User perceptions of COVID-19 telemedicine testing services, disease risk, and pandemic preparedness: findings from a private clinic in Hong Kong

INTRODUCTION

During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been regarded as a method for providing safe access to healthcare. Here, we explored the experiences of individuals using telemedicine in Hong Kong during the COVID-19 pandemic to understand their risk perceptions and preparedness measures.

METHODS

We conducted a cross-sectional online survey of telemedicine users of private clinic-based COVID-19 testing services from 6 April to 11 May 2020. All users were invited to complete an anonymous online survey regarding COVID-19 risk perception and preparedness measures. The results of the survey were compared with the findings of a previous territory-wide survey.

RESULTS

In total, 141 of 187 telemedicine users agreed to participate; the response rate was 75.4%. Of the participants, 95.1% (116/122) believed that telemedicine consultations were useful. Nearly half of the participants (49.0%) agreed or strongly agreed that telemedicine consultations were appropriate during the COVID-19 pandemic. Most participants believed that telemedicine consultations could perform the functions of 'health protection, promotion and disease prevention' (73.6%) and 'diagnosis' (64.0%). Concerning the choice of telemedicine provider, almost all participants (99.2%) were willing to consult medical doctors; more than half of the participants (54.1%) were willing to consult registered nurses, but only 13.1% were willing to consult non-clinical staff who had been trained to provide telemedicine services.

CONCLUSION

The use of telemedicine for screening and patient education can be encouraged during the COVID-19 pandemic in Hong Kong.

A longitudinal study of COVID-19 preventive behavior fatigue in Hong Kong: a city with previous pandemic experience

BACKGROUND

In addition to high vaccination levels, COVID-19 control requires uptake and continued adherence to personal hygiene and social distancing behaviors. It is unclear whether residents of a city with successive experience in worldwide pandemics such as SARS, would quickly adopt and maintain preventive behaviors.

METHODS

A population-based, longitudinal telephone survey was conducted between in first local wave of the COVID-19 pandemic (April 2020) and third local wave (December 2020) (n = 403). The study examined factors associated with personal hygiene and social distancing behavior fatigue, as measured by reduced adherence.

RESULTS

Over 9 months, face mask use increased (96.5-100%, p < 0.001). Although habitual hand hygiene remained unchanged (92.0%), blue collar workers and non-working individuals showed higher risk of hand hygiene fatigue. There was a decline (p < 0.05) in avoidance of social gatherings (81.1 to 70.7%), avoidance of public places (52.9-27.5%) and avoidance of international travel (81.9-77.4%) even with rising caseloads. Lowered perception of COVID-19 disease severity was associated with decreased avoidance of social gatherings and public places while lower education was associated with decline in avoidance of social gatherings.

CONCLUSION

Even in regions with past pandemic experience, maintaining social distancing behaviors during a protracted pandemic remains a major public health challenge.

The way forward to achieve high COVID-19 vaccination and revaccination coverage in a city amid a period of tranquility

Background

Amid the current COVID-19 pandemic, there is an urgent need for both vaccination and revaccination ("boosting"). This study aims to identify factors associated with the intention to receive a booster dose of the coronavirus (COVID-19) vaccine among individuals vaccinated with two doses and characterize their profiles in Hong Kong, a city with a low COVID-19 incidence in the initial epidemic waves. Among the unvaccinated, vaccination intention is also explored and their profiles are investigated.

Methods

From December 2021 - January 2022, an online survey was employed to recruit 856 Hong Kong residents aged 18 years or over from an established population-based cohort. Latent class analysis and multivariate logistic regression modeling approaches were used to characterize boosting intentions.

Results

Of 638 (74.5%) vaccinated among 856 eligible subjects, 42.2% intended to receive the booster dose. Four distinct profiles emerged with believers having the highest intention, followed by apathetics, fence-sitters and skeptics. Believers were older and more likely to have been vaccinated against influenza. Older age, smoking, experiencing no adverse effects from a previous COVID-19 vaccination, greater confidence in vaccines and collective responsibility, and fewer barriers in accessing vaccination services were associated with higher intentions to receive the booster dose. Of 218 unvaccinated, most were fence-sitters followed by apathetics, skeptics, and believers.

Conclusion

This study foretells the booster intended uptake lagging initial vaccination across different age groups and can help refine the current or future booster vaccination campaign. Given the fourth COVID-19 vaccine dose may be offered to all adults, strategies for improving boosting uptake include policies targeting young adults, individuals who experienced adverse effects from previous doses, fence-sitters, apathetics, and the general public with low trust in the health authorities.

Individual socioeconomic status as a modifier of the association between high ambient temperature and hospital admissions: a time series study in Hong Kong, 2010-2019

Few studies have examined individual socioeconomic status (SES) as a potential modifier of ambient temperature-health associations, especially for temperature-related hospitalizations. We fit penalized distributed lag non-linear models within generalized additive models to study the short-term associations (0-3 days) between temperature and hospital admissions stratified by common causes, age, and individual SES, as determined by whether patients received public assistance (PA) to cover their medical fee at the time of hospitalizations, during the hot season (May 15 to October 15) in Hong Kong for the years 2010-2019. We calculated the ratio of relative risk (RRR) and corresponding 95% confidence interval (CI) to statistically test the difference of the associations between PA groups. For 75 + patients, the PA group had significantly increased risks of hospitalizations at higher temperature for most causes, with relative risks (RR, 99th %ile vs. 25%ile) and 95% CIs of 1.138 (1.099, 1.179), 1.057 (1.008, 1.109), and 1.163 (1.094, 1.236) estimated for all non-cancer non-external, circulatory, and respiratory admissions, respectively. There were slight decreases of RRs with higher temperature for 75 + patients without PA. The strengths of temperature-hospitalization associations were strongly and significantly different between PA groups for all examined causes for 75 + patients, with the most considerable discrepancy found for ischemic heart disease (RRR = 1.266; 95% CI, 1.137, 1.410). Hospitalizations for patients aged 15-74 were less affected by heat, and the difference of the associations between groups was small. Individual SES is a significant modifier of high temperature-hospitalization associations in Hong Kong among the elderly. Public health interventions are needed to better protect this subpopulation from adverse health impacts of high temperature.

Spatiotemporal relationship between temperature and non-accidental mortality: Assessing effect modification by socioeconomic status

BACKGROUND

Most published studies have assessed the overall health impact of temperature by using one-station or multiple-station averaged meteorological and air quality data. Concern has arisen about whether the temperature health impact is homogeneous across the whole territory geographically, since green space and socioeconomic factors may modify the impact.

OBJECTIVE

This study aims at investigating how small-area mortality is modified by local temperature and other meteorological, air quality, green space, and socioeconomic factors of small geographic units in a subtropical urban setting.

METHODS

Data on meteorological, air pollutants, and non-accidental mortality count in Hong Kong during 2006-2016 were obtained. Combined with green space and socioeconomic data, spatiotemporal analysis using Generalized Additive Mixed Models was conducted to examine the temperature-mortality relationship, adjusted for seasonality, long-term trend, other meteorological factors, pollutants, socioeconomic characteristics and green space.

RESULTS

Socioeconomic status was found to modify the temporal temperature-mortality relationship. A J-shape association was identified for most areas in Hong Kong, where a sharp increase of mortality was observed when daily minimum temperature dropped lower than the turning point. However, for people living in the most affluent areas, after the initial increase there was a decrease of mortality for colder days. Besides, when comparing the two spatiotemporal models (i.e. using nearby or central temperature monitoring station), while leaving the other predictors unchanged, this study showed that there was little difference in the overall model performances.

CONCLUSION

This study indicated that the daily fluctuation of mortality was associated with daily temperature, while the spatial variation of mortality within this city could be explained by the geographical distribution of green space and socioeconomic factors. Since people living in affluent areas were found to be more tolerant of cold temperatures, it would be more efficient to tailor cold temperature health education and warning information for socioeconomically deprived communities.

Consumption of home-prepared meal at workplace as a predictor of glycated haemoglobin among people with type 2 diabetes in Hong Kong: a mixed-methods study

OBJECTIVES

There is increasing attention on association between eating patterns and diabetes control following global changes in eating patterns. There had been very limited research on the eating patterns of diabetic patients with employment, although working age population has seen the highest increase in diabetes incidence. This study aimed to identify workplace eating patterns in relation to glycaemic control among type 2 diabetic patients with employment.

