment and with no evidence of recurrent disease. Psychological adjustment was measured by self-rating on self-esteem, outlook on life, self-role, and femininity. Neuroticism and anxiety were assessed using a neuroticism score and the Hamilton Anxiety Scale. Depressive symptoms were questioned directly. Social adjustment was assessed by changes in working capacity or work status, leisure activity, marital relationship, and sexual activity.

RESULTS

Seventy-four women participated. Adjustment problems did not occur in the majority of patients. Psychosocial adjustment was different for patients receiving different types of treatments. Improvement in feminism (P = 0.050) and neuroticism (P = 0.010) was observed for patients receiving chemotherapy and deterioration was observed in patients treated with surgery. Deterioration in neuroticism was associated with lower education level (P = 0.032). With religious belief, there was better family support and more significant improvement in social activity (P = 0.038).

CONCLUSION

Most patients adapted well. Patients at risk for psychosocial maladjustment include those who are treated surgically, less educated, and without religious belief.

Fetal growth, early postnatal growth and motor development in Pakistani infants

BACKGROUND

Studies have often compared the postnatal motor development of 'small' versus 'normal' newborns. Not much is known about the associations between a broad spectrum of size at birth and motor development. The effect of early postnatal growth on motor development is little researched. Growth failure in terms of shortness and thinness should be differentiated, but not many studies have the data for this analysis.

METHODS

This is a longitudinal study of infants born in Lahore, Pakistan, between 1984 and 1987. Age at commencement of independent walking and age at 'building a 3-cube tower' were taken as indicators of gross and fine motor development, respectively. Size at birth was captured by length and thinness as continuous variables; postnatal growth from birth to 6 months of age was measured by changes in length and thinness. Adjustment for covariates and handling of censored cases were performed by generalized log gamma regression.

RESULTS

Thinness at birth and postnatal stunting and wasting had a linear, inverse association with gross motor development (each P < 0.05). Birth length had a non-linear, inverse association with this outcome (P < 0.05). Birth length, thinness at birth and postnatal wasting had a linear, inverse association with fine motor development (each P < 0.05).

CONCLUSION

Both fetal and early postnatal growth over a broad spectrum may affect infants' motor development. It is not just the babies who were very small at birth that suffered. Birth length appeared to be more influential than other anthropometric indicators.

The profile of bone mineral density in chinese women: its changes and significance in a longitudinal study

Bone mineral density (BMD) has been shown to be different in different ethnic groups. When lifestyle and diet evolve, there is a possibility of a change in the normal reference BMD values within an ethnic group over a period of time. As the osteoporotic risk uses the T-score as the bench mark, it is pertinent to evaluate whether such changes do occur. Two measurements, 5 years apart, of the BMD of the spine and the hip were made in a cohort of Chinese women in Hong Kong. A kernel function smoothing method, a nonparametric statistical method, was employed to present the BMD data. The greatest rate of bone loss was found to occur between 50 and 59 years of age, but this rate of loss was reduced from age 60 onwards. The BMD values obtained in these two measurements were different from the previous studies in the same population and were found to be higher at the lumbar spine and neck of femur in women over 65 years of age. Even within the cohort, there seemed to be a reduction in the BMD values of the hip in a span of 5 years, although the differences were statistically insignificant. These studies suggest that BMD values could change in a population for a variety of possible reasons. Hence, the reference BMD values might need to be evaluated at regular intervals for the T-score to be meaningful.

Seasonal variation in suicides: diminished or vanished. Experience from England and Wales, 1982-1996

BACKGROUND

Seasonal variation in suicidal death has been observed in many countries. In particular, a cyclic variation was found for both men and women in England and Wales in the 1960s and 1970s. Men showed a single 12-month cycle whereas women showed two cycles.

AIMS

To re-examine the seasonal variation in suicides in England and Wales for the period 1982-1996.

METHOD

A harmonic analysis was used to detect the seasonality of the suicide data.

