Informal Child Care and Adolescent Psychological Well-Being: Hong Kong’s “Children of 1997” Birth Cohort

Background Informal child care (child care by untrained family members, relatives or employees in the home) in Western populations is often associated with poorer psychological well-being, which may be confounded by socioeconomic position. We examined the association of informal child care, common in non-Western settings, with adolescent psychological wellbeing, using Hong Kong’s Chinese “Children of 1997” birth cohort. Methods Multivariable linear regression was used to examine the adjusted associations of informal child care (at 0.5, 3, 5 and 11 years) with parent-reported Rutter score for child behavior at 11 years, self-reported Culture-Free Self-Esteem Inventories score at 11 years and selfreported Patient Health Questionnaire-9 depressive symptom score at 13 years. Model comparisons were used to identify the best representation of child care, in terms of a critical period of exposure to informal child care (independent variable) at a specific age, combination of exposures to informal child care at several ages or an accumulation of exposures to informal child care. Results Child care was not associated with behavioral problems. A model considering child care at 3 years best represented the association of child care with self-esteem while a model considering child care at 5 years best represented the association of child care with depressive symptoms. Informal child care at 3 years was associated with lower self-esteem (-0.70, 95% confidence interval (CI) -1.26 to -0.14). Informal child care at 5 years was associated with more depressive symptoms (0.45, 95% CI 0.17 to 0.73)

Breast-feeding and childhood hospitalizations for infections

Background: Infectious disease is a leading cause of morbidity and hospitalization for infants and children. During infancy, breast-feeding protects against infectious diseases, particularly respiratory infections, gastrointestinal infections, and otitis media. Little is known about the longer-term impact of breast-feeding on infectious disease in children. Methods: We investigated the relationship between infant feeding and childhood hospitalizations from respiratory and gastrointestinal infections in a population-based birth cohort of 8327 children born in 1997 and followed for 8 years. The main outcomes were public hospital admissions for respiratory infections, gastrointestinal infections, and all infectious diseases. Cox regression was used to assess time to first hospitalization. Results: Breast-feeding only (no formula-feeding) for 3 or more months was associated with a lower risk of hospital admission in the first 6 months of life for respiratory infections (hazard ratio = 0.64 [95% confidence interval = 0.42-0.97]), gastrointestinal infections (0.51 [0.25-1.05]), and any infection (0.61 [0.44-0.85]), adjusted for sex, type of hospital at birth, and household income. Partial breast-feeding (both breast-feeding and formula-feeding) in the first 3 months also reduced hospitalizations from infections but with smaller effect sizes. Beyond 6 months of age, there was no association between breast-feeding status at 3 months and hospitalization for infectious disease. Conclusions: Giving breast milk and no formula for at least 3 months substantially reduced hospital admissions for many infectious diseases in the first 6 months of life, when children are most vulnerable. © 2010 by Lippincott Williams & Wilkins.postprin

Mode of delivery and child and adolescent psychological well-being: Evidence from Hong Kong’s “Children of 1997” birth cohort

Mode of delivery (vaginal or cesarean section) is thought to affect gut microbiota, which in turn may affect psychological well-being. As such, mode of delivery is potentially a modifiable factor for psychological well-being. Here we examined the association of mode of delivery with child and adolescent psychological well-being. We used multivariable linear regression in a populationrepresentative Hong Kong Chinese birth cohort, “Children of 1997,” to examine the adjusted associations of mode of delivery with behavioral problems assessed from parent-reported Rutter score at ~7 (n = 6294) and ~11 years (n = 5598), self-esteem assessed from self-reported Culture-Free Self- Esteem Inventory score at ~11 years (n = 6937) and depressive symptoms assessed from self-reported Patient Health Questionnaire-9 score at ~13 years (n = 5797). Cesarean Section (CS) was associated with children born in private hospitals, boys, and firstborns, higher maternal body mass index, higher maternal age, preeclampsia, higher socioeconomic position (SEP) and maternal birth in Hong Kong. CS was unrelated to behavior, self-esteem and depressive symptoms adjusted for infant characteristics (sex, gestational age, birthweight, parity and breast feeding), maternal characteristics (mother’s age and place of birth) and SEP. In a developed non-Western setting, mode of delivery was not clearly associated with childhood or early adolescent psychological well-being

Trends in Mortality from Septicaemia and Pneumonia with Economic Development: An Age-Period-Cohort Analysis

