register interest

Professor Emily Y.Y. Chan

Research Area: Global Health
Scientific Themes: Tropical Medicine & Global Health
Keywords: Disaster and Humanitarian Crisis Epidemiology, Climate Change and Health, Rural and Ethnic Minority Health, Injury and Violence epidemiology, Macro-determinants of health (Globalization, Urbanization, Migration) and Health Needs Assessment and Impact Evaluation Methodologies
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Prof Emily Ying Yang Chan serves as Professor and Assistant Dean (Development) of Faculty of Medicine, and Associate Director (External Affairs and Collaboration) of the JC School of Public Health and Primary Care at Chinese University of Hong Kong. She concurrently holds a Visiting Professorship at Oxford University Nuffield Department of Medicine and Fellowships at FXB Centre of Health and Human rights as well as the Harvard Humanitarian Initiative of Harvard School of Public Health.

She is the Director of the CUHK Centre for Global Health (CGH) and Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC). Specifically, CCOUC is recognised as a Centre of Excellence (ICoE-CCOUC) of Integrated Research on Disaster Risk (IRDR) program co-sponsored by the International Council for Science (ICSU), the International Social Science Council (ISSC), and the UNISDR.  

Since 2016, Prof Chan co-chairs the WHO Thematic Platform for Health Emergency & Disaster Risk Management Research Group and is a core member of Asia Science Technology and Academia Advisory Group (ASTAAG) of UNISDR. Her main research interests are Health emergency disaster risk management (H-EDRM), Disaster and Humanitarian Medicine, Climate and Planetary Health, Evidence-based public health and medical interventions in resource deficit settings.

Name Department Institution Country
Professor Michael Van Rooyen Harvard Humanitarian Initiative Harvard University United States
Professor Jennifer Leaning The FXB Center for Health and Human Rights Harvard University United States
Wang P, Goggins WB, Chan EYY. 2018. Associations of Salmonella hospitalizations with ambient temperature, humidity and rainfall in Hong Kong. Environ Int, 120 pp. 223-230. | Show Abstract | Read more

BACKGROUND: Little is known about the relationship between Salmonella infection and meteorological parameters other than air temperature. This study aimed to explore associations of Salmonella hospitalizations with temperature, relative humidity (RH) and rainfall. METHODS: With negative binomial distribution assumed, time-series regression model adjusting for season and time trend were constructed employing distributed lag non-linear models and generalized additive models. Meteorological variables including mean temperature, RH, and daily total rainfall as well as indicator variables including day of the week and public holiday were incorporated in the models. RESULTS: Higher temperature was strongly associated with more hospitalizations over the entire range of temperatures observed. There was a net 6.13 (95%Confidence Interval (CI) 3.52-10.67) relative risk of hospitalization at a temperature of 30.5 °C, relative to 13 °C, lag 0-16 days. Positive associations were found for RH above 60% and rainfall between 0 and 0.14 mm. Extreme high humidity (96%) and trace rainfall (0.02 mm) were associated with 2.06 (95%CI 1.35-3.14), lag 0-17 day, and 1.30 (95%CI 1.01-1.67), lag 0-26 days, relative risks of hospitalizations, relative to 60% and no rain, respectively. CONCLUSIONS: High temperatures, high RH and light rainfall are positively associated with Salmonella hospitalizations. The very strong association with temperatures implies that hotter days will lead to increases in Salmonella morbidity in the absence of other changes, and the public health implications of this could be exacerbated by global climate change.

Tam G, Huang Z, Chan EYY. 2018. Household Preparedness and Preferred Communication Channels in Public Health Emergencies: A Cross-Sectional Survey of Residents in an Asian Developed Urban City. Int J Environ Res Public Health, 15 (8), | Show Abstract | Read more

Disaster awareness and household preparedness are crucial for reducing the negative effects of a disaster. This study aims to examine the citizens' preparedness level in the event of a general disaster or outbreak of infectious disease and to identify suitable channels for community disease surveillance and risk communication. We used a stratified random design to conduct a digit-dialed telephone survey in Hong Kong during February 2014. Level of disaster preparedness was examined according to the possession of disaster kit items. Associations between socio-demographic factors and good household preparedness were assessed using multiple logistic regression models. Preferences for infectious disease surveillance were collected and analyzed. There were 1020 respondents. Over half of the respondents (59.2%) had good household preparedness. After adjustment, female respondents, having higher education and higher household income were significantly associated with good household preparedness. Television and telephone were the preferred channels to obtain and report infectious disease information, respectively. In conclusion, general and specific infectious-disease household preparedness levels in Hong Kong were generally good. Tailored preparedness programs targeted to specific communities are necessary for those lacking preparedness. Risk communication and public health surveillance should be conducted through television and telephone, respectively.

Pickering CJ, O'Sullivan TL, Morris A, Mark C, McQuirk D, Chan EY, Guy E, Chan GK, Reddin K, Throp R et al. 2018. The Promotion of 'Grab Bags' as a Disaster Risk Reduction Strategy. PLoS Curr, 10 | Show Abstract | Read more

INTRODUCTION: An all-of-society approach to disaster risk reduction emphasizes inclusion and engagement in preparedness activities. A common recommendation is to promote household preparedness through the preparation of a 'grab bag' or 'disaster kit', that can be used to shelter-in-place or evacuate. However, there are knowledge gaps related to how this strategy is being used around the world as a disaster risk reduction strategy, and what evidence there is to support recommendations. METHODS: In this paper, we present an exploratory study undertaken to provide insight into how grab bag guidelines are used to promote preparedness in Canada, China, England, Japan, and Scotland, and supplemented by a literature review to understand existing evidence for this strategy. RESULTS: There are gaps in the literature regarding evidence on grab bag effectiveness. We also found variations in how grab bag guidelines are promoted across the five case studies. DISCUSSION:  While there are clearly common items recommended for household grab bags (such as water and first aid kits), there are gaps in the literature regarding: 1) the evidence base to inform guidelines; 2) uptake of guidelines; and 3) to what extent grab bags reduce demands on essential services and improve disaster resilience.

Lam HCY, Chan JCN, Luk AOY, Chan EYY, Goggins WB. 2018. Short-term association between ambient temperature and acute myocardial infarction hospitalizations for diabetes mellitus patients: A time series study. PLoS Med, 15 (7), pp. e1002612. | Show Abstract | Read more

BACKGROUND: Acute myocardial infarction (AMI) is the leading cause of death among people with diabetes mellitus (DM) and has been found to occur more frequently with extreme temperatures. With the increasing prevalence of DM and the rising global mean temperature, the number of heat-related AMI cases among DM patients may increase. This study compares excess risk of AMI during periods of extreme temperatures between patients with DM and without DM. METHODS: Distributed lag nonlinear models (DLNMs) were used to estimate the short-term association between daily mean temperature and AMI admissions (International Classification of Diseases 9th revision [ICD-9] code: 410.00-410.99), stratified by DM status (ICD-9: 250.00-250.99), to all public hospitals in Hong Kong from 2002 to 2011, adjusting for other meteorological variables and air pollutants. Analyses were also stratified by season, age group, gender, and admission type (first admissions and readmissions). The admissions data and meteorological data were obtained from the Hong Kong Hospital Authority (HA) and the Hong Kong Observatory (HKO). FINDINGS: A total of 53,769 AMI admissions were included in the study. AMI admissions among DM patients were linearly and negatively associated with temperature in the cold season (cumulative relative risk [cumRR] [95% confidence interval] in lag 0-22 days (12 °C versus 24 °C) = 2.10 [1.62-2.72]), while those among patients without DM only started increasing when temperatures dropped below 22 °C with a weaker association (cumRR = 1.43 [1.21-1.69]). In the hot season, AMI hospitalizations among DM patients started increasing when the temperature dropped below or rose above 28.8 °C (cumRR in lag 0-4 days [30.4 versus 28.8 °C] = 1.14 [1.00-1.31]), while those among patients without DM showed no association with temperature. The differences in sensitivity to temperature between patients with DM and without DM were most apparent in the group <75 years old and among first-admission cases in the cold season. The main limitation of this study was the unavailability of data on individual exposure to ambient temperature. CONCLUSIONS: DM patients had a higher increased risk of AMI admissions than non-DM patients during extreme temperatures. AMI admissions risks among DM patients rise sharply in both high and low temperatures, with a stronger effect in low temperatures, while AMI risk among non-DM patients only increased mildly in low temperatures. Targeted health protection guidelines should be provided to warn DM patients and physicians about the dangers of extreme temperatures. Further studies to project the impacts of AMI risks on DM patients by climate change are warranted.

Wang P, Goggins WB, Chan EYY. 2018. A time-series study of the association of rainfall, relative humidity and ambient temperature with hospitalizations for rotavirus and norovirus infection among children in Hong Kong. Sci Total Environ, 643 pp. 414-422. | Show Abstract | Read more

BACKGROUND: Rotavirus and norovirus are infectious pathogens primarily affecting children under 5 years old. The impact of rainfall on diarrheal diseases remains inconclusive. This study aimed to evaluate the association between short-term variation in rainfall, temperature and humidity, and rotavirus and norovirus hospitalizations among young children in Hong Kong. METHODS: Generalized additive negative binomial regression models with distributed lag non-linear terms, were fit with daily counts of hospital admissions due to rotavirus and norovirus infection as the outcomes and daily total rainfall and other meteorological variables as predictors, adjusting for seasonality and trend. RESULTS: Generally, greater rainfall was associated with fewer rotavirus, but more norovirus hospitalizations. Extreme precipitation (99.5 mm, 99th percentile) was found to be associated with 0.40 (95% confidence interval (CI) 0.20-0.79) and 1.93 (95% CI 1.21-3.09) times the risk of hospitalization due to rotavirus and norovirus infection respectively, relative to trace rainfall. Stronger associations were observed in winter for rotavirus and in summer for norovirus. The duration of association with rotavirus was notably longer than norovirus. Higher temperatures were found to be associated with fewer hospitalizations for both rotavirus and norovirus infection, while higher relative humidity was generally associated with more norovirus, but fewer rotavirus, hospitalizations. CONCLUSIONS: Both rotavirus and norovirus hospitalizations were strongly associated with recent precipitation variation but in opposite directions. With the introduction of the rotavirus vaccine norovirus is likely to become a greater threat than rotavirus and thus greater precipitation may become more clearly associated with more childhood diarrhea.

Shi P, Shaw R, Ardalan A, Chan EYY, Choudhury JR, Cui P, Fu B, Han G, Han Q, Izumi T et al. 2018. Fourteen Actions and Six Proposals for Science and Technology-Based Disaster Risk Reduction in Asia INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE, 9 (2), pp. 275-279. | Read more

Lam HC-Y, Chan EY-Y, Goggins WB. 2018. Comparison of short-term associations with meteorological variables between COPD and pneumonia hospitalization among the elderly in Hong Kong-a time-series study. Int J Biometeorol, 62 (8), pp. 1447-1460. | Show Abstract | Read more

Pneumonia and chronic obstructive pulmonary diseases (COPD) are the commonest causes of respiratory hospitalization among older adults. Both diseases have been reported to be associated with ambient temperature, but the associations have not been compared between the diseases. Their associations with other meteorological variables have also not been well studied. This study aimed to evaluate the associations between meteorological variables, pneumonia, and COPD hospitalization among adults over 60 and to compare these associations between the diseases. Daily cause-specific hospitalization counts in Hong Kong during 2004-2011 were regressed on daily meteorological variables using distributed lag nonlinear models. Associations were compared between diseases by ratio of relative risks. Analyses were stratified by season and age group (60-74 vs. ≥ 75). In hot season, high temperature (> 28 °C) and high relative humidity (> 82%) were statistically significantly associated with more pneumonia in lagged 0-2 and lagged 0-10 days, respectively. Pneumonia hospitalizations among the elderly (≥ 75) also increased with high solar radiation and high wind speed. During the cold season, consistent hockey-stick associations with temperature and relative humidity were found for both admissions and both age groups. The minimum morbidity temperature and relative humidity were at about 21-22 °C and 82%. The lagged effects of low temperature were comparable for both diseases (lagged 0-20 days). The low-temperature-admissions associations with COPD were stronger and were strongest among the elderly. This study found elevated pneumonia and COPD admissions risks among adults ≥ 60 during periods of extreme weather conditions, and the associations varied by season and age group. Vulnerable groups should be advised to avoid exposures, such as staying indoor and maintaining satisfactory indoor conditions, to minimize risks.

Yang J, Siri JG, Remais JV, Cheng Q, Zhang H, Chan KKY, Sun Z, Zhao Y, Cong N, Li X et al. 2018. The Tsinghua-Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China. Lancet, 391 (10135), pp. 2140-2184. | Read more

Chan EYY, Lam HCY, So SHW, Goggins WB, Ho JY, Liu S, Chung PPW. 2018. Association between Ambient Temperatures and Mental Disorder Hospitalizations in a Subtropical City: A Time-Series Study of Hong Kong Special Administrative Region. Int J Environ Res Public Health, 15 (4), pp. 754-754. | Show Abstract | Read more

Background: Mental disorders have been found to be positively associated with temperature in cool to cold climatic regions but the association in warmer regions is unclear. This study presented the short-term association between temperatures and mental disorder hospitalizations in a subtropical city with a mean annual temperature over 21 °C. Methods: Using Poisson-generalized additive models and distributed-lagged nonlinear models, daily mental disorder hospitalizations between 2002 and 2011 in Hong Kong were regressed on daily mean temperature, relative humidity, and air pollutants, adjusted for seasonal trend, long-term trend, day-of-week, and holiday. Analyses were stratified by disease class, gender and age-group. Results: 44,600 admissions were included in the analysis. Temperature was positively associated with overall mental-disorder hospitalizations (cumulative relative risk at 28 °C vs. 19.4 °C (interquartile range, lag 0-2 days) = 1.09 (95% confidence interval 1.03, 1.15)), with the strongest effect among the elderly (≥75 years old). Transient mental disorders due to conditions classified elsewhere and episodic mood disorders also showed strong positive associations with temperature. Conclusion: This study found a positive temperature-mental-disorder admissions association in a warm subtropical region and the association was most prominent among older people. With the dual effect of global warming and an aging population, targeted strategies should be designed to lower the disease burden.

Yan R, Tse LA, Liu Z, Bo J, Chan EY, Wang Y, Yin L, Li W, PURE-China Investigators. 2018. Ethnic differences in spirometry measurements in China: Results from a large community-based epidemiological study. Respirology, 23 (7), pp. 704-713. | Show Abstract | Read more

BACKGROUND AND OBJECTIVE: No previous studies have examined differences in spirometry measurements among ethnic populations in China, and factors which may influence ethnic differences are unclear. Our study aimed to investigate whether forced expiratory volume in 1 s (FEV1 ) and forced vital capacity (FVC) differ among Han Chinese and other ethnic minorities in China. METHODS: We recruited 7137 individuals aged 35-70 years from four areas of China inhabited by ethnic minority groups between 2007 and 2009. We conducted spirometry tests for all available participants, and compared FEV1 and FVC among Uygur, Hui, Mongolian, Dai and Han Chinese ethnicities, using nonlinear multiplicative regression models. RESULTS: A total of 2005 healthy never-smokers were enrolled in the analysis. For all ethnicities, spirometry values increased with height and decreased with age; FEV1 and FVC were consistently higher in males than in females. Compared with Han Chinese, FEV1 was 4.42% (95% CI: 2.11-6.78%) higher in Mongolians, 4.08% (95% CI: 1.33-6.76%) lower in Uygurs, 4.39% (95% CI: 1.33-7.35%) lower in Hui people and 4.72% (95% CI: 1.80-7.55%) lower in Dai people, after adjusted for potential confounders including height, age, sex and place of residence. We observed similar differences for FVC. CONCLUSIONS: We detected significant differences in spirometry measurements among ethnic populations in China. Such differences cannot be fully explained by demographic, anthropometric or socioeconomic factors, but may also be attributed to genetic background as well as indoor and outdoor environmental exposures that need further investigation.

