Harm resulting from screening is likely to be high where prevalence of breast cancer is low: Letters to the editor

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Preventing avoidable death: the case of cervical cancer in Hong Kong

Cervical cancer remains an important cause of avoidable morbidity and mortality in Hong Kong. This paper briefly reviews the epidemiology of cervical cancer and explores the evidence on the effectiveness of screening. The essential components of a successful cervical cancer screening programme, based on international experience, are discussed. The present situation in Hong Kong is then examined and the options outlined for the way ahead.published_or_final_versio

Exercise and health--new imperatives for public health policy in Hong Kong

Physical inactivity is an important and largely avoidable cause of incapacity. Regular physical activity protects against several chronic diseases, including cardiovascular diseaseԸ?one of the major causes of death in Hong Kong. Significant benefits can be achieved by regular participation in moderate amounts of either recreational or general lifestyle physical activities. Even more is gained from increasing the frequency, duration, and vigour of exercise. In Hong Kong, 59% of all adults lead a fairly sedentary lifestyle and only one in three exercise at levels that are thought to offer significant health benefits. An even more disturbing fact is that Hong Kong probably has the most inactive primary level schoolchildren in the world. The prevalence of these risk behaviours should make schoolchildren a priority for any public health prevention programme.published_or_final_versio

The pattern of cervical cancer screening in Hong Kong

Health Services Research Fund & Health Care and Promotion Fund: Research Dissemination Reports (Series 2)published_or_final_versio

From meadows to milk to mucosa – adaptation of Streptococcus and Lactococcus species to their nutritional environments

Lactic acid bacteria (LAB) are indigenous to food-related habitats as well as associated with the mucosal surfaces of animals. The LAB family Streptococcaceae consists of the genera Lactococcus and Streptococcus. Members of the family include the industrially important species Lactococcus lactis, which has a long history safe use in the fermentative food industry, and the disease-causing streptococci Streptococcus pneumoniae and Streptococcus pyogenes. The central metabolic pathways of the Streptococcaceae family have been extensively studied because of their relevance in the industrial use of some species, as well as their influence on virulence of others. Recent developments in high-throughput proteomic and DNA-microarray techniques, in in vivo NMR studies, and importantly in whole-genome sequencing have resulted in new insights into the metabolism of the Streptococcaceae family. The development of cost-effective high-throughput sequencing has resulted in the publication of numerous whole-genome sequences of lactococcal and streptococcal species. Comparative genomic analysis of these closely related but environmentally diverse species provides insight into the evolution of this family of LAB and shows that the relatively small genomes of members of the Streptococcaceae family have been largely shaped by the nutritionally rich environments they inhabit.

Aldehyde dehydrogenase 2-a potential genetic risk factor for lung function among southern Chinese: Evidence from the Guangzhou Biobank Cohort Study

Purpose: In Asia, moderate alcohol users have better lung function. Never users have more inactive aldehyde dehydrogenase 2 (ALDH2) alleles (A) potentially generating confounding because inactive alleles may increase acetaldehyde exposure and reduce lung function. Methods: We examined the association of ALDH2 genotypes with percentage predicted lung function (forced expiratory volume in 1second; forced vital capacity) for age, sex, and height among 5641 older Chinese using multivariable linear regression. Results: ALDH2 genotypes were associated with alcohol use and height but not other attributes. Inactive alleles were inversely associated with lung function (percentage predicted forced expiratory volume in 1second-1.52%, 95% confidence interval [CI],-2.52% to-0.51% for one inactive allele and-2.05%, 95% CI,-3.85% to-0.26% for two inactive alleles compared with two active alleles; and for percentage predicted forced vital capacity-1.25%, 95% CI-2.15% to-0.35% and-1.65%, 95% CI,-3.25% to-0.04%). The association of moderate use with lung function was attenuated after adjusting for ALDH2, in addition to other potential confounders. Conclusions: Previous findings in Chinese may be confounded by ALDH2. High frequency of inactive ALDH2 alleles in East Asia may exacerbate the effect of environmental acetaldehyde exposure on lung function and potentially on chronic obstructive pulmonary disease. © 2014 Elsevier Inc.postprin

The UK's Global Health Respiratory Network: Improving respiratory health of the world's poorest through research collaborations.

