Association of healthy lifestyle behaviours with incident irritable bowel syndrome: a large population-based prospective cohort study.

OBJECTIVES: To evaluate the association between healthy lifestyle behaviours and the incidence of irritable bowel syndrome (IBS). DESIGN: Population-based prospective cohort study. SETTING: The UK Biobank. PARTICIPANTS: 64 268 adults aged 37 to 73 years who had no IBS diagnosis at baseline were enrolled between 2006 and 2010 and followed up to 2022. MAIN EXPOSURE: The five healthy lifestyle behaviours studied were never smoking, optimal sleep, high level of vigorous physical activity, high dietary quality and moderate alcohol intake. MAIN OUTCOME MEASURE: The incidence of IBS. RESULTS: During a mean follow-up of 12.6 years, 961 (1.5%) incident IBS cases were recorded. Among the 64 268 participants (mean age 55.9 years, 35 342 (55.0%) female, 7604 (11.8%) reported none of the five healthy lifestyle behaviours, 20 662 (32.1%) reported 1 behaviour, 21 901 (34.1%) reported 2 behaviours and 14 101 (21.9%) reported 3 to 5 behaviours at baseline. The multivariable adjusted hazard ratios associated with having 1, 2 and 3 to 5 behaviours for IBS incidence were 0.79 (95% confidence intervals 0.65 to 0.96), 0.64 (0.53 to 0.78) and 0.58 (0.46 to 0.72), respectively (P for trend <0.001). Never smoking (0.86, 0.76 to 0.98, P=0.02), high level of vigorous physical activity (0.83, 0.73 to 0.95, P=0.006) and optimal sleep (0.73, 0.60 to 0.88, P=0.001) demonstrated significant independent inverse associations with IBS incidence. No significant interactions were observed between these associations and age, sex, employment status, geographic location, gastrointestinal infection, endometriosis, family history of IBS or lifestyle behaviours. CONCLUSIONS: Adhering to a higher number of healthy lifestyle behaviours is significantly associated with a lower incidence of IBS in the general population. Our findings suggest the potential of lifestyle modifications as a primary prevention strategy for IBS.

The Provision and Perceptions of Telemedicine Services Among Traditional Chinese Medicine Practitioners During COVID-19: A Cross-Sectional Study in Hong Kong, China.

Objectives: Telemedicine has been widely used during the COVID-19 pandemic. Among other health care professionals, Chinese medicine practitioners (CMPs) face practical challenges in providing telemedicine consultations. This study aims to explore CMPs' experience and perceptions of telemedicine service provision before and during the pandemic. Methods: A territory-wide cross-sectional online survey was conducted in Hong Kong between April and May 2022. A structured questionnaire with open-ended questions was used to investigate the provision of and perception on telemedicine service, as well as usability of telemedicine among CMPs. Results: A total of 195 CMPs participated the survey. Before COVID-19, 42% (81/195) had been providing telemedicine services, and the proportion doubled during COVID-19. CMPs in the private sector are the main providers. Mobile apps including WhatsApp, WeChat, and Zoom were commonly used for consultations (75%, 120/161). Barriers in providing telemedicine included inability of conducting physical examination on patients (69%, 134/195), legal and ethical concerns over medical negligence (61%, 118/195), and patients' incompetence on e-literacy (50%, 98/195). Respondents urged professional and regulatory bodies to provide an explicit clinical guideline that demonstrate best practice in traditional Chinese medicine telemedicine, and to clarify legal and ethical implications of such practice. Conclusions: CMPs demonstrated their competency in telemedicine, and most of them provided telemedicine during COVID-19. Development of appropriate guidelines on the provision of telemedicine would support CMPs to continue provision after the pandemic, whereas a user-friendly and comprehensive telemedicine e-platform would enhance quality of such service. Facilitating patients with lower e-literacy to access telemedicine is key to reduce disparities.

Depressive Symptoms Delayed Quit Attempts and Shortened Abstinence in Young Smokers of the Hong Kong Youth Quitline.

