Martin C.S. Wong

Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys

Objective To assess the acceptability of pre-pandemic influenza vaccination among healthcare workers in public hospitals in Hong Kong and the effect of escalation in the World Health Organization’s alert level for an influenza pandemic. Design Repeated cross sectional studies using self administered, anonymous questionnaires Setting Surveys at 31 hospital departments of internal medicine, paediatrics, and emergency medicine under the Hong Kong Hospital Authority from January to March 2009 and in May 2009 Participants 2255 healthcare workers completed the questionnaires in the two studies. They were doctors, nurses, or allied health professionals working in the public hospital system. Main outcome measures Stated willingness to accept pre-pandemic influenza vaccination (influenza A subtypes H5N1 or H1N1) and its associating factors. Results The overall willingness to accept pre-pandemic H5N1 vaccine was only 28.4% in the first survey, conducted at WHO influenza pandemic alert phase 3. No significant changes in the level of willingness to accept pre-pandemic H5N1 vaccine were observed despite the escalation to alert phase 5. The willingness to accept pre-pandemic H1N1 vaccine was 47.9% among healthcare workers when the WHO alert level was at phase 5. The most common reasons for an intention to accept were “wish to be protected” and “following health authority’s advice.” The major barriers identified were fear of side effects and doubts about efficacy. More than half of the respondents thought nurses should be the first priority group to receive the vaccines. The strongest positive associating factors were history of seasonal influenza vaccination and perceived risk of contracting the infection. Conclusions The willingness to accept pre-pandemic influenza vaccination was low, and no significant effect was observed with the change in WHO alert level. Further studies are required to elucidate the root cause of the low intention to accept pre-pandemic vaccination.

Global Incidence and Mortality for Prostate Cancer: Analysis of Temporal Patterns and Trends in 36 Countries

BACKGROUND Prostate cancer (PCa) is a leading cause of mortality and morbidity globally, but its specific geographic patterns and temporal trends are under-researched. OBJECTIVE To test the hypotheses that PCa incidence is higher and PCa mortality is lower in countries with higher socioeconomic development, and that temporal trends for PCa incidence have increased while mortality has decreased over time. DESIGN, SETTING, AND PARTICIPANTS Data on age-standardized incidence and mortality rates in 2012 were retrieved from the GLOBOCAN database. Temporal patterns were assessed for 36 countries using data obtained from Cancer incidence in five continents volumes I-X and the World Health Organization mortality database. Correlations between incidence or mortality rates and socioeconomic indicators (human development index [HDI] and gross domestic product [GDP]) were evaluated. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The average annual percent change in PCa incidence and mortality in the most recent 10 yr according to join-point regression. RESULTS AND LIMITATIONS Reported PCa incidence rates varied more than 25-fold worldwide in 2012, with the highest incidence rates observed in Micronesia/Polynesia, the USA, and European countries. Mortality rates paralleled the incidence rates except for Africa, where PCa mortality rates were the highest. Countries with higher HDI (r=0.58) and per capita GDP (r=0.62) reported greater incidence rates. According to the most recent 10-yr temporal data available, most countries experienced increases in incidence, with sharp rises in incidence rates in Asia and Northern and Western Europe. A substantial reduction in mortality rates was reported in most countries, except in some Asian countries and Eastern Europe, where mortality increased. Data in regional registries could be underestimated. CONCLUSIONS PCa incidence has increased while PCa mortality has decreased in most countries. The reported incidence was higher in countries with higher socioeconomic development. PATIENT SUMMARY The incidence of prostate cancer has shown high variations geographically and over time, with smaller variations in mortality.

