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1.
Emerg Infect Dis ; 28(1): 62-68, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34932446

RESUMO

To determine the effects of nonpharmaceutical interventions (NPIs) for coronavirus disease on pediatric hospitalizations for infection with respiratory viruses other than severe acute respiratory syndrome coronavirus 2, we analyzed hospital data for 2017-2021. Compared with 2017-2019, age-specific hospitalization rates associated with respiratory viruses greatly decreased in 2020, when NPIs were in place. Also when NPIs were in place, rates of hospitalization decreased among children of all ages for infection with influenza A and B viruses, respiratory syncytial virus, adenovirus, parainfluenza viruses, human metapneumovirus, and rhinovirus/enterovirus. Regression models adjusted for age and seasonality indicated that hospitalization rates for acute febrile illness/respiratory symptoms of any cause were reduced by 76% and by 85%-99% for hospitalization for infection with these viruses. NPIs in Hong Kong were clearly associated with reduced pediatric hospitalizations for respiratory viruses; implementing NPIs and reopening schools were associated with only a small increase in hospitalizations for rhinovirus/enterovirus infections.


Assuntos
COVID-19 , Vírus Sincicial Respiratório Humano , Infecções Respiratórias , Vírus , Criança , Hong Kong/epidemiologia , Hospitalização , Humanos , Lactente , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , SARS-CoV-2
2.
Gut ; 71(1): 100-110, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33619167

RESUMO

BACKGROUND: There were limited data on the risk of post-polypectomy bleeding (PPB) in patients on direct oral anticoagulants (DOAC). We aimed to evaluate the PPB and thromboembolic risks among DOAC and warfarin users in a population-based cohort. METHODS: We performed a territory-wide retrospective cohort study involving patients in Hong Kong from 2012 to 2020. Patients who received an oral anticoagulant and had undergone colonoscopy with polypectomy were identified. Propensity-score models with inverse probability of treatment weighting were developed for the warfarin-DOAC and between-DOAC comparisons. The primary outcome was clinically significant delayed PPB, defined as repeat colonoscopy requiring haemostasis within 30 days. The secondary outcomes were 30-day blood transfusion requirement and new thromboembolic event. RESULTS: Apixaban was associated with lower PPB risk than warfarin (adjusted HR (aHR) 0.39, 95% CI 0.24 to 0.63, p<0.001). Dabigatran (aHR 2.23, 95% CI 1.04 to 4.77, adjusted p (ap)=0.035) and rivaroxaban (aHR 2.72, 95% CI 1.35 to 5.48, ap=0.002) were associated with higher PPB risk than apixaban. In subgroup analysis, apixaban was associated with lower PPB risk in patients aged ≥70 years and patients with right-sided colonic polyps.For thromboembolic events, apixaban was associated with lower risk than warfarin (aHR 0.22, 95% CI 0.11 to 0.45, p<0.001). Dabigatran (aHR 2.60, 95% CI 1.06 to 6.41, ap=0.033) and rivaroxaban (aHR 2.96, 95% CI 1.19 to 7.37, ap =0.013) were associated with higher thromboembolic risk than apixaban. CONCLUSIONS: Apixaban was associated with a significantly lower risk of PPB and thromboembolism than warfarin, dabigatran and rivaroxaban, particularly in older patients with right-sided polyps.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia , Inibidores do Fator Xa/efeitos adversos , Hemorragia Gastrointestinal/epidemiologia , Tromboembolia/epidemiologia , Varfarina/efeitos adversos , Idoso , Anticoagulantes/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Estudos de Coortes , Dabigatrana/efeitos adversos , Hong Kong/epidemiologia , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Rivaroxabana/efeitos adversos
3.
Emerg Infect Dis ; 28(1): 247-250, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34932453

RESUMO

We sequenced ≈50% of coronavirus disease cases imported to Hong Kong during March-July 2021 and identified 70 cases caused by Delta variants of severe acute respiratory syndrome coronavirus 2. The genomic diversity detected in Hong Kong was similar to global diversity, suggesting travel hubs can play a substantial role in surveillance.


Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/diagnóstico , COVID-19/epidemiologia , Genômica , Hong Kong/epidemiologia , Humanos , Programas de Rastreamento , SARS-CoV-2/isolamento & purificação , Viagem
4.
Chemosphere ; 287(Pt 3): 132043, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34543905

RESUMO

With the prevalence of stroke rising due to both aging societies and more people getting strokes at a younger age, a comprehensive investigation into the relationship between urban characteristics and age-specific stroke mortality for the development of a healthy built environment is necessary. Specifically, assessment of various dimensions of urban characteristics (e.g. short-term environmental change, long-term environmental conditions) is needed for healthy built environment designs and protocols. A multifactorial assessment was conducted to evaluate associations between environmental and sociodemographic characteristics with age-stroke mortality in Hong Kong. We found that short-term (and temporally varying) daily PM10, older age and being female were more strongly associated with all types of stroke deaths compared to all-cause deaths in general. Colder days, being employed and being married were more strongly associated with hemorrhagic stroke deaths in general. Long-term (and spatially varying) regional-level air pollution were more strongly associated with non-hemorrhagic stroke deaths in general. These associations varied by age. Employment (manual workers) and low education were risk factors for stroke mortality at younger ages (age <65). Greenness and open space did not have a significant association with stroke mortality. Since a significant connection was expected, this leads to questions about the health-inducing efficacy of Hong Kong's compact open spaces (natural greenery being limited to steep slopes, and extensive impervious surfaces on public open spaces). In conclusion, urban plans and designs for stroke mortality prevention should implement age-specific health care to neighborhoods with particular population segments.


Assuntos
Poluição do Ar , Acidente Vascular Cerebral , Fatores Etários , Idoso , Poluição do Ar/análise , Ambiente Construído , Feminino , Hong Kong/epidemiologia , Humanos
6.
Health Soc Care Community ; 30(1): e86-e94, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34169598

RESUMO

Diabetes among working population brings to society concerns on productivity and social welfare cost, in addition to healthcare burden. While lower socio-economic status has been recognised as a risk factor of diabetes; occupation, compared with other socio-economic status indicators (e.g., education and income), has received less attention. There is some evidence from studies conducted in Europe that occupation is associated with diabetes risk, but less is known in Asia, which has different organisational cultures and management styles from the West. This study examines the association between occupation and diabetes risk in a developed Asian setting, which is experiencing an increasing number of young onset of diabetes and aging working population at the same time. This is a cross-sectional study of working population aged up to 65 with data from a population-based survey collecting demographic, socio-economic, behavioural and metabolic data from Hong Kong residents, through both self-administered questionnaires and clinical health examinations (1,429 participants). Non-skilled occupation was found to be an independent risk factor for diabetes, with an odds ratio (OR) of 3.38 (p < 0.001) and adjusted OR of 2.59 (p = 0.022) after adjusting for demographic, behavioural and metabolic risk factors. Older age (adjusted OR = 1.08, p < 0.001), higher body mass index (adjusted OR = 1.23, p < 0.001) and having hypertriglyceridemia (adjusted OR = 1.93, p = 0.033) were also independently associated with diabetes. Non-skilled workers were disproportionately affected by diabetes with the highest age-standardized prevalence (6.3%) among all occupation groups (4.9%-5.0%). This study provides evidence that non-skilled occupation is an independent diabetes risk factor in a developed Asian setting. Health education on improving lifestyle practices and diabetes screening should prioritise non-skilled workers, in particular through company-based and sector-based diabetes screening programmes. Diabetes health service should respond to the special needs of non-skilled workers, including service at non-office hour and practical health advice in light of their work setting.


