1
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Ho I, Wong CK, Wong YK, Lam TH, Sze-Him Leung I, Lin M, Tak-Wai Lui D, Kwok WC, Tam CC, Chan YH, Chan EW, Tse HF. Aromatase Inhibitor Therapy Increases the Risk of New-Onset Atrial Fibrillation in Patients With Breast Cancer. JACC Asia 2024; 4:150-160. [PMID: 38371283 PMCID: PMC10866735 DOI: 10.1016/j.jacasi.2023.09.014] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 02/20/2024]
Abstract
Background Previous studies suggest that aromatase inhibitors (AIs) increase the risk of adverse cardiovascular events and cardiac arrhythmias in patients with breast cancer, but it is unclear whether AIs also increase the risk of new-onset atrial fibrillation (AF). Objectives The purpose of this study was to investigate whether the use of AIs was associated with an increased risk of new-onset AF in patients with breast cancer. Methods We performed a retrospective analysis involving 5,707 patients with breast cancer (mean age 63.9 ± 11.2 years and 99.9% women) who received adjunctive hormone therapy with an AI (AI group, n = 4,878) or tamoxifen (tamoxifen group, n = 829) in Hong Kong between January 1, 1999, and December 31, 2020. After propensity score matching, there were 1,658 and 829 patients with balanced characteristics in the AI group and tamoxifen group, respectively. Results After 8,863 patient-years of follow-up, patients who were prescribed AI had a trend toward more new-onset arrhythmias compared with those prescribed tamoxifen (0.62 vs 0.30 per 100 patient-years; crude HR: 2.05; P = 0.053). The difference in arrhythmic risk was mainly driven by a higher incidence rate of new-onset AF in the AI group (0.59 vs 0.27 per 100 patient-years; crude HR: 2.18; P = 0.046). The use of AIs was confirmed to be an independent risk factor for new-onset AF on multivariate analysis (adjusted HR: 2.75; P = 0.01). Conclusions Among breast cancer patients prescribed adjunctive hormonal therapy, AI was associated with an increased risk of new-onset AF. Regular surveillance for new-onset AF should be considered in breast cancer patients treated with an AI.
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Affiliation(s)
- Isaac Ho
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR
| | - Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yuen-Kwun Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Tsun-Ho Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | | | - Minqing Lin
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - David Tak-Wai Lui
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Wang Chun Kwok
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Chor-Cheung Tam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yap-Hang Chan
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Esther W.Y. Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Hung-Fat Tse
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Cardiac and Vascular Center, Hong Kong University Shenzhen Hospital, Shenzhen, China
- Center for Translational Stem Cell Biology, Hong Kong SAR, China
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Wang MP, Lam TH, Viswanath K, Cheng RCK, Kwok TTO, Cheung DYT, Wong CKH, Lee JJJ, Chan HCH. Combining interactive communication and nicotine replacement therapy for smokers: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 7:4-8. [PMID: 38148648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Affiliation(s)
- M P Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - K Viswanath
- Department of Social and Behavioral Sciences, Center for Community-Based Research, Dana Farber Cancer Institute, TH Chan School of Public Health, Harvard University, United States
| | - R C K Cheng
- Department of Computer Science, The University of Hong Kong, Hong Kong SAR, China
| | - T T O Kwok
- Technology-Enriched Learning Initiative, The University of Hong Kong, Hong Kong SAR, China
| | - D Y T Cheung
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - C K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - J J J Lee
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - H C H Chan
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Hong Kong SAR, China
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Kwok MK, Leung GM, Xu L, Tse HF, Lam TH, So TH, Schooling CM. Effects of puerarin supplementation on cardiovascular disease risk factors: a randomised, double-blind, placebo-controlled, two-way crossover trial (abridged secondary publication). Hong Kong Med J 2023; 29 Suppl 4:18-21. [PMID: 37690802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
- M K Kwok
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - G M Leung
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - L Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - H F Tse
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - T H So
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C M Schooling
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, United States
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Cheung DYT, Chan HCH, Conway M, Wong CKH, Li WHC, Wang MP, Lam TH. WhatsApp group discussion for smoking relapse prevention: a randomised controlled trial (abridged secondary publication). Hong Kong Med J 2023; 29 Suppl 3:16-18. [PMID: 37357585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- D Y T Cheung
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - H C H Chan
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong SAR, China
| | - M Conway
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - C K H Wong
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W H C Li
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - M P Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - T H Lam
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Leung CC, Lam TH. Combating the tridemic: new guidelines, masking and altruism. Int J Tuberc Lung Dis 2023; 27:96-97. [PMID: 36853112 DOI: 10.5588/ijtld.22.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- C C Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Hong Kong, China
| | - T H Lam
- The School of Public Health, The University of Hong Kong, Hong Kong, China
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Wang MP, Luk TT, Lam TH, Li WHC, Leung WC, Leung KY, Cheung KW, Kwa C, Siong KH, Tang KK, Lee KW. Combination of brief advice, nicotine replacement therapy sampling, and active referral for smoking expectant fathers: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 2:25-28. [PMID: 36951002] [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: 03/24/2023] Open
Affiliation(s)
- M P Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - T T Luk
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - W H C Li
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China
| | - K Y Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K W Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong SAR, China
| | - C Kwa
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong SAR, China
| | - K H Siong
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Hong Kong SAR, China
| | - K K Tang
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K W Lee
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong SAR, China
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Li HCW, Lam TH, Ho KY, Lam KWK. Instant messaging applications to promote smoking cessation in smokers with chronic diseases: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 2:22-24. [PMID: 36951001] [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: 03/24/2023] Open
Affiliation(s)
- H C W Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - K Y Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - K W K Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Wong CK, Lam TH, Liao SY, Lau YM, Tse HF, So BYF. Immunopathogenesis of Immune Checkpoint Inhibitor Induced Myocarditis: Insights from Experimental Models and Treatment Implications. Biomedicines 2023; 11:biomedicines11010107. [PMID: 36672615 PMCID: PMC9855410 DOI: 10.3390/biomedicines11010107] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Despite the extraordinary success of immune checkpoint inhibitors (ICIs) in cancer treatment, their use is associated with a high incidence of immune-related adverse events (IRAEs), resulting from therapy-related autoimmunity against various target organs. ICI-induced myocarditis is one of the most severe forms of IRAE, which is associated with risk of hemodynamic compromise and mortality. Despite increasing recognition and prompt treatment by clinicians, there remain significant gaps in knowledge regarding the pathophysiology, diagnosis and treatment of ICI-induced myocarditis. As the newly emerged disease entity is relatively rare, it is challenging for researchers to perform studies involving patients at scale. Alternatively, mouse models have been developed to facilitate research understanding of the pathogenesis of ICI-induced myocarditis and drug discovery. Transgenic mice with immune checkpoint genes knocked out allow induction of myocarditis in a highly reproducible manner. On the other hand, it has not been possible to induce ICI-induced myocarditis in wild type mice by injecting ICIs monotherapy alone. Additional interventions such as combinational ICI, tumor inoculation, cardiac sarcomere immunization, or cardiac irradiation are necessary to mimic the underlying pathophysiology in human cancer patients and to induce ICI-induced myocarditis successfully. This review focuses on the immunopathogenesis of ICI-induced myocarditis, drawing insights from human studies and animal models, and discusses the potential implications for treatment.
