Papers by William Goggins
Epidemiology, 2019
Background: Pneumonia is a common cause of childhood hospitalization. Both host and pathogen fac... more Background: Pneumonia is a common cause of childhood hospitalization. Both host and pathogen factors are associated with environmental conditions, but the associations between childhood pneumonia and meteorological variables are unclear. This study investigated the short-term associations between childhood pneumonia admissions and meteorological variables.
Methods: A retrospective time-series analysis was conducted using distributed lagged nonlinear models. Daily pneumonia admissions among children <15-year-old in Hong Kong during 2004–2011 were regressed on daily meteorological variables with air pollutants, influenza admissions, seasonal trend, and long-term trend adjusted. Analyses were stratified by age group.
Results: There were 34,303 admissions during 2004–2011. Temperature had a u-shaped association with childhood pneumonia admissions with minimum morbidity temperature at 25°C and with a long lagged effect up to 45 days. The cumulative relative risk (cum RR [95% confidence interval]) (vs. 25°C; lag 0–45 days) at 30°C was 1.41 (1.11, 1.79) and was 1.58 (1.21, 2.06) at 12°C. Relative humidity (RH) showed a u-shaped association with minimum risk at 65% and lagged effect up to 45 days. The cum RR (vs. 65%; lag 0–45 days) at 53% was 1.26 (1.04, 1.54) and was 2.22 (1.78, 2.77) at 94%. Children 5- to 14-year- olds were highly sensitive to temperature and RH while admissions among children <5-year-old were only associated with high RH. Conclusions: Childhood pneumonia admissions were very strongly associated with both high and low temperature and RH for children
5–14-year-olds. Efforts to reduce exposure of children to extreme temperatures and RH may have the potential to reduce the burden of pediatric pneumonia.
Environmental health : a global access science source, Jan 19, 2013
Numerous studies have found associations between extreme temperatures and human mortality but rel... more Numerous studies have found associations between extreme temperatures and human mortality but relatively few studies have been done in sub-tropical and tropical cities, especially in Asia. In this study we examine the impact of cold temperatures, cold waves and other meteorological and environmental variables on cool season mortality in 2 subtropical Asian cities. Separate analysis of daily mortality time-series from Hong Kong and Taipei using Generalized Additive Models with natural mortality as the outcome daily mean temperature as the main explanatory variable and relative humidity, solar radiation, wind speed, pollutants (nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), respirable suspended particulates (PM(10)), ozone (O(3)), seasonality and day of the week controlled as potential confounders. Lags up to 35 days were considered for temperature, and distributed lag models were used to determine the number of lags for final models. Subgroup analyses were also done by gender, age...
Background and Purpose—Many studies have reported increases in daily cardiovascular mortality and... more Background and Purpose—Many studies have reported increases in daily cardiovascular mortality and hospital admissions associated with increases in levels of air pollutants. However, little is known about the relationship between hospital admissions for stroke and air pollution. This study was undertaken to determine whether there is an association between air pollution and hospital admissions for stroke in Kaohsiung, Taiwan. Methods—Data
Background. The concept of a frailty index, developed in Canadian elderly populations as an indic... more Background. The concept of a frailty index, developed in Canadian elderly populations as an indicator of biological age as opposed to chronological age, was tested in an elderly Chinese population to determine whether it is applicable in a different ethnic and cultural setting. Methods. A data set including 62 physical, psychological, and socioeconomic variables from a cohort of 2032 persons
Public health, 2014
To examine the uptake of breast screening and its associated factors among Hong Kong Chinese wome... more To examine the uptake of breast screening and its associated factors among Hong Kong Chinese women aged ≥50 years. Cross-sectional population-based survey. A sample of Hong Kong Chinese women was recruited through telephone random-digit dialling. The survey consisted of six sections: perceived health status, use of complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of breast screening were analysed using logistic regression analysis. In total, 1002 women completed the (anonymous) telephone survey. The mean age was 63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong Chinese women aged ≥50 years was 34%. The primary reasons for undertaking breast screening were as part of a regular medical check-up (74%), prompted by local signs and symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or coha...
