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1.
Artículo en Inglés | MEDLINE | ID: mdl-34117050

RESUMEN

INTRODUCTION: Patients with diabetes mellitus are risk of premature death. In this study, we developed a machine learning-driven predictive risk model for all-cause mortality among patients with type 2 diabetes mellitus using multiparametric approach with data from different domains. RESEARCH DESIGN AND METHODS: This study used territory-wide data of patients with type 2 diabetes attending public hospitals or their associated ambulatory/outpatient facilities in Hong Kong between January 1, 2009 and December 31, 2009. The primary outcome is all-cause mortality. The association of risk variables and all-cause mortality was assessed using Cox proportional hazards models. Machine and deep learning approaches were used to improve overall survival prediction and were evaluated with fivefold cross validation method. RESULTS: A total of 273 678 patients (mean age: 65.4±12.7 years, male: 48.2%, median follow-up: 142 (IQR=106-142) months) were included, with 91 155 deaths occurring on follow-up (33.3%; annualized mortality rate: 3.4%/year; 2.7 million patient-years). Multivariate Cox regression found the following significant predictors of all-cause mortality: age, male gender, baseline comorbidities, anemia, mean values of neutrophil-to-lymphocyte ratio, high-density lipoprotein-cholesterol, total cholesterol, triglyceride, HbA1c and fasting blood glucose (FBG), measures of variability of both HbA1c and FBG. The above parameters were incorporated into a score-based predictive risk model that had a c-statistic of 0.73 (95% CI 0.66 to 0.77), which was improved to 0.86 (0.81 to 0.90) and 0.87 (0.84 to 0.91) using random survival forests and deep survival learning models, respectively. CONCLUSIONS: A multiparametric model incorporating variables from different domains predicted all-cause mortality accurately in type 2 diabetes mellitus. The predictive and modeling capabilities of machine/deep learning survival analysis achieved more accurate predictions.


Asunto(s)
Diabetes Mellitus Tipo 2 , Anciano , HDL-Colesterol , Hong Kong/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo
2.
Artículo en Inglés | MEDLINE | ID: mdl-34070713

RESUMEN

This paper explores how trust in formal information sources (government and media) and informal information sources (interpersonal) about COVID-19 influences compliance with preventive measures. This cross-sectional study uses convenience sampling of 478 adult participants. Data analyses using structural equation modeling with multigroup comparisons examine hypothesized relationships between trust in information sources and preventative behaviors and social distancing. Results suggest that understanding of COVID-19 causes is related to trust in formal information sources, but not to trust in informal information. Self-efficacy for prevention is related to trust in informal information sources, but not to trust in formal information sources. Worry about contracting COVID-19 is related to trust in formal information sources, but not to informal ones. Engaging in preventive measures is linked to both self-efficacy for prevention and worry, while social distancing was related only to worry. These findings have important implications for public health policy guidelines centered on clear and truthful media messages. The findings also facilitate comparative analyses of reactions to information sources across a decade of evolving attitudes toward media and government, between two cultures (Hong Kong vs. the USA), and between two different global pandemics.


Asunto(s)
COVID-19 , Pandemias , Adulto , Estudios Transversales , Hong Kong , Humanos , Pandemias/prevención & control , SARS-CoV-2 , Confianza
3.
Artículo en Inglés | MEDLINE | ID: mdl-34070782

RESUMEN

Studies have shown individuals with chronic illnesses tend to experience poorer mental health compared to their counterparts without a chronic illness under the COVID-19 pandemic. The pervasive disruption on daily lifestyles due to social distancing could be a contributing factor. In this study, we collaborated with local patient support groups to explore the psychological adjustment among a group of community-dwelling individuals with chronic illnesses under the COVID-19 pandemic in Hong Kong. We collected responses from 408 adults with one or more chronic illnesses using an online survey. Results show that about one in four participants experienced moderate to high levels of depression (26.0%), anxiety (26.2%) and stress (20.1%) symptoms measured by the Depression, Anxiety and Stress Scale and the World Health Organisation-Five Well-Being Index. While 62.3% (gatherings) to 91.9% (contact with others) of participants reported changes in their daily lifestyles, these changes-both an increase and a decrease-were related to poorer mental health. The relationship was mediated by psychological resilience, measured by the Connor-Davidson Resilience Scale, with an estimate of indirect effect of -0.28 (95% confidence interval -0.44 to -0.10). In light of our findings, we urge social and healthcare professionals to support chronic illness patients to continue their daily lifestyles such as exercises and social contacts as much as possible by educating the public on feasible and practical preventive measures and enhance the psychological resilience of community-dwelling patients with scalable and efficacious psychological interventions.