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Affiliation(s)
- Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tsun-Ho Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Song-Yan Liao
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yee-Man Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
- Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
- Centre for Stem Cell Translational Biology, Hong Kong SAR, China
| | - Benjamin Y. F. So
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Correspondence: ; Tel.: +852-2255-3111
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Lai V, Tong H, Leung LT, Ho SY, Lam TH. Will heated tobacco products be banned in Hong Kong? Int J Tuberc Lung Dis 2021; 25:956-958. [PMID: 34686242 DOI: 10.5588/ijtld.21.0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- V Lai
- Hong Kong Council on Smoking and Health, Wanchai, Hong Kong, China
| | - H Tong
- Hong Kong Council on Smoking and Health, Wanchai, Hong Kong, China
| | - L T Leung
- Hong Kong Council on Smoking and Health, Wanchai, Hong Kong, China
| | - S Y Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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10
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Chau SL, Wang MP, Wu Y, Cheung DYT, Kong A, Lai V, Lam TH, Ho SY. Polytobacco product use among current cigarette smokers in Hong Kong, China: results from population surveys (2015-17). BMC Public Health 2021; 21:307. [PMID: 33549071 PMCID: PMC7866759 DOI: 10.1186/s12889-021-10341-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polytobacco product use is increasingly popular, but little is known about the prevalence, trend, and factors of such use particularly in non-western countries. METHOD A representative sample of 1139 current cigarette smokers aged 15+ (84.1% male) were telephone interviewed in Tobacco Control Policy-related Surveys in 2015-2017. Information collected included poly-tobacco use (PTU), smoking and socio-demographic characteristics. Associations of current PTU with related factors were analyzed using logistic regression with adjustment for confounders. Prevalence was weighted by age and sex of current cigarette users in the general population. RESULTS Eighty-four point one percent (95% CI 81.4-86.6%) were exclusive cigarette smokers. Fifteen point nine percent (13.4-18.6%) were current polytobacco product users, 12.3% (10.2-14.8%) used one tobacco product and 2.52% (1.59-3.97%) used two tobacco products in addition to cigarette. Cigarette use with cigar was more common (6.28%, 4.75-8.27%), and the least used product with cigarette was e-cigarette (1.05%, 0.44-2.50%). The changes in overall prevalence of PTU by number of products use varied in 3 years. Current PTU was associated with being male (AOR 2.01, 95% CI 1.12-3.61), younger age (AORs range from 1.34-4.65, P for trend < .001) and less ready to quit (2.08, 1.09-3.97). CONCLUSIONS Prevalence of PTU increased slowly by year, one tobacco product use with cigarette was more common. The most used tobacco product with cigarette was cigar. Being male, younger and less ready to quit were associated with current PTU.
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Affiliation(s)
- S L Chau
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - M P Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Y Wu
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - D Y T Cheung
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - A Kong
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - V Lai
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - T H Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
| | - S Y Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
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Ching RCT, Mak SP, Wong MCS, Lam M, Chan WM, Wong MFY, Liang R, Lam TH. Response to the World Health Organization's working document for the development of a global action plan to reduce alcohol-related harm: Position Statement of the Hong Kong Alliance for Advocacy Against Alcohol. Hong Kong Med J 2021; 27:4-6. [PMID: 33518532 DOI: 10.12809/hkmj215109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- R C T Ching
- Hong Kong Alliance for Advocacy Against Alcohol
| | - S P Mak
- Hong Kong Alliance for Advocacy Against Alcohol
| | - M C S Wong
- Hong Kong Alliance for Advocacy Against Alcohol
| | - M Lam
- Hong Kong Alliance for Advocacy Against Alcohol
| | - W M Chan
- Hong Kong Alliance for Advocacy Against Alcohol
| | - M F Y Wong
- Hong Kong Alliance for Advocacy Against Alcohol
| | - R Liang
- Hong Kong Alliance for Advocacy Against Alcohol
| | - T H Lam
- Hong Kong Alliance for Advocacy Against Alcohol
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12
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Leung GM, Hedley AJ, Kong J, Lam TH, Lau FL, Rainer T, Wong TW, Tong YH. Correction to: A clinical prediction rule for diagnosing severe acute respiratory syndrome in the emergency department. Hong Kong Med J 2020; 26. [PMID: 32255435 DOI: 10.12809/hkm0810sp5p8-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Affiliation(s)
- C C Leung
- The Advisory Committee on Communicable Diseases, Hong Kong Medical Association, Hong Kong, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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Kaptoge S, Pennells L, De Bacquer D, Cooney MT, Kavousi M, Stevens G, Riley LM, Savin S, Khan T, Altay S, Amouyel P, Assmann G, Bell S, Ben-Shlomo Y, Berkman L, Beulens JW, Björkelund C, Blaha M, Blazer DG, Bolton T, Bonita Beaglehole R, Brenner H, Brunner EJ, Casiglia E, Chamnan P, Choi YH, Chowdry R, Coady S, Crespo CJ, Cushman M, Dagenais GR, D'Agostino Sr RB, Daimon M, Davidson KW, Engström G, Ford I, Gallacher J, Gansevoort RT, Gaziano TA, Giampaoli S, Grandits G, Grimsgaard S, Grobbee DE, Gudnason V, Guo Q, Tolonen H, Humphries S, Iso H, Jukema JW, Kauhanen J, Kengne AP, Khalili D, Koenig W, Kromhout D, Krumholz H, Lam TH, Laughlin G, Marín Ibañez A, Meade TW, Moons KGM, Nietert PJ, Ninomiya T, Nordestgaard BG, O'Donnell C, Palmieri L, Patel A, Perel P, Price JF, Providencia R, Ridker PM, Rodriguez B, Rosengren A, Roussel R, Sakurai M, Salomaa V, Sato S, Schöttker B, Shara N, Shaw JE, Shin HC, Simons LA, Sofianopoulou E, Sundström J, Völzke H, Wallace RB, Wareham NJ, Willeit P, Wood D, Wood A, Zhao D, Woodward M, Danaei G, Roth G, Mendis S, Onuma O, Varghese C, Ezzati M, Graham I, Jackson R, Danesh J, Di Angelantonio E. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health 2019; 7:e1332-e1345. [PMID: 31488387 PMCID: PMC7025029 DOI: 10.1016/s2214-109x(19)30318-3] [Citation(s) in RCA: 449] [Impact Index Per Article: 89.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/16/2019] [Accepted: 07/10/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. METHODS In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. FINDINGS Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629-0·741) to 0·833 (0·783-0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. INTERPRETATION We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. FUNDING World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.
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Lam TH, Wong KH, Chan KK, Chan MC, Chao DV, Cheung AN, Fan CY, Ho J, Hui EP, Lam KO, Law CK, Law WL, Loong HH, Ngan RK, Tsang TH, Wong MC, Yeung RM, Ying AC, Ching R. Recommendations on prevention and screening for colorectal cancer in Hong Kong. Hong Kong Med J 2019; 24:521-526. [PMID: 30318477 DOI: 10.12809/hkmj177095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Colorectal cancer is the commonest cancer in Hong Kong. The Cancer Expert Working Group on Cancer Prevention and Screening was established in 2002 under the Cancer Coordinating Committee to review local and international scientific evidence, assess and formulate local recommendations on cancer prevention and screening. At present, the Cancer Expert Working Group recommends that average-risk individuals aged 50 to 75 years and without significant family history consult their doctors to consider screening by: (1) annual or biennial faecal occult blood test, (2) sigmoidoscopy every 5 years, or (3) colonoscopy every 10 years. Increased-risk individuals with significant family history such as those with a first-degree relative diagnosed with colorectal cancer at age ≤60 years; those who have more than one first-degree relative diagnosed with colorectal cancer irrespective of age at diagnosis; or carriers of genetic mutations associated with familial adenomatous polyposis or Lynch syndrome should start colonoscopy screening earlier in life and repeat it at shorter intervals.
