Xilin Yang

SARS transmission, risk factors, and prevention in Hong Kong.

We analyzed information obtained from 1,192 patients with probable severe acute respiratory syndrome (SARS) reported in Hong Kong. Among them, 26.6% were hospital workers, 16.1% were household members of SARS patients and had probable secondary infections, 14.3% were Amoy Garden residents, 4.9% were inpatients, and 20.1% were contacts of SARS patients who were not family members. The remaining 347 case-patients (29.1%) did not have “known” sources of infection. Excluding those <16 years of age, 330 patients with cases from “undefined” sources were used in a 1:2 matched case-control study. Multivariate analysis of this case-control study showed that having visited mainland China, hospitals, or the Amoy Gardens were risk factors (odds ratio [OR] 1.95 to 7.63). In addition, frequent mask use in public venues, frequent hand washing, and disinfecting the living quarters were significant protective factors (OR 0.36 to 0.58). In Hong Kong, therefore, community-acquired infection did not make up most transmissions, and public health measures have contributed substantially to the control of the SARS epidemic.

SARS-related perceptions in Hong Kong.

To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and ≈70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and ≈40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.

Impacts of SARS on health-seeking behaviors in general population in Hong Kong.

Abstract Background. The severe acute respiratory syndrome (SARS) epidemic that occurred in Hong Kong in 2003 caused serious public health consequences. Its impacts on health-seeking behaviors of the general public have not been assessed. Methods. Two cross-sectional, random telephone surveys interviewed 1603 Hong Kong adult residents in the post-SARS epidemic period, June and September 2003 to investigate changes in the post-SARS period. Results. Noteworthy percentages of the respondents self-reported increased frequencies of practicing favorable health-seeking behaviors in June 2003, as compared with the pre-SARS period. Few respondents reported the opposite. This was observed in different dimensions: health services seeking, adoption of healthier lifestyle, spending more resources on health, adoption of good personal hygiene, mask use when ill with influenza, and avoidance of risk behaviors. The frequencies of practicing most of these health-seeking behaviors, as measured in June and September 2003, were comparable. Further increases in healthy diet and weight control, etc., were observed during that period. Those who worried about contracting SARS were more likely to have improved health-seeking behaviors. Conclusions. The community in Hong Kong responded to the SARS epidemic by practicing more favorable health-seeking behaviors. Public health workers should utilize these opportunities to foster favorable changes.

SARS in Three Categories of Hospital Workers, Hong Kong

The SARS attack rate for hospital workers in Hong Kong was 1.20% and was significantly higher in nonmedical support staff.

SARS related preventive and risk behaviours practised by Hong Kong-mainland China cross border travellers during the outbreak of the SARS epidemic in Hong Kong

Objectives: To investigate patterns of behaviours and attitudes related to SARS prevention in the Hong Kong cross border traveller population. Settings: A survey was carried out at the Hong Kong-China cross border checkpoint in the middle of the epidemic. Participants: A total of 839 Hong Kong adult residents returning to Hong Kong from mainland China were surveyed. Main outcome measures: Practice of preventive measures and relevant behaviours and attitudes. Results: Around 40% of the respondents were using masks all or most of the time in public places or washing their hands frequently (>10 times per day) and about one third avoided visiting crowded places in mainland China. Such figures were however lower than those practised by the general public in Hong Kong. SARS related perceptions, such as perceived risk of transmission and efficacy, etc, were associated with mask use and not visiting crowded places, but not with hand washing, which was associated with duration of stay. Gender differences were also observed. Around 70% of the travellers would have delayed medical consultation for influenza-like illness in China; 12.7% would not wear masks during such episodes of illness. Furthermore, about 30% of the respondents used to wear masks in Hong Kong but not in mainland China. Conclusions: The findings have implications on cross border prevention of SARS. It seems that those travelling during the SARS epidemic were a “self selected” group, and they were using less preventive measures. Special attention and intervention need to be provided to travellers to prevent a second wave cross border transmission of the disease.

Infertility-related perceptions and responses and their associations with quality of life among rural chinese infertile couples.

An anonymous cross-sectional survey interviewed 192 infertile couples consulting a family planning clinic in rural China. Of them, over 30% believed that childless couples could not live well, 80% desired to have a child very badly, over 60% pressured themselves or spouse due to infertility, and over 50% felt pressured when having sex. Furthermore, 19.8% of men and 37.5% of women felt that infertility is humiliating for women. A multivariate analyses showed that a lower income, a worsened spousal relationship, infertility related perceptions, pressuring oneself or spouse due to infertility, and a strong desire for children were significantly associated with a lowered quality of life. Gender differences were also observed.

