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1.
Ann Fam Med ; 19(1): 48-54, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33431392

RESUMO

Hong Kong, Singapore, and Beijing have some of the highest numbers of international arrivals and densest living spaces globally, yet these cities have reported low numbers of deaths amid the coronavirus disease 2019 (COVID-19) outbreak. Primary care has played different roles in each of the health systems in combatting the pandemic. Both Hong Kong and Singapore have a 2-tiered health system with the majority of primary care provided in the private sector. The primary care system in Beijing consists of community health facilities, township health centers, and village clinics. The role of primary care in Hong Kong includes using the public primary care clinics as part of an enhanced surveillance program together with accident and emergency departments, as well as triaging patients with suspected infection to hospitals. Singapore's response to COVID-19 has included close cooperation between redeveloped polyclinics and private and public health preparedness clinics to provide screening with swab tests for suspected cases in the primary care setting. Beijing's unique response has consisted of using online platforms for general practitioners to facilitate monitoring among community residents, as well as public health education and a mobilized pharmacy refill program to reduce risk of transmission. Established challenges, however, include shortages of personal protective equipment and the heavy workload for health care staff. Regardless, all 3 cities have demonstrated enhanced preparedness since experiencing the severe acute respiratory syndrome epidemic, and the responses of their primary care systems therefore may offer learning points for other countries during the COVID-19 pandemic.


Assuntos
Assistência à Saúde/métodos , Atenção Primária à Saúde/métodos , Pequim/epidemiologia , Hong Kong/epidemiologia , Humanos , Singapura/epidemiologia
2.
Nat Commun ; 12(1): 63, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397909

RESUMO

The SARS-CoV-2 pandemic poses the greatest global public health challenge in a century. Neutralizing antibody is a correlate of protection and data on kinetics of virus neutralizing antibody responses are needed. We tested 293 sera from an observational cohort of 195 reverse transcription polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 infections collected from 0 to 209 days after onset of symptoms. Of 115 sera collected ≥61 days after onset of illness tested using plaque reduction neutralization (PRNT) assays, 99.1% remained seropositive for both 90% (PRNT90) and 50% (PRNT50) neutralization endpoints. We estimate that it takes at least 372, 416 and 133 days for PRNT50 titres to drop to the detection limit of a titre of 1:10 for severe, mild and asymptomatic patients, respectively. At day 90 after onset of symptoms (or initial RT-PCR detection in asymptomatic infections), it took 69, 87 and 31 days for PRNT50 antibody titres to decrease by half (T1/2) in severe, mild and asymptomatic infections, respectively. Patients with severe disease had higher peak PRNT90 and PRNT50 antibody titres than patients with mild or asymptomatic infections. Age did not appear to compromise antibody responses, even after accounting for severity. We conclude that SARS-CoV-2 infection elicits robust neutralizing antibody titres in most individuals.


Assuntos
Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , /imunologia , Adolescente , Adulto , Animais , Anticorpos Antivirais/sangue , /epidemiologia , Chlorocebus aethiops , Estudos de Coortes , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Pandemias , Células Vero , Adulto Jovem
3.
J Sex Med ; 18(1): 29-34, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33223429