METHODS

This is a sequential mixed-methods study. The exploratory qualitative study involved focus group interviews with 31 type 2 diabetic patients with employment, which guided the design of a subsequent cross-sectional investigation involving 185 patients with employment. Thematic analysis was conducted on the qualitative data to identify workplace eating patterns most relevant to glycaemic control. Hierarchical multiple linear regression was performed to examine association between workplace eating pattern and glycaemic control, proxied by HbA1c.

RESULTS

The focus group interviews identified frequency in the consumption of home-prepared meals (HPM) and meal hours as the major workplace eating patterns that affected glycaemic control. The cross-sectional study confirmed that regular consumption of HPM at workplace could explain variance of HbA1c, independent of socio-demographic factors, lifestyle factors and disease condition, with R² = 0.146, F(14, 170) = 2.075, p = 0.015; adjusted R² = 0.076. Patients who were female, in non-skilled occupation, on shift, with fixed work location and had break during work were more likely to consume HPM.

CONCLUSIONS

Consumption of HPM at workplace should be promoted to facilitate better glycaemic control by type 2 diabetic patients with employment, possibly through more practical dietary advice, and workplace accommodation in terms of space and facilities. In the context of COVID-19 pandemic, consumption of HPM also meant additional protection for diabetic patients through reducing close contact exposures in restaurants.

Challenges of Data Availability and Use in Conducting Health-EDRM Research in a Post-COVID-19 World

Disasters disrupt communication channels, infrastructure, and overburden health systems. This creates unique challenges to the functionality of surveillance tools, data collection systems, and information sharing platforms. The WHO Health Emergency and Disaster Risk Management (Health-EDRM) framework highlights the need for appropriate data collection, data interpretation, and data use from individual, community, and global levels. The COVID-19 crisis has evolved the way hazards and risks are viewed. No longer as a linear event but as a protracted hazard, with cascading and compound risks that affect communities facing complex risks such as climate-related disasters or urban growth. The large-scale disruptions of COVID-19 show that disaster data must evolve beyond mortality and frequency of events, in order to encompass the impact on the livelihood of communities, differentiated between population groups. This includes relative economic losses and psychosocial damage. COVID-19 has created a global opportunity to review how the scientific community classifies data, and how comparable indicators are selected to inform evidence-based resilience building and emergency preparedness. A shift into microlevel data, and regional-level information sharing is necessary to tailor community-level interventions for risk mitigation and disaster preparedness. Real-time data sharing, open governance, cross-organisational, and inter-platform collaboration are necessary not just in Health-EDRM and control of biological hazards, but for all natural hazards and man-made disasters.

Efficacy and practice of facemask use in general population: a systematic review and meta-analysis

In recent decades, respiratory infections, including SARS, HINI and the currently spreading COVID-19, caused by various viruses such as influenza and coronavirus have seriously threatened human health. It has generated inconsistent recommendations on the mandatory use of facemasks across countries on a population level due to insufficient evidence on the efficacy of facemask use among the general population. This meta-analysis aimed to explore (1) the efficacy of facemask use on preventing respiratory infections, and (2) the perceptions, intentions, and practice about facemask use among the general population worldwide. We searched PubMed, MEDLINE, Web of Science, Cochrane, bioRxiv, and medRxiv databases since inception to August 17, 2020. From 21,341 records identified, eight RCTs on facemask in preventing infections and 78 studies on perception, intention, and practice of facemask use among the general population were included in the analysis. The meta-analysis of RCTs found a significant protective effect of facemask intervention (OR = 0.84; 95% CI = 0.71-0.99; I2 = 0%). This protective effect was even more pronounced when the intervention duration was more than two weeks (OR = 0.76; 95% CI = 0.66-0.88; I2 = 0%). The meta-analysis of observational studies on perception, intention, and practice on facemask use showed that 71% of respondents perceived facemasks to be effective for infection prevention, 68% of respondents would wear facemasks, and 54% of respondents wore facemasks for preventing respiratory infections. Differences in perception, intention, and practice behavior of facemask use in different regions may be related to the impact of respiratory infections, regional culture, and policies. The governments and relevant organizations should make effort to reduce the barriers in the use of facemasks.

Association of weather, air pollutants, and seasonal influenza with chronic obstructive pulmonary disease hospitalization risks

The influences of weather and air pollutants on chronic obstructive pulmonary disease (COPD) have been well-studied. However, the heterogeneous effects of different influenza viral infections, air pollution and weather on COPD admissions and re-admissions have not been thoroughly examined. In this study, we aimed to elucidate the relationships between meteorological variables, air pollutants, seasonal influenza, and hospital admissions and re-admissions due to COPD in Hong Kong, a non-industrial influenza epicenter. A total number of 507703 hospital admissions (i.e., index admissions) and 301728 re-admission episodes (i.e., episodes within 30 days after the previous discharge) for COPD over 14 years (1998-2011) were obtained from all public hospitals. The aggregated weekly numbers were matched with meteorological records and outdoor air pollutant concentrations. Type-specific and all-type influenza-like illness positive (ILI+) rates were used as proxies for influenza activity. Generalized additive models were used in conjunction with distributed-lag non-linear models to estimate the associations of interest. According to the results, high concentrations of fine particulate matter, oxidant gases, and cold weather were strong independent risk factors of COPD outcomes. The cumulative adjusted relative risks exhibited a monotone increasing trend except for ILI+ B, and the numbers were statistically significant over the entire observed range of ILI+ total and ILI+ A/H3N2 when the reference rate was zero. COPD hospitalization risk from influenza infection was higher in the elderly than that in the general population. In conclusion, our results suggest that health administrators should impose clean air policies, such as strengthening emissions control on petrol vehicles, to reduce pollution from oxidant gases and particulates. An extension of the influenza vaccination program for patients with COPD may need to be encouraged: for example, vaccination may be included in hospital discharge planning, particularly before the winter epidemic.

Comparison of somatic mutation landscapes in Chinese versus European breast cancer patients

Recent genomic studies suggest that Asian breast cancer (BC) may have distinct somatic features; however, most comparisons of BC genomic features across populations did not account for differences in age, subtype, and sequencing methods. In this study, we analyzed whole-exome sequencing (WES) data to characterize somatic copy number alterations (SCNAs) and mutation profiles in 98 Hong Kong BC (HKBC) patients and compared with those from The Cancer Genome Atlas of European ancestry (TCGA-EA, N = 686), which had similar distributions of age at diagnosis and PAM50 subtypes as in HKBC. We developed a two-sample Poisson model to compare driver gene selection pressure, which reflects the effect sizes of cancer driver genes, while accounting for differences in sample size, sequencing platforms, depths, and mutation calling methods. We found that somatic mutation and SCNA profiles were overall very similar between HKBC and TCGA-EA. The selection pressure for small insertions and deletions (indels) in GATA3 (false discovery rate (FDR) corrected p < 0.01) and single-nucleotide variants (SNVs) in TP53 (nominal p = 0.02, FDR corrected p = 0.28) was lower in HKBC than in TCGA-EA. Among the 13 signatures of single-base substitutions (SBS) that are common in BC, we found a suggestively higher contribution of SBS18 and a lower contribution of SBS1 in HKBC than in TCGA-EA, while the two APOBEC-induced signatures showed similar prevalence. Our results suggest that the genomic landscape of BC was largely very similar between HKBC and TCGA-EA, despite suggestive differences in some driver genes and mutational signatures that warrant future investigations in large and diverse Asian populations.

Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water

Waterborne diseases account for 1.5 million deaths a year globally, particularly affecting children in low-income households in subtropical areas. It is one of the most enduring and economically devastating biological hazards in our society today. The World Health Organization Health Emergency and Disaster Risk Management (health-EDRM) Framework highlights the importance of primary prevention against biological hazards across all levels of society. The framework encourages multi-sectoral coordination and lessons sharing for community risk resilience. A narrative review, conducted in March 2021, identified 88 English-language articles published between January 2000 and March 2021 examining water, sanitation, and hygiene primary prevention interventions against waterborne diseases in resource-poor settings. The literature identified eight main interventions implemented at personal, household and community levels. The strength of evidence, the enabling factors, barriers, co-benefits, and alternative measures were reviewed for each intervention. There is an array of evidence available across each intervention, with strong evidence supporting the effectiveness of water treatment and safe household water storage. Studies show that at personal and household levels, interventions are effective when applied together. Furthermore, water and waste management will have a compounding impact on vector-borne diseases. Mitigation against waterborne diseases require coordinated, multi-sectoral governance, such as building sanitation infrastructure and streamlined waste management. The review showed research gaps relating to evidence-based alternative interventions for resource-poor settings and showed discrepancies in definitions of various interventions amongst research institutions, creating challenges in the direct comparison of results across studies.