Respiratory disorders are responsible for considerable morbidity, health care utilisation, societal costs and approximately one in five deaths worldwide [1-4]. Yet, despite this substantial health and societal burden – which particularly affects the world’s poorest populations and as such is a major contributor to global health inequalities – respiratory disorders have historically not received the policy priority they warrant. For example, despite causing an estimated 1000 deaths per day, less than half of the world’s countries collect data on asthma prevalence (http://www.globalasthmareport.org/). This is true for both communicable and non-communicable respiratory disorders, many of which are either amenable to treatment or preventable

Cohort profile: The Guangzhou Biobank Cohort Study, a Guangzhou-Hong Kong-Birmingham collaboration

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Preventing childhood obesity, phase II feasibility study focusing on South Asians: BEACHeS

Objective: To assess feasibility and acceptability of a multifaceted, culturally appropriate intervention for preventing obesity in South Asian children, and to obtain data to inform sample size for a definitive trial. Design: Phase II feasibility study of a complex intervention. Setting: 8 primary schools in inner city Birmingham, UK, within populations that are predominantly South Asian. Participants: 1090 children aged 6–8 years took part in the intervention. 571 (85.9% from South Asian background) underwent baseline measures. 85.5% (n=488) were followed up 2 years later. Interventions: The 1-year intervention consisted of school-based and family-based activities, targeting dietary and physical activity behaviours. The intervention was modified and refined throughout the period of delivery. Main outcome measures: Acceptability and feasibility of the intervention and of measurements required to assess outcomes in a definitive trial. The difference in body mass index (BMI) z-score between arms was used to inform sample size calculations for a definitive trial. Results: Some intervention components (increasing school physical activity opportunities, family cooking skills workshops, signposting of local leisure facilities and attending day event at a football club) were feasible and acceptable. Other components were acceptable, but not feasible. Promoting walking groups was neither acceptable nor feasible. At follow-up, children in the intervention compared with the control group were less likely to be obese (OR 0.41; 0.19 to 0.89), and had lower adjusted BMI z-score (−0.15 kg/m2; 95% CI −0.27 to −0.03). Conclusions: The feasibility study informed components for an intervention programme. The favourable direction of outcome for weight status in the intervention group supports the need for a definitive trial. A cluster randomised controlled trial is now underway to assess the clinical and cost-effectiveness of the intervention. Trial registration number: ISRCTN51016370

Barriers and enablers of physical activity engagement for patients with COPD in primary care

Maria-Christina Kosteli,1 Nicola R Heneghan,1 Carolyn Roskell,1 Sarah E Williams,1 Peymane Adab,2 Andrew P Dickens,2 Alexandra Enocson,2 David A Fitzmaurice,2 Kate Jolly,2 Rachel Jordan,2 Sheila Greenfield,2 Jennifer Cumming1 1School of Sport, Exercise and Rehabilitation Sciences, 2Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK Background: Given that physical activity (PA) has a positive impact on COPD symptoms and prognosis, this study examined the factors that both encourage and limit participation in PA for individuals with COPD in a primary care setting from the perspective of social cognitive theory.Methods: A purposive sample of 26 individuals with a range of COPD severity (age range: 50–89 years; males =15) were recruited from primary care to participate in one of four focus groups. Thematic analysis was undertaken to identify key concepts related to their self-efficacy beliefs.Results: Several barriers and enablers closely related to self-efficacy beliefs and symptom severity were identified. The main barriers were health related (fatigue, mobility problems, breathing issues caused by the weather), psychological (embarrassment, fear, frustration/disappointment), attitudinal (feeling in control of their condition, PA perception, older age perception), and motivational. The main enabling factors were related to motivation (autonomous or controlled), attitudes, self-regulation, and performance accomplishments.Clinical implications: When designing interventions for individuals with COPD, it is important to understand the patient-specific social cognitive influences on PA participation. This information can then inform individually tailored management planning. Keywords: COPD, social cognitive theory, self-efficacy, barriers, enablers, primary car