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Affiliation(s)
- T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - K Kl Chan
- The Hong Kong College of Obstetricians and Gynaecologists, Hong Kong
| | - M Cm Chan
- Hospital Authority (Surgical), Hong Kong
| | - D Vk Chao
- The Hong Kong College of Family Physicians, Hong Kong
| | - A Ny Cheung
- The Hong Kong College of Pathologists, Hong Kong
| | - C Ym Fan
- Professional Development and Quality Assurance, Department of Health, Hong Kong
| | - J Ho
- World Cancer Research Fund Hong Kong, Hong Kong
| | - E P Hui
- Hong Kong College of Physicians, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - C K Law
- Hong Kong College of Radiologists, Hong Kong
| | - W L Law
- The College of Surgeons of Hong Kong, Hong Kong
| | - H Hf Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - R Kc Ngan
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - T Hf Tsang
- Hong Kong College of Community Medicine, Hong Kong
| | - M Cs Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - R Mw Yeung
- Hospital Authority (Non-surgical), Hong Kong
| | - A Ch Ying
- The Hong Kong Anti-Cancer Society, Hong Kong
| | - R Ching
- Centre for Health Protection, Department of Health, Hong Kong
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Ho DSY, Huang R, Wang MP, Lo WS, Lam TH. Adolescent alcohol drinking in Hong Kong: a school-based survey. Hong Kong Med J 2019; 25 Suppl 3:13-15. [PMID: 30792366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- D S Y Ho
- School of Public Health, The University of Hong Kong
| | - R Huang
- School of Public Health, The University of Hong Kong
| | - M P Wang
- School of Nursing, The University of Hong Kong
| | - W S Lo
- School of Public Health, The University of Hong Kong
| | - T H Lam
- School of Public Health, The University of Hong Kong
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Lam TH, Wong KH, Chan KK, Chan MC, Chao DV, Cheung AN, Fan CY, Ho J, Hui EP, Lam KO, Law CK, Law WL, Loong HH, Ngan RK, Tsang TH, Wong MC, Yeung RM, Ying AC, Ching R. Recommendations on prevention and screening for breast cancer in Hong Kong. Hong Kong Med J 2018; 24:298-306. [PMID: 29926793 DOI: 10.12809/hkmj177037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In Hong Kong, breast cancer is the most common cancer among women and poses a significant health care burden. The Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) was set up in 2002 by the Cancer Coordinating Committee to review and assess local and international scientific evidence, and to formulate recommendations for cancer prevention and screening. After considering the local epidemiology, emerging scientific evidence, and local and overseas screening practices, the CEWG concluded that it was unclear whether population-based breast cancer screening did more harm than good in local asymptomatic women at average risk. The CEWG considers that there is insufficient evidence to recommend for or against population-based mammography screening for such individuals. Women who consider breast cancer screening should be adequately informed about the benefits and harms. The CEWG recommends that all women adopt primary preventive measures, be breast aware, and seek timely medical attention for suspicious symptoms. For women at high risk of breast cancer, such as carriers of confirmed BRCA1/2 deleterious mutations and those with a family history of breast cancer, the CEWG recommends that they seek doctor's advice for annual mammography screening and the age at which the process should commence. Additional annual screening by magnetic resonance imaging is recommended for confirmed BRCA1/2 mutation carriers or women who have undergone radiation therapy to the chest between the age of 10 and 30 years. Women at moderate risk of breast cancer should discuss with doctors the pros and cons of breast cancer screening before making an informed decision about mammography screening every 2 to 3 years.
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Affiliation(s)
- T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K H Wong
- DDepartment of Health, Hong Kong
| | - K Kl Chan
- The Hong Kong College of Obstetricians and Gynaecologists, Hong Kong
| | - M Cm Chan
- Hospital Authority (Surgical), Hong Kong
| | - D Vk Chao
- The Hong Kong College of Family Physicians, Hong Kong
| | - A Ny Cheung
- The Hong Kong College of Pathologists, Hong Kong
| | - C Ym Fan
- Professional Development and Quality Assurance, Department of Health, Hong Kong
| | - J Ho
- World Cancer Research Fund Hong Kong, Hong Kong
| | - E P Hui
- Hong Kong College of Physicians, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - C K Law
- Hong Kong College of Radiologists, Hong Kong
| | - W L Law
- The College of Surgeons of Hong Kong, Hong Kong
| | - H Hf Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - R Kc Ngan
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - T Hf Tsang
- Hong Kong College of Community Medicine, Hong Kong
| | - M Cs Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - R Mw Yeung
- Hospital Authority (Non-surgical), Hong Kong
| | - A Ch Ying
- The Hong Kong Anti-Cancer Society, Hong Kong
| | - R Ching
- Centre for Health Protection, Department of Health, Hong Kong
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Lam TH. Population-based mammography screening programme should be rigorously evaluated. Hong Kong Med J 2018; 24:428. [DOI: 10.12809/hkmj187547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Leung JY, Lin SL, Lee RS, Lam TH, Schooling CM. Framingham risk score for predicting cardiovascular disease in older adults in Hong Kong. Hong Kong Med J 2018; 24 Suppl 4:8-11. [PMID: 30135267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- J Yy Leung
- School of Public Health, The University of Hong Kong, Hong Kong
| | - S L Lin
- School of Public Health, The University of Hong Kong, Hong Kong
| | - R Sy Lee
- Elderly Health Service, Department of Health, Hong Kong
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - C M Schooling
- School of Public Health, The University of Hong Kong, Hong Kong
- School of Public Health and Health Policy, City University of New York, USA
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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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Ho KY, Li WHC, Wang MP, Lam KKW, Lam TH, Chan SSC. Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: A Phase 2 randomized controlled trial. Patient Educ Couns 2018; 101:885-893. [PMID: 29439844 DOI: 10.1016/j.pec.2018.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/19/2018] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To compare the effectiveness of quitting immediately and cutting down to quit in promoting smoking abstinence among smokers in an outpatient clinic. METHODS A total of 100 subjects were randomized into two groups, 50 in the quit immediately group, who received an intervention on abruptly quitting, and 50 in the cut down to quit group, who received an intervention on gradual reduction. All subjects were followed up at 6 and 12 months via telephone. The intention-to-treat principle was used. RESULTS At the 6-month follow-up, the self-reported quit rate of subjects in the quit immediately group was significantly higher than in the cut down to quit group (18.0% vs. 4.0%, p = 0.04). However, this difference was not significant at the 12-month follow-up (12.0% vs. 4.0%, p = 0.16). CONCLUSION These data suggest that quitting immediately might be more effective than cutting down to quit at 6 months but not at 12 months. PRACTICE IMPLICATIONS It is crucial to allow smokers to select quitting immediately or reducing the number of cigarettes smoked. Further studies are warranted to compare the effectiveness of various approaches for achieving smoking abstinence.
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Affiliation(s)
- K Y Ho
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - William H C Li
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - M P Wang
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - K K W Lam
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - T H Lam
- School of Public Health, The University of Hong Kong, HKSAR, Hong Kong
| | - Sophia S C Chan
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
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Li WHC, Wang MP, Ho KY, Lam KKW, Cheung DYT, Cheung YTY, Lam TH, Chan SSC. Helping cancer patients quit smoking using brief advice based on risk communication: A randomized controlled trial. Sci Rep 2018; 8:2712. [PMID: 29426956 PMCID: PMC5807437 DOI: 10.1038/s41598-018-21207-1] [Citation(s) in RCA: 14] [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: 09/18/2017] [Accepted: 01/31/2018] [Indexed: 12/28/2022] Open
Abstract
This randomized controlled trial aimed to examine the effectiveness of a smoking cessation intervention using a risk communication approach. A total of 528 smoking cancer patients were randomly allocated either into an intervention group (n = 268) to receive brief advice based on risk communication by a nurse counselor or a control group (n = 260) to receive standard care. Subjects in both groups received a smoking cessation booklet. Patient follow-ups were at 1 week and at 1, 3, 6, 9 and 12 months. No significant differences were found in self-reported point-prevalence 7-day abstinence between the intervention and control groups at 6 months (15.7% vs 16.5%; OR 0.94, 95% CI 0.59-1.50). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88-2.35). The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60-3.16). These data suggest that advice based on risk communication was not effective for quitting but improved the rate of smoking reduction among smoking cancer patients.
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Affiliation(s)
- William H C Li
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong, China.
| | - M P Wang
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong, China
| | - K Y Ho
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Katherine K W Lam
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Derek Y T Cheung
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Yannes T Y Cheung
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, HKSAR, Hong Kong, China
| | - Sophia S C Chan
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong, China
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Xu L, Lam TH, Jiang CQ, Zhang WS, Jin YL, Zhu T, Zhu F, Thomas GN, Cheng KK. Adiposity and incident diabetes within 4 years of follow-up: the Guangzhou Biobank Cohort Study. Diabet Med 2017; 34:1400-1406. [PMID: 28477424 DOI: 10.1111/dme.13378] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 01/19/2023]
Abstract
AIM Whether different adiposity measures predict incident diabetes differentially in general Chinese populations is unclear. We investigated this in Chinese people aged 50+ years in the Guangzhou Biobank Cohort Study. METHODS Waist circumference and BMI were measured at baseline, and fasting glucose was measured at both baseline and follow-up examinations. Incident diabetes was defined as fasting glucose ≥ 7.0 mmol/l, glucose after 2-h oral glucose tolerance test ≥ 11.1 mmol/l, and/or self-reported physician-diagnosed diabetes during the follow-up period. RESULTS Of 15 752 people without diabetes at baseline from 2003 to 2008, 1779 (11.3%) developed incident diabetes during the follow-up from 2008 to 2012 (mean = 3.6 years, sd = 1.0). After mutually adjusting each other and adjusting for other potential confounders, waist circumference showed a higher predictive value than BMI. The odds ratio (OR) (95% confidence interval (CI) was 1.50 (95% CI 1.37-1.64) for a 1 sd increment in waist circumference and 1.21 (95% CI 1.11-1.33), for a 1 sd increment in BMI. Similarly, after mutual adjustment, abdominal obesity was associated with an almost twofold odds of incident diabetes (OR 1.93, 95% CI 1.71-2.17), which was higher than that for general obesity (OR 1.76, 95% CI 1.50-2.06). The area under receiver operating characteristic curve (AUC) for waist circumference was higher than that for BMI [AUC = 0.676 (95% CI 0.660-0.686) vs. 0.665 (95% CI 0.651-0.678), P = 0.02]. CONCLUSION Abdominal obesity predicted incident diabetes in older people better than general obesity. Our findings may be an early warning signal for local government or public health practitioners to develop and investigate more effective intervention programmes for diabetes, and should also be disseminated to the public to pay more attention to this important public health issue.
