The Impact of Improving Suicide Death Classification in South Korea: A Comparison with Japan and Hong Kong

IntroductionThe suicide rate of South Korea has increased dramatically during the past decades, as opposed to steadily decreasing trends in Japan and Hong Kong. Although the recent increase of suicide in South Korea may be related to changing socioeconomic conditions and other contextual factors, it may also reflect, in part, a reduction of misidentified suicide cases due to improving classification of manner of death.MethodWe compared the annual proportional change of suicide, undetermined death, and accidental death from South Korea with those of Japan and Hong Kong from 1992 to 2011; a greater proportional change of the manner-of-death categories during the period is indicative of a relatively less stable registration and hence a greater potential for misclassification bias on reported suicide trends. Subgroup analyses stratifying the deaths by methods were also conducted. To estimate the impact, the age-standardized rates of these three death categories in each site were calculated.ResultsWe found that, during the 20-year observation period, the proportional change of suicide, undetermined death, and accidental death in South Korea was significantly greater than Japan and Hong Kong. Similar observations were made in subgroup analyses. While death rates of the three manners in Japan and Hong Kong generally moved in a parallel fashion, the increase of suicide in South Korea occurred concomitantly with a significant reduction of its accidental death rate. 43% of the increase in suicides could be attributed to the decrease in accidental deaths, while 57% of the increase could be due to fundamental causes.ConclusionOur data suggest that, during the mid-1990s and after, the increasing burden of suicide in South Korea initially was masked, in part, by misclassification. Thus, the later apparently rapid increase of suicides reflected steadily improving classification of manner of death, as well as a more fundamental increase in the suicide rate.     

Regional Changes in Charcoal-Burning Suicide Rates in East/Southeast Asia from 1995 to 2011: A Time Trend Analysis

Background

Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 y of the first reported cases in the early 2000s. The objectives of this analysis were to investigate (i) time trends and regional patterns of charcoal-burning suicide throughout East/Southeast Asia during the time period 1995–2011 and (ii) whether any rises in use of this method were associated with increases in overall suicide rates. Sex- and age-specific trends over time were also examined to identify the demographic groups showing the greatest increases in charcoal-burning suicide rates across different countries.

Methods and Findings

We used data on suicides by gases other than domestic gas for Hong Kong, Japan, the Republic of Korea, Taiwan, and Singapore in the years 1995/1996–2011. Similar data for Malaysia, the Philippines, and Thailand were also extracted but were incomplete. Graphical and joinpoint regression analyses were used to examine time trends in suicide, and negative binomial regression analysis to study sex- and age-specific patterns. In 1995/1996, charcoal-burning suicides accounted for <1% of all suicides in all study countries, except in Japan (5%), but they increased to account for 13%, 24%, 10%, 7%, and 5% of all suicides in Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore, respectively, in 2011. Rises were first seen in Hong Kong after 1998 (95% CI 1997–1999), followed by Singapore in 1999 (95% CI 1998–2001), Taiwan in 2000 (95% CI 1999–2001), Japan in 2002 (95% CI 1999–2003), and the Republic of Korea in 2007 (95% CI 2006–2008). No marked increases were seen in Malaysia, the Philippines, or Thailand. There was some evidence that charcoal-burning suicides were associated with an increase in overall suicide rates in Hong Kong, Taiwan, and Japan (for females), but not in Japan (for males), the Republic of Korea, and Singapore. Rates of change in charcoal-burning suicide rate did not differ by sex/age group in Taiwan and Hong Kong but appeared to be greatest in people aged 15–24 y in Japan and people aged 25–64 y in the Republic of Korea. The lack of specific codes for charcoal-burning suicide in the International Classification of Diseases and variations in coding practice in different countries are potential limitations of this study.