Assuntos
Diabetes Mellitus , Vida Independente , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/epidemiologia , Hong Kong/epidemiologia , Humanos , Ocupações , Fatores de Risco
7.
Environ Res ; 204(Pt A): 111866, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34390721

RESUMO

The spatiotemporal assessment of health risk due to exposure to particulate matter (PM) components should be well studied because of the different toxicity among PM components. However, this research topic has long been overlooked. This study aimed to examine the spatiotemporal variability in ambient respirable PM (PM10) components associated inhalation carcinogenic and non-carcinogenic risk (ICR and INCR) in Hong Kong over 2015-2019. The land-use regression (LUR) approach was adopted to predict the spatial distribution of PM10 component concentrations for the period of 2015-2019, whereas the ICR and INCR values of PM10 components were also estimated using the classic health risk assessment method. Both concentration of PM10 and INCR of PM10 components showed a general decreasing trend, while ICR of PM10 components increased slightly over the study period. LUR-model-based spatial maps at 500 m × 500 m resolution revealed the important spatial variability in PM10 and its eleven components, and their associated ICR and INCR values. High pollution levels and high ICR and INCR of studied PM10 components were generally found in developed urban areas and along the road network. Despite the fact that the PM10 concentrations met the Hong Kong annual PM10 air quality objective of 50 µg/m3, there was still significant potential health risk from the studied PM10 components. This study highlights the importance of taking PM component concentrations and associated inhalation health risk as well as PM mass concentrations into account for the perspective of air quality management and protecting public health.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Monitoramento Ambiental , Hong Kong/epidemiologia , Material Particulado/análise , Material Particulado/toxicidade
8.
Nutrients ; 13(12)2021 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-34959911

RESUMO

The Portfolio Diet has demonstrated its cardiovascular benefit from interventions, but the association between Portfolio Diet adherence and the risk of all-cause and cause-specific mortality has not been examined in Chinese population. The present study has collected Portfolio Diet adherence (assessed by food frequency questionnaire), lifestyle factors and mortality status of 3991 participants in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox regression models were used to examine the association between the Portfolio Diet adherence and mortality risk (all-cause, cardiovascular disease or cancer). The highest quartile of the Portfolio Diet score was associated with a 28% lower risk of all-cause (hazard ratio, HR: 0.72) and cancer (HR: 0.72) mortality, respectively. The association between Portfolio Diet adherence and cardiovascular disease mortality did not reach statistical significance (HR: 0.90, 95% CI = 0.64, 1.26). Among male participants, the highest adherence to the Portfolio Diet was also associated with a lower risk of all-cause (HR: 0.63) and cancer mortality (HR: 0.59), and there was an inverse association between food sources of plant protein and the risk of cardiovascular mortality (HR: 0.50). However, most associations between the Portfolio Diet and mortality were not significant among females. The protection for cancer mortality risk might reach the plateau at the highest adherence to the Portfolio Diet for females. To conclude, greater adherence to the Portfolio Diet was significantly associated with a lower risk of mortality in Hong Kong older adults, and the associations appeared stronger among males.


Assuntos
Doenças Cardiovasculares/mortalidade , Causas de Morte , Dieta Saudável , Neoplasias/mortalidade , Osteoporose/mortalidade , Fatores Etários , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Risco , Inquéritos e Questionários
9.
BMJ Open ; 11(12): e055909, 2021 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930744