Population Adherence to Infection Control Behaviors during Hong Kong's First and Third COVID-19 Waves: A Serial Cross-Sectional Study

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.

Unequal availability of workplace policy for prevention of coronavirus disease 2019 across occupations and its relationship with personal protection behaviours: a cross-sectional survey

BACKGROUND

The evolving pandemic of coronavirus disease 2019 (COVID-19) has become a severe threat to public health, and the workplace presents high risks in terms of spreading the disease. Few studies have focused on the relationship between workplace policy and individual behaviours. This study aimed to identify inequalities of workplace policy across occupation groups, examine the relationship of workplace guidelines and measures with employees' behaviours regarding COVID-19 prevention.

METHODS

A cross-sectional online survey using a structured questionnaire was conducted to gather employees' access to workplace guidelines and measures as well as their personal protection behaviours. Statistical associations between these two factors in different occupations were examined using multiple ordinal logistic regressions.

RESULTS

A total of 1048 valid responses across five occupational groups were analysed. Manual labourers reported lower availability of workplace guidelines and measures (76.9% vs. 89.9% for all, P = 0.003). Employees with available workplace guidelines and measures had higher compliance of hand hygiene, wearing masks, and social distancing, and this association was more significant among managers/administrators and manual labourers.

CONCLUSIONS

Protection of the quantity and quality of employment is important. Awareness about the disease and its prevention among employers and administrators should be promoted, and resources should be allocated to publish guidelines and implement measures in the workplace during the pandemic. Both work-from-home arrangement and other policies and responses for those who cannot work from home including guidelines encouraging the health behaviours, information transparency, and provision of infection control materials by employers should be established to reduce inequality. Manual labourers may require specific attention regarding accessibility of relevant information and availability of medical benefits and compensation for income loss due to the sickness, given their poorer experience of workplace policy and the nature of their work. Further studies are needed to test the effectiveness of specific workplace policies on COVID-19 prevention.

Relationship between acute kidney injury, seasonal influenza, and environmental factors: A 14-year retrospective analysis

Despite high incidence of acute kidney injury (AKI) among patients hospitalised for influenza, no previous work has attempted to analyse and quantify the association between the two. Herein, we made use of Hong Kong's surveillance data to evaluate the time-varying relationship between seasonal influenza and risk of AKI with adjustment for potential environmental covariates. Generalized additive model was used in conjunction with distributed-lag non-linear model to estimate the association of interest with daily AKI admissions as outcome and daily influenza admissions as predictor, while controlling for environmental variables (i.e. temperature, relative humidity, total rainfall, nitrogen dioxide, and ozone). Results suggested a positive association between risk of AKI admission and number of influenza hospitalisation cases, with relative risk reaching 1.12 (95% confidence interval, 1.10-1.15) at the 95th percentile. Using median as reference, an almost U-shaped association between risk of AKI admission and temperature was observed; the risk increased significantly when the temperature was low. While ozone was not shown to be a risk factor for AKI, moderate-to-high levels of nitrogen dioxide (50-95th percentile) were significantly associated with increased risk of AKI admission. This study mentioned the possibility that AKI hospitalisations are subject to environmental influences and offered support for a positive association between seasonal influenza and AKI occurrence in Hong Kong. Authorities are urged to extend the influenza vaccination program to individuals with pre-existing renal conditions to safeguard the health of the vulnerable. Given that adverse health effects are evident at current ambient levels of nitrogen dioxide, the government is recommended to adopt clean-air policies at the earliest opportunity to protect the health of the community.

Psychobehavioral Responses and Likelihood of Receiving COVID-19 Vaccines during the Pandemic, Hong Kong

To access temporal changes in psychobehavioral responses to the coronavirus disease (COVID-19) pandemic, we conducted a 5-round (R1–R5) longitudinal population-based online survey in Hong Kong during January–September 2020. Most respondents reported wearing masks (R1 99.0% to R5 99.8%) and performing hand hygiene (R1 95.8% to R5 97.7%). Perceived COVID-19 severity decreased significantly, from 97.4% (R1) to 77.2% (R5), but perceived self-susceptibility remained high (87.2%–92.8%). Female sex and anxiety were associated with greater adoption of social distancing. Intention to receive COVID-19 vaccines decreased significantly (R4 48.7% to R5 37.6%). Greater anxiety, confidence in vaccine, and collective responsibility and weaker complacency were associated with higher tendency to receive COVID-19 vaccines. Although its generalizability should be assumed with caution, this study helps to formulate health communication strategies and foretells the initial low uptake rate of COVID-19 vaccines, suggesting that social distancing should be maintained in the medium term.

The Evolution in Anxiety and Depression with the Progression of the Pandemic in Adult Populations from Eight Countries and Four Continents

Nearly a year after the classification of the COVID-19 outbreak as a global pandemic, it is clear that different factors have contributed to an increase in psychological disorders, including public health measures that infringe on personal freedoms, growing financial losses, and conflicting messages. This study examined the evolution of psychosocial impacts with the progression of the pandemic in adult populations from different countries and continents, and identified, among a wide range of individual and country-level factors, which ones are contributing to this evolving psychological response. An online survey was conducted in May/June 2020 and in November 2020, among a sample of 17,833 adults (Phase 1: 8806; Phase 2: 9027) from eight countries/regions (Canada, the United States, England, Switzerland, Belgium, Hong Kong, the Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depressive episode (MDE) were assessed. The independent role of potential factors was examined using multilevel logistic regression. Probable GAD or MDE was indicated by 30.1% and 32.5% of the respondents during phases 1 and 2, respectively (a 7.9% increase over time), with an important variation according to countries/regions (range from 22.3% in Switzerland to 38.8% in the Philippines). This proportion exceeded 50% among young adults (18-24 years old) in all countries except for Switzerland. Beyond young age, several factors negatively influenced mental health in times of pandemic; important factors were found, including weak sense of coherence (adjusted odds ratio aOR = 3.89), false beliefs (aOR = 2.33), and self-isolation/quarantine (aOR = 2.01). The world has entered a new era dominated by psychological suffering and rising demand for mental health interventions, along a continuum from health promotion to specialized healthcare. More than ever, we need to innovate and build interventions aimed at strengthening key protective factors, such as sense of coherence, in the fight against the adversity caused by the concurrent pandemic and infodemic.

Evolving Epidemiological Characteristics of COVID-19 in Hong Kong From January to August 2020: Retrospective Study

BACKGROUND

COVID-19 has plagued the globe, with multiple SARS-CoV-2 clusters hinting at its evolving epidemiology. Since the disease course is governed by important epidemiological parameters, including containment delays (time between symptom onset and mandatory isolation) and serial intervals (time between symptom onsets of infector-infectee pairs), understanding their temporal changes helps to guide interventions.

OBJECTIVE

This study aims to characterize the epidemiology of the first two epidemic waves of COVID-19 in Hong Kong by doing the following: (1) estimating the containment delays, serial intervals, effective reproductive number (Rt), and proportion of asymptomatic cases; (2) identifying factors associated with the temporal changes of the containment delays and serial intervals; and (3) depicting COVID-19 transmission by age assortativity and types of social settings.

METHODS

We retrieved the official case series and the Apple mobility data of Hong Kong from January-August 2020. The empirical containment delays and serial intervals were fitted to theoretical distributions, and factors associated with their temporal changes were quantified in terms of percentage contribution (the percentage change in the predicted outcome from multivariable regression models relative to a predefined comparator). Rt was estimated with the best fitted distribution for serial intervals.

RESULTS

The two epidemic waves were characterized by imported cases and clusters of local cases, respectively. Rt peaked at 2.39 (wave 1) and 3.04 (wave 2). The proportion of asymptomatic cases decreased from 34.9% (0-9 years) to 12.9% (≥80 years). Log-normal distribution best fitted the 1574 containment delays (mean 5.18 [SD 3.04] days) and the 558 serial intervals (17 negative; mean 4.74 [SD 4.24] days). Containment delays decreased with involvement in a cluster (percentage contribution: 10.08%-20.73%) and case detection in the public health care sector (percentage contribution: 27.56%, 95% CI 22.52%-32.33%). Serial intervals decreased over time (6.70 days in wave 1 versus 4.35 days in wave 2) and with tertiary transmission or beyond (percentage contribution: -50.75% to -17.31%), but were lengthened by mobility (percentage contribution: 0.83%). Transmission within the same age band was high (18.1%). Households (69.9%) and social settings (20.3%) were where transmission commonly occurred.