Introduction: There are limited studies that examine how injury patterns might be affected by ele... more Introduction: There are limited studies that examine how injury patterns might be affected by elevated temperature in urban cities of Asia. Study objectives are to: 1) examine the relationship between temperature and injury related hospital admissions in Hong Kong, and 2) identify high-risk demographic subgroups related to temperature/injury patterns. Method: A retrospective, ecological, generalized additive (Poisson) temperature- injury model study of routine hospital, weather and pollution data from 1998-2008. Health outcomes (ICD 10) included unintentional (ICD-10: S00-T32, V01-X59)) and intentional injuries (ICD-10: X60-X84, X85-Y09), daily weather variables (mean daily temperatures, dew point temperatures, and mean humidity), pollution data (NO2, SO2, O3, and PM10) were obtained from Hong Kong Hospital Authority (HA), Hong Kong Observatory (HKO) and Hong Kong Environmental Protection Department (EPD) respectively. Individual socioeconomic proxy variable was constructed by match...
Background: Few published studies have examined the health impacts of floods, especially in middl... more Background: Few published studies have examined the health impacts of floods, especially in middle-income countries such as China, and the effects of ethnicity and older age have not been explored. In October 2010, Hainan Island in China experienced severe flooding following heavy rainfall. This study describes the physical and mental health impacts of the floods and investigates differences between age and ethnic groups. Methods: A cross-sectional survey of 267 households was conducted three months after the flooding. A four-stage cluster sampling method was used to randomly select households from affected areas. Information was collected on socio-demographic status, pre-disaster health and experience of the disaster. Results: The incidence of self-reported flood-related physical illness was 22.8%. The most common illnesses were respiratory infections, diarrhea and skin disease. 7.1% reported sustaining an injury. Han Chinese were more likely to report a physical illness/injury tha...
We tested the hypotheses firstly that people dying in older age groups do not use hospital servic... more We tested the hypotheses firstly that people dying in older age groups do not use hospital services more than those dying in younger age groups in the previous 3 years before death; secondly, that there may be compression of morbidity demonstrated by a decline in the use of hospital services among people in the last 3 years before death in the older age groups. We extracted mortality data from all hospitals of the Hospital Authority and analyzed the data using negative binomial regression with duration of hospital stay before death as the outcome variables; age, gender, year of death (period), and birth cohort were predictor variables. People dying in older age groups do not use in patient hospital services more than younger age groups in the 3 years before death. However, they do use more AED services. No compression in morbidity was demonstrated. Data obtained from this retrospective study may be used to project future usage for each type of service as a result of changing age structure of the population.
Environmental health : a global access science source, 2013
Numerous studies have found associations between extreme temperatures and human mortality but rel... more Numerous studies have found associations between extreme temperatures and human mortality but relatively few studies have been done in sub-tropical and tropical cities, especially in Asia. In this study we examine the impact of cold temperatures, cold waves and other meteorological and environmental variables on cool season mortality in 2 subtropical Asian cities. Separate analysis of daily mortality time-series from Hong Kong and Taipei using Generalized Additive Models with natural mortality as the outcome daily mean temperature as the main explanatory variable and relative humidity, solar radiation, wind speed, pollutants (nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), respirable suspended particulates (PM(10)), ozone (O(3)), seasonality and day of the week controlled as potential confounders. Lags up to 35 days were considered for temperature, and distributed lag models were used to determine the number of lags for final models. Subgroup analyses were also done by gender, age...
Geospatial health, 2013
A deeper understanding of extreme hot weather are needed in cities sensitive to heat effects, an ... more A deeper understanding of extreme hot weather are needed in cities sensitive to heat effects, an investigation was done in the tropical town of Kaohsiung in Taiwan. Its 11 districts were divided into three climatic classes varying from high urban heat, low levels of green space and lack of proximity to water bodies to low urban heat, adequate green space and proximity to water bodies. Daily data on natural mortality, meteorological variables, and pollutants from May-October 1999-2008 were analysed using generalised additive models for the time-series data. Subgroup analyses were conducted, stratifying decedents according to the level of planning activity required in order to mitigate adverse heat effects in their residential areas, classifying districts as "level 1" for those requiring a high level of mitigation action; "level 2" for those requiring some action; and "level 3" for those that need only preserve existing conditions. Stratified analyses showed that mortality increases per 1 °C rise on average, either on the same day or in the previous 4 days (lags 0-4), were associated with 2.8%, 2.3% and -1.3% for level 1, 2 and 3 districts, respectively. The slope describing the association between temperature and mortality was higher above 29.0 °C resulting in corresponding increases of 4.2%, 5.0% and 0.3% per per 1 °C rise in temperature, respectively. Other meteorological variables were not significantly associated with mortality. It is concluded that hot season mortality in Kaohsiung is only sensitive to heat effects in districts classified as having unfavourably climatic conditions and requiring mitigation efforts in city planning. Urban planning measures designed to improve climatic conditions could reduce excess mortality resulting from extreme hot weather.
