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Lam RPK, Hung KKC, Lui CT, Kwok WS, Lam WWT, Lau EHY, Sridhar S, Ng PYT, Cheng CH, Tsang TC, Tsui MSH, Graham CA, Rainer TH. Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol. BMJ Open 2024; 14:e080676. [PMID: 38307529 PMCID: PMC10836386 DOI: 10.1136/bmjopen-2023-080676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Early sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs. METHODS AND ANALYSIS We will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics. ETHICS AND DISSEMINATION The institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. TRIAL REGISTRATION NUMBER NCT05731349.
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Affiliation(s)
- Rex Pui Kin Lam
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Chun Tat Lui
- Accident and Emergency Department, Tuen Mun Hospital, Hospital Authority, Hong Kong, China
| | - Wai Shing Kwok
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong, China
| | - Wendy Wing Tak Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eric Ho Yin Lau
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Siddharth Sridhar
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peter Yau Tak Ng
- Accident and Emergency Department, Tuen Mun Hospital, Hospital Authority, Hong Kong, China
| | - Chi Hung Cheng
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Tat Chi Tsang
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Matthew Sik Hon Tsui
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Colin Alexander Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Timothy Hudson Rainer
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
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Hung KKC, Chan EYY, Lo ESK, Huang Z, Wu JCY, Graham CA. User perceptions of COVID-19 telemedicine testing services, disease risk, and pandemic preparedness: findings from a private clinic in Hong Kong. Hong Kong Med J 2023; 29:404-411. [PMID: 37822258 DOI: 10.12809/hkmj219414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
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.
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Affiliation(s)
- K K C Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, The Chinese University of Hong Kong, Hong Kong SAR, China
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - E Y Y Chan
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, The Chinese University of Hong Kong, Hong Kong SAR, China
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - E S K Lo
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, The Chinese University of Hong Kong, Hong Kong SAR, China
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Z Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, The Chinese University of Hong Kong, Hong Kong SAR, China
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Y Wu
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- CUHK Medical Centre, Hong Kong SAR, China
| | - C A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, The Chinese University of Hong Kong, Hong Kong SAR, China
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Kim JH, Kwok KO, Huang Z, Poon PKM, Hung KKC, Wong SYS, Chan EYY. A longitudinal study of COVID-19 preventive behavior fatigue in Hong Kong: a city with previous pandemic experience. BMC Public Health 2023; 23:618. [PMID: 37004041 PMCID: PMC10064631 DOI: 10.1186/s12889-023-15257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/10/2023] [Indexed: 04/03/2023] Open
Abstract
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.
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Affiliation(s)
- Jean H Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Paul Kwok-Ming Poon
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin Kei Ching Hung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Accident & Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily Ying Yang Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China.
- GX Foundation, Hong Kong, China.
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Lo RSL, Lyngholm LE, Brabrand M, Leung LY, Hung KKC, Laugesen S, Posth S, Cooksley T, Graham CA, Nickel CH. A tale of two continents: The performance of six early warning scores in two emergency departments. HONG KONG J EMERG ME 2023. [DOI: 10.1177/10249079231153719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Background: Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. Methods: In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). Results: We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Discussion: Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality Conclusion: All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value.
