The challenge of chronic conditions in Hong Kong.

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Hospitals must become 'focused factories'

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Diabetic complications and their implications on health care in Asia.

Diabetes mellitus is a growing health problem in the Asia-Pacific region. The acute and chronic complications of diabetes mellitus are major causes of hospital admissions, blindness, renal failure, amputations, stroke, and coronary heart disease in this region. Compared with the general population, the annual per capita health care expenditure is estimated to be four-fold for people with diabetes. Recent prospective studies have provided unequivocal evidence for the crucial role of prolonged hyperglycaemia in the development of chronic diabetic complications. Although the aetiology of hyperglycaemia-induced damage of the kidneys, eyes, nerves, and arteries still remain to be elucidated, observational and interventional studies show that the occurrence and progression of these complications can be prevented by the optimal control of blood glucose, hypertension, and dyslipidaemia. Lifestyle changes such as weight control, increased physical exercise, and smoking cessation are also potentially beneficial in preventing diabetes mellitus and coronary artery disease. Furthermore, the morbidity and mortality caused by diabetes mellitus can be reduced by secondary prevention through regular screening, early detection, and appropriate treatment of chronic complications. Improved diabetes education is needed among health professionals as well as the general and diabetic populations. Government and public health officials should be mindful of the economic impact of this major health problem so that adequate health care resources can be allocated for the primary and secondary prevention of diabetic complications.published_or_final_versio

A socio-biological explanation for social disparities in non-communicable chronic diseases: The product of history?

This study places social disparities in the major non-communicable chronic diseases within their global economic and historical contexts. Rapid economic transition outside the developed world provides a unique opportunity to re-examine the origins of, and biological mechanisms driving, social disparities. Gaps in prevailing theories focusing on material resources, civic infrastructure and social structure are identified. Using longstanding experimental evidence and epigenetic theories, it is suggested that exposure to economic development over generations (ie, improved living conditions over historical time) could by acting on different biological axes (somatotrophic and gonadotrophic) generate specific patterns of social disparities. Moreover, these same processes could initially generate a transient epidemic of diabetes as well as a permanent increase in male risk of premature ischaemic heart disease. As such, this study demonstrates the importance of context, and implies that current evidence from the developed world may be largely uninformative for preventing or mitigating social disparities in non-communicable chronic diseases elsewhere, suggesting research efforts should be focused on developing countries.published_or_final_versio

New anti-smoking legislation on second-hand smoke exposure of children in homes

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Efficiency is dependent on the control of supply.

At a time when health care systems are undergoing reform, it is useful to review the causes of inefficiency in health care, along with potential solutions. Such solutions can affect suppliers (supply-side measures) or users of care (demand-side measures). This paper argues that to have an efficient health care system, supply-side measures must be implemented. Some examples of supply-side measures, with particular relevance to the Hong Kong situation, are discussed. By their nature, supply-side measures require government intervention. Only then, can allocative efficiency, as well as technical efficiency, be achieved. Once a health care system is operating efficiently, it is an easier task to determine whether the system requires more resources, either currently, or in the future.published_or_final_versio

Public health interventions to control the spread of a directly transmitted human pathogen within and between Hong Kong and Guangzhou.

The ability to detect and differentiate between fast and slow spatial spread of infectious disease depends on the density of the surveillance network. 2. The results of this study suggest that more concentrated surveillance networks are required in Guangzhou compared with other regions, such as Thailand and Europe, as long-distance travel is less frequent.published_or_final_versio

Associations of birth order with early adolescent growth, pubertal onset, blood pressure and size: Evidence from Hong Kong’s “Children of 1997” birth cohort

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Optimal design of studies of influenza transmission in households. I: Case-ascertained studies

Case-ascertained household transmission studies, in which households including an index case are recruited and followed up, are invaluable to understanding the epidemiology of influenza. We used a simulation approach parameterized with data from household transmission studies to evaluate alternative study designs. We compared studies that relied on self-reported illness in household contacts vs. studies that used home visits to collect swab specimens for virological confirmation of secondary infections, allowing for the trade-off between sample size vs. intensity of follow-up given a fixed budget. For studies estimating the secondary attack proportion, 2-3 follow-up visits with specimens collected from all members regardless of illness were optimal. However, for studies comparing secondary attack proportions between two or more groups, such as controlled intervention studies, designs with reactive home visits following illness reports in contacts were most powerful, while a design with one home visit optimally timed also performed well. © 2011 Cambridge University Press.published_or_final_versio

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