INTRODUCTION: Young smokers often report depressive symptoms while receiving smoking cessation counseling. This study examines time patterns in the quitting process among young smokers with or without notable depressive symptoms. METHODS: The quitting trajectories of young smokers aged 12 to 25 (n = 578) who called the Youth Quitline in Hong Kong between March 2006 and May 2011 were recorded and analyzed through multiple telephone sessions over periods of up to 6 months. The time patterns of young smokers who had or did not have notable depressive symptoms were compared using nonparametric Kaplan-Meier methods with log-rank tests. RESULTS: Among young smokers with low levels of nicotine dependence, those who had notable depressive symptoms were less likely to initiate a quit attempt within 28 days after their baseline telephone intervention (probability = .38 vs. .60; P value = .04). Furthermore, young smokers who had notable depressive symptoms were less likely to remain abstinent from smoking for 2 days after starting a quit attempt (probability = .50 vs. .64; P value = .012). Young adults aged 18 or above were more likely to relapse into smoking (adjusted HR = 1.50, 95% CI = 1.01, 2.22). CONCLUSIONS: Depressive symptoms may delay young smokers from initiating quit attempts and shorten their abstinence. A baseline screening process is suggested for identifying youths with co-occurring depressive disorder and nicotine dependence. Further studies should examine a collaborative model of smoking cessation that involves both counselors and physicians in preventing young smokers from rapid relapses after they make quit attempts.

A block randomized controlled trial of a brief smoking cessation counselling and advice through short message service on participants who joined the Quit to Win Contest in Hong Kong.

The present trial examined the effectiveness of brief interventions for smokers who joined the Hong Kong Quit to Win Contest to quit smoking. A block randomized controlled trial allocated 1003 adult daily smokers to three groups: (i) The TEL group (n = 338) received a 5-min nurse-led telephone counselling; (ii) The SMS group (n = 335) received eight text messages through mobile phone and (iii) The CONTROL group (n = 330) did not receive the above interventions. Participants with biochemically verified abstinence at 6-month follow-up could receive cash incentive. The primary outcome was the self-reported 7-day point prevalence (PP) of tobacco abstinence at 6-month follow-up. The abstinence rate in the TEL, SMS and CONTROL group was 22.2, 20.6 and 20.3%, respectively (P for TEL versus CONTROL = 0.32; P for SMS versus CONTROL = 0.40). When abstinence at 2-, 6- and 12-month follow-up was modelled simultaneously, the TEL group had a higher abstinence than the CONTROL group (Adjusted OR = 1.38, 95% CI = 1.01-1.88, P = 0 .04). In the Quit to Win Contest, the brief telephone counselling might have increased abstinence, but the text messages had no significant effect. Further studies on intensive intervention and interactive messaging services are warranted.

Will mothers of sick children help their husbands to stop smoking after receiving a brief intervention from nurses? Secondary analysis of a randomised controlled trial.

BACKGROUND: Second-hand smoke is a severe health hazard for children. Clinical guidelines suggest that nurses advise smoking parents to quit when they accompany their sick children to paediatric settings, but the guidelines did not mention what nurses can do if the parents are not with the children. This study examines the effectiveness of a low-intensity, nurse-led health instructional initiative for non-smoking mothers, to motivate them to take action to help their husbands stop smoking. METHODS: This was a randomised controlled trial and 1,483 non-smoking women, who were living with husbands who do smoke, were recruited when they accompanied with their sick children on hospital admission in general paediatic wards/outpatient departments of four hospitals in Hong Kong. The women were randomly allocated into intervention and control groups. The former received brief health education counselling from nurses, a purpose-designed health education booklet, a "no smoking" sticker, and a telephone reminder one week later; the control group received usual care. The primary outcome was the women"s action to help their smoking husbands stop smoking at 3-, 6- and 12-month follow-ups. RESULTS: A higher proportion of women in the intervention than the control group had taken action to help their husbands stop smoking at the 3-month (76% vs. 65%, P < .001), 6-month (66% vs. 49%, P < .001) and 12-month (52% vs. 40%, P < .001) follow-ups. Women who had received the intervention, had better knowledge of the health hazards of smoking, higher intention to take action, perceived their husbands' willingness to stop/reduce smoking, had previously advised their husbands to give up smoking, were aware of their husbands' history of smoking and, were aware that their husbands had made an earlier quit attempt and intended to help them stop smoking at the follow-ups. CONCLUSIONS: A brief health education intervention by nurses in paediatric settings can be effective in motivating the mothers of sick children to take action to help their husbands quit smoking. We recommend adding the following to the clinical practice guidelines on treating tobacco use and dependence: 'Nurses should offer every non-smoking mother of a sick child brief advice to encourage their husbands to stop smoking'. TRIAL REGISTRATION: Current Controlled Trials ISRCTN72290421.

