Infectious Diseases

A major goal of this research programme is to further the understanding of the interplay between the variables that determine the typical course of infection within an individual host and the variables that control the pattern of infection within communities of people. The techniques that are required to address research questions in this area include the study of the properties of non-linear differential equations, the organisation and management of large-scale field studies of the transmission and control of infection and the analysis and manipulation of large and complex databases.

This is a new research direction that was undertaken by the Department following its successful and rapid epidemiological response to the 2003 SARS outbreak. During the epidemic, the team was the only public health/epidemiology consultants (locally or internationally) that were formally commissioned by the Health, Welfare and Food Bureau to coordinate, develop and maintain an integrated database (SARSID) of all SARS cases and related clinical, epidemiological and laboratory data and to perform advanced epidemiological and modelling analyses on the determinants and transmission dynamics of the SARS causative agent (SARS-CoV).

We currently play a leading role in the Centre for Health Protection of the Department of Health in advanced data analysis and epidemiological modelling for infectious diseases through a large commissioned grant from the Health, Welfare and Food Bureau to build capacity locally in collaboration with international partners.

More information on our infectious diseases research programme ...

Environmental Health Hazards

The Environmental Health Research Group (EHRG) has conducted research in environmental health for more than twenty years. Notably, the EHRG is the leading team in the first coordinated Public Health and Air Pollution in Asia (PAPA) project funded by the. Health Effects Institute (HEI), U.S.A. The team conducted one of the first air quality intervention studies in the world. With the support of this HEI funding, the team initiated and developed daily time-series methods for assessing long-term effects of air pollution on populations. We contributed in literature to the establishment of the 2005 WHO Global Air Quality Guidelines and established the first health and environment index, namely the Hedley Index, which focuses on communicating the risk and community cost of air pollution to the general public. 

The EHRG conducts studies on that consider the socio-economic and lifestyle modifiers of the effects of air pollution.  We have developed the Hong Kong Social Deprivation Index and assessed the health effects of air pollution on socially deprived groups as a demonstration of environmental injustice. Unique among environmental health study teams, we have examined the air pollution, seasonality, meteorological conditions and personal socio-economic and lifestyle conditions exposure effect on the disease burden of influenza. 

The EHRG had been successful in obtaining support from local and overseas funding organizations, including the Welcome Trust, the HEI, the Health and Health Service Research Fund, and the Research Fund for Control of Infectious Diseases as well as from the Environmental Protection Department.  The Wellcome Trust grant will support cohort studies of the long-term effects of air pollution in complex urban and geographic environments such as Hong Kong.  

Statistical Modelling

A major theme of our work in environmental health has been to develop and apply statistical modelling to assess the health effects of air pollution, the interaction between health, the environment (including infectious agents and geographical factors), behavioural lifestyle factors and health service utilisation. The statistical methods and approaches that have been
developed or are under development include the following.

	Binary latent modelling
	Daily time-series with offset
	Poisson regression for influenza epidemics and circulation
	Case-crossover design for weekly covariates
	Interaction between air pollution and lifestyle factors and influenza
	Application of a geographical information system to environmental and infectious disease epidemiology
	Economic evaluation of the health effects of air pollution
	Assessment of air quality interventions

Infectious Diseases Epidemiology

The burden of non-communicable chronic diseases, such as cancer, cardiovascular disease, stroke, obesity, diabetes and mental ill health, increases as populations grow and age with socio-economic development and the epidemiological transition. A major goal of this research theme is to identify how economic development (via economic growth or migration) affects overall population health and disparities in health. Rapid economic transition, in Southern China, provides a unique opportunity to re-examine the etiological origins of patterns of disease and health disparities in the developed world, as well as potentially informing contextually-specific evidence-based public health responses in the developing world. Southern China provides an ideal social laboratory to re-examine and elucidate the influences of lifestyle, life course environment and molecular factors on health in a non-western context, because the population has a unique demographic history of recent and rapid economic transition over the last 60 years, particularly in Hong Kong.

