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1.
Lancet Psychiatry ; 7(2): 135-147, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31974072

RESUMO

BACKGROUND: Psychiatric disorders are established risk factors for self-harm. However, variation in the risk of self-harm by specific psychiatric disorder and stratified by gender and age is rarely examined in population-representative samples. This study aimed to investigate the risk of self-harm following diagnosis of different psychiatric disorders in an Asian population, through a review of inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS). METHODS: For this nested case-control study, the inpatient data of people admitted for any reason to Hong Kong public hospitals, between Jan 1, 2000, and Dec 31, 2010, were extracted from CDARS. Cases were people aged 10 years or older who had been admitted to inpatient care with a first-listed record of psychiatric disorder during the study period. The seven psychiatric disorders of interest were: depression, alcohol misuse or dependence, personality disorders, bipolar disorders, anxiety disorders, schizophrenia, and substance misuse or dependence. Two control patients were matched per case from a subsample of all individuals with the same gender, age, and admission time (ie, same calendar year and month), who did not have any record of the psychiatric disorders of interest. Any patients with a history of self-harm diagnosis before, or at the same time as, the first diagnosis of psychiatric disorder (cases) or admission (controls), were excluded. For each diagnostic category, a Cox proportional hazard regression model was fitted to estimate the adjusted hazard ratio (HR; plus 95% CIs) of associated self-harm, adjusting for gender, age, control-matched admission time, 20 districts of residence, physical comorbidities established as risk factors for self-harm (diabetes, asthma, migraine, epilepsy, HIV, and cancer), and presence of the six other psychiatric disorders. We repeated this analysis in subgroups stratified by gender (male and female) and by age (adolescent, 10-24 years; young adult, 25-44 years; middle-aged, 45-64 years; and older people, ≥65 years). FINDINGS: Between 2000 and 2010, we followed up a cohort of 86 353 people with a first-recorded diagnosis of a psychiatric disorder of interest, and 134 857 matched controls. The highest risk of self-harm was observed in patients with substance misuse or dependence (adjusted HR vs matched controls, 9·6 [95% CI 8·4-11·0]), followed by those with personality disorders (3·7 [2·8-4·9]) and alcohol misuse or dependence (3·2 [2·9-3·7]). When stratified by gender and age, the highest risk of self-harm behaviour was found in the substance misuse or dependence group for both genders (for female patients: adjusted HR vs matched controls, 7·7 [6·0-9·8]; and for male patients, 10·5 [8·9-12·4]), and for all age groups (adolescent: 9·6 [7·2-12·7]; young adults: 10·2 [8·4-12·3]; middle-aged: 11·2 [8·0-15·6], and older people: 3·2 [1·7-6·1]). INTERPRETATION: First-recorded diagnoses of psychiatric disorders were significantly associated with an elevated risk of subsequent self-harm. The associations varied considerably by diagnostic categories across gender and age subgroups. Our findings highlight the need to develop more efficient and targeted preventive measures in psychiatric care management, with specific attention to demographic characteristics linked to increased risk within the same diagnostic category. FUNDING: None.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Depressivo/epidemiologia , Transtornos da Personalidade/epidemiologia , Esquizofrenia/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Hong Kong/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Risco , Fatores Sexuais , Adulto Jovem
3.
BMC Public Health ; 19(1): 1514, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718611

RESUMO

BACKGROUND: Cervical cancer was the fourth most common cancer among women worldwide in 2012 and was the eighth most common cancer in 2014 and the eighth greatest cause of female cancer deaths in Hong Kong in 2015. Human papillomavirus (HPV) vaccination has been clinically documented to have a high efficacy in reducing HPV-related cervical intraepithelial neoplasia incidence. Therefore, receiving vaccination is a crucial public health measure to reduce disease burden. Significant others, such as schools and schoolteachers, have prominent influence in shaping adolescents' health perceptions and behavior. Therefore, the perspective of schools and schoolteachers regarding vaccination can significantly influence students' acceptance and accessibility of the vaccine. However, few studies have analyzed the perceptions of schoolteachers toward HPV vaccination, and even fewer have concerned how schoolteachers' perceptions influence their schools' motivation in implementing school-based HPV vaccination programs. This study was thus conducted to fill this literature gap. METHODS: With a Chinese community as the field site of this study, a qualitative approach of five focus group interviews was conducted with 35 schoolteachers from five primary and eight secondary schools in Hong Kong between July 2014 and January 2015. Thematic content analysis was used for data analysis. RESULTS: Perceptual, institutional, student and parental, and collaborator barriers interacted to discourage the sampled schoolteachers from organizing school-based HPV vaccination programs. Lack of knowledge regarding HPV vaccination, perception of HPV vaccination as inappropriate given the students' age, violation of traditional cultural values, lack of perceived needs and perceived risk, opposition from schools, low priority of HPV vaccination over other health education topics, lack of government support, lack of interest from parents and students, and lack of confidence in implementing organizations, all were the mentioned barriers. CONCLUSIONS: The sampled schoolteachers were demotivated to organize school-based HPV vaccination programs because of their perceptions and various social and cultural factors. As significant influencers of adolescent students, schoolteachers and schools should receive more support and information on organizing school-based HPV vaccination programs in the future.