Conclusions

Charcoal-burning suicides increased markedly in some East/Southeast Asian countries (Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore) in the first decade of the 21st century, but such rises were not experienced by all countries in the region. In countries with a rise in charcoal-burning suicide rates, the timing, scale, and sex/age pattern of increases varied by country. Factors underlying these variations require further investigation, but may include differences in culture or in media portrayals of the method. Please see later in the article for the Editors'' Summary     

2000-2030年深港景观格局演变时空分异与趋势对比分析

自然气候条件相近但社会经济制度差异显著的深圳与香港为我国制度探索与经济建设提供了重要窗口,两地的景观格局演变规律与发展趋势将深刻影响粤港澳大湾区的生态文明建设进程。以深港两地三期历史土地覆被数据为依据,应用CA-Markov模型预测了2030年景观类型,采用地学信息图谱、景观格局指数等方法对比了深港景观格局的时空分异特征,并通过地理探测器模型、logistic回归模型等方法,探讨了深圳与香港景观格局变化的驱动机制的异同。结果表明：（1）研究期内,深港两地景观格局变化显著,各景观类型之间互相转移频繁。深圳人造地表景观面积将持续增加,而香港则呈现先减少后增加的趋势;（2）深港两地的优势景观类型仍然是人造地表与林地。两地景观形状将趋于简单,相比于香港,深圳景观在呈现较高多样性的同时具有更为破碎化的特点;（3）夜间灯光所表征的经济发展水平对两地人造地表的扩张影响很大。在政策规划、社会经济水平、自然地理条件等多种因素的综合作用下,两地未来景观发展趋同存异。     

Missing teeth: Discordances in the trade of hippo ivory between Africa and Hong Kong

As the global epicentre of wildlife trade, Hong Kong plays an important role in the preservation or demise of biodiversity, including species found continents away. If mismanaged, legal trade in threatened species can lead to unsustainable exploitation. Inaccurate and incomplete trade records from the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) undermine the regulation of this trade. We examine the trade of hippo (Hippopotamus amphibius) teeth to illustrate the extent of mismatched data between key trading nations. More than 90% of global hippo teeth trade is imported to, and re‐exported from, Hong Kong. Of that imported, over 75% originated in Tanzania or Uganda, but there are notable disparities in declared trade volumes. In most transactions, Hong Kong declares more volume imported than the volume declared exported by Uganda. Overall, Hong Kong has reported the import of 3,176 kg more hippo teeth than declared exported by Tanzania. This indicates that actual trade levels may exceed internationally agreed quotas. In total, over 14,000 kg of hippo teeth is unaccounted for between Uganda and Hong Kong, representing more than 2,700 individual hippos—2% of the global population. This gross discordance in trade data undermines regulatory measures and challenges the persistence of hippo populations in Africa.     

A possible geographic origin of endemic hepatitis C virus 6a in Hong Kong: evidences for the association with Vietnamese immigration

Background

Hepatitis C virus (HCV) 6a accounts for 23.6% of all HCV infections of the general population and 58.5% of intravenous drug users in Hong Kong. However, the geographical origin of this highly predominant HCV subgenotype is largely unknown. This study explores a hypothesis for one possible transmission route of HCV 6a to Hong Kong.

Methods

NS5A sequences derived from 26 HCV 6a samples were chosen from a five year period (1999–2004) from epidemiologically unrelated patients from Hong Kong. Partial-NS5A sequences (513-bp from nt 6728 to 7240) were adopted for Bayesian coalescent analysis to reconstruct the evolutionary history of HCV infections in Hong Kong using the BEAST v1.3 program. A rooted phylogenetic tree was drawn for these sequences by alignment with reference Vietnamese sequences. Demographic data were accessed from “The Statistic Yearbooks of Hong Kong”.

Results

Bayesian coalescent analysis showed that the rapid increase in 6a infections, which had increased more than 90-fold in Hong Kong from 1986 to 1994 correlated to two peaks of Vietnamese immigration to Hong Kong from 1978 to 1997. The second peak, which occurred from 1987 through 1997, overlapped with the rapid increase of HCV 6a occurrence in Hong Kong. Phylogenetic analyses have further revealed that HCV 6a strains from Vietnam may be ancestral to Hong Kong counterparts.

Conclusions

The high predominance of HCV 6a infections in Hong Kong was possibly associated with Vietnamese immigration during 1987–1997.     

Conservation and variation in the hemagglutinins of Hong Kong subtype influenza viruses during antigenic drift.