among Hong Kong Chinese is much higher than in many other developed countries. Conclusions: There... more among Hong Kong Chinese is much higher than in many other developed countries. Conclusions: There were different trends of hemorrhagic and ischemic stroke incidence in Hong Kong. The findings highlight the public health importance of further research into the underlying causes of the increasing trend in hemorrhagic stroke in the younger age group, and the higher overall age-adjusted stroke incidence in Hong Kong compared with other developed countries.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2014
JAMA Internal Medicine, 2014
In type 2 diabetes mellitus (T2DM), team management using protocols with regular feedback improve... more In type 2 diabetes mellitus (T2DM), team management using protocols with regular feedback improves clinical outcomes, although suboptimal self-management and psychological distress remain significant challenges. To investigate if frequent contacts through a telephone-based peer support program (Peer Support, Empowerment, and Remote Communication Linked by Information Technology [PEARL]) would improve cardiometabolic risk and health outcomes by enhancing psychological well-being and self-care in patients receiving integrated care implemented through a web-based multicomponent quality improvement program (JADE [Joint Asia Diabetes Evaluation]). Between 2009 and 2010, 628 of 2766 Hong Kong Chinese patients with T2DM from 3 publicly funded hospital-based diabetes centers were randomized to the JADE + PEARL (n = 312) or JADE (n = 316) groups, with comprehensive assessment at 0 and 12 months. Thirty-three motivated patients with well-controlled T2DM received 32 hours of training (four 8-hour workshops) to become peer supporters, with 10 patients assigned to each. Peer supporters called their peers at least 12 times, guided by a checklist. Changes in hemoglobin A(1c) (HbA(1c)) level (primary), proportions of patients with attained treatment targets (HbA(1c) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;7%; blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;130/80 mm Hg; low-density lipoprotein cholesterol &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.6 mmol/L [to convert to milligrams per deciliter, divide by 0.0256]) (secondary), and other health outcomes at month 12. Both groups had similar baseline characteristics (mean [SD] age, 54.7 [9.3] years; 57% men; disease duration, 9.4 [7.7] years; HbA(1c) level, 8.2% [1.6%]; systolic blood pressure, 136 [19] mm Hg; low-density lipoprotein cholesterol level, 2.89 [0.82] mmol/L; 17.4% cardiovascular-renal complications; and 34.9% insulin treated). After a mean (SD) follow-up period of 414 (55) days, 5 patients had died, 144 had at least 1 hospitalization, and 586 had repeated comprehensive assessments. On intention-to-treat analysis, both groups had similar reductions in HbA(1c) (JADE + PEARL, 0.30% [95% CI, 0.12%-0.47%], vs JADE, 0.29% [95% CI, 0.12%-0.47%] [P = .97]) and improvements in treatment targets and psychological-behavioral measures. In the JADE + PEARL group, 90% of patients maintained contacts with their peer supporters, with a median of 20 calls per patient. Most of the discussion items were related to self-management. In patients with T2DM receiving integrated care, peer support did not improve cardiometabolic risks or psychological well-being. clinicaltrials.gov Identifier: NCT00950716.
Geospatial health, 2011
Geographical variations in stroke incidence and case-fatality have been documented worldwide. Thi... more Geographical variations in stroke incidence and case-fatality have been documented worldwide. This study examines whether there are spatio-temporal variations in stroke incidence and case-fatality in Hong Kong and attempts to determine to what extent socioeconomic status (SES) and healthcare provision account for these variations. Residence-based hospital discharge data from the Hospital Authority (HA) in Hong Kong were geo-referenced and used to examine incidence rates and case-fatality rates by stroke subtype among the population aged 35 years and above in 1999-2007. Multilevel models were used to examine the spatio-temporal variations. Ischemic stroke incidence was found to decrease among those aged above 55 years, while hemorrhagic stroke incidence increased. Ischemic stroke case-fatality was found to decrease but hemorrhagic stroke case-fatality remained stable. For both subtypes, there were significant variations in stroke incidence and case-fatality across the districts of residence, but insignificant variations across HA service clusters. Only variations in ischemic stroke incidence and hemorrhagic stroke case-fatality at the district level could be partly explained by district-level SES. Identification of districts with higher risk for stroke incidence and case-fatality would help to formulate enhanced preventive measures. Future studies are needed to identify factors that contribute to the geographical variations.
