Assuntos
Mudança Climática , Mortalidade , Humanos , Temperatura , Hong Kong , Previsões , Temperatura AltaRESUMO
OBJECTIVE: To examine the uptake of breast screening and its associated factors among Hong Kong Chinese women aged ≥50 years. STUDY DESIGN: Cross-sectional population-based survey. METHODS: A sample of Hong Kong Chinese women was recruited through telephone random-digit dialling. The survey consisted of six sections: perceived health status, use of complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of breast screening were analysed using logistic regression analysis. RESULTS: In total, 1002 women completed the (anonymous) telephone survey. The mean age was 63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong Chinese women aged ≥50 years was 34%. The primary reasons for undertaking breast screening were as part of a regular medical check-up (74%), prompted by local signs and symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram. CONCLUSIONS: This study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies.
Assuntos
Neoplasias da Mama/prevenção & controle , Mamografia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/genética , Terapias Complementares/estatística & dados numéricos , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Hong Kong , Humanos , Pessoa de Meia-Idade , Relações Médico-Paciente , Fatores SocioeconômicosAssuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/intoxicação , Medicamentos sem Prescrição/efeitos adversos , Medicamentos sem Prescrição/intoxicação , Adolescente , Adulto , Comportamento de Procura de Droga , Feminino , Hong Kong/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Educação de Pacientes como Assunto , Automedicação , Inquéritos e Questionários , Adulto JovemAssuntos
Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , Qualidade de Vida , Estomatite/induzido quimicamente , Adolescente , Antineoplásicos/uso terapêutico , Ansiedade/complicações , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Neutropenia/complicações , Estudos Prospectivos , Fatores de Risco , Estomatite/epidemiologiaRESUMO
BACKGROUND: Trauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong. METHODS: We report the five year follow up results of a multicentre, prospective cohort from the trauma registries of three regional trauma centres in Hong Kong. The original cohort recruited 400 adult trauma patients with ISS ≥ 9. Telephone follow up was conducted longitudinally at seven time points, and the extended Glasgow Outcome Scale (GOSE) and Short-Form 36 (SF36) were tracked. RESULTS: 119 out of 309 surviving patients (39%) completed follow up after 5 years. The trajectory of GOSE, PCS and MCS showed gradual improvements over the seven time points. 56/119 (47.1%) patients reported a GOSE = 8 (upper good recovery), and the mean PCS and MCS was 47.8 (95% CI 45.8, 49.9) and 55.8 (95% CI 54.1, 57.5) respectively at five years. Univariate logistic regression showed change in PCS - baseline to 1 year and 1 year to 2 years, and change in MCS - baseline to 1 year were associated with GOSE = 8 at 5 years. Linear mixed effects model showed differences in PCS and MCS were greatest between 1-month and 6-month follow up. CONCLUSIONS: After injury, the most rapid improvement in PCS and MCS occurred in the first six to 12 months, but further recovery was still evident for MCS in patients aged under 65 years for up to five years.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Recuperação de Função Fisiológica/fisiologia , Sistema de Registros/estatística & dados numéricos , Centros de Traumatologia , Atividades Cotidianas , Adulto , Idoso , Feminino , Hong Kong/epidemiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Análise de Sobrevida , Centros de Traumatologia/estatística & dados numéricos , Resultado do TratamentoRESUMO
BACKGROUND: Women with polycystic ovary syndrome (PCOS) frequently exhibit central obesity, glucose intolerance, atherogenic dyslipidaemia and hypertension which are characteristic features of the metabolic syndrome (MetS). METHODS: A total of 295 premenopausal Chinese women with PCOS diagnosed by the Rotterdam criteria (mean age: 30.2 +/- 6.4 years) and 98 control subjects without PCOS were evaluated for prevalence of MetS and cardiovascular risk factors, including dyslipidaemia and dysglycaemia. RESULTS: Using the 2005 modified Adult Treatment Panel III criteria, MetS (presence of three or more risk factors) was found in 24.9% of PCOS women compared to 3.1% of controls. The prevalence of MetS in PCOS women increased from 16.7% at under 30 years of age to 53.3% at over 40 years. MetS was also more prevalent in overweight and obese (41.3%) than normal-weight PCOS women (0.9%). However, multivariate regression analysis showed that women with PCOS had a 5-fold increase in risk of MetS (odds ratio 4.90; 95% confidence interval: 1.35-17.84) compared with women without PCOS even after controlling for age and BMI, suggesting PCOS alone is an independent risk factor for MetS. CONCLUSIONS: There is high prevalence of MetS in Hong Kong Chinese women with PCOS despite their relatively young age. Recognition of these cardiometabolic risk factors requires a high level of awareness in conjunction with early and regular screening.