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Affiliation(s)
- Ronson Sze Long Lo
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Le Elias Lyngholm
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sune Laugesen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Stefan Posth
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Tim Cooksley
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Hung KKC, Leung LY, Yeung JHH, Wong TK, Yiu TY, Leung YK, Chan D, Lui CT, Ng WK, Ho HF, Cheng CH, Cheung NK, Graham CA. A prediction model for return to work after injury in Hong Kong: abridged secondary publication. Hong Kong Med J 2022; 28 Suppl 6:39-44. [PMID: 36535799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- K K C Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital
| | - L Y Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong
| | - J H H Yeung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital
| | - T K Wong
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong
| | - T Y Yiu
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong
| | - Y K Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong
| | - D Chan
- Department of Surgery, The Chinese University of Hong Kong
| | - C T Lui
- Accident & Emergency Department, Tuen Mun Hospital
| | - W K Ng
- Trauma Committee, Princess Margaret Hospital
| | - H F Ho
- Accident & Emergency Department, Queen Elizabeth Hospital
| | - C H Cheng
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital
| | - N K Cheung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital
| | - C A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital
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Chan DYC, He OY, Poon WS, Ng SCP, Yeung JHH, Hung KKC, Mak WK, Chan DTM, Cheung NK, Griffith JF, Graham CA, Wong GKC. Univariate and Multivariable Analyses on Independent Predictors for Cervical Spinal Injury in Patients with Head Injury. World Neurosurg 2022; 166:e832-e840. [PMID: 35926701 DOI: 10.1016/j.wneu.2022.07.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aims to identify independent factors associated with cervical spinal injuries in head-injured patients. The extent of injuries to other body parts was assessed by the Abbreviated Injury Scale (AIS) and was included in the analysis. METHODS Consecutive head-injured patients admitted via the emergency department from January 1, 2014 to December 31, 2016 were retrospectively reviewed. The inclusion criteria were head-injured patients with an Abbreviated Injury Scale (AIS) score ≥2 (i.e., head injuries with intracranial hematoma or skull fracture). Patients with minor head injuries with only scalp abrasions or superficial lacerations without significant intracranial injuries (i.e., head injury AIS score = 1) were excluded. The primary outcome was to identify independent predictors associated with cervical spinal injuries in these head-injured patients. Univariate and multivariable analyses were conducted. RESULTS A total of 1105 patients were identified. Of these patients, 11.2% (n = 124) had cervical spinal injuries. Univariate and multivariable analyses identified male gender (P = 0.006), the presence of thoracic injury (including rib fracture, hemothorax, or pneumothorax) (P = 0.010), and hypotension with systolic blood pressure <90 mm Hg on admission (P = 0.009) as independent predictors for cervical spinal injury in head-injured patients. CONCLUSIONS This study showed that about 1 in 10 patients with significant head injury had cervical spine injury, usually associated with fracture or dislocation. Male gender, the presence of thoracic injury, and hypotension on admission were independent risk factors associated with cervical spinal injuries.
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Affiliation(s)
- David Yuen Chung Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR.
| | - Orson Yuzhong He
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Stephanie Chi Ping Ng
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | | | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, Hong Kong; School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong SAR; Trauma and Emergency Centre, Prince of Wales Hospital, New Territories, Hong Kong SAR
| | - Wai Kit Mak
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Danny Tat Ming Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Nai Kwong Cheung
- Accident and Emergency Medicine Academic Unit, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, Hong Kong; Trauma and Emergency Centre, Prince of Wales Hospital, New Territories, Hong Kong SAR
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, Hong Kong; School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong SAR; Trauma and Emergency Centre, Prince of Wales Hospital, New Territories, Hong Kong SAR
| | - George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
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Chan EYY, Tong KHY, Dubois C, Mc Donnell K, Kim JH, Hung KKC, Kwok KO. Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water. Int J Environ Res Public Health 2021; 18:ijerph182312268. [PMID: 34885995 PMCID: PMC8656607 DOI: 10.3390/ijerph182312268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-2252-8850
| | - Kimberley Hor Yee Tong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | - Caroline Dubois
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | | | - Jean H. Kim
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong, China
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Chan EYY, Kim JH, Kwok KO, Huang Z, Hung KKC, Wong ELY, Lee EKP, Wong SYS. Population Adherence to Infection Control Behaviors during Hong Kong's First and Third COVID-19 Waves: A Serial Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:ijerph182111176. [PMID: 34769694 PMCID: PMC8583559 DOI: 10.3390/ijerph182111176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (K.K.C.H.)
- GX Foundation, Hong Kong, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
- Correspondence:
| | - Jean H. Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Kin-on Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (K.K.C.H.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Eliza Lai Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Eric Kam Pui Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (K.-o.K.); (E.L.Y.W.); (E.K.P.L.); (S.Y.S.W.)
