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Global marine vessels emissions are adversely affecting human health particularly in southeast Asia. But health burdens from both ocean- and river-going vessels in Pearl River Delta (PRD) regions are not quantified. We estimated the potential health impacts using pooled relative risks of mortality and hospital admissions in China, and the model derived concentrations of sulfur dioxide (SO₂), particulate matter (PM₁₀), nitrogen dioxide (NO₂) and ozone (O₃) due to vessels emissions. SO₂ concentrations due to marine emissions in Hong Kong were 13.6 μg m⁻³ compared with 0.7 μg m⁻³ in PRD regions that were far from the marine vessels. In PRD regions, the estimated annual numbers (per million people) of excess deaths from all natural causes and hospital admissions from cardiorespiratory causes attributable to SO₂, NO₂, O₃ and PM₁₀ combined from marine emissions were 45 and 265 respectively. Marine emission control measures could contribute a large reduction in mortality and hospital admissions in PRD regions especially in Hong Kong., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death, particularly in developing countries. Little is known about the effects of economic development on COPD mortality, although economic development may potentially have positive and negative influences over the life course on COPD. We took advantage of a unique population whose rapid and recent economic development is marked by changes at clearly delineated and identifiable time points, and where few women smoke, to examine the effect of macro-level events on COPD mortality., Methods: We used Poisson regression to decompose sex-specific COPD mortality rates in Hong Kong from 1981 to 2005 into the effects of age, period and cohort., Results: COPD mortality declined strongly over generations for people born from the early to mid 20th century, which was particularly evident for the first generation to grow up in a more economically developed environment for both sexes. Population wide COPD mortality decreased when air quality improved and increased with increasing air pollution. COPD mortality increased with age, particularly after menopause among women., Conclusions: Economic development may reduce vulnerability to COPD by reducing long-lasting insults to the respiratory system, such as infections, poor nutrition and indoor air pollution. However, some of these gains may be offset if economic development results in increasing air pollution or increasing smoking.

High levels of p,p'-DDT were detected in Hong Kong breast milk sampled in 1976 and 1985. Monitoring DDT levels in human breast milk in this region is important to identify trends in exposure. As part of the 2002-03 WHO/EURO coordinated exposure study, the concentrations of DDT and its metabolites were determined in 10 pooled milk samples classified by geographic origin and dietary history, comprising milk samples from 238 primiparous mothers giving birth in Hong Kong. Analysis was performed by Gas Chromatography (GC) with electron capture detector and confirmed by GC/Mass Spectrometry. The sum-DDT concentration (range: 0.92-2.05 mg/kg fat) was age-dependent and indicated a decreasing trend since the 1970s. Mothers who recently came from mainland China had higher p,p'-DDT to p,p'-DDE ratios, suggesting a more recent exposure compared to women mainly residing in Hong Kong. The average Hong Kong sum-DDT level (1.50 mg/kg fat) was among the highest of the contemporary levels (range: 0.12-1.97 mg/kg fat; median: 0.40 mg/kg fat) in the 16 countries/regions participating in the 2002-03 WHO/EURO exposure study. This is probably due to the previous extensive DDT exposure and continuing use of DDT in agriculture in mainland China. Despite the apparent decrease of DDT body load over 30 years, the environmental health hazard from DDT contamination in the Pearl River Delta region remains a concern. Measures to eradicate illegal use of DDT in mainland China and regular food monitoring programs are needed in the region. Despite the presence of DDT and other persistent organic pollutants in human breast milk, breastfeeding should continue to be strongly supported for its life-long benefits to infants.

Background: Childhood living conditions have been hypothesized to be associated with the development of cardiovascular diseases and diabetes mellitus in adult life., Methods: We analysed, using logistic regression, the risk of self-reported diabetes, hypertension, hyperlipidaemia, and ischaemic heart disease in a population-based sample of 3643 Chinese men and 3778 Chinese women some of whom had experienced a change to more favourable economic conditions at different life stages through migration from mainland China to Hong Kong., Results: Adjusting for socio-economic status, risk behaviours, and family history, the development of diabetes was associated with migration from China to Hong Kong in the first two decades of life, albeit with a decreasing intensity of effect (OR = 2.02, 95% CI: 1.18, 3.45, OR = 1.84, 95% CI: 1.27, 2.66, and OR = 1.72, 95% CI: 1.21, 2.45 for migration at ages 0-7, 8-17, and 18-24, respectively). The development of hypertension was mostly susceptible to environmental change during the growth spurt and puberty (migration at ages 8-17 OR = 1.56, 95% CI: 1.22, 1.99). The development of heart disease was associated with a sex-specific critical period in early childhood for men (migration at ages 0-7 OR = 3.17, 95% CI: 1.70, 5.91)., Conclusion: Environmental change by migration throughout the first two decades of life can affect the development of diabetes, hypertension, hyperlipidaemia, and ischaemic heart disease, although adverse childhood conditions alone may not be a risk factor. Our results suggest that specific life course pathways may pre-dispose to these conditions and could be relevant to their aetiology in populations undergoing rapid development.

