Diabetes management in a Primary Care Network (PCN) of private general practitioners in Singapore: An observational study.

A Primary Care Network (PCN) is a virtual network of general practitioners (GPs), sharing common resources and common clinical governance framework for effective chronic disease management. In this study, we analyzed the frequency of assessment as well as control of HbA1c, blood pressure (BP), and low-density lipoprotein (LDL) over time among adult patients with diabetes managed by a group of private GPs under PCN.Data, including clinical measurements of HbA1c, BP, and LDL from 2012 to 2015, of 943 subjects at 9 GP clinics that piloted PCN in Singapore in 2012 was obtained from the chronic disease register for this analysis.The total number of PCN patients increased from 371 in 2012 to 911 in 2015. The average HbA1c decreased from 7.5% in 2012 to 7.3% in 2015, with a significant yearly improving trend of -0.11% (P < .001). The trends in change for systolic BP and LDL were not statistically significant during the same follow-up period. Regular assessment of HbA1c decreased from 80% in 2012 to 55% in 2015. Such decreases were also found in BP and LDL assessments. We also found that receiving government subsidies under a national scheme was a major determinant for maintaining regular assessment, with patients so covered 3 to 20 times more likely to have regular assessments.The PCN model can help improve care and clinical outcomes in adult patients with diabetes in the private primary care sector. Investing greater financial and human resources to augment service capacity and expanding subsidy coverage may be important to ensure the effectiveness, scalability, and sustainability of such a model of care.

Human health risk assessment based on trace metals in suspended air particulates, surface dust, and floor dust from e-waste recycling workshops in Hong Kong, China.

This study investigated health risks exerted on electronic waste (e-waste) recycling workers exposed to cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb), nickel (Ni), mercury (Hg), and zinc (Zn) in Hong Kong. E-waste recycling workshops were classified into eight working areas: 1 = office, 2 = repair, 3 = dismantling, 4 = storage, 5 = desoldering, 6 = loading, 7 = cable shredding, and 8 = chemical waste. The aforementioned metal concentrations were analyzed in suspended air particulates, surface dust and floor dust collected from the above study areas in five workshops. Elevated Pb levels were measured in dismantling and desoldering areas (582 and 486 µg/100 cm(2) in surface and 3,610 and 19,172 mg/kg in floor dust, respectively). Blood lead levels of 10 and 39.5 µg/dl were estimated using United States Environmental Protection Agency's Adult Lead Model as a result of exposure to the floor dust from these two areas. Human health risk assessments were conducted to evaluate cancer and noncancer risks resulting from exposure to floor dust through the combined pathways of ingestion, dermal contact, and inhalation. Findings indicated that workers may be exposed to cancer risks above the acceptable range at 147 in a million at the 95th percentile in the dismantling area. Workers should be informed of associated risks to safeguard their health.

Cancer risk assessments of Hong Kong soils contaminated by polycyclic aromatic hydrocarbons.

The aim of this study was to evaluate soils from 12 different land use types on human cancer risks, with the main focus being on human cancer risks related to polycyclic aromatic hydrocarbons (PAHs). Fifty-five locations were selected to represent 12 different types of land use (electronic waste dismantling workshop (EW (DW)); open burning site (OBS); car dismantling workshop (CDW) etc.). The total concentrations of 16 PAHs in terms of total burden and their bioaccessibility were analysed using GC/MS. The PAHs concentrations were subsequently used to establish cancer risks in humans via three exposure pathways, namely, accident ingestion of soil, dermal contact soil and inhalation of soil particles. When the 95th centile values of total PAH concentrations were used to derive ingestion and dermal cancer risk probabilities on humans, the CDW land use type indicated a moderate potential for cancerous development (244 × 10(-6) and 209 × 10(-6), respectively). Bioaccessible PAHs content in soil samples from CDW (3.60 × 10(-6)) were also classified as low cancer risk. CDW soil possessed a higher carcinogenic risk based on PAH concentrations. Bioremediation is recommended to treat the contaminated soil.

A material flow analysis on current electrical and electronic waste disposal from Hong Kong households.

A material flow study on five types of household electrical and electronic equipment, namely television, washing machine, air conditioner, refrigerator and personal computer (TWARC) was conducted to assist the Government of Hong Kong to establish an e-waste take-back system. This study is the first systematic attempt on identifying key TWARC waste disposal outlets and trade practices of key parties involved in Hong Kong. Results from two questionnaire surveys, on local households and private e-waste traders, were used to establish the material flow of household TWARC waste. The study revealed that the majority of obsolete TWARC were sold by households to private e-waste collectors and that the current e-waste collection network is efficient and popular with local households. However, about 65,000 tonnes/yr or 80% of household generated TWARC waste are being exported overseas by private e-waste traders, with some believed to be imported into developing countries where crude recycling methods are practiced. Should Hong Kong establish a formal recycling network with tight regulatory control on imports and exports, the potential risks of current e-waste recycling practices on e-waste recycling workers, local residents and the environment can be greatly reduced.