A Modified Guideline for High-Fidelity Patient Simulation to Improve Student Satisfaction and Self-Confidence in Learning: A Mixed Study.

The coronaviral pandemic has led to a shift in traditional teaching methods to more innovative approaches, such as high-fidelity patient simulation (HFPS), which can improve students' clinical judgment and decision making for quality patient care. A modified guideline was introduced to enhance students' satisfaction and self-confidence in learning through HFPS. The study involved 189 baccalaureate nursing students, with 92 in the intervention group and 97 in the control group. The intervention group received the modified HFPS guideline, while the control group received standard treatment with basic instruction. After the HFPS debriefing session, students provided narrative feedback on their learning experiences. The quantitative results showed that students in the intervention group reported a significant improvement in satisfaction and self-confidence in learning compared to the control group. The modified HFPS guideline provided clear guidance for students to learn and apply knowledge and skills more effectively, leading to increased engagement during interactive simulation sessions. The results suggest that the HFPS guideline should be added to the curriculum to enhance students' satisfaction and self-confidence in learning, even for junior students. After the pandemic, innovative teaching methods, such as HFPS, can be necessary and beneficial for healthcare professional training.

Patterns and predictors of quitting among youth quitline callers in Hong Kong.

OBJECTIVES: To examine the time patterns and predictors of initiating a quit attempt and subsequent sustained abstinence among youth smokers after receiving a telephone smoking cessation intervention. METHODS: This was a longitudinal study of 408 current youth smokers aged 12-25 years who called a smoking cessation hotline in Hong Kong. Telephone surveys were conducted at baseline; 1 week; and 1, 3, and 6 months to assess smoking status and other risk factors. Nonparametric Kaplan-Meier methods and hierarchical Cox's proportional odds models were applied to explore the time patterns and predictors of the quitting process. RESULTS: Half of the youth smokers initiated a quit attempt within 1 month after receiving the baseline telephone intervention, while the likelihood of further quit attempts decreased over time. Two thirds relapsed within the first 7 days after starting a quit attempt. Intention to quit, previous quit attempts, perceived physical unfitness, and other factors could predict the initiation of a quit attempt. Sustained abstinence was facilitated by making an immediate attempt to quit, adopting self-help strategies, and a perceived improvement in physical health. CONCLUSIONS: Our findings support the "catastrophic" pathway of youth smokers initiating a quit attempt. Counselors should capture the quitting momentum and motivate youth smokers to quit immediately. Interventions should include a health assessment and discussion of smokers' physical fitness. During the first week of abstinence, intensive monitoring of withdrawal symptoms, together with booster counseling, is helpful in preventing smoking relapse and could remotivate those who fail to sustain their quit attempt.

Quitting trajectories of Chinese youth smokers following telephone smoking cessation counseling: a longitudinal study.

INTRODUCTION: The smoking patterns of youth remain unknown after they have received smoking cessation counseling. This study aims to examine the quitting trajectories of Chinese youth smokers after they have received quitline services and to examine factors to predict their quitting trajectories. METHODS: A total of 402 Chinese youth smokers (aged 12-25 years) called a quitline and participated in telephone follow-ups at 1 week, 1 month, and 3 and 6 months after initial telephone counseling. Finite mixture modeling was employed to examine the quitting trajectories by the SAS Proc Traj group-based modeling procedure. Hierarchical multinomial logistic regression was used to compare the baseline intention to quit smoking, prosmoking attitudes, social influences, self-efficacy to quit, smoking profile, quitting history, and demographic characteristics among the trajectory groups. RESULTS: Three distinct quitting trajectory groups were identified: quitters, reducers, and persistent smokers. Both quitters and reducers dramatically reduced the level of their cigarette consumption immediately after initial counseling. Youth smokers who were intended to quit at baseline, perceived confidence to quit, and perceived importance of quitting were more likely to have successfully quit smoking at six-month follow-up. Those who had prosmoking attitudes were less likely to quit smoking. CONCLUSION: The findings reveal the profiles of youth smokers who can quit successfully and can guide the development of better and relevant interventions based on the psychosocial characteristics of youth smokers. Short-term goals such as an abrupt quit attempt or immediately reducing cigarette consumption by half may be the key to help youth smokers quit successfully.