Tam G, Chan EYY, Liu S. 2018. A Web-Based Course on Public Health Principles in Disaster and Medical Humanitarian Response: Survey Among Students and Faculty. JMIR Med Educ, 4 (1), pp. e2. | Show Abstract | Read more

BACKGROUND: Web-based public health courses are becoming increasingly popular. "Public Health Principles in Disaster and Medical Humanitarian Response" is a unique Web-based course in Hong Kong. This course aimed to fill a public health training gap by reaching out to postgraduates who are unable to access face-to-face learning. OBJECTIVE: The aim of this paper was to use a structured framework to objectively evaluate the effectiveness of a Web-based course according to Greenhalgh et al's quality framework and the Donabedian model to make recommendations for program improvement. METHODS: An interim evaluation of the first cohort of students in 2014 was conducted according to the Donabedian model and a quality framework by Greenhalgh et al using objective and self-reported data. RESULTS: Students who registered for the first cohort (n=1152) from June 16, 2014 to December 15, 2014 (6 months) were surveyed. Two tutors and the course director were interviewed. The Web-based course was effective in using technology to deliver suitable course materials and assessment and to enhance student communication, support, and learning. Of the total number of students registered, 59.00% (680/1152) were nonlocal, originating from 6 continents, and 72.50% (835/1152) possessed a bachelor's or postgraduate degree. The completion rate was 20.00% (230/1152). The chi-square test comparing students who completed the course with dropouts showed no significant difference in gender (P=.40), age (P=.98), occupation (P=.43), or qualification (P=.17). The cost (HK $272 per student) was lower than that of conducting a face-to-face course (HK $4000 per student). CONCLUSIONS: The Web-based course was effective in using technology to deliver a suitable course and reaching an intended audience. It had a higher completion rate than other Web-based courses. However, sustainable sources of funding may be needed to maintain the free Web-based course.

Chan EYY, Chiu CP, Chan GKW. 2018. Medical and health risks associated with communicable diseases of Rohingya refugees in Bangladesh 2017. Int J Infect Dis, 68 pp. 39-43. | Show Abstract | Read more

Complex emergencies remain major threats to human well-being in the 21st century. More than 300000 Rohingya people from Myanmar, one of the most forgotten minorities globally, have fled to neighboring countries over the past decades. In the recent crisis, the sudden influx of Rohingya people over a 3-month period almost tripled the accumulated displaced population in Bangladesh. Using the Rohingya people in Bangladesh as a case context, this perspective article synthesizes evidence in the published literature regarding the possible key health risks associated with the five main health and survival supporting domains, namely water and sanitation, food and nutrition, shelter and non-food items, access to health services, and information, for the displaced living in camp settlements in Asia.

Smith AD, Chan EYY. 2018. Disaster Risk Reduction in Myanmar: A Need for Focus on Community Preparedness and Improved Evaluation of Initiatives. Disaster Med Public Health Prep, 12 (4), pp. 422-426. | Show Abstract | Read more

Myanmar is a country in political and economic transition. Facing a wide-variety of natural hazards and ongoing conflict, the country's under-developed infrastructure has resulted in high disaster risk. Following the devastation of Cyclone Nargis in 2008 and increased global focus on disaster management and risk reduction, Myanmar has begun development of national disaster policies. Myanmar's Action Plan for Disaster Risk Reduction addressed multiple stages of disaster development and has made progress towards national projects, however, has struggled to implement community-based preparedness and response initiatives. This article analyses Myanmar's disaster strategy, though the use of a disaster development framework and suggests areas for possible improvement. In particular, the article aims to generate discussion regarding methods of supporting objective evaluation of risk reduction initiatives in developing countries. (Disaster Med Public Health Preparedness. 2018;12:422-426).

Newnham EA, Balsari S, Lam RPK, Kashyap S, Pham P, Chan EYY, Patrick K, Leaning J. 2017. Self-efficacy and barriers to disaster evacuation in Hong Kong. Int J Public Health, 62 (9), pp. 1051-1058. | Show Abstract | Read more

OBJECTIVES: To investigate specific challenges to Hong Kong's capacity for effective disaster response, we assessed perceived barriers to evacuation and citizens' self-efficacy. METHODS: Global positioning system software was used to determine random sampling locations across Hong Kong, weighted by population density. The resulting sample of 1023 participants (46.5% female, mean age 40.74 years) were invited to complete questionnaires on emergency preparedness, barriers to evacuation and self-efficacy. Latent profile analysis and multinomial logistic regression were used to identify self-efficacy profiles and predictors of profile membership. RESULTS: Only 11% of the sample reported feeling prepared to respond to a disaster. If asked to evacuate in an emergency, 41.9% of the sample cited significant issues that would preclude them from doing so. Self-efficacy was negatively associated with barriers to disaster response so that participants reporting higher levels of self-efficacy cited fewer perceived barriers to evacuation. CONCLUSIONS: Hong Kong has established effective strategies for emergency response, but concerns regarding evacuation and mobilisation remain. The findings indicate that improving self-efficacy for disaster response has potential to increase evacuation readiness.

Chan EYY, Shi P. 2017. Health and Risks: Integrating Health into Disaster Risk Reduction, Risk Communication, and Building Resilient Communities INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE, 8 (2), pp. 107-108. | Read more

Chan EYY, Guo C, Lee P, Liu S, Mark CKM. 2017. Health Emergency and Disaster Risk Management (Health-EDRM) in Remote Ethnic Minority Areas of Rural China: The Case of a Flood-Prone Village in Sichuan INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE, 8 (2), pp. 156-163. | Show Abstract | Read more

© 2017, The Author(s). Remote, rural ethnic-minority communities face greater disaster-related public health risks due to their lack of resources and limited access to health care. The Ethnic Minority Health Project (EMHP) was initiated in 2009 to work with remote, disaster-prone ethnic-minority villages that live in extreme poverty. One of the project’s aims is to develop and evaluate bottom-up health risk reduction efforts in emergency and disaster risk management (Health-EDRM). This article shares project updates and describes field intervention results from the Yi ethnic community of Hongyan village in China’s Sichuan Province, an area that experiences recurrent floods. It was found that 64% of the village respondents had never considered any form of disaster preparation, even with the recurrent flood risks. Health intervention participants showed sustained knowledge retention and were nine times more likely to know the correct composition of oral rehydration solution (ORS) after the intervention. Participants also retained the improved knowledge on ORS and disaster preparedness kit ownership 12 months after the intervention.

Lo STT, Chan EYY, Chan GKW, Murray V, Abrahams J, Ardalan A, Kayano R, Yau JCW. 2017. Health Emergency and Disaster Risk Management (Health-EDRM): Developing the Research Field within the Sendai Framework Paradigm INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE, 8 (2), pp. 145-149. | Show Abstract | Read more

© 2017, The Author(s). The intersection of health and disaster risk reduction (DRR) has emerged in recent years as a field of critical inquiry. Health is recognized as an outcome and a goal of DRR, and the integration of both fields is essential to ensure the implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030. Health Emergency and Disaster Risk Management (Health-EDRM) has emerged as an umbrella field that encompasses emergency and disaster medicine, DRR, humanitarian response, community health resilience, and health systems resilience. In September 2016, an international group of experts met in Hong Kong to assess the current status and potential of the Health-EDRM research field, a research area that these scholars characterized as underdeveloped and fragmented. Key challenges identified include research overlap, lack of strategic research agenda, absence of consensus regarding terminology, and limited coordination between stakeholders. The Sendai Framework provides a useful paradigm within which to shape the research field’s strategic development. The WHO Thematic Platform for Health-EDRM Research Group was established to coordinate activities, promote information-sharing, develop partnerships, and provide technical advice to strengthen the Health-EDRM research field. This group will promote the generation of robust and scientific health research to support the meaningful implementation of the Sendai Framework.

Chan EYY, Huang Z, Mark CKM, Guo C. 2017. Weather Information Acquisition and Health Significance during Extreme Cold Weather in a Subtropical City: A Cross-sectional Survey in Hong Kong INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE, 8 (2), pp. 134-144. | Show Abstract | Read more

© 2017, The Author(s). Health and disaster risk reduction are important and necessary components in building a smart city, especially when climate change may increase the frequency of extreme temperatures and the health risks of urban dwellers. However, limited knowledge is available about the best way to disseminate weather warnings and health protection information. This study explores the weather information acquisition patterns of the Hong Kong public and examines the sociodemographic predictors of these patterns to establish the potential public health implications of smart city development. A population-based, stratified cross-sectional, random digit dialing telephone survey was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong in early 2016. Analyses were conducted based on 1017 valid samples, with a response rate of 63.6%. Cold Weather Warnings were well disseminated in Hong Kong, with 95.7% of the respondents reporting awareness of the public warnings. Television and smartphone apps were the two most important channels for weather information acquisition. Age and education level are the main social-demographic variables associated with the current utilization and future preference of smartphone technology. Among those who were not using a preferred channel to acquire weather information, 61.3% considered switching to a smartphone app. Moreover, the patterns of individual health protection measures and self-reported health impacts were significantly different between smartphone app users and non-users. Weather information dissemination should be tailored to the sociodemographic characteristics of the users.

Goggins WB, Chan EY. 2017. A study of the short-term associations between hospital admissions and mortality from heart failure and meteorological variables in Hong Kong: Weather and heart failure in Hong Kong. Int J Cardiol, 228 pp. 537-542. | Show Abstract | Read more

BACKGROUND: Previous research has shown winter peaks for both hospitalizations and mortality from HF, but few studies have examined the association between meteorological parameters and HF. METHODS: Daily HF admissions to Hong Kong public hospitals, which cover about 83% of total admissions, and daily HF deaths, were obtained for 2002-2011. Generalized additive (Poisson) regression models were used with daily HF admissions/mortality as outcomes and daily mean temperature, humidity, and wind speed as predictors, while controlling for pollutant levels, time trend, season, day of the week, and holiday. Non-linear distributed lag functions were used for predictors to allow for non-linear and delayed associations. RESULTS: Lower mean daily temperatures were strongly associated with increased HF admissions and mortality with a cumulative (to 23days) relative risk (RR) (95% confidence interval (CI)) for HF admissions of 2.63 (2.43, 2.84) for an 11°C. vs. a 25°Cday, and cumulative (42days) RR (95% CI)=3.13 (1.90, 5.16) for HF mortality. The association with cold weather was stronger among older age groups and for new hospitalizations compared to recurrent ones, while presence of co-morbidities did not modify the association. Both high and low relative humidity were modestly associated with more admissions. CONCLUSIONS: Both HF admissions and mortality in Hong Kong were very strongly associated with cold temperatures. Reducing exposure to cold temperatures among those at risk for HF has the potential to reduce hospitalizations and mortality.

Burkle FM, Erickson T, von Schreeb J, Kayden S, Redmond A, Chan EY, Della Corte F, Cranmer H, Otomo Y, Johnson K, Roy N. 2017. The Solidarity and Health Neutrality of Physicians in War & Peace. PLoS Curr, 9 (Disasters), | Show Abstract | Read more

The wars in the Middle East have led to unprecedented threats and attacks on patients, healthcare workers, and purposeful targeting of hospitals and medical facilities. It is crucial that every healthcare provider, both civilian and military, on either side of the conflict become aware of the unique and inherent protections afforded to them under International Humanitarian Law. However, these protections come with obligations. Whereas Governments must guarantee these protections, when violated, medical providers have equal duty and obligations under the Law to ensure that they will neither commit nor assist in these violations nor take part in any act of hostility. Healthcare providers must not allow any inhuman or degrading treatment of which they are aware and must report such actions to the appropriate authorities. Failure to do so leads to risks of moral, ethical and legal consequences as well as penalties for their actions and inactions. There must be immediate recognition by all parties of the neutrality of health care workers and their rights and responsibilities to care for any sick and injured patient, regardless of their nationality, race, religion, or political point of view.

Chan EYY, Gao Y, Li L, Lee PY. 2017. Injuries caused by pets in Asian urban households: a cross-sectional telephone survey. BMJ Open, 7 (1), pp. e012813. | Show Abstract | Read more

OBJECTIVES: Little is known about pet-related injuries in Asian populations. This study primarily aimed to investigate the incidence rate of pet-related household injuries in Hong Kong, an urban Chinese setting. SETTING: Cantonese-speaking non-institutionalised population of all ages in Hong Kong accessible by telephone land-line. PARTICIPANTS: A total of 43 542 telephone numbers were dialled and 6570 residents successfully completed the interviews. PRIMARY AND SECONDARY OUTCOME MEASURES: Data of pet-related household injuries in the previous 12 months, pet ownership and socio-demographic characteristics were collected with a questionnaire. Direct standardisation of the incidence rates of pet-related household injuries by gender and age to the 2009 Hong Kong Population Census was estimated. Univariate and multivariate analyses were performed to estimate risks of socio-demographic factors and pet ownership for the injury. RESULTS: A total of 84 participants experienced pet-related household injuries in the past 12 months, with an overall person-based incidence rate of 1.28%. The majority of the victims were injured once (69.6%). Cats (51.6%) were the most common pets involved. Pet owners were at an extremely higher risk after controlling for other factors (adjusted OR: 52.0, 95% CI 22.1 to 98.7). Females, the unmarried, those with higher monthly household income and those living in lower-density housing were more likely to be injured by pets. CONCLUSIONS: We project a pet-related household injury incidence rate of 1.24% in the general Hong Kong population, with 86 334 residents sustaining pet-related injuries every year. Pet ownership puts people at extremely high risk, especially the unmarried. Further studies should focus on educating pet owners to reduce pet-related injuries in urban Greater China.

Chan EYY, Wang SS, Ho JY-E, Huang Z, Liu S, Guo C. 2017. Socio-demographic predictors of health and environmental co-benefit behaviours for climate change mitigation in urban China. PLoS One, 12 (11), pp. e0188661. | Show Abstract | Read more

OBJECTIVE: This study aims to examine the patterns and socio-demographic predictors of health and environmental co-benefit behaviours that support climate change mitigation in a densely populated Asian metropolis-Hong Kong. METHODS: A population-based, stratified and cross-sectional random digit dialling telephone survey study was conducted between January and February 2016, among the Cantonese-speaking population aged 15 and above in Hong Kong. Socio-demographic data and the self-reported practice of 10 different co-benefit behaviours were solicited. Ethics approval and participant's verbal consent were sought. FINDINGS: The study sample consisted of 1,017 respondents (response rate: 63.6%) were comparable to the age, gender and geographical distributions of the Hong Kong population found in the latest 2011 Hong Kong Population Census. Among the co-benefit behaviours, using less packaging and disposable shopping bags were practiced in the highest frequency (70.1%). However, four behaviours were found to have never been practiced by more than half of the respondents, including bringing personal eating utensils when dining in restaurants or small eateries, showering less than five minutes, having one vegetarian meal a week, and buying more organic food. Results of multivariable logistic regression showed that frequency of practicing co-benefit behaviours were consistently associated with gender and age. CONCLUSION: Urban residents in Hong Kong do not engage in the practice of co-benefit behaviours in a uniform way. In general, females and older people are more likely to adopt co-benefit behaviours in their daily lives. Further research to assess the knowledge and attitudes of the population towards these co-benefit behaviours will provide support to relevant climate change mitigation policies and education programmes.

