Affluent Setting Research Articles

Addressing Climate Change Through Social Innovation Initiatives

While social innovation has traditionally emphasised social sustainability, it also presents potential for the mitigation of climate change by influencing social practices. This study explores how social innovation initiatives address social practices to mitigate climate change. Our qualitative study in an affluent setting, a Swedish municipality with high emissions, led to the identification of four dimensions relevant for climate mitigation: SIIs’ social motives, inspiration of others, beneficiary participation, and use of artefacts. Social motives for climate relevant social ends focused on altering the meaning of practices while SIIs’ had social means focused on changing meaning, competences, and materials of emission-intensive practices.

Evaluating the impact of sugar-sweetened beverages tax on overweight, obesity, and type 2 diabetes in an affluent Asian setting: A willingness-to-pay survey and simulation analysis

BackgroundThe potential health effects of taxing sugar-sweetened beverages (SSBs) has been insufficiently examined in Asian contexts. This study aimed to assess the impact of SSB taxation on the prevalence of obesity/overweight and type 2 diabetes mellitus (T2DM) in Hong Kong using a willingness-to-pay (WTP) survey and simulation analysis. MethodsA random telephone survey was conducted with 1000 adults from May to June 2020. We used a contingent valuation approach to assess individuals' WTP for SSBs under four tax payment scenarios (5%, 10%, 40%, and 50% of the current market price). Based on the WTP, a simulation analysis was conducted to project changes in SSB purchase and associated reductions in the prevalence of obesity/overweight and T2DM over a 10-year simulation period. FindingsWhen 5% and 10% taxation rates were introduced, approximately one-third of the population were unwilling to maintain their SSB purchase. Our simulation demonstrated a gradual decline in the prevalence of obesity/overweight and diabetes with a more pronounced decrease when higher taxation rates were introduced. 10% taxation resulted in a mean reduction of 1532.7 cases of overweight/obesity per 100 thousand population at the sixth year, while T2DM prevalence decreased by 267.1 (0.3%). ConclusionsThis study underscores the effects of an SSB tax on purchase behaviors and health outcomes in an affluent Asia setting, with a more pronounced influence on adult population. These findings are expected to inform policymakers in making decisions regarding an effective and equitable tax rate on SSBs.

Association between Diabetes and Levels of Micronutrients in Qatar-A Case-Control Study.

The objectives of this study were to investigate associations between micronutrient levels and diabetes and to explore the association in individuals with controlled and uncontrolled diabetes. A case-control study, matched on age and gender, was performed on participants with (cases) and without diabetes (controls), who were Qatari or long-term residents (≥15 years of residence). Participants with diabetes were divided into those with controlled and uncontrolled diabetes using an HbA1c cutoff of 7%. Levels of micronutrients were measured from serum and categorized into normal and abnormal levels. A total of 1118 participants (374 cases and 744 controls) were included with a mean age of 41.7 years (SD 9.9), of whom 53.9% were female. Of those with diabetes, 229 had controlled diabetes and 145 had uncontrolled diabetes. Compared to those without diabetes, participants with diabetes had significantly lower mean magnesium (0.80 mmol/L (SD 0.07) vs. 0.84 mmol/L (SD 0.06), respectively, p < 0.001). Lower magnesium and iron were observed in participants with uncontrolled compared to participants with controlled diabetes. After multivariable logistic regression, diabetes was associated with hypomagnesemia (OR 3.2, 95% CI 3.4-213.9) and low iron (OR 1.49, 95% CI 1.03-2.15). Uncontrolled diabetes showed stronger odds of association with hypomagnesemia (OR 5.57, 95% CI 3.65-8.52). In an affluent setting in the MENA region, diabetes was associated with low magnesium and low iron, and this association was stronger in individuals with uncontrolled diabetes.

Exploring the role of point-of-care ultrasound for people with HIV in a resource affluent setting: A prospective observational study.