Assuntos
Neoplasia Intraepitelial Cervical/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Papillomaviridae , Infecções por Papillomavirus/prevenção & controle , Professores Escolares , Instituições Acadêmicas , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Neoplasia Intraepitelial Cervical/virologia , Criança , Feminino , Educação em Saúde , Hong Kong/epidemiologia , Humanos , Programas de Imunização , Masculino , Motivação , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus , Pais , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Serviços de Saúde Escolar , Estudantes , Neoplasias do Colo do Útero/virologia , Vacinação , Adulto Jovem
4.
BMC Public Health ; 19(1): 1290, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615481

RESUMO

BACKGROUND: Global warming has reduced the adaptability of the people living in subtropical regions to cope up with cold stress due to lengthening of hot days and shortening of transition period from hot to cold weather. However, existing studies on measuring cold stress are based on biometeorological indices designed for temperate regions. This may overestimate the impact of wind chill on mortality risk in subtropical cities. METHODS: This study developed an Adjusted Wind Chill Equivalent Temperature (AWCET) index. A spatially-controlled time-stratified approach was applied to evaluate the ability of AWCET for estimating cold mortality in subtropical cities, based on a mortality dataset (2008-2012) in Hong Kong. RESULTS: The use of AWCET could indicate increase in all-cause, cardiovascular, respiratory, and cancer-related mortality risk during the days with average temperature < = 1st [11.0 °C], <= 3rd [12.6 °C] and < = 5th [13.4 °C] percentiles. The results were stable and consistent based on both log-linear and curve-linear relationships between AWCET and mortality risk. AWCET was also compared with the New Wind Chill Equivalent Temperature (NWCET) designed for temperate regions, and has found that higher magnitude of mortality risk would be found when using AWCET for assessing all-cause and cause-specific mortality in Hong Kong, for days with average temperature < = 1st, <= 3rd and < = 5th percentiles. CONCLUSIONS: AWCET is validated to be effective to access cold mortality in the context of subtropical cities. The use of AWCET may enhance the cold weather warning system in subtropical cities, as a supplementary tool to help demonstrating small administrative-level perceived temperature with volunteered geographic information.


Assuntos
Temperatura Baixa/efeitos adversos , Mortalidade , Vento , Cidades , Hong Kong/epidemiologia , Humanos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Análise Espaço-Temporal , Clima Tropical
5.
Asia Pac J Clin Oncol ; 15 Suppl 6: 8-13, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31642191

RESUMO

AIM: The 2017 Advanced Prostate Cancer Consensus Conference (APCCC) convened an international multidisciplinary panel to vote on controversial issues in the management of advanced prostate cancer (APC). We aimed to compare their conclusions with the opinions of local specialists and explore the practicability of international recommendations in the healthcare setting in Hong Kong. METHODS: Urologists and clinical oncologists practicing in Hong Kong were invited to complete a survey based on the original APCCC 2017 questionnaire and recently published trials in APC. A joint committee of expert key opinion leaders was convened to discuss and analyze the voting differences between local specialists and the APCCC 2017 panel. RESULTS: The respondents constituted 21% (28/132) of registered urologists and 21% (31/146) of clinical oncologists in Hong Kong. Discrepancies in three key areas were identified as being the most timely for this analysis: (a) management of metastatic hormone-sensitive/naïve prostate cancer; (b) management of metastatic castration-resistant prostate cancer; and (c) treatment monitoring and initiation of androgen-deprivation therapy. Fears of toxicity and intolerance among patients and physicians (especially urologists) may be driving the relative underuse of chemotherapy in multiple APC patient groups in Hong Kong. Local patients can face long wait times and limited access to contemporary imaging modalities compared with other developed countries. CONCLUSION: Increased collaborative efforts by urologists and clinical oncologists could ensure that patients gain wider access to the latest diagnostic, treatment and monitoring modalities for APC in Hong Kong.


