SARS: public health measures in Hong Kong

As there are no validated and rapid diagnostic tests nor specific treatment for severe acute respiratory syndrome (SARS) at the initial stage of the outbreak, public health measures are vital for the control of the disease. These included an enhanced disease surveillance system, expanded laboratory diagnostic capacity, heightened infection control in hospitals and residential institutions for the elderly, intensive contact tracing coupled with medical surveillance at designated medical centres, quarantine of close contacts by way of home confinement, formation of multidisciplinary investigation and response teams, and public education and communication. The above measures were implemented in many countries during the outbreak. To prevent spread in the region and beyond, port health measures targeted at both entry and exit health screenings were also carried out together with regional and international liaison.     

Weather,pollution, and acute myocardial infarction in Hong Kong and Taiwan

Background

Several previous studies examined the association between acute myocardial infarction (AMI) incidence and temperature and/or air pollution. Results of these studies have been inconsistent and few studies have been done in cities with sub-tropical or tropical climates.

Methods

Daily data on AMI hospitalizations, mean temperature and humidity, and pollutants, were collected for 2000–2009 for three warm-climate Asian cities. Poisson Generalized Additive Models were used to regress daily AMI counts on temperature, humidity, and pollutants while controlling for day of the week, long-term trends and seasonal effects. Smoothing splines allowing non-linear associations were used for temperature and humidity while pollutants were modeled as linear terms.

Results

A 1 °C drop below a threshold temperature of 24 °C was significantly (p < .0001) associated with AMI hospitalization increases of 3.7% (average lag 0–13 temperature) in Hong Kong, 2.6% (average lag 0–15) in Taipei, and 4.0% (average lag 0–11) in Kaohsiung. No significant heat effects were observed. Among pollutants same day nitrogen dioxide (NO₂) levels were the strongest predictors in all three cities, with a 10 mg/m³ increase in NO₂ being associated with a 1.1% rise in AMI hospitalization in Hong Kong, and a 10 ppb rise being associated with 4.4% and 2.6% rises in Taipei and Kaohsiung, respectively.

Conclusions

Cool temperatures and higher NO₂ levels substantially raised AMI risk in these warm-climate cities and the effect sizes we observed were stronger than those found in previous studies. More attention should be paid to the health dangers of cold weather in warm-climate cities.     

Severe acute respiratory syndrome (SARS) in Hong Kong

Severe acute respiratory syndrome (SARS) is a recently recognized and highly contagious pneumonic illness, caused by a novel coronavirus. While developments in diagnostic, clinical and other aspects of SARS research are well underway, there is still great difficulty for frontline clinicians as validated rapid diagnostic tests or effective treatment regimens are lacking. This article attempts to summarize some of the recent developments in this newly recognized condition from the Asia Pacific perspective.     

SARS: retrospective cohort study among German guests of the Hotel 'M', Hong Kong

Hong Kong played a pivotal role in the international spread of the Severe Acute Respiratory Syndrome (SARS): a doctor who spent the night of 21-22 February 2003 at Hotel 'M' was identified as the index case for four national and international clusters of SARS. In parallel to the international collaborative study led by WHO and United States, a retrospective study on the cohort of German persons staying at Hotel 'M' was conducted. The inclusion criteria covered a period from 21 February to 3 March 2003 to allow the detection of cases possibly due to environmental contamination. In the twenty-one German guests traced as having stayed at Hotel "M" during this period, one case of laboratory confirmed SARS was found. The case history suggests that close vicinity to the index patient may have played a role in transmission. In line with findings of environmental investigations in the hotel, environmental contamination should be considered as a possible source of infection.     

Prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong, and Taiwan

This article reviews and describes trends and differences in prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong and Taiwan based on literatures published in the MEDLINE Advanced database (January 1966-October 2005) in both Chinese and English languages. Chinese populations in Hong Kong and Taiwan have significant higher prevalence rates of diabetes than their Mainland counterparts, with odds ratios 1.5 (95% confidence intervals: 1.4, 1.7) and 2.0 (95% confidence intervals: 1.8, 2.2), respectively in 1995-2003 adjusted for age and diagnostic criteria. Using stratified diagnostic criteria; the odds ratios in Hong Kong and Taiwan were consistently higher than Mainland China for the periods of 1985-1994 and 1995-2003. A large proportion, i.e. 68.6% (95% confidence intervals: 67.4%, 69.7%) of diabetic patients remains undiagnosed in Mainland China as compared to 52.6% (95% confidence intervals: 49.8%, 55.5%) undiagnosed in Hong Kong and Taiwan. The prevalence rates of diabetes and impaired glucose tolerance of the Chinese populations rise in older age groups. In tandem with economic development and change toward lifestyle that is lack of physical activity and rich in high-fat diet, prevalence of diabetes of the Chinese populations are on the rise. If the undiagnosed individuals left uncontrolled, they are subject to higher risks of developing diabetes and its complications. These will increase the burdens of diabetes medically and financially.     

Prevalence of subclinical infection by the SARS coronavirus among general practitioners in Hong Kong

Eight general practitioners had severe acute respiratory distress syndrome (SARS) in Hong Kong during the epidemic, and others may have been infected by the SARS coronavirus without developing the full syndrome. We conducted a serological and questionnaire survey to determine the prevalence of subclinical infection by SARS coronavirus among general practitioners in Hong Kong. Participants had to be doctors actively practising in family medicine and who did not have SARS. Approximately 3200 general practitioners were invited to participate and the results of 574 were eligible for analysis. 29 samples were tested positive by enzyme-linked immunosorbent assay, but all these samples had titre < 25 by immunoflorescence assay. The prevalence for seropositivity was thus 0% (95% CI, 0.0%-0.6%). This finding documents the lack of subclinical infection by SARS coronavirus in an at-risk group in the community.     

Tuberculosis in older people: a retrospective and comparative study from Hong Kong

OBJECTIVES: To compare tuberculosis (TB) in older and younger patients. DESIGN: A retrospective and comparative observational study. SETTING: Four chest clinics and two chest hospitals in Hong Kong. PARTICIPANTS: All notifications from the participating hospitals and clinics in 1996 were extracted from the TB notification registry. The characteristics of patients aged 65 and older were compared with a one-in-three random sampling of those aged 16 to 64. MEASUREMENTS: Demographic, clinical, radiological, and laboratory data of the two groups were compared alongside treatment and outcomes. RESULTS: Older people with TB were more likely to be male, to smoke, to have had TB previously, to have coexisting medical diseases, to be socioeconomically disadvantaged, and to weigh less than younger people with TB. Dyspnea, weight loss, and malaise were more common, whereas extrathoracic lymph node enlargement was less common. Chest radiograph showed more extensive disease and lower zone involvement. Positive tuberculin test was present in only 61.9%. Sputum bacteriology was more likely to be positive. There was a longer delay in presentation and commencement of treatment, and 77.2% required at least one admission. Adverse effects of treatment, notably hepatic dysfunction, occurred more commonly. Fluoroquinolones appeared well tolerated. Only 72.5% of the older people were cured or completed their treatment. Mortality was 16%. Age of 65 and older, comorbidity, socioeconomic disadvantage, moderate-extensive disease, positive sputum smear, and poor adherence were factors independently associated with unfavorable outcomes (P <.001 to P = .01; odds ratios = 1.61-27.02). CONCLUSION: Substantial differences were found between older and younger TB patients. Many of these were associated with unfavorable outcome. Increased awareness in disease recognition and better medical and social support are therefore needed in addressing the growing problem of TB in older people.     