Meta-analysis on night shift work and risk of metabolic syndrome

This study aims to quantitatively summarize the association between night shift work and the risk of metabolic syndrome (MetS), with special reference to the dose–response relationship with years of night shift work. We systematically searched all observational studies published in English on PubMed and Embase from 1971 to 2013. We extracted effect measures (relative risk, RR; or odd ratio, OR) with 95% confidence interval (CI) from individual studies to generate pooled results using meta‐analysis approach. Pooled RR was calculated using random‐ or fixed‐effect model. Downs and Black scale was applied to assess the methodological quality of included studies. A total of 13 studies were included. The pooled RR for the association between ‘ever exposed to night shift work’ and MetS risk was 1.57 (95% CI = 1.24–1.98, pheterogeneity = 0.001), while a higher risk was indicated in workers with longer exposure to night shifts (RR = 1.77, 95% CI = 1.32–2.36, pheterogeneity = 0.936). Further stratification analysis demonstrated a higher pooled effect of 1.84 (95% CI = 1.45–2.34) for studies using the NCEP‐ATPIII criteria, among female workers (RR = 1.61, 95% CI = 1.10–2.34) and the countries other than Asia (RR = 1.65, 95% CI = 1.39–1.95). Sensitivity analysis confirmed the robustness of the results. No evidence of publication bias was detected. The present meta‐analysis suggested that night shift work is significantly associated with the risk of MetS, and a positive dose–response relationship with duration of exposure was indicated.

Hypertension prevalence, awareness, treatment, control, and associated factors in adults in southern China.

BACKGROUND Hypertension is the most important risk factor for cardiovascular diseases. Little information exists on the status of hypertension among southern Chinese. We therefore investigated the hypertension prevalence, awareness, treatment, control, and associated factors in a southern Chinese population with 85 million residents. METHODS Stratified multistage cluster sampling with probability proportional to size method was used in this survey. A representative sample of 13,889 residents aged 20 years or above with completed questionnaire and blood pressure (BP) measurement was obtained. BP was measured in accordance with the 1999 World Health Organization/International Society of Hypertension Guidelines. Information related to history of diagnosis and treatment of hypertension was collected through questionnaire. RESULTS The prevalence of hypertension in this population was 20.5% (16.5%, 24.4%), which translated to 9.8 million adults suffering from hypertension in Guangdong province. The urban population had higher prevalence of hypertension than the rural population (25.1 vs. 16.1%). The prevalence of awareness, treatment, and control of hypertension in hypertensive patients living in urban regions were 42.8, 37.9, and 13.5%, respectively, which were higher than those in rural regions (the corresponding figures were 17.6, 10.4, and 3.4%, respectively). Nearly 50% urban adults and 80% rural adults did not measure their BP in the last 12 months. Frequency of BP measurement was associated with both awareness and treatment. CONCLUSIONS Hypertension was prevalent in southern China. The prevalence of awareness, treatment, and control of hypertension is low. Urgent strategies are needed to improve prevention, detection, and treatment of hypertension in this large Chinese population.

Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China

BackgroundChina, like other countries, is facing a growing burden of chronic disease but the prevalence of multimorbidity and implications for the healthcare system have been little researched. We examined the epidemiology of multimorbidity in southern China in a large representative sample. The effects of multimorbidity and other factors on usual source of healthcare were also examined.MethodsWe conducted a large cross-sectional survey among approximately 5% (N = 162,464) of the resident population in three prefectures in Guangdong province, southern China in 2011. A multistage, stratified random sampling was adopted. The study population had many similar characteristics to the national census population. Interviewer-administered questionnaires were used to collect self-report data on demographics, socio-economics, lifestyles, healthcare use, and health characteristics from paper-based medical reports.ResultsMore than one in ten of the total study population (11.1%, 95% confidence interval (CI) 10.6 to 11.6) had two or more chronic conditions from a selection of 40 morbidities. The prevalence of multimorbidity increased with age (adjusted odds ratio (aOR) = 1.36, 95% CI 1.35 to 1.38 per five years). Female gender (aOR = 1.70, 95% CI 1.64 to 1.76), low education (aOR = 1.26, 95% CI 1.23 to 1.29), lack of medical insurance (aOR = 1.79, 95% CI 1.71 to 1.89), and unhealthy lifestyle behaviours were independent predictors of multimorbidity. Multimorbidity was associated with the regular use of secondary outpatient care in preference to primary care.ConclusionsMultimorbidity is now common in China. The reported preferential use of secondary care over primary care by patients with multimorbidity has many major implications. There is an urgent need to further develop a strong and equitable primary care system.

