Synchrony of clinical and laboratory surveillance for influenza in Hong Kong

Background: Consultation rates of influenza-like illness (ILI) in an outpatient setting have been regarded as a good indicator of influenza virus activity in the community. As ILI-like symptoms may be caused by etiologies other than influenza, and influenza virus activity in the tropics and subtropics is less predictable than in temperate regions, the correlation between of ILI and influenza virus activity in tropical and subtropical regions is less well defined. Methodology and Principal Findings: In this study, we used wavelet analysis to investigate the relationship between seasonality of influenza virus activity and consultation rates of ILI reported separately by General Out-patient Clinics (GOPC) and General Practitioners (GP). During the periods 1998-2000 and 2002-2003, influenza virus activity exhibited both annual and semiannual cycles, with one peak in the winter and another in late spring or early summer. But during 2001 and 2004-2006, only annual cycles could be clearly identified. ILI consultation rates in both GOPC and GP settings share a similar non-stationary seasonal pattern. We found high coherence between ILI in GOPC and influenza virus activity for the annual cycle but this was only significant (P<0.05) during the periods 1998-1999 and 2002-2006. For the semiannual cycle high coherence (p<0.05) was also found significant during the period 1998-1999 and year 2003 when two peaks of influenza were evident. Similarly, ILI in GP setting is also associated with influenza virus activity for both the annual and semiannual cycles. On average, oscillation of ILI in GP and of ILI in GOPC preceded influenza virus isolation by approximately four and two weeks, respectively. Conclusions: Our findings suggest that consultation rates of ILI precede the oscillations of laboratory surveillance by at least two weeks and can be used as a predictor for influenza epidemics in Hong Kong. The validity of our model for other tropical regions needs to be explored. © 2008 Yang et al.published_or_final_versio

Is exercise protective against influenza-associated mortality?

Background: Little is known about the effect of physical exercise on influenza-associated mortality. Methods and Findings: We collected information about exercise habits and other lifestyle, and socioeconomic and demographic status, the underlying cause of death of 24,656 adults (21% aged 30-64, 79% aged 65 or above who died in 1998 in Hong Kong, and the weekly proportion of specimens positive for influenza A (H3N1 and H1N1) and B isolation during the same period. We assessed the excess risks (ER) of influenza-associated mortality due to all-natural causes, cardiovascular diseases, or respiratory disease among different levels of exercise: never/seldom (less than once per month), low/moderate (once per month to three times per week), and frequent (four times or more per week) by Poisson regression. We also assessed the differences in ER between exercise groups by case-only logistic regression. For all the mortality outcomes under study in relation to each 10% increase in weekly proportion of specimens positive for influenza A+B, never/seldom exercise (as reference) was associated with 5.8% to 8.5% excess risks (ER) of mortality (P<0.0001), while low/moderate exercise was associated with ER which were 4.2% to 6.4% lower than those of the reference (P<0.001 for all-natural causes; P=0.001 for cardiovascular; and P=0.07 for respiratory mortality). Frequent exercise was not different from the reference (change in ER -0.8% to 1.7%, P=0.30 to 0.73). Conclusion: When compared with never or seldom exercise, exercising at low to moderate frequency is beneficial with lower influenza-associated mortality. © 2008 Wong et al.published_or_final_versio

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

Socioeconomic and urban-rural differentials in exposure to air pollution and mortality burden in England