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak has fundamentally changed daily routine, including sexual activity. However, most research on sexual activity during the COVID-19 pandemic focused on heterosexual individuals. The only study so far on men who have sex with men was conducted in the United States. AIM: Our study expands the understanding of sexual activity during the COVID-19 pandemic by studying gay and bisexual men in Hong Kong. Although sexual desire and sexual activity continue to be important aspects of one's life during the COVID-19 pandemic, there are COVID-19-related barriers to having sex. This study therefore examined the association between sexual desire, COVID-19-related barriers, and whether to engage in sexual activity or not during the COVID-19 pandemic. METHODS: 857 cisgender sexual minority people in Hong Kong participated in an online survey study, and for this article, only male participants were included in the analysis, yielding an analytical sample of 376 gay and bisexual men. OUTCOMES: Participants were asked to assess their sexual desire (ie, sexual drive and sexual motivation), COVID-19-related barriers (ie, perceived difficulties to have sex with another person during the pandemic and perceived risk of COVID-19 infection), and sexual activity during the COVID-19 pandemic. RESULTS: It was found that while sexual desire remained prevalent among the gay and bisexual men, COVID-19-related barriers were also commonly observed. Sexual drive and sexual motivation were positively associated with sexual activity. Perceived difficulties to have sex with another person during the pandemic and perceived risk of COVID-19 infection were negatively predictive of engaging in sexual activity, after controlling for general sexual desire. CLINICAL IMPLICATIONS: Understanding the ambivalence and driving and inhibiting factors for having sex during the COVID-19 pandemic can provide a new framework for understanding people's sexual activity during an unprecedented scale of the pandemic. It is likely that abstinence would not work as the respondents expressed strong sexual desire and that the pandemic is going to last for a long time. Governments, policy makers, and sexual scientists need to work together to come up with practicable, feasible, and easy-to-follow guidelines for having sex during the pandemic. STRENGTH & LIMITATIONS: This is one of the first studies to examine the impact of COVID-19 on sexual activity among gay and bisexual men. The results should be interpreted with caution because of the use of cross-sectional design and nonprobability sampling. CONCLUSION: Sexual desire and COVID-19-related barriers serve as driving and inhibiting factors in explaining whether or not people have sex during the COVID-19 pandemic. Suen YT, Chan RCH, Wong EMY. To Have or Not to Have Sex? COVID-19 and Sexual Activity Among Chinese-Speaking Gay and Bisexual Men in Hong Kong. J Sex Med 2021;18:29-34.


Assuntos
Minorias Sexuais e de Gênero , Grupo com Ancestrais do Continente Asiático , Bissexualidade , Estudos Transversais , Homossexualidade Masculina , Hong Kong/epidemiologia , Humanos , Masculino , Pandemias , Comportamento Sexual , Estados Unidos
4.
Emerg Infect Dis ; 27(1): 196-204, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33350913

RESUMO

Initial cases of coronavirus disease in Hong Kong were imported from mainland China. A dramatic increase in case numbers was seen in February 2020. Most case-patients had no recent travel history, suggesting the presence of transmission chains in the local community. We collected demographic, clinical, and epidemiologic data from 50 patients, who accounted for 53.8% of total reported case-patients as of February 28, 2020. We performed whole-genome sequencing to determine phylogenetic relationship and transmission dynamics of severe acute respiratory syndrome coronavirus 2 infections. By using phylogenetic analysis, we attributed the community outbreak to 2 lineages; 1 harbored a common mutation, Orf3a-G251V, and accounted for 88.0% of the cases in our study. The estimated time to the most recent common ancestor of local coronavirus disease outbreak was December 24, 2019, with an evolutionary rate of 3.04 × 10-3 substitutions/site/year. The reproduction number was 1.84, indicating ongoing community spread.


Assuntos
/epidemiologia , Surtos de Doenças , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Evolução Molecular , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Filogenia , Filogeografia , /isolamento & purificação , Sequenciamento Completo do Genoma , Adulto Jovem
5.
Psychiatry Res ; 295: 113593, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33276269

RESUMO

The COVID-19 crisis has resulted in disruption of everyday life worldwide but the impact and response to the pandemic have not been uniform. Many countries rapidly deployed physical-distancing mandates to curb the spread of the virus; others did not. Social distancing strategies are necessary to reduce the transmission of the virus but there may be unintended consequences. We examined psychological distress in four societies with distinct public health strategies (South Korea, Hong Kong, France and the United States) to identify common and region-specific factors that may contribute to mental health outcome during the pandemic. From March to July of 2020, a survey of demographics, general health, mental health, loneliness and social networks was conducted. Overall, younger age, greater concern for COVID, and more severe loneliness predicted worse psychological outcome but the magnitudes of these effects varied across the four regions. Objective measures of social isolation did not affect mental health. There were also notable differences in psychological outcome; Hong Kong, with very strict social distancing protocols plus ongoing political unrest, suffered the most drastic deterioration of mental health. To prepare for an impending mental health crisis, concerted efforts to reduce loneliness should be integrated into a comprehensive public health strategy.