RESULTS

The seasonal effect on suicide is greatly diminished in England and Wales. This is shown by the reduced amplitude and smaller proportion of variance accounted for by the season.

CONCLUSIONS

The seasonal effect on suicide has either diminished or vanished.

Further evaluation on long-term depot-medroxyprogesterone acetate use and bone mineral density: a longitudinal cohort study

Cross-sectional studies on the effects of depot-medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) have been controversial. The present longitudinal cohort study on 59 Chinese women over a period of 3 years has shown that their annual rate of bone loss at 3 sites (0.44% in lumbar spine, 0.40% in neck of femur, 1.05% in Ward's triangle) was substantially less than the projected values (1.1% in lumbar spine, 2.3% in neck of femur, 3.5% in Ward's triangle) in a cross-sectional study that had demonstrated a significant reduction in BMD in DMPA users than the non-user population. The trochanter BMD measurement did not show the projected annual bone loss of 2.4%. The rate of bone loss is probably non-linear, with a rapid loss in the first 5 years and a leveling off afterwards. The duration of DMPA use was not significantly correlated with the rate of bone loss. Multiple linear regression analysis demonstrated that age and body mass index were significant variables in modeling the rate of bone loss in the lumbar spine and neck of femur, but not in the trochanter and Ward's triangle areas. The Z scores also suggested a retardation in bone loss with time and potentially due to the effect of progesterone in decreasing bone turnover that is similar to the situation in postmenopausal women. The present data provide another aspect of reassurance to the long-term use of DMPA.

Urban/rural and gender differentials in suicide rates: east and west

BACKGROUND

Many epidemiological studies indicate suicide rates are higher for males than females and for urban than rural. Here we re-examine gender, urban and rural differentials in suicide in Australia and Beijing (China). More specifically, to test the two hypotheses (i) that the male to female ratio is larger than one; (ii) that the urban suicide rate is higher than the rural in both places.

METHODS

Suicide data with information of gender, rural and urban regions for Australia and Beijing (China) for the period of 1991-1996 were used. Ratios between the gender-specific urban and rural suicides rates with the associated confidence intervals were constructed to examine gender, urban and rural differentials in Australia and Beijing.

RESULTS

The rural suicide rate in Beijing for both genders was higher than for their urban counterparts. Further, the elderly had the highest suicide rate followed by women aged 20-29. Also, the male to female ratio in China was less than one. In Australia, the rural male suicide rate was higher than the urban whereas the urban female suicide rate was higher than the rural. The male to female ratio was 4 to 1. The differences in rural to urban and male to female ratios between Australia and Beijing are statistically significant.

CONCLUSIONS

In contrast to the west, male suicide rates are not higher than female rates in China. Urban rates are not necessarily higher than rural rates --not even in a western setting. Cultural factors and regional differences in socio-economic situation are significant in explaining the low gender ratio and the relatively higher suicide rates in rural China.

LIMITATIONS

The suicide rate in the Beijing region might not exactly reflect the same for the whole of China.

Acute renal failure after immersion in seawater polluted by diesel oil

Acute renal failure after exposure to toxic doses of hydrocarbon has been uniformly associated with multiorgan failure. We report a case of isolated acute renal failure in a patient after immersion in seawater polluted by diesel oil. The sites of absorption were likely to be skin, gastrointestinal tract, and lung. Investigations showed renal impairment as the only consequence from the exposure. The patient recovered uneventfully and did not require dialysis. This case highlighted the unusual consequence of isolated renal involvement resulting from hydrocarbon toxicity.

Estimation of population size based on additive hazards models for continuous-time recapture experiments

We use the semiparametric additive hazards model to formulate the effects of individual covariates on the capture rates in the continuous-time capture-recapture experiment, and then construct a Horvitz-Thompson-type estimator for the unknown population size. The resulting estimator is consistent and asymptotically normal with an easily estimated variance. Simulation studies show that the asymptotic approximations are adequate for practical use when the average capture probabilities exceed .5. Ignoring covariates would underestimate the population size and the coverage probability is poor. A wildlife example is provided.