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Affiliation(s)
- L Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong
- School of Public Health, the University of Hong Kong, Hong Kong
| | - T H Lam
- School of Public Health, the University of Hong Kong, Hong Kong
- Guangzhou 12th Hospital, Guangzhou, China
| | - C Q Jiang
- School of Public Health, the University of Hong Kong, Hong Kong
| | - W S Zhang
- Guangzhou 12th Hospital, Guangzhou, China
| | - Y L Jin
- Guangzhou 12th Hospital, Guangzhou, China
| | - T Zhu
- Guangzhou 12th Hospital, Guangzhou, China
| | - F Zhu
- Guangzhou 12th Hospital, Guangzhou, China
| | - G N Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Leung DY, Chan SS, Lam TH. Prevalence and characteristics of hardcore smokers in Hong Kong. Hong Kong Med J 2017; 23 Suppl 2:4-9. [PMID: 29938662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- D Yp Leung
- Nethersole School of Nursing, The Chinese University of Hong Kong
| | - S Sc Chan
- School of Nursing, The University of Hong Kong
| | - T H Lam
- School of Public Health, The University of Hong Kong
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Yoon S, Lam WWT, Sham JTL, Lam TH. Underage drinking, group identity and access to alcohol: a qualitative study of Chinese youths. Health Educ Res 2017; 32:269-278. [PMID: 28482058 DOI: 10.1093/her/cyx045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
Despite substantial research into underage youth's source of alcohol, few studies have examined how they go about obtaining alcohol through various means. This study explored the nature of alcohol access by Chinese adolescents and how their own perceptions around alcohol availability influence them to source alcohol in particular ways. This research involved focus groups with 111 young people aged 14-17 in Hong Kong, China. A grounded theory analysis was conducted using NVivo 10. While participants perceived ease of obtaining alcohol from retail outlets, proxy purchasing through friendship group members was reported as routine experience primarily to avoid potential embarrassment of being turned away. Convincing vendors that they were of legal drinking age was the convention used most commonly by Chinese teen drinkers. Participants expressed resentment toward adults who were willing to supply minors with alcohol. Nevertheless, this feeling of disappointment did not alter the ways they sourced alcohol. Access activities embodied a symbol of group identity in the collectivist Chinese culture. Results suggest that greater consideration should be given to understanding the complex interplay between alcohol access and community experience within peers. The perceived importance of face saving in Chinese culture may provide avenues for preventing youth access to alcohol.
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Affiliation(s)
- S Yoon
- Academic Medicine Research Institute & Programme in Health Services and Systems Research, Duke-NUS Medical School Singapore, The Academia, 20 College Road, Singapore 169856, Singapore
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, People's Republic of China
| | - W W T Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, People's Republic of China
| | - J T L Sham
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, People's Republic of China
| | - T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, People's Republic of China
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Lam TH, Li WH, Wang MP, Cheung YT, Cheung DY, Ho KY, Tan KC, Chan SS. A brief, tailored smoking cessation intervention for smokers with diabetes mellitus in Hong Kong. Hong Kong Med J 2017; 23 Suppl 2:10-11. [PMID: 29938663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- T H Lam
- School of Public Health, The University of Hong Kong
| | - W Hc Li
- School of Nursing, The University of Hong Kong
| | - M P Wang
- School of Nursing, The University of Hong Kong
| | - Y Ty Cheung
- School of Nursing, The University of Hong Kong
| | - D Yt Cheung
- School of Nursing, The University of Hong Kong
| | - K Y Ho
- School of Nursing, The University of Hong Kong
| | - K Cb Tan
- Department of Medicine, The University of Hong Kong
| | - S Sc Chan
- School of Nursing, The University of Hong Kong
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Ho SY, Leung LT, Chen JJ, Wang MP, Lam TH. Favourable perceptions of electronic cigarettes relative to cigarettes and the associations with intention to use electronic cigarettes in Hong Kong adolescents. Tob Prev Cessat 2017. [DOI: 10.18332/tpc/70207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Li WHC, Chan SSC, Wan ZSF, Wang MP, Ho KY, Lam TH. Development of a community-based network to promote smoking cessation among female smokers in Hong Kong. BMC Public Health 2017; 17:311. [PMID: 28399845 PMCID: PMC5387243 DOI: 10.1186/s12889-017-4213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/01/2017] [Indexed: 12/03/2022] Open
Abstract
Background There is a need for population-based smoking cessation interventions targeting female smokers in Hong Kong. This study describes the development of a community-based network to promote smoking cessation among female smokers in Hong Kong. Methods Local women’s organizations collaborated to launch a project to provide gender-specific smoking cessation services. In the first phase of the project, the Women Against Tobacco Taskforce (WATT) was created. In the second phase, a smoking cessation training curriculum was developed and female volunteers were trained. The third and final phase included the provision of gender-specific smoking cessation counseling services in Hong Kong. Results A need assessment survey with 623 workers and volunteers of WATT members was carried out to develop a gender-specific smoking cessation training curriculum. A 1-day training workshop to 28 WATT affiliates who provided brief cessation counseling in the community was organized. Fourteen organizations (69 service units) agreed to form a network by joining WATT to promote smoking cessation and increase awareness of the specific health risks among female smokers. Conclusions The community-based network to promote smoking cessation was effective in helping female smokers to quit smoking or reduce their cigarette consumption. The results also suggest that this community model of promoting gender-specific smoking cessation services is feasible. Trial registration Clinicaltrials.gov ID NCT02968199 (Retrospectively registered on November 16, 2016). Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4213-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- William H C Li
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Sophia S C Chan
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong
| | - Zoe S F Wan
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong
| | - M P Wang
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong
| | - K Y Ho
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong
| | - T H Lam
- School of Public Health, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), No 7 Sassoon Road, Pokfulam, Hong Kong
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Zhang H, Wong WCW, Ip P, Lai GWF, Lam TH, Lam KF, Fan S, Lee A, Cheung DYT, Zhang Y, Yip PSF. A Study of Violence Among Hong Kong Young Adults and Associated Substance Use, Risky Sexual Behaviors, and Pregnancy. Violence Vict 2016; 31:985-996. [PMID: 27523605 DOI: 10.1891/0886-6708.vv-d-13-00181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aimed to estimate the self-reported prevalence of violence perpetration and victimization among Hong Kong youths and the associated health risk behaviors using a representative sample of 1,126 young adults aged 18-27 years. Perpetrating physical and emotional violence was common in Hong Kong, with prevalences ranging from 20.8% to 38.3% in males and from 6.4% to 21.3% in females. Victimization of physical and emotional violence was also common for both sexes, with prevalences ranging from 16.4% to 36.3% in males and from 6.6% to 19.2% in females. Perpetration of sexual harassment and sexual violence was less prevalent, whereas victimization of sexual harassment and sexual violence ranged from 0.6% to 3.6% in males and from 2.3% to 13.2% in females. Both violence perpetration and victimization among youths were significantly associated with substance use, risky sexual behaviors, and pregnancy. The implications of this study for violence prevention programs are discussed.
