Tai Hing Lam

The University of Hong Kong, Hong Kong, Hong Kong

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Publications (530)2109.88 Total impact

  • Journal of the American Geriatrics Society 01/2008; 55(12):2090-1. · 4.22 Impact Factor
  • Diabetes care 01/2008; 30(12):3116-8. · 7.74 Impact Factor
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    ABSTRACT: Female height impacts fertility differently in western and nonwestern cultures. Leg length or relatively longer legs comprise key components of height and possibly indicates mate value. We examined the associations between height, its components, and reproductive outcomes in a large Chinese cohort. Multivariable regression was used to assess the association of height, leg length (standing minus sitting height) and relatively longer legs with number of offspring in a cross-sectional sample of 9998 Chinese people aged at least 50 years from Phase 2 of the Guangzhou Biobank Cohort Study recruited in 2005–2006. Older and less educated respondents had more children. Adjusted for age, childhood socioeconomic status (SES), and education, women with longer legs had more offspring; however, there was no such association in men. When stratified by childhood SES (reported parental material possessions), longer legs and relatively longer legs were most strongly associated with more offspring in women from poorer backgrounds. Fertility was specifically associated with longer legs and relatively longer legs in women only. The difference in the association of leg length to number of offspring by childhood SES suggests a preference advantage rather than a physiological advantage in being taller. However, these benefits were specific to reproductive success in women and particularly women from poorer backgrounds suggesting that social factors may have facilitated fertility.
    Evolution and Human Behavior - EVOL HUM BEHAV. 01/2008; 29(6):434-443.
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    ABSTRACT: In western populations, young age of menarche is associated with increased cardiovascular risk. Little is known about the potential impact of menarche on the metabolic syndrome (as a proxy for cardiovascular risk) in rapidly economically developing populations where age of menarche is falling. We sought to determine the relation between age of menarche and the metabolic syndrome in a rapidly developing Chinese population. We carried out a retrospective historical cohort study of 7349 women from the Guangzhou Biobank Cohort Study, China, enrolled in 2003-2004. Cardiovascular risk factors were obtained from physical examination; age of menarche was obtained from self-report. The main outcome measure was the metabolic syndrome and its components. Adjusted for age, education, and number of pregnancies, young age of menarche (<12.5 years) compared with age of menarche > or =14.5 years was associated with a higher risk of the metabolic syndrome (odds ratio = 1.49; 95% confidence interval = 1.22-1.82), central obesity (1.35; 1.10-1.65), raised blood pressure (1.34; 1.09-1.65), raised fasting glucose (1.40; 1.15-1.71), and higher triglyceride levels (1.36; 1.12-1.67). Further adjustment by waist circumference attenuated these effects, but the odds ratios remained elevated. Earlier age of menarche experienced by younger women in China today, now 12.5 years on average in urban populations, may contribute to an increase in the metabolic syndrome and thereby an increase in cardiovascular disease as these women age. These results further highlight the importance of childhood antecedents of adulthood disease.
    Epidemiology 11/2007; 18(6):740-6. · 5.74 Impact Factor
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    ABSTRACT: Better childhood conditions, inferred from height and specifically leg length, are usually protective against ischemic heart disease and its risk factors in Western countries. In other geoethnic populations, height is less clearly protective, casting doubt on there being a biological etiology. To clarify the role of childhood conditions, we examined the associations of height and its components with cardiovascular risk among older Chinese people. We used multivariable regression to examine the associations of height and its components with blood pressure, lipid profile, and diabetes in 10413 older Chinese adults (mean age=64.6 years). After we adjusted for age, gender, socioeconomic status, and lifestyle habits, greater sitting height was associated with diabetes and dyslipidemia. Longer legs were associated with lower pulse pressure and lower low-density lipoprotein cholesterol. We provide indirect anthropometric evidence for the role of pre-pubertal and pubertal exposures on cardiovascular risk. Pubertal exposures are stronger than are prepubertal exposures but may be influenced by osteoporotic decline in old age. Further research should establish whether the observed relations are ethnically specific or relate to the stage or trajectory of socioeconomic development.