BackgroundHong Kong population has experienced drastic changes in its economic development in the 1940s. Taking advantage of Hong Kong’s unique demographic and socioeconomic history, characterized by massive, punctuated migration waves from Southern China, and recent, rapid transition from a pre-industrialized society to the first ethnic Chinese community reaching ‘‘first world’’ status over the last 60 years (i.e., in two or three generations), we examined the longitudinal trends in infection related mortality including septicemia compared to trends in non-bacterial pneumonia to generate hypotheses for further testing in other recently transitioned economies and to provide generalized aetiological insights on how economic transition affects infection-related mortality. Methods We used deaths from septicemia and pneumonia not specified as bacterial, and population figures in Hong Kong from 1976–2005. We fitted age-period-cohort models to decompose septicemia and non-bacterial pneumonia mortality rates into age, period and cohort effects. Results Septicaemia-related deaths increased exponentially with age, with a downturn by period. The birth cohort curves had downward inflections in both sexes in the 1940s, with a steeper deceleration for women. Non-bacterial pneumoniarelated deaths also increased exponentially with age, but the birth cohort patterns showed no downturns for those born in the 1940s. Conclusion The observed changes appeared to suggest that better early life conditions may enable better development of adaptive immunity, thus enhancing immunity against bacterial infections, with greater benefits for women than men. Given the interaction between the immune system and the gonadotropic axis, these observations are compatible with the hypothesis that upregulation of the gonadotropic axis underlies some of the changes in disease patterns with economic development

Breast cancer incidence and mortality in a transitioning Chinese population: current and future trends

Background Projections of future trends in cancer incidence and mortality are important for public health planning. Methods By using 1976–2010 data in Hong Kong, we fitted Poisson age-period-cohort models and made projections for future breast cancer incidence and mortality to 2025. Results Age-standardised breast cancer incidence (/mortality) is projected to increase (/decline) from 56.7 (/9.3) in 2011–2015 to 62.5 (/8.6) per 100 000 women in 2021–2025. Conclusions The incidence pattern may relate to Hong Kong’s socio-economic developmental history, while falling mortality trends are, most likely, due to improvements in survival from treatment advancement and improved health service delivery

Does historical data still count? Exploring the applicability of smart building applications in the post-pandemic period

The emergence of COVID-19 pandemic is causing tremendous impact on our daily lives, including the way people interact with buildings. Leveraging the advances in machine learning and other supporting digital technologies, recent attempts have been sought to establish exciting smart building applications that facilitates better facility management and higher energy efficiency. However, relying on the historical data collected prior to the pandemic, the resulting smart building applications are not necessarily effective under the current ever-changing situation due to the drifts of data distribution. This paper investigates the bidirectional interaction between human and buildings that leads to dramatic change of building performance data distributions post-pandemic, and evaluates the applicability of typical facility management and energy management applications against these changes. According to the evaluation, this paper recommends three mitigation measures to rescue the applications and embedded machine learning algorithms from the data inconsistency issue in the post-pandemic era. Among these measures, incorporating occupancy and behavioural parameters as independent variables in machine learning algorithms is highlighted. Taking a Bayesian perspective, the value of data is exploited, historical or recent, pre- and post-pandemic, under a people-focused view

Is better nutrition in childhood in a developing population associated with better cognitive function in later adulthood?: The Guangzhou Biobank Cohort Study

Objective: There is growing evidence that early life exposures, such as childhood socioeconomic status, are related to later adulthood cognition. However, the specific aspect of early conditions underlying this association is not clear. Animal protein intake is positively associated with earlier walking in infants. Dietary supplementation with meat in infants and children in developing countries results in better cognitive function, independent of iron status. Protein energy supplementation with vegetables, milk and sugar (not meat) given from birth to 24 months in developing populations is associated with better cognitive function in early adulthood (mean age 32 years), especially amongst women. Inadequate childhood nutrition is associated with poor short term academic and cognitive outcomes. However, it is not known whether childhood nutrition has life long effects on cognitive function. We examined the association of childhood meat eating with adulthood cognitive function in southern China where the older population lived through significant hardship during their early years. Methods: Multivariable linear regression was used in a crosssectional study of 20,086 Chinese men and women aged >50 years from the Guangzhou Biobank Cohort Study (phases 2 and 3) 2005–8. We assessed the association of childhood meat eating with amnesic-MCI and delayed 10-word recall score. The 10-word recall is a test of new learning ability from the CERAD (Consortium to Establish a Registry for Alzheimer’s Disease) test battery which has been validated as a culturally and educationally sensitive tool for identifying dementia in population based research in developing countries. Amnesic-MCI was defined as a delayed recall score of 3 or less out of 10, corresponding to 1 standard deviation below the mean. Results: Adjusted for age, sex and education, childhood meat eating 1–6 days per week and daily childhood meat eating were associated with a higher 10-word recall score (number of words recalled 50.08 [95% confidence interval50.02 to 0.13] and 0.24 [0.16 to 0.33] respectively) and with lower odds of amnesic-MCI (odds ratio50.80 [95% confidence interval50.72 to 0.89] and 0.79 [0.67 to 0.94] respectively). Additional adjustment for childhood and adulthood socio economic position and current physical activity attenuated these findings, however daily childhood meat eating remained associated with a higher 10-word recall score (0.17 [0.08 to 0.26]. Conclusions: A diet that includes a small amount of daily meat in childhood (after infancy) may have long-term positive effects on cognitive function. If confirmed, these results highlight the importance of adequate childhood nutrition. Alternatively childhood meat eating may reflect a generally more cognitively protective childhood environment and nutrition. Irrespective, these findings also emphasise the childhood and adolescent antecedents of adult disease, with corresponding public health implications for healthy aging. Future research should examine the role of childhood exposures in long term cognitive development and if a role for childhood meat eating is verified, should elucidate the type and quantity of macro and micro nutrients that may be cognitively protective and the biological mechanisms behind these effects, so that preventive strategies can be implemented. Acknowledgements: The University of Hong Kong (HKSAR), Guangzhou Public Health Bureau (China), Guangzhou Science and Technology Bureau (China), The University of Birmingham (UK).published_or_final_versio