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Hung KKC, Rainer TH, Yeung JHH, Cheung C, Leung Y, Leung LY, Chong M, Ho HF, Tsui KL, Cheung NK, Graham C. Seven-year excess mortality, functional outcome and health status after trauma in Hong Kong. Eur J Trauma Emerg Surg 2021; 48:1417-1426. [PMID: 34086062 DOI: 10.1007/s00068-021-01714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose was to investigate long-term health impacts of trauma and the aim was to describe the functional outcome and health status up to 7 years after trauma. METHODS We conducted a prospective, multi-centre cohort study of adult trauma patients admitted to three regional trauma centres with moderate or major trauma (ISS ≥ 9) in Hong Kong (HK). Patients were followed up at regular time points (1, 6 months and 1, 2, 3, 4, 5, 6, and 7 years) by telephone using extended Glasgow Outcome Scale (GOSE) and the Short-Form 36 (SF36). Observed annual mortality rate was compared with the expected mortality rate estimated using the HK population cohort. Linear mixed model (LMM) analyses examined the changes in SF36 with subgroups of age ≥ 65 years, ISS > 15, and GOSE ≥ 5 over time. RESULTS At 7 years, 115 patients had died and 48% (138/285) of the survivors responded. The annual mortality rate (AMR) of the trauma cohort was consistently higher than the expected mortality rate from the general population. Forty-one percent of respondents had upper good recovery (GOSE = 8) at 7 years. Seven-year mean PCS and MCS were 45.06 and 52.06, respectively. LMM showed PCS improved over time in patients aged < 65 years and with baseline GOSE ≥ 5, and the MCS improved over time with baseline GOSE ≥ 5. Higher mortality rate, limited functional recovery and worse physical health status persisted up to 7 years post-injury. CONCLUSION Long-term mortality and morbidity should be monitored for Asian trauma centre patients to understand the impact of trauma beyond hospital discharge.
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Affiliation(s)
- Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Timothy H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Emergency Medicine Unit, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Janice Hiu Hung Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Catherine Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yuki Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Marc Chong
- School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hiu Fai Ho
- Accident and Emergency Department, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Kwok Leung Tsui
- Trauma Committee, New Territory West Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Nai Kwong Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Colin Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. .,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong.
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10
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Walline JH, Hung KKC, Yeung JHH, Song PP, Cheung NK, Graham CA. The impact of SARS and COVID-19 on major trauma in Hong Kong. Am J Emerg Med 2021; 46:10-15. [PMID: 33690070 PMCID: PMC7894201 DOI: 10.1016/j.ajem.2021.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has been enormously disruptive and harmful to people around the world, but its impact on other illnesses and injuries has been more variable. To evaluate the ramification of infectious disease outbreaks on major traumatic injuries, we compared changes in the incidence of major trauma cases during the 2003 Severe Acute Respiratory Syndrome (SARS) period with COVID-19 in 2020. Methods Data were analyzed from the trauma registry of a major, tertiary-care teaching hospital in Hong Kong. Patients presenting with major traumatic injuries during the first six months of 2001–03 and 2018–20 were retrieved for analysis. Patient characteristics, injury mechanism, admitting service, and emergency department (ED)/hospital lengths of stay (LOS) were recorded. Raw and adjusted survival rates (using the modified Trauma Injury Severity Score (TRISS)) were recorded. Results The number of trauma cases fell dramatically during 2003 and 2020 compared with previous years. In both 2003 and 2020, the number of trauma registry patients fell by 49% in April (compared to the preceding reference years of 2001/02 and 2018/19, respectively). Patient characteristics, treatments, and outcomes were also different during the outbreak years. Comparing 2003 to 2020 relative to their respective reference baselines, the percentages of injuries that happened at home, patients without co-morbidities, and patients' mean age all increased in 2003 but decreased in 2020. Work-place injuries drastically dropped in 2003, but not in 2020. Average ED LOS dropped in 2003 by 36.4 min (95% CI 12.5, 60.3) but declined by only 14.5 min (95% CI -2.9, 32.1) in 2020. Both observed and expected 30-day mortality declined in 2020 vs. 2003 (observed 4.5% vs. 11.7%, p = 0.001, OR 0.352, 95% CI 0.187, 0.661) (expected 4.5% vs 11.6%, p = 0.002, OR 0.358, 95% CI 0.188, 0.684). Conclusion Major trauma cases dropped by half during both the peak of the 2003 SARS and 2020 COVID-19 pandemics in Hong Kong, suggesting a trend for future pandemic planning. If similar findings are seen at other trauma centers, proactive personnel and resource allocations away from trauma towards medical emergency systems may be more appropriate for future pandemics.
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Affiliation(s)
- Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; Department of Emergency Medicine, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; Department of Emergency Medicine, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Janice Hiu Hung Yeung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; Department of Emergency Medicine, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Priscilla P Song
- Centre for the Humanities and Medicine, The University of Hong Kong, Hong Kong
| | - Nai-Kwong Cheung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; Department of Emergency Medicine, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; Department of Emergency Medicine, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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11
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Chan EYY, Dubois C, Fong AHY, Shaw R, Chatterjee R, Dabral A, Loyzaga A, Kim YK, Hung KKC, Wong CS. Reflection of Challenges and Opportunities within the COVID-19 Pandemic to Include Biological Hazards into DRR Planning. Int J Environ Res Public Health 2021; 18:1614. [PMID: 33567697 PMCID: PMC7915833 DOI: 10.3390/ijerph18041614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (K.K.C.H.); (C.S.W.)