Asunto(s)
COVID-19 , Resiliencia Psicológica , Adulto , Ansiedad , Enfermedad Crónica , Depresión/epidemiología , Hong Kong/epidemiología , Humanos , Estilo de Vida , Salud Mental , Pandemias , SARS-CoV-2 , Estrés Psicológico
4.
Artículo en Inglés | MEDLINE | ID: mdl-34062769

RESUMEN

Nearly a year after the classification of the COVID-19 outbreak as a global pandemic, it is clear that different factors have contributed to an increase in psychological disorders, including public health measures that infringe on personal freedoms, growing financial losses, and conflicting messages. This study examined the evolution of psychosocial impacts with the progression of the pandemic in adult populations from different countries and continents, and identified, among a wide range of individual and country-level factors, which ones are contributing to this evolving psychological response. An online survey was conducted in May/June 2020 and in November 2020, among a sample of 17,833 adults (Phase 1: 8806; Phase 2: 9027) from eight countries/regions (Canada, the United States, England, Switzerland, Belgium, Hong Kong, the Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depressive episode (MDE) were assessed. The independent role of potential factors was examined using multilevel logistic regression. Probable GAD or MDE was indicated by 30.1% and 32.5% of the respondents during phases 1 and 2, respectively (a 7.9% increase over time), with an important variation according to countries/regions (range from 22.3% in Switzerland to 38.8% in the Philippines). This proportion exceeded 50% among young adults (18-24 years old) in all countries except for Switzerland. Beyond young age, several factors negatively influenced mental health in times of pandemic; important factors were found, including weak sense of coherence (adjusted odds ratio aOR = 3.89), false beliefs (aOR = 2.33), and self-isolation/quarantine (aOR = 2.01). The world has entered a new era dominated by psychological suffering and rising demand for mental health interventions, along a continuum from health promotion to specialized healthcare. More than ever, we need to innovate and build interventions aimed at strengthening key protective factors, such as sense of coherence, in the fight against the adversity caused by the concurrent pandemic and infodemic.


Asunto(s)
COVID-19 , Trastorno Depresivo Mayor , Adolescente , Adulto , Ansiedad/epidemiología , Trastornos de Ansiedad/epidemiología , Bélgica , Canadá , Estudios Transversales , Depresión/epidemiología , Trastorno Depresivo Mayor/epidemiología , Inglaterra , Hong Kong , Humanos , Nueva Zelanda/epidemiología , Pandemias , Filipinas , SARS-CoV-2 , Suiza , Adulto Joven
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(6): 752-758, 2021 Jun 06.
Artículo en Chino | MEDLINE | ID: mdl-34139816

RESUMEN

Objective: To analyze the regional inequality of height among Chinese Han students aged 7 to 18 years from 1985 to 2014. Methods: The Chinese Han students aged 7 to 18 years with complete basic information and height data from 30 mainland provinces (excluding Hong Kong, Macao, Taiwan and Tibet in China) were extracted as participants from 6 successive cross-sectional surveys of the Chinese National Survey on Student's Constitution and Health (CNSSCH). After excluding extreme and illogical cases, a total of 1 495 182 students were included in the analysis. The data of gross domestic product (GDP) per capita of each province at each survey year were collected from the website of National Bureau of statistics of China. Mann-Kendall trend test was used to analyze the trend of mean height across years. Weighted linear regression model was used to analyze the association between mean height of students aged 7 to18 years and GDP per capita at provincial level. Height difference, height ratio, slope index of inequality (SII) and relative index of inequality (RII) were used to measure the height inequality by gender and age groups. Results: The mean height of Chinese Han students aged 7 to 18 years increased from 144.9 cm in 1985 to 151.8 cm in 2014 (P<0.05). The height difference between urban and rural students in all age groups was reducing (P<0.05). The height difference between urban and rural boys aged 13 to 15 years decreased from 5.3 cm in 1985 to 2.5 cm in 2014, and the difference between urban and rural girls aged 7 to 12 years decreased from 4.6 cm in 1985 to 2.4 cm in 2014. The mean height of students aged 7 to 18 years was positively associated with GDP per capita in all survey years for both genders (P<0.001). Taking Shanghai and Guizhou as the representatives of economically developed and underdeveloped provinces, from 1985 to 2014, the height differences between two provinces were 6.8-9.2 cm, 8.0-12.4 cm and 6.3-8.8 cm for boys aged 7 to 12 years, 13 to 15 years and 16 to 18 years, respectively, and the height ratios were stable at 1.05-1.07, 1.05-1.08 and 1.04-1.05 respectively. From 1985 to 2014, the SII of mean height for boys in three age groups were 4.4-6.2, 4.9-6.7 and 2.5-4.7, respectively. The RII of mean height of boys in three age groups were 1.03-1.05, 1.03-1.04 and 1.01-1.03, respectively. In the same period, the SII of mean height for girls in three age groups were 4.2-6.2, 2.8-4.5 and 2.5-3.9, and the RII were 1.03-1.05, 1.02-1.03 and 1.02, respectively. Conclusion: From 1985 to 2014, the urban-rural inequality of height development among Chinese Han students aged 7 to 18 years was narrowing, but the socio-economic inequality of height persisted and remained at a relatively stable level.