    American Journal of Public Health 11/2007; 97(10):1834-41. · 3.93 Impact Factor
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    ABSTRACT: This study investigates the relation of five chronic cardiovascular diseases and diabetes mellitus (DM) to perceived health, and the moderating effects of sex and age. In a community-based cross-sectional telephone survey in Hong Kong, 7730 Chinese aged 25-74 were interviewed in 1994-1996. The odds ratio for poor perceived health associated with each condition was calculated adjusting for age, sex and education. Subjects free from the six conditions were treated as the comparison group. Hypertension, angina, DM, coronary heart disease (CHD) and stroke were significantly associated with poor perceived health. The odds ratio of poor perceived health was significantly greater in men than in women for having more than one condition among DM, CHD and stroke (p=0.02), and insignificantly greater for stroke, CHD and angina. The odds ratios were significantly greater in the young (25-39) versus the old (60-74) for DM (p=0.008) in men and women combined, and for having either DM, CHD or stroke in men (p=0.02). These findings suggest that the relation of DM, CHD and stroke with poor perceived health tends to be stronger in men and younger adults. These findings have implications for health care workers and home carers who need to appreciate that the same condition may have a different perceived impact on persons of different sex and age, and be sensitive to their varying needs.
    Social Science [?] Medicine 11/2007; 65(7):1386-96. · 2.73 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in China, where the population is also exposed to high levels of passive smoking, yet little information exists on the effects of such exposure on COPD. We examined the relation between passive smoking and COPD and respiratory symptoms in an adult Chinese population. We used baseline data from the Guangzhou Biobank Cohort Study. Of 20 430 men and women over the age of 50 recruited in 2003-06, 15,379 never smokers (6497 with valid spirometry) were included in this cross-sectional analysis. We measured passive smoking exposure at home and work by two self-reported measures (density and duration of exposure). Diagnosis of COPD was based on spirometry and defined according to the GOLD guidelines. There was an association between risk of COPD and self-reported exposure to passive smoking at home and work (adjusted odds ratio 1.48, 95% CI 1.18-1.85 for high level exposure; equivalent to 40 h a week for more than 5 years). There were significant associations between reported respiratory symptoms and increasing passive smoking exposure (1.16, 1.07-1.25 for any symptom). Exposure to passive smoking is associated with an increased prevalence of COPD and respiratory symptoms. If this association is causal, we estimate that 1.9 million excess deaths from COPD among never smokers could be attributable to passive smoking in the current population in China. Our findings provide strong evidence for urgent measures against passive smoking in China.
    The Lancet 10/2007; 370(9589):751-7. · 39.21 Impact Factor
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    ABSTRACT: To examine the association between serum c-reactive protein (CRP) concentration and the metabolic syndrome (MS) using the International Diabetes Federation Metabolic Syndrome Guidelines (April, 2005) definition in an older Chinese population. Three thousand and fourteen men and 7275 women aged 50-85 years were recruited and received a full medical check-up including measurement of blood pressure, obesity indices, fasting total, LDL-, HDL-cholesterol, triglycerides, glucose and c-reactive protein. Data describing socioeconomic and lifestyle factors was also collected. Vascular risk factors including waist circumference, weight gain and waist gain since the age of 18, body mass index, waist-hip-ratio, triglyceride, HDL-cholesterol, and systolic and diastolic blood pressures were positively associated with CRP in both men and women (p from <0.001 to 0.016). Compared to those without MS components, adjusted odds ratios for having elevated CRP increased in those with the MS or its components compared those without MS or components (all p<0.001), except for the low HDL-cholesterol in both genders and raised fasting glucose in men. Similarly, the risk of elevated CRP increased with escalating MS components even after adjustment of a range of potential confounders. There is a strong relationship between CRP and the constellation of MS components and associated vascular risk in this older Chinese population.
    Atherosclerosis 10/2007; 194(2):483-9. · 3.71 Impact Factor
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    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 09/2007; 13(4):332; author reply 332-3.
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    ABSTRACT: This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of risk.