The nucleotide sequence was determined for the hemagglutinin gene of the Hong Kong subtype influenza strain A/Bangkok/1/79. The amino acid sequence predicted from these data shows a total of 36 amino acid changes as compared with hemagglutinin for a 1968 Hong Kong strain, 11 more than had occurred in a 1975 strain. The distribution of these changes confirmed that there are conserved and highly variable regions in hemagglutinin as the viral gene evolves during antigenic drift in the Hong Kong subtype. Of the four variable regions found in this study, only two have been seen previously. Correlation of highly variable areas in the hemagglutinins of Hong Kong subtype field strains with sites of amino acid changes in antigenically distinct influenza variants enabled us to predict likely antigenic regions of the protein. The results support and extend similar predictions made recently, based on the three-dimensional arrangement of hemagglutinin from a 1968 influenza strain.     

Phylodynamics of HIV-1 subtype B among the men-having-sex-with-men (MSM) population in Hong Kong

The men-having-sex-with-men (MSM) population has become one of the major risk groups for HIV-1 infection in the Asia Pacific countries. Hong Kong is located in the centre of Asia and the transmission history of HIV-1 subtype B transmission among MSM remained unclear. The aim of this study was to investigate the transmission dynamics of HIV-1 subtype B virus in the Hong Kong MSM population. Samples of 125 HIV-1 subtype B infected MSM patients were recruited in this study. Through this study, the subtype B epidemic in the Hong Kong MSM population was identified spreading mainly among local Chinese who caught infection locally. On the other hand, HIV-1 subtype B infected Caucasian MSM caught infection mainly outside Hong Kong. The Bayesian phylogenetic analysis also indicated that 3 separate subtype B epidemics with divergence dates in the 1990s had occurred. The first and latest epidemics were comparatively small-scaled; spreading among the local Chinese MSM while sauna-visiting was found to be the major sex partner sourcing reservoir for the first subtype B epidemic. However, the second epidemic was spread in a large-scale among local Chinese MSM with a number of them having sourced their sex partners through the internet. The epidemic virus was estimated to have a divergence date in 1987 and the infected population in Hong Kong had a logistic growth throughout the past 20 years. Our study elucidated the evolutionary and demographic history of HIV-1 subtype B virus in Hong Kong MSM population. The understanding of transmission and growth model of the subtype B epidemic provides more information on the HIV-1 transmission among MSM population in other Asia Pacific high-income countries.     

Eating Metropolitaneity: Hong Kong Identity in yumcha

In Hong Kong, yumcha as a pervasive form of eating in the public has become an institution which epitomises the diversity and inclusiveness that Hong Kong people think are quintessential to the civility and economic achievement of the metropolis. It stands out particularly as a practice that has come to represent both locally and overseas a Hong Kong culture which has previously been characterised as residual of ‘Chinese tradition’ and ‘Western customs’, and hence is virtually non-existent. This paper looks at the consumption of metropolitaneity and the culturalisation of the heunggongyan or Hong Kong personal identity in the form, content and social relations involved in yumcha. It points to the significance of yumcha as a key to understanding a collective identity which has become more and more apparent as Hong Kong people vehemently try to establish a city with its own culture, first against the colonial grip and then the return of sovereignty to China in 1997.     

A Review of the Legal and Policy Framework for Vessel Source Pollution in Hong Kong

Vessel source marine pollution is an increasingly major concern at both the national and international levels. Hong Kong, as an important maritime center, is naturally concerned with vessel source pollution. To meet the challenges, Hong Kong has formulated policies and measures that emphasize “green shipping” as part of an overall planning strategy that promotes a “green economy.” This article provides a review and analysis of Hong Kong's marine pollution laws, with a view toward making policy suggestions. It argues that the general perception of the adequacy of Hong Kong's marine laws in combating vessel source pollution is flawed. It suggests that Hong Kong should adopt a more forward-looking perspective in the formulation of legal measures to control vessel source pollution.     