Predictors of intention to quit smoking in Hong Kong secondary school children.

BACKGROUND: Behavioral theories suggest that a past quit attempt influences psycho-social determinants to predict smokers' intention to quit, although no study has tested the hypothesis among youth smokers. METHODS: A sample of 1561 Chinese secondary students, who were current smokers, were collected in a cross-sectional school-based survey in Hong Kong. RESULTS: For the 943 students with past quit attempts, those with lower daily cigarette consumption; who perceived smoking would not elicit positive social responses from others; who had one parent/teacher who prohibited them to smoke; who were aware of the health hazards of smoking and being male smokers, were more likely to have an intention to quit smoking. For the 618 students without a past quit attempt, those who did not perceive any benefit from smoking; who had parents and teachers to prohibit them to smoke and who received social support to quit, were more likely to have an intention to quit smoking. CONCLUSION: Strengthening the prohibition of smoking and providing social support may help initiate the intention to quit among youth smokers without a past quit attempt, while de-normalizing social images of smoking, providing information about the health hazards of smoking and relieving nicotine addiction may sustain quitting intentions among youth smokers with past quit attempts.

Ferritin in the fungus Phycomyces.

The iron-protein ferritin has been purified from mycelium, sporangiophores, and spores of the fungus Phycomyces blakesleeanus. It has a protein-to-iron ratio of 5, a sedimentation coefficient of 55S, a buoyant density in CsCl of 1.82 g/cm(3), and the characteristic morphology of ferritin in the electron microscope. Apoferritin prepared from Phycomyces ferritin has a sedimentation coefficient of 18S and consists of subunits of molecular weight 25,000. In the cytoplasm of Phycomyces, ferritin is located on the surface of lipid droplets (0.5-2.0 micro in diameter) where it forms crystalline monolayers which are conspicuous in electron micrographs of sporangiophore thin-sections. Ferritin is found in all developmental stages of Phycomyces but is concentrated in spores. The level of ferritin iron is regulated by the iron level in the growth medium, a 50-fold increase occurring on iron-supplemented medium.

Mini-collagens in hydra nematocytes.

We have isolated and characterized four collagen-related c-DNA clones (N-COL 1, N-COL 2, N-COL 3, N-COL 4) that are highly expressed in developing nematocytes in hydra. All four c-DNAs as well as their corresponding transcripts are small in size (600-1,000 bp). The deduced amino acid sequences show that they contain a central region consisting of 14 to 16 Gly-X-Y triplets. This region is flanked amino-terminal by a stretch of 14-23 proline residues and carboxy-terminal by a stretch of 6-9 prolines. At the NH2- and COOH-termini are repeated patterns of cysteine residues that are highly conserved between the molecules. A model is proposed which consists of a central stable collagen triple helix of 12-14 nm length from which three 9-22 nm long polyproline II type helices emerge at both ends. Disulfide linkage between cysteine-rich segments in these helices could lead to the formation of oligomeric network structures. Electrophoretic characterization of nematocyst extracts allows resolution of small proline-rich polypeptides that correspond in size to the cloned sequences.

Fibrous mini-collagens in hydra nematocysts.

Nematocysts (cnidocysts) are exocytotic organelles found in all cnidarians. Here, atomic force microscopy and field emission scanning electron microscopy reveal the structure of the nematocyst capsule wall. The outer wall consists of globular proteins of unknown function. The inner wall consists of bundles of collagen-like fibrils having a spacing of 50 to 100 nanometers and cross-striations at intervals of 32 nanometers. The fibrils consist of polymers of "mini-collagens," which are abundant in the nematocysts of Hydra. The distinct pattern of mini-collagen fibers in the inner wall can provide the tensile strength necessary to withstand the high osmotic pressure (15 megapascals) in the capsules.

Short-term impact of new smoke-free legislation on the utilization of a quitline in Hong Kong.