Sentinel laboratory surveillance from one hospital and passive discharge diagnosis (Clinical Mana... more Sentinel laboratory surveillance from one hospital and passive discharge diagnosis (Clinical Management System, CMS) data from all public Hospital Authority (HA) hospitals were used to estimate disease burden and incidence of rotavirus in hospitalised Hong Kong children over 14 rotavirus seasons (1 July 1997 to 31 March 2011). A primary diagnosis of a gastroenteritis-related disorder was noted in 9.8% of children aged below 5 years, and a primary or secondary diagnosis in 11.8%. Any CMS diagnosis of rotavirus (ICD 008.61) was initially used to derive incidence estimates of rotavirus by age group. Rotavirus was recorded as any primary or any secondary diagnosis in 1.6% of children below 5 years of age. The unadjusted incidence rates per 100,000 person-years based on any CMS diagnosis of rotavirus were: 249 (0 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1m); 612 (1 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2m); 1066 (2 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6m); 1383 (6 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;11m); 959 (1 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2y); 406 (2 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3y); 233 (3 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;4y); 124 (4 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5y). Overall the rotavirus incidence was 1071 in children below 2 years and 542 in children below 5 years of age, with the incidence rates trending up during the time period (p=0.001). A similar but less marked upward trend (p=0.046) was noted for the incidence of all-cause gastroenteritis. Laboratory results from a single surveillance hospital (1 July 2000 to 31 March 2011) were then linked to these CMS codes to derive adjustment factors for possible over- and under-diagnosis of rotavirus based on CMS codes alone. This analysis suggested that a CMS diagnosis of rotavirus alone likely under-reported true incidence by a factor of between 1.59 and 2.02 in children below 5 years of age. Despite the availability of rotavirus vaccines in the private sector since 2006, no reduction in the incidence of hospitalisation for either rotavirus or all-cause gastroenteritis was noted in Hong Kong children below 5 years of age over 14 rotavirus seasons (1997-2011).
Alzheimer's disease (AD), the most common dementia, is characterized by potentially neurotoxic ag... more Alzheimer's disease (AD), the most common dementia, is characterized by potentially neurotoxic aggregation of Aβ peptide and tau protein, and their deposition as amyloid plaques and neurofibrillary tangles (NFTs). Tau aggregation also occurs in other common neurodegenerative diseases. Frontotemporal dementia (FTD) can be caused by tau mutations that increase the susceptibility of tau to hyperphosphorylation and aggregation, which may cause neuronal dysfunction and deposition of NFTs. 17-allylamino-17-demethoxygeldanamycin (17-AAG) is a potent inhibitor of heat shock protein 90 (Hsp90), a cytosolic chaperone implicated in the proper folding and functions of a repertoire of client proteins. 17-AAG binds to Hsp90 and enhances degradation of Hsp90 client protein. We sought to determine whether 17-AAG can reduce Aβ and tau pathology in the brains of AD and FTD model mice expressing Aβ or P301L mutant tau, respectively. Mice were randomized to receive 25, 5, or 0 mg/kg 17-AAG thrice weekly from age eight to 11 months. Analysis was performed by rotarod test on motor function, on the area occupied by plaques in hippocampus or NFTs in medulla tissue sections, and on mortality. A high dose of 17-AAG tended to decrease NFTs in male mice (p = 0.08). Further studies are required to confirm the effect of 17-AAG in diseases of tau aggregation.
Pharmacological research : the official journal of the Italian Pharmacological Society, 2007
Studies in animals and a short-term human study have suggested that curcumin, a polyphenolic comp... more Studies in animals and a short-term human study have suggested that curcumin, a polyphenolic compound concentrated in the curry spice turmeric, decreases serum cholesterol concentration. However, no controlled human trials have examined the effect of curcumin on cholesterol. This study investigated the effects of consuming curcumin on the serum lipid profile in men and women. Elderly subjects (n=36) consumed 4 g/d curcumin, 1g/d curcumin, or placebo in a 6-month, randomized, double-blind trial. Plasma curcumin and its metabolites were measured at 1 month, and the serum lipid profile was measured at baseline, 1 month, and 6 months. The plasma curcumin concentration reached a mean of 490 nmol/L. The curcumin concentration was greater after capsule than powder administration. Consumption of either dose of curcumin did not significantly affect triacylglycerols, or total, LDL, and HDL cholesterol over 1 month or 6 months. However, the concentrations of plasma curcumin and serum cholester...
