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Background: The impact of heatwaves on public health has led to an urgent need to describe extremely hot weather events (EHWEs) and evaluate their health impacts., Methods: In Hong Kong, a very hot day (VHD) can be defined when the daily maximum temperature ≥ 33 °C, and a hot night (HN) can be identified if the daily minimum temperature ≥ 28 °C. Three lengths of time, nine combinations of VHD and HN, and four categories of occurrence intervals between two EHWEs were considered over 2006-2015. The daily relative risk (RR) of all-cause mortality was estimated using Poisson generalized additive regression models, controlling for both short-term and long-term trends in temperature as well as four air pollutants. Lagged effects of the representative EHWEs were further examined for their association with mortality. Subgroup analysis was conducted for different sex and age groups., Results: Significant associations with raised mortality risks were observed for a single HN, while stronger associations with mortality were observed as significant for five or more consecutive VHDs/HNs. More HNs between the consecutive VHDs also significantly amplified the impact on mortality, with the strongest association observed for EHWEs characterized as 2D3N, and the effect significantly lagged for five days. Therefore, with identifiable health impacts, three thresholds (5VHDs, 5HNs, & 2D3N) were determined to be representative of identical types of EHWEs in Hong Kong. Furthermore, by taking 2 (3) consecutive VHDs (HNs) as one daytime (nighttime) EHWE event, those occurring consecutively without non-hot days (nights) in between were found to be significantly associated with excess mortality risks. Moreover, females and older adults were determined to be relatively more vulnerable to all defined EHWEs., Conclusions: Among all the observed significant heat-mortality associations in highly urbanized cities, EHWEs that occurred during the nighttime, with extended length, consecutively without any break in between, or in the pattern of 2D3N might require the meteorological administration, healthcare providers, and urban planners to work interactively., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: To examine whether neighborhood green space was related to frailty risk longitudinally and to examine the relative contributions of green space, physical activity, and individual health conditions to the frailty transitions., Design, Setting, and Participants: Four thousand community-dwelling Chinese adults aged ≥65 years participating in the Mr. and Ms. Os (Hong Kong) study in 2001-2003 were followed up for 2 years., Methods: The percentage of green space within a 300-meter radial buffer around the participants' place of residence was derived for each participant at baseline based on the normalized difference vegetation index. Frailty status was classified according to the Fried criteria at baseline and after 2 years. Ordinal logistic regression and path analysis were used to examine associations between green space and the frailty transitions, adjusting for demographics, socioeconomic status, lifestyle factors, health conditions, and baseline frailty status., Results: At baseline, 53.5% of the participants met the criterion for robust, 41.5% were classified as prefrailty, and 5.0% were frail. After 2 years, 3240 participants completed all the measurements. Among these, 18.6% of prefrail or frail participants improved, 66% remained in their frailty state, and 26.8% of robust or prefrail participants progressed in frailty status. In multivariable models, the frailty status of participants living in neighborhoods with more than 34.1% green space (the highest quartile) at baseline was more likely to improve at the 2-year follow-up than it was for those living in neighborhoods with 0 to 4.5% (the lowest quartile) [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.04-1.60; P for trend: 0.022]. When men and women were analyzed separately, the association between green space and frailty remained significant in men (OR: 1.40, 95% CI: 1.03-1.90) but not in women. Path analysis showed that green space directly affects frailty transitions (β = 0.041, P < .05) and also exerts an effect through physical activity (β = 0.034, P < .05). Physical activity directly affects frailty (β = 0.134, P < .05), and also indirectly affects frailty through health conditions including number of diseases (β = -0.057, P < .05) and cognitive functions (β = 0.041, P < .05). The magnitude of the direct effect of green space on the 2-year frailty transitions is comparable to those of the indirect effect through physical activity., Conclusion: Older people living in neighborhoods with a higher percentage of green space were associated with improvement in frailty status, independent of a wide range of individual characteristics., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Green space has been shown to be beneficial for human wellness through multiple pathways. This study aimed to explore the contributions of neighbouring green space to cause-specific