Nutrient flow in a major urban settlement: Hong Kong

A nutrient balance is established for the contemporary urban ecosystem of Hong Kong. The flow of nutrients in the Hong Kong food system in particular is examined, including current and potential nutrient recycling patterns. Losses of nutrients in food for human consumption are found to be up to 20% for major nutrients. The flow of mineral phosphorus in the Hong Kong food system is examined in detail. About 3600 tonnes of phosphorus are lost from the Hong Kong food system each year. A comparison is made between the land-based forage area demand of the Hong Kong population and a similar-sized Western population, that of Sydney, Australia. It is estimated that the average Hong Kong person consumes a diet which requires only half the land area needed to produce the diet of the average Sydney person. However, Hong Kong relies on the ocean for 25% of its animal protein supply compared with 2.5% for Sydney. Patterns of food production and nutrient recycling are proposed, with the aim of optimizing resource utilization in close association with contemporary urban settlements.     

Electron microscopy of influenza virus. A comparison of negatively stained and ice-embedded particles

An electron microscopical study was made of the influenza virus, type B/Hong Kong, in the unstained, frozen, hydrated state after quench-freezing in cooled liquid ethane. The results are compared with data from negatively stained specimens. It is shown that cryo-electron microscopy confirms and extends the data obtained by conventional methods. In particular, the virus is shown to be circular in projection with no indication of icosahedral symmetry, the lipid membrane is clearly resolved as a bi-layer and it is demonstrated that the distribution of material within the bi-layer is non-uniform, with a shell of more electron dense material surrounding a less dense central region. Neuraminidase spikes are not clearly distinguished from haemaglutinin spikes. The diameter of the complete B/Hong Kong virus was estimated from cryo-micrographs as 1270(+/- 70) A. Some preliminary data for influenza virus type A/X31 are presented.     

Bayesian analysis of severe acute respiratory syndrome: the 2003 Hong Kong epidemic

This paper analyzes data arising from a Severe Acute Respiratory Syndrome (SARS) epidemic in Hong Kong in 2003 involving 1755 cases. A discrete time stochastic model that uses a back-projection approach is proposed. Markov Chain Monte Carlo (MCMC) methods are developed for estimation of model parameters. The algorithm is further extended to integrate numerically over unobserved variables of the model. Applying the method to SARS data from Hong Kong, a value of 3.88 with a posterior standard deviation of 0.09 was estimated for the basic reproduction number. An estimate of the transmission parameter at the beginning of the epidemic was also obtained as 0.149 with a posterior standard deviation of 0.003. A reduction in the transmission parameter during the course of the epidemic forced the effective reproduction number to cross the threshold value of one, seven days after control interventions were introduced. At the end of the epidemic, the effective reproduction number was as low as 0.001 suggesting that the epidemic was brought under control by the intervention measures introduced.     

Weather factors in the short-term forecasting of daily ambulance calls

The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1–7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8 % decrease in the root mean square error, RMSE?=?53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10 % drop in prediction error (RMSE?=?62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory’s official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.     

Effects of temperature variation on suicide in five U.S. counties, 1991–2001

Effects of weather variables on suicide are well-documented, but there is still little consistency among the results of most studies. Nevertheless, most studies show a peak in suicides during the spring season, and this is often attributed to increased temperatures. The purpose of this study is to test the relationship between monthly temperature and monthly suicide, independent of months or seasons, for five counties located across the United States. Harmonic analysis shows that four of the five counties display some seasonal components in the suicide data. However, simple linear regression shows no correlation between suicide and temperature, and discriminant analysis shows that monthly departure from mean annual suicide rates is not a useful tool for identifying months with temperatures that are colder or warmer than the annual average. Therefore, it appears that the seasonality of suicides is due to factors other than temperature.     

Review of evolution of clinical,training and educational services and research program for autism spectrum disorders in Hong Kong