香港结核性脑膜炎的登记情况

背景:对结核性脑膜炎(TBM)的就诊、诊断、治疗和转归的前瞻性观察研究。方法:对结核性脑膜炎患者的人口学资料、临床信息、治疗及转归进行随访。确诊后3年内每6个月对转归资料核实1次。对死亡和完全康复的预后因素分别进行多因素COX和logistic回归模型分析。结果:1993-2000年共入选结核性脑膜炎患者166例。患者平均年龄42.9岁,其中中国公民153例,男性81例;92%的患者接受了HRZS(H=异烟肼;R=利福平;Z=吡嗪酰胺;S=链霉素),HRZE(E=乙胺丁醇)或HRZES方案治疗。应用激素的有105例,激素对转归无明显影响。3年随访结束,完全康复110例,残疾20例,死亡26例。死亡与就诊时年老、脑脊液淋巴细胞低下及意识水平差有显著的相关性。完全康复与年轻、女性及无合并症有相关性。结论:随访至3年,香港结核性脑膜炎治疗转归较好,病死率为15.7(26/166)。早发现,早确诊和使用有效的治疗方案可能是降低死亡率和发病率最重要的因素。     

Ageing in Hong Kong

Abstract. Hong Kong has experienced a steady and significant growth in its elderly population. Being essentially a Chinese community, the traditional virtue of filial piety has been upheld and the family is expected to be the prime source of care for its members. However, there has been a gradual increase in the number of nuclear families and a gradual dwindling of the positive image of the elderly person, which threatens the basis for community care for the elderly. About half of the elderly population are living in government rental housing and are receiving public primary medical care. Community support services are not in-home support in nature and are of low levels of care. The professional and social organisations unanimously urge the government to take a more proactive stance in providing services to the elderly and encourage the community to revitalise its traditional Chinese cultural heritage in caring for the elderly.     

香港防痨工作的过去和展望

过去４０年，香港的防痨工作有显著的成就。目前，结核病的呈报率是每１０万人口中有１１０．４人，死亡率每１０万人口中有６．７人，结核病者平均死亡年龄是６９岁，由于香港初生婴儿卡介苗注射非常成功，历年来接种率都达到差不多百分之百，所以结核病在婴儿或儿童发生的情形已甚为罕见。香港的防痨工作分为三方面进行：①公共卫生──这包括宣传及卫生教育、初生婴儿卡介苗注射、辅导痨病患者及他的家人和痨病调查等。②胸肺科诊疗所服务──香港痨病的治疗大部分是在胸肺科诊疗所提供，现在有１１间全日开放和５间部分开放的胸肺科诊疗所分布全港各区，专门为各种工作时间不同的人士服务。③医院服务──医院服务是主要给严重患者、有并发症或需要住院接受检查和手术的人士。公共卫生和胸肺科诊疗所服务大部分是由卫生署提供。医院治疗是由医院管理局辖下的医院提供，而属于香港防痨心脏及胸病协会的律敦治医院和葛量洪医院则是本港主要的胸肺科医院。香港的防痨工作虽然有此骄人成就，但仍面对很多挑战，中国和香港防痨组织能彼此合作对预防和控制痨病将有帮助。     

An actuarial analysis of long-term care demand in Hong Kong

Hong Kong is a fast-aging society. More than 775 000 citizens (around 11% of the total population) in Hong Kong were aged 65 or above in 2002, and it is expected the figure will increase to 2.2 million (or 24% of the total) in 2031. In this paper, an actuarial projection of the demand of long-term care (LTC) services in Hong Kong using the US National Long-Term Care Surveys (NLTCS) data, is provided. The need for LTC in Hong Kong will be growing drastically for older ages in the next few years; around 10% for elderly aged between 65 and 74 and the proportion would mount to 60% for the elderly at age 85 or above. Using a Markov Chain model, an individual's (age–gender specific) future LTC expenditures in Hong Kong have been projected. The net actuarial present values of total future LTC costs are expected to be HK$83 000 and HK$160 000 for males aged 65 and females aged 65, respectively. Alternative funding strategies for these liabilities are discussed. A simple private insurance scheme is chosen to illustrate the actuarial calculations. The results could be useful for funding and planning LTC services in Hong Kong.