Assuntos
/prevenção & controle , Comparação Transcultural , Solidão , Saúde Mental/estatística & dados numéricos , Rede Social , Estresse Psicológico/epidemiologia , Adulto , Feminino , França/epidemiologia , Hong Kong/epidemiologia , Humanos , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estados Unidos/epidemiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-33260472

RESUMO

This study examined the associations of perceived social capital and income change since the outbreak with probable depression and preventive behaviors during the COVID-19 pandemic in Hong Kong. Random digit dialing recruited a population-representative sample of 3011 Hong Kong Chinese aged ≥ 15 years (mean = 44, 55% females) between February 25 and April 29 2020. Respondents reported social capital (perceived interpersonal trust, social harmony, and sense of belonging), income change since the outbreak (loss vs. gain/no change), depressive symptoms, preventive behaviors, and demographics. Controlling for sociodemographics, lack of perceived interpersonal trust was associated with probable depression and avoiding contact with people with respiratory symptoms. Lack of perceived sense of belonging was associated with probable depression and decreased odds of adopting preventive behaviors. Lack of perceived social harmony was associated with probable depression and increased odds of used face masks among respondents with income loss only. Our results suggest that social capital is related to lower risk of depression and to higher chance of used face masks particularly among those experiencing income loss related to COVID-19. Prevention of mental health problems and promotion of effective preventive behaviors could be implemented by focusing on support for those who are socioeconomically disadvantaged.


Assuntos
/economia , Renda , Pandemias , Capital Social , /prevenção & controle , Depressão/epidemiologia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Apoio Social , Confiança
7.
PLoS One ; 15(12): e0244351, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382758

RESUMO

The COVID-19 pandemic is currently spreading widely around the world, causing huge threats to public safety and global society. This study analyzes the spatiotemporal pattern of the COVID-19 pandemic in China, reveals China's epicenters of the pandemic through spatial clustering, and delineates the substantial effect of distance to Wuhan on the pandemic spread. The results show that the daily new COVID-19 cases mostly occurred in and around Wuhan before March 6, and then moved to the Grand Bay Area (Shenzhen, Hong Kong and Macau). The total COVID-19 cases in China were mainly distributed in the east of the Huhuanyong Line, where the epicenters accounted for more than 60% of the country's total in/on 24 January and 7 February, half in/on 31 January, and more than 70% from 14 February. The total cases finally stabilized at approximately 84,000, and the inflection point for Wuhan was on 14 February, one week later than those of Hubei (outside Wuhan) and China (outside Hubei). The generalized additive model-based analysis shows that population density and distance to provincial cities were significantly associated with the total number of the cases, while distances to prefecture cities and intercity traffic stations, and population inflow from Wuhan after 24 January, had no strong relationships with the total number of cases. The results and findings should provide valuable insights for understanding the changes in the COVID-19 transmission as well as implications for controlling the global COVID-19 pandemic spread.


Assuntos
/epidemiologia , Modelos Biológicos , Pandemias , Cidades/epidemiologia , Hong Kong/epidemiologia , Humanos , Macau/epidemiologia , Análise Espacial
8.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33305559

RESUMO

To the Editor The COVID-19 pandemic has been consistently on the rise across the globe. The recovered patients getting long-term sequelae, especially lung fibrosis and residual neurological deficits, is an area of concern. Another extremely important conundrum is the risk of re-infection. It has been recently documented from Hong Kong  and puts an unpleasant question mark on long term immunity, sampling technique standardization, viral mutation and efficacy of herd immunity. There are definitions for COVID -19 infection and its severity, but unfortunately none for re-infection.