Chan EYY, Murray V. 2017. What are the health research needs for the Sendai Framework? Lancet, 390 (10106), pp. e35-e36. | Read more

Zhang N, Miao R, Huang H, Chan EYY. 2016. Contact infection of infectious disease onboard a cruise ship. Sci Rep, 6 (1), pp. 38790. | Show Abstract | Read more

Cruise tourism has become more popular. Long-term personal contact, complex population flows, a lack of medical care facilities, and defective infrastructure aboard most cruise ships is likely to result in the ship becoming an incubator for infectious diseases. In this paper, we use a cruise ship as a research scenario. Taking into consideration personal behavior, the nature and transfer route of the virus across different surfaces, virus reproduction, and disinfection, we studied contact infection of infectious disease on a cruise ship. Using gastroenteritis caused by the norovirus as an example, we analyzed the characteristics of infectious disease propagation based on simulation results under different conditions. We found hand washing are the most important factors affecting virus propagation and passenger infection. It also decides either the total number of virus microorganisms or the virus distribution in different functional areas. The transfer rate between different surfaces is a key factor influencing the concentricity of the virus. A high transfer rate leads to high concentricity. In addition, the risk of getting infected is effectively reduced when the disinfection frequency is above a certain threshold. The efficiency of disinfection of functional areas is determined by total virus number and total contact times of surfaces.

Wang P, Goggins WB, Chan EYY. 2016. Hand, Foot and Mouth Disease in Hong Kong: A Time-Series Analysis on Its Relationship with Weather. PLoS One, 11 (8), pp. e0161006. | Show Abstract | Read more

BACKGROUND: Hand, foot and mouth disease (HFMD) is an emerging enterovirus-induced infectious disease for which the environmental risk factors promoting disease circulation remain inconclusive. This study aims to quantify the association of daily weather variation with hospitalizations for HFMD in Hong Kong, a subtropical city in China. METHODS: A time series of daily counts of HFMD public hospital admissions from 2008 through 2011 in Hong Kong was regressed on daily mean temperature, relative humidity, wind speed, solar radiation and total rainfall, using a combination of negative binomial generalized additive models and distributed lag non-linear models, adjusting for trend, season, and day of week. RESULTS: There was a positive association between temperature and HFMD, with increasing trends from 8 to 20°C and above 25°C with a plateau in between. A hockey-stick relationship of relative humidity with HFMD was found, with markedly increasing risks over 80%. Moderate rainfall and stronger wind and solar radiation were also found to be associated with more admissions. CONCLUSIONS: The present study provides quantitative evidence that short-term meteorological variations could be used as early indicators for potential HFMD outbreaks. Climate change is likely to lead to a substantial increase in severe HFMD cases in this subtropical city in the absence of further interventions.

Lee KL, Chan YH, Lee TC, Goggins WB, Chan EYY. 2016. The development of the Hong Kong Heat Index for enhancing the heat stress information service of the Hong Kong Observatory. Int J Biometeorol, 60 (7), pp. 1029-1039. | Show Abstract | Read more

This paper presents a study to develop a heat index, for use in hot and humid sub-tropical climate in Hong Kong. The study made use of hospitalization data and heat stress measurement data in Hong Kong from 2007 to 2011. The heat index, which is called Hong Kong Heat Index (HKHI), is calculated from the natural wet bulb temperature, the globe temperature, and the dry bulb temperature together with a set of coefficients applicable to the high humidity condition in the summer of Hong Kong. Analysis of the response of hospitalization rate to variation in HKHI and two other heat indices, namely Wet Bulb Globe Temperature (WBGT) and Net Effective Temperature (NET), revealed that HKHI performed generally better than WBGT and NET in reflecting the heat stress impact on excess hospitalization ratio in Hong Kong. Based on the study results, two reference criteria of HKHI were identified to establish a two-tier approach for the enhancement of the heat stress information service in Hong Kong.

Chan EY, Yue J, Lee P, Wang SS. 2016. Socio-demographic Predictors for Urban Community Disaster Health Risk Perception and Household Based Preparedness in a Chinese Urban City. PLoS Curr, 8 (Disasters), | Show Abstract | Read more

OBJECTIVES: There is limited evidence on urban Asian communities' disaster risk perceptions and household level preparedness. Hong Kong is characterized by high population density, and is susceptible to large-scale natural disasters and health crises such as typhoons, fires and infectious disease outbreaks. This research paper investigates the rates and predictors of urban community disaster risk perception, awareness and preparedness, at individual and household levels. METHODS: A randomized cross-sectional, population-based telephone survey study was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong. Descriptive statistics were reported. A stepwise multivariate logistic regression analysis was conducted to determine the independent associations between risk perceptions, socioeconomic factors, household characteristics, and personal background. FINDINGS: Final study sample comprised of 1002 respondents with a 63% response rate. The majority of respondents (82.3%) did not perceive Hong Kong as a disaster-susceptible city. Half (54.6%) reported beliefs that the local population had lower disaster awareness than other global cities. Infectious disease outbreak (72.4%), typhoon (12.6%), and fire (7.1%) were ranked as the most-likely-to-occur population-based disasters. Although over 77% believed that basic first aid training was necessary for improving individual disaster preparedness, only a quarter (26.1%) of respondents reported participation in training. CONCLUSION: Despite Hong Kong's high level of risk, general public perceptions of disaster in Hong Kong were low, and little preparedness has occurred at the individual or household levels. This report has potential to inform the development of related policies and risk communication strategies in Asian urban cities.

Lam HC-Y, Li AM, Chan EY-Y, Goggins WB. 2016. The short-term association between asthma hospitalisations, ambient temperature, other meteorological factors and air pollutants in Hong Kong: a time-series study. Thorax, 71 (12), pp. 1097-1109. | Show Abstract | Read more

BACKGROUND: Previous studies have found associations between meteorological variables and asthma hospitalisations but the nature of these associations has varied and few studies have been done in subtropical areas or evaluated effect modification by age. OBJECTIVES: This study aimed to evaluate associations between asthma hospitalisations and meteorological factors and to assess effect modification of these associations by age and season in Hong Kong. METHODS: Poisson generalised additive models combined with distributed lag nonlinear models and piecewise linear models were used to model associations between daily asthma hospitalisations from 2004 to 2011 and meteorological factors and air pollutants, adjusting for day of week, seasonality and trend. Subgroup analyses by age and season were performed. RESULTS: In the hot season, hospitalisations were lowest at 27°C, rose to a peak at 30°C, then plateaued between 30°C and 32°C. The cumulative relative risk for lags 0-3 days (RRlag0-3) for 30°C vs 27°C was 1.19 (95% CI 1.06 to 1.34). In the cold season, temperature was negatively associated with asthma hospitalisations. The cumulative RRlag0-3 for 12°C vs 25°C was 1.33 (95% CI 1.13 to 1.58). Adult admissions were most sensitive to temperatures in both seasons while admissions among children under 5 were least associated. Higher humidity and ozone levels in the hot season, and low humidity in the cold season were also associated with more asthma admissions. CONCLUSIONS: People with asthma should avoid exposure to adverse conditions by limiting outdoor activities during periods of extreme temperatures, combinations of high humidity and high temperature, and low humidity and low temperature, and high ozone levels.

Hemstock SL, Buliruarua LA, Chan EYY, Chan G, Combes HJD, Davey P, Farrell P, Griffiths S, Hansen H, Hatch T et al. 2016. Accredited qualifications for capacity development in disaster risk reduction and climate change adaptation Australasian Journal of Disaster and Trauma Studies, 20 (1), pp. 15-34. | Show Abstract

© The Author(s) 2016. Increasingly practitioners and policy makers working across the globe are recognising the importance of bringing together disaster risk reduction and climate change adaptation. From studies across 15 Pacific island nations, a key barrier to improving national resilience to disaster risks and climate change impacts has been identified as a lack of capacity and expertise resulting from the absence of sustainable accredited and quality assured formal training programmes in the disaster risk reduction and climate change adaptation sectors. In the 2016 UNISDR Science and Technology Conference on the Implementation of the Sendai Framework for Disaster Risk Reduction 2015-2030, it was raised that most of the training material available are not reviewed either through a peer-to-peer mechanism or by the scientific community and are, thus, not following quality assurance standards. In response to these identified barriers, this paper focuses on a call for accredited formal qualifications for capacity development identified in the 2015 United Nations landmark agreements in DRR and CCA and uses the Pacific Islands Region of where this is now being implemented with the launch of the Pacific Regional Federation of Resilience Professionals, for DRR and CCA. A key issue is providing an accreditation and quality assurance mechanism that is shared across boundaries. This paper argues that by using the United Nations landmark agreements of 2015, support for a regionally accredited capacity development that ensures all countries can produce, access and effectively use scientific information for disaster risk reduction and climate change adaptation. The newly launched Pacific Regional Federation of Resilience Professionals who work in disaster risk reduction and climate change adaptation may offer a model that can be used more widely.

Chan EYY, Wang Z, Mark CKM, Da Liu S. 2015. Industrial accidents in China: risk reduction and response. Lancet, 386 (10002), pp. 1421-1422. | Read more

Chan EYY, Cheng CKY, Tam G, Huang Z, Lee P. 2015. Knowledge, attitudes, and practices of Hong Kong population towards human A/H7N9 influenza pandemic preparedness, China, 2014. BMC Public Health, 15 (1), pp. 943. | Show Abstract | Read more

BACKGROUND: Since SARS epidemic in 2003, Hong Kong has experienced several major epidemic risks, but how general community might react to the repeated infectious diseases health risks have not been studied. In 2013, imported human H7N9 influenza infected cases from China were reported. Our study aims to assess the knowledge, attitude and practice (KAP) concerning A/H7N9 among Hong Kong general population regarding pandemic preparedness in early 2014. METHODS: A cross-sectional, population-based telephone survey study was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong in February 2014. The study survey was composed of 78 KAP questions. Factors associated with individual and household pandemic preparedness were analyzed. RESULTS: Final study sample was 1,020 with a response rate of 45.9 %. Among the respondents, most of them believed personal hygiene and avoidance of avian contacts were effective in preventing H7N9 infections. The majority of respondents had satisfactory hand hygiene practices and avoided touching avian species but did not employ other preventive measures. Female, 25 years old or older, white collar workers, people with chronic diseases and people living in the city center tended to report better hygiene practices. The average State-Trait Anxiety Inventory score was 1.85, similar to that of the period during the first wave and at the start of the second wave of the H7N9 epidemic. Self-reported face masks wearing when having influenza-like illness in general population dropped from 92.4 % during H5N1 period in 2007 to 39.0 % in this study. CONCLUSION: Hong Kong citizens show a low level of anxiety, misconceptions regarding the novel strains as well as gaps between perceived usefulness and practice of preventive measures towards influenza outbreaks. Educational campaigns and framing the issue to increase public and media awareness are crucial in preventing the current public fatigue towards outbreaks.

Qiu H, Yu IT-S, Tse LA, Chan EYY, Wong TW, Tian L. 2015. Greater temperature variation within a day associated with increased emergency hospital admissions for asthma. Sci Total Environ, 505 pp. 508-513. | Show Abstract | Read more

Asthma is one of the most common chronic conditions affecting both children and adults. Examining the health effects of environmental triggers such as temperature variation may have implications for maintenance of asthma control and prevention. We hypothesized that large diurnal temperature range (DTR) might be a source of additional environmental stress and therefore a risk factor for asthma exacerbation. Daily meteorological data, air pollution concentrations and emergency hospital admissions for asthma from 2004 to 2011 in Hong Kong were collected. Poisson regression models were used to fit the relationship between daily DTR and asthma, after adjusting for the time trend, seasonality, mean temperature, humidity, and levels of outdoor air pollution. Acute adverse effect of DTR on asthma was observed. An increment of 1 °C in DTR over lag0 to lag4 days was associated with a 2.49% (95% CI: 1.86%, 3.14%) increase in daily emergency asthma hospitalizations. The association between DTR and asthma was robust on the adjustment for daily absolute temperature and air pollution. DTR exhibited significantly greater effect in cool season. Males and female children appeared to be more vulnerable to DTR. Results supported that greater temperature variation within a day was an environmental risk factor for asthma exacerbation.

Hung KKC, Lin AKY, Cheng CKY, Chan EYY, Graham CA. 2015. Pre-travel health preparation for malaria prevention among Hong Kong travellers. Postgrad Med J, 91 (1073), pp. 127-131. | Show Abstract | Read more

BACKGROUND: Malaria remains a significant cause of travel-related mortality and morbidity. Asians are known to have higher risks because they are less careful in pre-travel health preparations. This study reports on a cohort of travellers to malaria-prone regions examined in a previous study, which explored general levels of pre-travel health preparation. OBJECTIVES: To describe the preparations taken by travellers at Hong Kong International Airport going to destinations with significant malaria risks according to the WHO. METHOD: A cross-sectional survey was conducted by personal interviews at the boarding gates of flights in April 2013. The flights were chosen from those to malaria-prone regions (type I or above) from the 2012 WHO International Travel and Health Country List. RESULTS: 403 respondents (75.6% Chinese ethnicity) were travelling to malaria-prone regions. 95.3% were travelling to developing countries including China, Thailand, Malaysia and India. 55.1% of respondents had taken at least one mosquito prevention measure and 8.9% of respondents had malaria chemoprophylaxis. Stepwise multivariate logistic regression analysis showed that female gender (OR=2.21, 95% CI 1.23 to 3.97), residence outside Hong Kong (OR=2.71, 95% CI 1.46 to 5.04) and travel including rural areas (OR=5.67, 95% CI 3.11 to 10.34) were predictors of optimum pre-travel health preparations. CONCLUSIONS: Underestimation of malaria risks was a major barrier to adequate pre-travel health preparations. Targeted health education and information about risk is necessary to improve levels of travel health preparedness.

Chan EY-Y, Cheng CK-Y, Tam GC-H, Huang Z, Lee PY. 2015. Willingness of future A/H7N9 influenza vaccine uptake: A cross-sectional study of Hong Kong community. Vaccine, 33 (38), pp. 4737-4740. | Show Abstract | Read more

We conducted a population telephone survey in Hong Kong during the second wave of influenza A/H7N9 outbreak in 2014. Among the respondents, 50.5% of the respondents would like to accept A/H7N9 vaccination in future. Respondents had poor knowledge of A/H7N9 influenza and vaccines. More than 60% of respondents mixed up seasonal influenza this year and A/H7N9 influenza. Results show that socio-demographic factors were all independent of the vaccine uptake willingness while anxiety level and vaccine history were the main affecting factors. Vaccine promotion strategies may focus on influenza knowledge, attitude and behavior.

Goggins WB, Yang C, Hokama T, Law LSK, Chan EYY. 2015. Using Annual Data to Estimate the Public Health Impact of Extreme Temperatures. Am J Epidemiol, 182 (1), pp. 80-87. | Show Abstract | Read more

Short-term associations between both hot and cold ambient temperatures and higher mortality have been found worldwide. Few studies have examined these associations on longer time scales. Age-standardized mortality rates (ASMRs) were calculated for 1976-2012 for Hong Kong SAR, People's Republic of China, defining "annual" time periods in 2 ways: from May through April of the following year and from November through October. Annual frequency and severity of extreme temperatures were summarized by using a degree-days approach with extreme heat expressed as annual degree-days >29.3°C and cold as annual degree-days <27.5°C. For example, a day with a mean temperature of 25.0°C contributes 2.5 cold degree-days to the annual total. Generalized additive models were used to estimate the association between annual hot and cold degree-days and the ASMR, with adjustment for long-term trends. Increases of 10 hot or 200 cold degree-days in an annual period, the approximate interquartile ranges for these variables, were significantly (all P's ≤ 0.011) associated with 1.9% or 3.1% increases, respectively, in the annual ASMR for the May-April analyses and with 2.2% or 2.8% increases, respectively, in the November-October analyses. Associations were stronger for noncancer and elderly mortality. Mortality increases associated with extreme temperature are not simply due to short-term forward displacement of deaths that would have occurred anyway within a few weeks.

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Wang F, Zhang L, Zhang Y, Zhang B, He Y, Xie S, Li M, Miao X, Chan EYY, Tang JL et al. 2014. Meta-analysis on night shift work and risk of metabolic syndrome. Obes Rev, 15 (9), pp. 709-720. | Show Abstract | Read more

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.