INTRODUCTION: New smoke-free legislation implemented in Hong Kong on 1 January 2007, prohibited smoking in the vast majority of indoor workplaces and public places. Experiences of western countries indicated that the need for smoking cessation services would increase after enactment of the smoke-free legislation, but no systematic study of this issue has been undertaken in Southeast Asia. The present study aimed to examine the impact of smoke-free legislation in promoting smoking cessation through a local quitline. METHODS: The present study reports the results of a telephone survey using interrupted time-series analysis. We operated a toll-free smoking cessation hotline (quitline) for the general public from August 2005 to September 2007. The present study measured the percent change in the number of telephone calls received and handled before and after the smoke-free legislation. RESULTS: We evaluated the quitline for 9-month periods before (January-September 2006) and after (January-September 2007) the smoke-free legislation was implemented. The call rate in the initial period was 27.6 per month compared with 34.9 per month after enactment of the legislation, a 26% increase. Based on interrupted time-series models, the initial impact of the smoke-free legislation was to increase the number of telephone calls received and handled per week (p < .001), but the impact was temporal and deteriorated within 6 months. DISCUSSION: Implementation of the new smoke-free legislation had a short-term effect in promoting the utilization of a smoking cessation quitline in Hong Kong. A systematic and long-term tobacco control campaign should be combined with smoke-free legislation to promote and sustain smokers' interests in smoking cessation.

Helping Chinese fathers quit smoking through educating their nonsmoking spouses: a randomized controlled trial.

PURPOSE: Assess the effectiveness of a two-step health education program by nurses delivered through nonsmoking mothers to help fathers of sick children quit smoking. DESIGN: Randomized, controlled trial. SETTING: General pediatric wards of four major hospitals in Hong Kong. SUBJECTS: Nonsmoking mothers who had a live-in smoking spouse were recruited when they brought sick children to the hospital. A total of 752 mothers were randomized into the intervention arm and 731 into the control arm. INTERVENTION: The intervention group received standardized health advice, behavior modification booklets, and a 1-week telephone reminder. The control group received usual care. MEASUREMENTS: The main outcome measure was the quit rate (7-day point prevalence) of smoking fathers as determined by telephone follow-up with mothers at 3 and 12 months. Quit attempts and smoking reduction were secondary outcome measures. RESULTS: At 3 months, more fathers in the intervention group had quit smoking (7.4% vs. 4.8%; p = .03), reduced daily cigarette consumption by 50% or more (30.6% vs. 22.6%; p < .001), and reported quit attempts (6.5% vs. 3.6%; p = .01). The differences were not statistically significant by 12 months. CONCLUSION: A simple health education intervention provided by nurses to mothers of sick children has a short-term effect in helping smoking fathers quit, reduce consumption, and trigger quit attempts. Future studies should confirm the longer-term sustainability of the effect.

The establishment and promotion of the first Youth Quitline in Hong Kong: challenges and opportunities.

This study describes the establishment, promotion, and preliminary findings of a peer-led smoking cessation quitline for Chinese youth smokers in Hong Kong. The Youth Quitline targeted Chinese smokers aged 12 to 25, who smoked at least one cigarette in the past 30 days and were willing to leave telephone numbers for follow up. The protocol was translated from the California Smoker's Helpline and we provided toll-free telephone counseling based on motivational intervention with multiple follow-up sessions for smokers who called the service. By intention-to-treat analysis, 55% reported at least one quit attempt, and the quit rate was 22.1% (self-reported 7-day point prevalence) or 17.5% (self-reported 30-day point prevalence). The Hong Kong Youth Quitline, along with enforcement of the antismoking legislation for both youth and adults, advocacy to de-normalize smoking in the society, and appropriate publicity, could help to promote quitting among youth smokers in Hong Kong.

Building an integrated model of tobacco control education in the nursing curriculum: findings of a students' survey.

This study examined the outcome of a 2-hour introductory lecture on tobacco and health in improving the knowledge and attitudes of nursing students toward smoking and tobacco control. A group of 78 first-year undergraduate nursing students of a major university in Hong Kong were invited to complete a self-administered questionnaire before and after the lecture. The findings indicated a significant improvement in knowledge of and attitudes about tobacco control. The study suggests that education about smoking and tobacco control should be introduced into the nursing curriculum at an early stage so appropriate knowledge, attitudes, and skills can be subsequently strengthened to prepare students to lead an effective role in delivering tobacco control nursing interventions. Finally, a model of integrating tobacco control content in the undergraduate nursing curriculum was recommended.

Identification of caspases and apoptosis in the simple metazoan Hydra.