Assuntos
/virologia , Saúde Pública/normas , /genética , /epidemiologia , Portador Sadio , Genótipo , Hong Kong/epidemiologia , Humanos , Imunidade Coletiva/fisiologia , Mutação , Risco , Índice de Gravidade de Doença , Carga Viral/genética
10.
Artigo em Inglês | MEDLINE | ID: mdl-33322751

RESUMO

The coronavirus (COVID-19) pandemic has adversely affected individuals' mental health. Social isolation as a result of social distancing during the pandemic potentially affects the associations among perceived available peer support, emotional well-being, and depression in university students. The present study examined the associations among university students' perceived available peer support, emotional well-being (as indicated negatively by loneliness and negative affects and positively by positive affects and hope), and depressive symptoms. During the third wave of the COVID-19 outbreak in July, 2020, 255 students at a public university in Hong Kong participated in an online-based survey that assessed their perceived available peer support, emotional well-being, and depressive symptoms. Results showed that perceived available peer support negatively contributed to depressive symptoms; both negative and positive indicators of emotional well-being mediated the association between perceived available peer support and depressive symptoms. Our results also suggested that university students showed signs of elevated depressive symptoms during the pandemic. Thus, our study advanced the theoretical understanding of university students' mental health in the time of a global pandemic. Our study also highlighted the practical needs for preventive efforts and accessible care to support the psychological and emotional needs of young people during the COVID-19 pandemic.


Assuntos
/psicologia , Depressão , Saúde Mental , Apoio Social , Estudantes/psicologia , Adolescente , Adulto , Depressão/epidemiologia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pandemias , Grupo Associado , Universidades , Adulto Jovem
11.
BMJ Open ; 10(11): e041191, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33203637

RESUMO

OBJECTIVES: Globally, the COVID-19 pandemic has overwhelmed many healthcare systems, which has hampered access to routine clinical care during lockdowns. Informal home care, care provided by non-healthcare professionals, increases the community's healthcare capacity during pandemics. There is, however, limited research about the characteristics of informal home care providers and the challenges they face during such public health emergencies. DESIGN: A random, cross-sectional, population-based, RDD, telephone survey study was conducted to examine patterns of home care, characteristics of informal home care providers and the challenges experienced by these care providers during this pandemic. SETTING: Data were collected from 22 March to 1 April 2020 in Hong Kong, China. PARTICIPANTS: A population representative study sample of Chinese-speaking adults (n=765) was interviewed. PRIMARY AND SECONDARY OUTCOME MEASURES: The study examined the characteristics of informal home care providers and self-reported health requirements of those who needed care. The study also examined providers' self-perceived knowledge to provide routine home care as well as COVID-19 risk reduction care. Respondents were asked of their mental health status related to COVID-19. RESULTS: Of the respondents, 25.1% of 765 provided informal home care during the studied COVID-19 pandemic period. Among the informal home care providers, 18.4% of respondents took leave from school/work during the epidemic to provide care for the sick, fragile elderly and small children. Care providers tended to be younger aged, female and housewives. Approximately half of care providers reported additional mental strain and 37.2% reported of challenges in daily living during epidemic. Although most informal home care providers felt competent to provide routine care, 49.5% felt inadequately prepared to cope with the additional health risks of COVID-19. CONCLUSION: During public health emergencies, heavy reliance on informal home healthcare providers necessitates better understanding of their specific needs and increased government services to support informal home care.


Assuntos
Adaptação Psicológica , Pessoal de Saúde/psicologia , Serviços de Assistência Domiciliar , Assistência ao Paciente/métodos , Vigilância da População , Idoso , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pandemias
12.
Arch Osteoporos ; 15(1): 176, 2020 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-33159570

RESUMO

MrOS MsOS (Hong Kong) studies year 14 follow-up shows for subjects without baseline osteoporotic vertebral deformity, women's incident vertebral fracture (VF) rate was twice that of men. For subjects with vertebral deformity of baseline ≥ 20% height loss, counting subject, women's incident VF rate was three times higher than that of men. INTRODUCTION: For MrOS MsOS (Hong Kong) baseline (BL) studies, 2000 men and 2000 women ≥ 65 years were recruited during 2001 to 2003. This study presents the year 14 follow-up (FU). MATERIALS: Whole spine MRI was performed in 271 males (mean, 82.8 ± 3.6 years) and 150 females (mean, 82.0 ± 4.29 years). Osteoporotic vertebral deformity (OVD) classification included no OVD (grade 0), and OVDs with < 20%, 20~25%, > 25%~1/3, > 1/3~40%, > 40%~2/3, and > 2/3 height loss (grade 1~6). With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade 0 to ≥ grade 2 or to grade 1 with ≥ 10% height loss. OVD progression and new incident OVD were considered incident VF. RESULTS: The proportion of osteoporotic subjects only slightly increased during FU for men but doubled for women. Groupwise, OVD was not associated with back pain in men; but OVD with > 1/3 height loss was associated with back pain in women. For subjects without BL OVD, 7.9% of men and 14.6% of women had incident VF. For subjects with BL OVD of ≥ 20% height loss, men's and women's incident VF were 17.6% and 52.6%, respectively, counting subject and 1.68% and 7.89%, respectively, counting vertebra. CONCLUSION: Elderly men with or without existing osteoporotic VD have much lower future VF risk than elderly women.