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Huang R, Ho SY, Wang MP, Lo WS, Lam TH. Reported alcohol drinking and mental health problems in Hong Kong Chinese adolescents. Drug Alcohol Depend 2016; 164:47-54. [PMID: 27177803 DOI: 10.1016/j.drugalcdep.2016.04.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 09/14/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the association between reported alcohol drinking and mental health problems in Hong Kong adolescents. METHODS In a school-based questionnaire survey in 2012-13 on 4620 Secondary one (US Grade seven) to six students (mean age 14.5, SD 1.6 years; 53.4% boys), alcohol drinking was classified as never drinking (reference), experimental, former, less-than-weekly and weekly drinking. Binge drinking was defined as drinking at least five drinks on one occasion. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) with five subscales (emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial activity) and the total difficulties score (sum of the first four subscales). Multilevel regression was used to analyse the associations of mental health problems with drinking frequency and binge drinking, adjusting for potential confounders. RESULTS Compared with never drinking, higher total difficulties scores were associated with less-than-weekly drinking (adjusted odds ratio AOR 1.39, 95% CI 1.01-1.91), weekly drinking (AOR 3.21, 95% CI 2.18-4.70), and binge drinking (AOR 2.18, 95% CI 1.42-3.32). Weekly drinking was most strongly associated with hyperactivity (AOR 6.27, 95% CI 1.42-3.32) among all subscales. Girls were more likely than boys to report emotional problems (AOR 3.36 vs 1.47) and hyperactivity (AOR 19.2 vs 2.31) related to weekly alcohol drinking (both P for interaction <0.05). CONCLUSIONS In Hong Kong adolescents, less-than-weekly, weekly, and binge drinking are associated with higher risks of mental health problems based on self-reported data. Prospective studies are warranted to explore the causality between alcohol drinking and mental health problems.
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Affiliation(s)
- R Huang
- Zhejiang Medical College, Hangzhou, China; School of Public Health, The University of Hong Kong, Hong Kong
| | - S Y Ho
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - M P Wang
- School of Nursing, The University of Hong Kong, Hong Kong
| | - W S Lo
- School of Public Health, The University of Hong Kong, Hong Kong
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong
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Jiang CQ, Chan YH, Xu L, Jin YL, Zhu T, Zhang WS, Cheng KK, Lam TH. Smoking and serum vitamin D in older Chinese people: cross-sectional analysis based on the Guangzhou Biobank Cohort Study. BMJ Open 2016; 6:e010946. [PMID: 27338881 PMCID: PMC4932269 DOI: 10.1136/bmjopen-2015-010946] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Studies on serum vitamin D in smokers showed conflicting results. We examined the association of smoking status with serum vitamin D in older Chinese men, taking advantage of a community-based sample with natural exposure to vitamin D. DESIGN Cross-sectional study based on the Guangzhou Biobank Cohort Study (GBCS). SETTING Community-based sample from the Guangzhou Biobank Cohort Study. PARTICIPANTS 612 male participants aged 50+years recruited from 2009 to 2011. RESULTS The mean (SD) of vitamin D concentration was 58.3 (17.2), 57.0 (15.0) and 54.7 (15.4) nmol/L for never, former and current smokers, respectively. Adjusted for multiple confounders, vitamin D decreased from never to former, then to current smokers (P for trend 0.02). Compared to never smokers, current smokers had lower serum concentrations of vitamin D, and the concentrations decreased with the increasing number of cigarettes per day (-3.11 (95% CI -9.05 to 2.82), -3.29 (-8.3 to 1.72) and -4.61 (-8.89 to -0.33) for 1-9, 10-19 and 20+cigarettes per day, respectively; p for trend 0.01), duration of smoking (-1.39 (-6.09 to 3.30) and -5.39 (-9.42 to -1.35) for 1-39 and 40+years, respectively; p for trend 0.008) as well as pack-years (-2.89 (-6.78 to 1.01) and -5.58 (-10.48 to -0.67) for 1-39 and 40+pack-years, respectively; p for trend 0.009). Longer duration of quitting smoking was associated with higher vitamin D than was current smoking (P for trend 0.04). CONCLUSIONS Current smokers had lower vitamin D than never smokers, and the association showed a dose-response pattern.
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Affiliation(s)
- C Q Jiang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - Y H Chan
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - L Xu
- School of Public Health, the University of Hong Kong, Hong Kong, China
| | - Y L Jin
- Guangzhou No 12 Hospital, Guangzhou, China
| | - T Zhu
- Guangzhou No 12 Hospital, Guangzhou, China
| | - W S Zhang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - T H Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
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Yu NX, Lam TH, Liu IKF, Stewart SM. Mediation of Short and Longer Term Effects of an Intervention Program to Enhance Resilience in Immigrants from Mainland China to Hong Kong. Front Psychol 2015; 6:1769. [PMID: 26640446 PMCID: PMC4661285 DOI: 10.3389/fpsyg.2015.01769] [Citation(s) in RCA: 9] [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: 06/12/2015] [Accepted: 11/04/2015] [Indexed: 11/25/2022] Open
Abstract
Few clinical trials report on the active intervention components that result in outcome changes, although this is relevant to further improving efficacy and adapting effective programs to other populations. This paper presents follow-up analyses of a randomized controlled trial to enhance adaptation by increasing knowledge and personal resilience in two separate brief interventions with immigrants from Mainland China to Hong Kong (Yu et al., 2014b). The present paper extends our previous one by reporting on the longer term effect of the interventions on personal resilience, and examining whether the Resilience intervention worked as designed to enhance personal resilience. The four-session intervention targeted at self-efficacy, positive thinking, altruism, and goal setting. In this randomized controlled trial, 220 immigrants were randomly allocated to three arms: Resilience, Information (an active control arm), and Control arms. Participants completed measures of the four active components (self-efficacy, positive thinking, altruism, and goal setting) at baseline and immediately after the intervention. Personal resilience was assessed at baseline, post-intervention, and 3- and 6-month follow-ups. The results showed that the Resilience arm had greater increases in the four active components post-intervention. Changes in each of the four active components at the post-intervention assessment mediated enhanced personal resilience at the 3-month follow-up in the Resilience arm. Changes in self-efficacy and goal setting showed the largest effect size, and altruism showed the smallest. The arm effects of the Resilience intervention on enhanced personal resilience at the 6-month follow-up were mediated by increases of personal resilience post-intervention (Resilience vs. Control) and at the 3-month follow-up (Resilience vs. Information). These findings showed that these four active components were all mediators in this Resilience intervention. Our results of the effects of short term increases in personal resilience on longer term increase in personal resilience in some models suggest how changes in intervention outcomes might persist over time.
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Affiliation(s)
- Nancy X Yu
- Department of Applied Social Sciences, City University of Hong Kong Hong Kong, Hong Kong ; School of Public Health, The University of Hong Kong Hong Kong, Hong Kong
| | - T H Lam
- School of Public Health, The University of Hong Kong Hong Kong, Hong Kong
| | - Iris K F Liu
- International Social Service Hong Kong Branch Hong Kong, Hong Kong
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center Dallas, TX, USA
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Kavikondala S, Stewart SM, Ni MY, Chan BHY, Lee PH, Li KK, McDowell I, Johnston JM, Chan SS, Lam TH, Lam WWT, Fielding R, Leung GM. Structure and validity of Family Harmony Scale: An instrument for measuring harmony. Psychol Assess 2015; 28:307-18. [PMID: 26146946 DOI: 10.1037/pas0000131] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Culture plays a role in mental health, partly by defining the characteristics that are indicative of positive adjustment. In Chinese cultures, positive family relationships are considered central to well-being. The culturally emphasized characteristic of family harmony may be an important factor associated with psychopathology. This article presents the development and psychometric examination of the Family Harmony Scale (FHS), an indigenously developed 24-item instrument tapping family harmony in 17,461 Hong Kong residents from 7,791 households. A higher-order model with 1 second-order factor and 5 first-order factors fit the data well and showed factorial invariance across sex and participants in different family roles. A 5-item short form (FHS-5) was also developed, with 1 item from each first-order factor. The short scale showed, as expected, a single-factor structure with good fit. Both scales demonstrated high internal consistency, acceptable test-retest reliability, and good convergent and discriminant validity. The 24-item FHS was negatively associated with depressive symptoms after accounting for individual risk factors and general family function. Family harmony moderated the relationship between life stress and depressive symptoms such that those individuals who reported low family harmony had stronger associations between life stress and depressive symptoms. This study adds to the literature a systematically developed, multidimensional measure of family harmony, which may be an important psychological protective factor, in a large urban Chinese sample. The FHS-5 minimizes operational and respondent burdens, making it an attractive tool for large-scale epidemiological studies with Chinese populations in urban settings, where over half of China's 1.4 billion people reside.