Assuntos
Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Dislipidemias/epidemiologia , Feminino , Hong Kong/epidemiologia , Humanos , Síndrome Metabólica/complicações , Síndrome do Ovário Policístico/complicações , Pré-Menopausa , Prevalência , Fatores de RiscoRESUMO
Previous studies have found that having a first-degree blood relative with lung cancer was a possible predictor of lung cancer risk, but some studies have indicated that the association is non-significant or only significant for a subset of the studied population. To determine the familial aggregation and whether there is any evidence for a gene controlling the susceptibility to developing lung cancer in female non-smokers, multiple logistic regression methods for estimating covariate effects and maximum likelihood segregation analyses were performed using data from 216 female non-smoking lung cancer probands (2328 individuals) in a population-based case-control study. Having a family history of lung cancer was found to be a significant predictor of lung cancer for non-smoking females (Adjusted Odds Ratio (OR)=5.7, 95% Confidence Interval (CI)=1.9-16.9). Having a female relative with lung cancer (adjusted OR=14.4, 95% CI=2.7-75.5) was more strongly associated with the lung cancer risk than was having a male relative with lung cancer. This association was stronger for probands aged less than 60 years at onset (adjusted OR=11.2, 95% CI=2.2-56.9). All of the Mendelian models fitted the data significantly better than the sporadic (no major type) model or the environmental model (P<0.00l). The Mendelian codominant models provided the best fit of the data for the early onset probands and showed a stronger effect for a major susceptibility locus for non-smoking lung cancer probands. The results of this study provide evidence that a rare autosomal codominant gene may influence the risk lung cancer in non-smoker and is responsible for the familial aggregation observed in non-smoking lung cancer patients.
Assuntos
Neoplasias Pulmonares/genética , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Pessoa de Meia-Idade , Linhagem , Prevalência , Análise de Regressão , Fatores de Risco , Taiwan/epidemiologiaRESUMO
OBJECTIVES: To report the results of a pilot study on the prognostic value of a newly identified actin-binding protein, thymosin beta-15 (Tbeta15), in predicting prostate-specific antigen (PSA) and bone failure in patients with Gleason 6/10 clinically localized prostate cancer. METHODS: Thirty-two patients (median age 70 years) with clinically localized, moderately differentiated (Gleason 6/10) prostate cancer treated by external beam radiotherapy alone (68.4 Gy) with available paraffin blocks at the Massachusetts General Hospital were evaluated for this pilot study. All patients had clinical Stage M0 disease at initial presentation, which was documented by bone scan (T1c-4,NX). Their corresponding biopsy specimens were stained immunohistochemically for Tbeta15, which was then correlated with the clinical outcome in a blinded manner. The median follow-up was 6 years (range 1 to 19) for all of the patients. RESULTS: The outcomes of the 32 patients can be grouped into three categories: patients with no evidence of disease (n = 11), patients with PSA failure without documented bone failure (n = 11), and patients with PSA failure and documented bone failure (n = 10). Tbeta15 staining intensity strongly correlated with clinical outcome. Of those patients whose specimens stained 3+ (strongest staining), 62% developed bone failure compared with 13% of those patients whose specimens stained 1+ (weakest staining) (P = 0.01). The 5-year freedom from PSA failure was only 25% for those patients with 3+ staining compared with 83% for those with 1+ staining (P = 0.02). CONCLUSIONS: The results of this pilot study have demonstrated that Tbeta15 staining intensity may be a potentially important marker to identify high-risk patients with moderately differentiated, clinically localized prostate cancer.