Assuntos
Fraturas por Osteoporose , Radiologia , Fraturas da Coluna Vertebral , Idoso , Densidade Óssea , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-33153082

RESUMO

The COVID-19 pandemic negatively impacts psychological well-being (e.g., anxiety symptoms) among the general population of Hong Kong and migrant Filipina domestic helpers (FDHs). Having to live with the employers by law, FDHs' working environment might affect their well-being during COVID-19 (e.g., household crowdedness/size, insufficiency of protective equipment against COVID-19, increased workload). Research has suggested that coping resources (e.g., social support, COVID-19-related information literacy) and COVID-19-specific worries are associated with people's well-being during COVID-19. This study examined the psychosocial correlates of probable anxiety among FDHs in Hong Kong amid the COVID-19 pandemic. By purposive sampling, FDHs (n = 295) were recruited and invited to complete a cross-sectional survey. Participants' working environment (crowdedness, household size), COVID-19 job arrangements (workload, provision of protective equipment), coping resources (social support, COVID-19 information literacy), COVID-19-specific worries (contracting COVID-19, getting fired if contracting COVID-19), and anxiety symptoms were measured. Multivariate regression results showed that the insufficiency of protective equipment (OR = 1.58, 95%CI: 1.18, 2.11), increased workload (OR = 1.51, 95%CI: 1.02, 2.25), and worries about being fired if getting COVID-19 (OR = 1.32, 95%CI: 1.04, 1.68) were significantly associated with probable anxiety. This was one of the earliest studies to indicate that job arrangements and COVID-19-specific worries significantly contributed to FDHs' anxiety symptoms. Our findings shed light on the importance of addressing employment-related rights and pandemic-specific worries through interventions among FDHs in Hong Kong during pandemic situations.


Assuntos
Ansiedade/etnologia , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Adolescente , Adulto , Betacoronavirus , Estudos Transversais , Aglomeração , Características da Família , Hong Kong/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias , Filipinas/etnologia , Adulto Jovem
14.
BMC Geriatr ; 20(1): 442, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143635

RESUMO

BACKGROUND: The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. METHODS: This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective. RESULTS: A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51-4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47-8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22-3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01-0.73). CONCLUSIONS: While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.


Assuntos
Setor Privado , Setor Público , Idoso , Estudos Transversais , Hong Kong/epidemiologia , Humanos , Atenção Primária à Saúde
15.
Artigo em Inglês | MEDLINE | ID: mdl-33202764

RESUMO

Tobacco use is a possible risk factor for contracting and spreading COVID-19. We aimed to describe the impact of the COVID-19 pandemic on the Youth Quitline service and quitting behaviors of its users in Hong Kong. We conducted a telephone survey involving 201 participants of the Youth Quitline service, and retrospectively analyzed the operation and use of Quitline since the COVID-19 outbreak in Hong Kong. The number of incoming calls to the Youth Quitline and the participants' quit rate has increased since the COVID-19 outbreak in Hong Kong. Many participants (68%) did not realize that tobacco use potentially increased their risk for developing and spreading COVID-19; however, 43% agreed that the pandemic motivated their intention to quit, and 83% changed their smoking habits during the pandemic. These changes were mainly due to wearing masks (30%), closure of bars/pubs (25%), suspension of classes (14%), and being unable to socialize with friends (24%). Overall, 58% reduced their tobacco use; of these participants, 66% reported a ≥50% reduction in daily cigarette consumption. The participants reduced their smoking during the COVID-19 pandemic despite lacking knowledge about the potentially increased risk for contracting COVID-19 from continued smoking. The pandemic could create new opportunities to motivate young smokers to quit smoking, especially those seeking support for smoking cessation, and may further contribute to reducing the risks posed by COVID-19.