Assuntos
Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Neoplasias da Próstata/terapia , Inquéritos e Questionários , Antagonistas de Androgênios/uso terapêutico , Antineoplásicos/uso terapêutico , Terapia Combinada , Consenso , Gerenciamento Clínico , Hong Kong/epidemiologia , Humanos , Masculino , Prostatectomia , Neoplasias da Próstata/epidemiologia , Radioterapia
6.
Helicobacter ; 24 Suppl 1: e12643, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31486238

RESUMO

Gastric cancer (GC) was responsible for over 1 000 000 new cases in 2018 and an estimated 783 000 deaths, making it still the fifth most frequently diagnosed cancer and the third leading cause of cancer deaths in both sexes worldwide. Divergent trends for GC incidence were observed in the USA. Incidence rates, particularly for non-cardia GC, were stable or increasing among persons aged <50 years. In an analysis of data from a public hospital database in Hong Kong, treatment of Helicobacter pylori infection was associated with a lower risk of GC, particularly in older subjects who received treatment ≥10 years before. Based on the results of a 16-year endoscopy-based follow-up eradication trial, patients with incomplete-type intestinal metaplasia (IM) should receive endoscopic surveillance upon H. pylori eradication therapy. Updated guidelines on the endoscopic surveillance of preneoplastic conditions of the stomach (MAPS II) have been published. In the RAINFALL trial, the addition of ramucirumab to a backbone chemotherapy as a first-line regimen failed to improve overall survival (OS) of patients with metastatic disease. Also, pembrolizumab did not prolong OS when compared to paclitaxel in the second-line treatment of patients with advanced GC or esophagogastric junction (EGJ) cancer. Trifluridine/tipiracil improved OS by 2.1 months in the third or further treatment line of patients with advanced GC. In a systematic investigation conducted on Chinese patients with GC, CLDN18-ARHGAP26/6 fusion was associated with signet-ring cell content and was prognostic for a worse outcome and predictive for no benefit from oxaliplatin/fluoropyrimidine-based chemotherapy. Organoid cultures represent an appealing model that may be applied for therapy response testing in the near future.


Assuntos
Antineoplásicos/uso terapêutico , Infecções por Helicobacter/complicações , Interações Hospedeiro-Patógeno , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/epidemiologia , Pesquisa Biomédica/tendências , China/epidemiologia , Hong Kong/epidemiologia , Humanos , Incidência , Estados Unidos/epidemiologia
7.
BMC Public Health ; 19(1): 1123, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420031

RESUMO

BACKGROUND: Little is known about the risk and addiction perceptions of e-cigarettes among Asian populations. We examined e-cigarette perceptions among young adults in Hong Kong and the association between the perceptions and e-cigarette use patterns. METHODS: An online survey was administered to a convenience sample of Hong Kong residents aged 18-35 (N = 1186). Measures of e-cigarette perceptions included perceived harm and addictiveness of e-cigarettes, perceived harm of secondhand e-cigarette aerosol, and perceived popularity of e-cigarette use among peers. Separate multinomial logistic regression models were conducted to examine the associations between the four perceptions and former and current use of e-cigarettes relative to never use, controlling for demographics and current cigarette smoking status. Interactions of e-cigarette perceptions and current cigarette smoking were assessed in all models. Among current e-cigarette users, bivariate exact logistic regression models were used to examine the relationships between each of the perceptions and frequent e-cigarette use (≥3 days in past 30-day vs. 1-2 days). Among participants who had never used e-cigarettes, separate multivariable logistic regression models were conducted to examine the associations between e-cigarette perceptions and susceptibility to e-cigarette use. RESULTS: Overall, 97.2% of participants were aware of e-cigarettes, and 16.1% had tried e-cigarettes (11.3% former users; 4.8% current users). Young adults perceived e-cigarettes (and aerosol) as less harmful, less addictive, and less popular than cigarettes. Current cigarette smokers reported significantly lower perceived harmfulness and addictiveness of e-cigarettes, lower perceived harmfulness of e-cigarette aerosol, and higher perceived popularity than nonsmokers. The lower degree of harm and addiction perceptions, and higher levels of popularity perceptions were associated with greater odds of e-cigarette use, and these relationships were generally stronger among nonsmokers compared to current cigarette smokers. E-cigarette perceptions were not associated with frequent e-cigarette use. Perceiving e-cigarettes (and aerosol) as less harmful and less addictive were associated with greater susceptibility to e-cigarette use. Compared to nonsmokers, current smokers were more likely to report e-cigarette use and susceptibility. CONCLUSIONS: Continued monitoring of e-cigarette use and perceptions is needed. Educational programs should emphasize the potential harmful and addictive properties of e-cigarettes and the risks of secondhand exposure to e-cigarette aerosol.