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
- GX Foundation, Hong Kong, China;
- Accident & Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Caroline Dubois
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
- GX Foundation, Hong Kong, China;
| | | | - Rajib Shaw
- Graduate School of Media and Governance, Keio University, Fujisawa 252-0882, Japan;
- Resilience Innovation Knowledge Academy (RIKA), New Delhi 110059, India or (R.C.); (A.D.)
| | - Ranit Chatterjee
- Resilience Innovation Knowledge Academy (RIKA), New Delhi 110059, India or (R.C.); (A.D.)
- Graduate School of Informatics, Kyoto University, Kyoto 606-8501, Japan
| | - Ambika Dabral
- Resilience Innovation Knowledge Academy (RIKA), New Delhi 110059, India or (R.C.); (A.D.)
| | | | - Yong-kyun Kim
- Ministry of Interior and Safety, Sejong 30128, Korea;
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (K.K.C.H.); (C.S.W.)
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
- Accident & Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Shing Wong
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (K.K.C.H.); (C.S.W.)
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
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12
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Chan EYY, Lo ESK, Huang Z, Lam HCY, Yeung MPS, Kwok KO, Hung KKC, Tse SLA. 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. PLoS Negl Trop Dis 2021; 15:e0008993. [PMID: 33465094 PMCID: PMC7846016 DOI: 10.1371/journal.pntd.0008993] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/29/2021] [Accepted: 11/19/2020] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Eugene Siu Kai Lo
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Holly Ching Yu Lam
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - May Pui-shan Yeung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kin-on Kwok
- JC (Jockey Club) School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Shelly Lap-ah Tse
- JC (Jockey Club) School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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13
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Chan EYY, Wong CS, Hung KKC, Kalonji G, Cui P, Zhou G, Shaw R. Report of Alliance of International Science Organizations on Disaster Risk Reduction (ANSO-DRR) Conference 2020. Int J Environ Res Public Health 2020; 17:ijerph17238772. [PMID: 33255935 PMCID: PMC7731225 DOI: 10.3390/ijerph17238772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (C.S.W.); (K.K.C.H.)
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence:
| | - Chi Shing Wong
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (C.S.W.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (C.S.W.); (K.K.C.H.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
| | - Gretchen Kalonji
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610207, China;
| | - Peng Cui
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, Chengdu 610041, China; (P.C.); (G.Z.)
| | - Gordon Zhou
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, Chengdu 610041, China; (P.C.); (G.Z.)
| | - Rajib Shaw
- Graduate School of Media and Governance, Keio University, Tokyo 252-0882, Japan;
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14
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Yim VWC, Ip CML, Siu AYC, Leung LY, Hung KKC, Graham CA, Song PP, Walline JH. Cardiopulmonary resuscitation training in secondary education: A prospective cross-sectional survey of 110 Hong Kong secondary schools. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920971159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hong Kong rates of bystander cardiopulmonary resuscitation are very low by international standards. Several Hong Kong secondary schools have begun incorporating cardiopulmonary resuscitation training into their curriculums for teachers and students. Objective: This study aimed to explore secondary school cardiopulmonary resuscitation programs and better understand school principals’ attitudes toward cardiopulmonary resuscitation training. Methods: A cross-sectional survey was sent to all Hong Kong secondary school principals (public and private, except for special education schools) between December 2017 and March 2018. A self-administered questionnaire of 20 items focusing on school characteristics, details of any in-school cardiopulmonary resuscitation materials or training, attitudes toward teaching cardiopulmonary resuscitation, and any barriers or ways to promote school cardiopulmonary resuscitation training was given to all school principals in the territory. This study was approved by the Survey and Behavioural Research Ethics committee of the Chinese University of Hong Kong on September 13, 2017. Results: Out of the 506 schools contacted, 110 completed surveys were returned (21.7%). Cardiopulmonary resuscitation training was offered in 33.6% (37/110), while 92.7% (102/110) had an automatic external defibrillator. A majority (69.1% (76/110)) agreed or strongly agreed that cardiopulmonary resuscitation training should be compulsory for secondary school students. In schools where cardiopulmonary resuscitation was taught, most cardiopulmonary resuscitation students were aged 15–17 years, and most courses ran for < 5 h. Increased funding could encourage more schools to offer cardiopulmonary resuscitation training to students in the future. Conclusion: One-third (33.6%) of Hong Kong secondary schools offer cardiopulmonary resuscitation training. Increased funding may support school-based cardiopulmonary resuscitation instruction and improve rates of bystander cardiopulmonary resuscitation in the future.