Estimation of the size of an open population from capture-recapture data using weighted martingale methods

A weighted martingale method, akin to a moving average, is proposed to allow the use of modified closed-population methods in the estimation of the size of a smoothly changing open population when there are frequent capture occasions. We concentrate here on modifications to martingale estimating functions for model Mt, but a wide range of closed-population estimators may be modified in this fashion. The method is motivated by and applied to weekly capture-recapture data from the Mai Po bird sanctuary in Hong Kong. Simulations show that the weighted martingale estimator compared well with the Jolly-Seber estimator when the conditions for the latter to be valid are met, and it performed far better when individuals were allowed to leave and reenter the population. Expressions are derived for the asymptotic bias and variance of the estimator in an appendix.

Abnormal expression or mutation of TP53 and HPV in vulvar cancer

HPV (human papillomavirus) plays an important role in cervical cancer and may also play a role in vulvar cancer. TP53 mutation is common in a variety of cancers but its role in vulvar cancer is not well established. The aim of this study was to assess the prevalence of HPV infection and TP53 mutation as well as their correlation in vulvar cancer. Also, HPV detection and abnormal p53 expression were assessed in relation to age, co-existing vulvar intraepithelial neoplasia and vulvar dystrophy. Forty-eight samples of vulvar cancer were studied. DNA was extracted from formalin-fixed paraffin embedded tissue for polymerase chain reaction/Southern blot study with HPV 16 and 18 and L1 primers. Paraffin sections were immunostained (IHS) for p53 protein using three antibodies, p1801, CM1 and DO7. The p53 mutation was also screened using polymerase chain reaction (PCR) single-stranded conformation polymorphism (SSCP) and confirmed by sequencing. Overall, HPV was detected in 48% (23/48), of which 96% (22/23) were HPV 16 or 18. By IHS, p53 overexpression was detected in 46% of cases whilst TP53 mutations were identified in 21%. In HPV positive and negative tumours, p53 abnormal expression was detected in 39% and 52%, respectively, and TP53 mutation was found in 22% and 20%, respectively. Mutations were mainly found at codons 273 and 204. Age was not found to be associated with HPV detection. However, the presence of HPV (71%) or absence of abnormal p53 expression (65%) were higher in tumours with VIN3, but were not correlated with dystrophy.

Suicide notes: what do they tell us?

Police investigation records of all suicide cases in 1992 (n = 769) and the suicide notes that had been left (224 notes for 154 subjects) were examined. Note-leavers were characterized as young females, of non-widowed marital status, with no history of previous suicide attempts, no previous psychiatric illness, and with religious beliefs. Suicide notes written by young people were longer, rich in emotions, and often begging for forgiveness. Suicide notes written by the elderly were shorter, contained specific instructions, and were less emotional. A significant proportion of note-leavers did mention their difficulties. Suicide notes may serve some explanatory purpose and may have a therapeutic role in helping the surviving relatives to understand the suicide. A knowledge of the messages contained within suicide notes could be useful for suicide prevention programmes. The significance of suicide notes is best understood within the context of the occurrence of suicides.

Teenage attempted suicide in Hong Kong

We examined the epidemiological profiles and characteristics of suicide attempters admitted to the Accident and Emergency Department of a regional hospital in Hong Kong (Princess Margaret Hospital) in the period from January to December 1995. These consisted of 101 adolescents (16 males and 85 females) aged between 10 to 24 years. There were significantly more female attempters than males, especially in the group aged 10-19, which had a male-to-female ratio of suicide rates of 1:11. Most of the methods used were nonlethal; the attempters were not serious enough and had no real intention to die. The use of painkillers and sleeping pills was most common. The main precipitating factor was interpersonal problems, for example, relationships, spousal and parental problems, especially among teenage girls. More than 90% of the cases stayed at the hospital for further observation, the mean length of stay in the hospital being 3.3 days. The potential health cost to the hospital system was around HK $11.7 million. Underestimating the prevalence of attempted suicides in Hong Kong could be a serious matter.