Lifestyle

Initially our efforts concentrated on tobacco related health problems, because of the public health impact of tobacco. Moreover changes in smoking habits could underlie the changes in population health with economic development. We have a world-renowned reputation for research into tobacco-related health problems and chronic diseases. We have contributed strong evidence of the adverse health effects that are caused by active and passive smoking in adults and children.  We have conducted randomised controlled trials on smoking cessation in different populations across the lifespan. Currently, we are evaluating the potential of web-based applications for smoking prevention and tobacco denormalisation.

We have also generated evidence concerning the effects of diet, physical activity, obesity and alcohol on morbidity and mortality in a developed non-western setting. As would be expected, diet, physical activity and obesity have similar effects to those seen elsewhere. However there appears to be less evidence of any protective effect of moderate alcohol use in our setting for cognition or mortality, which we are currently investigating. We have particular interest in exploiting innovative study designs to examine the causal role of lifestyle factors, such as physical activity, alcohol use or adiposity, in morbidity and mortality. We are currently using a Mendelian randomization design to examine the effect of moderate alcohol use on health.

Given the emerging epidemic of adiposity, particularly in infants and children, we are monitoring obesity locally, as well as identifying predisposing factors and the long-term consequences. We are particularly focusing on the broader societal and environmental factors in obesity and unhealthy lifestyles, such as the social determinants of health including the built environment.

Life course

Adult lifestyles, and changes with economic development or migration, are a key driver of disease risk and population health. Nevertheless, differences in disease patterns by setting and trajectory of economic development suggest that environmental influences may have long-range effects across the life course or across generations. We are specifically interested in how environmentally and inter-generationally driven changes during growth to the somatotrophic and gonadotrophic axes, perhaps mediated by epigenetics and sex-steroids, provide a socio-biological explanation for the trends in both size (height, frame, musculature) and non-communicable chronic diseases seen with economic development. Focusing etiological attention on the imprint of historical time also raises the possibility that empirically driven hypotheses in long-term developed populations are historical co-incidences, which we are investigating.

We have also contributed anovel, physiologically-based theory concerning the pathogenesis of the epidemics of diabetes, hormonally-related cancers and eventually male ischemic heart disease (IHD) which arise with economic development, mediated we suggest by changing levels of pubertal sex-steroids. In recently developed or migrant populations, relatively high rates of diabetes may be the flip side of low rates of IHD and hormonally driven cancers, and a temporary phenomenon specific to their socio-historical context. From an etiological perspective, one key exposure elegantly explains diverse changes in disease patterns with economic development. Moreover, from a public health perspective adolescence may be a key a phase when disease risks associated with economic development are actuated and thus a key window of intervention.

Molecular

Traditionally, most epidemiological studies have ignored the role of genetic factors, whereas most laboratory-based genetic studies have ignored lifestyle and environmental factors. In the past few years, western countries have devoted a huge amount of resources to research programmes that are aimed at the frontiers of lifestyle, environmental and genetic interactions. To facilitate our active research programmes examining the lifestyle, life-course and molecular determinants of chronic conditions, we have set up large cohort studies with the long-term collection of bio-specimens (usually blood, plasma or serum). Through many years of collaboration with partners in Southern China, including Guangzhou No 12 Hospital, the Department of Health in Hong Kong and the Hospital Authority in Hong Kong, we have gained access to population- and activity-related databases for infants, children, adolescents and the elderly on growth, hospital admissions and mortality. We have used this collaboration to create a number of large, long-running prospective cohort studies covering different age-groups. Cohorts we have created in support of our research programmes include.

Guangzhou Biobank Cohort Study

This prospective study comprises 30,000 older adults (50+ years) recruited 2003-8 in Guangzhou. The participants underwent a thorough examination at baseline including the collection of bio-specimens now held in long-term storage including the liquid nitrogen storage of plasma and live white cells. The participants will be actively followed up for the rest of their lives.