This paper reviews current understanding of the epidemiology, transmission dynamics and control of the aetiological agent of severe acute respiratory syndrome (SARS). We present analyses of data on key parameters and distributions and discuss the processes of data capture, analysis and public health policy formulation during the SARS epidemic are discussed. The low transmissibility of the virus, combined with the onset of peak infectiousness following the onset of clinical symptoms of disease, transpired to make simple public health measures, such as isolating patients and quarantining their contacts, very effective in the control of the SARS epidemic. We conclude that we were lucky this time round, but may not be so with the next epidemic outbreak of a novel aetiological agent. We present analyses that help to further understanding of what intervention measures are likely to work best with infectious agents of defined biological and epidemiological properties. These lessons learnt from the SARS experience are presented in an epidemiological and public health context.

Purpose: To compare the mortality risk of smoking and overall occupational exposure in Guangzhou, China., Methods: Baseline data on smoking and occupational exposure of 82159 workers aged 30+ were retrieved from medical records established in 1988-92. Vital status and causes of death were followed through 1998., Results: During follow-up 1584 workers had died. Adjusted relative risks (RR) with 95% confidence intervals (95%CI) for ever-smoking in men was 1.23 (1.07-1.41) for total deaths, 1.43 (1.17-1.74) for all cancer, 3.77 (2.31-6.14) for lung cancer and 2.54 (1.09-5.92) for stomach cancer (all showing significant linear trends with amount and duration of smoking). The RR in women of 1.10 (0.59-2.06) for total deaths and 1.60 (0.65-3.92) for all cancer were positive but not significant. No significant excess mortality risk was observed for occupational exposure in each gender. In both genders combined, the RR for total deaths was 1.23 (1.08-1.40) for smoking and 1.07 (0.96-1.19) for occupational exposure. If the relationships were causal, 12% of all deaths could be attributed to smoking but only 3% to occupational exposure., Conclusion: Smoking was more predictive of premature deaths than overall occupational exposures in middle aged workers. Smoking cessation should be a top priority in occupational health practice.

Background: The risk factors for sexually transmitted diseases (STDs) and having casual sex among the Chinese people are unknown., Goal: The goal of the study was to estimate the prevalence of STDs and to develop a profile of risk behavior among patients attending STD clinics in Hong Kong., Study Design: In a clinic-based, cross-sectional study, 448 patients attending two government STD clinics were randomly sampled and interviewed by means of a structured questionnaire., Results: The prevalence of STDs was 51% (70% of men and 35% of women). Attendees who had STDs diagnosed were more likely to be male, never married, and smokers and alcohol users (ever) and to have had casual sex or sex during travel with someone not their usual partner. Those who did not always use condoms were more likely to be male and never married. Having had casual sex was reported by 63% of the respondents. Those who reported having had casual sexual encounters were more likely to have the following characteristics: male; never married; no religious belief; ever smoker and alcohol user; current STD; had sex during travel; history of STD; inconsistent condom user; and perception of being at low risk for STD. After adjustment, only male gender was associated with casual sexual encounters., Conclusion: The results of this study indicated several risk factors among Chinese patients for the acquisition of STDs, for not using condoms, and for having casual sex. This information is useful in strengthening and evaluating currently available STD prevention and control strategies for the Chinese population in Hong Kong and elsewhere.

The pattern of tobacco, alcohol, and other substance use was assessed among 1,197 Chinese undergraduates in Hong Kong. Students reported their current and past use of tobacco (13%), alcohol (61%), marijuana (2%), and other illicit drugs (0.4%). Perceptions of risk from the use of different substances were low among those who use substances and among senior students. The rate of substance use was higher among males, residents of university hall, senior students, and among those who possessed a positive attitude towards substance use. There were significant associations between different substance uses among the respondents.

Objective: To assess the mortality currently associated with smoking in Hong Kong, and, since cigarette consumption reached its peak 20 years earlier in Hong Kong than in mainland China, to predict mortality in China 20 years hence., Design: Case-control study. Past smoking habits of all Chinese adults in Hong Kong who died in 1998 (cases) were sought from those registering the death., Setting: All the death registries in Hong Kong., Participants: 27 507 dead cases (81% of all registered deaths) and 13 054 live controls aged >/=35 years., Main Outcome Measures: Mortality from all causes and from specific causes., Results: In men aged 35-69 the adjusted risk ratios (and 95% confidence intervals) comparing smokers with non-smokers were 1.92 (1.70 to 2.16) for all deaths, 2.22 (1.94 to 2.55) for neoplastic deaths, 2.60 (2.10 to 3.21) for respiratory deaths (including tuberculosis, risk ratio 2.54), and 1.68 (1.43 to 1.97) for vascular deaths (each P<0.0001). In women aged 35-69 the corresponding risk ratios were 1.62 (1.40 to 1.88) for all deaths, 1.60 (1.33 to 1.93) for neoplastic deaths, 3.13 (2.21 to 4.44) for respiratory deaths, and 1.55 (1.20 to 1.99) for vascular deaths (each P<0.001). If these associations with smoking are largely or wholly causal then, among all registered deaths at ages 35-69 in 1998, tobacco caused about 33% (2534/7588) of all male deaths and 5% (169/3341) of all female deaths (hence 25% of all deaths at these ages). At older ages tobacco seemed to be the cause of 15% (3017/20 420) of all deaths., Conclusions: Among middle aged men the proportion of deaths caused by smoking is more than twice as big in Hong Kong now (33%) as in mainland China 10 years earlier. This supports predictions of a large increase in tobacco attributable mortality in China as a whole.