CONCLUSIONS

First, the factors associated with reduced containment delays suggested government-enacted interventions were useful for achieving outbreak control and should be further encouraged. Second, the shorter serial intervals associated with the composite mobility index calls for empirical surveys to disentangle the role of different contact dimensions in disease transmission. Third, the presymptomatic transmission and asymptomatic cases underscore the importance of remaining vigilant about COVID-19. Fourth, the time-varying epidemiological parameters suggest the need to incorporate their temporal variations when depicting the epidemic trajectory. Fifth, the high proportion of transmission events occurring within the same age group supports the ban on gatherings outside of households, and underscores the need for residence-centered preventive measures.

A 21-year retrospective analysis of environmental impacts on paediatric acute gastroenteritis in an affluent setting

BACKGROUND

Extreme weather events happen more frequently along with global warming and they constitute a challenge for public health preparedness. For example, many investigations showed heavy rainfall was associated with an increased risk of acute gastroenteritis. In this study, we examined the associations between different meteorological factors and paediatric acute gastroenteritis in an affluent setting in China controlling for pollutant effects.

METHODS

Aggregated total weekly number of intestinal infection-related hospital admissions, and meteorological and air pollution data during 1998-2018 in Hong Kong were collected and analysed by a combination of quasi-Poisson generalized additive model and distributed lag nonlinear model. Study population was restricted to children under 5 years of age at the time of admission.

RESULTS

While heavy rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to intestinal infections, low temperature and humidity extremes (both relative humidity and vapour pressure) did. Compared with the temperature at which the lowest risk was detected (i.e. 22.5 °C), the risk was 6.4% higher (95% confidence interval: 0.0% to 13.0% at 15.1 °C (i.e. the 5th percentile)). We also found the risk of paediatric admission was statistically significantly associated with an increase in the number of extreme cold days in a week over the study period.

CONCLUSION

Cold condition may have greater impact on disease transmission through increased stability and infectivity of enteric viruses in affluent settings like Hong Kong and thus resulted in an increased risk for paediatric acute gastroenteritis. On the contrary, an insignificant impact from heavy rainfall and high temperature may indicate a minor effect on disease transmission through bacterial growth in contaminated food and water. With the identified impacts of weather factors, extreme weather events are likely to distort the prevalence and seasonal pattern of diarrhoeal diseases in the future.

Research in Health-Emergency and Disaster Risk Management and Its Potential Implications in the Post COVID-19 World

Health-Emergency Disaster Risk Management (Health-EDRM) is one of the latest academic and global policy paradigms that capture knowledge, research and policy shift from response to preparedness and health risk management in non-emergency times [...].

Reflection of Challenges and Opportunities within the COVID-19 Pandemic to Include Biological Hazards into DRR Planning

COVID-19 has reinforced the need to revisit the integration of health within disaster risk reduction (DRR) strategies for biological hazards in a system-wide approach. In November 2020, DRR experts attended the Asia-Pacific Partnership for Disaster Risk Reduction (APP-DRR) Forum to share progress and learnings in the areas of health system resilience, data management, residual risk management, risk communication, digital literacy, and knowledge product marketing. Advancements for health in DRR included the importance of multi-sectoral, multi-hazard action plans; adaptation to technological advancements in data collection, dissemination and protection; promoting the health and wellbeing of essential and nonprofessional workers; and improving inclusivity in digital literacy. COVID-19 has affected progress towards the Sustainable Development Goals (SDG) and created a unique opportunity within DRR to re-evaluate the adequacy of response mechanisms against concurrent, cascading or interacting risks of future biological hazards. Health emergency disaster risk management (Health-EDRM) is a new World Health Organization paradigm that includes DRR at intra-, inter- and multidisciplinary levels. Scientific advancement under Health-EDRM is necessary for health and non-health actors in DRR education and research. Continuous education on the multifaceted risk governance is a key to building awareness, capacity and accelerating towards achieving the international DRR and the SDG targets.

Sociodemographic predictors of knowledge, mosquito bite patterns and protective behaviors concerning vector borne disease: The case of dengue fever in Chinese subtropical city, Hong Kong

Geographic pattern of dengue fever is changing due to the global environmental and climate changes in the 21st century. Evidence of community's knowledge, mosquito bite patterns and protective behavior practices in non-endemic regions is limited. This study examined the knowledge of dengue, mosquito bite patterns, protective behavior practices and their associated factors in Hong Kong, a non-endemic subtropical city. A population-based random telephone survey (n = 590) was conducted three weeks after the government announcement of a local dengue outbreak in August 2018. Sociodemographic status, awareness, knowledge, protective measures, bite patterns of mosquito were collected. Results indicated high level of community awareness of the local outbreak (95.2%), symptom identification (84.0%) and adoption of at least one mosquito protective measures (nearly 80%). About 40% of respondents reported that they were bitten by mosquitoes during the study period, a high mosquito season in Hong Kong. Mosquito bites were prevalent near grassy area (63.4%), at home (42.6%) and at public transportation waiting spots (39.6%). Younger people (< 25 years old), female, those who lived on lower floors (≤the 6th) and near grassy area were at higher risk of mosquito bites at home. Respondents perceived higher threat of dengue to society were more likely to practice mosquito prevention. While residential factors affected their indoor prevention, other socio-demographic factors affected the outdoor prevention. Practicing prevention behaviors were associated with self-reported mosquito bite at home. Furthermore, the general prevention uptake rate unchanged after the announcement of local dengue outbreak. Although the uptake rate of protective measures during August was high, 40% participants reported they were bitten. Also public locations are more common area for bites, which suggested stronger mosquito prevention and control on public environments and more personal protective behaviors should be advocated.

Narrative review of non-pharmaceutical behavioural measures for the prevention of COVID-19 (SARS-CoV-2) based on the Health-EDRM framework

INTRODUCTION

Non-pharmaceutical measures to facilitate a response to the COVID-19 pandemic, a disease caused by novel coronavirus SARS-CoV-2, are urgently needed. Using the World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework, behavioural measures for droplet-borne communicable diseases and their enabling and limiting factors at various implementation levels were evaluated.

SOURCES OF DATA

Keyword search was conducted in PubMed, Google Scholar, Embase, Medline, Science Direct, WHO and CDC online publication databases. Using the Oxford Centre for Evidence-Based Medicine review criteria, 10 bottom-up, non-pharmaceutical prevention measures from 104 English-language articles, which published between January 2000 and May 2020, were identified and examined.

AREAS OF AGREEMENT

Evidence-guided behavioural measures against transmission of COVID-19 in global at-risk communities were identified, including regular handwashing, wearing face masks and avoiding crowds and gatherings.

AREAS OF CONCERN

Strong evidence-based systematic behavioural studies for COVID-19 prevention are lacking.

GROWING POINTS

Very limited research publications are available for non-pharmaceutical measures to facilitate pandemic response.

AREAS TIMELY FOR RESEARCH

Research with strong implementation feasibility that targets resource-poor settings with low baseline health-EDRM capacity is urgently needed.

Report of Alliance of International Science Organizations on Disaster Risk Reduction (ANSO-DRR) Conference 2020

This article summarizes the proceedings of the four-session meeting (webinar) conducted by the Alliance of International Science Organizations on Disaster Risk Reduction (ANSO-DRR) on 18 May 2020. ANSO-DRR is an international, nonprofit and nongovernmental scientific alliance bringing together academies of science, research organizations and universities which share a strong interest in disaster risk reduction in the regions along the land-based and maritime routes of the Belt and Road Initiative. ANSO-DRR convenes an annual meeting to review its work progress and discuss its scientific programs. The first session was the opening statements and was followed by the introduction and updates on ANSO-DRR in the second session. The third session was the depiction of the big picture of ANSO, the umbrella organization of ANSO-DRR, led by the Assistant Executive Director of ANSO, while the fourth session was a presentation of perspectives on the strategic development of ANSO-DRR. One of ANSO-DRR’s key strategies is to enhance disaster mitigation and response through multidisciplinary cooperation among disaster and healthcare sciences (i.e., health emergency and disaster risk management (Health-EDRM)). It aims to enhance DRR efforts by performing as an instrument in connecting people along the Belt and Road regions, focusing on DRR resource and database development, involving higher education institutions in DRR efforts and increasing disaster resilience in built infrastructures.