The Role of Dairy Products and Milk in Adolescent Obesity: Evidence from Hong Kong's "Children of 1997" Birth Cohort

Background: Observational studies, mainly from Western populations, suggest dairy consumption is inversely associated with adiposity. However, in these populations the intake range is limited and both diet and obesity may share social patterning. Evidence from non-Western developed settings with different social patterning, is valuable in distinguishing whether observed associations are biologically mediated or socially confounded. Objective: To examine the associations of milk or other dairy product consumption with adolescent obesity. Methods: We used multivariable linear regression models to examine the associations of milk or other dairy product consumption, obtained from a food frequency questionnaire, at 11 years with body mass index (BMI) z-scores at 13 years and waist hip ratio (WHR) at 11 years, in 5,968 adolescents from a Chinese birth cohort, comprising 88% of births in April and May 1997. We used multiple imputation for missing exposures and confounders. Results: Only 65.7% regularly consumed milk and 72.4% other dairy products. Milk and other dairy product consumption was positively associated with socio-economic position but not with BMI z-score or WHR, with or without adjustment for sex, mother's birthplace, parental education, physical activity and other food consumption. Conclusions: The lack of association of milk and other dairy product consumption with adiposity in a non-Western setting was not consistent with the majority of evidence from Western settings. Observed anti-obesigenic effects in Western settings may be due to socially patterned confounding. © 2012 Lin et al.published_or_final_versio

A randomised-controlled trial of two educational modes for undergraduate evidence-based medicine learning in Asia

BackgroundAs the overall evidence for the effectiveness of teaching of evidence based medicine (EBM) is not strong, and the impact of cultural and societal influences on teaching method is poorly understood, we undertook a randomised-controlled trial to test the effectiveness and learning satisfaction with two different EBM teaching methods (usual teaching vs. problem based learning (PBL)) for undergraduate medical students. MethodsA mixed methods study that included a randomised-controlled crossover trial with two intervention arms (usual teaching and PBL) and a nested qualitative study with focus groups to explore student perceptions of learning and to assess the effectiveness and utility of the two teaching methods. All 129 second-year medical students at the University of Hong Kong in 2007. The main outcomes measures were attitudes towards EBM; personal application and current use of EBM; EBM knowledge; future use of EBM. ResultsPBL was less effective at imparting knowledge than usual teaching consisting of a lecture followed by a group tutorial. After usual teaching students showed improvement in scores for \u27attitudes towards EBM\u27, \u27personal application and current use of EBM\u27 and \u27EBM knowledge, which were not evident after PBL. In contrast to the usual teaching, students found PBL difficult as they lacked the statistical knowledge necessary to support discussion, failed to understand core concepts, and lost direction. ConclusionThe evidence presented here would suggest that the teaching of EBM within an Asian environment should adopt a format that facilitates both the acquisition of knowledge and encourages enquiry

Pathways between Socioeconomic Disadvantage and Childhood Growth in the Scottish Longitudinal Study, 1991–2001

Socioeconomically disadvantaged children are more likely to be of shorter stature and overweight, leading to greater risk of obesity in adulthood. Disentangling the mediatory pathways between socioeconomic disadvantage and childhood size may help in the development of appropriate policies aimed at reducing these health inequalities. We aimed to elucidate the putative mediatory role of birth weight using a representative sample of the Scottish population born 1991-2001 (n = 16,628). Estimated height and overweight/obesity at age 4.5 years were related to three measures of socioeconomic disadvantage (mother's education, Scottish Index of Multiple Deprivation, synthetic weekly income). Mediation was examined using two approaches: a 'traditional' mediation analysis and a counterfactual-based mediation analysis. Both analyses identified a negative effect of each measure of socioeconomic disadvantage on height, mediated to some extent by birth weight, and a positive 'direct effect' of mother's education and Scottish Index of Multiple Deprivation on overweight/obesity, which was partly counterbalanced by a negative 'indirect effect'. The extent of mediation estimated when adopting the traditional approach was greater than when adopting the counterfactual-based approach because of inappropriate handling of intermediate confounding in the former. Our findings suggest that higher birth weight in more disadvantaged groups is associated with reduced social inequalities in height but also with increased inequalities in overweight/obesity