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Affiliation(s)
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Centre at Dallas
| | - Michael Y Ni
- School of Public Health, The University of Hong Kong
| | | | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University
| | - Kin-Kit Li
- Department of Applied Social Studies, College of Liberal Arts and Social Sciences, City University of Hong Kong
| | - Ian McDowell
- Department of Epidemiology and Community Medicine, University of Ottawa
| | | | | | - T H Lam
- School of Public Health, The University of Hong Kong
| | - Wendy W T Lam
- School of Public Health, The University of Hong Kong
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Xu L, Jiang CQ, Schooling CM, Zhang WS, Cheng KK, Lam TH. Liver enzymes and incident diabetes in China: a prospective analysis of 10 764 participants in the Guangzhou Biobank Cohort Study. J Epidemiol Community Health 2015; 69:1040-4. [PMID: 26139641 DOI: 10.1136/jech-2015-205518] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/08/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Impaired liver function has been shown to be associated with incident diabetes. The independent role of the different liver enzymes, including γ-glutamyltransferase (GGT), alanine transaminase (ALT) and aspartate transaminase (AST), has not been addressed properly, taking into account their high collinearity. We used partial least squares (PLS) regression to identify the contribution of ALT, AST and GGT, which appears causally associated with diabetes as a validation factor, to incident diabetes in a South China population where liver impairment and diabetes are common. METHODS Participants were from the Guangzhou Biobank Cohort Study recruited in 2003-2008, with follow-up re-examination up to the end of 2012. Multivariable generalised linear models and PLS were used to examine the adjusted associations of ALT, AST and GGT with diabetes. Incident diabetes was defined as self-reported diabetes, and/or initiation of hypoglycaemia medication or insulin during follow-up, or fasting glucose ≥7.0 mmol/L, or 2 h oral glucose tolerance test, glucose ≥11.1 mmol/L at follow-up examination. RESULTS In 10 764 Chinese participants aged ≥50 years with no diabetes at baseline, 1228 (11.4%) developed diabetes during the median 4 years of follow-up. Using PLS, the risk for incident diabetes was higher by 18% (95% CI 8% to 27%) per 1 SD increment in log-ALT, and expectedly higher by 36% (95% CI 26% to 52%) for log-GGT, adjusted for age, sex, education, smoking, alcohol, physical activity, waist circumference and body mass index. Similarly adjusted, no association for log-AST (relative risk 0.92, 95% CI 0.85 to 1.01) was found. CONCLUSIONS ALT but not AST was associated with incident diabetes. Further experimental studies are needed to confirm the causal association and clarify the underlying mechanisms.
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Affiliation(s)
- L Xu
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - C Q Jiang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - C M Schooling
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong CUNY School of Public Health and Hunter College, New York, USA
| | - W S Zhang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - K K Cheng
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
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Li WHC, Chan SSC, Wang KMP, Lam TH. Helping cancer patients quit smoking by increasing their risk perception: a study protocol of a cluster randomized controlled trial. BMC Cancer 2015; 15:490. [PMID: 26122078 PMCID: PMC4486692 DOI: 10.1186/s12885-015-1496-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022] Open
Abstract
Background Despite smoking cessation can largely improve cancer prognosis and quality of life, many patients continued smoking after the diagnosis of cancer. This study aims to test the effectiveness of a smoking cessation intervention using risk communication approach to help cancer patients quit smoking, and to improve their health related quality of life. Methods A cluster randomized controlled trial will be employed. Cancer patients who continued smoking after the diagnosis of cancer and have medical follow-up at the out-patient clinics of the five acute hospitals in Hong Kong will be invited to participate. Subjects in the experimental group will receive (1) health warnings of smoking based on a special designed leaflet; and (2) a patient-centred counseling from nurse counselors with emphasis on risk perceptions of smoking to cancer prognosis. Additionally, they will receive two more telephone counseling at 1-week and 1-month. Control group receive standard care and a generic self-help smoking cessation booklet. Outcomes measure include (a) self-reported and the biochemically validated quit rate, (b) patient’s smoking reduction by at least 50 % compared to baseline, (c) quit attempt(s), (d) change in the intention to quit, (e) change in risk perceptions of smoking, and (f) change in health related quality of life. Discussion This study will make an important contribution to evidence-based practice by testing the effectiveness of a tailored smoking cessation intervention for cancer patients. The results will support the development of clinical practice guidelines to promote smoking cessation in cancer patients to improve their prognosis and quality of life. Trial registration ClinicalTrials.gov NCT01685723. Registered 9 November 2012.
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Affiliation(s)
- William H C Li
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Sophia S C Chan
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Kelvin M P Wang
- School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong.
| | - T H Lam
- School of Public Health, 5/F, William MW Mong Block, No 21 Sassoon Road, Pokfulam, Hong Kong.
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Hou WW, Tse MA, Lam TH, Leung GM, Schooling CM. Adolescent testosterone, muscle mass and glucose metabolism: evidence from the 'Children of 1997' birth cohort in Hong Kong. Diabet Med 2015; 32:505-12. [PMID: 25307068 DOI: 10.1111/dme.12602] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 01/19/2023]
Abstract
AIMS Diabetes rates are high in Asia despite relatively low rates of obesity, which might be related to lower muscle mass. Muscle mass plays an important role in glucose metabolism. Peak muscle mass is obtained in late adolescence. We tested the hypothesis that pubertal testosterone is negatively associated with glucose metabolism mediated by muscle mass. METHODS Participants aged 15 years (278 boys and 223 girls) were recruited from the Hong Kong's 'Children of 1997' birth cohort in 2012. Multivariable linear regression with multiple imputation and inverse probability weighting was used to examine the adjusted associations of pubertal testosterone with skeletal muscle index, body fat percentage, fasting glucose, insulin and homeostasis model of assessment - insulin resistance. RESULTS Total testosterone was negatively associated with fasting glucose (-0.008, 95% confidence interval -0.015 to -0.002), insulin (-0.43, 95% confidence interval -0.56 to -0.30) and insulin and homeostasis model of assessment - insulin resistance (-0.09, 95% confidence interval -0.12 to -0.06) adjusted for sex, birth weight, highest parental education, mother's place of birth and physical activity. These associations were attenuated by additional adjustment for skeletal mass index or body fat percentage. CONCLUSIONS Adolescent glucose metabolism may be influenced by testosterone, perhaps partially via skeletal muscle mass.
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Affiliation(s)
- W W Hou
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Lam TH, Stewart SM, Hirschmann MR, Fabrizio CS, Yu NX. Can randomized controlled trials be conducted in community social service settings? Public Health 2015; 129:601-3. [PMID: 25773311 DOI: 10.1016/j.puhe.2015.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 11/16/2022]
Affiliation(s)
- T H Lam
- The University of Hong Kong, School of Public Health, Hong Kong
| | - S M Stewart
- The University of Hong Kong, School of Public Health, Hong Kong; University of Texas Southwestern Medical Center at Dallas, Department of Psychiatry, TX, USA.
| | - M R Hirschmann
- The University of Hong Kong, School of Public Health, Hong Kong
| | - C S Fabrizio
- The University of Hong Kong, School of Public Health, Hong Kong
| | - N X Yu
- The University of Hong Kong, School of Public Health, Hong Kong; Department of Applied Social Sciences, City University of Hong Kong, Hong Kong
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Jagielski AC, Jiang CQ, Xu L, Taheri S, Zhang WS, Cheng KK, Lam TH, Thomas GN. Glycaemia is associated with cognitive impairment in older adults: the Guangzhou Biobank Cohort Study. Age Ageing 2015; 44:65-71. [PMID: 25005262 DOI: 10.1093/ageing/afu088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS an association between T2DM and cognitive impairment has been reported among Western populations, but data are limited in other settings. We investigated the cross-sectional association between fasting blood glucose (FBG) and cognition in an older Chinese population. METHODS the Guangzhou Biobank Cohort Study included 27,971 individuals (50-96 years, mean age 61.5 years, 72% female) with measures of cognitive function assessed using modified Delayed Word Recall Test (DWRT) and Mini-Mental State Examination (MMSE). Fasting glucose and lipids, and potential confounders were measured. RESULTS after adjustment for potential confounders, the risk for cognitive impairment as measured by DWRT, significantly increased [odds ratio (OR) = 1.18, 95% CI 1.00-1.40] but the association was of borderline significance when measured by MMSE (OR = 1.04, 95% CI 0.73-1.47) in those with diabetes relative to those without diabetes. Fasting blood glucose was significantly negatively associated with cognitive function as measured by DWRT but not MMSE, with an increase of 1 mmol/l of FBG associated with a decrease of 0.02 in DWRT (P < 0.05, 95% CI -0.03 to -0.002) and 0.03 in MMSE score (P = 0.114, 95% CI -0.06-0.01). CONCLUSIONS an FBG level indicative of T2DM was associated with increased risk for cognitive impairment. The findings also demonstrate that glycaemia is continuously associated with cognitive impairment, suggesting that dysfunction is associated with increasing glucose levels even in the normoglycaemic range.