Assuntos
Atitude Frente a Saúde , Vaping/epidemiologia , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Hong Kong/epidemiologia , Humanos , Masculino , Medição de Risco , Adulto Jovem
8.
J Med Microbiol ; 68(9): 1367-1372, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31329093

RESUMO

Methicillin-resistant Staphylococcus lugdunensis (MRSL) is increasingly recognized in healthcare and community settings. To obtain a better understanding of the emergence of MRSL, this study characterized the structure and content of the SCCmec elements harboured by 36 MRSL isolates obtained from diverse sources in Hong Kong from 2008 to 2017. The isolates were investigated by whole-genome sequencing. SCCmec types and subtypes were assigned according to the guidelines from the International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements. The sequence type (ST)-SCCmec combinations in the 36 MRSL isolates were as follows: ST3-SCCmec IV (n=2), ST3-SCCmec V (n=28), ST27-SCCmec V (n=5) and ST42-SCCmec V (n=1). The two SCCmec IV elements were highly similar to the SCCmec IV element harboured by the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain, JCSC6668. The J3-mec complex-J2 regions in the SCCmec V elements were highly similar to the corresponding regions in the CA-MRSA strains PM1 (n=13) or WIS (n=21). Based on the J1 to J3 sequences, the SCCmec V elements can be categorized into nine different subtypes. Our findings highlight the diversified structures of SCCmec elements among MRSL strains and their close relationship with SCCmec elements harboured by CA-MRSA.


Assuntos
Cromossomos Bacterianos/genética , Infecções Comunitárias Adquiridas/microbiologia , Genes Bacterianos/genética , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/genética , Antibacterianos/farmacologia , Infecções Comunitárias Adquiridas/epidemiologia , DNA Bacteriano/genética , Genoma Bacteriano/genética , Hong Kong/epidemiologia , Humanos , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Análise de Sequência de DNA , Infecções Estafilocócicas/epidemiologia , Estudantes de Medicina
9.
Nutrients ; 11(8)2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31349710

RESUMO

The role of diet and circulatory carotenoids and docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are implicated in age-related macular degeneration (AMD) but not well studied in Chinese. However, other fatty acids were not comprehensively evaluated if it had additional consequence on AMD. This study investigated the relationship among dietary habits, fatty acids levels, carotenoids and AMD in Hong Kong Chinese adults. In this cross-sectional case-controlled study, plasma fatty acids including, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA), and carotenoids levels were quantified between patients with neovascular AMD (n = 99) and age-gender-matched controls (n = 198). A food frequency questionnaire was also conducted. Low blood carotenoid levels and omega-3 PUFAs namely DHA, EPA and -linolenic acid increased the odds ratio of developing neovascular AMD. High blood omega-6 PUFAs specifically arachidonic acid and eicosadienoic acid, oleic acid (a MUFA) and SFA levels increased the odds ratio of having neovascular AMD. Neovascular AMD group had significantly less omega-3 PUFA rich food (vegetables, nuts, seafood) intake and higher SFA (meat) intake than controls. In short, neovascular AMD was associated with lower circulatory levels of carotenoids and omega-3 PUFAs, and higher level of omega-6 PUFAs, oleic acid and SFAs in the Hong Kong Chinese population. These findings enhance the understandings of dietary impacts on neovascular AMD and provide a context for future nutritional intervention studies.


Assuntos
Carotenoides/sangue , Dieta/efeitos adversos , Ácidos Graxos/sangue , Comportamento Alimentar , Degeneração Macular/epidemiologia , Neovascularização Patológica , Estado Nutricional , Valor Nutritivo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Carotenoides/administração & dosagem , Estudos de Casos e Controles , Estudos Transversais , Ácidos Graxos/administração & dosagem , Feminino , Hong Kong/epidemiologia , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/patologia , Degeneração Macular/prevenção & controle , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Medição de Risco , Fatores de Risco
10.
Sci Total Environ ; 690: 923-931, 2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31302556

RESUMO

BACKGROUND: The impact of heatwaves on public health has led to an urgent need to describe extremely hot weather events (EHWEs) and evaluate their health impacts. METHODS: In Hong Kong, a very hot day (VHD) can be defined when the daily maximum temperature ≥ 33 °C, and a hot night (HN) can be identified if the daily minimum temperature ≥ 28 °C. Three lengths of time, nine combinations of VHD and HN, and four categories of occurrence intervals between two EHWEs were considered over 2006-2015. The daily relative risk (RR) of all-cause mortality was estimated using Poisson generalized additive regression models, controlling for both short-term and long-term trends in temperature as well as four air pollutants. Lagged effects of the representative EHWEs were further examined for their association with mortality. Subgroup analysis was conducted for different sex and age groups. RESULTS: Significant associations with raised mortality risks were observed for a single HN, while stronger associations with mortality were observed as significant for five or more consecutive VHDs/HNs. More HNs between the consecutive VHDs also significantly amplified the impact on mortality, with the strongest association observed for EHWEs characterized as 2D3N, and the effect significantly lagged for five days. Therefore, with identifiable health impacts, three thresholds (5VHDs, 5HNs, & 2D3N) were determined to be representative of identical types of EHWEs in Hong Kong. Furthermore, by taking 2 (3) consecutive VHDs (HNs) as one daytime (nighttime) EHWE event, those occurring consecutively without non-hot days (nights) in between were found to be significantly associated with excess mortality risks. Moreover, females and older adults were determined to be relatively more vulnerable to all defined EHWEs. CONCLUSIONS: Among all the observed significant heat-mortality associations in highly urbanized cities, EHWEs that occurred during the nighttime, with extended length, consecutively without any break in between, or in the pattern of 2D3N might require the meteorological administration, healthcare providers, and urban planners to work interactively.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Temperatura Alta , Mortalidade/tendências , Cidades , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Urbanização
11.
ScientificWorldJournal ; 2019: 2685437, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281231