Assuntos
Adenocarcinoma/radioterapia , Adenocarcinoma/secundário , Neoplasias Ósseas/secundário , Neoplasias da Próstata/química , Neoplasias da Próstata/radioterapia , Timosina/análise , Adenocarcinoma/química , Adenocarcinoma/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Prognóstico , Neoplasias da Próstata/patologiaRESUMO
BACKGROUND: Tropical cyclones are huge circulating masses of wind which form over tropical and sub-tropical waters. They affect an average of 78 million people each year. Hong Kong is a large urban centre with a population of just over 7 million which is frequently affected by tropical cyclones. We aimed to describe the numbers and types of injuries due to tropical cyclones in Hong Kong, as well as their relation to tropical cyclone characteristics. METHODS: The records of all patients presenting to Hong Kong's public hospital emergency departments from 1st January 2004 to 31st December 2009 with tropical cyclone related injuries were reviewed and information regarding patient and injury characteristics was collected. Meteorological records for the relevant periods were examined and data on wind speed, rainfall and timing of landfall and warning signals was recorded and compared with the timing of tropical cyclone related injuries. RESULTS: A total of 460 tropical cyclone related injuries and one fatality across 15 emergency departments were identified during the study period. The mean age of those injured was 48 years and 48% were female. 25.4% of injuries were work related. The head (33.5%) and upper limb (32.5%) were the most commonly injured regions, with contusions (48.6%) and lacerations (30.2%) being the most common injury types. Falls (42.6%) were the most common mechanism of injury, followed by being hit by a falling or flying object (22.0%). In univariable analysis the relative risk of injury increased with mean hourly wind speed and hourly maximum gust. Multivariable analysis, however, showed that relative risk of injury increased with maximum gust but not average wind speed, with relative risk of injury rising sharply above maximum gusts of greater than 20 m/s. Moderate wind speed with high gust (rather than high average and high gust) appears to be the most risky situation for injuries. Relative risk of injury was not associated with rainfall. The majority of injuries (56%) occurred in the 3h before and after a tropical cyclone's closest proximity to Hong Kong, with relative risk of injury being highest mid-morning. CONCLUSIONS: In tropical cyclone related injuries in Hong Kong the head and upper limb are the most commonly affected sites with falls and being hit by a falling or flying object being the most common mechanisms of injury. Hourly maximum gust appears to be more important that mean hourly wind speed in determining risk of injury. These findings have implications for injury prevention measures and emergency planning in Hong Kong and other regions effected by tropical cyclones.