Determinants of Medication Adherence to Antihypertensive Medications among a Chinese Population Using Morisky Medication Adherence Scale

Background and Objectives Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients. Methods A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8). Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points). Results From 1114 patients, 725 (65.1%) had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence. Conclusion This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior.

The association between shift duty and abnormal eating behavior among nurses working in a major hospital: A cross-sectional study

BACKGROUND Shift work induces stress, disturbs family life and interrupts regular meal schedules. Few studies have addressed the association between shift duties and abnormal eating behavior among hospital nurses. OBJECTIVES AND DESIGN We tested the hypothesis that shift duties were independent predictors of abnormal eating. Self-administered surveys consisting of socio-demographic data, working pattern, Perceived Organizational Support (POS) questionnaire and the patterns of eating style identified by the Dutch Eating Behavior Questionnaires (DEBQ) were used. SETTINGS One major acute hospital in one Territory of Hong Kong. PARTICIPANTS All 662 nurses who worked on a full-time basis in this hospital were invited to join the study and among them, 378 completed surveys were collected with a response rate of 57.1%. The average age was 37.2 years, and 91.5% were female. 67.3 were registered nurses, 17.9% enrolled nurses; and 14.5% were ranked nursing officers or above. 39.1% worked in acute settings (medical wards, intensive care units and emergency departments), and 62.1% of respondents had at least 11 years of clinical experience and 76.2% of respondents had shift duties with 81.9% having at least four shift duties per month. Only 66.7% of respondents had normal body mass index (BMI 18.5-22.9 kg/m2). METHODS Three binary logistic regression analyses were conducted with abnormal emotional, external and restraint DEBQ as outcome variables, respectively. We controlled for age, gender, marital status, work setting (acute vs. non-acute), years of clinical experience, the frequency of shift duties, body mass index, perception of body weight changes in the past 6 months, self-perception of recent overeating and POS. RESULTS The proportions of participants having abnormal emotional, external and restraint DEBQ scores were 66.4%, 61.4% and 64.0%, respectively. From multiple regression analysis, nurses having 4 or more shift duties per month were more likely to present with abnormal emotional (adjusted odds ratio aOR 2.91, 95% C.I. 1.57-5.42, p=0.001) and restraint (aOR 3.35, 95% C.I. 1.76-6.38, p<0.001) DEBS scores. CONCLUSIONS Shift duties were positively associated with abnormal eating behavior among nurses working in hospitals. More health promotional initiatives should be targeted towards hospital nurses whose duties require frequent night shifts to enhance healthy eating.

Natural History of Cervical Papilloma Virus Infection in Systemic Lupus Erythematosus — A Prospective Cohort Study

Objective. To ascertain the incidence, cumulative prevalence, persistence, and clearance of human papilloma virus (HPV) infection in patients with systemic lupus erythematosus (SLE), and to assess the risk factors for the acquisition and persistence of HPV infection. Methods. One hundred forty-four patients with SLE were evaluated at 6-month intervals for up to 3 years. At each visit, a Pap test, a test for HPV DNA, and clinical assessment were performed. Results. The cumulative prevalence of HPV infection increased significantly (12.5% at baseline to 25.0% after 3 years; p = 0.006). Regarding type-specific HPV infection, 18.8% patients experienced 68 incident infections. The cumulative prevalence of high-risk HPV infection (11.1% at baseline to 20.8% after 3 years; p = 0.02) and multiple HPV infection also increased significantly (6.9% at baseline to 16.7% after 3 years; p = 0.009). Half (33/68, 48.5%) of the incident infections persisted for ≥ 6 months. Overall, 29/32 (90.6%) of the preexisting infection and 10/68 (14.7%) of the incident infections were cleared. Independent risk factors associated with incident HPV infection included younger age at first sexual intercourse (p = 0.025) and baseline Systemic Lupus International Collaborating Clinics score ≥ 1 (p = 0.038). Independent risk factor associated with persistent HPV infection included preexisting HPV infection (p = 0.04) and multiple HPV infection during first incident infection (p = 0.02). Conclusion. High frequency of persistent HPV infection, especially high-risk and multiple HPV infection, may explain why squamous intraepithelial lesions occurred frequently in patients with SLE. Patients with high inflammatory burden are at risk of acquiring HPV infection.

