Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study.

BACKGROUND: Hong Kong has been embroiled in increasingly violent social unrest since June, 2019. We examined the associated population mental health burden, risk factors, and health-care needs. METHODS: In a population-based prospective cohort, adult participants aged 18 years or older were assessed at nine timepoints from 2009. Probable depression was measured using the Patient Health Questionnaire-9 (score ≥10) and suspected post-traumatic stress disorder (PTSD) by the PTSD Checklist-Civilian Version (score ≥14), plus direct exposure to traumatic events related to the ongoing social unrest. We used multivariable logistic regression to identify factors associated with both outcomes, adjusting for doctor-diagnosed depression or anxiety disorders before the unrest. On the basis of routine service statistics and respondents' intention to seek professional care, we projected the number of additional ambulatory specialist psychiatric visits required. FINDINGS: After the two baseline surveys, we followed up random subsets of 1213-1736 adults at each timepoint. Probable depression was reported by 11·2% (95% CI 9·8-12·7) of participants in 2019, compared with 1·9% (1·6-2·1) during 2009-14 and 6·5% (5·3-7·6) in 2017 after the Occupy Central Movement and before the current unrest. Prevalence of suspected PTSD in 2019 was estimated to be 12·8% (11·2-14·4). Age, sex, educational attainment, or household income were not associated with either outcome, whereas heavy social media use (≥2 h per day) was associated with both. Political attitude or protest participation was not associated with probable depression, but neutrality towards the extradition bill approximately halved the risk of suspected PTSD. Family support mitigated against probable depression. We estimated that the mental health burden identified would translate into roughly an excess 12% service requirement to the public sector queue or equivalent. INTERPRETATION: We have identified a major mental health burden during the social unrest in Hong Kong, which will require substantial increases in service surge capacity. Health-care and social care professionals should be vigilant in recognising possible mental health sequelae. In a world of increasing unrest, our findings might have implications for service planning to better protect population mental health globally. FUNDING: Research Grants Council, University Grants Committee of Hong Kong, Hong Kong Jockey Club Charities Trust.

Spatial proximity and childhood hospital admissions in a densely populated conurbation: evidence from Hong Kong's 'Children of 1997' birth cohort.

OBJECTIVES: Physical distance affects hospital use. In a densely populated city in China, we examined if child public hospital use was associated with individual-level proximity, and any differences by admission type or geo-spatially. METHODS: We used negative binomial regression in a large, population-representative birth cohort to examine the adjusted associations of proximity to emergency facilities (A&E) with hospital admissions, bed-days and length of stay from 8 days to 8 years of age. We used geographically weighted regression to assess geo-spatial variation. RESULTS: Proximity was positively associated with emergency admissions (incidence rate ratio (IRR) 1.21, 95% confidence interval (CI) 1.10 to 1.34 for <1km compared to ≥2km) and bed-days but not with length of stay, adjusted for parental education and mother's birthplace. There was no such association for other admissions (IRR 1.03, 95% CI 0.84 to 1.26). There was little geo-spatial variation. CONCLUSIONS: Proximity was associated with emergency admissions. Given the societal costs of such use and the risks of iatrogenesis, attention should focus on achieving a more effective use of scarce resources.

Socio-economic disparities of childhood Body Mass Index in a newly developed population: evidence from Hong Kong's 'Children of 1997' birth cohort.