One Virus, Four Continents, Eight Countries: An Interdisciplinary and International Study on the Psychosocial Impacts of the COVID-19 Pandemic among Adults

The novel coronavirus disease 2019 (COVID-19) pandemic brought about several features that increased the sense of fear and confusion, such as quarantine and financial losses among other stressors, which may have led to adverse psychosocial outcomes. The influence of such stressors took place within a broader sociocultural context that needs to be considered. The objective was to examine how the psychological response to the pandemic varied across countries and identify which risk/protective factors contributed to this response. An online survey was conducted from 29 May 2020-12 June 2020, among a multinational sample of 8806 adults from eight countries/regions (Canada, United States, England, Switzerland, Belgium, Hong Kong, Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depression episode (MDE) were assessed. The independent role of a wide range of potential factors was examined using multilevel logistic regression. Probable GAD and MDE were indicated by 21.0% and 25.5% of the respondents, respectively, with an important variation according to countries/regions (GAD: 12.2-31.0%; MDE: 16.7-32.9%). When considered together, 30.2% of the participants indicated probable GAD or MDE. Several factors were positively associated with a probable GAD or MDE, including (in descending order of importance) weak sense of coherence (SOC), lower age, false beliefs, isolation, threat perceived for oneself/family, mistrust in authorities, stigma, threat perceived for country/world, financial losses, being a female, and having a high level of information about COVID-19. Having a weak SOC yielded the highest adjusted odds ratio for probable GAD or MDE (3.21; 95% confidence interval (CI): 2.73-3.77). This pandemic is having an impact on psychological health. In some places and under certain circumstances, however, people seem to be better protected psychologically. This is a unique opportunity to evaluate the psychosocial impacts across various sociocultural backgrounds, providing important lessons that could inform all phases of disaster risk management.

Health Service Utilization in Hong Kong During the COVID-19 Pandemic - A Cross-sectional Public Survey

Background: As health systems across the world respond to the coronavirus disease 2019 (COVID-19), there is rising concern that patients without COVID-19 are not receiving timely emergency care, resulting in avoidable deaths. This study examined patterns of self-reported health service utilization, their socio-demographic determinants and association with avoidable deaths during the COVID-19 outbreak.

Methods: A cross-sectional telephone survey was conducted between March 22 and April 1, 2020, during the peak rise in confirmed COVID-19 cases in Hong Kong. Cantonese-speaking Hong Kong residents over 18-years-old were recruited using a computerised random digital dialling (RDD) system. The RDD method used stratified random sampling to ensure a representative sample of the target population by age, gender, and residential district. A structured self-reported questionnaire was used.

Results: Out of 1738 placed calls, 765 subjects responded to the questionnaire (44.0% response rate). The factors associated with avoiding medical consultation included being female (37.2% vs. 22.5%, P<.001), married (32.8% vs. 27%, P=.044), completing tertiary education (35.3% vs. 27.7% (secondary) vs. 14.8% (primary), P=.005), and those who reported a "large/very large" impact of COVID-19 on their mental health (36.1% vs 30.5% (neutral) vs. 19.7% (very small/small), P=.047) using logistic regression analysis.

Conclusion: Married females with both higher educational attainment and concern about COVID-19 were associated with avoiding healthcare services. Timely public communication to encourage and promote early health seeking treatment even during extreme events such as pandemics are needed.

Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: A cross-sectional survey

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Refusal rate of nurses to influenza vaccine reduced during the pandemic.

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A low acceptance level and high hesitancy level to COVID vaccination was observed.

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A strong association between COVID-19 and influenza vaccine acceptance was found.

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Major concern of nurses about the COVID-19 vaccine was its efficacy and safety.

Background

Maintaining health of healthcare workers with vaccination is a major component of pandemic preparedness and acceptance of vaccinations is essential to its success. This study aimed to examine impact of the coronavirus disease 2019 (COVID-19) pandemic on change of influenza vaccination acceptance and identify factors associated with acceptance of potential COVID-19 vaccination.

Method

A cross-sectional self-administered anonymous questionnaire survey was conducted among nurses in Hong Kong, China during 26 February and 31 March 2020. Their previous acceptance of influenza vaccination and intentions to accept influenza and COVID-19 vaccination were collected. Their relationship with work-related and other factors were examined using multiple multinomial logistic regressions.

Results

Responses from 806 participants were retrieved. More nurses changed from vaccination refusal to hesitancy or acceptance than those changed from acceptance to vaccination hesitancy or refusal (15.5% vs 6.8% among all participants, P < 0.001). 40.0% participants intended to accept COVID-19 vaccination, and those in private sector (OR: 1.67, 95%CI: 1.11–2.51), with chronic conditions (OR: 1.83, 95%CI: 1.22–2.77), encountering with suspected or confirmed COVID-19 patients (OR: 1.63, 95%CI: 1.14–2.33), accepted influenza vaccination in 2019 (OR: 2.03, 95%CI: 1.47–2.81) had higher intentions to accept it. Reasons for refusal and hesitation for COVID-19 vaccination included “suspicion on efficacy, effectiveness and safety”, “believing it unnecessary”, and “no time to take it”.

Conclusion

With a low level of COVID-19 acceptance intentions and high proportion of hesitation in both influenza and COVID-19 vaccination, evidence-based planning are needed to improve the uptake of both vaccinations in advance of their implementation. Future studies are needed to explore reasons of change of influenza vaccination acceptance, look for actual behaviour patterns of COVID-19 vaccination acceptance and examine effectiveness of promotion strategies.

The Asia Pacific Disaster Mental Health Network: Setting a Mental Health Agenda for the Region

Addressing the psychological mechanisms and structural inequalities that underpin mental health issues is critical to recovery following disasters and pandemics. The Asia Pacific Disaster Mental Health Network was established in June 2020 in response to the current disaster climate and to foster advancements in disaster-oriented mental health research, practice and policy across the region. Supported by the World Health Organization (WHO) Thematic Platform for Health Emergency and Disaster Risk Management (Health EDRM), the network brings together leading disaster psychiatry, psychology and public health experts. Our aim is to advance policy, research and targeted translation of the evidence so that communities are better informed in preparation and response to disasters, pandemics and mass trauma. The first meetings of the network resulted in the development of a regional disaster mental health agenda focused on the current context, with five priority areas: (1) Strengthening community engagement and the integration of diverse perspectives in planning, implementing and evaluating mental health and psychosocial response in disasters; (2) Supporting and assessing the capacity of mental health systems to respond to disasters; (3) Optimising emerging technologies in mental healthcare; (4) Understanding and responding appropriately to addressing the mental health impacts of climate change; (5) Prioritising mental health and psychosocial support for high-risk groups. Consideration of these priority areas in future research, practice and policy will support nuanced and effective psychosocial initiatives for disaster-affected populations within the Asia Pacific region.

Narrative Review on Health-EDRM Primary Prevention Measures for Vector-Borne Diseases

Climate change is expanding the global at-risk population for vector-borne diseases (VBDs). The World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework emphasises the importance of primary prevention of biological hazards and its value in protecting against VBDs. The framework encourages stakeholder coordination and information sharing, though there is still a need to reinforce prevention and recovery within disaster management. This keyword-search based narrative literature review searched databases PubMed, Google Scholar, Embase and Medline between January 2000 and May 2020, and identified 134 publications. In total, 10 health-EDRM primary prevention measures are summarised at three levels (personal, environmental and household). Enabling factor, limiting factors, co-benefits and strength of evidence were identified. Current studies on primary prevention measures for VBDs focus on health risk-reduction, with minimal evaluation of actual disease reduction. Although prevention against mosquito-borne diseases, notably malaria, has been well-studied, research on other vectors and VBDs remains limited. Other gaps included the limited evidence pertaining to prevention in resource-poor settings and the efficacy of alternatives, discrepancies amongst agencies' recommendations, and limited studies on the impact of technological advancements and habitat change on VBD prevalence. Health-EDRM primary prevention measures for VBDs require high-priority research to facilitate multifaceted, multi-sectoral, coordinated responses that will enable effective risk mitigation.

What Happened to People with Non-Communicable Diseases during COVID-19: Implications of H-EDRM Policies

People with existing non-communicable diseases (NCDs) are particularly vulnerable to health risks brought upon by emergencies and disasters, yet limited research has been conducted on disease management and the implications of Health-EDRM policies that address health vulnerabilities of people with NCDs during the COVID-19 pandemic. This paper reports the baseline findings of an anonymous, random, population-based, 6-month cohort study that aimed to examine the experiences of people with NCDs and their relevant self-care patterns during the COVID-19 pandemic. A total of 765 telephone interviews were completed from 22nd March to 1st April 2020 in Hong Kong, China. The dataset was representative of the population, with 18.4% of subjects reporting at least one NCD. Results showed that low household income and residence in government-subsidized housing were significant predictors for the subjects who experienced difficulty in managing during first 2 months of the pandemic (11% of the NCD patients). Of those on long-term NCD medication, 10% reported having less than one week’s supply of medication. Targeted services for vulnerable groups during a pandemic should be explored to support NCD self-care.