mortality., Methods: Data from 3544 Chinese men and women (aged ≥65 years at baseline) in a community-based cohort study were analysed. Outcome measures, identified from the death registry, were death from all-cause, respiratory system disease, circulatory system disease. The quantity of green space (%) within a 300 m radius buffer was calculated for each subject from a map created based on the Normalised Difference Vegetation Index. Cox proportional hazard models adjusted for demographics, socioeconomics, lifestyle, health conditions and housing type were used to estimate the HRs and 95% CIs., Results: During a mean of 10.3 years of follow-up, 795 deaths were identified. Our findings showed that a 10% increase in coverage of green space was significantly associated with a reduction in all-cause mortality (HR 0.963, 95% CI 0.930 to 0.998), circulatory system-caused mortality (HR 0.887, 95% CI 0.817 to 0.963) and stroke-caused mortality (HR 0.661, 95% CI 0.524 to 0.835), independent of age, sex, marital status, years lived in Hong Kong, education level, socioeconomic ladder, smoking, alcohol intake, diet quality, self-rated health and housing type. The inverse associations between coverage of green space with all-cause mortality (HR 0.964, 95% CI 0.931 to 0.999) and circulatory system disease-caused mortality (HR 0.888, 95% CI 0.817 to 0.964) were attenuated when the models were further adjusted for physical activity and cognitive function. The effects of green space on all-cause and circulatory system-caused mortality tended to be stronger in females than in males., Conclusion: Higher coverage of green space was associated with reduced risks of all-cause mortality, circulatory system-caused mortality and stroke-caused mortality in Chinese older people living in a highly urbanised city., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose: To evaluate the role of apolipoprotein E (APOE) polymorphisms in primary open angle glaucoma (POAG)., Methods: A cohort of 400 unrelated Chinese POAG patients was examined, including 294 cases of high tension glaucoma (HTG) and 106 with normal tension glaucoma (NTG). Also studied were 300 unrelated Chinese control subjects. The genotypes of the APOE polymorphisms in exon 4 and in the promoter at positions -491, -427, and -219 were determined by polymerase chain reaction and restriction endonuclease analysis. Frequencies of the genotypes were compared between patients and controls by chi test or Fisher exact test. The association of APOE polymorphisms with POAG phenotypes including age at diagnosis, intraocular pressure (IOP) at diagnosis, highest IOP, cup-disc ratio, and visual field score was investigated by the Kruskal-Wallis test., Results: No significant difference was detected in the frequencies of APOE promoter polymorphisms between POAG patients and control subjects (P>0.0125). For the exon 4 polymorphism, when compared with control subjects, the frequency of epsilon 4 carriers was significantly lower in patients with NTG (P=0.008; odds ratio=0.36, 95% confidence interval=0.17, 0.79) but not in HTG (P=0.07). Compared with -219TT, the -219G carriers had a significant higher age at diagnosis (P=0.0046). No significant association was found between other APOE polymorphisms and POAG phenotypes (P>0.07)., Conclusions: Our findings suggest that the APOE epsilon 4 allele confers a protective effect against NTG, whereas the APOE promoter polymorphisms do not contribute to POAG risk. However, the APOE -219G carriers tended to have later-onset POAG.

Objective: To identify the mutation patterns of RHO and RP1 genes in the Chinese patients with retinitis pigmentosa (RP) and to explore their potential interactions in the pathogenesis of RP., Methods: Sequence alterations in the entire coding region and splice sites of RHO and RP1 gene were screened in 151 RP affected probands and 150 unrelated controls who were all Hong Kong Chinese. Additional 46 relatives of 12 RP probands carrying possible mutations in RHO or RP1 were recruited for segregation analysis. Univariate analysis, multivariate analysis and genotype-pedigree disequilibrium test were used to examine the associations of polymorphisms in these two genes with RP., Results: Two mutations in the RHO gene, 5211delC and P347L, were identified each in one proband from the 151 probands, accounting for 1.3% of the RP patients. Two mutations in the RP1 gene, R677X and D984G, were identified each in one proband from the 151 probands, also accounting for 1.3% of the RP patients. In univariate analysis, non-coding sequence variants in the RHO gene, -26G > A, was found to increase the risk of RP, while R872H in the RP1 gene was likely to be a protective factor for RP. Multivariable logistic regression analysis and haplotype analysis confirmed these associations., Conclusion: The prevalences of RHO and RP1 mutations among the RP patients in Chinese population are both less than reported in other populations. Besides the disease-causing mutations, non-coding sequence alterations may also be a modifier for RP. The potential interactions between RHO and RP1 suggest a digenic etiology for RP.