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Affiliation(s)
- A C Jagielski
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK Birmingham and Black Country NIHR CLAHRC, Birmingham, UK
| | - C Q Jiang
- Guangzhou Number 12 People's Hospital, Guangzhou, China
| | - L Xu
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - S Taheri
- Birmingham and Black Country NIHR CLAHRC, Birmingham, UK Department of Medicine, Weill Cornell Medical College in New Youk, NY, USA Department of Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar Department of Medicine, King's College London, London, UK
| | - W S Zhang
- Guangzhou Number 12 People's Hospital, Guangzhou, China
| | - K K Cheng
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - G N Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK Mannheim Medical Faculty, Institute of Public Health, Social and Preventive Medicine, University of Heidelberg, Mannheim 68135, Germany
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Schooling CM, Chan WM, Leung SL, Lam TH, Lee SY, Shen C, Leung JY, Leung GM. Cohort Profile: Hong Kong Department of Health Elderly Health Service Cohort. Int J Epidemiol 2014; 45:64-72. [PMID: 25480143 DOI: 10.1093/ije/dyu227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 01/26/2023] Open
Abstract
The Department of Health Elderly Health Service Cohort in Hong Kong was set up to promote understanding of ageing in a global context, to exploit the role of Hong Kong as a sentinel for populations currently experiencing very rapid economic development, to provide a developed non-Western 'social laboratory' where empirically derived hypotheses can be tested and to leverage the different patterns of common chronic diseases between East and West to generate novel hypotheses about their determinants. The initial cohort enrolled from July 1998 to the end of December 2001 includes 66 820 people aged 65 years or older, forming about 9% of the population of this age. A comprehensive health assessment was made at enrollment and then repeated regularly on an ongoing basis. The health assessment included a comprehensive assessment of lifestyle, social circumstances, physical health and mental health, including an assessment of cognition and depressive symptoms. Health services use and deaths have been obtained by record linkage and confirmed, where necessary, by telephone interview. Currently, the data are not publicly available; we would welcome collaborations and research proposals.
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Affiliation(s)
- C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - W M Chan
- Department of Health, Government of Hong Kong SAR, China
| | - S L Leung
- Department of Health, Government of Hong Kong SAR, China
| | - T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - S Y Lee
- Department of Health, Government of Hong Kong SAR, China
| | - C Shen
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - J Y Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
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Wong CM, Chan WM, Yang L, Chan KP, Lai HK, Thach TQ, Ho LM, Lam TH, Peiris JSM. Effect of lifestyle factors on risk of mortality associated with influenza in elderly people. Hong Kong Med J 2014; 20 Suppl 6:16-19. [PMID: 25482965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- C M Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - W M Chan
- Department of Health, The Government of the Hong Kong Special Administrative Region
| | - L Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - K P Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - H K Lai
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - T Q Thach
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - L M Ho
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - J S M Peiris
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
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Abstract
BACKGROUND The longitudinal associations between oral health (OH) and physical and mental health-related quality of life (HRQoL) are unclear. PURPOSE This study examined the relationship of self-reported OH with the trajectories of physical and mental HRQoL in Hong Kong at 3, 9, and 15 months after the measurement period using a latent growth curve model. METHODS This study included 5,710 participants recruited in the FAMILY project cohort study during March-October 2009. Self-report OH was measured using a five-point single-item scale, and HRQoL was measured using the physical component scale (PCS) and mental component scale (MCS) of Short Form 12. Latent growth curve model was used to compute the relationship of self-reported OH with the trajectories on HRQoL over time, adjusted for age and sex. RESULTS The latent growth curve model gave good fit to both the PCS (normed fit index (NFI) = 0.98, comparative fit index (CFI) = 0.99, and standardized root mean square residual (SRMR) = 0.03) and MCS (NFI = 0.97, CFI = 0.98, and SRMR = 0.03). Better self-reported OH was associated with higher PCS and MCS at the baseline. The longitudinal association with PCS remained constant over time (coefficient = -0.02, p = 0.07) but that with MCS diminished over time with baseline oral health status (coefficient = -0.04, p = 0.002). CONCLUSION Better self-reported OH status was associated with higher level of physical and mental HRQoL, and with negative change in mental HRQoL.
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Affiliation(s)
- Paul H Lee
- FAMILY: A Jockey Club Initiative for a Harmonious Society, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
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Zhong Y, Jiang CQ, Cheng KK, Zhang WS, Liu B, Jin YL, Lam TH, Leung GM, Schooling CM. Height, its components, and coagulability among older Chinese: the Guangzhou biobank cohort study. Am J Hum Biol 2014; 26:603-8. [PMID: 24909113 DOI: 10.1002/ajhb.22568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/21/2014] [Accepted: 05/12/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The causal role of some cardiovascular risk factors, such as HDL cholesterol, has been increasingly challenged and attention is returning to all elements of Virchow's triad, i.e., hypercoagulability (including viscosity) as well as endothelial function and blood flow. We examined the life course origins of coagulability. METHODS We used multivariable linear regression to assess whether childhood influences, proxied by height and its components, were associated with hematocrit (Hct), hemoglobin (HGB), and other hematological parameters in 28,595 older Chinese adults (mean age = 61.8 years) from the Guangzhou Biobank Cohort Study. RESULTS Adjusted for age, sex, and recruitment phase, leg length was negatively associated with platelets (PLT) (-0.83 × 10(9) /l per centimeter (cm), 95% confidence interval (CI) -1.01 to -0.65). Sitting height and height were positively associated with Hct (0.05% per cm, 95% CI 0.04-0.07 for sitting height; 0.02% per cm, 95% CI 0.01-0.02 for height), HGB (0.21 g/l per cm, 95% CI 0.17-0.25; 0.07 g/l per cm, 95% CI 0.04-0.09) and negatively associated with PLT (-1.2 × 10(9) /l per cm, 95% CI -1.4 to -1.0; -0.83 × 10(9) /l per cm, 95% CI -0.95 to -0.70). Further adjustment for potential confounders did little to change the estimates. CONCLUSIONS For the first time we provide anthropometric evidence for the different roles of prepubertal and pubertal influences in relation to Hct and HGB. Whether factors that promote leg growth but reduce growth of sitting height may help to prevent cardiovascular events, via effects on hypercoagulability or viscosity, overall or in specific subgroups, remains to be determined.
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Affiliation(s)
- Y Zhong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
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Thomas GN, Macfarlane DJ, Guo B, Cheung BM, McGhee SM, Chou KL, Deeks JJ, Lam TH, Tomlinson B. Pedometry and 'peer support' in older Chinese adults: a 12-month cluster randomised controlled trial. Hong Kong Med J 2014; 20:11-14. [PMID: 25001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- G N Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham, UK
| | - D J Macfarlane
- Institute of Human Performance, The University of Hong Kong
| | - B Guo
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham, UK
| | - B My Cheung
- Departments of Medicine, The University of Hong Kong
| | - S M McGhee
- Department of Community Medicine, The University of Hong Kong
| | - K L Chou
- Sau Po Centre on Ageing, The University of Hong Kong
| | - J J Deeks
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham, UK
| | - T H Lam
- Department of Community Medicine, The University of Hong Kong
| | - B Tomlinson
- Department of Medicine and Therapeutics, Chinese University of Hong Kong
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Zhao J, Jiang CQ, Lam TH, Liu B, Cheng KK, Kavikondala S, Zhang WS, Leung GM, Schooling CM. Genetically predicted 17β-estradiol and systemic inflammation in women: a separate-sample Mendelian randomisation analysis in the Guangzhou Biobank Cohort Study. J Epidemiol Community Health 2014; 68:780-5. [DOI: 10.1136/jech-2013-203451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Li WHC, Chan SSC, Lam TH. Helping cancer patients to quit smoking by understanding their risk perception, behavior, and attitudes related to smoking. Psychooncology 2014; 23:870-7. [PMID: 24493624 DOI: 10.1002/pon.3486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 08/12/2013] [Revised: 11/22/2013] [Accepted: 12/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Evidence shows that smoking is a major cause of cancer, and cancer patients who continue smoking are at greater risk for all causes of mortality, cancer recurrence, and second primary cancers. Nevertheless, many cancer patients still smoke and are not willing to quit. This study aimed at understanding the needs and concerns of current and ex-smoking cancer patients, including their risk perceptions, and the behavior and attitudes related to smoking. METHODS A qualitative research was conducted in an oncology outpatient clinic. A one-to-one semi-structured interview was conducted with current Chinese smokers and ex-smokers after they had been diagnosed with cancer. Data saturation was achieved after interviewing a total of 20 current smokers and 20 ex-smokers. RESULTS A total of 241 patients who were smokers prior to their diagnosis of cancer were identified. Of 241 patients, 208 (86.31%) quitted and 33 (13.69%) continued smoking after receiving a cancer diagnosis. In general, patients who refused to quit smoking subsequent to a cancer diagnosis thought that the perceived barriers to quitting outweighed the perceived benefits of quitting. In contrast, most cancer patients who quit after their cancer diagnoses thought that the perceived benefits of quitting greatly outweighed the perceived barriers to quitting. CONCLUSIONS It is vital that healthcare professionals should help cancer patients to quit smoking. Understanding how current smokers and ex-smokers perceive the risks of smoking, and their behavior, attitudes, and experiences related to smoking is an essential prerequisite for the design of an effective smoking cessation intervention.