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Affiliation(s)
- Vivian Wan Cheong Yim
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Crystal Ming-Lai Ip
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Axel Yuet Chung Siu
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Colin Alexander Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Priscilla P Song
- Centre for the Humanities and Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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15
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Graham CA, Leung LY, Lo RSL, Yeung CY, Chan SY, Hung KKC. NEWS and qSIRS superior to qSOFA in the prediction of 30-day mortality in emergency department patients in Hong Kong. Ann Med 2020; 52:403-412. [PMID: 32530356 PMCID: PMC7877938 DOI: 10.1080/07853890.2020.1782462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We aim to compare the prognostic value of Quick Sepsis-Related Organ Failure Assessment (qSOFA) and the previous Systemic Inflammatory Response Syndrome (SIRS) criteria, the National Early Warning Score (NEWS) and along with their combinations in the emergency department (ED). METHODS This single-centre prospective study recruited a convenience sample of unselected ED patients triaged as category 2 (Emergency) and 3 (Urgent). Receiver Operating Characteristic analyses were performed to determine the Area Under the Curve (AUC), along with sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for the various scores. RESULTS Of 1253 patients recruited, overall 30-day mortality was 5.7%. The prognostic value for prediction of 30-day mortality, with AUCs for qSOFA ≥2, SIRS ≥2, NEWS ≥5, qSIRS (qSOFA + SIRS) ≥2 and NSIRS (NEWS + SIRS) ≥5 of 0.56 (95%CI 0.53-0.58), 0.61 (95%CI 0.58-0.64), 0.61 (95%CI 0.58-0.64), 0.64 (95%CI 0.62-0.67) and 0.61 (95%CI 0.58-0.63), respectively. Using pairwise comparisons of ROC curves, NEWS ≥5 and qSIRS ≥2 were better than qSOFA ≥2 at predicting 30-day mortality. CONCLUSIONS Among unselected emergency and urgent ED patients, the prognostic value for NEWS and qSIRS were greater than qSOFA, Combinations of qSOFA and SIRS could improve the predictive value for 30-day mortality for ED patients. Key messages NEWS ≥5 and qSIRS ≥2 were better than qSOFA ≥2 at predicting 30-day mortality in ED patients. Combinations of qSOFA and SIRS could improve the predictive value for 30-day mortality for ED patients.
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Affiliation(s)
- Colin A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ronson Sze Long Lo
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun Yu Yeung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Suet Yi Chan
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
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16
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Chan EYY, Kim JH, Lo ESK, Huang Z, Hung H, Hung KKC, Wong ELY, Lee EKP, Wong MCS, Wong SYS. What Happened to People with Non-Communicable Diseases during COVID-19: Implications of H-EDRM Policies. Int J Environ Res Public Health 2020; 17:ijerph17155588. [PMID: 32756382 PMCID: PMC7432008 DOI: 10.3390/ijerph17155588] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.K.L.); (Z.H.); (K.K.C.H.)
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
- Correspondence:
| | - Jean Hee Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
| | - Eugene Siu Kai Lo
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.K.L.); (Z.H.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.K.L.); (Z.H.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
| | - Heidi Hung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.K.L.); (Z.H.); (K.K.C.H.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Eliza Lai Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
| | - Eric Kam Pui Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
| | - Martin Chi Sang Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (J.H.K.); (H.H.); (E.L.Y.W.); (E.K.P.L.); (M.C.S.W.); (S.Y.S.W.)