    Suicide and Life-Threatening Behavior 09/2007; 37(4):453-66. · 1.33 Impact Factor
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    ABSTRACT: Objective:We examined the psychometric properties of the Eating Disorder Diagnostic Scale (EDDS) in a community sample of Hong Kong school children.Method:Participants (359 boys and 387 girls), aged 12 to 19 years, were assessed on the EDDS on two occasions, one month apart. Factor structure, internal consistency, test-retest reliability, and validity against the Eating Disorders Examination–Questionnaire (EDE-Q) and Center for Epidemiological Studies-Depression (CES-D) were investigated.Results:Four groupings emerged on exploratory factor analysis: body dissatisfaction, bingeing behaviors, bingeing frequency, and frequency of compensatory behaviors. Items loaded on the same factors for boys and girls. Internal consistency for these factors was acceptable. Test-retest reliability was high for body dissatisfaction factor but weak to moderate for other factors and for diagnoses. High concurrent validity with the EDE-Q, and correlation with the CES-D was shown.Conclusion:We offer preliminary reliability and validity evidence to support the further development of the EDDS as a screening instrument to assess eating disturbances in Hong Kong youth. © 2007 by Wiley Periodicals, Inc.
    International Journal of Eating Disorders 08/2007; 40(6):569 - 574. · 3.03 Impact Factor
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    ABSTRACT: Most dietary recommendations are based on studies of limited power and do not adequately reflect the current knowledge base, particularly with regard to effects of diet on clinical outcomes, the most important endpoint from the patients' perspective. In this review we discusses the current state of dietary research, and present a summary of the evidence upon which to base dietary recommendations and guidelines for atherosclerotic vascular disease prevention. We also highlight the complexity and limitations of interpreting current diet-based epidemiological studies in isolation.
    Cardiovascular & Haematological Disorders - Drug Targets(Formerly Current Drug Targets - Cardiovascular & Hematological Disorders) 07/2007; 7(2):87-97.
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    ABSTRACT: Cigarette smoking is becoming increasingly common in Asia while quitting remains rare, in part because of a lack of knowledge about the risks of smoking. This study compared the risk of death from lung cancer associated with smoking habits in Australia and New Zealand and in Asia by using data from the Asia Pacific Cohort Studies Collaboration: 31 studies involving 480,125 individuals. Cox regression models were used. The hazard ratios for lung cancer mortality associated with current smoking were, for men, 2.48 (95% confidence interval (CI): 1.99, 3.11) in Asia versus 9.87 (95% CI: 6.04, 16.12) in Australia and New Zealand; p for homogeneity <0.0001. For women, the corresponding estimates were 2.35 (95% CI: 1.29, 4.28) in Asia versus 19.33 (95% CI: 10.0, 37.3) in Australia and New Zealand; p for homogeneity <0.0001. Quitting was beneficial in both regions; the hazard ratios for former compared with current smokers were 0.69 (95% CI: 0.53, 0.92) in Asia and 0.30 (95% CI: 0.22, 0.41) in Australia and New Zealand. The lesser effect in Asia was partly explained by the fewer number of cigarettes smoked and the shorter duration of follow-up in Asian studies. These results suggest that tobacco control policies in Asia should not solely concentrate on preventing the uptake of smoking but also attend to cessation.
    American Journal of Epidemiology 07/2007; 165(11):1280-6. · 4.78 Impact Factor
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    ABSTRACT: To assess the association between systolic blood pressure (SBP) and cardiovascular diseases (CVD) among participants with and without diabetes from cohorts in the Asia-Pacific region. Hazards ratios and 95% confidence intervals (CI) for CVD were calculated from Cox models, stratified by sex and region and adjusted for age using individual participant data from 36 cohort studies. Repeat measurements of SBP were used to adjust for regression dilution bias. During follow-up, 7387 fatal or non-fatal cardiovascular endpoints were recorded among 368 307 participants (6.4% with diabetes). SBP was associated with coronary heart disease (CHD), ischaemic stroke and haemorrhagic stroke in a continuous log-linear fashion among individuals with diabetes, as well as those without diabetes. Overall, each 10 mmHg higher usual SBP was associated with 18% (95% CI: 9-27%) and 23% (19-26%) greater risk for CHD among those with and without diabetes, respectively. The corresponding values for ischaemic stroke were 29% (14-45%) and 43% (37-50%), and for haemorrhagic stroke, 56% (32-83%) and 74% (66-82%). The test for heterogeneity by diabetes status in each of these associations was not significant (P >or= 0.10). Systolic blood pressure is an important marker of risk of CVD in people with and without diabetes. A given reduction in systolic blood pressure is likely to have a similar relative effect on reducing the risk of a cardiovascular event, regardless of diabetes status.