Elderly Health Centre Cohort

This prospective study comprises 60,000 older adults (65+ years) recruited in 1998-2001 in Hong Kong. The participants underwent a through examination at baseline including the collection of blood. Hospital use and mortality are regularly obtained via record linkage.

Hong Kong Student Obesity Surveillance

This population-based study comprises a stratified cluster sample of 30,000 students (11 to 18 years) recruited in 2006-7 from 42 schools in Hong Kong.  

Children of 1997 birth cohort

This prospective, population-representative study comprises all births in Hong Kong in April and May 1997. It initially focused on infant lifestyle (secondhand smoke exposure and breastfeeding) and health services utilization. Information on infant growth, childhood adiposity and hospital use has since been assembled via record linkage. In-person follow-up and collection of bio-specimens is now in progress. To date, we have used this cohort to test both empirically driven hypotheses from western settings concerning childhood obesity, such as the role of breastfeeding or socio-economic position, as well as to test theoretically derived hypotheses about rates of maturation, such as the role of infant infections.  

The goals of this research theme are (1) to generate new knowledge on the independent, interactive and long-range effects of lifestyle, environmental risk factors and molecular parameters (including genetic, epigenetic, lipids and hormones) in the aetiology of common health problems (including obesity, cardiovascular disease, diabetes and dementia and other mental ill health conditions) in adults and children; (2) to develop evidence-based practices, particularly through randomised controlled trials, for effective health promotion and interventions (such as smoking cessation, physical activity promotions and selenium supplements for the prevention of liver cancer); and (3) to foster multidisciplinary research in public health-related areas, such as nursing, primary care maternity and child health, mental health and elderly health. We aim to study the interplay of lifestyle and molecular factors, incorporate the lifecourse approach to the causes of common health problems, such as obesity, diabetes, cardiovascular diseases, cancer and mental ill health, and to research effective prevention and control measures. 

We have been commissioned by the Health, Welfare and Food Bureau to undertake several projects, and have a rich source of local epidemiological and economic data. Our unique team has special skills in health economics and evaluation, health services research, and health care management research.

Drawing on economic analysis, accounting and management sciences, and philosophical and ethical principles, we work to develop theories and methods that are necessary to define and diagnose system problems, devise solutions, facilitate adoption and implementation and ensure the attainment of the system-wide goals of equity, efficiency, quality and user satisfaction towards the ultimate objective of better health in the population. Our research team has been engaged by the Government's Food and Health Bureau to conduct studies to assist in its policy-making process. Specifically, we are commissioned to update Hong Kong's Domestic Health Accounts and are a key partner in the Asia-Pacific Equity in Health Financing Initiative (EQUITAP), which is jointly funded by the European Community, the Rockefeller Foundation and the Ford Foundation and involves 13 countries in the region; to prepare a health care manpower planning and forecasting model for health care professionals in Hong Kong and undertake cost effectiveness analysis of specific health care interventions.

We have applied evaluative and economic methodologies to answer questions that are of importance to health care systems. This includes evaluations of the efficacy and cost-effectiveness of screening (breast and cervical cancer), hepatitis B management strategies in Chinese populations, influenza vaccination in the elderly and the population's knowledge and use of ophthalmologic services. the impact of waiting times and 'doctor-shopping' on specialist outpatient services, the extent of health informatics penetration in Hong Kong and utility of mHealth interventions for risk reduction in patients with chronic disease, the methodological optimisation of survey techniques, the application of conjoint analysis to emergency services and a novel community service for the elderly; and the impact of hospital accreditation on quality of care.

Our current work is focused on the impact of health risks on chronic diseases, social inequalities in health, healthy ageing and the future impact of current demographic and behavioural patterns on health care systems. We have used locally derived epidemiological data to determine the impact of risk factors (health risk behaviours and environmental risks) on health service use at present and in the future and the economic impact of such risk factors on society as a whole and on specific sectors, such as the health care system.