A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects

Objective We aim to develop and validate a clinical scoring system to predict the risks of colorectal neoplasia to better inform screening participants and facilitate their screening test choice. Design We recruited 5220 Chinese asymptomatic screening participants who underwent colonoscopy in Hong Kong during 2008–2012. From random sampling of 2000 participants, independent risk factors were evaluated for colorectal neoplasia, defined as adenoma, advanced neoplasia, colorectal cancer or any combination thereof using binary regression analysis. The ORs for significant risk factors were used to develop a scoring system ranging from 0 to 6: 0–2 ‘average risk’ (AR) and 3–6 ‘high risk’ (HR). The other 3220 screening participants prospectively enrolled between 2008 and 2012 for screening colonoscopy formed an independent validation cohort. The performance of the scoring system for predicting colorectal neoplasia was evaluated. Results The prevalence of colorectal neoplasia in the derivation and validation cohorts was 31.4% and 30.8%, respectively. Using the scoring system developed, 78.9% and 21.1% in the validation cohort were classified as AR and HR, respectively. The prevalence of colorectal neoplasia in the AR and HR groups was 27.1% and 44.6%, respectively. The subjects in the HR group had 1.65-fold (95% CI 1.49 to 1.83) increased prevalence of colorectal neoplasia than the AR group. Conclusions The scoring system based on age, gender, smoking, family history, Body Mass Index and self-reported diabetes is useful in predicting the risk of colorectal neoplasia.

Distribution of human papillomavirus types in cervical cancers in Hong Kong: Current situation and changes over the last decades

Human papillomavirus (HPV) type distribution among cervical cancers and its possible changes over time are key issues that determine the cost‐effectiveness of HPV vaccines. Cervical cancers diagnosed during 3 periods (1997–2007, N = 280; 1984–1986, N = 74; 1972–1973, N = 81) in Hong Kong were examined for HPV type distribution using sensitive broad‐catching methods. The results showed a variation in HPV distribution between histological groups. Among cervical squamous cell carcinoma (SCC) cases diagnosed over the past 10 years, HPV16 was most commonly found (61.2%), followed by HPV18 (17.7%), HPV52 (14.7%) and HPV58 (9.9%), whereas adeno/adenosquamous cell carcinoma was dominated by HPV18 (56.3%) and HPV16 (50.0%). The proportion of HPV16‐positive SCC showed a significant linear trend of increase with time (45.2% for 1972–1973, 58.8% for 1984–1986, 61.2% for 1997–2007; pTrend = 0.023), whereas HPV52‐positive SCC decreased with time (30.1% for 1972–1973; 29.4% for 1984–1986, 14.7% for 1997–2007; pTrend = 0.001). Vaccines comprising HPV16/18 cover 62.6% of SCC and 93.8% of adeno/adenosquamous carcinoma in Hong Kong, and inclusion of HPV52 and HPV58 can increase the coverage by 18.4% for SCC and 4.1% for adeno/adenosquamous cell carcinoma. HPV type distribution may change over time. Further investigations to reveal the determinants for such changes and continuous monitoring for possible type replacement as a result of widespread long‐term use of HPV vaccines are warranted. Multiple infections are commonly revealed by sensitive broad‐catching methods such as those used in this study. However, their implication on vaccine efficacy and cost‐effective analyses should be taken cautiously.