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Previous research has suggested an association between depression and subsequent acute stroke incidence, but few studies have examined any effect modification by sociodemographic factors. In addition, no studies have investigated this association among primary care recipients with hypertension.
We examined the anonymized records of all public general outpatient visits by patients aged 45+ during January 2007–December 2010 in Hong Kong to extract primary care patients with hypertension for analysis. We took the last consultation date as the baseline and followed them up for 4 years (until 2011–2014) to observe any subsequent acute hospitalization due to stroke. Mixed-effects Cox models (random intercept across 74 included clinics) were implemented to examine the association between depression (ICPC diagnosis or anti-depressant prescription) at baseline and the hazard of acute stroke (ICD-9: 430–437.9). Effect modification by age, sex, and recipient status of social security assistance was examined in extended models with respective interaction terms specified.
In total, 396 858 eligible patients were included, with 9099 (2.3%) having depression, and 10 851 (2.7%) eventually hospitalized for stroke. From the adjusted analysis, baseline depression was associated with a 17% increased hazard of acute stroke hospitalization [95% confidence interval (CI) 1.03–1.32]. This association was suggested to be even stronger among men than among women (hazard ratio = 1.29, 95% CI 1.00–1.67).
Depression is more strongly associated with acute stroke incidence among male than female primary care patients with hypertension. More integrated services are warranted to address their needs.
Frozen raw breaded chicken products (FRBCP) have been identified as a risk factor for Salmonella infection in Canada. In 2017, Canada implemented whole genome sequencing (WGS) for clinical and non-clinical Salmonella isolates, which increased understanding of the relatedness of Salmonella isolates, resulting in an increased number of Salmonella outbreak investigations. A total of 18 outbreaks and 584 laboratory-confirmed cases have been associated with FRBCP or chicken since 2017. The introduction of WGS provided the evidence needed to support a new requirement to control the risk of Salmonella in FRBCP produced for retail sale.
This article contributes to the search for suitable approaches to combat social exclusion faced by disabled people in capitalist wage labour markets. Referring to policy and service examples in Hong Kong, it reviews four social exclusion approaches – the Moral Underclass (MUD), Social Integrationist (SID), Redistributive (RED) and Collective Production (COP) approaches. These approaches are explored in relation to three key issues: (1) the diverse preferences of disabled people; (2) the myth of infeasibility regarding unconventional approaches and (3) the defects of the medical model of disability. The article argues that the MUD and SID approaches are more associated with the medical model of disability and emphasise individual changes. The RED and COP approaches contain more features of the social model of disability and are in favour of social and structural changes. The COP approach stresses the diverse preferences of disabled people and supports innovative services to combat social exclusion.
Introduction: When ventricular fibrillation (VF) cannot be terminated with conventional external defibrillation, it is classified as refractory VF (RVF). There is a paucity of information regarding prehospital or patient factors that may be associated with RVF. The objectives of this study were to determine factors that may be associated with RVF, the initial ED rhythm for patients with prehospital RVF, and the incidence of survival in patients who had RVF and were transported to hospital. Methods: Ambulance Call Records (ACRs) of patients with out of hospital cardiac arrest between Mar. 1 2012 and Apr. 1 2016 were reviewed. Cases of RVF (≥5 consecutive shocks delivered) were determined by manual review of the ACR. ED and hospital records were analyzed to determine outcomes of patients who were in RVF and transported to hospital. Descriptive statistics were calculated and all variables were tested for an association with initial ED rhythm, survival to admission, and survival to discharge. Results: Eighty-five cases of RVF were identified. A history of coronary artery disease (47.10%) and hypertension (50.60%) were the most common comorbidities in patients transported to the ED with RVF. Upon arrival to the ED, 24 (28.2%) remained in RVF, 38 (44.7%) had a non-shockable rhythm, and 23 (27.1%) had return of spontaneous circulation. Thirty-four (40%) survived to admission, while only 18 (21.2%) survived to discharge. Pre-existing comorbidities, time to first shock, time on scene, and transport time were not statistically associated with initial ED rhythm, survival to admission or discharge. Patient age was statistically associated with improved rhythm on ED arrival (p=0.013) and survival to discharge (58.24 yrs vs 67.40 yrs, Δ9.17, 95% CI 1.82 to 16.52, p=0.015). Conclusion: The majority of patients with prehospital RVF have a rhythm deterioration by the time care is transferred to the ED. Of these patients with a rhythm deterioration, few survive to hospital discharge. Younger patients are more likely to remain in RVF and survive to discharge. Further research is required to determine prehospital treatment strategies for RVF, as well as patient populations that may benefit from those treatments.
Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013–2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.
To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).
We analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.
Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).
Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.
The organometallic approach was successfully applied to synthesize water-soluble ruthenium nanoparticles displaying interesting catalytic properties in hydrogenation of unsaturated model-substrates. Nanocatalyst synthesis was performed by hydrogenation of the complex [Ru(COD)(COT)] in the presence of sulfonated diphosphines and cyclodextrins as protective agents providing very small ruthenium nanoparticles (ca. 1.2-1.5 nm) with narrow size distribution and high stability. Catalysis results in water evidenced a control of the surface properties of these novel ruthenium nanocatalysts at a supramolecular level.
The ‘Frankfurter Neutronenquelle am Stern–Gerlach–Zentrum’ (FRANZ), which is currently under development, will be the strongest neutron source in the astrophysically interesting energy region in the world. It will be about three orders of magnitude more intense than the well-established neutron source at the Research Center Karlsruhe (FZK).
Two analytical tasks have been conducted in this article. The first is to construct a defamilisation typology that covers eighteen OECD members and four tiger economies (namely Hong Kong, Taiwan, South Korea and Singapore). The second is to demonstrate this typology's contribution to the debate on the existence of two essential preconditions for the development of an all-encompassing East Asian welfare regime: (1) the existence of significant differences in the welfare systems between the East Asian countries and the non-East Asian OECD countries; and (2) the existence of significant similarities in the welfare systems of the East Asian countries.
We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15–64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.
Background: The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB.
Methods: The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest.
Results: The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest.
Conclusions: The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.
A population-based telephone survey of acute gastroenteritis (AG) was conducted in Hong Kong from August 2006 to July 2007. Study subjects were recruited through random digit-dialling with recruitments evenly distributed weekly over the 1-year period. In total, 3743 completed questionnaires were obtained. An AG episode is defined as diarrhoea ⩾3 times or any vomiting in a 24-h period during the 4 weeks prior to interview, in the absence of known non-infectious causes. The prevalence of AG reporting was 7%. An overall rate of 0·91 (95% CI 0·81–1·01) episodes per person-year was observed with women having a slightly higher rate (0·94, 95% CI 0·79–1·08) than men (0·88, 95% CI 0·73–1·04). The mean duration of illness was 3·6 days (s.d.=5·52). Thirty-nine percent consulted a physician, 1·9% submitted a stool sample for testing, and 2·6% were admitted to hospital. Of the subjects aged ⩾15 years, significantly more of those with AG reported eating raw oysters (OR 2·4, 95% CI 1·3–4·4), buffet meals (OR 1·8, 95% CI 1·3–2·5), and partially cooked beef (OR 1·8, 95% CI 1·2–2·7) in the previous 4 weeks compared to the subjects who did not report AG. AG subjects were also more likely to have had hot pot, salad, partially cooked or raw egg or fish, sushi, sashimi, and ‘snacks bought at roadside’ in the previous 4 weeks. This first population-based study on the disease burden of AG in Asia showed that the prevalence of AG in Hong Kong is comparable to that experienced in the West. The study also revealed some ‘risky’ eating practices that are more prevalent in those affected with AG.
A comprehensive analysis of the epidemiology of salmonellosis in a major hospital in Hong Kong from 1982–93 is reported. The trend of salmonella isolations over the past 12 years and changes in the occurrence of individual serotypes are delineated. A total of 5328 isolates were analyzed. Groups B (Salmonella typhimurium and S. derby) and E (S. anatum) were the commonest serogroups isolated from the intestinal tract in all age groups. A significant increase in the isolation of group D salmonellae has been observed since 1989. This is accounted for by a substantial rise in S. enteritidis isolation as seen in Western countries, despite a concomitant decrease of S. typhi. The extraintestinal isolation index (EII) is proposed as an index of the virulence potential of individual serotypes and serogroups. Group D salmonella was found to be the most invasive serogroup. While group D was the predominant serogroup isolated from extraintestinal sites in patients older than 1 year, group B serotypes (especially S. typhimurium) were more frequently seen in infants younger than 12 months.