Asunto(s)
Estudiantes , China , Estudios Transversales , Femenino , Hong Kong , Humanos , Macao , Masculino , Taiwán , Tibet
7.
Vaccine ; 39(25): 3372-3378, 2021 06 08.
Artículo en Inglés | MEDLINE | ID: mdl-34016472

RESUMEN

Effectiveness of seasonal influenza vaccine (SIV) varies with the degree of matching with the vaccine and circulating viruses. We continued our SIV effectiveness against medically-attended influenza-like illness (ILI) under the Department of Health Hong Kong's sentinel private medical practitioners (PMP) network, using the test-negative case-control design, for the 2018/19 and 2019/20 season. In addition, we studied the potential interference between SIV and ILI caused by non-influenza respiratory viruses (NIRV) based on data collated from 2017/18 to 2019/20 seasons. 3404 patients were analysed. Across the 2017/18 to 2019/20 seasons, the vaccine effectiveness (VE) of SIV was 44% (95% CI 30-56%) against pan-negative controls, 57% (95%CI. 42-68%) against NIRV controls and 50% (95%CI 38-59%) against both. SIV was moderately effective against medically-attended ILI caused by influenza A/B in both 2018/19 and 2019/20 winter seasons (53.2% (95%CI 36.7-65.5%) and 41.8% (95%CI 6.3-64.1%), respectively). The VE against the main circulating subtype, influenza A(H1), was higher for the 2018/19 season (57.2% (95%CI 39.8-69.9%), compared to 34.6% (95%CI -9.6-61.4%) in the 2019/20 season). When compared to pan negative controls, those with single NIRV infections were similarly likely to have received SIV (OR 1.05 (95%CI 0.72-1.54) within the influenza season; OR 0.97 (95%CI 0.73-1.29) when including non-influenza seasons). Analyses by type of virus showed no increased risk of SIV identified among those with single infections of EV/RV, HMPV and parainfluenza but a 2-fold increased risk was shown for those with single infections of adenovirus and parainfluenza virus (adenovirus: OR 2.54 (95%CI 1.24-5.14) within influenza season and OR 1.78 (95%CI 1.01-3.09) for the whole period; parainfluenza virus: OR 2.01 (95%CI 1.22-3.29) within influenza season and OR 1.89 (95%CI 1.29-2.76) for the whole period). SIV programme and surveillance of influenza and NIRV, including SARS-CoV-2, should continue during the COVID-19 pandemic.


Asunto(s)
COVID-19 , Subtipo H1N1 del Virus de la Influenza A , Vacunas contra la Influenza , Gripe Humana , Estudios de Casos y Controles , Hong Kong/epidemiología , Humanos , Subtipo H3N2 del Virus de la Influenza A , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Pandemias , Atención Primaria de Salud , SARS-CoV-2 , Estaciones del Año , Vacunación
8.
Vaccine ; 39(27): 3602-3607, 2021 06 16.
Artículo en Inglés | MEDLINE | ID: mdl-34034950