Gao Y, Chan EY, Li L, Lau PW, Wong TW. 2014. Chronic effects of ambient air pollution on respiratory morbidities among Chinese children: a cross-sectional study in Hong Kong. BMC Public Health, 14 (1), pp. 105. | Show Abstract | Read more

BACKGROUND: The chronic health effects from exposure to ambient air pollution are still unclear. This study primarily aims to examine the relationship between long-term exposure to ambient air pollution and respiratory morbidities in Chinese children. METHODS: A cross-sectional study was conducted among 2,203 school children aged 8-10 in three districts with different air pollution levels in Hong Kong. Annual means for ambient PM10, SO2, NO2 and O3 in each district were used to estimate participants' individual exposure. Two questionnaires were used to collect children's respiratory morbidities and other potential risk factors. Multivariable logistic regression was fitted to estimate the risks of air pollution for respiratory morbidities. RESULTS: Compared to those in the low-pollution district (LPD), girls in the high-pollution district (HPD) were at significantly higher risk for cough at night (ORadj. = 1.81, 95% CI: 1.71-2.78) and phlegm without colds (ORadj. = 3.84, 95% CI: 1.74-8.47). In addition, marginal significance was reached for elevated risks for asthma, wheezing symptoms, and phlegm without colds among boys in HPD (adjusted ORs: 1.71-2.82), as well as chronic cough among girls in HPD (ORadj. = 2.03, 95% CI: 0.88-4.70). CONCLUSIONS: Results have confirmed certain adverse effects on children's respiratory health from long-term exposure to ambient air pollution. PM10 may be the most relevant pollutant with adverse effects on wheezing and phlegm in boys. Both PM10 and NO2 may be contributing to cough and phlegm in girls.

Hung KKC, Lin AKY, Cheng CKY, Chan EYY, Graham CA. 2014. Travel health risk perceptions and preparations among travelers at Hong Kong International Airport. J Travel Med, 21 (4), pp. 288-291. | Show Abstract | Read more

Four levels of pre-travel health preparations were defined to allow the measurement of general travel health preparations by the traveling public. A cross-sectional survey of 770 travelers using Hong Kong International Airport was conducted. Important gaps were found in the self-preparation domain. Length of travel was the only factor associated with higher levels of health preparations after adjusting for potential confounders. Targeted health education should be considered to improve health risk perceptions among travelers in Hong Kong and other similar metropolitan cities that are critical hubs for commercial air transport.

Xu F, Wang X, Ware RS, Tse LA, Wang Z, Hong X, Chan EYY, Li J, Wang Y. 2014. A school-based comprehensive lifestyle intervention among Chinese kids against Obesity (CLICK-Obesity) in Nanjing City, China: the baseline data. Asia Pac J Clin Nutr, 23 (1), pp. 48-54. | Show Abstract | Read more

BACKGROUND: urgent development of effective interventions to prevent rapidly rising childhood obesity in China is needed. METHODS: Between May 2010 and December 2013, a cluster randomized controlled trial was conducted among 4th graders in eight urban primary schools randomly assigned to intervention or control groups in Nanjing, China. A multi-component intervention program was implemented within the treatment group, while students in the control group followed their usual health education curriculum without additional intervention. RESULTS: At baseline, 638 and 544 students were enrolled in the intervention and control group, respectively. The prevalence of excess body weight was 26.8%, with 27.4% in the intervention group and 26.1% in the control group (p=0.61). The mean (SD) BMI and WC was 18.7 (3.0) and 63.0 (9.2) for participants in intervention schools, and 18.5 (2.9) and 63.6 (8.7) for students in control group, separately (p=0.24 and 0.41, respectively). Compared to those who were not aware of what lifestyle/behavior factors were unhealthy, students who were aware of the unhealthy lifestyle/ behavior factors consumed fewer fried snacks (0.46±0.76 serves/week vs 0.65±0.91 serves/week; p<0.01), soft drinks (160±194 ml/week vs 199±227 ml/week; p<0.01), but larger amount of meat (502±429 g/week vs 449±344 g/week; p=0.03), and reported less screen time (214±232 minutes/week vs 252±264 minutes/week; p<0.01). Moreover, there was no difference within physical activity time between these two groups (257±341 minutes/week vs 218±324 minutes/week; p=0.13). CONCLUSIONS: Main characteristics of participants were balanced at baseline within intervention and control schools, but a gap existed between healthy lifestyle knowledge and actual healthy behavior in students. TRIAL REGISTRATION NUMBER: ChiCTR-ERC-11001819.

Xu F, Ware RS, Tse LA, Wang Y, Wang Z, Hong X, Chan EYY, Dunstan DW, Owen N. 2014. Joint associations of physical activity and hypertension with the development of type 2 diabetes among urban men and women in Mainland China. PLoS One, 9 (2), pp. e88719. | Show Abstract | Read more

BACKGROUND: Physical activity (PA) and hypertension (HTN) are important influences on the development of type 2 diabetes (T2D). However, the joint impact of PA and HTN on T2D development is unknown. METHODS: Two community-based prospective cohort studies, with the same protocols, instruments and questionnaires, were conducted among adults in urban areas of Nanjing, China, during 2004-2007 and 2007-2010. T2D was defined using World Health Organization criteria based on physicians' diagnosis and fasting blood glucose concentration. PA level (sufficient/insufficient) and blood pressure status (hypertensive/normotensive) were assessed at baseline and the third year of follow-up. We pooled and analyzed data from these two studies. RESULTS: Among 4550 participants aged 35 years or older, the three-year cumulative incidence of T2D was 5.1%. After adjusting for potential confounders, participants with sufficient PA were less likely to develop T2D than those with insufficient PA (OR = 0.43, 95%CI = 0.27, 0.68) and those who were normotensive were less likely to develop T2D than those who were hypertensive (OR = 0.39, 95%CI = 0.29, 0.51). Compared to participants with insufficient PA and who were hypertensive, those with sufficient PA and hypertension were at lower risk of developing T2D (OR = 0.36, 95%CI = 0.19, 0.69), as were those with insufficient PA who were normotensive (OR = 0.37, 95%CI = 0.28, 0.50) and those with sufficient PA who were normotensive (OR = 0.19, 95%CI = 0.10, 0.37). CONCLUSIONS: Insufficient PA was found to be associated with the development of T2D among adults with and without hypertension. These findings support a role for promoting higher physical activity levels to lower T2D risk in both hypertensive and non-hypertensive individuals.

Chan EYY, Liu S, Hung KKC. 2013. Typhoon Haiyan and beyond. Lancet, 382 (9908), pp. 1873. | Read more

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Wang F, Yeung KL, Chan WC, Kwok CCH, Leung SL, Wu C, Chan EYY, Yu ITS, Yang XR, Tse LA. 2013. A meta-analysis on dose-response relationship between night shift work and the risk of breast cancer. Ann Oncol, 24 (11), pp. 2724-2732. | Show Abstract | Read more

This study aimed to conduct a systematic review to sum up evidence of the associations between different aspects of night shift work and female breast cancer using a dose-response meta-analysis approach. We systematicly searched all cohort and case-control studies published in English on MEDLINE, Embase, PSYCInfo, APC Journal Club and Global Health, from January 1971 to May 2013. We extracted effect measures (relative risk, RR; odd ratio, OR; or hazard ratio, HR) from individual studies to generate pooled results using meta-analysis approaches. A log-linear dose-response regression model was used to evaluate the relationship between various indicators of exposure to night shift work and breast cancer risk. Downs and Black scale was applied to assess the methodological quality of included studies. Ten studies were included in the meta-analysis. A pooled adjusted relative risk for the association between 'ever exposed to night shift work' and breast cancer was 1.19 [95% confidence interval (CI) 1.05-1.35]. Further meta-analyses on dose-response relationship showed that every 5-year increase of exposure to night shift work would correspondingly enhance the risk of breast cancer of the female by 3% (pooled RR = 1.03, 95% CI 1.01-1.05; Pheterogeneity < 0.001). Our meta-analysis also suggested that an increase in 500-night shifts would result in a 13% (RR = 1.13, 95% CI 1.07-1.21; Pheterogeneity = 0.06) increase in breast cancer risk. This systematic review updated the evidence that a positive dose-response relationship is likely to present for breast cancer with increasing years of employment and cumulative shifts involved in the work.

Goggins WB, Ren C, Ng E, Yang C, Chan EYY. 2013. Effect modification of the association between meteorological variables and mortality by urban climatic conditions in the tropical city of Kaohsiung, Taiwan. Geospat Health, 8 (1), pp. 37-44. | Show Abstract | Read more

A deeper understanding of extreme hot weather are needed in cities sensitive to heat effects, an investigation was done in the tropical town of Kaohsiung in Taiwan. Its 11 districts were divided into three climatic classes varying from high urban heat, low levels of green space and lack of proximity to water bodies to low urban heat, adequate green space and proximity to water bodies. Daily data on natural mortality, meteorological variables, and pollutants from May-October 1999-2008 were analysed using generalised additive models for the time-series data. Subgroup analyses were conducted, stratifying decedents according to the level of planning activity required in order to mitigate adverse heat effects in their residential areas, classifying districts as "level 1" for those requiring a high level of mitigation action; "level 2" for those requiring some action; and "level 3" for those that need only preserve existing conditions. Stratified analyses showed that mortality increases per 1 °C rise on average, either on the same day or in the previous 4 days (lags 0-4), were associated with 2.8%, 2.3% and -1.3% for level 1, 2 and 3 districts, respectively. The slope describing the association between temperature and mortality was higher above 29.0 °C resulting in corresponding increases of 4.2%, 5.0% and 0.3% per per 1 °C rise in temperature, respectively. Other meteorological variables were not significantly associated with mortality. It is concluded that hot season mortality in Kaohsiung is only sensitive to heat effects in districts classified as having unfavourably climatic conditions and requiring mitigation efforts in city planning. Urban planning measures designed to improve climatic conditions could reduce excess mortality resulting from extreme hot weather.

Barnett-Vanes A, Hung KKC, Maruthappu M, Shalhoub J, Chan EYY. 2013. Improving health in humanitarian crises: from reactive to proactive. Lancet, 382 (9893), pp. 679. | Read more

Chan EYY, Goggins WB, Yue JSK, Lee P. 2013. Hospital admissions as a function of temperature, other weather phenomena and pollution levels in an urban setting in China. Bull World Health Organ, 91 (8), pp. 576-584. | Show Abstract | Read more

OBJECTIVE: To explore the relationship between weather phenomena and pollution levels and daily hospital admissions (as an approximation to morbidity patterns) in Hong Kong Special Administrative Region (SAR), China, in 1998-2009. METHODS: Generalized additive models and lag models were constructed with data from official sources on hospital admissions and on mean daily temperature, mean daily wind speed, mean relative humidity, daily total global solar radiation, total daily rainfall and daily pollution levels. FINDINGS: During the hot season, admissions increased by 4.5% for every increase of 1 °C above 29 °C; during the cold season, admissions increased by 1.4% for every decrease of 1 °C within the 8.2-26.9 °C range. In subgroup analyses, admissions for respiratory and infectious diseases increased during extreme heat and cold, but cardiovascular disease admissions increased only during cold temperatures. For every increase of 1 °C above 29 °C, admissions for unintentional injuries increased by 1.9%. During the cold season, for every decrease of 1 °C within the 8.2-26.9 °C range, admissions for cardiovascular diseases and intentional injuries rose by 2.1% and 2.4%, respectively. Admission patterns were not sensitive to sex. Admissions for respiratory diseases rose during hot and cold temperatures among children but only during cold temperatures among the elderly. In people aged 75 years or older, admissions for infectious diseases rose during both temperature extremes. CONCLUSION: In Hong Kong SAR, hospitalizations rise during extreme temperatures. Public health interventions should be developed to protect children, the elderly and other vulnerable groups from excessive heat and cold.

Hung KKC, Lam ECC, Chan EYY, Graham CA. 2013. Disease pattern and chronic illness in rural China: the Hong Kong Red Cross basic health clinic after 2008 Sichuan earthquake. Emerg Med Australas, 25 (3), pp. 252-259. | Show Abstract | Read more

BACKGROUND: Medical teams might have difficulties preparing for deployment to rural towns due to a lack of prior information. The study objective was to identify the health needs and chronic disease prevalence of rural Chinese following a major earthquake. METHODS: Hong Kong Red Cross organised a basic healthcare team to Yanmen town, Jiangyou 3 weeks after the 2008 Sichuan earthquake. A cross-sectional records-based study of all patients treated by the Hong Kong Red Cross basic healthcare team from 1 June to 19 June 2008 was conducted. RESULTS: Two thousand and thirty-four individual patient encounters occurred during the 19-day period. Musculoskeletal, respiratory and gastrointestinal problems were the top three categories and accounted for 30.4%, 17.4% and 12.7%, respectively. The 43.4% of the 762 patients with blood pressure measurements were above the recognised criteria for hypertension. CONCLUSIONS: We identified that the management of chronic diseases was an important issue, especially with the high prevalence of hypertension found in our study. Medical responders need to be aware of the potential pre-existing disease burden in the community, with the possible exacerbation in post-disaster situations. Careful planning on the use of treatment guidelines with particular focus on the local health resources available and issues with continuation of care will provide better care for the patients.

Chan EYY. 2013. Bottom-up disaster resilience NATURE GEOSCIENCE, 6 (5), pp. 327-328. | Read more

Hung KKC, Cocks RA, Poon WK, Chan EYY, Rainer TH, Graham CA. 2013. Medical volunteers in commercial flight medical diversions. Aviat Space Environ Med, 84 (5), pp. 491-497. | Show Abstract | Read more

BACKGROUND: In-flight medical emergencies are difficult to manage and medical volunteers can be valuable when these events occur. The study objective was to examine the role of medical volunteers in medical emergencies which resulted in medical flight diversions. METHODS: This was a retrospective cohort study of medical diversions in a large Hong Kong commercial airline from December 2003 to November 2008. This study is derived from a database of in-flight medical events which has been previously reported. The presence of medical volunteers, the need for diversion, and the outcome for all in-flight medical events were recorded. The records of the medical diversion incidents were reviewed in detail and symptom-based categorization applied. RESULTS: Medical volunteers were available in 1439 (35.4%) of the 4068 medical events and in 39 (84.8%) of the 46 cases which required medical diversions. Suspected stroke cases, as categorized under the nonspecific category, was the most common, followed by chest pains and deaths. CONCLUSIONS: Medical volunteers presented more often for more serious events, and may be due to the airline medical incident policy and medical legal concerns for volunteers. This study identified measures which may reduce medical diversions, including cabin crew training for stroke screening, and promote the use of the Medical Information Form (MEDIF) and indemnity forms. Recommendations for medical diversion may require more specialized training than is currently given in undergraduate medical courses, and may benefit from better communication with ground-based medical advice services.

Hung KKC, Lam ECC, Wong MCS, Wong TW, Chan EYY, Graham CA. 2013. Emergency physicians' preparedness for CBRNE incidents in Hong Kong HONG KONG JOURNAL OF EMERGENCY MEDICINE, 20 (2), pp. 90-97. | Show Abstract | Read more

Background: Recent terrorist attacks with biological and chemical weapons have caused much concern for the public. The purpose of this study was to assess emergency doctors' preparedness in handling Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) incidents. Methods: This is a cross sectional survey of all emergency doctors working in public emergency departments (ED) in Hong Kong. Apart from the experience and confidence to handle these events, data on participants' willingness to participate in CBRNE incidents and training motivations were also analysed. Results: Biological and radiological events were found to be the least commonly encountered. Few respondents reported they were confident to manage biological events (10.6% to 29.8%), despite 66% of respondents reported having prior training in CBRNE management. Conclusions: This study demonstrates ED doctors' low confidence in managing specific CBRNE incidents. Current strengths identified include the good awareness of hospital emergency plans and high motivation to get more training.