Ambient temperature, seasonal influenza and risk of cardiovascular disease in a subtropical area in Southern China

BACKGROUND

Given the regular winter recurrence of influenza epidemics and the biologically plausible association between seasonal influenza and cardiovascular events, researchers assumed a valid and reliable influenza forecast could envision the timing and burden of winter surge in cardiovascular (CVD) hospitalizations. This, however, is well justified only in temperate regions. In this study, we aim to investigate the temporal association between ambient temperature, seasonal influenza and risk of cardiovascular events in a subtropical city.

METHODS

Generalized additive model was used in conjunction with distributed-lag non-linear model of quasi-Poisson family to estimate the association of interest with daily CVD admissions as outcome and daily influenza admissions as predictor, while controlling for meteorological factors (i.e. temperature, relative humidity, wind speed and total rainfall) and respiratory pollutants (i.e. nitrogen dioxide, sulphur dioxide, ozone and PM₁₀). Results were expressed in the form of relative risk (RR).

RESULTS

Using median as the reference value, a U-shaped association was observed between CVD admissions and temperature. A slight decrease in RR was detected mainly towards the lower end of the temperature scale after adjusting for influenza admissions. Risk of CVD admission was found to be positively associated with the number of influenza hospitalization cases; this association remained consistent and statistically significant across subgroups of age except for those aged 5-49 years.

CONCLUSION

The slight reduction in CVD admission risk towards the lower end of the temperature scale after controlling for influenza activity might be attributed to the winter peaks of influenza, meaning that the effect of low temperature on CVD admissions might be partly mediated by influenza infection. In summary, this study reassures us that ambient temperature is independently associated with CVD hospital admissions and offers support for a positive association between seasonal influenza activity and cardiovascular events in Hong Kong.

Factors Associated with Urban Risk-Taking Behaviour during 2018 Typhoon Mangkhut: A Cross Sectional Study

Although much of the health emergency and disaster risk management (Health-EDRM) literature evaluates methods to protect health assets and mitigate health risks from disasters, there is a lack of research into those who have taken high-risk behaviour during extreme events. The study's main objective is to examine the association between engaging in high-risk behaviour and factors including sociodemographic characteristics, disaster risk perception and household preparedness during a super typhoon. A computerized randomized digit dialling cross-sectional household survey was conducted in Hong Kong, an urban metropolis, two weeks after the landing of Typhoon Mangkhut. Telephone interviews were conducted in Cantonese with adult residents. The response rate was 23.8% and the sample was representative of the Hong Kong population. Multivariable logistic regressions of 521 respondents adjusted with age and gender found education, income, risk perception and disaster preparedness were insignificantly associated with risk-taking behaviour during typhoons. This suggests that other factors may be involved in driving this behaviour, such as a general tendency to underestimate risk or sensation seeking. Further Health-EDRM research into risk-taking and sensation seeking behaviour during extreme events is needed to identify policy measures.

Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China

In addition to top-down Health-Emergency and Disaster Risk Management (Health-EDRM) efforts, bottom-up individual and household measures are crucial for prevention and emergency response of the COVID-19 pandemic, a Public Health Emergency of International Concern (PHEIC). There is limited scientific evidence of the knowledge, perception, attitude and behavior patterns of the urban population. A computerized randomized digital dialing, cross-sectional, population landline-based telephone survey was conducted from 22 March to 1 April 2020 in Hong Kong Special Administrative Region, China. Data were collected for socio-demographic characteristics, knowledge, attitude and risk perception, and various self-reported Health-EDRM behavior patterns associated with COVID-19. The final study sample was 765. Although the respondents thought that individuals (68.6%) had similar responsibilities as government (67.5%) in infection control, less than 50% had sufficient health risk management knowledge to safeguard health and well-being. Among the examined Health-EDRM measures, significant differences were found between attitude and practice in regards to washing hands with soap, ordering takeaways, wearing masks, avoidance of visiting public places or using public transport, and travel avoidance to COVID-19-confirmed regions. Logistic regression indicated that the elderly were less likely to worry about infection with COVID-19. Compared to personal and household hygiene practices, lower compliance was found for public social distancing.

Personal Cold Protection Behaviour and Its Associated Factors in 2016/17 Cold Days in Hong Kong: A Two-Year Cohort Telephone Survey Study

Background: Despite larger health burdens attributed to cold than heat, few studies have examined personal cold protection behaviours (PCPB). This study examined PCPB during cold waves and identified the associated factors in a subtropical city for those without central heating system. Methods: A cohort telephone survey was conducted in Hong Kong during a colder cold wave (2016) and a warmer cold wave (2017) among adults (≥15). Socio-demographic information, risk perception, self-reported adverse health effects and patterns of PCPB during cold waves were collected. Associated factors of PCPB in 2017 were identified using multiple logistic regression. Results: The cohort included 429 subjects. PCPB uptake rates were higher during the colder cold wave (p < 0.0005) except for ensuring indoor ventilation. Of the vulnerable groups, 63.7% had low self-perceived health risks. High risk perception, experience of adverse health effects during the 2016 cold wave, females and older groups were positive associated factors of PCPB in 2017 (p < 0.05). Conclusions: PCPB changed with self-risk perception. However vulnerable groups commonly underestimated their own risk. Indoor ventilation may be a concern during cold days in settings that are less prepared for cold weather. Targeted awareness-raising promotion for vulnerable groups and practical strategies for ensuring indoor ventilation are needed.

Time-Series Study of Associations between Rates of People Affected by Disasters and the El Niño Southern Oscillation (ENSO) Cycle

The El Niño Southern Oscillation (ENSO) is a major driver of climatic variability that can have far reaching consequences for public health globally. We explored whether global, regional and country-level rates of people affected by natural disasters (PAD) are linked to ENSO. Annual numbers of PAD between 1964–2017 recorded on the EM-DAT disaster database were combined with UN population data to create PAD rates. Time-series regression was used to assess de-trended associations between PAD and 2 ENSO indices: Oceanic Niño Index (ONI) and multivariate El Niño Index (MEI). Over 95% of PAD were caused by floods, droughts or storms, with over 75% of people affected by these three disasters residing in Asia. Globally, drought-related PAD rate increased sharply in El Niño years (versus neutral years). Flood events were the disaster type most strongly associated with El Niño regionally: in South Asia, flood-related PAD increased by 40.5% (95% CI 19.3% to 65.6%) for each boundary point increase in ONI (p = 0.002). India was found to be the country with the largest increase in flood-related PAD rates following an El Niño event, with the Philippines experiencing the largest increase following La Niña. Multivariate ENSO Index (MEI)-analyses showed consistent results. These findings can be used to inform disaster preparedness strategies.

Effects of high temperature on existing allergic symptoms and the effect modification of allergic history on health outcomes during hot days among adults: An exploratory cross-sectional telephone survey study

OBJECTIVE

The effects of high temperature on existing allergic conditions are unclear. This study explored the prevalence of allergic symptoms and the effects of high temperature on existing allergic symptoms among an adult population. The effects of high temperature on other non-allergic health outcomes were compared between adults with and without a history of allergic symptoms.

METHOD

A cross-sectional telephone survey study was conducted in Hong Kong two weeks after a heat wave in 2017. Socio-demographic information, history of allergic symptoms, non-allergic health symptoms and self-reported changes of allergic symptoms during the study hot period were collected using multiple-choice questions.

RESULTS

Of the 436 respondents, 24% had reported an allergic history. During the study hot period, 22.4% and 15.7% of those who had skin and nasal allergies had reported worsen symptoms comparing to normal days. Comparing to people without an allergic history, those ever having allergic symptoms reported a higher rate of mucus secretions, mouth ulcers, poorer sleeping quality and worsen mood during the study hot period. The main limitation of this study is the lack of baseline information and the changes in symptoms were based on self-report basis.

CONCLUSION

A noticeable proportion of the study adult population reported an allergic history. Some of these symptoms got worse during period of high temperature. Pre-existing allergic symptoms were found associated with more adverse health effects and worse quality of life during hot days. Strategic health promotion policy should be planned to increase the awareness of the potential impacts of high temperature on allergy and the related health issues.