Apoptosis is a normal process by which cells die and are eliminated from tissue by phagocytosis [1]. It is involved in regulating cell numbers in adult tissues and in eliminating 'excess' cells during embryogenesis and development. Apoptosis is mediated by activation of caspases, which then cleave a variety of cellular substrates and thereby cause the characteristic morphology of apoptotic cells (rounded cells, condensed chromatin, susceptibility to phagocytosis) [2]. Although apoptosis has been well documented in nematodes, insects and mammals, it is not yet clear how early in evolution apoptosis or its component enzymes arose. In the simple metazoan Hydra vulgaris, cell death regulates cell numbers [3] [4] [5]. In starved animals, for example, epithelial cell proliferation continues at a nearly normal rate although the tissue does not increase in size; the excess cells produced are eliminated by phagocytosis. Cell death can also be induced in wild-type hydra by treatment with colchicine [6] or in a mutant strain (sf-1) by temperature shock [7]. Here, we show that cell death in hydra is morphologically indistinguishable from apoptosis in higher animals, that hydra polyps express two genes with strong homology to members of the caspase 3 family, and that caspase-3-specific enzyme activity accompanies apoptosis in hydra. The occurrence of apoptosis and caspases in a member of the ancient metazoan phylum Cnidaria supports the idea that the invention of apoptosis was an essential feature of the evolution of multicellular animals.

Parental response to child's isolation during the SARS outbreak.

OBJECTIVES: To examine the needs, uncertainties, and experiences of parents during their child's hospitalization with highly suspected severe acute respiratory syndrome (HSS), and to identify ways to improve their psychological preparedness and communication with health care professionals and their isolated children during future infectious disease outbreaks. METHODS: Qualitative, semistructured interviews were conducted in July 2003 with parents of HSS pediatric patients. Seventeen HSS patients were hospitalized in a pediatric outpatient clinic of a major academic medical center in Hong Kong, between March 20 and May 28, 2003, during severe acute respiratory syndrome (SARS). Seven parents (41%) consented to participate in the study. RESULTS: Four major themes were identified from the interviews: 1) fear of immediate isolation and infection control procedures, 2) sources of anxiety, 3) coping, and 4) communication with children and health care professionals. CONCLUSIONS: Findings indicate a need to improve the psychological preparedness of the parents regarding the child's immediate isolation during hospitalization. Ample preparation and appropriate communication among parents, health care workers, and children might minimize fear and anxiety, sustain trust, and facilitate mutual understanding during an infectious disease outbreak.

Improving older adults' knowledge and practice of preventive measures through a telephone health education during the SARS epidemic in Hong Kong: a pilot study.

BACKGROUND: The outbreak of severe acute respiratory syndrome (SARS) in Hong Kong posed many challenges for health promotion activities among a group of older adults with low socio-economic status (SES). With concerns that this vulnerable group could be at higher risk of contracting the disease or spreading it to others, the implementation of health promotion activities appropriate to this group was considered to be essential during the epidemic. OBJECTIVES: To assess the effectiveness of delivering a telephone health education programme dealing with anxiety levels, and knowledge and practice of measures to prevent transmission of SARS among a group of older adults with low SES. DESIGN: Pretest/posttest design. SETTINGS: Subjects were recruited from registered members of a government subsidized social service center in Hong Kong and living in low-cost housing estates. PARTICIPANTS: The eligibility criteria were: (1) aged 55 or above; (2) able to speak Cantonese; (3) no hearing impairment, and (4) reachable by telephone. Of the 295 eligible subjects, 122 older adults completed the whole study. METHODS: The interviewers approached all eligible subjects by telephone during the period of 15-25 May 2003. After obtaining the participants' verbal consent, the interviewer collected baseline data by use of a questionnaire and implemented a health education programme. A follow-up telephone call was made a week later using the same questionnaire. RESULTS: The level of anxiety was lowered (t=3.28, p<0.001), and knowledge regarding the transmission routes of droplets (p<0.001) and urine and feces (p<0.01) were improved after the intervention. Although statistical significant difference was found in the practice of identified preventive measures before and after intervention, influence on behavioral changes needed further exploration. CONCLUSION: The telephone health education seemed to be effective in relieving anxiety and improving knowledge of the main transmission routes of SARS in this group, but not the practice of preventing SARS. Telephone contact appears to be a practical way of providing health education to vulnerable groups when face-to-face measure is not feasible and may be useful in raising health awareness during future outbreaks of emerging infections.