RESUMO

OBJECTIVES: This study aims to explore the attenuated impact of reported avoidance behaviours adherence on the transmission of COVID-19 through cross-sectional surveys in Hong Kong, in order to make up for the lack of research on avoidance behaviours fatigue. DESIGN: 40 cross-sectional telephone surveys. SETTING: All districts in Hong Kong. PARTICIPANTS: 31 332 Cantonese or English-speaking participants at age of 18 years or above. METHODS: We collected data on behaviours and estimated the average effective reproduction number ([Formula: see text]) among the Hong Kong adult population during the COVID-19 epidemic wave in November-December 2020 and compared with the preceding epidemic in June-July 2020. RESULTS: We observed a reduction in adherence to voluntary avoidance behaviours due to pandemic fatigue, but continued adherence to regulated avoidance behaviours. The average [Formula: see text] during the post-work from home period was higher in November-December wave with estimated [Formula: see text] of 0.81 (95% CI: 0.75 to 0.87) compared with the June-July wave with an [Formula: see text] of 0.67 (95% CI: 0.60 to 0.75). CONCLUSIONS: The declined effectiveness of social distancing interventions in reducing COVID-19 transmission was associated with fatigue with voluntary avoidance behaviours in Hong Kong population, implying a need for the government to reinvigorate the public to maintain effective pandemic control.


Assuntos
COVID-19 , Pandemias , Adolescente , Adulto , Aprendizagem da Esquiva , Estudos Transversais , Fadiga/epidemiologia , Fadiga/prevenção & controle , Hong Kong/epidemiologia , Humanos , SARS-CoV-2 , Inquéritos e Questionários , Telefone
10.
Artigo em Inglês | MEDLINE | ID: mdl-34769694

RESUMO

BACKGROUND: Although COVID-19 has affected over 220 countries by October 2021, there is limited research examining the patterns and determinants of adherence to infection control measures over time. AIMS: Our study examines the sociodemographic factors associated with changes in the frequency of adherence to personal hygiene and social distancing behaviors in Hong Kong. METHODS: A serial cross-sectional telephone survey in the general population was conducted during the first (March 2020) (n = 765) and third wave (December 2020) (n = 651) of the local outbreak of the COVID-19 pandemic. Respondents were asked about their level of compliance with various personal hygiene and social distancing recommendations. RESULTS: By the third wave, mask use increased to 100%, and throughout the study periods, >90% practiced frequent hand hygiene. However, adherence to social distancing measures significantly waned over time: avoidance of social gatherings (80.5% to 72.0%), avoidance of public places/public transport (53.3% to 26.0%), avoidance of international travel (85.8% to 76.6%) (p < 0.05). The practice of ordering food takeout/home delivery, however, increased, particularly among high-income respondents. Higher education, female gender and employment status were the most consistently associated factors with adherence to COVID-19 preventive practices in the multivariable models. CONCLUSIONS: In urban areas of this region, interventions to improve personal hygiene in a prolonged pandemic should target males and those with low education. In addition to these groups, the working population needs to be targeted in order to improve adherence to social distancing guidelines.


Assuntos
COVID-19 , Pandemias , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Controle de Infecções , Masculino , SARS-CoV-2 , Inquéritos e Questionários
11.
Int J Public Health ; 66: 603810, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744569

RESUMO

Objectives: This study aimed to estimate the long-term trends of breast cancer incidence in Shanghai, Hong Kong, and Los Angeles (LA). Methods: Data were obtained from Cancer Incidence in Five Continents (CI5plus) database. The average annual percent change (AAPC) was conducted by joinpoint regression analysis, and the age, period and cohort effects were estimated by age-period-cohort (APC) analysis. Results: The age-standardized incidence rates (ASIRs) in LA were higher than Shanghai and Hong Kong. During 1988-2012, the ASIRs significantly decreased in white women in LA (AAPC = -0.6%, 95% CI: -0.9% to -0.4%) while increased in Shanghai (2.5%: 2.1%-2.9%) and Hong Kong (2.2%: 2.0%-2.5%). The APC analysis revealed significantly increased effects of age and period, and decreased effect of birth cohort. Conclusion: Although age and cohort effects were relatively strong, the period effect may be the key factor affecting trends of incidence, which may be caused by increasing exposures to carcinogens and risk factors. Therefore, more effective measures should be carried out promptly to protect high-risk populations such as elder women, to avoid exposures to risk factors of breast cancer.