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Affiliation(s)
- William H C Li
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
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Lee PH, Macfarlane DJ, Lam TH. Factors associated with participant compliance in studies using accelerometers. Gait Posture 2013; 38:912-7. [PMID: 23688408 DOI: 10.1016/j.gaitpost.2013.04.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 01/13/2012] [Revised: 02/25/2013] [Accepted: 04/24/2013] [Indexed: 02/02/2023]
Abstract
Participant compliance is an important issue in studies using accelerometers. Some participants wear the accelerometer for the duration specified by the researchers but many do not. We investigated a range of demographic factors associated with participant compliance in obtaining analyzable accelerometer data. A total of 3601 participants (aged 47.6±13.1 years, 44.6% male) were included. They were asked to wear an accelerometer (ActiGraph) for four consecutive days after completing a household survey during March 2009-January 2011 in Hong Kong. Participants wore the accelerometer on average for 13.9h in a 24-h day. No significant difference was found between males and females (p=0.38). Using log-linear regression, it was found that older participants (0.5% more wearing hours for each year of age, p<0.001), those with full-time job (p<0.01), with tertiary education (p<0.01), non-smokers (p<0.01) and with high self-reported health (p<0.05) wore the accelerometer for more hours. These results provide details for estimating compliance rates for samples with different characteristics and thus sample size calculation to account for participant compliance.
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Affiliation(s)
- Paul H Lee
- FAMILY: A Jockey Club Initiative for a Harmonious Society, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
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Au Yeung SL, Jiang CQ, Zhang WS, Lam TH, Cheng KK, Leung GM, Schooling CM. Systematic differences among never, occasional and moderate alcohol users in southern China, and its use in alcohol research: a cross-sectional study. J Epidemiol Community Health 2013; 67:1054-60. [PMID: 23969348 DOI: 10.1136/jech-2013-202807] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Western observational studies show moderate alcohol use, compared with never use, positively associated with health. Moderate users differ systematically from others, making these observations vulnerable to confounding. Observations from other contexts may help distinguish whether these associations are confounded. To assess whether southern Chinese would provide a more suitable setting to examine the association of moderate alcohol use with health, we compared never alcohol users with moderate alcohol users and occasional users in this setting. METHODS We used age-adjusted multinomial regression to assess sex-stratified associations of alcohol use (never, occasional (<1 occasion/week), moderate (≤140 g ethanol/week for women and ≤210 g for men)) with health attributes and indicators in the Guangzhou Biobank Cohort Study (2003-2008) (n=26 361). RESULTS Among men, moderate alcohol users, when compared with never users, had slightly lower socioeconomic position and unhealthier lifestyle. Conversely, occasional alcohol users, when compared with never users, had higher socioeconomic position and healthier lifestyle. Among women, when compared with never users, both occasional and moderate users had higher socioeconomic position and healthier lifestyle. However, all alcohol users for both sexes, when compared with never users, were more likely to be ever smokers and to be exposed to secondhand smoke. CONCLUSIONS Observations in alcohol epidemiology may be affected by confounding due to contextually specific systematic differences. Results from a particular setting should not be interpreted as causal unless they are verified in different populations and, preferably, in non-observational studies.
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Affiliation(s)
- S L Au Yeung
- Li Ka Shing Faculty of Medicine, Lifestyle and Lifecourse Epidemiology Group, School of Public Health, The University of Hong Kong, , Hong Kong, China
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Ho SY, Lai YK, Lam TH, Chan V, Mak KK, Lo WS. Risk factors and outcomes of childhood obesity in Hong Kong: a retrospective cohort study. Hong Kong Med J 2013; 19 Suppl 4:45-47. [PMID: 23775188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
1. Onset of obesity is related to age, gender, pubertal stage, dietary habits, and parental occupation. Targeting the high riskgroups may help curb obesity in children. 2. Obesity may lead to poor self-esteem and potential psychosocial risk. The psychosocial impact of obesity could be more pronounced in girls than boys. 3. The association between obesity and psychosocial health could be bi-directional. Improving psychosocial health could be beneficial in weight management for normal-weight and obese children. 4. Obesity is associated with higher blood pressures.
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Affiliation(s)
- S Y Ho
- School of Public Health, The University of Hong Kong, 21 Sassoon Road,Pokfulam, Hong Kong SAR, China.
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Lam TH, Shen M, Chia JM, Chan SH, Ren EC. Population-specific recombination sites within the human MHC region. Heredity (Edinb) 2013; 111:131-8. [PMID: 23715014 DOI: 10.1038/hdy.2013.27] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 01/22/2013] [Accepted: 03/06/2013] [Indexed: 01/04/2023] Open
Abstract
Genetic rearrangement by recombination is one of the major driving forces for genome evolution, and recombination is known to occur in non-random, discreet recombination sites within the genome. Mapping of recombination sites has proved to be difficult, particularly, in the human MHC region that is complicated by both population variation and highly polymorphic HLA genes. To overcome these problems, HLA-typed individuals from three representative populations: Asian, European and African were used to generate phased HLA haplotypes. Extended haplotype homozygosity (EHH) plots constructed from the phased haplotype data revealed discreet EHH drops corresponding to recombination events and these signatures were observed to be different for each population. Surprisingly, the majority of recombination sites detected are unique to each population, rather than being common. Unique recombination sites account for 56.8% (21/37 of total sites) in the Asian cohort, 50.0% (15/30 sites) in Europeans and 63.2% (24/38 sites) in Africans. Validation carried out at a known sperm typing recombination site of 45 kb (HLA-F-telomeric) showed that EHH was an efficient method to narrow the recombination region to 826 bp, and this was further refined to 660 bp by resequencing. This approach significantly enhanced mapping of the genomic architecture within the human MHC, and will be useful in studies to identify disease risk genes.
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Affiliation(s)
- T H Lam
- Singapore Immunology Network, A*STAR, Singapore
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Lee SL, Cheung YF, Wong HSW, Leung TH, Lam TH, Lau YL. Chronic health problems and health-related quality of life in Chinese children and adolescents: a population-based study in Hong Kong. BMJ Open 2013; 3:bmjopen-2012-001183. [PMID: 23293240 PMCID: PMC3549227 DOI: 10.1136/bmjopen-2012-001183] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We examined the association of different chronic physical and mental conditions, individually or comorbidly on health-related quality of life (QoL) in Chinese children aged ≤14 years in Hong Kong. DESIGN Population-based cross-sectional survey. PARTICIPANTS Approximately 7500 Chinese children aged <14 years in Hong Kong. INTERVENTIONS Nil. PRIMARY AND SECONDARY OUTCOME MEASURES Various health concepts of validated Chinese version of Child Health Questionnaire (CHQ), a health-related QoL questionnaire in children. RESULT There was significant association of physical and mental health conditions, either individually or comorbidly, on the various concepts of CHQ. Children with mental health problems were apparently more affected than those with physical health problems. Chronic renal disease and congenital malformation were the physical health conditions associated with the lowest scores in CHQ concepts in children aged 5-10 years and aged 10-14 years, respectively. Behavioural problem was the mental health condition associated with the lowest score in CHQ concepts in both age groups. CONCLUSIONS Our study shows important information concerning the prevalence of different health conditions and its association, either individually or comorbidly on the QoL in a representative sample of Chinese children in HK.
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Affiliation(s)
- S L Lee
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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