The Behavioural Medicine & Wellbeing theme encompasses various dimensions of research in health-related behaviour, both individually and at the group level.

The Centre for Psycho-oncology Research and Training (CePORT), widely recognised as a regional benchmark in East Asia, works closely with clinicians, researchers and NGOs in HKSAR regional hospitals, and collaborates with research and clinical groups in Australia, China, Germany, Malaysia, Taiwan, and the United States. Our work has focused on unpicking the causes of distress following cancer diagnoses and treatments, and on impacts of culture and care delivery. Contrary to established belief, only a small fraction, typically around 15% of Chinese women with breast cancer, even in advanced disease, experience high levels of psychosocial distress that persist. These high levels of distress are essentially preventable through tailored clinical diagnostic and treatment-planning consultations. We are close to defining high-risk groups that can be detected by screening, thereby improving resource use. We have developed interventions for patients to aid treatment decision-making, trained clinicians and use RCTs to evaluate these and other interventions. We make particular use of longitudinal and structural equation modeling methods to describe the changes patients experience over time which enabls identification of critical points and targeted interventions.

The Health Behaviour Research Group (HBRG) collaborates with Schools of Public Health and hospitals in East and South East Asia, most recently on perceptions and behaviours surrounding traditional food marketing practices, principally in relation to H5N1 Avian influenza risks. Related local studies include perceptions and behaviour regarding seasonal and pandemic influenza vaccination; childhood vaccination among new immigrant families, and vaccination against adult diseases. Current focus is on informal social influences on vaccination decision-making using various modeling approaches.

HBRG also collaborates with other researchers, principally Dr Wing S. Wong in HKSAR and others overseas on studying chronic pain in the Chinese population, including the assembly of a repertoire of suitable instrumentation, and theoretical contributions to understanding the complex interactions between pain, pain disability, medically unexplained symptoms and “unwellness”. 

We continue to develop and refine instruments for behavioural assessment and to build on our expertise in qualitative research methods. In particular, there is a need to develop instrumentation that is suitable to the cultural context of the HKSAR. A more systematic integration of qualitative methods with quantitative approaches has resulted in an extremely successful exploration and clarification of the role of patient decision-making involvement in cancer care.
 

Centre for Psycho-oncology Research and Teaching

Research Training in Psycho-oncology at CePORT

Hong Kong Cancer Fund Scholarship in Psycho-oncology

The vision:

To develop a research centre of international excellence for research on influenza and other emerging virus diseases through a multi-disciplinary research program with the integration of basic, clinical and epidemiological research spanning the animal-human interface, thereby also enhancing capacity to confront other emerging viral pathogens.

The specific research aims include but are not limited to:

* Defining the ecology and evolution of influenza and other viruses of animals and humans to identify viruses of threats to human and animal health.

* Identifying viral and host determinants of pathogenesis, antiviral immunity and interspecies transmission.

* Identifing evidence-based options for the control of influenza in humans and animals by defining the transmission dynamics and quantifying the impact of interventions; and

* Developing novel options for diagnosis, vaccines and therapy.

The Centre also encompasses the following:

• HKU Pasteur Research Pole, a part of the Pasteur International Network

• Area of Excellence program on Pandemic and Inter-pandemic influenza supported by the UGC

• WHO H5 reference laboratory

• Is an international partner of the St Jude CEIRS (Centers of Excellence for Influenza Research and Surveillance of the National Institute of Allergy and Infectious Diseases) program.

The Centre functions in collaboration with other Centres and Departments within The University of Hong Kong including the School of Public Health, Departments of Microbiology, Pathology and Paediatrics and with relevant Government Departments including those of Health, Agriculture Fisheries and Conservation and the Food and Environmental Hygiene Department.