Assuntos
Neoplasias da Mama , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/história , China/epidemiologia , Estudos de Coortes , Feminino , História do Século XX , História do Século XXI , Hong Kong/epidemiologia , Humanos , Incidência , Los Angeles/epidemiologia , Fatores de Risco
12.
Sci Rep ; 11(1): 22480, 2021 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-34795312

RESUMO

Monitoring community psychological and behavioural responses to coronavirus disease 2019 (COVID-19) is important for informing policy making and risk communication to sustain public compliance with challenging precautionary behaviours and mitigating the psychological impacts. Monthly telephone-based cross-sectional surveys in January-April 2020 and then weekly surveys from May through December 2020 were conducted to monitor changes in public risk perception of COVID-19, personal efficacy in self-protection, confidence in government's ability to control the pandemic, precautionary behaviours, perceived impact of precautionary behaviours, psychological fatigue and distress in Hong Kong, and examine their inter-relationships. While worry about contracting COVID-19 increased, personal efficacy and confidence in government declined as the community incidence of COVID-19 increased. The public maintained high compliance with most precautionary behaviours throughout but relaxed behaviours that were more challenging when disease incidence declined. Public confidence in government was persistently low throughout, of which, a lower level was associated with more psychological fatigue, lower compliance with precautionary behaviours and greater psychological distress. Perceived greater negative impact of precautionary behaviours was also associated with more psychological fatigue which in turn was associated with relaxation of precautionary behaviours. Female, younger and unemployed individuals reported greater psychological distress throughout different stages of the pandemic. Risk communication should focus on promoting confidence in self-protection and pandemic control to avoid helplessness to act when the pandemic resurges. Policy making should prioritize building public trust, enhancing support for sustaining precautionary behaviours, and helping vulnerable groups to adapt to the stress during the pandemic.


Assuntos
Ansiedade , COVID-19 , Comportamentos Relacionados com a Saúde , Pandemias , Angústia Psicológica , SARS-CoV-2 , Adolescente , Adulto , Fatores Etários , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , COVID-19/epidemiologia , COVID-19/psicologia , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
13.
Artigo em Inglês | MEDLINE | ID: mdl-34770053

RESUMO

BACKGROUND: Only a few studies have studied the link between risk perception and sleep in the context of the COVID-19 pandemic. The purpose of our study is to propose and test a theoretical model to understand the relationships between COVID-19 risk appraisals-risk perception and perception of collective coordinated defense (PCCD) in particular-and subjective sleep quality in Chinese adults in Hong Kong during the COVID-19 pandemic. COVID-19-related fear and rumination were examined as potential mediators of the relationships. METHODS: Data were collected using a self-report online questionnaire from a convenience sample of 224 Chinese adults during the fourth wave of the COVID-19 pandemic in Hong Kong. RESULTS: Risk perception and PCCD were found to predict poor sleep quality. Mediation analysis showed that both fear and rumination mediated the relationship between risk perception and sleep quality, whereas only fear mediated the relationship between PCCD and sleep quality. The model was an excellent fit to the data and accounted for 44% of the variance in sleep quality in Chinese adults. This study indicated that both perception of high risks of contracting COVID-19 and anticipations of collective disease preventive efforts had adverse effects on subjective sleep quality via increasing COVID-19-related fear. CONCLUSIONS: These findings underscore the need for addressing sleep problems induced by psychological consequences of the pandemic. While policy makers often deliver public messaging campaigns that frame disease prevention as a collective goal, developing evidence-based coping strategies to combat COVID-19 adverse impacts on psychological health is equally important.