An epidemiological profile of elderly suicides in Hong Kong

Suicide rates in Hong Kong increased with age, and the highest suicide rate occurred among the oldest age groups. Hong Kong has one of the highest elderly suicide rates in the world. The elderly suicide rate was four to five times above the average. Furthermore, gender differences were observed among different marital status groups. For example, single males had a much higher rate than single females and married males had a higher rate than their widowed counterparts. The suicide rate for an economically inactive person was six times higher than for an active one. Jumping has become increasingly common and seems to substitute for other methods of suicide. Winter months and the Chinese New Year period had the lowest suicide occurrence. Some explanations are given.

A study of elderly suicides in Hong Kong

Hong Kong has one of the highest rates of suicide among the elderly in the world. Most of the existing suicide prevention programs have had very little effect on the elderly, who rarely utilize these programs. This study aims to help in understanding the problem, so that effective prevention can be provided to this high-risk group of suicidal people. Specifically, the study (1) describes the characteristics of the suicidal elderly, (2) investigates the reason(s) why the elderly are in distress and become suicidal, and (3) formulates a policy and service model to reach the elderly high-risk group. This research project involves secondary data analysis. Police records on elderly suicide cases in 1992 were scrutinized to find out the major reason(s) for fatal death in the elderly. Our study points out those districts that are more crowded and have fewer medical and social facilities tended to have higher suicide rates. Most of the deaths occurred at home or nearby, and the suicidal elderly were alone before their death. The majority of elderly suicide victims suffered from chronic diseases. Very few of them, however, were totally dependent: About 40% of the cases had consulted medical practitioners, and 27% had consulted psychiatrists within one month before their deaths. Close to 70% of the cases had indicated to family members or other their suicidal thoughts, and many of them had revealed numerous suicidal indications. Both policy and practice issues are discussed in light of the findings.

Suicides in Hong Kong and Australia

Although the suicide rate for both Hong Kong and Australia was about 12 per 100,000 in 1994, the age- and gender-specific rates, methods of suicide, and time trends vary greatly for these two places. This paper explores the possible social, economic, and cultural background to explain this discrepancy. We used the official suicide death statistics of Hong Kong and Australia for the period 1984-1994. We calculated age-standardized suicide rates in order to take into account the differences in the age composition between the two countries and years. We employed a log-linear (Poisson) model to detect the age- and gender-specific trends, and to determine whether there were specific age or gender groups whose suicide behavior had changed significantly between 1984 and 1994. Hong Kong experienced a slight increase in suicide rate for both genders in the years 1984-1994, whereas Australia experienced a cubic trend for both genders during the same period and a rise in suicide rate in recent years. The suicide rate in Hong Kong increased with age, with a sharp increase (nearly four times the average) among the group aged 75 or over. A relatively low gender ratio (male:female) was also observed in Hong Kong, whereas in Australia there was not much difference in suicide rates among all age groups, though the suicide rate of the group aged 75 or over was 1.2 times the average. The gender ratio in Australia was higher, and the male suicide rate was four times higher than that of females. The Hong Kong suicide rate in females was twice that of Australia, whereas the Hong Kong male suicide rate was about half that of Australia. Jumping and hanging were the most common methods of suicide in Hong Kong, accounting for more than 80% of all suicide deaths. Poisoning (including gas poisoning) was the most common method used in Australia, with firearms being more common among young males. Australia had a higher years of potential life lost (YPLL) than Hong Kong because of the higher suicide rate among young males (aged 15-24). The high suicide rate among the elderly in Hong Kong raises the possibility that medical and social support to the elderly could be enhanced. The high female suicide rate in Hong Kong could be related to workload, responsibility, and expectations. The high suicide rate in Australia among males aged 15-24 was disturbing. Availability of the suicide methods is certainly one explanation for the difference in suicide methods used in Hong Kong and Australia.