RESUMO

Objectives: To determine the prevalence of orthodontic treatment need in 12-year-old children in Hong Kong and its relationship with the psychosocial impact of malocclusion and to assess their associations with sociodemographic factors. Materials and Methods: A random sample of 687 12-year-old children was recruited from 45 secondary schools in Hong Kong. Orthodontic treatment need was assessed on study models by five indices: the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC), the Aesthetic Component of the IOTN (IOTN-AC), the Dental Aesthetic Index (DAI), the Index of Complexity Outcome and Need (ICON), and the Peer Assessment Rating (PAR). The psychosocial impact of malocclusion on participants and sociodemographic factors were obtained from a questionnaire. Logistic regression was used to examine the correlations between treatment need and the psychosocial impact of malocclusion as well as their associations with sociodemographic factors. Results: The final number of participants was 667 (339 boys and 328 girls, participation rate 667/687 = 97.1%). The prevalence of orthodontic treatment need varied depending on the indices used (10.9-47.8%), but significant correlations were found among the five indices (p < 0.01). The uptake of treatment among the cohort was 2.3%. Boys had higher IOTN-DHC (p < 0.05), DAI (p < 0.05), and PAR (p = 0.05) scores than girls. IOTN-AC was significantly associated with the psychosocial impact of malocclusion (p < 0.05). Parents' level of education and household income were not significantly associated with either treatment need or the psychosocial impact of malocclusion (p > 0.05). Conclusion: The need for orthodontic treatment in 12-year-old children in Hong Kong remained high, and the uptake of treatment was low. Boys had a higher normative treatment need than girls. Among the five indices, IOTN-AC appears to be the best indicator of the psychosocial impact of malocclusion.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Má Oclusão/epidemiologia , Ortodontia Corretiva , Fatores Etários , Criança , Estudos Transversais , Assistência Odontológica , Feminino , Hong Kong/epidemiologia , Humanos , Índice de Necessidade de Tratamento Ortodôntico , Masculino , Má Oclusão/psicologia , Má Oclusão/terapia , Razão de Chances , Ortodontia Corretiva/estatística & dados numéricos , Psicologia , Fatores Socioeconômicos
12.
Artigo em Inglês | MEDLINE | ID: mdl-31159482

RESUMO

To assess the mechanism responsible for the improvement in life expectancy in Hong Kong over the past several decades, Arriaga's decomposition method was applied to quantify the influence of the age structure and the leading causes of death on the increase in life expectancy in Hong Kong from 1986 to 2015. Our results showed that, during the observed period, the major contribution to the improvement in life expectancy in Hong Kong was attributable to the older population for both males and females. Contributions of malignant neoplasms in the period of 1986-1995, 1996-2005 and 2006-2015 were 0.613, 0.279 and 0.887 years in males and 0.391, 0.312 and 0.226 years in females, respectively. For circulatory diseases, the corresponding figures were 1.452, 0.202 and 0.832 years in males and 0.675, 0.192 and 1.069 years in females, with the largest contribution also shifting to older ages. However, these positive contributions were partly offset by the negative contribution of pneumonia, especially among those at advanced ages. Furthermore, although the impact was limited, attention should also be paid to the prevalence of some chronic diseases among the younger age groups in recent years.


Assuntos
Causas de Morte , Expectativa de Vida , Adulto , Idoso , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Clin Neurosci ; 66: 51-55, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31155343

RESUMO

The data for oligoclonal IgG bands (OCB) in cerebrospinal fluid and the association with clinical profiles of Chinese patients with multiple sclerosis (MS) is lacking. We aimed to investigate the positive OCB incidence, as well as the clinical and magnetic resonance imaging (MRI) features associated with positive OCB in MS patients in South China. Consecutive MS patients were recruited from two centers, located in Guangzhou city and Hong Kong in South China. MS was re-diagnosed by McDonald criteria 2017. OCB was tested using isoelectric focusing method. The difference in the clinical and MRI features between OCB-positive and OCB-negative MS patients was evaluated. Among 184 MS patients analyzed (102 from Guangzhou and 82 from Hong Kong), 110 (59.8%) patients were OCB-positive. Except for onset age (P = 0.019), there was no significant difference between MS patients with or without OCB in relation to the course of disease, symptoms of first attack, lesion distribution on MRI, relapse rates, or disability progression. Our results demonstrate no significant clinical differences between the OCB positive and negative MS patients in this MS cohort. Larger cohort in Chinese patients with MS is warranted.