The evolution of a local fragmented model of services for children with autism in Hong Kong emerged gradually over the past three decades with lack of government funding or support. This had been due to increasing number of children with autism being detected and referred for earlier assessment. With increasing pressure from parents due to long waiting time for assessment and training services and the increasing polarization by mass media there had been a gradual increasing public awareness over the past five years. Though still highly fragmented in the availability of services, there is a growing "business model" available in the community due to increasing need and lack of public funding for support. There is a lack of strategic planning for medical diagnostic and management issues in Hong Kong. Our University of Hong Kong based Autism Research Program was pioneered in 1985 based on the increasing load of autism cases referred for assessment for other developmental problems and diagnosed as Autism in the Duchess of Kent Children's Hospital. As the first author has been the staff of the University of Hong Kong, this program flourished as a research based program. The benefits of early identification and intervention of autism spectrum disorder(ASD) had been increasingly recognized, and with the increased public awareness and increasing trend of earlier diagnosis, there has been a continuously high demand from parents for earlier assessment and training for children suspected to have ASD. This model had not received extra funding for this integrated program for research, teaching and training in autism. We had to apply for various donations and grants to support the development of this pioneer program. The research output and organization of forums for public education and awareness are reviewed. The latter part of the paper reports the summary of clinical profile of autism cases(N=1441) assessed from 1985 to 2010 June under the University of Hong Kong. As the waiting time for initial developmental assessment for any children in Hong Kong is 12?24 months, we also report our preliminary experience with a newly launched triaging service provision for children suspected to be ASD since 2009, including multi-disciplinary assessment and parallel interim training in our university affiliated child assessment centre in Hong(N=89).     

入侵我国红火蚁的三种单倍型

红火蚁Solenopsis invicta Buren是重要的经济害虫,特别是在农业和生态系统危害方面。2004年底在广东和香港的部分地区发现红火蚁入侵。本文用线粒体细胞色素氧化酶Ⅰ（CO Ⅰ）基因对境内的13个种群进行了入侵蚁巢是否独立传入进行了分析。通过对共计28个蚁巢56个体的包含904个碱基的CO Ⅰ基因分析,发现入侵中国的红火蚁中存在3种单倍型。基于未修正的配对序列变异分析表明,单倍型Ⅱ与单倍型Ⅲ之间的变异最小。而香港种群同时具有这三种单倍型,是入侵中国的红火蚁种群中多样性最丰富的地区。这三种单倍型都分别在阿根廷红火蚁种群中有记录。同源性分析显示,中国的红火蚁可能起源于阿根廷或南美洲,而香港可能是所研究种群的第一入侵地点。     

Hong Kong’s rich marine biodiversity: the unseen wealth of South China’s megalopolis

Hong Kong is famous as a bustling harbour and financial centre, with a dense burgeoning population impacting its coastal environment. Yet, away from the skyscrapers and the pressures of anthropogenic influence, Hong Kong supports a rich marine biodiversity, including corals and mangrove communities. Despite having a small marine area (1651 km²), a total of 5943 marine species have been recorded in Hong Kong waters. Most of these species were reported during the 1980s and 1990s, but new species continue to be discovered, and ~6500 species are estimated. Even though Hong Kong’s marine area is only ~0.03 % of that of China, the number of marine species recorded in Hong Kong already accounts for ~26 % of the total recorded in China. Hong Kong also contributes to a considerable amount (>30 %) of the species records for several taxa including amphipods, cephalopods, polychaetes and fish in the South China Sea, and ~29 % of the hermit crab species in the largest global marine species database, the World Register of Marine Species. These findings demonstrate the rich marine biota found in Hong Kong, which probably reflects Hong Kong’s location within the fringes of the world’s marine biodiversity hotspot.     

Vermicomposting in the management of pig-waste in Hong Kong

The treatment and disposal of pig-waste in Hong Kong has received much attention in recent years but, following any of the presently used treatment processes, solids remain to be further stabilized. Vermicomposting is a waste stabilization technique which converts waste into potentially recyclable materials such as worm protein and worm casts. The earthworm, Pheretima asiatica, can stabilize most of the solids arising from the treatment of pig-waste, including raw pig manure, suggesting that vermicomposting has a high potential as a unit process in the management of pig-waste in Hong Kong.S.H. Wong is with the Environmental Protection Department, Hong Kong; and D.A. Griffiths is with the Department of Botany, University of Hong Kong, Hong Kong.     

香港特区公营医院运行机制评估及对内地的启示

回顾香港医疗融资的发展历程并简述香港公营医院的运营状况与开支构成比,重点分析香港公营医院的管理机构——香港医院管理局,研究其宗旨任务与目标策略相结合的管理医院管理战略,跟踪其主要经费来源的变化趋势,对其财务状况进行深入探究并进行预测。在对香港公营医院运行机制进行评估的基础上,探讨香港公营医院存在的问题以及对内地的启示,为内地医院管理机构借鉴香港逐步建立以政府投入为主体的医疗融资体系提供参考。