In low resource settings point of care ultrasound (POCUS) has proven value for the detection of opportunistic diseases in HIV, especially tuberculosis. Few studies have explored POCUS in people with HIV and potential opportunistic infections in resource affluent settings. We performed a prospective observational study in the Netherlands. Outpatients newly diagnosed with HIV and a CD4 T-cell count below 350 cells/mm3 and inpatients with HIV on the infectious diseases ward were included. POCUS of chest and abdomen were performed to detect opportunistic diseases and patients were followed for 1 year to register the presence or absence of opportunistic diseases as detected during routine care. Primary outcome was the number of HIV-related and unrelated conditions detected by POCUS and interobserver variation (ClinicalTrials.gov registration NCT04246983). We included 34 patients (79% males, median CD4 T-cell count 115/mm3). Observers had 97.5% agreement (Cohen's kappa for interobserver reliability 0.75). POCUS examination indicated at least one new opportunistic disease in 11 patients. In all these patients additional investigations confirmed opportunistic disease, predominantly Pneumocystis jirovecii pneumonia, bacterial pneumonia, Mycobacterium avium complex infection and lymphoma. In four patients an opportunistic disease was diagnosed in foci inaccessible for POCUS and a normal POCUS correctly excluded opportunistic diseases of the investigated structures in all patients, yielding a sensitivity of 73% and a specificity of 100%. POCUS can be a reliable, valuable addition to physical examination of people with HIV and advanced immune suppression. The data support further exploration of POCUS in people with HIV in resource affluent settings.

91Is rainfall associated with paediatric acute gastroenteritis in an affluent setting? A 21-Year Retrospective Investigation

Abstract Background Although many literatures demonstrated heavy rainfall was associated with an increased risk of acute gastroenteritis via contaminated food and water, we hypothesized there is no association between rainfall and paediatric acute gastroenteritis in a setting with high-standard food and water hygiene. Methods Intestinal infection-related hospital admissions data during 1998-2018 for children under 5 years of age in Hong Kong were collected. Meteorological data were collected from the Hong Kong Observatory. A distributed lag nonlinear model was employed to examine the associations between meteorological factors and the risk of hospital admissions due to acute gastroenteritis. Results Rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to acute gastroenteritis but low temperature, low and high relative humidity did. The risk was 6.3% higher (95% confidence interval: 0.3% to 12.6%) when temperature was at 15.1oC (i.e. the 5th percentile). The adjusted relative risk was statistically significantly higher when relative humidity was ≤73.0% or ≥ 84.0%. Conclusions Text: We suggest rainfall playing a minor role in disease transmission via contaminated food and water in affluent societies like Hong Kong. Instead, we speculate low temperature and humidity extremes have greater impact on transmission through increased stability and infectivity of enteric viruses. Key messages Weather plays a minor role in food and water contamination in affluent societies. Low temperature and humidity extremes might improve survival of enteric viruses.

PAM1 Willingness to Pay for Sugar-Sweetened Beverages Tax in an Affluent Setting of ASIA: A Preliminary Finding

To assess the tax rates that an individual will change their consumption frequency for sugar-sweetened beverages (SSB) products i.e. Willingness to pay (WTP) We conducted a cross-sectional study via a random telephone survey for adult residents in Hong Kong from May to June, 2020. SSBs products were referred to all non-alcoholic water based beverages with added sugar. WTP of a respondent was defined as the accepted price that he is willing to pay for the SSB products without a reduction of purchase given a taxation scenario, and the maximum WTP (WTPM) was defined as the highest accepted price that a respondent consuming SSB products. The questionnaire was designed consisting of socio-demographics, physical conditions, SSB consumption frequency, perception about SSB products, and WTP for each types of SSBs. A total of 1,000 subjects were successfully interviewed and the response rate was 59.1%. We found the local population had a high consumption behavior of SSB products and even though a half of them perceived that a consumption of SSB products could contribute a risk of getting chronic diseases, only a moderate proportion of WTP (>60%) at a typical range of taxation (i.e. 5%-10%) was reported. Among the SSB products, we found a comparatively higher proportion of WTP in sweetened tea/coffee and the WTPM was less sensitive when the price was increased, primarily due to a regular consumption in the daily lives of local population. Compared with the adults, the proportions of WTP in children were relatively lower indicating a higher effect of SSB tax. This is the very first study in the Chinese society to identify determinants for individuals’ WTP and evaluate the acceptability of taxation policy on SSB products. The findings thus help with designing SSB tax policy especially in the Chinese population.