Assuntos
Esclerose Múltipla/epidemiologia , Esclerose Múltipla/metabolismo , Bandas Oligoclonais/metabolismo , Adulto , Idade de Início , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , China/epidemiologia , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Imagem por Ressonância Magnética/tendências , Masculino , Esclerose Múltipla/diagnóstico por imagem , Recidiva , Adulto Jovem
14.
East Asian Arch Psychiatry ; 29(2): 41-47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237245

RESUMO

OBJECTIVE: To examine the prevalence and comorbidity of gastro-oesophageal reflux disease (GORD) with generalised anxiety disorder (GAD) and major depressive episodes (MDE) in a general population using DSM-IV, and to evaluate the associations between these conditions and healthcare utilisation. METHODS: A random population-based telephone survey was conducted to record frequency of GORD symptoms, symptoms of GAD and MDE based on DSM-IV, and healthcare utilisation. RESULTS: Of 2011 respondents, 4.2% had weekly GORD and 13.9% had monthly GORD, whereas 3.8% reported GAD and 12.4% reported MDE. Those with monthly GORD had higher risk of GAD (p = 0.01) and MDE (p < 0.001). GORD symptom frequency was independently correlated with MDE and GAD in a dose-response manner. The number of psychiatric diagnoses was independently correlated with GORD. GORD symptom frequency, GAD, and MDE were correlated with consultation frequency. GORD symptom frequency was corelated with high investigation expenditure. CONCLUSION: GORD had a strong dose-response relationship with GAD and MDE in a Hong Kong population. Excessive healthcare utilisation should alert clinicians to the risk of psychiatric comorbidity.


Assuntos
Transtornos de Ansiedade , Transtorno Depressivo Maior , Refluxo Gastroesofágico , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/fisiopatologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/psicologia , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Medição de Risco
15.
East Asian Arch Psychiatry ; 29(2): 57-62, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237247

RESUMO

This article reviews the poisoning epidemiology in Hong Kong, assessment and treatment of acute poisoning, and management of acute psychiatric medication overdose. In 2016, nearly 4000 poisoning cases involving approximately 6000 poisons were reported to Hong Kong Poison Information Centre. About 25% of the poisons involved were psychiatric-related medications. The initial medical assessment on poisoning includes history taking, vital signs monitoring, and focused physical examination. Approaches in managing acute poisoning include supportive measures, decontamination, antidote use, and enhanced elimination. Management on overdose of psychiatric medications (zopiclone, tricyclic antidepressants, selective serotonin reuptake inhibitor, antipsychotics, valproic acid, lithium, and methylphenidate) are discussed with practical tips highlighted.


Assuntos
Overdose de Drogas , Transtornos Mentais , Psicotrópicos , Overdose de Drogas/epidemiologia , Overdose de Drogas/etiologia , Hong Kong/epidemiologia , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Psicotrópicos/classificação , Psicotrópicos/uso terapêutico , Psicotrópicos/toxicidade
16.
BMC Public Health ; 19(1): 754, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196044

RESUMO

BACKGROUND: Sedentary behaviors are prevalent in Chinese children, however, the studies on their trends and socioeconomic disparities are scarce. We examined the time trends of daily television (TV) viewing and video game playing and the associated socioeconomic factors in Chinese children in Hong Kong, the most developed and westernized city in China. METHODS: In a panel data study involving 538,300 primary four and 510,294 primary six students from 1999/2000 to 2008/09, data on socioeconomic status, sedentary behaviors (TV viewing and video game playing) and other lifestyle habits were collected using a self-administered questionnaire. Trends in sedentary behaviors over time were assessed. Their socioeconomic disparities were examined by interactions in generalized estimating equations with the adjustment for weight status and extracurricular physical activities. RESULTS: The age and sex-standardized prevalence of ≥2 h daily TV viewing decreased from 51.4% (95% confidence interval [CI] 51.1-51.8%) in 1999/2000 to 43.8% (95% CI 43.4-44.2%) in 2008/09 (P for trend < 0.001), whereas that of ≥1 h daily video game playing increased from 8.2% (95% CI 7.9-8.4%) to 22.4% (95% CI 22.0-22.7%). Both sedentary behaviors were more prevalent in boys than girls, but the disparities decreased over time (Ratio of odds ratio [ROR] = 0.996 and 0.924 for TV viewing and video game playing, respectively). In contrast, both sedentary behaviors were increasingly more prevalent in children whose parents had lower education levels or non-managerial/professional occupations (ROR 1.006-1.082). CONCLUSIONS: Children in lower socioeconomic families in Hong Kong were increasingly at risk of having sedentary behaviors over years and thus deserve more attention. Effective strategies targeting children and/or their parents of lower socioeconomic status are needed to reduce sedentary behaviors.