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Tenney JW, Yip JHY, Lee RHY, Wong BCY, Hung KKC, Lam RPK, Wong DKW, Wong WT. Retrospective evaluation of resuscitation medication utilization in hospitalized adult patients with cardiac arrest. J Cardiol 2020; 76:9-13. [DOI: 10.1016/j.jjcc.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/18/2019] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
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Chan EYY, Gobat N, Kim JH, Newnham EA, Huang Z, Hung H, Dubois C, Hung KKC, Wong ELY, Wong SYS. Informal home care providers: the forgotten health-care workers during the COVID-19 pandemic. Lancet 2020; 395:1957-1959. [PMID: 32497509 PMCID: PMC7263813 DOI: 10.1016/s0140-6736(20)31254-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China; Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK; JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China; GX Foundation, Phnom Penh, Cambodia, and Vientiane, Laos; Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China; FXB Center for Health and Human Rights, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Nina Gobat
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Jean H Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Elizabeth A Newnham
- School of Psychology, Curtin University, Perth, WA, Australia; FXB Center for Health and Human Rights, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China; JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Heidi Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China; JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | | | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China; Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Eliza Lai Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
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19
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Lam RPK, Hung KKC, Lau EHY, Lui CT, Chan KL, Leung CS, Wong IW, Wong KW, Graham CA, Woo PCY. Clinical, laboratory, and radiological features indicative of novel coronavirus disease (COVID-19) in emergency departments - a multicentre case-control study in Hong Kong. J Am Coll Emerg Physicians Open 2020; 1:597-608. [PMID: 32838379 PMCID: PMC7323237 DOI: 10.1002/emp2.12183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/06/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives Little is known about the value of routine clinical assessment in identifying patients with coronavirus disease 2019 (COVID‐19) in the emergency department (ED). We aimed to compare the exposure history, signs and symptoms, laboratory, and radiographic features of ED patients who tested positive and negative for COVID‐19. Methods This was a case‐control study in 7 EDs in Hong Kong from 20 January to 29 February 2020. Thirty‐seven patients with laboratory‐confirmed COVID‐19 were age‐ and sex‐matched to 111 controls. We compared the groups with univariate analysis and calculated the odds ratio (OR) of having COVID‐19 for each characteristic that was significantly different between the groups with adjustment for age and presumed location of acquiring the infection. Results There were no significant differences in patient characteristics and reported symptoms between the groups. A positive contact history within 14 days (adjusted OR 37.61, 95% CI: 10.86–130.19), bilateral chest radiograph shadow (adjusted OR 13.19, 95% CI: 4.66–37.35), having prior medical consultation (adjusted OR 7.43, 95% 2.89–19.09), a lower white blood cell count (adjusted OR 1.30, 95% CI: 1.11–1.51), and a lower platelet count (adjusted OR 1.07, 95% CI: 1.01–1.12) were associated with a higher odds of COVID‐19 separately. A higher neutrophil count was associated with a lower odds of COVID‐19 (adjusted OR 0.77, 95% CI: 0.65–0.91). Conclusion This study highlights a number of clinical features that may be useful in identifying high‐risk patients for early testing and isolation while waiting for the test result. Further studies are warranted to verify the findings.
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Affiliation(s)
- Rex Pui Kin Lam
- Emergency Medicine Unit Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region China.,Accident and Emergency Department Queen Mary Hospital Hong Kong Special Administrative Region China.,Accident and Emergency Department Pamela Youde Nethersole Eastern Hospital Hong Kong Special Administrative Region China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit Chinese University of Hong Kong Prince of Wales Hospital Hong Kong Special Administrative Region China
| | - Eric Ho Yin Lau
- School of Public Health Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region China
| | - Chun Tat Lui
- Accident and Emergency Department Tuen Mun Hospital Hong Kong Special Administrative Region China
| | - Kin Ling Chan
- Accident and Emergency Department Queen Elizabeth Hospital Hong Kong Special Administrative Region China
| | - Chin San Leung
- Accident and Emergency Department Princess Margaret Hospital Hong Kong Special Administrative Region China
| | - Ion Wa Wong
- Accident and Emergency Department United Christian Hospital Hong Kong Special Administrative Region China
| | - Kin Wa Wong
- Emergency Medicine Unit Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region China.,Accident and Emergency Department Pamela Youde Nethersole Eastern Hospital Hong Kong Special Administrative Region China
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit Chinese University of Hong Kong Prince of Wales Hospital Hong Kong Special Administrative Region China
| | - Patrick Chiu Yat Woo
- Department of Microbiology Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region China
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20
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Shang ESW, Lo ESK, Huang Z, Hung KKC, Chan EYY. Factors Associated with Urban Risk-Taking Behaviour during 2018 Typhoon Mangkhut: A Cross Sectional Study. Int J Environ Res Public Health 2020; 17:ijerph17114150. [PMID: 32532050 PMCID: PMC7312186 DOI: 10.3390/ijerph17114150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Evan Su Wei Shang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.W.S.); (E.S.K.L.); (Z.H.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eugene Siu Kai Lo
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.W.S.); (E.S.K.L.); (Z.H.); (K.K.C.H.)
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.W.S.); (E.S.K.L.); (Z.H.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.W.S.); (E.S.K.L.); (Z.H.); (K.K.C.H.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (E.S.W.S.); (E.S.K.L.); (Z.H.); (K.K.C.H.)