"More of a Girl Thing?" Examining the Role of Gender and Campus Context in Perceptions of Risk and the Shadow of Sexual Assault.

One of the most consistent predictors of fear of crime is gender, whereby women are more fearful of crime than men, despite their lower rates of victimization. An often-cited explanation for this apparent paradox is the "shadow" of sexual assault, which has received overwhelming support in studies among college students. However, this work has been largely quantitative and rarely comparative in nature. Using in-depth qualitative interviews with 70 undergraduates attending a suburban and an urban university, the focus of the current study was to understand if and how gender shapes students' fear of crime and perceptions of risk on campus, as well as whether the influence of gender varies across contexts. Consistent with the shadow hypothesis, this study found that students attending university in the relatively affluent suburban setting were most concerned about the sexual assault and rape of their female peers, especially by non-student outsiders. Yet in the less advantaged urban context, the shadow was missing from students' remarks. Instead, participants believed they were most likely to be robbed and generally knew someone who had been a victim of the crime, had they not been robbed themselves. The findings from this study have theoretical implications for the role of context in the shadow of sexual assault hypothesis, as well as methodological implications for how scholars examine gender and students' fear of crime.

A 21-year retrospective analysis of environmental impacts on paediatric acute gastroenteritis in an affluent setting

BackgroundExtreme weather events happen more frequently along with global warming and they constitute a challenge for public health preparedness. For example, many investigations showed heavy rainfall was associated with an increased risk of acute gastroenteritis. In this study, we examined the associations between different meteorological factors and paediatric acute gastroenteritis in an affluent setting in China controlling for pollutant effects. MethodsAggregated total weekly number of intestinal infection-related hospital admissions, and meteorological and air pollution data during 1998–2018 in Hong Kong were collected and analysed by a combination of quasi-Poisson generalized additive model and distributed lag nonlinear model. Study population was restricted to children under 5 years of age at the time of admission. ResultsWhile heavy rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to intestinal infections, low temperature and humidity extremes (both relative humidity and vapour pressure) did. Compared with the temperature at which the lowest risk was detected (i.e. 22.5 °C), the risk was 6.4% higher (95% confidence interval: 0.0% to 13.0% at 15.1 °C (i.e. the 5th percentile)). We also found the risk of paediatric admission was statistically significantly associated with an increase in the number of extreme cold days in a week over the study period. ConclusionCold condition may have greater impact on disease transmission through increased stability and infectivity of enteric viruses in affluent settings like Hong Kong and thus resulted in an increased risk for paediatric acute gastroenteritis. On the contrary, an insignificant impact from heavy rainfall and high temperature may indicate a minor effect on disease transmission through bacterial growth in contaminated food and water. With the identified impacts of weather factors, extreme weather events are likely to distort the prevalence and seasonal pattern of diarrhoeal diseases in the future.

Survival after cancer in children, adolescents and young adults in the Nordic countries from 1980 to 2013