Assuntos
Comportamento Infantil , Disparidades nos Níveis de Saúde , Comportamento Sedentário , Criança , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Prevalência , Fatores Socioeconômicos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Televisão/estatística & dados numéricos , Fatores de Tempo , Jogos de Vídeo/estatística & dados numéricos
17.
Ann Thorac Surg ; 108(4): 1029-1036, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31181207

RESUMO

BACKGROUND: Definitive chemoradiotherapy is offered for most patients with isolated cervical esophageal tumor. Surgery is reserved for locally advanced diseases and salvage for failed chemoradiotherapy. Traditionally, surgery comprises total pharyngolaryngeal esophagectomy and gastric pull-up, which is associated with high morbidity and mortality rates. We hereby propose pharyngo-laryngo-cervico-esophagectomy by a transcervical approach, allowing preservation of the esophagus and stomach below, reducing operative morbidity and mortality. METHODS: A retrospective review of 31 patients who underwent curative pharyngo-laryngo-cervico-esophagectomy for isolated cervical esophageal tumor at the Department of Surgery, The University of Hong Kong, Queen Mary Hospital, between January 1, 2005, and June 30, 2018, was performed. RESULTS: There were 26 male and 5 female patients. Median age was 64.8 years. Seventeen patients underwent definitive surgery. Fourteen patients underwent salvage surgery for failed chemoradiotherapy. Most patients presented with stage III and IV diseases (90.3%). Median length of pharyngoesophageal defect was 14.0 cm (range, 8.0-21.0 cm). Free jejunal flap was used for pharyngoesophageal reconstruction in 77.4%. Eight complications developed in 7 patients (22.6%). There was no in-hospital mortality. Clear radial and longitudinal resection margins were achieved in 96.8%. Median follow-up was 21.5 months. Locoregional recurrence rate was 32.3%. Nine patients died of disease progression (29.0%). Seven died of other causes (22.6%). Median survival was 21.5 months. Overall 2-year survival rate was 36.7%. CONCLUSIONS: Transcervical pharyngo-laryngo-cervico-esophagectomy should be considered in patients with isolated cervical esophageal tumors. Pharyngo-laryngo-cervico-esophagectomy allows adequate tumor resection while preserving the esophagus and stomach below. Operative morbidity and mortality outcomes were improved without compromising oncologic control.


Assuntos
Neoplasias Esofágicas/terapia , Esofagectomia/métodos , Esôfago/cirurgia , Terapia de Salvação/métodos , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Esofagoscopia , Esôfago/diagnóstico por imagem , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
18.
Environ Sci Pollut Res Int ; 26(23): 24272-24285, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31230236

RESUMO

Temperature is associated with mortality risk across cities. However, there is lack of study investigating the summer effect on mortality associated with mental/behavioral disorders, especially in cities with subtropical climate. In addition, summer mortality in subtropical cities is different from tropical cities, and previous studies have not investigated the urban environmental inequality on heat mortality associated with mental/behavioral disorders. A register-based study was developed to estimate the temperature effects on decedents on days with 50th percentile of average daily temperature between 2007 and 2014 in Hong Kong (n = 133,359). Poisson regression was firstly applied to estimate the incidence rate ratio (IRR) from the summer temperature effects on all-cause mortality, cardiovascular mortality, respiratory mortality, and mortality associated with mental/behavioral disorders. For a 1 °C increase in average temperature on days with temperature ≥ 24.51 °C, IRRs of mortality associated with mental and behavioral disorders on lag 0 and lag 1 days were 1.033 [1.004, 1.062] and 1.030 [1.002, 1.060], while temperature effects on cardiovascular mortality and respiratory mortality during normal summer days (not extreme heat events) were not significant. A further investigation with linear regression has shown that decedents with mental/behavioral disorders on higher temperature days resided in areas with lower percentage of sky view, lower percentage of vegetation cover, higher level of neighborhood-level PM2.5, higher level of neighborhood-level NO, and higher level of neighborhood-level black carbon (BC). In order to develop protocols for community healthcare based on the "Leaving no one behind" scheme documented in the 2016 Sustainable Development Goals report of the United Nations, it is necessary to include heat effects on mental/behavioral disorders, especially people with dementia, for community planning and healthcare development.