Age, sex, marital status and suicide: an empirical study of east and west

The relationships among age, sex, marital status and suicidal behaviour in Australia and Hong Kong showed disparity in age-specific suicide rates among the four marital status groups, never married, married, widowed and divorced, for both sexes in the two locations. Examining the coefficients of preservation suggested the coefficient for never married to married in all cases was larger than 1, except for the groups of teenagers aged 15-19 years for both sexes and of elderly women aged 60 years or over in Hong Kong. The widowed or divorced groups have lower suicide rates than the married women among the elderly in Hong Kong. Hong Kong women seem not to have been benefited in marriage as much as men. Responsibility and workload in married life rather than low social status are the likely reasons for the relative high female suicide rate in Hong Kong. Possible cultural and environmental factors which are somewhat speculative (yet to be confirmed) are discussed.

Suicides in Hong-Kong and Singapore: a tale of two cities

Suicide statistics from Hong Kong and Singapore over the period 1984-1994 were studied. The suicide behaviours in Hong Kong and Singapore are remarkably similar. Suicide rates increased with age, with a sharp increase among the elderly which was about four to five times the average. A relatively low male:female ratio and low teenage suicide were also found. Jumping from a height was the commonest method of suicide. Nevertheless, a different time trend of the suicide rates was observed, with an upward and downward trend for Hong Kong and Singapore respectively. The cultural, social and economic aspects in understanding suicidal behaviour in Hong Kong and Singapore are also discussed.

A re-examination of seasonal variation in suicides in Australia and New Zealand

BACKGROUND

To examine the seasonality of suicides in Australia and New Zealand during the period 1981 to 1993.

METHODS

A chi-square test and a harmonic analysis were used to detect the seasonality of the suicide data.

RESULTS

The reduced amplitude and a smaller proportion of variance accounted for by seasonality suggested the seasonal effect on suicide is greatly diminished. The absence of biseasonal distribution of female suicides was also consistently found in the two countries. The finding was contrary to the reported results in seventies in many Western countries.

CONCLUSIONS

The change in living condition, roles of males and females and communication pattern resulted in the reduction of climatic and environment effect in the seasonality of suicides were suggested.

LIMITATIONS

The results would be better if a longer series of suicide date were available.

Suicides in Hong Kong, 1981-1994

Suicide in Hong Kong is experiencing a slight upward trend. The standardized suicide rate increased by 9.8%, from 10.3 per 100,000 population in 1981 to 11.3 per 100,000 in 1994. About 57% of the increase can be explained by a change in the age composition and the ageing problem in Hong Kong. Suicide ranked seventh in the ten leading causes of death since 1985. It was the leading cause of death in females aged 15-24 years. The female suicide rate in Hong Kong was among the highest in the world. The suicide rate increased steadily with age. Males aged 75 years or over had the highest suicide rate among all age groups in the population. Furthermore, in single males aged 60 years, the suicide rate was 80 per 100,000. The suicide rate for economically inactive persons was 4 times more than for the active. Jumping has become increasingly common and seems to substitute for other methods of suicide. The years of potential life lost were 342 years per 100,000 population in 1994.

Suicides in Hong Kong, Taiwan and Beijing

BACKGROUND

Differences and similarities were examined of suicide in Hong Kong, Beijing and Taiwan, the populations of which are all ethnically Chinese and share some characteristics of culture but which have very different social and political environments.

METHODS

The official death statistics were used for the periods 1981-94 (Hong Kong and Taiwan) and 1987-94 (Beijing).

RESULTS

Hong Kong has experienced a slight increase in suicide rate, whereas a significant decline was observed in Taiwan and Beijing. The suicide rates in all three increased with age, the rate among the elderly being four to five times the average. A relatively low male: female ratio (1.0-1.9) was also observed. Jumping and hanging were the most common methods of suicide in Hong Kong and Taiwan, respectively. Hong Kong had the most years of potential life lost.

CONCLUSIONS

Despite the remarkable economic growth in all three places during the study period, the differences in suicide trends suggest that the social and political environments may be more important than the economic environment in suicide. In Hong Kong the suicide rate is likely to remain high or even to increase.