Assuntos
Tempestades Ciclônicas , Serviço Hospitalar de Emergência/organização & administração , Incidentes com Feridos em Massa/estatística & dados numéricos , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Hong Kong/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Fatores de Tempo , Clima Tropical , População Urbana , Adulto JovemRESUMO
BACKGROUND: In December 2009, the World Health Organization (WHO) issued updated guidelines on the prevention of H1N1 influenza virus in healthcare settings. In 2010, the WHO pandemic influenza alert level was still at phase 6. AIM: To study the practice of infection control measures during the 2009 influenza H1N1 pandemic among healthcare workers (HCWs) in three countries. METHODS: A standardized, self-administered anonymous questionnaire survey was conducted in 2010 among doctors, nurses and allied HCWs in 120 hospital-based clinical departments in Hong Kong, Singapore and the UK. Questions were asked on demographics; previous experience and perceived severity of influenza; infection control practices; uptake of seasonal influenza vaccination and H1N1 vaccination. Multiple logistic regression was used to test the independent association with different factors. FINDINGS: A total of 2100 HCWs in the three countries participated. They reported high compliance (>80%) with infection control procedures regarded as standard for droplet-transmitted infections including wearing and changing gloves, and washing hands before and after patient contact. However, the reported use of masks with indirect or direct patient contact (surgical or N95 as required by their hospital) varied considerably (96.4% and 70.4% for Hong Kong; 82.3% and 87.7% for Singapore; 25.3% and 62.0% for the UK). Reported compliance was associated with job title, number of patient contacts and perceived severity of pandemics. There was no association between the uptake for seasonal or 2009 H1N1 vaccines and compliance. CONCLUSIONS: Compliance with infection control measures for pandemic influenza appears to vary widely depending on the setting.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Controle de Infecções/métodos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hong Kong/epidemiologia , Humanos , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Singapura/epidemiologia , Inquéritos e Questionários , Reino Unido/epidemiologiaRESUMO
This paper focuses on the methodology developed for analyzing a multivariate interval-censored data set from an AIDS observational study. A purpose of the study was to determine the natural history of the opportunistic infection cytomeglovirus (CMV) in an HIV-infected individual. For this observational study, laboratory tests were performed at scheduled clinic visits to test for the presence of the CMV virus in the blood and in the urine (called CMV shedding in the blood and urine). The study investigators were interested in determining whether the stage of HIV disease at study entry was predictive of an increased risk for CMV shedding in either the blood or the urine. If all patients had made each clinic visit, the data would be multivariate grouped failure time data and published methods could be used. However, many patients missed several visits, and when they returned, their lab tests indicated a change in their blood and/or urine CMV shedding status, resulting in interval-censored failure time data. This paper outlines a method for applying the proportional hazards model to the analysis of multivariate interval-censored failure time data from a study of CMV in HIV-infected patients.
Assuntos
Análise Multivariada , Modelos de Riscos Proporcionais , Falha de Tratamento , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/urina , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/urina , Infecções por HIV/sangue , Infecções por HIV/complicações , Infecções por HIV/urina , Humanos , Fatores de Risco , Fatores de Tempo , Eliminação de Partículas ViraisRESUMO
This study is based on an ergonomic job analysis designed to develop a hazard prevention program for the premixing and compounding processes in animal health products plants. Animal health products plants are "pharmaceutical facilities" for livestock or domestic animals. A hazardous aerosol (highly concentrated antibiotics, anthelmintics, mineral oil, and animal hormones) is generated in the premixing or compounding processes. The animal health premixing jobs are heavy-duty jobs and have high potential for chemical exposure, heat stress, and ergonomic hazards. Ergonomic job analysis was used to recognize, identify, and evaluate actuarial and potential risks of injures or irritations. Chemical hazards and eight ergonomic factors were discussed: (1) forceful exertions, (2) awkward postures, (3) localized contract stresses, (4) vibration, (5) noise, (6) temperature extremes, (7) repetitive activities, and (8) prolonged activities. The results show that (1) current practices do not violate occupational safety and health regulations or recommended guidelines, but that hazards should be identified to protect worker health and safety; (2) for chemical hazards prevention, operators wear whole-body protection equipment, which also causes heat stress and increases the noise level in the work zone; and (3) the loading weight of the bags used needs to be reduced.