Goggins WB, Chan EYY, Yang C, Chong M. 2013. Associations between mortality and meteorological and pollutant variables during the cool season in two Asian cities with sub-tropical climates: Hong Kong and Taipei. Environ Health, 12 (1), pp. 59. | Show Abstract | Read more

BACKGROUND: Numerous studies have found associations between extreme temperatures and human mortality but relatively few studies have been done in sub-tropical and tropical cities, especially in Asia. In this study we examine the impact of cold temperatures, cold waves and other meteorological and environmental variables on cool season mortality in 2 subtropical Asian cities. METHODS: Separate analysis of daily mortality time-series from Hong Kong and Taipei using Generalized Additive Models with natural mortality as the outcome daily mean temperature as the main explanatory variable and relative humidity, solar radiation, wind speed, pollutants (nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), respirable suspended particulates (PM(10)), ozone (O(3)), seasonality and day of the week controlled as potential confounders. Lags up to 35 days were considered for temperature, and distributed lag models were used to determine the number of lags for final models. Subgroup analyses were also done by gender, age group, cause of death and geographical area of residence. RESULTS: Cold temperatures were strongly associated with higher mortality with lagged effects persisting up to 3 weeks in Hong Kong and 2 weeks in Taipei. Cold effects were much stronger for deaths among older people and non-cancer deaths. Prolonged cold spells modestly but significantly raised mortality after accounting for the effects of individual cold days. Higher daily ozone levels were also strongly associated with higher short-term mortality in Taipei and Hong Kong, while relative humidity and solar radiation were weakly and inconsistently associated with mortality. CONCLUSIONS: Cold temperatures and cold spells substantially increase short-term mortality in sub-tropical Asian cities particularly among the elderly. Greater attention needs to be paid to the adverse health effects of cold temperatures. Interventions including provisions of shelters, cold weather warnings and education about the possible health effects of cold temperature should be carried out in sub-tropical areas.

Gao Y, Li L, Chan EYY, Lau J, Griffiths SM. 2013. Parental migration, self-efficacy and cigarette smoking among rural adolescents in south China. PLoS One, 8 (3), pp. e57569. | Show Abstract | Read more

OBJECTIVES: Millions of children and adolescents in rural China are left behind as their parents move away for work. Little is known about the impact of parental migration on their smoking and self-efficacy. This study explores the associations among parental migration, self-efficacy and smoking. METHODS: A cross-sectional study was conducted among middle school students in Liangying Township, Guangdong, China. Socio-demographic and parental migration characteristics, as well as adolescent past 30-day smoking and self-efficacy level were collected using a self-administered questionnaire. Univariate and multivariate analyses were performed to estimate the risk of parental migration features for smoking and self-efficacy. Hierarchical regression was fitted to examine the relationship among parental migration, self-efficacy and smoking. RESULTS: 2609 students (93.4%) participated into the study, 44% of who were with parents who had ever been or were currently migrating. Smoking prevalence was 9.7% in boys and 0.9% in girls. Paternal migration was protective for adolescent smoking, whilst maternal migration increased the risk. Both paternal and maternal migration had adverse effects on self-efficacy, a strong influencing factor for smoking. No significant relationship was found between other migration features and smoking and self-efficacy. The smoking risk of maternal migration was partly mediated by self-efficacy. There were no differences between boys and girls. CONCLUSIONS: Our findings suggest that adolescents whose mothers migrate from home to work elsewhere are at elevated risk for smoking. Improving self-efficacy may be an effective means to keep adolescents away from smoking, especially for those with maternal migration.

Gao Y, Chan EYY, Zhu Y, Wong TW. 2013. Adverse effect of outdoor air pollution on cardiorespiratory fitness in Chinese children Atmospheric Environment, 64 pp. 10-17. | Show Abstract | Read more

Little is known about the health impact of air pollution on children's cardiovascular health. A cross-sectional study was conducted and data was analysed in 2048 Chinese schoolchildren (aged 8-10 years) in three districts of Hong Kong to examine the association between exposure to outdoor air pollution and cardiorespiratory fitness. Annual means of ambient PM10, SO2, NO2and O3from 1996 to 2003 were used to estimate individual exposure of the subjects. Cardiorespiratory fitness was measured for maximal oxygen uptake (VO2max), predicted by the multistage fitness test (MFT). Height and weight were measured and other potential confounders were collected with questionnaires. Analysis of covariance was performed to estimate the impact of air pollution on complete speed in the MFT and predicted VO2max. The results showed that children in high-pollution district had significantly lower complete speed and predicted VO2maxcompared to those in low- and moderate-pollution districts. Complete speed and predicted VO2maxwas estimated to reduce 0.327 km h-1and 1.53 ml kg-1min-1per 10 μg m-3increase in PM10annual mean respectively, with those in girls being greater than in boys. Being physically active could not significantly result in improved cardiorespiratory fitness in polluted districts. The adverse effect seems to be independent of short-term exposure to air pollution. We concluded that long-term exposure to higher outdoor air pollution levels was negatively associated with cardiorespiratory fitness in Chinese schoolchildren, especially for girls. PM10is the most relevant pollutant of the adverse effect. Elevated cardiorespiratory fitness observed in physically activate children could be negated by increased amount of inhaled pollutants during exercise. © 2012 Elsevier Ltd.

Chan EYY, Kim JH, Lin C, Cheung EYL, Lee PPY. 2014. Is previous disaster experience a good predictor for disaster preparedness in extreme poverty households in remote Muslim minority based community in China? J Immigr Minor Health, 16 (3), pp. 466-472. | Show Abstract | Read more

Disaster preparedness is an important preventive strategy for protecting health and mitigating adverse health effects of unforeseen disasters. A multi-site based ethnic minority project (2009-2015) is set up to examine health and disaster preparedness related issues in remote, rural, disaster prone communities in China. The primary objective of this reported study is to examine if previous disaster experience significantly increases household disaster preparedness levels in remote villages in China. A cross-sectional, household survey was conducted in January 2011 in Gansu Province, in a predominately Hui minority-based village. Factors related to disaster preparedness were explored using quantitative methods. Two focus groups were also conducted to provide additional contextual explanations to the quantitative findings of this study. The village household response rate was 62.4 % (n = 133). Although previous disaster exposure was significantly associated with perception of living in a high disaster risk area (OR = 6.16), only 10.7 % households possessed a disaster emergency kit. Of note, for households with members who had non-communicable diseases, 9.6 % had prepared extra medications to sustain clinical management of their chronic conditions. This is the first study that examined disaster preparedness in an ethnic minority population in remote communities in rural China. Our results indicate the need of disaster mitigation education to promote preparedness in remote, resource-poor communities.

Yang G-J, Tanner M, Utzinger J, Malone JB, Bergquist R, Chan EYY, Gao Q, Zhou X-N. 2012. Malaria surveillance-response strategies in different transmission zones of the People's Republic of China: preparing for climate change. Malar J, 11 (1), pp. 426. | Show Abstract | Read more

BACKGROUND: A sound understanding of malaria transmission patterns in the People's Republic of China (P.R. China) is crucial for designing effective surveillance-response strategies that can guide the national malaria elimination programme (NMEP). Using an established biology-driven model, it is expected that one may design and refine appropriate surveillance-response strategies for different transmission zones, which, in turn, assist the NMEP in the ongoing implementation period (2010-2020) and, potentially, in the post-elimination stage (2020-2050). METHODS: Environmental data obtained from 676 locations across P.R. China, such as monthly temperature and yearly relative humidity (YRH), for the period 1961-2000 were prepared. Smoothed surface maps of the number of months suitable for parasite survival derived from monthly mean temperature and YRH were generated. For each decade, the final malaria prediction map was overlaid by two masked maps, one showing the number of months suitable for parasite survival and the other the length of YRH map in excess of 60%. RESULTS: Considering multiple environmental factors simultaneously, the environmental variables suitable for malaria transmission were found to have shifted northwards, which was especially pronounced in northern P.R. China. The unstable suitable regions (transmission periods between five and six months) showed increased transmission intensity due to prolonged suitable periods, especially in the central part of the country. CONCLUSION: Adequate and effective surveillance-response strategies for NMEP should be designed to achieve the goal of malaria elimination in P.R. China by 2020, especially in the zones predicted to be the most vulnerable for climate change.

Gao Y, Chan EYY, Li LP, He QQ, Wong TW. 2013. Chronic effects of ambient air pollution on lung function among Chinese children. Arch Dis Child, 98 (2), pp. 128-135. | Show Abstract | Read more

OBJECTIVES: To examine the association between long-term exposure to air pollution and lung function among Chinese schoolchildren in Southern China (Hong Kong). METHODS: We conducted a cross-sectional study among 3168 schoolchildren (aged 8-10 years) in 3 districts in Hong Kong. Annual means of ambient PM10 (particulate matter <10 µm), SO2, NO2 and O3 from 1996 to 2003 were used to estimate the individual exposure of the subjects. Children's lung function was measured for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow between 25% and 75% of FVC (FEF(25-75)) and forced expiratory flow at 75% of FVC (FEF75). Analysis of covariance was performed separately by gender to estimate the impact of air pollution on lung function, with adjustment for socioeconomic characteristics, respiratory morbidities, height and weight, physical activity level, indoor air contaminants and short-term exposure to the air pollutants. RESULTS: After controlling for potential confounding factors, FEV1, FEF(25-75) and FEF75 for boys in a high-pollution district (HPD) were significantly lower than those in a low-pollution district (LPD) by 3.0%, 7.6% and 8.4%, respectively. No significant differences were found for girls. Results from the comparison between a moderate-pollution district (MPD) and the HPD were similar. There were no differences between children in the LPD and MPD, except that a higher FEF75 was found in boys in the MPD. PM10 is the primary pollutant responsible for the lung function deficit. Asthmatic children were more vulnerable to exposure to air pollution. CONCLUSIONS: Long-term exposure to higher ambient air pollution levels was associated with lower lung function in Chinese schoolchildren, especially among boys. Adverse effects were observed on large and small airways, with a stronger effect on the latter.

Goggins WB, Chan EYY, Yang C-Y. 2013. Weather, pollution, and acute myocardial infarction in Hong Kong and Taiwan. Int J Cardiol, 168 (1), pp. 243-249. | Show Abstract | Read more

BACKGROUND: Several previous studies examined the association between acute myocardial infarction (AMI) incidence and temperature and/or air pollution. Results of these studies have been inconsistent and few studies have been done in cities with sub-tropical or tropical climates. METHODS: Daily data on AMI hospitalizations, mean temperature and humidity, and pollutants, were collected for 2000-2009 for three warm-climate Asian cities. Poisson Generalized Additive Models were used to regress daily AMI counts on temperature, humidity, and pollutants while controlling for day of the week, long-term trends and seasonal effects. Smoothing splines allowing non-linear associations were used for temperature and humidity while pollutants were modeled as linear terms. RESULTS: A 1°C drop below a threshold temperature of 24°C was significantly (p<.0001) associated with AMI hospitalization increases of 3.7% (average lag 0-13 temperature) in Hong Kong, 2.6% (average lag 0-15) in Taipei, and 4.0% (average lag 0-11) in Kaohsiung. No significant heat effects were observed. Among pollutants same day nitrogen dioxide (NO2) levels were the strongest predictors in all three cities, with a 10mg/m(3) increase in NO2 being associated with a 1.1% rise in AMI hospitalization in Hong Kong, and a 10 ppb rise being associated with 4.4% and 2.6% rises in Taipei and Kaohsiung, respectively. CONCLUSIONS: Cool temperatures and higher NO2 levels substantially raised AMI risk in these warm-climate cities and the effect sizes we observed were stronger than those found in previous studies. More attention should be paid to the health dangers of cold weather in warm-climate cities.

Goggins WB, Woo J, Ho S, Chan EYY, Chau PH. 2012. Weather, season, and daily stroke admissions in Hong Kong. Int J Biometeorol, 56 (5), pp. 865-872. | Show Abstract | Read more

Previous studies examining daily temperature and stroke incidence have given conflicting results. We undertook this retrospective study of all stroke admissions in those aged 35 years old and above to Hong Kong public hospitals from 1999 through 2006 in order to better understand the effects of meteorological conditions on stroke risk in a subtropical setting. We used Poisson Generalized Additive Models with daily hemorrhagic (HS) and ischemic stroke (IS) counts separately as outcomes, and daily mean temperature, humidity, solar radiation, rainfall, air pressure, pollutants, flu consultation rates, day of week, holidays, time trend and seasonality as predictors. Lagged effects of temperature, humidity and pollutants were also considered. A total of 23,457 HS and 107,505 IS admissions were analyzed. Mean daily temperature had a strong, consistent, negative linear association with HS admissions over the range (8.2-31.8°C) observed. A 1°C lower average temperature over the same day and previous 4 days (lags 0-4) being associated with a 2.7% (95% CI: 2.0-3.4%, P < .0.0001) higher admission rate after controlling for other variables. This association was stronger among older subjects and females. Higher lag 0-4 average change in air pressure from previous day was modestly associated with higher HS risk. The association between IS and temperature was weaker and apparent only below 22°C, with a 1°C lower average temperature (lags 0-13) below this threshold being associated with a 1.6% (95% CI:1.0-2.2%, P < 0.0001) higher IS admission rate. Pollutant levels were not associated with HS or IS. Future studies should examine HS and IS risk separately.

Chan EYY, Goggins WB, Kim JJ, Griffiths SM. 2012. A study of intracity variation of temperature-related mortality and socioeconomic status among the Chinese population in Hong Kong. J Epidemiol Community Health, 66 (4), pp. 322-327. | Show Abstract | Read more

BACKGROUND: Hong Kong, a major city in China, has one of the world's highest income inequalities and one of the world's highest average increases in urban ambient temperatures. Heat-related mortality in urban areas may vary with acclimatisation and population characteristics. This study examines how the effect of temperature on mortality is associated with sociodemographic characteristics at an intracity level in Hong Kong, China, during the warm season. METHODS: Data from the Hong Kong Observatory, Census and Statistics Department, Environmental Protection Department and government general outpatient clinics during 1998-2006 were used to construct generalised additive (Poisson) models to examine the temperature mortality relationship in Hong Kong. Adjusted for seasonality, long-term trends, pollutants and other potential confounders, effect modification of the warm season temperature-mortality association by demographic, socioeconomic factors and urban design were examined. RESULTS: An average 1°C increase in daily mean temperature above 28.2°C was associated with an estimated 1.8% increase in mortality. Heat-related mortality varied with sociodemographic characteristics: women, men less than 75 years old, people living in low socioeconomic districts, those with unknown residence and married people were more vulnerable. Non-cancer-related causes such as cardiovascular and respiratory infection-related deaths were more sensitive to high temperature effects. CONCLUSION: Public health protection strategies that target vulnerable population subgroups during periods of elevated temperature should be considered.

Cheung P, Hung WK, Cheung C, Chan A, Wong TT, Li L, Chan SWW, Chan KW, Choi P, Kwan WH et al. 2012. Early data from the first population-wide breast cancer-specific registry in Hong Kong. World J Surg, 36 (4), pp. 723-729. | Show Abstract | Read more

BACKGROUND: Current measures for breast cancer prevention and options for treatment adopted in Hong Kong are mainly based on research data and clinical evidence from overseas. It is essential to establish a cancer-specific registry to monitor the status of breast cancer in Hong Kong. OBJECTIVES: We summarized the current status of breast cancer in Hong Kong based on the data collected from Hong Kong Breast Cancer Registry (HKBCR). METHODS: Prevalent and newly diagnosed breast cancers (including in situ and invasive breast cancers) were registered in the HKBCR. Information on patient demographics, risk factors, medical information, and survival were analyzed and reported in this study. RESULTS: Data of 2,330 breast cancer patients were analyzed. We observed an earlier median age at diagnosis in Hong Kong than those reported in other countries. Distribution of cancer stage was: stage 0 (11.4%), stage I (31.4%), stage II (41%), stage III (12.5%), stage IV (0.8%), and unclassified (2.9%). The percentages of patients who received surgery, chemotherapy, radiation therapy, and endocrine therapy were 98.7, 67.9, 64.8, and 64.1%, respectively. At a median follow-up of 1.2 years, locoregional recurrence was recorded at 2%, distant recurrence at 2.8%, and breast-cancer-related mortality at 0.3%. CONCLUSIONS: The HKBCR serves as a surveillance program to monitor disease and treatment patterns. It is pivotal to support research for more effective breast cancer prevention and treatment strategies in Hong Kong.