BackgroundThe present study aimed to assess whether the widespread concern of inferior cancer survival in adolescents and young adults (AYAs) compared with children and adults holds true in a Nordic setting with important differences in healthcare organisation compared with the United States (e.g. free access to healthcare) and the United Kingdom (e.g. young teenagers are treated in paediatric departments).MethodsFive-year relative survival was calculated for 17 diagnostic groups in patients diagnosed in 2000–2013 in three diagnostic age categories: children (0–14 years), AYAs (15–24 years) and adults (25–34 years).ResultsFor 13 out of 17 diagnostic groups examined, there was no difference in survival between AYAs and neighbouring age categories. For acute lymphoblastic leukaemias, astrocytomas, rhabdomyosarcomas and non-rhabdomyosarcoma soft tissue sarcomas we found survival in children to be superior to that in AYAs. For these four diagnostic groups, the rate of survival improvement over three calendar periods (1980–1989, 1990–1999 and 2000–2013) was not particularly low in AYAs compared with neighbouring age categories.ConclusionsThe present study suggests that in an affluent setting with free access to healthcare, meaningful differences in survival between AYA patients and either childhood or adult patients are a phenomenon of the past for most AYA cancer diagnostic groups.

Introducing tablet computers to a rural primary school: An Activity Theory case study

This paper reports on a case study investigating the introduction of tablet computers into a rural primary school in Oman. The school is unusual in that it is in an economically-disadvantaged, mountainous region which is prone to flooding. There is little infrastructure, with no internet and there is a high turnover of staff. The project to introduce tablets was a personal initiative of the head teacher who needed to convince the Ministry of Education, her staff and parents of the pupils. The study used Activity Theory to explore the introduction of the tablet computers, seeing the school and the classrooms as Activity Systems. The Activity Theory analysis made it possible to see how changing one aspect of an Activity System, by introducing new mediational tools, affected the agents, the community, the rules and the division of labour. The study found that the tablets changed the working culture of staff in the project and the behaviour and responsibilities of the pupils.The significance of the study lies in the fact that the school was such an unlikely setting for such an innovation and the consequent effects such as staff collaboration and partnership between teachers and pupils – which might have been standard practice in an affluent urban setting – constituted radical changes in the culture of the school and classrooms. The study also innovates in the use of Activity Theory to examine all components of the System in order to understand the unexpected impacts of an innovation such as tablet computers in education.

Interpreting population reach of a large, successful physical activity trial delivered through primary care

BackgroundFailure to include socio-economically deprived or ethnic minority groups in physical activity (PA) trials may limit representativeness and could lead to implementation of interventions that then increase health inequalities. Randomised intervention trials often have low recruitment rates and rarely assess recruitment bias. A previous trial by the same team using similar methods recruited 30% of the eligible population but was in an affluent setting with few non-white residents and was limited to those over 60 years of age.MethodsPACE-UP is a large, effective, population-based walking trial in inactive 45-75 year-olds that recruited through seven London general practices. Anonymised practice demographic data were available for all those invited, enabling investigation of inequalities in trial recruitment. Non-participants were invited to complete a questionnaire.ResultsFrom 10,927 postal invitations, 1150 (10.5%) completed baseline assessment. Participation rate ratios (95% CI), adjusted for age and gender as appropriate, were lower in men 0.59 (0.52, 0.67) than women, in those under 55 compared with those ≥65, 0.60 (0.51, 0.71), in the most deprived quintile compared with the least deprived 0.52 (0.39, 0.70) and in Asian individuals compared with whites 0.62 (0.50, 0.76). Black individuals were equally likely to participate as white individuals. Participation was also associated with having a co-morbidity or some degree of health limitation. The most common reasons for non-participation were considering themselves as being too active or lack of time.ConclusionsConducting the trial in this diverse setting reduced overall response, with lower response in socio-economically deprived and Asian sub-groups. Trials with greater reach are likely to be more expensive in terms of recruitment and gains in generalizability need to be balanced with greater costs. Differential uptake of successful trial interventions may increase inequalities in PA levels and should be monitored.Trial registrationISRCTN.com ISRCTN98538934. Registered 2nd March 2012.