Cancer biology & medicine, 2014
To investigate the uptake rate of prostate specific antigen (PSA) testing among Hong Kong Chinese... more To investigate the uptake rate of prostate specific antigen (PSA) testing among Hong Kong Chinese males aged 50 or above, and identify factors associated with the likelihood of undergoing a PSA test. A population-based telephone survey was conducted in Hong Kong in 2007. The survey covered demographic information, perceived health status, use of complementary therapy, cancer screening behavior, perceived susceptibility to cancer and family history of cancer. Descriptive statistics, percentages and logistic regression analysis were used for data analysis. A total of 1,002 men aged 50 or above took part in the study (response rate =67%), and the uptake rate of PSA testing was found to be 10%. Employment status, use of complementary therapy, perceiving regular visits to a doctor as good for health and the recommendations of health professionals were significant factors associated with PSA testing. The uptake rate of PSA testing in the study population was very low. Among all the factor...
The American Journal of Gastroenterology, 2009
The association of interleukin-1B ( IL-1B )-511 polymorphism with gastric cancer is still controv... more The association of interleukin-1B ( IL-1B )-511 polymorphism with gastric cancer is still controversial, and the association of IL-1B -511 polymorphism with subtypes of gastric cancer is still largely unknown. We investigated whether the association between IL-1B -511 polymorphism and gastric cancer risk varies by clinically important tumor characteristics and the prognostic value of this polymorphism in a large population-based case -control study among Chinese.
Clinical transplants, 2009
Indiana University's kidney transplant program has undergone changes in the program's app... more Indiana University's kidney transplant program has undergone changes in the program's approach to immunosuppression. This change in philosophy has moved the program away from multiple chronic maintenance immunosuppression strategies with corticosteroids to steroid-free maintenance immunosuppressive strategies for both adults and pediatric recipients. Anti-thymocyte globulin induction (beginning pre-reperfusion) has allowed for the rapid post-transplant withdrawal of corticosteroids. Steroid-free maintenance immunosuppression has been achieved with excellent patient and graft survival as well as lower rejection rates in the first posttransplant year. Desensitized recipients can also be safely included in steroid-free protocols. The administration of anti-thymocyte globulin prereperfusion combined with pulsatile perfusion storage of deceased donor kidneys has led to an extremely low delayed graft function rate.
Uploads
Papers by William Goggins
Methods: A retrospective time-series analysis was conducted using distributed lagged nonlinear models. Daily pneumonia admissions among children <15-year-old in Hong Kong during 2004–2011 were regressed on daily meteorological variables with air pollutants, influenza admissions, seasonal trend, and long-term trend adjusted. Analyses were stratified by age group.
Results: There were 34,303 admissions during 2004–2011. Temperature had a u-shaped association with childhood pneumonia admissions with minimum morbidity temperature at 25°C and with a long lagged effect up to 45 days. The cumulative relative risk (cum RR [95% confidence interval]) (vs. 25°C; lag 0–45 days) at 30°C was 1.41 (1.11, 1.79) and was 1.58 (1.21, 2.06) at 12°C. Relative humidity (RH) showed a u-shaped association with minimum risk at 65% and lagged effect up to 45 days. The cum RR (vs. 65%; lag 0–45 days) at 53% was 1.26 (1.04, 1.54) and was 2.22 (1.78, 2.77) at 94%. Children 5- to 14-year- olds were highly sensitive to temperature and RH while admissions among children <5-year-old were only associated with high RH. Conclusions: Childhood pneumonia admissions were very strongly associated with both high and low temperature and RH for children
5–14-year-olds. Efforts to reduce exposure of children to extreme temperatures and RH may have the potential to reduce the burden of pediatric pneumonia.
Methods: A retrospective time-series analysis was conducted using distributed lagged nonlinear models. Daily pneumonia admissions among children <15-year-old in Hong Kong during 2004–2011 were regressed on daily meteorological variables with air pollutants, influenza admissions, seasonal trend, and long-term trend adjusted. Analyses were stratified by age group.
Results: There were 34,303 admissions during 2004–2011. Temperature had a u-shaped association with childhood pneumonia admissions with minimum morbidity temperature at 25°C and with a long lagged effect up to 45 days. The cumulative relative risk (cum RR [95% confidence interval]) (vs. 25°C; lag 0–45 days) at 30°C was 1.41 (1.11, 1.79) and was 1.58 (1.21, 2.06) at 12°C. Relative humidity (RH) showed a u-shaped association with minimum risk at 65% and lagged effect up to 45 days. The cum RR (vs. 65%; lag 0–45 days) at 53% was 1.26 (1.04, 1.54) and was 2.22 (1.78, 2.77) at 94%. Children 5- to 14-year- olds were highly sensitive to temperature and RH while admissions among children <5-year-old were only associated with high RH. Conclusions: Childhood pneumonia admissions were very strongly associated with both high and low temperature and RH for children
5–14-year-olds. Efforts to reduce exposure of children to extreme temperatures and RH may have the potential to reduce the burden of pediatric pneumonia.