Goggins WB, Chan EYY, Ng E, Ren C, Chen L. 2012. Effect modification of the association between short-term meteorological factors and mortality by urban heat islands in Hong Kong. PLoS One, 7 (6), pp. e38551. | Show Abstract | Read more

BACKGROUND: Prior studies from around the world have indicated that very high temperatures tend to increase summertime mortality. However possible effect modification by urban micro heat islands has only been examined by a few studies in North America and Europe. This study examined whether daily mortality in micro heat island areas of Hong Kong was more sensitive to short term changes in meteorological conditions than in other areas. METHOD: An urban heat island index (UHII) was calculated for each of Hong Kong's 248 geographical tertiary planning units (TPU). Daily counts of all natural deaths among Hong Kong residents were stratified according to whether the place of residence of the decedent was in a TPU with high (above the median) or low UHII. Poisson Generalized Additive Models (GAMs) were used to estimate the association between meteorological variables and mortality while adjusting for trend, seasonality, pollutants and flu epidemics. Analyses were restricted to the hot season (June-September). RESULTS: Mean temperatures (lags 0-4) above 29 °C and low mean wind speeds (lags 0-4) were significantly associated with higher daily mortality and these associations were stronger in areas with high UHII. A 1 °C rise above 29 °C was associated with a 4.1% (95% confidence interval (CI): 0.7%, 7.6%) increase in natural mortality in areas with high UHII but only a 0.7% (95% CI: -2.4%, 3.9%) increase in low UHII areas. Lower mean wind speeds (5(th) percentile vs. 95(th) percentile) were associated with a 5.7% (95% CI: 2.7, 8.9) mortality increase in high UHII areas vs. a -0.3% (95% CI: -3.2%, 2.6%) change in low UHII areas. CONCLUSION: The results suggest that urban micro heat islands exacerbate the negative health consequences of high temperatures and low wind speeds. Urban planning measures designed to mitigate heat island effects may lessen the health effects of unfavorable summertime meteorological conditions.

Gupta S, Carmichael C, Simpson C, Clarke MJ, Allen C, Gao Y, Chan EYY, Murray V. 2012. Electric fans for reducing adverse health impacts in heatwaves. Cochrane Database Syst Rev, 2017 (7), pp. CD009888. | Show Abstract | Read more

BACKGROUND: Heatwaves are hot weather events, which breach regional or national thresholds, that last for several days. They are likely to occur with increasing frequency in some parts of the world. The potential consequences were illustrated in Europe in August 2003 when there were an estimated 30,000 excess deaths due to a heatwave. Electric fans might be used with the intention of reducing the adverse health effects of a heatwave. Fans do not cool the ambient air but can be used to draw in cooler air from outside when placed at an open window. The aim of the fans would be to increase heat loss by increasing the efficiency of all normal methods of heat loss, but particularly by evaporation and convection methods. However, it should be noted that increased sweating can lead to dehydration and electrolyte imbalances if these fluids and electrolytes are not replaced quickly enough. Research has also identified important gaps in knowledge about the use of fans, which might lead to their inappropriate use. OBJECTIVES: To determine whether the use of electric fans contributes to, or impedes, heat loss at high ambient temperatures during a heatwave, and to contribute to the evidence base for the public health impacts of heatwaves. SEARCH METHODS: We sought unpublished and published studies that had been published in any language. The review team were able to assess studies reported in English, Chinese, Dutch, French and German; and reports in other languages would have been translated into English as necessary. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, the Indian biomedical literature (IndMED and MedIND) and databases of Chinese literature (Chinese Journal Net and Digital Periodical of WanFang Data). The most recent electronic searches were done in April 2012. We also checked the reference lists of relevant articles and the websites of relevant national and international organisations, and consulted with researchers and policy makers with experience in strategies to manage heatwaves to identify additional studies. The titles and abstracts from each search were checked independently by two review authors. The full text articles that we retrieved were checked independently by at least two authors for their relevance and for references to potentially eligible studies. SELECTION CRITERIA: Randomised trials and other experimental designs, such as interrupted time series and controlled before-and-after studies, comparing the use of electric fans with no fans during a heatwave were eligible for this review. The electric fans could be hand-held (battery operated), portable or mounted on the wall or ceiling, or in a window. We sought interventions delivered to anyone for whom a heatwave was likely to have serious adverse health impacts. This would include people of all ages but with a particular focus on some groups (for example older people). Populations from high-, middle- and low-income countries were eligible for the review. DATA COLLECTION AND ANALYSIS: If we had identified eligible studies, they would have been assessed independently by at least two review authors and data would have been extracted on the characteristics of the study, its participants and interventions, as well as the effects on health outcomes. The primary outcomes were mortality, hospital admission and other contacts with healthcare services. MAIN RESULTS: We did not identify any eligible studies despite the extensive searching and correspondence with several experts in this topic area. We identified retrospective, observational studies, usually with a case-control design, that investigated the association between the use of electric fans and health outcomes, including death. The results of these studies were mixed. Some studies found that the use of fans was associated with better health outcomes, others found the reverse. AUTHORS' CONCLUSIONS: The evidence we identified does not resolve uncertainties about the health effects of electric fans during heatwaves. Therefore, this review does not support or refute the use of electric fans during a heatwave. People making decisions about electric fans should consider the current state of the evidence base, and they might also wish to make themselves aware of local policy or guidelines when making a choice about whether or not to use or supply electric fans. The main implication of this review is that high quality research is needed to resolve the long standing and ongoing uncertainty about the benefits and harms of using electric fans during a heatwave, for example randomised trials comparing the health effects in people with electric fans to those in people without them.

Chan EYY, Hung KKC, Yue C. 2011. An epidemiological study of technological disasters in China: 1979-2005. Eur J Emerg Med, 18 (4), pp. 234-237. | Show Abstract | Read more

Although China has been known for its high frequency and human toll resulting from natural disasters, limited information is available to understand the human impact of its technological disasters (TD). This study provides a time trend analysis of the TD-induced injuries and fatalities since 1979 in mainland China. Through reviewing available academic literature and the examination of two public accessible databases, descriptive analysis of TD epidemiological profile in China was conducted by Emergency Events Database of the Centre for Research on the Epidemiology of Disasters in Brussels and Energy-related Severe Accidents Database of Paul Scherrer Institute in Switzerland which focuses on energy-related severe accidents. Implications on health protection policy and global health were discussed.

Chan EYY, Goggins WB, Kim JJ, Griffiths S, Ma TKW. 2011. Help-seeking behavior during elevated temperature in Chinese population. J Urban Health, 88 (4), pp. 637-650. | Show Abstract | Read more

The negative impact of extreme temperatures on health is well-established. Individual help-seeking behavior, however, may mitigate the extent of morbidity and mortality during elevated temperatures. This study examines individual help-seeking behavior during periods of elevated temperatures among a Chinese population. Help-seeking patterns and factors that influence behavior will be identified so that vulnerable subgroups may be targeted for health protection during heat crises. A retrospective time-series Poisson generalized additive model analysis, using meteorological data of Hong Kong Observatory and routine emergency help call data from The Hong Kong Senior Citizen Home Safety Association during warm seasons (June-September) 1998-2007, was conducted. A "U"-shaped association was found between daily emergency calls and daily temperature. About 49% of calls were for explicit health-related reasons including dizziness, shortness of breath, and general pain. The associate with maximum temperature was statistically significant (p = 0.034) with the threshold temperature at which the frequency of health-related calls started to increase being around 30-32°C. Mean daily relative humidity (RH) also had a significant U-shaped association with daily emergency health-related calls with call frequency beginning to increase with RH greater than 70-74% (10-25% of the RH distribution). Call frequency among females appeared to be more sensitive to high temperatures, with a threshold between 28.5°C and 30.5°C while calls among males were more sensitive to cold temperatures (threshold 31.5-33.5°C). Results indicate differences in community help-seeking behavior at elevated temperatures. Potential programs or community outreach services might be developed to protect vulnerable subgroups from the adverse impact of elevated temperatures.

Chan EYY, Kim J. 2011. Chronic health needs immediately after natural disasters in middle-income countries: the case of the 2008 Sichuan, China earthquake. Eur J Emerg Med, 18 (2), pp. 111-114. | Show Abstract | Read more

Few studies have focused on chronic health needs immediately after natural disasters in middle-income countries. This study examines chronic medical needs during the acute phase after the 2008 Sichuan earthquake. A descriptive, cross-sectional study was conducted in an emergency triage clinic in Sichuan, China. Information on physical, social, and public health preparedness was collected in predesigned templates. Descriptive and Pearson's χ association analyses were conducted. One hundred and eighty-two evacuees were received at the triage site. Of these, 54% required trauma treatment and 77% of evacuated patients who required care had underlying chronic medical conditions. Tetanus immunizations and the possession of chronic health medication were low, particularly among older patients. Chronic health needs constituted a significant proportion of emergency care during the acute phase in the study population. Effective post-disaster assistance requires attention to demographic and epidemiological population profiles.

Chan E, Griffiths S. 2010. The implication of water on public health: the case of China. Perspect Public Health, 130 (5), pp. 209-210. | Read more

Chan EYY, Griffiths SM. 2010. The epidemiology of mine accidents in China. Lancet, 376 (9741), pp. 575-577. | Read more

Hung KKC, Chan EYY, Cocks RA, Ong RM, Rainer TH, Graham CA. 2010. Predictors of flight diversions and deaths for in-flight medical emergencies in commercial aviation. Arch Intern Med, 170 (15), pp. 1401-1402. | Read more

Yu X-N, Lau JTF, Zhang J, Mak WWS, Choi KC, Lui WWS, Zhang J, Chan EYY. 2010. Posttraumatic growth and reduced suicidal ideation among adolescents at month 1 after the Sichuan Earthquake. J Affect Disord, 123 (1-3), pp. 327-331. | Show Abstract | Read more

BACKGROUND: This study investigated posttraumatic growth (PTG) and reduced suicidal ideation among Chinese adolescents at one month after the occurrence of the Sichuan Earthquake. METHODS: A cross-sectional survey was administered to 3324 high school students in Chengdu, Sichuan. The revised Posttraumatic Growth Inventory for Children and the Children's Revised Impact of Event Scale assessed PTG and posttraumatic stress disorder (PTSD), respectively. RESULTS: Multivariate analysis showed that being in junior high grade 2, having probable PTSD, visiting affected areas, possessing a perceived sense of security from teachers, and being exposed to touching news reports and encouraging news reports were associated with probable PTG; the reverse was true for students in senior high grade 1 or senior high grade 2 who had experienced prior adversities. Among the 623 students (19.3% of all students) who had suicidal ideation prior to the earthquake, 57.4% self-reported reduced suicidal ideation when the pre-earthquake and post-earthquake situations were compared. Among these 623 students, the multivariate results showed that being females, perceived sense of security obtained from teachers and exposure to encouraging news reports were factors associated with reduced suicidal ideation; the reverse was true for experience of pre-earthquake corporal punishment and worry about severe earthquakes in the future. LIMITATIONS: The study population was not directly hit by the earthquake. This study is cross-sectional and no baseline data were collected prior to the occurrence of the earthquake. CONCLUSIONS: The earthquake resulted in PTG and reduced suicidal ideation among adolescents. PTSD was associated with PTG. Special attention should be paid to teachers' support, contents of media reports, and students' experience of prior adversities.

Chan EYY, Kim JJ. 2010. Characteristics and health outcomes of internally displaced population in unofficial rural self-settled camps after the 2005 Kashmir, Pakistan earthquake. Eur J Emerg Med, 17 (3), pp. 136-141. | Show Abstract | Read more

OBJECTIVES: No published study, to date, has examined the characteristics and health outcomes of natural disaster-affected populations in unofficial rural self-settled internally displaced camps. By examining resident profiles in various unofficial rural displaced settlements after the 2005 Kashmir, Pakistan earthquake, this study aims to (i) describe the demographic and epidemiological characteristics of residents, (ii) compare their health outcomes with those of residents in official displaced camps, and (iii) highlight health needs and discuss implications for future disaster health relief operations. METHODS: A cross-sectional, cluster-sampling, face-to-face household survey was conducted in 167 households in various forms of internally displaced camps within a 185 km radius around Muzafarabad city 4 months after the 2005 Kashmir, Pakistan earthquake. Demographic characteristics, earthquake damage, and self-reported health outcomes were collected from these camps, and descriptive statistics were determined and chi significance comparison conducted. RESULTS: Significant differences in demographic characteristics and health outcomes were found according to the size of the unofficial internally displaced camps. Although residents of larger unofficial self-settled camps seemed to have similar characteristics and health outcomes to residents of official camps, those living in smaller unofficial camps had the largest average family size; received the least assistance and resources to sustain livelihood; had less access to information, medical service, and chronic disease medication for underlying medical problems; and worse self-reported health outcomes. CONCLUSION: The study results indicate that future post-earthquake medical relief operations should evaluate health needs and consider delivery of direct medical assistance to small unofficial self-settled camps in affected rural communities.

Chan EYY, Kim JJ. 2010. Remote mobile health service utilization post 2005 Kashmir-Pakistan earthquake. Eur J Emerg Med, 17 (3), pp. 158-163. | Show Abstract | Read more

AIMS: Limited published studies have examined patient characteristics and disease patterns served by mobile clinics in remote areas post natural disaster. By comparing users of a remote mountainous stationary clinic and a mobile helicopter outreach clinic in Neelam Valley, 4 months post Pakistan-Kashmir earthquake, this study aims to: (i) compare the demographic and disease profile of health service users, (ii) examine how acute and chronic disease patterns vary with clinical settings, and (iii) discuss the potential implications to mobile emergency clinical service planning acute phase of natural disaster in remote areas. METHODS: Cross-sectional, retrospective record-based study in two remote clinical settings in Neelam Valley, Kashmir-Pakistan. Patients who presented to clinics from 21 January to 20 February, and whose diagnoses were available, were included in the study. Descriptive statistics and chi significance tests were conducted. RESULTS: Different users and disease profiles were found between mobile and stationary clinics. While older age, female sex, living further way from clinics, earthquake-related trauma, wound and gastrointestinal infections were found to be more significantly associated with mobile clinic users, stationary clinics patients tended to be younger, living closer to the clinic site, and disease profiles were predominantly chronic in nature. CONCLUSION: In addition to the provision of acute and chronic medical clinical service, mobile clinics operating during post acute emergency phase of natural disaster in remote areas should be sex sensitive, with highly trained and experienced staff as well as the capacity to provide trauma care.

Lau JTF, Yu X, Zhang J, Mak WWS, Choi KC, Lui WWS, Zhang J, Chan EYY. 2010. Psychological distress among adolescents in Chengdu, Sichuan at 1 month after the 2008 Sichuan earthquake. J Urban Health, 87 (3), pp. 504-523. | Show Abstract | Read more

A devastating earthquake occurred on May 12, 2008 in Sichuan, China. This study investigated the prevalence and factors in association with psychological problems among secondary school students living in Chengdu (90 km away from the disaster epicenter) in June 2008. In a cross-sectional survey, 3,324 secondary students self-administered a structured questionnaire in classroom setting. Validated scales were used in this study. Among all respondents, 22.3% reported post-traumatic stress disorder (PTSD); 22.6% were probable depression cases; 10.6% reported suicidal ideation; and 14.1% would like to receive psychological counseling. No gender differences were found. While social/emotional support from teachers or peers (OR from 0.40 to 0.78) and exposure to positive news reports (OR from 0.59 to 0.62) were found protective, prior experience of severe mental distress (OR from 1.60 to 2.68) and corporal punishment (OR from 1.31 to 1.58), worry about future aftershocks (OR from 1.64 to 3.11), absence from school when it was not closed (OR from 1.38 to 1.48), exposures to scary or sorrowful disaster media coverage (OR from 1.39 to 2.07), post-disaster visits to affected sites (OR from 1.51 to 1.59), separation from parents (OR = 1.61), etc., were risk factors predictive of some of the aforementioned psychological problems. Negative mental health impacts were prevalent among the respondents. Teachers, parents, and the mass media are all important in maintaining good mental health among adolescents that are indirectly affected by the severe earthquake. The results have important implications for earthquake preparedness and relief work in the future.