RESUMEN

BACKGROUND: Although vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most desired solution to end the coronavirus disease (COVID-19) pandemic, there are growing concerns that vaccine hesitancy would undermine its potential. We examined the intention to receive vaccination against SARS-CoV-2 and the associated factors in a representative sample of Chinese adults in Hong Kong. METHODS: We did a dual-frame (landline and mobile) cross-sectional survey of a random sample of 1501 Hong Kong residents aged 18 years or older (53.6% females) in April 2020. We collected data on the intention to receive SARS-CoV-2 vaccine when it becomes available (yes/ no/ undecided), knowledge and perceptions of COVID-19, smoking, alcohol drinking, and sociodemographic factors. Prevalence estimates were weighted by the sex, age, and education of the general population of Hong Kong. RESULTS: Overall, 45.3% (95% CI: 42.3-48.4%) of the participants had intentions to vaccinate against SARS-CoV-2 when it becomes available, 29.2% (26.5-32.1%) were undecided, and 25.5% (22.9-28.2%) had no intention. The most common reason for vaccine hesitancy (undecided or no intention) was safety concerns (56.5%). Multivariable partial proportional odds model showed higher vaccine hesitancy in males, younger adults, those with no chronic disease, current smokers, and non-alcohol drinkers. After adjusting for sociodemographic and other factors, inadequate knowledge of SARS-CoV-2 transmission (adjusted ORs ranged from 1.27 to 2.63; P < 0.05) and lower perceived danger of COVID-19 (adjusted ORs ranged from 1.62 to 2.47; P < 0.001) were significantly associated with vaccine hesitancy. CONCLUSIONS: In a representative sample of Chinese adults in Hong Kong, only 45.3% of the participants intended to vaccinate against SARS-CoV-2 when available. Vaccine hesitancy was associated with inadequate knowledge about SARS-CoV-2 transmission and lower perceived danger of COVID-19, which needed to be addressed to improve vaccination uptake.


Asunto(s)
COVID-19 , Vacunas , Adulto , Vacunas contra la COVID-19 , Estudios Transversales , Femenino , Hong Kong/epidemiología , Humanos , Masculino , Prevalencia , SARS-CoV-2 , Vacunación
9.
JAMA Netw Open ; 4(5): e218824, 2021 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-33938934

RESUMEN

Importance: Schools were closed intermittently across Hong Kong to control the COVID-19 outbreak, which led to significant physical and psychosocial problems among children and youths. Objective: To compare the clinical characteristics and sources of infection among children and youths with COVID-19 during the 3 waves of outbreaks in Hong Kong in 2020. Design, Setting, and Participants: This cross-sectional study involved children and youths aged 18 years or younger with COVID-19 in the 3 waves of outbreaks from January 23 through December 2, 2020. Data were analyzed from December 2020 through January 2021. Main Outcomes and Measures: Demographic characteristics, travel and contact histories, lengths of hospital stay, and symptoms were captured through the central electronic database. Individuals who were infected without recent international travel were defined as having domestic infections. Results: Among 397 children and youths confirmed with COVID-19 infections, the mean (SD) age was 9.95 (5.34) years, 220 individuals (55.4%) were male, and 154 individuals (38.8%) were asymptomatic. There were significantly more individuals who were infected without symptoms in the second wave (59 of 118 individuals [50.0%]) and third wave (94 of 265 individuals [35.5%]) than in the first wave (1 of 14 individuals [7.1%]) (P = .001). Significantly fewer individuals who were infected in the second and third waves, compared with the first wave, had fever (first wave: 10 individuals [71.4%]; second wave: 22 individuals [18.5%]; third wave: 98 individuals [37.0%]; P < .001) or cough (first wave: 6 individuals [42.9%]; second wave: 15 individuals [12.7%]; third wave: 52 individuals [19.6%]; P = .02). Among all individuals, 394 individuals (99.2%) had mild illness. One patient developed chilblains (ie, COVID toes), 1 patient developed multisystem inflammatory syndrome in children, and 1 patient developed post-COVID-19 autoimmune hemolytic anemia. In all 3 waves, 204 patients with COVID-19 (51.4%) had domestic infections. Among these individuals, 186 (91.2%) reported having a contact history with another individual with COVID-19, of which most (183 individuals [90.0%]) were family members. In the third wave, 18 individuals with domestic infections had unknown contact histories. Three schoolmates were confirmed with COVID-19 on the same day and were reported to be close contacts. Conclusions and Relevance: This cross-sectional study found that nearly all children and youths with COVID-19 in Hong Kong had mild illness. These findings suggest that household transmission was the main source of infection for children and youths with domestic infections and that the risk of being infected at school was small.