SARS preventive and risk behaviours of Hong Kong air travellers.

This study aims to investigate Severe Acute Respiratory Syndrome (SARS)-related behaviours of travellers returning to Hong Kong by air. A total of 820 travellers returning to Hong Kong by air were interviewed about their SARS-related behaviours in April 2003. Three quarters of the respondents wore a mask most/all of the time on board, 15% did so in public places at the travel destination. Perceived susceptibility to SARS at the destination predicted mask-wearing in public places and avoidance of crowded places, and perceived efficacy was a predictor for mask-wearing during flight. Approximately 16% of the respondents stated that they would delay their medical consultation for flu-like symptoms until returning to Hong Kong. Nearly 18.2% stated that they would not wear a mask in public places at the destination if they had flu-like symptoms. Education programmes, special services and effective thermal screening are required to minimize the chance of the spread of SARS by air travellers.

Cross-sectional and longitudinal factors predicting influenza vaccination in Hong Kong Chinese elderly aged 65 and above

OBJECTIVES The study investigated cross-sectional predictors of ever-undergone influenza vaccination (IV) and longitudinal predictors of first-time IV among Chinese elderly in Hong Kong. METHODS A random telephone survey interviewed 886 Chinese respondents aged 65 and above and 483 of these 886 respondents (54.5%) completed another follow-up questionnaire. RESULTS Of the 483 respondents, 25.1% (or 121) had ever undergone IV at baseline; 13% (47 of 362) were vaccinated for the first time during the follow-up period. The cross-sectional data identified 10 significant variables related to the Health Belief Model (HBM) predicting having ever undergone IV (e.g., perceived efficacy of prevention, side effects, financial difficulty, univariate OR=1.58-68.14 and 0.31-0.47). None of these variables could prospectively predict first-time IV during the follow-up period; the only significant variable was whether the respondent visited social centers during the follow-up period (OR=2.74). CONCLUSIONS The 10 studied variables (e.g., perceived efficacy, perceived side effects) were predictive of whether ever undergone IV in the cross-sectional survey. These variables were, however, unable to predict first-time IV in the longitudinal study. Therefore, programs modifying these cross-sectional factors (e.g. change perceptions on efficacy and safety) may not be effective in promoting first-time IV among the elderly. Longitudinal intervention studies are warranted.

Prevalence and factors associated with social avoidance of recovered SARS patients in the Hong Kong general population

Abstract The study investigated the general populations perceived infectivity of asymptomatic and recovered severe acute respiratory syndrome (SARS) patients and factors associated with avoidance and discriminatory attitudes, including demographic background, SARS-related perceptions and emotional response to the SARS epidemic. A population-based survey was conducted in Hong Kong during 3 December 2003 through 4 January 2004; 475 Hong Kong Chinese adults participated in the survey. Perceptions of the infectivity and health conditions of recovered SARS patients and avoidance and discrimination towards them were measured. Of the respondents, 75.7% and 16.2%, respectively, believed that SARS could be transmitted via asymptomatic SARS patients and those patients who have recovered from SARS for 18 months; 72.7% of the respondents believed that the health of SARS patients would severely and permanently be damaged; 16.6% showed some tendency of avoiding recovered SARS patients and 35.7% expressed some sort of job-related discriminatory attitudes. Perceived infectivity of asymptomatic and recovered SARS patients, health sequelae and emotional distress from SARS were independently associated with avoidance and discriminatory attitudes. The study showed that misconceptions about the infectivity of asymptomatic and recovered SARS patients were common. Recovered SARS patients may also be facing avoidance and discrimination.

Co-occurrence of sexual dysfunction within young married couple dyads living in rural China: a population-based study.

A total of 298 randomly selected married couple dyads in rural China were studied. Sexual dysfunction (SD) was reported by 84 (28.2%) of the husbands and 136 (45.6%) of the wives. Co-occurrence of SD was reported by 51 of the married couples; hence, SD co-occurred in the spouses of 60.7% of the husbands with SD and 37.5% of wives reporting SD. Pain during intercourse but not other SD of the wives was associated with SD of the husbands. Mens SD including inability to achieve orgasm, finding sex not pleasurable and lack of interest in sex, but not premature ejaculation or erectile dysfunction, were associated with the presence of SD among the wives. Decision-making control on sexual matters, communication between the spouses on sexual problems, the seeking of professional help, perceived adequacy of sexual knowledge as well as mental health and vitality quality of life indices were associated with co-occurrence of SD within the couple dyads.