    Journal of Hypertension 06/2007; 25(6):1205-13. · 4.22 Impact Factor
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    ABSTRACT: The metabolic syndrome has been associated with increased mortality in some Caucasian populations, but data in Asian populations are not available. We present data describing the association of the metabolic syndrome with mortality. The impact of the US National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) metabolic syndrome guidelines definition (using Asian central obesity criteria) on mortality was examined using Cox regression analyses in a population-based cohort (n = 2863) of Chinese subjects. The cohort was followed up for a mean duration of 8.45 years, a total of 24 101 person-years, with 89 deaths (33.7% of vascular origin). Compared to those without any component of the metabolic syndrome, following adjustment for age, socioeconomic status and a range of lifestyle habits, those with the metabolic syndrome had increased risk of both all-cause [hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.02-4.00, P for trend = 0.037] and vascular disease (HR 6.39, 95% CI 1.40-29.2, P < 0.05, P for trend = 0.002) mortality. When those with 0-2 components were compared to those with the metabolic syndrome, the HRs were 1.49 (95% CI 0.95-2.33, P = 0.084) and 3.36 (95% CI 1.57-7.19, P = 0.002), respectively. This study shows that the metabolic syndrome is associated with increased mortality risk in an Asian population. The high prevalence of the metabolic syndrome, particularly in the elderly, forewarns of a rapidly increasing problem in mainland China, and other Asian populations, which could have overwhelming public health ramifications.
    Clinical Endocrinology 06/2007; 66(5):666-71. · 3.40 Impact Factor
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    ABSTRACT: We investigated the association of the metabolic syndrome with new-onset diabetes in the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort. We followed up on 1,679 subjects without diabetes at baseline. Those with a previous diagnosis of diabetes or those who were receiving drug treatment were considered to be diabetic. The remaining subjects underwent a 75-g oral glucose tolerance test (OGTT). Diabetes was defined by plasma glucose > or =7.0 mmol/l with fasting and/or > or =11.1 mmol/l at 2 h. The prevalences of the metabolic syndrome at baseline were 14.5 and 11.4%, respectively, according to U.S. National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria. After a median of 6.4 years, there were 66 and 54 new cases of diabetes in men and women, respectively. The metabolic syndrome at baseline predicted incident diabetes. Hazard ratios (HRs) for the NCEP and IDF definitions of the syndrome were 4.1 [95% CI 2.8-6.0] and 3.5 [2.3-5.2], respectively. HRs for fasting plasma glucose (FPG) > or =6.1 or 5.6 mmol/l were 6.9 [4.1-11.5] and 4.1 [2.8-6.0], respectively. The NCEP and IDF criteria had 41.9 and 31.7% sensitivity and 87.5 and 90.2% specificity, respectively. Their positive predictive values were low, approximately 20%, but their negative predictive values were approximately 95%. The metabolic syndrome, particularly its component, elevated FPG, predicts diabetes in Chinese. An individual without the metabolic syndrome is unlikely to develop diabetes, but one who has it should practice therapeutic lifestyle changes and have periodic FPG measurements to detect new-onset diabetes.