Assuntos
Infecções por Coronavirus , Linhas Diretas/estatística & dados numéricos , Pandemias , Pneumonia Viral , Abandono do Hábito de Fumar/estatística & dados numéricos , Betacoronavirus , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
16.
Virol J ; 17(1): 183, 2020 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-33225958

RESUMO

Coronavirus disease 2019 (COVID-19) pandemic has been a catastrophic burden to global healthcare systems. The fast spread of the etiologic agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), highlights the need to identify unknown coronaviruses rapidly for prompt clinical and public health decision making. Moreover, owing to the high mutation rate of RNA viruses, periodic surveillance on emerging variants of key virus components is essential for evaluating the efficacy of antiviral drugs, diagnostic assays and vaccines. These 2 knowledge gaps formed the basis of this study. In the first place, we evaluated the feasibility of characterizing coronaviruses directly from respiratory specimens. We amplified partial RdRP gene, a stable genetic marker of coronaviruses, from a collection of 57 clinical specimens positive for SARS-CoV-2 or other human coronaviruses, and sequenced the amplicons with Nanopore Flongle and MinION, the fastest and the most scalable massively-parallel sequencing platforms to-date. Partial RdRP sequences were successfully amplified and sequenced from 82.46% (47/57) of specimens, ranging from 75 to 100% by virus type, with consensus accuracy of 100% compared with Sanger sequences available (n = 40). In the second part, we further compared 19 SARS-CoV-2 RdRP sequences collected from the first to third waves of COVID-19 outbreak in Hong Kong with 22,173 genomes from GISAID EpiCoV™ database. No single nucleotide variants (SNVs) were found in our sequences, and 125 SNVs were observed from global data, with 56.8% being low-frequency (n = 1-47) missense mutations affecting the rear part of RNA polymerase. Among the 9 SNVs found on 4 conserved domains, the frequency of 15438G > T was highest (n = 34) and was predominantly found in Europe. Our data provided a glimpse into the sequence diversity of a primary antiviral drug and diagnostic target. Further studies are warranted to investigate the significance of these mutations.


Assuntos
/virologia , /genética , /diagnóstico , Coronavirus/genética , Monitoramento Epidemiológico , Estudos de Viabilidade , Genoma Viral/genética , Hong Kong/epidemiologia , Humanos , Mutação de Sentido Incorreto , Sequenciamento por Nanoporos , /isolamento & purificação
17.
Emerg Microbes Infect ; 9(1): 2588-2596, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33138739

RESUMO

ABSTRACT As another wave of COVID-19 outbreak has approached in July 2020, a larger scale COVID-19 pediatric Asian cohort summarizing the clinical observations is warranted. Children confirmed with COVID-19 infection from the Republic of Korea, the Hong Kong Special Administrative Region (HKSAR) and Wuhan, China, during their first waves of local outbreaks were included. Their clinical characteristics and the temporal sequences of the first waves of local paediatric outbreaks were compared. Four hundred and twenty three children with COVID-19 were analyzed. Wuhan had the earliest peak, followed by Korea and HKSAR. Compared with Korea and Wuhan, patients in HKSAR were significantly older (mean age: 12.9 vs. 10.8 vs. 6.6 years, p < 0.001, respectively) and had more imported cases (87.5% vs. 16.5% vs. 0%, p < 0.001, respectively). The imported cases were also older (13.4 vs. 7.6 years, p < 0.001). More cases in HKSAR were asymptomatic compared to Korea and Wuhan (45.5% vs. 22.0% vs. 20.9%, p < 0.001, respectively), and significantly more patients from Wuhan developed fever (40.6% vs. 29.7% vs. 21.6%, p=0.003, respectively). There were significantly less imported cases than domestic cases developing fever after adjusting for age and region of origin (p = 0.046). 5.4% to 10.8% of patients reported anosmia and ageusia. None developed pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PMIS-TS). In general, adolescents were more likely to be asymptomatic and less likely to develop fever, but required longer hospital stays. In conclusion, majority patients in this pediatric Asian cohort had a mild disease. None developed PIMS-TS. Their clinical characteristics were influenced by travel history and age.


