published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Public Health / Master / Master of Public Health

Background: Research studies in recent years suggested possible role of dark chocolate in preventing cardiovascular diseases due to its high flavonal and procyanidins contents. Whether there is clear clinical benefit and the mechanisms mediating such benefits is controversial. Objective: This systematic review aims to comprehensively examine the current clinical evidence regarding effectiveness and the possible mechanisms of chocolate in reducing the risk and / or surrogate markers of cardiovascular diseases. Methods: Comprehensive electronic literature search was performed using Ovid, Medline and Cochrane database. Only English language literatures published during year 1950 - 2010 were reviewed. All intervention studies and observational studies of adult human subjects taking white or dark chocolate in relation to outcomes of cardiovascular risk were included. All review articles and meta-analysis were also included. Clinical diagnosis of cardiovascular disease and surrogate markers including blood pressure, vascular endothelial function as measured by flowed mediated vasodilation, and blood biomarkers such as lipid profile were studied as outcome variables. Results: The review outlines recent observational and interventional studies and meta-analysis to give an overview of the topic. For observational studies, a cohort studies and two case control studies were found. The observational studies showed that dark chocolate consumption was inversely associated with blood pressure, cardiovascular mortality and C-reactive protein. All interventional studies searched showed that dark chocolate increased FMD and improved platelet function. However, the effects of cocoa on intermediate outcomes such as blood pressure, antioxidant capacity and inflammatory marker changes were inconsistent among interventional studies. Three interventional studies indicated that there was a dose-dependent improvement in immediate outcome variables after 1 month or even 2 hours acute consumption of dark chocolate with procyanidins or cocoa drink with flavonol. However, publication bias and potential conflict of interests may be a potentially important factor in interpreting study results in the current literature. Conclusions: There are some clinical and scientific evidences that consumption of dark chocolate produces positive cardiovascular benefits. A small amount of dark chocolate may be good for the heart. However, gaps in our knowledge such as a lack of long-term RCT in clinical outcomes must be filled in before recommending habitual dark chocolate consumption for reduction of cardiovascular risk. / published_or_final_version / Community Medicine / Master / Master of Public Health

Background Large outbreaks of influenza are known to occur at correctional institutions such as prisons. Prisoners are particularly vulnerable due to a combination of environmental and socio-behavioural risk factors. Such outbreaks are also challenging to control because of the unique environmental constraints in these institutions. However, no local guidance is available for the prevention and control of influenza outbreaks in correctional institutions. This paper aims to review and synthesise relevant evidence on the topic so that practical recommendations can be offered to the local public health and correctional services. Methods A literature search was performed using PubMed, Google Scholar and Google to locate all relevant articles in English that examined the control of influenza outbreaks at correctional institutions up to May 2012. Findings Eleven studies describing 16 outbreaks of influenza or influenza-like illness at correctional institutions were included in the review. The studies included ten case reports and one case-control study from four countries. The majority of outbreaks took place at prisons. The number of cases in each outbreak ranged from three to over 500. Attack rates were highly variable between outbreaks, while case-fatality ratios were generally low. Control strategies used included social distancing measures, transmission-based precautions, active surveillance and testing, treatment, chemoprophylaxis and vaccination. Nine studies discussed the risk factors for spread and the challenges encountered in the control of the outbreaks. These included agent, host, socio-behavioural, environmental, staff and infrastructural factors. The limited expertise and capacity of correctional institutions in responding to influenza outbreaks should be acknowledged. Close communication and collaboration with public health agencies is called for. To better prepare these institutions to respond to pandemic influenza, a detailed, multidisciplinary response plan should be set up by the various government agencies involved. Conclusions Correctional institutions require the appropriate guidance and support from public health for the successful control of influenza outbreaks. These institutions should be recognised as serving a vital role in the community, and prisoners deserve the same standards of health care that are available to other members of society. / published_or_final_version / Public Health / Master / Master of Public Health

Introduction: Alcohol is a major contributor to pre-mature deaths globally, being ranked as the world's third greatest risk factor of deaths and disability and among the middle and high income countries the most important one. Recent meta-analyses have concluded that increasing alcohol tax is an effective mean to curb the alcohol epidemic by lowering alcohol consumption as the mediator. However, the Hong Kong Special Administrative Region (SAR) abolished the duty rate of all alcohol with strength less than 30% by volume effective from 27 February 2008. In this study, I reviewed the literature to assess and address the issues relating to the health impact of this policy change. Objectives: To evaluate the health impact of alcohol tax reduction in other regions based on published research reports and assess the generalizability of the findings to Hong Kong local setting Methods: Published studies on health impact of alcohol tax or price reduction were identified by PubMed. Inclusion criteria were: 1. all studies on alcohol tax reduction in any regions or countries; 2. in the studies outcome measures or any health impact of the alcohol tax reduction were clear and measurable; 3. original studies. On the other hand, editorial or legal reviews, commentaries, letters or articles with no component of epidemiological study and duplicated studies of the same data set were excluded. Non-English literature and non-human studies were excluded as well. There were totally 15 articles fulfilling all the criteria for final review. Results: There were diverging effects in the change of alcohol consumption after the alcohol tax reduction and the liberalization of the travellers’ import among Nordic regional countries and Switzerland. However, the studies consistently showed an increase of alcohol-related mortality and hospitalization among different subgroups, for instance, the older or younger age group and the worst or better off population including the more frequent and heavy drinkers. No effect on other alcohol related harms such as interpersonal violence, traumatic brain injuries or crimes were found in association with the policy changes. Discussion: Policy makers should cautiously weigh the apparent economic benefit of alcohol tax reduction against the cost of public health damage. Drinking small amount of alcohol especially wine is still regarded as something good for health among the general public in Hong Kong. With the alcohol taxation abolished, it is likely the drinking culture, among the younger people will be incubated. Raising the public awareness of the harmful effect from alcohol drinking among Chinese population should be set as a top priority. A comprehensive surveillance on alcohol consumption and its related harm is urgently needed. Additionally, further evidence-based studies are warranted in order to investigate the health impact from the abolition of alcohol tax in Hong Kong. / published_or_final_version / Community Medicine / Master / Master of Public Health