    Diabetes care 06/2007; 30(6):1430-6. · 7.74 Impact Factor
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    ABSTRACT: Although the harms of smoking are well established, it is unclear how they extend into old age in the Chinese. To examine the relationship of smoking with all-cause and major cause-specific mortality in elderly Chinese men and women, respectively, in Hong Kong. Mortality by smoking status was examined in a prospective cohort study of 56,167 (18,749 men, 37,416 women) Chinese aged > or = 65 years enrolled from 1998 to 2000 at all the 18 elderly health centres of the Hong Kong Government Department of Health. After a mean follow-up of 4.1 years, 1848 male and 2035 female deaths occurred among 54,214 subjects (96.5% successful follow-up). At baseline, more men than women were current smokers (20.3% vs 4.0%) and former smokers (40.8% vs 7.9%). The adjusted RRs (95% CI) for all-cause mortality in former and current smokers, compared with never smokers, were 1.39 (1.23 to 1.56) and 1.75 (1.53 to 2.00) in men and 1.43 (1.25 to 1.64) and 1.38 (1.14 to 1.68) in women, respectively. For current smokers, the RRs (95% CI) for all-cause mortality were 1.59 (1.39 to 1.82), 1.72 (1.48 to 2.00) and 1.84 (1.43 to 2.35) for daily consumption of 1-9, 10-20 and > 21 cigarettes, respectively (p for trend <0.001). RRs (95% CI) were 1.49 (1.30 to 1.72) and 2.20 (1.88 to 2.57) in former and current smokers for all deaths from cancer, and 1.24 (1.04 to 1.47) and 1.57 (1.28 to 1.94) for all cardiovascular deaths, respectively. Quitters had significantly lower risks of death than current smokers from all causes, lung cancer, all cancers, stroke and all cardiovascular diseases. In old age, smoking continues to be a major cause of death, and quitting is beneficial. Smoking cessation is urgently needed in rapidly ageing populations in the East.
    Tobacco control 06/2007; 16(3):182-9. · 3.85 Impact Factor
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    ABSTRACT: Obesity is increasingly prevalent in both developed and developing areas. Although undernutrition is well associated with tuberculosis, few studies have systematically examined the association with obesity. Method A cohort of 42 116 individuals 65 years or older enrolled at 18 health centers for elderly patients in Hong Kong, China (which has a tuberculosis incidence of approximately 90 per 100,000 population), in 2000 were followed up prospectively through the territory-wide tuberculosis registry for the development of active tuberculosis from 3 months after enrollment until December 31, 2005, using the identity card number as the unique identifier. The association with body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), as categorized by the Asian standards, was assessed with the control of other baseline characteristics. Obese (BMI>or=30) and overweight (BMI, 25 to <30) individuals were at significantly lower risks of developing active tuberculosis than normal-weight individuals (BMI, 18.5 to <25), with hazard ratios (95% confidence intervals) of 0.36 (0.20-0.66) and 0.55 (0.44-0.70), respectively, after adjustment for baseline demographic, social, and clinical variables. An inverse linear association was observed predominantly for pulmonary but not extrapulmonary tuberculosis. This association persisted after controlling for potential confounders or excluding individuals with known tuberculosis risk factors. Obesity is associated with a lower risk of active pulmonary tuberculosis in the older population of Hong Kong. The presence of such a strong but selective association across the whole spectrum of BMI could have major biological, clinical, and/or epidemiological implications. Further studies are indicated to explore the underlying mechanisms, potential clinical utilities, and possible epidemiological consequences.
    Archives of Internal Medicine 06/2007; 167(12):1297-304. · 11.46 Impact Factor
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    ABSTRACT: Better childhood conditions, proxied by greater height, are usually protective against ischemic heart disease in western countries. These relations are less evident in other settings. We used multivariable logistic regression to examine the relation of height to the metabolic syndrome and its components in a rapidly developed Asian population using a representative, cross-sectional Hong Kong Chinese sample of 2860 adults from 1994 to 1996. Height was inversely associated with increased blood pressure (odds ratio = 0.74; 95% confidence interval = 0.58-0.94) and raised fasting plasma glucose (0.71; 0.55-0.91), but only after adjustment for central obesity. Central obesity was also positively associated with height (2.09; 1.67-2.62) for tallest compared with shortest tertile, confounding these relationships. The association between height and central obesity was much stronger in men than in women. The relation of height to cardiovascular risk may relate to a society's history and stage of socioeconomic development.