Calculated homes, stretched emotions: Unmasking ‘rational’ investor-occupier subjects in large family homes in a coastal Sydney development

Owner-occupation is axiomatic in Australia and other Western housing markets. Amidst financialisation imperatives, the owned house is dually cast as a financial asset and instrument, while simultaneously persisting in its domestic role as ‘home’. This paper investigates emotional performances and accompanying socio-material expressions underwriting the figure of the investor-occupier subject. Ethnographic research was conducted in a new housing development in an increasingly affluent coastal setting in southern Sydney, where 21 households participated in semi-structured walking interviews focusing on purchasing decisions, building a new home, and early homemaking practices. Following the stories of new residents, three themes emerged, around which our analysis is structured: how households articulated overlapping domestic and economic ideals of home; the emotional performance of a calculative investor subject; and how ideals of opportunity and competitiveness became reflected materially in newly built homes. The paper explores moments of suppressed emotional complexity surrounding matters of financial expenditure – unmasking the ‘rational’ investor-occupier. We conclude by exploring what is potentially lost or gained from rewriting financially the emotional cues of the family home.

The Trojan horse of affluence and halal in the Arabian Gulf

PurposeThe purpose of this paper is to take the case of the United Arab Emirates (UAE) as a starting point for the analysis of the blend between the notions of halal and luxury in the Arab region because the UAE presents an interesting multicultural yet Islamic blend, which has yet not been investigated. Scholarly calls for the assessment of the relationship between consumption and wellbeing have raised interest in conspicuous consumption research. The global phenomenon of luxury consumption has drawn researcher interest at recent times. Despite consumer affluence in the oil-rich Arabian Gulf, research into this phenomenon at this emerging region to-date is still lacking. As the Arabian Gulf is also particularly Islamic, a significant body of literature has addressed halal purchasing yet had failed to examine the intersections between luxury and halal consumption.Design/methodology/approachThe research takes a qualitative methodological approach utilizing unstructured observation and content analysis of 138 visuals collected from prominent shopping malls in Dubai and Abu-Dhabi during the occasion of the minor Islamic Eid following Ramadan.FindingsThe results show that the UAE consumer culture combines authenticity with modernity portraying highly savvy cosmopolitan consumers sharing the global values of urbanization within the halal parameters.Research limitations/implicationsThe limitations relate to the utilization of the qualitative methodological approach; hence, the research findings need to be generalized with caution to relevant contexts. This research should be regarded as a critical starting point in analyzing the syllogisms between the notions of halal and affluence.Practical implicationsThe findings are relevant to consumer culture research which looks at the implications of modern consumption within the boundaries of halal. The research presents a critical approach and questioning of the overlaps between halal consumption, responsible consumption and luxury consumption in a unique multicultural and affluent setting which is the UAE.Social implicationsThe present paper invites academics and practitioners to introspect into the dimensions of responsible consumption, luxury consumption and halal consumption. It asks the critical metaphorical question of whether halal and luxury consumption are two faces of the same coin.Originality/valueThe research concludes with raising critical questions around the boundaries of luxury consumption from an Islamic perspective, thereby combining elements of religion and cultural approaches to Islamic marketing.

Healthy travel and the socio-economic structure of car commuting in Cambridge, UK: A mixed-methods analysis

Car use is associated with substantial health and environmental costs but research in deprived populations indicates that car access may also promote psychosocial well-being within car-oriented environments. This mixed-method (quantitative and qualitative) study examined this issue in a more affluent setting, investigating the socio-economic structure of car commuting in Cambridge, UK. Our analyses involved integrating self-reported questionnaire data from 1142 participants in the Commuting and Health in Cambridge study (collected in 2009) and in-depth interviews with 50 participants (collected 2009–2010). Even in Britain's leading ‘cycling city’, cars were a key resource in bridging the gap between individuals' desires and their circumstances. This applied both to long-term life goals such as home ownership and to shorter-term challenges such as illness. Yet car commuting was also subject to constraints, with rush hour traffic pushing drivers to start work earlier and with restrictions on, or charges for, workplace parking pushing drivers towards multimodal journeys (e.g. driving to a ‘park-and-ride’ site then walking). These patterns of car commuting were socio-economically structured in several ways. First, the gradient of housing costs made living near Cambridge more expensive, affecting who could ‘afford’ to cycle and perhaps making cycling the more salient local marker of Bourdieu's class distinction. Nevertheless, cars were generally affordable in this relatively affluent, highly-educated population, reducing the barrier which distance posed to labour-force participation. Finally, having the option of starting work early required flexible hours, a form of job control which in Britain is more common among higher occupational classes. Following a social model of disability, we conclude that socio-economic advantage can make car-oriented environments less disabling via both greater affluence and greater job control, and in ways manifested across the full socio-economic range. This suggests the importance of combining individual-level ‘healthy travel’ interventions with measures aimed at creating travel environments in which all social groups can pursue healthy and satisfying lives.