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
- Correspondence: ; Tel.: +852-2252-8702
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21
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Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. 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. Int J Environ Res Public Health 2020; 17:E3869. [PMID: 32485979 PMCID: PMC7312582 DOI: 10.3390/ijerph17113869] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (E.S.K.L.); (K.K.C.H.)
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (E.L.Y.W.); (S.Y.S.W.)
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (E.S.K.L.); (K.K.C.H.)
| | - Eugene Siu Kai Lo
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (E.S.K.L.); (K.K.C.H.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China; (Z.H.); (E.S.K.L.); (K.K.C.H.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Eliza Lai Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (E.L.Y.W.); (S.Y.S.W.)
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (E.L.Y.W.); (S.Y.S.W.)
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, School of Public Health and Primary Care, Prince of Wales Hospital, Sha tin, Hong Kong.
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Sha tin, Hong Kong
| | - Heidi Hoi Yi Hung
- School of Public Health and Primary Care, Prince of Wales Hospital, Sha tin, Hong Kong
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Sha tin, Hong Kong
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23
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Rainer TH, Hung KKC, Yeung JHH, Cheung SKC, Leung YK, Leung LY, Goggins WB, Ho HF, Kam CW, Cheung NK, Graham CA. Trajectory of functional outcome and health status after moderate-to-major trauma in Hong Kong: A prospective 5 year cohort study. Injury 2019; 50:1111-1117. [PMID: 30827704 DOI: 10.1016/j.injury.2019.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong. METHODS We report the five year follow up results of a multicentre, prospective cohort from the trauma registries of three regional trauma centres in Hong Kong. The original cohort recruited 400 adult trauma patients with ISS ≥ 9. Telephone follow up was conducted longitudinally at seven time points, and the extended Glasgow Outcome Scale (GOSE) and Short-Form 36 (SF36) were tracked. RESULTS 119 out of 309 surviving patients (39%) completed follow up after 5 years. The trajectory of GOSE, PCS and MCS showed gradual improvements over the seven time points. 56/119 (47.1%) patients reported a GOSE = 8 (upper good recovery), and the mean PCS and MCS was 47.8 (95% CI 45.8, 49.9) and 55.8 (95% CI 54.1, 57.5) respectively at five years. Univariate logistic regression showed change in PCS - baseline to 1 year and 1 year to 2 years, and change in MCS - baseline to 1 year were associated with GOSE = 8 at 5 years. Linear mixed effects model showed differences in PCS and MCS were greatest between 1-month and 6-month follow up. CONCLUSIONS After injury, the most rapid improvement in PCS and MCS occurred in the first six to 12 months, but further recovery was still evident for MCS in patients aged under 65 years for up to five years.
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Affiliation(s)
- T H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; School of Medicine, Cardiff University, United Kingdom
| | - K K C Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong
| | - J H H Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong
| | - S K C Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
| | - Y K Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
| | - L Y Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
| | - W B Goggins
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
| | - H F Ho
- Accident and Emergency Department, Queen Elizabeth Hospital, Hong Kong
| | - C W Kam
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Accident and Emergency Department, Tuen Mun Hospital, Hong Kong
| | - N K Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong
| | - C A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong.
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24
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Chan EYY, Man AYT, Lam HCY, Chan GKW, Hall BJ, Hung KKC. Is Urban Household Emergency Preparedness Associated with Short-Term Impact Reduction after a Super Typhoon in Subtropical City? Int J Environ Res Public Health 2019; 16:E596. [PMID: 30791356 PMCID: PMC6406516 DOI: 10.3390/ijerph16040596] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China.
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK.
| | - Asta Yi Tao Man
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China.
| | - Holly Ching Yu Lam
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China.
| | - Gloria Kwong Wai Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China.
| | - Brian J Hall
- Global and Community Mental Health Research Group, Faculty of Social Sciences, University of Macau, Macao, China.
| | - Kevin Kei Ching Hung
- Accident & Emergency Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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25
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Chan EYY, Huang Z, Hung KKC, Chan GKW, Lam HCY, Lo ESK, Yeung MPS. Health Emergency Disaster Risk Management of Public Transport Systems: A Population-Based Study after the 2017 Subway Fire in Hong Kong, China. Int J Environ Res Public Health 2019; 16:E228. [PMID: 30650569 PMCID: PMC6351960 DOI: 10.3390/ijerph16020228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/28/2018] [Accepted: 01/11/2019] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK.