Chan EYY, Gao Y, Griffiths SM. 2010. Literature review of health impact post-earthquakes in China 1906-2007. J Public Health (Oxf), 32 (1), pp. 52-61. | Show Abstract | Read more

BACKGROUND: Over the last 100 years, China has experienced the world's three most fatal earthquakes. The Sichuan Earthquake in May 2008 once again reminded us of the huge human toll geological disaster can lead to. METHODS: In order to learn lessons about the impact of earthquakes on health in China during the past century, we conducted a bilingual literature search of the publicly available health-related disaster databases published between 1906 and 2007. RESULTS: Our search found that research was limited and there were major gaps in the published literature about the impact on health in the post-earthquake period. However, the experiences recorded were similar to those of other parts of the world. The available studies provide useful information about preparedness and rapid early response. Gaps identified included care of chronic disease. CONCLUSION: Our literature review highlights the paucity of literature on the impact on health post-earthquake in China between 1906 and 2007. Disaster mitigation policies need to reflect the needs not only of the disaster-related impacts on health but also of the ongoing health needs of the chronically ill and to establish safeguards for the well-being of the vulnerable populations.

Chan EYY, Kim JH, Griffiths SM, Lau JTF, Yu I. 2009. Does living density matter for nonfatal unintentional home injury in Asian urban settings? Evidence from Hong Kong. J Urban Health, 86 (6), pp. 872-886. | Show Abstract | Read more

Injury is a major global disease burden for the twenty-first century. There are, however, few studies of unintentional household injury in Asian urban settings where living environments are characterized by extremely compact, high-living-density, multistory apartments. This study investigated the association between nonfatal unintentional household injuries with the resident's sociodemographic attributes and household characteristics in Hong Kong, the city with the world's highest population density. A cross-sectional retrospective recall study was conducted in May 2007 using a random telephone survey with a modified Chinese version of the World Health Organization Injury and Violence instrument. The study sample included 1,001 noninstitutionalized Cantonese-speaking Hong Kong residents of all ages, including foreign live-in domestic helpers. Multivariate regression was conducted to identify risk factors for nonfatal unintentional injuries in Hong Kong. Among a predominantly adult sample, household size and time spent at home were not associated with nonfatal unintentional household injuries in the general population in Hong Kong. The multivariate analyses indicated that female gender, owners of private homes, lower square footage of living space per person, and those with slip prevention devices in the bathroom were significantly associated with household injuries. Injured and noninjured groups were found to have adopted different injury prevention strategies toward household injuries. The results identified potential target groups for household injury prevention programs.

Chan EYY, Griffiths S. 2009. Comparision of health needs of older people between affected rural and urban areas after the 2005 Kashmir, Pakistan earthquake. Prehosp Disaster Med, 24 (5), pp. 365-371. | Show Abstract | Read more

INTRODUCTION: On 08 October 2005, an earthquake measuring 7.6 on the Richter scale, struck Pakistan's autonomous state of Kashmir and part of Indian-administrated Kashmir.The official death toll in Pakistan was 79,000, and nearly 1,400 in Kashmir. This study reports the findings of a three-week health needs assessment to understand the needs of rural, older people postearthquake. This study was conducted in February 2006 in the Neelum Valley of Kashmir, Pakistan, four months after the earthquake. HYPOTHESIS: During emergency relief, the vulnerability and health needs of older people in rural settings are different than are those in of urban areas. METHODS: A comparative, descriptive study was performed using health information to compare the differences between rural and urban health needs and the utilization of services of older people after the earthquake. Semi-structured interviews were conducted to collect information regarding demographic background, medical and drug history, self-reported health status, healthcare access and utilization, and social/financial concerns. Clinical records were reviewed and physical indicators for older patients also were collected on-site. RESULTS: The health profile, access to health care, service availability, and prevalence of non-communicable diseases differ between urban and rural settings. The greatest gap in health services at all sites was that non-communicable disease management was inadequate during non-acute, post-earthquake medical care. Health service utilization varied by gender, as in conservative rural areas, older, traditional women were less likely to receive medical services while older men were less likely to access psychological services in all sites. CONCLUSIONS: This is the first study to compare the post-earthquake healthcare needs of older people in urban and rural settings. Findings highlight specific health needs and issues related to long-term, chronic disease management. Given the global pattern of aging of the population, it is important to strengthen the capacity to respond appropriately to medical disasters, which includes preparedness for treating the health needs of older people.

Chan EYY. 2009. Why are older peoples' health needs forgotten post-natural disaster relief in developing countries? A healthcare provider survey of 2005 Kashmir, Pakistan earthquake. Am J Disaster Med, 4 (2), pp. 107-112. | Show Abstract

Although older people may be recognized as a vulnerable group post-natural disasters, their particular needs are rarely met by the providers of emergency services. Studies about older people's health needs post disasters in the South East Asia Tsunami, Kashmir, Pakistan, China, and United States has revealed the lack of concern for older people's health needs. Recent study of older people's health needs post the Kashmir Pakistan earthquake (2005) found older peoples' health needs were masked within the general population. This survey study examines the providers' perceptions of older people's vulnerabilities post-2005 Pakistan earthquake. It aims to understand the awareness of geriatric issues and issues related to current service provision/planning for older people's health needs post disasters. Specifically, service delivery patterns will be compared among different relief agencies. Cross-sectional, structured stakeholder interviews were conducted within a 2 weeks period in February 2006, 4 months post-earthquake in Pakistan-administrated Kashmir. Health/medical relief agencies of three different types of organizational nature: international nongovernmental organization (INGO), national organization, and local/community group were solicited to participate in the study. Descriptive analysis was conducted. Important issues identified include the need to sensitize relief and health workers about older people's health needs post disaster the development of relevant clinical guidelines for chronic disease management postdisaster in developing countries and the advocacy of building in geriatric related components in natural disaster medical relief programs. To effectively address the vulnerability of older people, it is important for governments, relief agencies, and local partners to include and address these issues during their relief operations and policy planning.

Gao Y, Griffiths S, Chan EYY. 2008. Community-based interventions to reduce overweight and obesity in China: a systematic review of the Chinese and English literature. J Public Health (Oxf), 30 (4), pp. 436-448. | Show Abstract | Read more

BACKGROUND: Overweight and obesity pose a challenge to public health in China. According to Chinese definition, 303 million Chinese are overweight (body mass index, BMI >or= 24 kg m(-2)). Among them, 73 million are clinically obese (BMI >or= 28 kg m(-2)). In line with the global trend, the rate of obesity in China continues to increase, with associated morbidity and mortality. This study was to identify interventions, which are effective in Mainland Chinese society. METHODS: All non-drug-controlled interventions (>or=3 months) in Mainland China, which used anthropometric outcome measures, were selected from three Chinese and nine international electronic databases (before May 2006) and included in this systematic review. RESULTS: A total of 20 studies met the selection criteria and were included in the review. Among them only one was published in an international journal. Most studies combined at least physical activity, dietary intervention and health education. Seventeen studies (85%) reported significant effects in anthropometric measurement outcomes. CONCLUSIONS: Comprehensive interventions with at least physical activity, dietary intervention and health education may be effective in reducing obesity in Chinese children. The role of grandparents as carers in the one-child society is worth considering further. Current evidence of effective interventions for adults is limited. Publication bias in Chinese databases should be taken into account.

Chan EYY, Griffiths SM, Chan CW. 2008. Public-health risks of melamine in milk products. Lancet, 372 (9648), pp. 1444-1445. | Read more

Chan EYY, Kim JH, Ng Q, Griffiths S, Lau JTF. 2008. A descriptive study of nonfatal, unintentional home-based injury in urban settings: evidence from Hong Kong. Asia Pac J Public Health, 20 Suppl pp. 39-48. | Show Abstract

This study investigates the epidemiological characteristics of non-fatal unintentional household injuries in Hong Kong, the city with the world's highest population density. A population-based, cross-sectional, random telephone survey was conducted with a modified Chinese WHO injury and violence survey questionnarie in May 2007. Descriptive and univariate analysis was conducted to highlight the associated factors. The prevalence of all non-fatal unintentional home injuries in the preceding year was 40.2%. Contusion/crushing injuries, open wounds and burn-related scalds were the most commonly reported home injury and the extremities were the commonest injured body parts. Female gender, younger age and residence in private housing residence were significantly associated with higher likelihood of injuries and most injuries had incurred medical expenses. This is the first study to reported systemtically about the patterns of non-fatal unintentional household injuries in Hong Kong. Future interventions should be targeted to these high risk groups identified in this study.

Chan EYY. 2008. The untold stories of the Sichuan earthquake. Lancet, 372 (9636), pp. 359-362. | Read more

Chan EYY, Griffiths S, Gao Y, Chan CW, Fok TF. 2008. Addressing disparities in children's health in China. Arch Dis Child, 93 (4), pp. 346-352. | Read more

Chan EYL, Woo KWS, Tang TMY. 2008. Occupational rehabilitation services provided by a community workers health centre in Hong Kong: a case study. Work, 30 (1), pp. 5-9. | Show Abstract

BACKGROUND: In Hong Kong, the Employees' Compensation Ordinance (ECO), based on the model of the English Workmen's Compensation Act 1943, establishes a no-fault, non-contributory system for work injuries. It focuses merely on the minimum social expectation in compensating injured workers in monetary terms, but does not place much emphasis on prevention, rehabilitation and return to work policies for workers with injury. There is a need to reform an effective and comprehensive occupational rehabilitation system for workers with work injury in Hong Kong. METHODS: This paper presents a case study of a worker with work injury undergoing occupational rehabilitation through services provided in the local community setting by the Hong Kong Workers' Health Centre. RESULTS: The case study highlights some crucial factors and/or intervention modalities in facilitating workers' return to work, including timely intervention, work-site based rehabilitation, communication among different stakeholders, dynamics of company, rehabilitation counselling, community integration and individualized work resettlement. CONCLUSION: Without reviewing and revamping the current ECO, the goal to provide timely and effective occupational rehabilitation services for workers with injury could not be fully achieved.

Tian L, Bi Y, Ho SC, Liu W, Liang S, Goggins WB, Chan EYY, Zhou S, Sung JJY. 2008. One-year delayed effect of fog on malaria transmission: a time-series analysis in the rain forest area of Mengla County, south-west China. Malar J, 7 (1), pp. 110. | Show Abstract | Read more

BACKGROUND: Malaria is a major public health burden in the tropics with the potential to significantly increase in response to climate change. Analyses of data from the recent past can elucidate how short-term variations in weather factors affect malaria transmission. This study explored the impact of climate variability on the transmission of malaria in the tropical rain forest area of Mengla County, south-west China. METHODS: Ecological time-series analysis was performed on data collected between 1971 and 1999. Auto-regressive integrated moving average (ARIMA) models were used to evaluate the relationship between weather factors and malaria incidence. RESULTS: At the time scale of months, the predictors for malaria incidence included: minimum temperature, maximum temperature, and fog day frequency. The effect of minimum temperature on malaria incidence was greater in the cool months than in the hot months. The fog day frequency in October had a positive effect on malaria incidence in May of the following year. At the time scale of years, the annual fog day frequency was the only weather predictor of the annual incidence of malaria. CONCLUSION: Fog day frequency was for the first time found to be a predictor of malaria incidence in a rain forest area. The one-year delayed effect of fog on malaria transmission may involve providing water input and maintaining aquatic breeding sites for mosquitoes in vulnerable times when there is little rainfall in the 6-month dry seasons. These findings should be considered in the prediction of future patterns of malaria for similar tropical rain forest areas worldwide.

Wong WCW, Holroyd E, Chan EY, Griffiths S, Bingham A. 2008. "One country, two systems": Sociopolitical implications for female migrant sex workers in Hong Kong. BMC Int Health Hum Rights, 8 (1), pp. 13. | Show Abstract | Read more

BACKGROUND: Under the "two countries, one system" policy implemented by China to manage the return of Hong Kong's sovereignty, Hong Kong has maintained a comparatively prosperous economy within the Asian region. This has resulted in an environment which fosters migration from the mainland to Hong Kong, due largely to proximity, higher earning potential, common language, and a relaxing of border control measures. However not all mainland China citizens are equally able to access these new migration schemes and indeed a number of women such as sex workers are either migrating and/or working illegally and without occupational, legal and health protection within Hong Kong. DISCUSSION: Female migrant sex workers are exposed to a number of significant threats to their health, however their illegal status contributes to even greater vulnerability. The prevailing discourses which view these women as either "trafficked women" or as "illegal immigrants" do not adequately account for the complex situations which result in such women's employment in Hong Kong's sex industry. Rather, their position can best be understood within the broader frameworks provided by migration literature and the concept of "structural violence". This allows for a greater understanding of the socio-political issues which are systematically denying migrant sex workers adequate access to health care and other opportunities for social advancement. When these issues are taken into account, it becomes clear that the current relevant legislation regarding both immigration and sex work is perpetuating the marginalised and vulnerable status of migrant sex workers. Unless changes are made, structural barriers will remain in place which impede the ability of migrant sex workers to manage their own health needs and status. CONCLUSION: Female migrant sex workers in Hong Kong are extremely vulnerable to a number of occupational health and safety hazards which have significantly detrimental effects on their health. These risks can best be understood within a broad framework of socio-political factors contributing to their vulnerability. Ensuring that migrant sex workers have adequate support for their health and legal rights requires require structural interventions such as decriminalisation and providing open and inclusive access to health service to counteract such factors.

Chan EYY. 2008. Doctors in natural disaster relief setting Hong Kong Practitioner, 30 (3), pp. 152-153.

Chan EYY, Sondorp E. 2007. Medical interventions following natural disasters: missing out on chronic medical needs. Asia Pac J Public Health, 19 Spec No (2), pp. 45-51. | Show Abstract | Read more

Although natural disasters may cause massive loss of human life and destruction of resources, they also present affected populations with a rare opportunity to access external resources. Nevertheless, many post-disaster medical relief intervention programmes only focus on the provision of acute medical services and the control of communicable diseases. Currently, no specific study has examined why chronic medical needs seem to be insufficiently addressed in disaster relief interventions. This paper review current knowledge about how natural disasters affect people with chronic medical needs, assess possible factors in disaster preparedness and response that pre-empt addressing chronic medical needs and suggest possible ways to overcome these barriers. Unawareness and insensitivity of relief workers towards chronic medical conditions, the practice of risk rather than need-based assessments, a focus on acute needs, the lack of reliable indicators and baseline information, and the multidimensional characteristics of chronic medical problems all pose serious challenges and probably deter the government and post-disaster relief agencies to deal with diseases of a chronic nature. It is important to increase the awareness and sensitivity of the stakeholders towards chronic medical problems during all phases of planning and intervention. Relevant assessment tools should be developed to rapidly identify chronic medical needs in resource deficit settings. Community partnership and collaboration that promote local ownership and technical transfer of chronic disease management skills will be essential for the sustainability of services beyond the disaster relief period. Potential programmes might include the technical training of local staff, establishment of essential drug and supply lists, and the provision of a range of medical services that may address chronic health needs.