Factors Associated with Height Catch-Up and Catch-Down Growth Among Schoolchildren

In developed countries, children with intrauterine growth restriction (IUGR) or born preterm (PT) tend to achieve catch-up growth. There is little information about height catch-up in developing countries and about height catch-down in both developed and developing countries. We studied the effect of IUGR and PT birth on height catch-up and catch-down growth of children from two cohorts of liveborn singletons. Data from 1,463 children was collected at birth and at school age in Ribeirão Preto (RP), a more developed city, and in São Luís (SL), a less developed city. A change in z-score between schoolchild height z-score and birth length z-score≥0.67 was considered catch-up; a change in z-score≤−0.67 indicated catch-down growth. The explanatory variables were: appropriate weight for gestational age/PT birth in four categories: term children without IUGR (normal), IUGR only (term with IUGR), PT only (preterm without IUGR) and preterm with IUGR; infant's sex; maternal parity, age, schooling and marital status; occupation of family head; family income and neonatal ponderal index (PI). The risk ratio for catch-up and catch-down was estimated by multinomial logistic regression for each city. In RP, preterms without IUGR (RR = 4.13) and thin children (PI<10th percentile, RR = 14.39) had a higher risk of catch-down; catch-up was higher among terms with IUGR (RR = 5.53), preterms with IUGR (RR = 5.36) and children born to primiparous mothers (RR = 1.83). In SL, catch-down was higher among preterms without IUGR (RR = 5.19), girls (RR = 1.52) and children from low-income families (RR = 2.74); the lowest risk of catch-down (RR = 0.27) and the highest risk of catch-up (RR = 3.77) were observed among terms with IUGR. In both cities, terms with IUGR presented height catch-up growth whereas preterms with IUGR only had height catch-up growth in the more affluent setting. Preterms without IUGR presented height catch-down growth, suggesting that a better socioeconomic situation facilitates height catch-up and prevents height catch-down growth.

Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study

BackgroundPsychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting.MethodsPatients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score <10, 187 men and 93 women. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CI) as being depressed were calculated for the psychosocial stressors and lifestyle circumstances, separately for men and women. Multiple logistic regression analyses were used to determine the age-adjusted main effect models for men and women.ResultsThe same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only.ConclusionsThree questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.

Affluence cues and first impressions: The moderating impact of the Protestant work ethic

This experiment examined how a target person’s affluence cues and the perceiver’s endorsement of the Protestant work ethic (PWE) influence interpersonal perceptions about others. Participants ( N=136) read scenarios that described a man or woman in either an affluent or less affluent home setting. They then evaluated the target person on 20 personal qualities and indicated their desire to have the target’s lifestyle. A positive relationship was found between affluence level and perceptions of personal abilities, sophistication, and the desire to have the target’s lifestyle. A negative relationship was found between affluence level and perceptions of considerateness. The perceiver’s endorsement of the PWE moderated two of these four relationships. High PWEs ascribed greater considerateness to an affluent target person than low PWEs. Low PWEs did not differ in their evaluation of a less affluent target person’s considerateness. Further, low PWEs, unlike high PWEs, displayed clear preference for the affluent over the less affluent target’s lifestyle. Results are discussed with respect to the information processing tendencies associated with PWE endorsement. Future research directions are also discussed.