Asunto(s)
Infecciones Asintomáticas/epidemiología , COVID-19 , Trazado de Contacto , SARS-CoV-2/aislamiento & purificación , Evaluación de Síntomas , Adolescente , COVID-19/epidemiología , COVID-19/terapia , COVID-19/transmisión , Niño , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Estudios Transversales , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Composición Familiar , Femenino , Hong Kong/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Enfermedad Relacionada con los Viajes
10.
Artículo en Inglés | MEDLINE | ID: mdl-33947146

RESUMEN

The impacts of the COVID-19 pandemic on physical and mental health-related behaviors among children and adolescents are likely to be profound and long-lasting. This study aimed to investigate the changes in lifestyle and social support and their associations with negative impacts due to the pandemic. A classroom survey using stratified random sampling and structured questionnaire was conducted among Hong Kong primary and secondary school students. The paper-and-pen survey, administered by well-trained research assistants, was completed by 2863 participants aged 9-17 years old (M = 12.6, SD = 1.3) at a brief school reopening six months after the outbreak of the COVID-19 pandemic. About 48% and 37% of the participants stated that they paid increased attention to physical and mental health, respectively. About 20% to 40% stated that they found more support from their friends and family members; only a small percentage reported decreased social support. Around 25% to 50% spent more time to rest, relax, and exercise. The aforementioned changes varied among genders, education groups, and socio-economic status. In general, higher perceived vulnerability, feeling more stressed, apprehensive, and helpless were associated with more reported positive lifestyle changes, including more social/family support, increased mental health awareness, and a positive lifestyle. These positive changes serve as important cushions against the negative impacts of COVID-19.


Asunto(s)
COVID-19 , Pandemias , Adolescente , Niño , Femenino , Hong Kong/epidemiología , Humanos , Estilo de Vida , Masculino , SARS-CoV-2 , Apoyo Social
11.
BMC Public Health ; 21(1): 836, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33933046

RESUMEN

BACKGROUND: This study aims to determine the changes in physical activity and actigraphy-measured rest-activity circadian rhythm among Hong Kong community aged population before and during the outbreak of COVID-19. METHODS: This is a three repeated measure population-based cross-sectional study. We recruited community older men aged > 60 years in three periods of the COVID-19 outbreak in Hong Kong, i.e., before the COVID-19 outbreak (2 July 2019-8 January 2020), between the 2nd and 3rd waves of COVID-19 (23 June 2020-9 July 2020), and during the 3rd wave of COVID-19 (15 September 2020-29 September 2020). Participants reported detailed information on their physical activity habits using the International Physical Activity Questionnaire and wore actigraphs continuously for 7 days (168 h). The actigraph data were then transferred to four rest-activity circadian rhythm parameters: midline statistic of rhythm (MESOR), amplitude, acrophase and percent rhythm. Multivariate logistic regression was performed to estimate the association of period effect of COVID-19 on physical activity and rest-activity circadian rhythm parameters. RESULTS: Among the 242 community older men, 106 (43.8%) of them were recruited before the COVID-19 outbreak, 66 (27.3%) were recruited between the 2nd and 3rd waves of COVID-19, and 70 (28.9%) were recruited during the late phase of the 3rd wave of COVID-19. Compared with those recruited before COVID-19, participants recruited between the 2nd and 3rd waves of COVID-19 had lower physical activity (adjusted odds ratio (AOR) = 2.03, 95% confidence interval (95%CI) =1.05-3.93), MESOR (AOR = 2.05, 95%CI = 1.01-4.18), and amplitude (AOR = 1.91, 95%CI = 0.95-3.83). There was no difference in physical activity or circadian rhythm parameters between subjects recruited before and during the late phase of the 3rd wave. CONCLUSIONS: This study found that the effect of COVID-19 on physical activity and rest-activity circadian rhythm for the community people may be short-term, indicating strong resilience of the community population. Although maintaining physical activity are encouraged for the older adults to sustain good health, a rebound in their physical activity may be a sign for the next wave of outbreak if insufficient social distancing and population protection are facilitated.