Assuntos
Indústria Farmacêutica , Doenças Profissionais/etiologia , Exposição Ocupacional , Análise e Desempenho de Tarefas , Poluição do Ar em Ambientes Fechados , Transtornos Traumáticos Cumulativos/etiologia , Transtornos Traumáticos Cumulativos/prevenção & controle , Ergonomia , Humanos , Ruído Ocupacional , Doenças Profissionais/prevenção & controle , Postura , Fatores de Risco , Estresse Mecânico , Drogas Veterinárias , VibraçãoRESUMO
BACKGROUND: Over the past 2 decades both cutaneous melanoma (CM) and non-Hodgkin lymphoma (NHL) incidence rates have increased substantially. One approach to better understanding the etiologic basis for these increases is to examine the risk of NHL in CM survivors and the risk of CM in NHL survivors. METHODS: To explore the possible association between CM and NHL, the authors followed cohorts of CM and NHL patients registered through the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 1996 and identified patients who developed CM after NHL and NHL after CM. The number of observed cases then were compared with the number of expected cases to see if CM survivors were at an increased risk of NHL or if NHL survivors were at an increased risk of CM. RESULTS: Between 1973 and 1996, 54,803 CM patients and 62,597 NHL patients who met the authors' inclusion criteria were identified through SEER. The authors found statistically significant elevated risks of NHL among CM survivors (standardized incidence ratio [SIR], 1.42; 95% confidence interval [CI], 1.23-1.63) and CM among NHL survivors (SIR, 1.75; 95% CI, 1.48-2.07). CONCLUSIONS: These results support an association between CM and NHL. Although detection bias and posttherapy effects may explain part of this association, shared genetic or etiologic factors, such as sunlight exposure, also may play a role.
Assuntos
Linfoma não Hodgkin/epidemiologia , Melanoma/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias Cutâneas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Programa de SEER , Sobreviventes , Estados Unidos/epidemiologiaRESUMO
The latency time of an infectious disease is defined as the time from infection to disease onset. This paper applies the proportional hazards model to estimate the effect of covariates on latency when the time of disease onset is exact or right-censored but the time of infection is interval-censored. We use a Monte Carlo EM algorithm to estimate parameters of the joint distribution of infection times and latency times. At each EM iteration, exact infection times are multiply imputed from the density determined by the parameters of the infection and latency time distributions. The methodology is tested using a simulation study and is applied to data from a cohort of haemophiliacs with HIV disease.
Assuntos
Soropositividade para HIV/complicações , Modelos Biológicos , Modelos de Riscos Proporcionais , Algoritmos , Estudos de Coortes , Simulação por Computador , Infecções por HIV/complicações , Infecções por HIV/imunologia , Soropositividade para HIV/imunologia , Hemofilia A/complicações , Hemofilia A/imunologia , Humanos , Método de Monte Carlo , Fatores de TempoRESUMO
This paper develops methodology for estimation of the effect of a binary time-varying covariate on failure times when the change time of the covariate is interval censored. The motivating example is a study of cytomegalovirus (CMV) disease in patients with human immunodeficiency virus (HIV) disease. We are interested in determining whether CMV shedding predicts an increased hazard for developing active CMV disease. Since a clinical screening test is needed to detect CMV shedding, the time that shedding begins is only known to lie in an interval bounded by the patient's last negative and first positive tests. In a Cox proportional hazards model with a time-varying covariate for CMV shedding, the partial likelihood depends on the covariate status of every individual in the risk set at each failure time. Due to interval censoring, this is not always known. To solve this problem, we use a Monte Carlo EM algorithm with a Gibbs sampler embedded in the E-step. We generate multiple completed data sets by drawing imputed exact shedding times based on the joint likelihood of the shedding times and event times under the Cox model. The method is evaluated using a simulation study and is applied to the data set described above.
Assuntos
Biometria , Modelos de Riscos Proporcionais , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/virologia , Algoritmos , Análise de Variância , Ensaios Clínicos como Assunto/estatística & dados numéricos , Simulação por Computador , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Humanos , Método de Monte Carlo , Fatores de TempoRESUMO
This paper proposes a Monte Carlo EM (MCEM) algorithm for fitting the proportional hazards model for interval-censored failure-time data. The algorithm generates orderings of the failures from their probability distribution under the model. We maximize the average of the log-likelihoods from these completed data sets to obtain updated parameter estimates. As with the standard Cox model, this algorithm does not require the estimation of the baseline hazard function. The performance of the algorithm is evaluated using simulations, and the method is applied to data from AIDS and cancer studies. Our results indicate that our method produced more precise and unbiased estimates than methods of right and midpoint imputation.