Acceptance of dementia screening in continuous care retirement communities: a mailed survey.

In a recent systematic review of the evidence for dementia screening to support recommendations from the US Preventive Services Task Force, we found no evidence regarding the interest or willingness of older adults to be screened, and insufficient evidence to provide an estimate of the potential harms of dementia screening. In an attempt to address the acceptability of dementia screening, we asked older adults living in two Continuous Care Retirement Communities (CCRC) if they would agree to routine screening for memory problems. Cross-sectional study using self-administered mailed survey questionnaires. Two CCRCs in Orange County, North Carolina. 500 residents of the independent living section of CCRCs. There was a 64% survey response rate. Of these, 49% of participants stated they would agree to routine screening for memory problems. In comparison to people who would not agree to routine memory screening, those who accepted memory screening were more likely to accept depression screening, be male, use drug-administration assisted devices, and take more medications. Approximately half of the residents in this affluent residential community setting were not willing to be screened routinely for memory problems. This high refusal rate indicates that dementia screening may be associated with perceived harms. We must improve our understanding of the decision-making process driving individual's beliefs and behaviors about dementia screening before implementing any broad-based screening initiatives for dementia or cognitive impairment.

Congenital rickets due to maternal vitamin D deficiency in a sunny island of Greece

A full‐term male infant presented with clinical and biochemical findings consistent with the diagnosis of congenital rickets: weak muscle tone, craniotabes, episodes of tremor, hypocalcaemia, elevated serum alkaline phosphatase, secondary hyperparathyroidism, decreased 25‐hydroxyvitamin D and normal 1,25‐dihydroxyvitamin D serum levels. The mother's history and biochemical findings suggested nutritional vitamin D deficiency. Treatment with calcium and vitamin D resulted in the disappearance of clinical findings of rickets, normalization of the baby's biochemical profile and normal growth. It is surprising that this case occurred in an affluent setting, in the Mediterranean island of Crete, with an abundance of sunlight throughout the year. Conclusion: We report this case in order to emphasize the continuing occurrence of congenital rickets even in populations not considered at risk for hypovitaminosis D. A high index of suspicion is required for prompt diagnosis and treatment, thus preventing complications.

Is the timing of exposure to infection a major determinant of acute lymphoblastic leukaemia in Hong Kong?

The hypothesis that protection of infants from exposure to infectious agents with delayed first exposure to one or more specific agents together contribute to the aetiology of childhood leukaemia, especially common acute lymphoblastic leukaemia (cALL), has substantial indirect support from descriptive epidemiology and case-control studies in developed Western countries. A case-control study of childhood leukaemia diagnosed at ages 2-14 years has now been conducted in Hong Kong. Cases (n=98) formed a consecutive series of Chinese children diagnosed with acute leukaemia; controls (n=228) were identified following a survey using random digit dialling and required to attend for medical examination by a paediatrician. Interviews with mothers were conducted in hospital by one trained interviewer using a structured questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) are reported for exposure variables capable of serving as proxies for exposure to infection in two critical time periods: first year of life, year before reference date (diagnosis for cases, corresponding date for controls). Analyses used logistic regression with adjustment for appropriate confounders. Change of area of residence reduced risk if during the first time period (OR = 0.47 [95% CI 0.23, 0.98]) and increased risk if during the second (OR=3.92, [95% CI 1.47, 10.46]). Reported roseola and/or fever and rash in the first year of life reduced risk (OR=0.33 [95% CI 0.16, 0.68]) whereas tonsillitis in the period 3-12 months before reference date increased risk (OR=2.56 [95% CI 1.22, 5.38]). Some other proxies for exposure to infection at the critical times were associated with predicted patterns of risk but day-care attendance failed to show predicted associations. These results provide support for the delayed exposure hypothesis in an affluent geographical setting in which population exposure to infectious agents is quite distinct from the settings of previous case-control studies.