Between June 1998 and October 1998, a cross-sectional survey was carried out in Hong Kong on 369 Chinese residents who had travelled to mainland China or elsewhere overseas in the previous 12 months. The aim was to collect data on which intervention strategies to minimise travel-related illness among the public might be based. In interviews by telephone, information on travel-related health problems, factors related to such problems, and barriers in the acquisition of travel-health advice was gathered using a structured, pre-tested questionnaire. Most of the subjects had travelled to countries in the Asia-Pacific region, with mainland China as the most popular destination (44%), followed by Thailand (14%). Overall, 16% of the respondents had developed health (mainly alimentary and respiratory) problems during or after their travel, 8% had received pre-travel health advice but 59% reported taking some form of precaution against travel-related illness. Although only 12% had lost at least a day of work or travel because of their travel-related health problems, 40% perceived themselves at risk of future travel-related illness, and 68% said they were willing to pay for the prevention of travel-health problems. Younger travellers and those who perceived relatively few health risks in future travel were relatively more likely to have developed health problems. There appears to be a clear need to develop appropriate health-promotion strategies to reduce travel-health risks among the residents of Hong Kong and the rest of the Asia-Pacific region.

Although fibrinogen is an established risk factor of coronary heart disease (CHD), whether fibrinogen is associated with CHD in Chinese is not clear. This population-based cross-sectional study aimed to analyse this relationship in Hong Kong Chinese. Fibrinogen was measured by the Clauss method in 1348 men and 1385 women aged 25-74 years. Severity of CHD was defined as most serious if the subjects had medically diagnosed CHD, as less serious if they had angina only, and as normal if they had neither. The prevalence of angina and CHD was respectively 2.4% and 2.2% in men and 3.2% and 2.7% in women. In men the age-adjusted mean fibrinogen concentration was 2.47 (95% confidence interval (CI) 2.43-2.51) g/l in the normal group, 2.65 (95% CI 2.45-2.85) g/l in the angina group, and 2.78 (95% CI 2.56-3. 00) g/l in the CHD cases (P<0.01); in women it was respectively 2.61 (95% CI 2.59-2.63), 2.66 (95% CI 2.50-2.82), 2.90 (95% CI 2.72-3.08) g/l (P<0.01). The differences were significant after adjustment of other significant risk factors. We conclude that fibrinogen should be considered as a risk factor in Chinese.

Study Design: A prospective observational study on the use of the Aberdeen Low Back Pain Disability Scale., Objective: To evaluate the reliability, validity, and responsiveness of the Chinese adaptation of the Aberdeen Low Back Pain Scale in Chinese patients in Hong Kong who have back pain., Summary of Background Data: Frontline clinicians, researchers, and health care managers in Hong Kong are urgently in need of a Chinese adaptation of a low back pain outcome measure that has been subjected to a rigorous process of psychometric and clinical testing., Methods: Four samples with 473 consecutive adult patients with low back pain from six physiotherapy outpatient departments in Hong Kong who completed the Aberdeen Low Back Pain Scale were observed and measured at time points including the beginning physiotherapy; 10 days, 3 weeks, and 6 weeks after physiotherapy; and when discharged from treatment., Results: The test-retest reliability coefficient was 0.94 (0.94 in the original English version; figures from the English version are reported in parentheses). The Cronbach alpha coefficient was 0.85 (0.80). The Spearman correlation coefficient, when the Aberdeen score was correlated with that of a generic current 42-item questionnaire regarding the patient's perceived health to establish cross-sectional construct validity, was 0.59 (0.36-0.66, with the Short Form 36 scale). The effect sizes (responsiveness) at weeks 3 and 6 after treatment began were 0.59 and 0.81, respectively (a high of 0.62 reported in the English version)., Conclusions: The Chinese version of the Aberdeen Low Back Pain Disability Scale retained the high levels of reliability, validity, and responsiveness of the original English version when tested in Hong Kong in four samples of Chinese patients with low back pain.

Few studies have examined fibrinogen in Chinese populations in which the incidence of coronary heart disease (CHD) is lower than that in the West. This study aimed to examine the relationship between fibrinogen and other CHD risk factors in Hong Kong Chinese. Fibrinogen was measured by the Clauss method in 1359 men and 1405 women aged 25-74 years, randomly selected from the Hong Kong population. Mean fibrinogen level increased with age, from 2.22 g/l in those aged 25-34 years to 2.76 g/l in 65-74 years in men, and from 2.42 to 2.94 g/l respectively in women. The most important factors associated with fibrinogen were age, obesity and blood lipid levels in both genders. In men, smoking was associated with higher fibrinogen levels and cessation of smoking with lower levels. Prospective studies are needed to examine the role of fibrinogen in CHD in Chinese and other Asian populations.