Assuntos
/epidemiologia , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , República da Coreia/epidemiologia
19.
PLoS Med ; 17(10): e1003367, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33007052

RESUMO

BACKGROUND: Diabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings. METHODS AND FINDINGS: The web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1-4, low-high), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured evaluation (blood/urine/eye/feet) in public and private outpatient clinics and diabetes centers in Hong Kong. We retrospectively analyzed the data of 16,624 Han Chinese patients with type 2 diabetes who were enrolled in 2007-2015. In the public setting, the non-JADE group (n = 3,587) underwent structured evaluation for risk factors and complications only, while the JADE (n = 9,601) group received a JADE report with group empowerment by nurses. In a community-based, nurse-led, university-affiliated diabetes center (UDC), the JADE-Personalized (JADE-P) group (n = 3,436) received a JADE report, personalized empowerment, and annual telephone reminder for reevaluation and engagement. The primary composite outcome was time to the first occurrence of cardiovascular-renal diseases, all-site cancer, and/or death, based on hospitalization data censored on 30 June 2017. During 94,311 person-years of follow-up in 2007-2017, 7,779 primary events occurred. Compared with the JADE group (136.22 cases per 1,000 patient-years [95% CI 132.35-140.18]), the non-JADE group had higher (145.32 [95% CI 138.68-152.20]; P = 0.020) while the JADE-P group had lower event rates (70.94 [95% CI 67.12-74.91]; P < 0.001). The adjusted hazard ratios (aHRs) for the primary composite outcome were 1.22 (95% CI 1.15-1.30) and 0.70 (95% CI 0.66-0.75), respectively, independent of risk profiles, education levels, drug usage, self-care, and comorbidities at baseline. We reported consistent results in propensity-score-matched analyses and after accounting for loss to follow-up. Potential limitations include its nonrandomized design that precludes causal inference, residual confounding, and participation bias. CONCLUSIONS: ICT-assisted integrated care was associated with a reduction in clinical events, including death in type 2 diabetes in public and private healthcare settings.


Assuntos
Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Adulto , Estudos de Coortes , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Autocuidado/métodos , Resultado do Tratamento
20.
Artigo em Inglês | MEDLINE | ID: mdl-33092052

RESUMO

Eczema is a multifactorial skin disease that affects 20% of children worldwide and has a complex relationship with microbial, nutritional, parental and environmental factors. In this study, we investigated the potential association of eczema with the gut microbiome and environmental factors. One hundred and fifty-two newborn subjects and their mothers were recruited within 10 days postnatally at the Prince of Wales Hospital in Hong Kong, China and asked to complete questionnaires on allergies, maternal diet and environmental assessment at enrolment. Then, the participants were classified as with or without eczema at four months after birth based on the Comprehensive Early Childhood Allergy Questionnaire (CECAQ) and SCORing Atopic Dermatitis (SCORAD) index (n = 48, with 24 in each group). Stool samples were collected from both groups at the same time. Microbial DNA was extracted from each stool sample, and 16S rRNA sequencing was performed to analyze the gut microbiome profiles of the subjects. Our results indicated that the abundance of Bifidobacterium was significantly higher in the eczema group than in the control group (p = 0.04). A multivariable logistic regression analysis was conducted, and the results showed that the father's education level and maternal intake of cereal products and nutritional supplements during pregnancy were associated with the development of eczema (p = 0.008, 0.032 and 0.015, respectively). In conclusion, this study provided preliminary information about the potential risk factors of eczema development in Hong Kong infants in support of a future full study.


Assuntos
Eczema , Microbioma Gastrointestinal , China , Eczema/epidemiologia , Eczema/microbiologia , Feminino , Hong Kong/epidemiologia , Humanos , Lactente , Masculino , Projetos Piloto , Gravidez , RNA Ribossômico 16S
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