Assuntos
COVID-19 , Pandemias , Adulto , China/epidemiologia , Estudos Transversais , Hong Kong/epidemiologia , Humanos , Percepção , SARS-CoV-2 , Sono
15.
PLoS One ; 16(10): e0258059, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34624047

RESUMO

Given the growing evidence that a range of lifestyle factors are involved in the etiology of depression, a 'lifestyle medicine' approach can be potentially safe and cost-effective to prevent or treat depression. To examine the effects and acceptability of a group-based, integrative lifestyle medicine intervention as a standalone treatment for managing depressive symptoms, a pilot randomized controlled trial (RCT) was conducted in a Chinese adult population in 2018. Participants (n = 31) with PHQ-9 score above the cut-off of ≥ 10, which was indicative of moderate to severe depression, were recruited from the general community in Hong Kong and randomly assigned to lifestyle medicine group (LM group) or care-as-usual group (CAU group) in a ratio of 1:1. Participants in the LM group received 2-hour group sessions once per week for six consecutive weeks, which covered diet, exercise, mindfulness, psychoeducation, and sleep management. Linear mixed-effects model analyses showed that the LM group had a significant reduction in PHQ-9 scores compared to the CAU group at immediate posttreatment and 12-week posttreatment follow-up (d = 0.69 and 0.73, respectively). Moreover, there were significantly greater improvements in anxiety, stress, and insomnia symptoms (measured by DASS-21 and ISI) at all time points in the LM group (d = 0.42-1.16). The results suggests that our 6-week group-based, integrative lifestyle intervention program is effective in lowering depressive, anxiety, stress, and insomnia symptoms in the Chinese population. Further studies in clinical populations with a larger sample size and longer follow-up are warranted.


Assuntos
Ansiedade/terapia , Depressão/terapia , Atenção Plena , Distúrbios do Início e da Manutenção do Sono/terapia , Adulto , Ansiedade/epidemiologia , Ansiedade/patologia , Ansiedade/prevenção & controle , Análise Custo-Benefício , Depressão/epidemiologia , Depressão/patologia , Depressão/psicologia , Terapia por Exercício , Feminino , Hong Kong/epidemiologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/patologia , Distúrbios do Início e da Manutenção do Sono/prevenção & controle
16.
BMC Public Health ; 21(1): 1878, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663279

RESUMO

BACKGROUND: Coronavirus Disease 2019 (COVID-19) led to pandemic that affected almost all countries in the world. Many countries have implemented border restriction as a public health measure to limit local outbreak. However, there is inadequate scientific data to support such a practice, especially in the presence of an established local transmission of the disease. OBJECTIVE: To apply a metapopulation Susceptible-Exposed-Infectious-Recovered (SEIR) model with inspected migration to investigate the effect of border restriction as a public health measure to limit outbreak of coronavirus disease 2019. METHODS: We apply a modified metapopulation SEIR model with inspected migration with simulating population migration, and incorporating parameters such as efficiency of custom inspection in blocking infected travelers in the model. The population sizes were retrieved from government reports, while the number of COVID-19 patients were retrieved from Hong Kong Department of Health and China Centre for Disease Control (CDC) data. The R0 was obtained from previous clinical studies. RESULTS: Complete border closure can help to reduce the cumulative COVID-19 case number and mortality in Hong Kong by 13.99% and 13.98% respectively. To prevent full occupancy of isolation facilities in Hong Kong; effective public health measures to reduce local R0 to below 1.6 was necessary, apart from having complete border closure. CONCLUSIONS: Early complete travel restriction is effective in reducing cumulative cases and mortality. However, additional anti-COVID-19 measures to reduce local R0 to below 1.6 are necessary to prevent COVID-19 cases from overwhelming hospital isolation facilities.


Assuntos
COVID-19 , Hong Kong/epidemiologia , Humanos , Pandemias , SARS-CoV-2 , Viagem
17.
BMJ Open ; 11(10): e055575, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635536