    Epidemiology 04/2007; 18(2):274-8. · 5.74 Impact Factor
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    ABSTRACT: The purpose of the study is to investigate the cross-sectional and prospective relation between workplace secondhand smoke (SHS) exposure and respiratory symptoms. Cross-sectional data for workplace SHS exposure and respiratory symptoms were collected by using random digit dialing from 7336 never-smoking Hong Kong workers 15 years or older in 1997 to 1998. In the 2000 to 2001 follow-up, 2213 workers who remained never smoking, had the same SHS exposure status, worked at the same job for at least 2 years, and were not exposed to SHS at home at follow-up were included for prospective analysis. Cross-sectionally, SHS was associated significantly with frequent colds, cough and phlegm, throat problems, and the presence of any respiratory symptoms with adjusted odds ratios of 1.89 (95% confidence interval [CI], 1.66-2.15), 1.65 (95% CI, 1.35-2.02), 1.88 (95% CI, 1.63-2.15), and 1.96 (95% CI, 1.75-2.20) at baseline, each having significant linear associations with duration of exposure. SHS was not associated with rhinitis. Prospectively, consistent SHS exposure increased the risk for cough and phlegm and any respiratory symptoms by 48% (12% to 97%) and 54% (13% to 109%), respectively. This first non-Western population-based prospective study shows that workplace SHS exposure is associated significantly with frequent respiratory symptoms, both cross-sectionally and prospectively, thus providing strong evidence that the association is causal.
    Annals of Epidemiology 03/2007; 17(2):126-31. · 2.48 Impact Factor

Publication Stats

7k Citations
2,109.88 Total Impact Points

Institutions

  • 1982–2014
    • The University of Hong Kong
      • • School of Public Health
      • • Department of Paediatrics and Adolescent Medicine
      • • Department of Community Medicine
      Hong Kong, Hong Kong
  • 2013
    • Worcestershire Acute Hospitals NHS Trust
      Worcester, England, United Kingdom
    • University of Glasgow
      • West of Scotland Cancer Surveillance Unit
      Glasgow, Scotland, United Kingdom
  • 2006–2013
    • The George Institute for Global Health
      Sydney, New South Wales, Australia
  • 1995–2013
    • University of Birmingham
      • Department of Public Health, Epidemiology and Biostatistics
      Birmingham, England, United Kingdom
  • 2012
    • University of Texas Southwestern Medical Center
      Dallas, Texas, United States
    • University of Ottawa
      Ottawa, Ontario, Canada
    • Universität Heidelberg
      • Faculty of Medicine Mannheim and Clinic Mannheim
      Heidelberg, Baden-Wuerttemberg, Germany
    • Lands Department of The Government of the Hong Kong Special Administrative Region
      Hong Kong, Hong Kong
  • 2004–2012
    • University of Sydney
      • George Institute for Global Health
      Sydney, New South Wales, Australia
  • 2011
    • London School of Hygiene and Tropical Medicine
      Londinium, England, United Kingdom
    • University of Minnesota Twin Cities
      • Division of Epidemiology and Community Health
      Minneapolis, MN, United States
  • 1997–2011
    • The Chinese University of Hong Kong
      • Department of Medicine and Therapeutics
      Hong Kong, Hong Kong
  • 2010
    • University of Oslo
      • Department of Biostatistics
      Oslo, Oslo, Norway
    • University of Groningen
      • Department of Epidemiology
      Groningen, Province of Groningen, Netherlands
  • 2009
    • Medical Research Council (UK)
      Londinium, England, United Kingdom
  • 2008–2009
    • Chinese PLA General Hospital (301 Hospital)
      Peping, Beijing, China
    • Hong Kong SAR Government
      Hong Kong, Hong Kong
  • 2003–2006
    • Queen Mary Hospital
      Hong Kong, Hong Kong
    • Isfahan University of Medical Sciences
      • Epidemiology and Biostatistics Department
      Eşfahān, Ostan-e Esfahan, Iran
  • 2004–2005
    • Imperial College London
      • Department of Infectious Disease Epidemiology
      London, ENG, United Kingdom
  • 2001–2005
    • The Hong Kong Polytechnic University
      • • School of Nursing
      • • Department of Rehabilitation Sciences
      Hong Kong, Hong Kong
  • 2000–2002
    • The University of Hong Kong - Shenzen Hospital
      Hong Kong, Hong Kong
    • Chongqing University of Medical Science
      Ch’ung-ch’ing-shih, Chongqing Shi, China
  • 1998
    • The University of Sheffield
      Sheffield, England, United Kingdom
  • 1988–1990
    • Caritas Medical Centre
      Hong Kong, Hong Kong
  • 1989
    • Christian Hospital
      Saint Louis, Michigan, United States