Asunto(s)
COVID-19 , Ritmo Circadiano , Actigrafía , Anciano , Estudios Transversales , Ejercicio Físico , Hong Kong/epidemiología , Humanos , Masculino , SARS-CoV-2 , Sueño
12.
BMC Med Educ ; 21(1): 286, 2021 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-34011322

RESUMEN

BACKGROUND: Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios. METHODS: Fifty Year-6 medical students attending the 'Serious Illness Communication Module' were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients. RESULTS: Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients' emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients' attention to treatment options; (4) acknowledging concerns about dying patients' physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients' emotional and physical needs. They also often informed and acknowledged the patients' family members. CONCLUSIONS: When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients' participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of   communication for critical conversation should be promoted.


Asunto(s)
Estudiantes de Medicina , China , Comunicación , Hong Kong , Humanos , Relaciones Médico-Paciente , Estudios Prospectivos , Revelación de la Verdad
13.
BMJ Open ; 11(5): e041336, 2021 05 18.
Artículo en Inglés | MEDLINE | ID: mdl-34006537

RESUMEN

OBJECTIVE: Transitional care is important to successful hospital discharge. Providing patients with a clear and concise summary of medication-related information can help improve outcomes, in particular, among older adults. The present study aimed to propose a framework for the development of salient medication reminders (SMR), which include drug-related risks and precautions, using the Delphi process. DESIGN: Identification of potential SMR statements for 80% of medication types used by older adult patients discharged from geriatric medicine departments, followed by a Delphi survey and expert panel discussion. SETTINGS: Medical and geriatric departments of public hospitals in Hong Kong. PARTICIPANTS: A panel of 13 geriatric medical experts. OUTCOME MEASURE: A Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) points, scoring item relevance, importance and clarity. The minimum of 70% consensus was required for each statement to be included. RESULTS: The expert panel achieved consensus through the Delphi process on 80 statements for 44 medication entities. Subsequently, the SMR steering group endorsed the inclusion of these statements in the SMR to be disseminated among older adults at the time of discharge from geriatric medicine departments. CONCLUSIONS: The Delphi process contributed to the development of SMR for older adult patients discharged from public hospitals in Hong Kong. Patient experience with and staff response to the SMR were assessed at four hospitals before implementation at all public hospitals.


Asunto(s)
Pacientes Internos , Alta del Paciente , Anciano , Consenso , Técnica Delfos , Hong Kong , Humanos
14.
J Environ Manage ; 292: 112822, 2021 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-34030017

RESUMEN

Estimating the composition of construction waste is crucial to the efficient operation of various waste management facilities, such as landfills, public fills, and sorting plants. However, this estimating task is often challenged by the desire of quickness and accuracy in real-life scenarios. By harnessing a valuable data set in Hong Kong, this research develops a big data-probability (BD-P) model to estimate construction waste composition based on bulk density. Using a saturated data set of 4.27 million truckloads of construction waste, the probability distribution of construction waste bulk density is derived, and then, based on the Law of Joint Probability, the BD-P model is developed. A validation experiment using 604 ground truth data entries indicates a model accuracy of 90.2%, Area Under Curve (AUC) of 0.8775, and speed of around 52 s per load in estimating the composition of each incoming construction waste load. The BD-P model also informed a linear model which can perform the estimation with an accuracy of 88.8% but consuming 0.4 s per case. The major novelty of this research is to harmonize big data analytics and traditional probability theories in improving the classic challenge of predictive analyses. In the practical sphere, it satisfactorily solves the construction waste estimation problem faced by many waste management facility operators. In the academic sphere, this research provides a vivid example that big data and theories are not adversaries, but allies.


Asunto(s)
Materiales de Construcción , Administración de Residuos , Macrodatos , Hong Kong , Probabilidad , Instalaciones de Eliminación de Residuos
15.
JMIR Mhealth Uhealth ; 9(5): e22599, 2021 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-33970119