RESUMO

OBJECTIVES: To compare the incidence and severity of invasive pneumococcal diseases (IPDs), pneumococcal pneumonia and all-cause pneumonia during the COVID-19 pandemic period with universal masking and social distancing with that of previous 5 years. DESIGN: Retrospective observational study on incidence of IPDs, pneumococcal pneumonia and all-cause pneumonia between January 2015-December 2019 and March 2020-March 2021. January-February 2020 was excluded from analysis as it was treated as a transitional period between normal time and pandemic. SETTING: Episode-based data by retrieval of hospitalisation records from the Hospital Authority's territory-wide electronic medical record database in Hong Kong. PARTICIPANTS: Hospitalised patients with IPD (n=742), pneumococcal pneumonia (n=2163) and all-cause pneumonia (including COVID-19 pneumonia, n=453 999) aged 18 years or above. Control diagnoses were included to assess confounding from health-seeking behaviours. PRIMARY AND SECONDARY OUTCOMES: Primary outcome is the incidence of diseases between two periods. Secondary outcomes include disease severity surrogated by length of stay and mortality. RESULTS: Monthly average number of IPD, pneumococcal pneumonia and all-cause pneumonia hospitalisation significantly decreased by 88.9% (95% CI 79.8% to 98.0%, p<0.0005), 72.5% (95% CI 65.9% to 79.1%, p<0.0005) and 17.5% (95% CI 16.8% to 18.2%, p<0.0005), respectively. Changes in trend from January 2015-December 2019 to March 2020-March 2021 were -70% (95% CI -87% to -35%, p=0.0025), -43% (95% CI -59% to -19%, p=0.0014) and -11% (95% CI -13% to -10%, p<0.0005), respectively. Length of stay for IPD and pneumococcal pneumonia episodes were insignificantly different in the two periods. No reductions in hospitalisations for control diagnoses were observed. CONCLUSIONS: Incidence of IPD, pneumococcal pneumonia and all-cause pneumonia decreased during the COVID-19 pandemic. This was observed with universal masking and social distancing. We postulated this is related to reduced transmission of respiratory viruses and bacteria.


Assuntos
COVID-19 , Infecções Pneumocócicas , Pneumonia Pneumocócica , Hong Kong/epidemiologia , Humanos , Incidência , Pandemias , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas , Pneumonia Pneumocócica/epidemiologia , SARS-CoV-2
20.
BMJ Open ; 11(10): e052310, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670765

RESUMO

OBJECTIVES: To investigate the association between baseline use of glucose-lowering drugs and serious clinical outcome among patients with type 2 diabetes. DESIGN: Territory-wide retrospective cohort of confirmed cases of COVID-19 between January 2020 and February 2021. SETTING: All public health facilities in Hong Kong. PARTICIPANTS: 1220 patients with diabetes who were admitted for confirmed COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Composite clinical endpoint of intensive care unit admission, requirement of invasive mechanical ventilation and/or in-hospital death. RESULTS: In this cohort (median age 65.3 years, 54.3% men), 737 (60.4%) patients were treated with metformin, 385 (31.6%) with sulphonylureas, 199 (16.3%) with dipeptidyl peptidase-4 (DPP-4) inhibitors and 273 (22.4%) with insulin prior to admission. In multivariate Cox regression, use of metformin and DPP-4 inhibitors was associated with reduced incidence of the composite endpoint relative to non-use, with respective HRs of 0.51 (95% CI 0.34 to 0.77, p=0.001) and 0.46 (95% CI 0.29 to 0.71, p<0.001), adjusted for age, sex, diabetes duration, glycated haemoglobin (HbA1c), smoking, comorbidities and drugs. Use of sulphonylureas (HR 1.55, 95% CI 1.07 to 2.24, p=0.022) and insulin (HR 6.34, 95% CI 3.72 to 10.78, p<0.001) were both associated with increased hazards of the composite endpoint. CONCLUSIONS: Users of metformin and DPP-4 inhibitors had fewer adverse outcomes from COVID-19 compared with non-users, whereas insulin and sulphonylurea might predict a worse prognosis.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Inibidores da Dipeptidil Peptidase IV , Metformina , Preparações Farmacêuticas , Idoso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Glucose , Hong Kong/epidemiologia , Mortalidade Hospitalar , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Metformina/uso terapêutico , Estudos Retrospectivos , SARS-CoV-2
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