Is "Perceived Water Insecurity" Associated with Disaster Risk Perception, Preparedness Attitudes, and Coping Ability in Rural China? (A Health-EDRM Pilot Study)

Water security is essential for maintaining health and well-being, and for reducing a population’s vulnerability in a disaster. Among resource-poor villagers in China, water-related disasters and climate change may increasingly affect people’s water security. The purpose of this study was to explore the relationship between perceived water security and disaster risk perception in a rural ethnic minority community. A cross-sectional household survey was conducted in 2015 in Xingguang village, Chongqing, China, examining the association between villagers’ perceptions of household water security, disaster risk, and sociodemographic variables. Among 52 household representatives, 84.6% relied on rainwater as their main water source and 63.5% reported having insufficient water on a regular basis. Only 32.7% perceived themselves to be living in a high-risk area, of which climate-related disasters such as storms (44.4%) and droughts (38.9%) were the most frequently reported disasters in their area. Insufficient water quantity, previous disaster experience, and household members on chronic disease medication were found to be associated with higher disaster risk perception. Perceived water security indicators were not found to be predictors of preparedness attitudes and coping ability. Addressing water sufficiency in both disaster risk reduction strategies and long-term water management will be necessary to improve the health and livelihood of rural villagers in the coming decades.

Planning of a Health Emergency Disaster Risk Management Programme for a Chinese Ethnic Minority Community

Rural populations living in poverty are the most vulnerable to disaster. Despite this increased risk of recurrent disaster, previous disaster experience is not a good predictor for disaster preparedness in these populations. This was evidenced on 31 August 2012, when a major flood occurred in Sichuan, China. A health needs assessment carried out in December 2012 showed that residents of Hongyan village, a Yi-minority community in Sichuan lacked disaster preparedness. This indicated that measures were necessary to improve Health Emergency Disaster Risk Management (Health-EDRM) in the community. Nutbeam's planning model for health promotion was used to guide the development of a Health-EDRM programme at Hongyan Village, Liangshan Yi Autonomous Prefecture, Sichuan. Relevant information was obtained from sources such as literature review, household surveys and stakeholder interviews. A team of stakeholders conducted an interactive workshop to train villagers on disaster preparedness in March 2014. Disaster kits and equipment for Oral Rehydration Solution preparation were handed out to villagers.

Scientific evidence on natural disasters and health emergency and disaster risk management in Asian rural-based area

INTRODUCTION

Disaster epidemiological studies indicate that Asia has the highest frequency of natural disasters. Rural communities are heavily impacted by natural disasters and have different healthcare needs to urban ones. Referencing Asian countries, this paper's objective is to provide an overview of health impacts and the current evidence for designing programmes and policies related to rural health emergency and disaster risk management (health-EDRM).

SOURCES OF DATA

This paper uses published English-only reports and papers retrieved from PubMed, Google Scholar, Embase, Medline and PsycINFO on rural disaster and emergency responses and relief, health impact and disease patterns in Asia (January 2000-January 2018).

AREAS OF AGREEMENT

Earthquakes are the most studied natural disasters in rural communities. The medical burden and health needs of rural communities were most commonly reported among populations of extreme age. Most of the existing research evidence for rural interventions was reported in China. There lacks published peer-reviewed reports of programme impacts on personal and community preparedness.

AREAS OF CONTROVERSY

There is a lack of evidence-based health-EDRM interventions to evaluate implementation effectiveness in rural areas despite vast volumes of health-related disaster literature.

GROWING POINTS

Climate change-related disasters are increasing in frequency and severity. Evidence is needed for disaster risk reduction interventions to address the health risks specific to rural populations.

AREAS TIMELY FOR DEVELOPING RESEARCH

To support global policy development, urgent evidence is needed on the intervention effectiveness, long-term health outcomes, local and cultural relevance as well as sustainability of health relief produced by Health-EDRM programmes in rural areas.

Different sensitivities to ambient temperature between first- and re-admission childhood asthma cases in Hong Kong - A time series study

OBJECTIVES

Asthma can be triggered by various factors due to different etiologies. Environmental factors remain a common trigger of asthma, especially amongst children, and such ambient exposures can be harder to avoid compared to behavioral triggers. As such, the contribution of environmental factors may be enhanced when considering repeat asthma cases compared to initial presentations. To test this hypothesis, we assessed associations between ambient temperature and hospital admissions for asthma in Hong Kong and stratified admission records into first and repeat asthma hospitalizations.

METHODS

The daily number of asthma hospitalizations among children aged 0-5 years in Hong Kong during 2007-2011 was regressed on daily mean temperature using distributed lagged nonlinear models, with adjustment for seasonal patterns, day-of-week effects, and other meteorological factors and air-pollutants. Analyses were stratified by summer/winter and by type of admission (first admission and repeated admission).

RESULTS

About 33% of the 12284 asthma hospitalizations were repeat admissions. Repeat admissions demonstrated higher sensitivity to high temperature in the summer. During this period, high temperatures were associated with increased risk of repeat admission but not with first admissions: RR (95% CI) comparing 31 °C vs. 29 °C across lags 0-15 days was 3.40 (1.26, 9.18) and 0.74 (0.31, 1.77) for repeat and first admissions respectively. In the cold season, all admissions increased with falls in temperature, with slightly stronger associations apparent for repeat admissions compared to first admission: 1.20 (1.00, 1.44) vs. 1.10 (0.96, 1.26) respectively comparing risk at 15 °C vs. 12 °C across lags 0-5 days.

CONCLUSIONS

To our knowledge, this is the first study to show stronger associations between ambient temperature and repeat asthma admissions compared to first admissions. The higher sensitivity among those experiencing repeat admissions may allow for more personalized disease management. Given the substantial differences in associations by admission type, future studies of ambient exposures on asthma should consider analyzing the two groups separately.

Hong Kong female’s breast cancer awareness measure: Cross-sectional survey

BACKGROUND

In women worldwide, breast cancer is the most common cancer. Breast cancer accounted for 26.6% of all new cancers in females diagnosed in 2015 in Hong Kong.

AIM

To examine women’s awareness, perception, knowledge, and screening practice of breast cancer in Hong Kong.

METHODS

We carried out a population-based survey using random telephone interviews to women aged 18 or above using the United Kingdom Cancer Research Breast Cancer Awareness Measure (United Kingdom CAM). The data was analysed using proportions, chi-square test (χ²-test) and adjusted odds ratios (ORs).

RESULTS

A total of 1000 participants completed the CAM questionnaire from 1,731 responses (response rate = 57.8%) from September to October 2017. One in five and one in four respondents recalled ≥ 3 early warning signs and ≥ 2 risk factors of breast cancer respectively. The majority (62.6%) reported they were not confident that they would notice a change in their breasts. Among the respondents, 16.8% would have regular mammography at least every two years. In general, 4 in 10 women had tried practices on preventing breast cancer. Respondents with better result in recalling breast cancer signs and symptoms were more likely to seek immediate medical help when noticed a change in their breasts (χ²-test P = 0.038), and more likely had tried prevention practice (χ²-test P < 0.001). Respondents received higher education (secondary school or above) had higher breast cancer awareness (OR = 2.83, CI: 1.61-4.97), more frequent screening (OR = 2.64, CI: 1.63-4.26) and more had tried prevention practices (OR = 2.80, CI: 1.96-4.02) when compared to those with lower education. Those in age groups 31-45 and 46-60 had higher percentages in performing breast self-exam and mammography when compared to the 18-30 and 61 or above age groups.

CONCLUSION

Population-wide public health initiatives should emphasize on prevention and early detection of breast cancer in women, with targeted strategy for those with low education level and advance in age.

Is Urban Household Emergency Preparedness Associated with Short-Term Impact Reduction after a Super Typhoon in Subtropical City?

Climate change-related extreme events are increasing in frequency and severity. Understanding household emergency preparedness capacity in Health-Emergency and Disaster Risk Management (Health-EDRM) for at risk urban communities is limited. The main objective of the study is to explore the association among risk perception, household preparedness, and the self-reported short-term impacts of Typhoons for urban residents. A population-based, cross-sectional telephone survey using random digit-dialling was conducted among Hong Kong adults within 2 weeks following 2018 Typhoon Mangkhut, the most intense typhoon that affected Hong Kong, a subtropical city, in thirty years. Among the 521 respondents, 93.9% and 74.3% reported some form of emergency preparedness and typhoon-specific preparedness measure (TSPM) against Mangkhut, respectively. Respondents who perceived a higher risk at home during typhoons and had practiced routine emergency preparedness measures (during nonemergency periods) were more likely to undertake TSPM. Of the respondents, 33.4% reported some form of impact (11.1% were household-specific) by Typhoon Mangkhut. Practicing TSPM was not associated with the reduction of short-term household impacts. Current preparedness measures may be insufficient to address the impact of super typhoons. Strategies for health-EDRM for urban residents will be needed to cope with increasing climate change-related extreme events.