Chan EYT, Ng DKK, Chan CH, Chow PY, Kwok KL, Lau WF. 2007. Chronic cough in children: A retrospective review Hong Kong Journal of Paediatrics, 12 (1), | Show Abstract

Cough is a common complaint in children. However, data on aetiologies and outcome of chronic cough are sparse in Hong Kong Chinese children. Methods: Records of children referred to the out-patient clinic for chronic cough, defined as cough for more than 4 weeks, in Kwong Wah Hospital, a secondary hospital, over a 12-month period were reviewed. Underlying diagnoses and outcomes after follow up for a variable period were ascertained. Results: 42 patients were included. Chronic cough cases represented 8% of the new referrals. The most common final diagnosis was allergic rhinitis (31%), followed by asthma. Over a follow up period ranging from 4 to 12 months, cough resolved in 54.8%, partially resolved in 40.5% and persisted in 4.7% of patients. Persistent nasal symptoms were identified in 54.8% of our chronic cough patient. 43.5% of allergic rhinitis patient had co-existing asthma. Conclusion: Allergic rhinitis with or without co-existing asthma is the commonest cause of chronic cough in children referred to this department.

Chan EY. 2006. Evidence-based public health practices: challenges for health needs assessments in disasters. Hong Kong Med J, 12 (4), pp. 324-326.

Ng DK, Lau W-F, Chan K-K, Pau BC, Lam Y-Y, Chan EY, Ho JC. 2005. Severe acute respiratory syndrome coronavirus infection in children. Pediatr Int, 47 (4), pp. 452-455. | Read more

Tsang HWH, Scudds RJ, Chan EYL. 2004. Psychosocial impact of SARS. Emerg Infect Dis, 10 (7), pp. 1326-1327. | Read more

Chan EY, Yue J, Lee P, Wang SS. 2016. Socio-demographic Predictors for Urban Community Disaster Health Risk Perception and Household Based Preparedness in a Chinese Urban City. PLoS Curr, 8 (Disasters), | Show Abstract | Read more

OBJECTIVES: There is limited evidence on urban Asian communities' disaster risk perceptions and household level preparedness. Hong Kong is characterized by high population density, and is susceptible to large-scale natural disasters and health crises such as typhoons, fires and infectious disease outbreaks. This research paper investigates the rates and predictors of urban community disaster risk perception, awareness and preparedness, at individual and household levels. METHODS: A randomized cross-sectional, population-based telephone survey study was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong. Descriptive statistics were reported. A stepwise multivariate logistic regression analysis was conducted to determine the independent associations between risk perceptions, socioeconomic factors, household characteristics, and personal background. FINDINGS: Final study sample comprised of 1002 respondents with a 63% response rate. The majority of respondents (82.3%) did not perceive Hong Kong as a disaster-susceptible city. Half (54.6%) reported beliefs that the local population had lower disaster awareness than other global cities. Infectious disease outbreak (72.4%), typhoon (12.6%), and fire (7.1%) were ranked as the most-likely-to-occur population-based disasters. Although over 77% believed that basic first aid training was necessary for improving individual disaster preparedness, only a quarter (26.1%) of respondents reported participation in training. CONCLUSION: Despite Hong Kong's high level of risk, general public perceptions of disaster in Hong Kong were low, and little preparedness has occurred at the individual or household levels. This report has potential to inform the development of related policies and risk communication strategies in Asian urban cities.

Chan EYY, Wang Z, Mark CKM, Da Liu S. 2015. Industrial accidents in China: risk reduction and response. Lancet, 386 (10002), pp. 1421-1422. | Read more

Chan EYY, Cheng CKY, Tam G, Huang Z, Lee P. 2015. Knowledge, attitudes, and practices of Hong Kong population towards human A/H7N9 influenza pandemic preparedness, China, 2014. BMC Public Health, 15 (1), pp. 943. | Show Abstract | Read more

BACKGROUND: Since SARS epidemic in 2003, Hong Kong has experienced several major epidemic risks, but how general community might react to the repeated infectious diseases health risks have not been studied. In 2013, imported human H7N9 influenza infected cases from China were reported. Our study aims to assess the knowledge, attitude and practice (KAP) concerning A/H7N9 among Hong Kong general population regarding pandemic preparedness in early 2014. METHODS: A cross-sectional, population-based telephone survey study was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong in February 2014. The study survey was composed of 78 KAP questions. Factors associated with individual and household pandemic preparedness were analyzed. RESULTS: Final study sample was 1,020 with a response rate of 45.9 %. Among the respondents, most of them believed personal hygiene and avoidance of avian contacts were effective in preventing H7N9 infections. The majority of respondents had satisfactory hand hygiene practices and avoided touching avian species but did not employ other preventive measures. Female, 25 years old or older, white collar workers, people with chronic diseases and people living in the city center tended to report better hygiene practices. The average State-Trait Anxiety Inventory score was 1.85, similar to that of the period during the first wave and at the start of the second wave of the H7N9 epidemic. Self-reported face masks wearing when having influenza-like illness in general population dropped from 92.4 % during H5N1 period in 2007 to 39.0 % in this study. CONCLUSION: Hong Kong citizens show a low level of anxiety, misconceptions regarding the novel strains as well as gaps between perceived usefulness and practice of preventive measures towards influenza outbreaks. Educational campaigns and framing the issue to increase public and media awareness are crucial in preventing the current public fatigue towards outbreaks.

Qiu H, Yu IT-S, Tse LA, Chan EYY, Wong TW, Tian L. 2015. Greater temperature variation within a day associated with increased emergency hospital admissions for asthma. Sci Total Environ, 505 pp. 508-513. | Show Abstract | Read more

Asthma is one of the most common chronic conditions affecting both children and adults. Examining the health effects of environmental triggers such as temperature variation may have implications for maintenance of asthma control and prevention. We hypothesized that large diurnal temperature range (DTR) might be a source of additional environmental stress and therefore a risk factor for asthma exacerbation. Daily meteorological data, air pollution concentrations and emergency hospital admissions for asthma from 2004 to 2011 in Hong Kong were collected. Poisson regression models were used to fit the relationship between daily DTR and asthma, after adjusting for the time trend, seasonality, mean temperature, humidity, and levels of outdoor air pollution. Acute adverse effect of DTR on asthma was observed. An increment of 1 °C in DTR over lag0 to lag4 days was associated with a 2.49% (95% CI: 1.86%, 3.14%) increase in daily emergency asthma hospitalizations. The association between DTR and asthma was robust on the adjustment for daily absolute temperature and air pollution. DTR exhibited significantly greater effect in cool season. Males and female children appeared to be more vulnerable to DTR. Results supported that greater temperature variation within a day was an environmental risk factor for asthma exacerbation.

Chan EY-Y, Cheng CK-Y, Tam GC-H, Huang Z, Lee PY. 2015. Willingness of future A/H7N9 influenza vaccine uptake: A cross-sectional study of Hong Kong community. Vaccine, 33 (38), pp. 4737-4740. | Show Abstract | Read more

We conducted a population telephone survey in Hong Kong during the second wave of influenza A/H7N9 outbreak in 2014. Among the respondents, 50.5% of the respondents would like to accept A/H7N9 vaccination in future. Respondents had poor knowledge of A/H7N9 influenza and vaccines. More than 60% of respondents mixed up seasonal influenza this year and A/H7N9 influenza. Results show that socio-demographic factors were all independent of the vaccine uptake willingness while anxiety level and vaccine history were the main affecting factors. Vaccine promotion strategies may focus on influenza knowledge, attitude and behavior.

Goggins WB, Yang C, Hokama T, Law LSK, Chan EYY. 2015. Using Annual Data to Estimate the Public Health Impact of Extreme Temperatures. Am J Epidemiol, 182 (1), pp. 80-87. | Show Abstract | Read more

Short-term associations between both hot and cold ambient temperatures and higher mortality have been found worldwide. Few studies have examined these associations on longer time scales. Age-standardized mortality rates (ASMRs) were calculated for 1976-2012 for Hong Kong SAR, People's Republic of China, defining "annual" time periods in 2 ways: from May through April of the following year and from November through October. Annual frequency and severity of extreme temperatures were summarized by using a degree-days approach with extreme heat expressed as annual degree-days >29.3°C and cold as annual degree-days <27.5°C. For example, a day with a mean temperature of 25.0°C contributes 2.5 cold degree-days to the annual total. Generalized additive models were used to estimate the association between annual hot and cold degree-days and the ASMR, with adjustment for long-term trends. Increases of 10 hot or 200 cold degree-days in an annual period, the approximate interquartile ranges for these variables, were significantly (all P's ≤ 0.011) associated with 1.9% or 3.1% increases, respectively, in the annual ASMR for the May-April analyses and with 2.2% or 2.8% increases, respectively, in the November-October analyses. Associations were stronger for noncancer and elderly mortality. Mortality increases associated with extreme temperature are not simply due to short-term forward displacement of deaths that would have occurred anyway within a few weeks.

Chan EYY, Liu S, Hung KKC. 2013. Typhoon Haiyan and beyond. Lancet, 382 (9908), pp. 1873. | Read more

Barnett-Vanes A, Hung KKC, Maruthappu M, Shalhoub J, Chan EYY. 2013. Improving health in humanitarian crises: from reactive to proactive. Lancet, 382 (9893), pp. 679. | Read more

Chan EYY, Goggins WB, Yue JSK, Lee P. 2013. Hospital admissions as a function of temperature, other weather phenomena and pollution levels in an urban setting in China. Bull World Health Organ, 91 (8), pp. 576-584. | Show Abstract | Read more

OBJECTIVE: To explore the relationship between weather phenomena and pollution levels and daily hospital admissions (as an approximation to morbidity patterns) in Hong Kong Special Administrative Region (SAR), China, in 1998-2009. METHODS: Generalized additive models and lag models were constructed with data from official sources on hospital admissions and on mean daily temperature, mean daily wind speed, mean relative humidity, daily total global solar radiation, total daily rainfall and daily pollution levels. FINDINGS: During the hot season, admissions increased by 4.5% for every increase of 1 °C above 29 °C; during the cold season, admissions increased by 1.4% for every decrease of 1 °C within the 8.2-26.9 °C range. In subgroup analyses, admissions for respiratory and infectious diseases increased during extreme heat and cold, but cardiovascular disease admissions increased only during cold temperatures. For every increase of 1 °C above 29 °C, admissions for unintentional injuries increased by 1.9%. During the cold season, for every decrease of 1 °C within the 8.2-26.9 °C range, admissions for cardiovascular diseases and intentional injuries rose by 2.1% and 2.4%, respectively. Admission patterns were not sensitive to sex. Admissions for respiratory diseases rose during hot and cold temperatures among children but only during cold temperatures among the elderly. In people aged 75 years or older, admissions for infectious diseases rose during both temperature extremes. CONCLUSION: In Hong Kong SAR, hospitalizations rise during extreme temperatures. Public health interventions should be developed to protect children, the elderly and other vulnerable groups from excessive heat and cold.

Gao Y, Chan EYY, Zhu Y, Wong TW. 2013. Adverse effect of outdoor air pollution on cardiorespiratory fitness in Chinese children Atmospheric Environment, 64 pp. 10-17. | Show Abstract | Read more

Little is known about the health impact of air pollution on children's cardiovascular health. A cross-sectional study was conducted and data was analysed in 2048 Chinese schoolchildren (aged 8-10 years) in three districts of Hong Kong to examine the association between exposure to outdoor air pollution and cardiorespiratory fitness. Annual means of ambient PM10, SO2, NO2and O3from 1996 to 2003 were used to estimate individual exposure of the subjects. Cardiorespiratory fitness was measured for maximal oxygen uptake (VO2max), predicted by the multistage fitness test (MFT). Height and weight were measured and other potential confounders were collected with questionnaires. Analysis of covariance was performed to estimate the impact of air pollution on complete speed in the MFT and predicted VO2max. The results showed that children in high-pollution district had significantly lower complete speed and predicted VO2maxcompared to those in low- and moderate-pollution districts. Complete speed and predicted VO2maxwas estimated to reduce 0.327 km h-1and 1.53 ml kg-1min-1per 10 μg m-3increase in PM10annual mean respectively, with those in girls being greater than in boys. Being physically active could not significantly result in improved cardiorespiratory fitness in polluted districts. The adverse effect seems to be independent of short-term exposure to air pollution. We concluded that long-term exposure to higher outdoor air pollution levels was negatively associated with cardiorespiratory fitness in Chinese schoolchildren, especially for girls. PM10is the most relevant pollutant of the adverse effect. Elevated cardiorespiratory fitness observed in physically activate children could be negated by increased amount of inhaled pollutants during exercise. © 2012 Elsevier Ltd.

Gao Y, Chan EYY, Li LP, He QQ, Wong TW. 2013. Chronic effects of ambient air pollution on lung function among Chinese children. Arch Dis Child, 98 (2), pp. 128-135. | Show Abstract | Read more

OBJECTIVES: To examine the association between long-term exposure to air pollution and lung function among Chinese schoolchildren in Southern China (Hong Kong). METHODS: We conducted a cross-sectional study among 3168 schoolchildren (aged 8-10 years) in 3 districts in Hong Kong. Annual means of ambient PM10 (particulate matter <10 µm), SO2, NO2 and O3 from 1996 to 2003 were used to estimate the individual exposure of the subjects. Children's lung function was measured for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow between 25% and 75% of FVC (FEF(25-75)) and forced expiratory flow at 75% of FVC (FEF75). Analysis of covariance was performed separately by gender to estimate the impact of air pollution on lung function, with adjustment for socioeconomic characteristics, respiratory morbidities, height and weight, physical activity level, indoor air contaminants and short-term exposure to the air pollutants. RESULTS: After controlling for potential confounding factors, FEV1, FEF(25-75) and FEF75 for boys in a high-pollution district (HPD) were significantly lower than those in a low-pollution district (LPD) by 3.0%, 7.6% and 8.4%, respectively. No significant differences were found for girls. Results from the comparison between a moderate-pollution district (MPD) and the HPD were similar. There were no differences between children in the LPD and MPD, except that a higher FEF75 was found in boys in the MPD. PM10 is the primary pollutant responsible for the lung function deficit. Asthmatic children were more vulnerable to exposure to air pollution. CONCLUSIONS: Long-term exposure to higher ambient air pollution levels was associated with lower lung function in Chinese schoolchildren, especially among boys. Adverse effects were observed on large and small airways, with a stronger effect on the latter.

Chan EYY, Goggins WB, Kim JJ, Griffiths SM. 2012. A study of intracity variation of temperature-related mortality and socioeconomic status among the Chinese population in Hong Kong. J Epidemiol Community Health, 66 (4), pp. 322-327. | Show Abstract | Read more

BACKGROUND: Hong Kong, a major city in China, has one of the world's highest income inequalities and one of the world's highest average increases in urban ambient temperatures. Heat-related mortality in urban areas may vary with acclimatisation and population characteristics. This study examines how the effect of temperature on mortality is associated with sociodemographic characteristics at an intracity level in Hong Kong, China, during the warm season. METHODS: Data from the Hong Kong Observatory, Census and Statistics Department, Environmental Protection Department and government general outpatient clinics during 1998-2006 were used to construct generalised additive (Poisson) models to examine the temperature mortality relationship in Hong Kong. Adjusted for seasonality, long-term trends, pollutants and other potential confounders, effect modification of the warm season temperature-mortality association by demographic, socioeconomic factors and urban design were examined. RESULTS: An average 1°C increase in daily mean temperature above 28.2°C was associated with an estimated 1.8% increase in mortality. Heat-related mortality varied with sociodemographic characteristics: women, men less than 75 years old, people living in low socioeconomic districts, those with unknown residence and married people were more vulnerable. Non-cancer-related causes such as cardiovascular and respiratory infection-related deaths were more sensitive to high temperature effects. CONCLUSION: Public health protection strategies that target vulnerable population subgroups during periods of elevated temperature should be considered.

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