- François-Xavier Bagnoud Center for Health & Human Rights, Harvard University, Boston, MA 02138, USA.
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
| | - Gloria Kwong Wai Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Holly Ching Yu Lam
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Eugene Siu Kai Lo
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - May Pui Shan Yeung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), JC (Jockey Club) School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Abstract
Background Recent terrorist attacks with biological and chemical weapons have caused much concern for the public. The purpose of this study was to assess emergency doctors' preparedness in handling Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) incidents. Methods This is a cross sectional survey of all emergency doctors working in public emergency departments (ED) in Hong Kong. Apart from the experience and confidence to handle these events, data on participants' willingness to participate in CBRNE incidents and training motivations were also analysed. Results Biological and radiological events were found to be the least commonly encountered. Few respondents reported they were confident to manage biological events (10.6% to 29.8%), despite 66% of respondents reported having prior training in CBRNE management. Conclusions This study demonstrates ED doctors' low confidence in managing specific CBRNE incidents. Current strengths identified include the good awareness of hospital emergency plans and high motivation to get more training.
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Affiliation(s)
- KKC Hung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - ECC Lam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - MCS Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - TW Wong
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- Pamela Youde Nethersole Eastern Hospital, Accident & Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - EYY Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - CA Graham
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Hung KKC, Graham CA, Yim WT, Yam ESF, Cheung NK, Rainer TH. Management of Suspected Deep Venous Thrombosis in an Emergency Medicine Ward in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Clinical signs and symptoms can vary for patients with deep venous thrombosis (DVT). DVT is an important diagnosis to recognise as it can lead to proximal embolism into the pulmonary circulation resulting in sudden collapse and death. The objective of this study is to describe the management of patients with suspected DVT in the emergency medicine ward (EMW) setting in Hong Kong using a standardised clinical pathway. Methods A retrospective review was conducted for patients with suspected DVT admitted to the EMW from April to December 2008 using a standardised protocol. The use of a clinical prediction rule and diagnostic tests (including the modified Well's score, D-dimer and ultrasound examination) and outcomes (including the length of stay and secondary admission rate) were investigated. Results A total of 100 patients with suspected DVT were admitted to the EMW in the nine-month study period. DVT was confirmed in 30% using ultrasonography. Fifty-two percent of patients were in the high-risk category according to the modified Well's score. Seventy-six percent of patients had positive D-dimer results. Ten percent of patients were safely discharged without an ultrasound examination. Mean length of stay in the EMW was 1.99 days. Thirteen percent of patients required second admission to other specialties. Conclusions This study suggests that a standardised clinical pathway based in the EMW can be used for patients with suspected DVT to reduce hospital admission.
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Yeung CY, Yim WW, Chan SY, Lo RSL, Leung LY, Hung KKC, Graham CA. Improvement of blood loss volume estimation by paramedics using a pictorial nomogram: A developmental study. Injury 2017; 48:2693-2698. [PMID: 29108791 DOI: 10.1016/j.injury.2017.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To propose and evaluate a nomogram to assist paramedics to visually estimate the external blood loss on a non-absorbent surface and to identify whether the nomogram improves visual estimation. METHODS The study was a prospective, paired-control design (pre-training control group & post-training group), utilizing Emergency Medical Assistant (EMA) I and II trainees from the Hong Kong Fire Services Ambulance Command Training School. A nomogram (blood loss volume to area on a non-absorbent surface) was prepared to aid blood loss estimation. All participants estimated four scenarios of blood pools twice (A: 180mL; B: 470mL;C: 940mL; D: 1550mL) before and after using the nomogram. Every participant received two-minute training on how to use the nomogram correctly. The difference between the estimations and the actual volume in each scenario was calculated. The absolute percentage errors were used for direct comparison and identification of improvement between visual estimation and the use of the nomogram. RESULTS Sixty-one participants with an average of 3-year paramedic field experience were recruited by convenience sampling. In combining all scenarios, the median of absolute percentage error of 61 participants was 43% (95%CI 38.0-50.9%) in visual estimation, while it was 23% (95%CI 17.4-27.0%) when using the nomogram. There was a significant reduction in absolute percentage error between visual estimation and the use of the nomogram (p<0.0001). CONCLUSION The nomogram significantly improved the estimation of external blood loss volume.
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Affiliation(s)
- Chun Yu Yeung
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Wai Wa Yim
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Suet Yi Chan
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ronson Sze Long Lo
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ling Yan Leung
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Kevin Kei Ching Hung
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Colin A Graham
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong Special Administrative Region
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