Health Emergency Disaster Risk Management of Public Transport Systems: A Population-Based Study after the 2017 Subway Fire in Hong Kong, China

Background: Literature on health emergency disaster risk management (Health-EDRM) for urban public transport safety is limited. This study explored: (i) the confidence in public transport safety, (ii) the relationship between socio-demographic characteristics and risk perception of transport safety and (iii) the association between previous first-aid training and response knowledge. Method: This is a population-based cross-sectional telephone survey conducted in March 2017, one month after a major subway incident in Hong Kong. Respondents were randomly selected with the Random Digit Dialing method among Cantonese-speaking population ≥15 years. Sociodemographic information, type of transport used and the corresponding worries, response knowledge and previous first-aid training experience (as a proxy for individual skills in Health-EDRM training proxy) were collected. Results: Among the 1000 respondents, 87% used public transport daily. The self-reported confidence in subway safety was 85.6% even after a subway fire accident. Female, those with lower income and people unmarried were more likely to express worry about transport safety. About 46.1⁻63.2% respondents had the correct fire related health response knowledge. Previous first-aid training (32%) was found to be associated with fire response knowledge in a mixed pattern. Conclusions: Despite inadequacy in fire response knowledge, previous first-aid training appeared to be a beneficial factor for emergency response knowledge. Emergency responses education should be provided to the public to reduce health losses during emergencies.

Mental health workers perceptions of disaster response in China

BACKGROUND

The post-disaster mental health crisis intervention (MHCI) system in China remains immature and unsystematic. We aim to report the perceptions of a large sample of MHCI workers and government administrators and provide recommendations for developing a national mental health disaster response management plan in China.

METHODS

An in-depth qualitative study was conducted, collecting data from 20 focus-group discussions and 25 key stakeholder interviews. These recruited participants who had been involved in different types of disaster rescue across 7 provinces/cities where disasters have recently occurred. We used thematic analysis to analyze the data and relevant findings were extracted for policy recommendation.

RESULTS

Mental health workers' perspectives were examined in detailed according to four core themes: forms of organization, intervention pathway, intervention strategy and technique, and public health information. Post-disaster MHCI should be approached in teams that are integrated with emergency medicine systems, and be led by unified command management. All levels of local health and family planning commission should prepare post-disaster MHCI work plans and build response teams/emergency centres. Future training for MHCI workers should focus on: building a sense of trust within the team; clarifying each member's role; strengthening the screening, assessment and referrals training for psychological professionals; and providing psychological intervention training for Chinese psychiatrists. It is necessary to set up guiding principles for disaster research ethics, mental health rehabilitation and media interaction.

CONCLUSIONS

Through exploring and analyzing the perceptions of current disaster response mental health workers and government administrators, our findings provide essential recommendations for developing a national to county level post-disaster MHCI emergency management plan and can guide the formulation of relevant laws and regulation in China.

Household Preparedness and Preferred Communication Channels in Public Health Emergencies: A Cross-Sectional Survey of Residents in an Asian Developed Urban City

Disaster awareness and household preparedness are crucial for reducing the negative effects of a disaster. This study aims to examine the citizens' preparedness level in the event of a general disaster or outbreak of infectious disease and to identify suitable channels for community disease surveillance and risk communication. We used a stratified random design to conduct a digit-dialed telephone survey in Hong Kong during February 2014. Level of disaster preparedness was examined according to the possession of disaster kit items. Associations between socio-demographic factors and good household preparedness were assessed using multiple logistic regression models. Preferences for infectious disease surveillance were collected and analyzed. There were 1020 respondents. Over half of the respondents (59.2%) had good household preparedness. After adjustment, female respondents, having higher education and higher household income were significantly associated with good household preparedness. Television and telephone were the preferred channels to obtain and report infectious disease information, respectively. In conclusion, general and specific infectious-disease household preparedness levels in Hong Kong were generally good. Tailored preparedness programs targeted to specific communities are necessary for those lacking preparedness. Risk communication and public health surveillance should be conducted through television and telephone, respectively.

Short-term association between ambient temperature and acute myocardial infarction hospitalizations for diabetes mellitus patients: A time series study

BACKGROUND

Acute myocardial infarction (AMI) is the leading cause of death among people with diabetes mellitus (DM) and has been found to occur more frequently with extreme temperatures. With the increasing prevalence of DM and the rising global mean temperature, the number of heat-related AMI cases among DM patients may increase. This study compares excess risk of AMI during periods of extreme temperatures between patients with DM and without DM.

METHODS

Distributed lag nonlinear models (DLNMs) were used to estimate the short-term association between daily mean temperature and AMI admissions (International Classification of Diseases 9th revision [ICD-9] code: 410.00-410.99), stratified by DM status (ICD-9: 250.00-250.99), to all public hospitals in Hong Kong from 2002 to 2011, adjusting for other meteorological variables and air pollutants. Analyses were also stratified by season, age group, gender, and admission type (first admissions and readmissions). The admissions data and meteorological data were obtained from the Hong Kong Hospital Authority (HA) and the Hong Kong Observatory (HKO).

FINDINGS

A total of 53,769 AMI admissions were included in the study. AMI admissions among DM patients were linearly and negatively associated with temperature in the cold season (cumulative relative risk [cumRR] [95% confidence interval] in lag 0-22 days (12 °C versus 24 °C) = 2.10 [1.62-2.72]), while those among patients without DM only started increasing when temperatures dropped below 22 °C with a weaker association (cumRR = 1.43 [1.21-1.69]). In the hot season, AMI hospitalizations among DM patients started increasing when the temperature dropped below or rose above 28.8 °C (cumRR in lag 0-4 days [30.4 versus 28.8 °C] = 1.14 [1.00-1.31]), while those among patients without DM showed no association with temperature. The differences in sensitivity to temperature between patients with DM and without DM were most apparent in the group <75 years old and among first-admission cases in the cold season. The main limitation of this study was the unavailability of data on individual exposure to ambient temperature.

CONCLUSIONS

DM patients had a higher increased risk of AMI admissions than non-DM patients during extreme temperatures. AMI admissions risks among DM patients rise sharply in both high and low temperatures, with a stronger effect in low temperatures, while AMI risk among non-DM patients only increased mildly in low temperatures. Targeted health protection guidelines should be provided to warn DM patients and physicians about the dangers of extreme temperatures. Further studies to project the impacts of AMI risks on DM patients by climate change are warranted.

A Web-Based Course on Public Health Principles in Disaster and Medical Humanitarian Response: Survey Among Students and Faculty

BACKGROUND

Web-based public health courses are becoming increasingly popular. "Public Health Principles in Disaster and Medical Humanitarian Response" is a unique Web-based course in Hong Kong. This course aimed to fill a public health training gap by reaching out to postgraduates who are unable to access face-to-face learning.

OBJECTIVE

The aim of this paper was to use a structured framework to objectively evaluate the effectiveness of a Web-based course according to Greenhalgh et al's quality framework and the Donabedian model to make recommendations for program improvement.

METHODS

An interim evaluation of the first cohort of students in 2014 was conducted according to the Donabedian model and a quality framework by Greenhalgh et al using objective and self-reported data.

RESULTS

Students who registered for the first cohort (n=1152) from June 16, 2014 to December 15, 2014 (6 months) were surveyed. Two tutors and the course director were interviewed. The Web-based course was effective in using technology to deliver suitable course materials and assessment and to enhance student communication, support, and learning. Of the total number of students registered, 59.00% (680/1152) were nonlocal, originating from 6 continents, and 72.50% (835/1152) possessed a bachelor's or postgraduate degree. The completion rate was 20.00% (230/1152). The chi-square test comparing students who completed the course with dropouts showed no significant difference in gender (P=.40), age (P=.98), occupation (P=.43), or qualification (P=.17). The cost (HK $272 per student) was lower than that of conducting a face-to-face course (HK $4000 per student).

CONCLUSIONS

The Web-based course was effective in using technology to deliver a suitable course and reaching an intended audience. It had a higher completion rate than other Web-based courses. However, sustainable sources of funding may be needed to maintain the free Web-based course.