RESUMEN

BACKGROUND: Smartphones and mobile applications have seen a surge in popularity in recent years, a pattern that has also been reflected in the health care system. Despite increased reliance among clinicians however, limited research has been conducted on the uptake and impact of smartphone usage in medical practice, especially outside the Western world. OBJECTIVE: This study aimed to identify the usage of smartphones and medical apps by doctors in the clinical setting in 2 culturally distinct countries: King Hamad University Hospital (KHUH), Bahrain and Queen Mary Hospital (QMH), Hong Kong. METHODS: A cross-sectional, comparative study was conducted where doctors in both hospitals were asked to take part in a 15-item online survey. The questions were categorized into the following groups: demographics of the study population, ownership and main use of smartphones, number and names of medical apps currently owned, rating usage of smartphones for medical purposes, time spent on a smartphone related to clinical use, clinical reliance on smartphones, and views on further integration of smartphones. The results were then tabulated and analyzed using SPSS Statistics 25 for Mac (IBM Corp Inc, Armonk, NY). RESULTS: A total of 200 doctors were surveyed, with a total of 99.0% (99/100) of the doctors owning a smartphone in both KHUH and QMH; 58% (57/99) and 55% (54/99) of the doctors from KHUH and QMH, respectively, identified communication as their main use of smartphones in the clinical setting (P=.004). Doctors from KHUH were likely to spend more time on medical apps than doctors from QMH (P=.002). According to the overall results of both hospitals, 48% (32/67) of the junior doctors claimed high reliance on smartphones, whereas only 32.3% (41/127) of the senior doctors said the same (P=.03). Of doctors in KHUH and QMH, 78.0% (78/100) and 69.0% (69/100), respectively, either strongly agreed or agreed that smartphones need to be integrated into the clinical setting. In terms of preferences for future apps, 48% (48/100) and 56% (56/100) of the doctors in KHUH and QMH, respectively, agreed that more medical applications need to be created in order to support smartphone use in the clinical setting. CONCLUSIONS: These results suggest a substantial acceptance of smartphones by doctors in the clinical setting. It also elicits the need to establish policies to officially integrate smartphone technology into health care in accordance with ethical guidelines. More emphasis should be placed on creating medical applications that aid health care professionals in attaining their information from accurate sources and also regulate a system to monitor the usage of mobile devices within hospitals to prevent a breach of patient privacy and confidentiality.


Asunto(s)
Aplicaciones Móviles , Teléfono Inteligente , Computadoras de Mano , Estudios Transversales , Hong Kong , Humanos
16.
Epidemiol Psychiatr Sci ; 30: e39, 2021 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-34044906

RESUMEN

AIMS: Bipolar disorder is associated with premature mortality, but evidence is mostly derived from Western countries. There has been no research evaluating shortened lifespan in bipolar disorder using life-years lost (LYLs), which is a recently developed mortality metric taking into account illness onset for life expectancy estimation. The current study aimed to examine the extent of premature mortality in bipolar disorder patients relative to the general population in Hong Kong (HK) in terms of standardised mortality ratio (SMR) and excess LYLs, and changes of mortality rate over time. METHODS: This population-based cohort study investigated excess mortality in 12 556 bipolar disorder patients between 2008 and 2018, by estimating all-cause and cause-specific SMRs, and LYLs. Trends in annual SMRs over the 11-year study period were assessed. Study data were retrieved from a territory-wide medical-record database of HK public healthcare services. RESULTS: Patients had higher all-cause [SMR: 2.60 (95% CI: 2.45-2.76)], natural-cause [SMR: 1.90 (95% CI: 1.76-2.05)] and unnatural-cause [SMR: 8.63 (95% CI: 7.34-10.03)] mortality rates than the general population. Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Men and women with bipolar disorder had 6.78 (95% CI: 6.00-7.84) years and 7.35 (95% CI: 6.75-8.06) years of excess LYLs, respectively. The overall mortality gap remained similar over time, albeit slightly improved in men with bipolar disorder. CONCLUSIONS: Bipolar disorder is associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to natural causes. Persistent mortality gap underscores an urgent need for targeted interventions to improve physical health of patients with bipolar disorder.


Asunto(s)
Trastorno Bipolar , Trastorno Bipolar/epidemiología , Causas de Muerte , Estudios de Cohortes , Femenino , Hong Kong/epidemiología , Humanos , Esperanza de Vida , Masculino
17.
Health Qual Life Outcomes ; 19(1): 145, 2021 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-33980245