A very high proportion (75%) of the pigs slaughtered in Hong Kong were found to be infected with salmonellas. Seven serotypes including Salmonella choleraesuis were isolated but the majority (91%) were S. anatum and S. derby. These serotypes, especially S. anatum and S. derby, had been isolated frequently from clinical cases, symptomless carriers and in this study from abattoir workers, suggesting that the pig was a significant source of human salmonella infection.
The majority of pigs slaughtered are imported and the high level of apparent infection was thought to be due to cross-infection during transport of the pigs under stress. S. anatum and S. derby were also isolated from pigs on local farms but the incidence was threefold lower. Scalding the pigs at 60 °C for 5 min caused no great reduction in the degree of superficial contamination. The two predominant serotypes were isolated from the tank and from drain swabs, and also from the latter held under scalding tank conditions. Thus, in spite of the introduction of hygienic slaughter under modernized conditions employing an automatic conveyance system, 55% of the carcasses were superficially contaminated after dressing before despatch to customers. Control of infection before slaughtering would appear crucial and a more thorough rinsing or washing of the dressed carcasses desirable.
An outbreak of diarrhoea due to Salmonella worthington in five newborn babies, 5 weeks after a similar outbreak in 13 babies for which no cause had been found, occurred in the nursery of a maternity ward. The source of infection was traced to the contaminated rubber tubing of a mechanical suction apparatus. S. worthington was isolated from the rubber tubing and the Y connexion of the suction apparatus from which all the five infected babies had received suction. Reflux of contaminated amniotic fluid into the sterile catheter connected to the apparatus some time before use could have been the means of introducing the infected material to the oropharynx of the newborn babies, and amniotic fluid, acting as a good medium to support the growth of S. worthington, might be responsible for the long-lasting contamination.
Salmonella johannesburg (1, 40: b: e, n, x), a previously rare salmonella serotype, has established itself rapidly as an important and highly prevalent cause of gastroenteritis among children. The clinical features of the infection are usually mild but chronic. It has been suggested that S. johannesburg was introduced into Hong Kong through imported foods but no common vehicle could be traced as the source of infection. A thorough investigation of one paediatric ward in a general hospital revealed that non-infected patients admitted to the ward usually acquired S. johannesburg infection within 3–7 days, with or without symptoms. Thus hospital cross-infection could be a significant factor in contributing to its rapid spread in the community. Furthermore, the rapidity with which S. johannesburg spread was facilitated by (a) its tendency to produce a chronic infection, (b) its multiple resistance to antibiotics, and (c) the higher infectivity of S. johannesburg over other salmonellas endemic in this locality. These factors combined with the overcrowded conditions in many of the hospitals in Hong Kong facilitated the occurrence of hospital infection, which in its turn contributed to the spread of the infection in the local community.
The mixing behavior of a two-channel micromixer with a circular mixing chamber at four different chamber depths and six different flow rates had been investigated. Experiments were implemented with the mixings of two fluids. An image inspection method using the variance of the image gray level contrast as the measurement parameter to determine the mixing efficiency distribution in these mixers. The steady, three-dimensional and laminar flow fields inside the micromixers were also simulated numerically with a finite volume discretization. Through the numerical integration over the chamber depth, the three-dimensional numerical prediction could be compressed into a two-dimensional result, which could be directly used to compare with the experimental measurements. Experimental results show that the measured mixing efficiency is raised with the increase of chamber depth. The numerical prediction of mixing efficiency agreed qualitatively with those obtained from the experimental measurements, while the ratio of the depth to diameter of the mixing chamber is big enough to eliminate the viscosity effect.
Various Lamp phosphors, including [Ca10(PO4)6(Cl,F):Sb:Mn], (Y,Eu)2O3 (YOE), BaMgAl10O17:Eu (BAM), and (La,Ce)PO4:Ce:Tb (LAP), with or without flux, have been synthesized by a microwave processing technique in a multimode microwave furnace operating at 2.45 GHz. The microwave-synthesized phosphors were comprehensively characterized for particle size, specific surface area, brightness, and luminescence. Although most properties of the microwave-synthesized phosphors were comparable to that of the conventional products, the kinetics of the phosphor synthesis was substantially enhanced in the microwave processing. As a result, the soaking time at the final temperature was reduced by up to 90% compared to a conventional process. In addition, the required synthesis temperature was also lowered by 100-200°C in microwave process, compared to the conventional process for these lamp phosphors. Certain improved property was also observed in some microwave synthesized samples. The mechanism and advantages of microwave process for the lamp phosphor synthesis through solid-state reaction are addressed.