Assuntos
Doenças Cardiovasculares/mortalidade , Transtornos Mentais/mortalidade , Temperatura Ambiente , Cidades , Hong Kong/epidemiologia , Temperatura Alta , Humanos , Mortalidade/tendências , Estações do Ano
19.
Int J Behav Nutr Phys Act ; 16(1): 48, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138203

RESUMO

BACKGROUND: Adolescent travel mode choices to/from school vary in their physical activity (PA) component and environmental sustainability. Research has typically focussed on correlates of active travel, the most healthy and sustainable mode, in comparison to other modes combined. Under the premise that a small shift from less to more healthy/sustainable modes may be a more feasible than a shift to 'pure' active travel (e.g., walking), we examined potential correlates of the odds of undertaking more vs. less healthy/sustainable modes. METHODS: Hong Kong adolescents attending secondary school and a parent/caregiver (n = 1299 dyads) participated in this cross-sectional study. Latent profile analyses identified groups of adolescents with different transport mode profiles to/from school. Profiles were ranked based on relative PA/sustainability outcomes. Multilevel logistic regression identified environmental, social and psychological factors associated with more vs. less PA/sustainable transport mode profiles to/from school. RESULTS: Most frequent transport modes were walking and public transport. Latent profile analysis resulted in a 7-profile model (walk (n = 430); walk & public transport (n = 93); public transport (n = 486); bicycle, car & taxi (n = 60); school bus to & public transport from school (n = 54); school bus (n = 106); car to & car/public transport from school (n = 70)). All profile comparisons were associated with at least one environmental variable. School proximity, access to services and parent transport-related PA were generally associated with higher odds of healthier-more sustainable transport modes. Adolescent-perceived distance and effort barriers to walking and cycling were generally associated with lower odds of more healthy/sustainable modes. DISCUSSION: Most adolescents engaged in relatively healthy/sustainable travel modes to/from school. Public transport to walking and school bus to public transport mode shifts are likely to have the biggest impact towards more healthy/sustainable modes. Encouraging parent-related transport PA may positively influence adolescent mode choice. Relatively dense, destination-rich neighbourhoods may encourage more healthy/sustainable transport modes to/from school by providing easy access to schools and services. CONCLUSION: Government policy encouraging enrolment in the closest local school and private school encouragement of public transport rather than school buses may have the greatest impact on shifts to more healthy/sustainable transport modes to/from school in Hong Kong adolescents.


Assuntos
Instituições Acadêmicas , Estudantes , Transportes/estatística & dados numéricos , Adolescente , Estudos Transversais , Hong Kong/epidemiologia , Humanos , Veículos Automotores , Pais , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Viagem , Caminhada
20.
J Urol ; 202(5): 986-993, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31112104

RESUMO

PURPOSE: In this study we assessed the effects of a ramping protocol in patients undergoing extracorporeal shock wave lithotripsy of renal stones. MATERIALS AND METHODS: In this prospective study patients with renal stones were randomized to receive shock wave lithotripsy delivered using a ramping protocol in group 1 (first 1,000 shocks at energy level 5 followed by 1,000 shocks at energy level 6 and 1,000 final shocks at energy level 7) and a fixed voltage protocol in group 2 (all 3,000 shocks at energy level 7). Treatment was administered using a Modulith® SLX-F2. The primary outcome was treatment success 12 weeks after a single shock wave lithotripsy session, defined as lack of a stone or a less than 4 mm stone fragment on computerized tomography. Other outcomes included the stone-free rate and the perinephric hematoma incidence. RESULTS: A total of 300 patients (150 per group) were recruited between February 2016 and June 2018. The 2 groups did not differ in baseline parameters. Group 1 received 14.8% lower energy than group 2, which was significant (p <0.001). The treatment success rate in groups 1 and 2 was 67.8% and 73.6%, respectively, which did not statistically differ (group 1 crude OR 0.753, 95% CI 0.456-1.244, p=0.268). The stone-free rate in groups 1 and 2 was 36.6% and 41.9%, respectively, which did not differ statistically between the groups. However, in groups 1 and 2 perinephric hematoma developed in 23.8% and 43.8% of patients, respectively, which was a statistically significant difference (p <0.001). CONCLUSIONS: The fixed voltage shock wave lithotripsy and ramping protocols provided similar treatment success rates for renal stones. However, the ramping protocol reduced the incidence of perinephric hematoma after shock wave lithotripsy.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Feminino , Seguimentos , Hematoma/epidemiologia , Hematoma/etiologia , Hong Kong/epidemiologia , Humanos , Incidência , Rim/irrigação sanguínea , Cálculos Renais/diagnóstico , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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