BACKGROUND: Socioeconomically disadvantaged populations often have higher exposures to particulate air pollution, which can be expected to contribute to differentials in life expectancy. We examined socioeconomic differentials in exposure and air pollution-related mortality relating to larger scale (5 km resolution) variations in background concentrations of selected pollutants across England. METHODS: Ozone and particulate matter (sub-divided into PM10, PM2.5, PM2.5-10, primary, nitrate and sulphate PM2.5) were simulated at 5 km horizontal resolution using an atmospheric chemistry transport model (EMEP4UK). Annual mean concentrations of these pollutants were assigned to all 1,202,578 residential postcodes in England, which were classified by urban-rural status and socioeconomic deprivation based on the income and employment domains of the 2010 English Index of Multiple Deprivation for the Lower-level Super Output Area of residence. We used life table methods to estimate PM2.5-attributable life years (LYs) lost in both relative and absolute terms. RESULTS: Concentrations of the most particulate fractions, but not of nitrate PM2.5 or ozone, were modestly higher in areas of greater socioeconomic deprivation. Relationships between pollution level and socioeconomic deprivation were non-linear and varied by urban-rural status. The pattern of PM2.5 concentrations made only a small contribution to the steep socioeconomic gradient in LYs lost due to PM2.5 per 103 population, which primarily was driven by the steep socioeconomic gradient in underlying mortality rates. In rural areas, the absolute burden of air pollution-related LYs lost was lowest in the most deprived deciles. CONCLUSIONS: Air pollution shows modest socioeconomic patterning at 5 km resolution in England, but absolute attributable mortality burdens are strongly related to area-level deprivation because of underlying mortality rates. Measures that cause a general reduction in background concentrations of air pollution may modestly help narrow socioeconomic differences in health

Cold and winter mortality from cardiovascular diseases in Guangzhou, China

Conference Theme: Technology, Environmental Sustainability and HealthSession - Climate Change and Environmental HealthThis journal suppl. entitled: Abstracts: ISEE 22nd Annual Conference, Seoul, Korea, 28 August-1 September 2010Background/Aims: Many studies have linked elevated ambient temperature and heat waves to cardiovascular deaths. However, despite of the enormity of winter excess mortality from cardiovascular diseases (CVD), the effects of cold exposure are not well documented. We assessed the cold-related mortality from CVD in Guangzhou, a subtropical city in southern China. Methods: We obtained meteorological data from National Climatic Data Center and mortality data from Guangzhou Department of Health. The study included 43,401 cardiovascular deaths, accounting for 37% of all-cause deaths during the period of 2003 to 2007. Cold exposure was measured using the average ambient temperature over the proceeding 0–4 days. A time-stratified case-crossover design with conditional logistic regression modeling was conducted to examine the association between daily temperature and mortality from CVD during winter periods (December to March), after adjusting for day of the week and daily mean humidity. We considered the potential effect modification by individual characteristics, including age, sex, and education level. Results: The mortality rate in winter was 15.13% higher than the average in the whole year. The winter excess mortality from CVD was up to 22.14%. We found that 1°C fall of daily mean temperature in winter was associated with a 2.44% (95% confidence interval [CI]: 1.88%–3.01%) increase in mortality from CVD. Very similar associations were found with mortality from stroke (2.26%, 95% CI: 1.30%–3.24%) and coronary heart diseases (2.53%, 95% CI: 1.52%–3.55%). The effects were greater in males than in females. The effects of cold exposure tended to increase with individual's education level. There was little evidence that the cold effects we found reduced over time. Conclusion: Mortality from CVD presented a clear seasonality with dramatic rises in winter. Our results indicate that cold exposure is a main environmental cause of high winter mortality even in subtropics.Link_to_subscribed_fulltex

First-trimester examination of fetal nasal bone in the Chinese population

Objectives: Absence of the nasal bone in fetuses with trisomy 21 is a potential ultrasound marker for Down syndrome from the first trimester onwards. Racial differences in fetal nasal bone length have been reported. There was no reference range for the first-trimester fetal nasal bone length (NBL) in the Chinese population. Methods: From January 2002 to February 2005, we investigated the reference range of NBL in 2169 singleton fetuses whose parents were Chinese with normal pregnancy outcome. Ultrasound measurements of NBL were performed on a midsagittal plane at 12-14 weeks' gestation. Results: The nasal bone length measurement showed a significant increase with gestational age (GA) (p < 0.05). A linear relationship between nasal bone length and gestational age (NBL = -3.3462 × GA + 0.627, R 2 = 0.30, p < 0.001) as well as a linear relationship between nasal bone length and crown-rump length (CRL) (NBL = 0.3741 × CRL + 0.284, R 2 = 0.30, P < 0.001) was established. Conclusion: The measurement of nasal bone length was feasible in the first trimester. The reference range of NBL in normal Chinese fetuses in the first-trimester of pregnancy was established. This formed a basis for further study on the use of fetal nasal bone measurement in the screening for aneuploidy in the Chinese population. Copyright © 2006 John Wiley & Sons, Ltd.link_to_subscribed_fulltex