RESUMEN

BACKGROUND: Existing studies on health-related quality of life (HRQoL) mainly covered single growth stages of childhood or adolescence and did not report on the trends in the relationships of HRQoL with sleep duration, physical activity, and screen time. This study aimed to establish the population norm of HRQoL in children and adolescents aged 6-17 years and examine the associations of screen time, sleep duration, and physical activity with HRQoL in this population. METHODS: We conducted a large-scale cross-sectional population-based survey study of Hong Kong children and adolescents aged 6 to 17 years. A representative sample of students were interviewed to assess their HRQoL using PedsQL and EQ-5D-Y-5L. Multivariable homoscedastic Tobit regression with linear form or restricted cubic spline of predictors was used to analyze the associations between screen time, sleep duration, and HRQoL. Multiple imputation by chained equations was performed to deal with missing data. RESULTS: A total of 7555 respondents (mean age 11.5, SD 3.2; 55.1% female) were sampled. Their EQ VAS scores, PedsQL physical summary scores, and psychosocial summary scores were positively correlated with sleep duration and moderate/vigorous activity but was negatively correlated with screen time. CONCLUSIONS: Children and adolescents who had longer exposure to screen, shorter sleep duration, and lower physical activity levels appeared to have poorer HRQoL as assessed by PedsQL and EQ-5D-Y-5L. Advice and guidance on screen time allocation for children and adolescents should be provided at the levels of school, community, and family.


Asunto(s)
Ejercicio Físico , Calidad de Vida/psicología , Tiempo de Pantalla , Sueño , Estudiantes/psicología , Adolescente , Niño , Estudios Transversales , Femenino , Hong Kong , Humanos , Masculino , Análisis de Regresión , Estudiantes/estadística & datos numéricos
18.
Front Public Health ; 9: 604455, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34012950

RESUMEN

Background: The asymptomatic proportion is a critical epidemiological characteristic that modulates the pandemic potential of emerging respiratory virus, which may vary depending on the nature of the disease source, population characteristics, source-host interaction, and environmental factors. Methods: We developed a simple likelihood-based framework to estimate the instantaneous asymptomatic proportion of infectious diseases. Taking the COVID-19 epidemics in Hong Kong as a case study, we applied the estimation framework to estimate the reported asymptomatic proportion (rAP) using the publicly available surveillance data. We divided the time series of daily cases into four stages of epidemics in Hong Kong by examining the persistency of the epidemic and compared the rAPs of imported cases and local cases at different stages. Results: As of July 31, 2020, there were two intermittent epidemics in Hong Kong. The first one was dominated by imported cases, accounting for 63.2% of the total cases, and the second one was dominated by local cases, accounting for 86.5% of the total cases. The rAP was estimated at 23.1% (95% CI: 10.8-39.7%) from January 23 to July 31, and the rAPs were estimated at 22.6% (95% CI: 11.1-38.9%) among local cases and 38.7% (95% CI: 9.0-72.0%) among imported cases. Our results showed that the rAPs of local cases were not significantly different between the two epidemics, but increased gradually during the first epidemic period. In contrast, the rAPs of imported cases in the latter epidemic period were significantly higher than that in the previous epidemic period. Conclusion: Hong Kong has a high rAP of imported COVID-19 cases and should continue to strengthen the detection and isolation of imported individuals to prevent the resurgence of the disease.


Asunto(s)
COVID-19 , Hong Kong/epidemiología , Humanos , Funciones de Verosimilitud , Pandemias , SARS-CoV-2
19.
Epidemiol Psychiatr Sci ; 30: e32, 2021 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-33902775

RESUMEN

AIMS: Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes. METHODS: In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted. RESULTS: In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2-12.0%; 14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of high quality, nine of moderate quality and six of high quality. CONCLUSIONS: There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.


Asunto(s)
COVID-19 , Enfermedades Transmisibles , Influenza Pandémica, 1918-1919 , Conducta Autodestructiva , Suicidio , Adolescente , Anciano , Niño , Enfermedades Transmisibles/epidemiología , Historia del Siglo XX , Hong Kong , Humanos , Japón , SARS-CoV-2 , Conducta Autodestructiva/epidemiología
20.
Emerg Infect Dis ; 27(5): 1492-1495, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33900193

RESUMEN

We describe an introduction of clade GH severe acute respiratory syndrome coronavirus 2 causing a fourth wave of coronavirus disease in Hong Kong. The virus has an ORF3a-Q57H mutation, causing truncation of ORF3b. This virus evades induction of cytokine, chemokine, and interferon-stimulated gene expression in primary human respiratory cells.


Asunto(s)
COVID-19 , Epidemias , China , Hong Kong/epidemiología , Humanos , SARS-CoV-2
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