BACKGROUND: Childhood adiposity in developed countries is often associated with lower socio-economic position (SEP) of the family and neighbourhood. However, the association of adiposity with SEP varies with national income. The authors examined whether childhood BMI was associated with family or neighbourhood socio-economic characteristics in a recently and rapidly developed Chinese population. METHODS: The authors used multilevel modelling in Hong Kong's population-representative 'Children of 1997' birth cohort (n=8327) to examine the association of BMI z-score and overweight (including obesity) at ages 6-11 years with parental education, mother's birthplace, sex and neighbourhood median income. RESULTS: In 7108 (85 % successful follow-up) children, boys were more adipose than girls. The association of parental education with BMI z-score varied with mother's birthplace (p value for interaction 0.001). In children of Hong Kong-born mothers, parental education was negatively associated with BMI z-score (mean difference -0.15, 95% CI -0.25 to -0.05 for highest compared with lowest). However, in children of mainland China-born mothers, parental education was positively associated with BMI z-score (0.18, 95% CI 0.02 to 0.34 in the same comparison). Neighbourhood had no association with BMI z-score. CONCLUSIONS: In this recently developed Chinese population, there was no consistent association between socio-economic characteristics and childhood BMI. Other factors, such as experience of economic transition, as proxied by mother's place of birth, exerted a modifying impact. The cultural and biological mechanisms underlying these socio-historical intergenerational influences need to be determined, so that effective interventions can be implemented in China and elsewhere.

Identification of stomatopod larvae (Crustacea: Stomatopoda) from Hong Kong waters using DNA barcodes.

The Stomatopoda (Crustacea: Malacostraca) from the South China Sea region are of commercial importance and although limited studies have been conducted on the adults, no research has ever been attempted on the larval stages because of the lack of identification keys or taxonomic descriptions. In the first study of its kind in the region, DNA barcoding was used successfully to identify unknown stomatopod larvae from plankton samples. Sequences of two mitochondrial genes, namely the cytochrome c oxidase subunit-I (COI) and the large ribosomal subunit (16S) rRNA, were applied as the barcodes to match DNA sequences from unknown larval morphotypes against those of known, locally occurring adult species. Intraspecific variations for the COI and 16S rRNA genes were found to be <2.4% and <2.1% respectively in terms of Kimura 2-Parameter (K2P) divergence of the adults, whereas variations between genera ranged from 13% to 24% and 3% to 11% respectively. These results imply that both genes are suitable for use in species identification of stomatopods; thus 14 of the 16 larval morphotypes (87.5%) obtained in Hong Kong waters can be identified to seven species through DNA barcoding. The findings of this study would also facilitate future research on the larval ecology and phylogenetic relationship of these crustaceans.

Statistical disease cluster surveillance of medically treated self-inflicted injuries in Alberta, Canada.

Routine surveillance of cases of disease can highlight geographic regions that need further study and intervention. Statistical disease cluster detection methods are one way to statistically assess the number of cases in administrative areas. Traditionally, disease cluster detection methods are used to monitor the incident cases of disease. We review a statistical cluster detection method that is applicable for regions with diverse administrative area population sizes. We apply the method to assess clustering of self-inflicted injury presentations to emergency departments in Alberta, Canada. Analyses focus on the pediatric population and are adjusted by the age and gender distributions of subregional health authorities. Fifteen clusters of self-inflicted injuries are identified and, based on age and gender distributions, the clusters are not likely chance occurrences. We believe that these clusters represent areas of excessive self-inflicted injury and that special intervention programs should be considered.

Short- and long-term outcomes of patients with electrocardiographic left ventricular hypertrophy after fibrinolysis for acute myocardial infarction.

There is conflicting evidence with regard to the value of electrocardiographic left ventricular hypertrophy (LVH) in myocardial infarction. Of 5,951 patients in the ASSENT-3 trial, 273 (5%) had LVH on baseline electrocardiograms and had significantly higher mortality rates at 30 days (11% vs 6%, p = 0.001) and 1 year (13% vs 8%, p = 0.007). After adjustment for differences in baseline parameters, LVH remained an independent predictor of 30-day (hazard ratio 2.3, 95% confidence interval 1.4 to 3.9) and 1-year (hazard ratio 1.8, 95% confidence interval 1.1 to 2.8) mortality rates. Thus, electrocardiographic LVH is a prognostic tool in identifying short- and long-term mortality rates in patients who have ST-elevation myocardial infarction and receive fibrinolysis.