Journal articles on the topic 'Children Health and hygiene China Hong Kong'

Departments of Paediatrics, Diagnostic Radiology, Orthopaedics and Traumatology and Chemical Pathology, Prince of Wales Hospital, Shatin, Hong Kong, China; Department of Paediatric Radiology, Hospital for Sick Children, Great Ormond Street Hospital, London, UK

The Lucky Dragon is a vitamin, Chinese medicine and nutraceutical company located in Causeway Bay in Hong Kong. Although the company was ran for 50 years by the Ng family, after the patriarch Mr. Ng Shu Chorn passed away, his children decided to sell it, as none of the three children were interested in managing the store or sourcing products and selling them to other shops. Increasingly, competition from mainland China had been eroding profit margins of similar businesses in Hong Kong, and each of the siblings had respectable jobs, so cashing in was the best course of action. Anderson Products LLC, a health and wellness company headquartered in Provo, Utah, had hoped to expand to the seemingly lucrative Chinese market, but they were inexperienced with international business and afraid of mainland China regulations. They saw the advertisement for the sale of The Lucky Dragon as a great opportunity to get their feet in the door, under the more auspicious regulations that Hong Kong could offer.

ObjectiveTo explore risk factors associated with non-typhoidal Salmonella gastroenteritis in young children in Hong Kong.DesignA case–control study.SettingPaediatrics wards at three public hospitals in Hong Kong.ParticipantsCases were children aged above 30 days to below 5 years hospitalised for gastroenteritis at three public hospitals in Hong Kong with culture confirmed non-typhoidal Salmonella infection. Controls were age-matched (±2 months) children admitted for a reason other than gastroenteritis.Main outcomes measuresA face-to-face interview by using standardised questionnaire on exposures 3 days prior to illness. Adjusted OR (aORs) and 95% CIs were calculated using multivariable logistic regression.ResultsA total of 102 cases and 204 age-matched controls were included in the analysis. Multivariable logistic regression revealed that having food purchased from places other than a supermarket, that is, from wet market/restaurant/farm (aOR, 2.64; 95% CI, 1.03 to 6.77; p=0.044) was a significant risk factor for non-typhoidal Salmonella infection. Having a household member with gastroenteritis symptoms (aOR, 2.03; 95% CI, 0.94 to 4.39; p=0.072) was of borderline significance and playing at a children’s indoor playroom was a protective factor (aOR, 0.28; 95% CI, 0.09 to 0.85; p=0.024).ConclusionsConsumption of food purchased from places other than a supermarket was the identified determinant factor for non-typhoidal Salmonella gastroenteritis in Hong Kong. Parents/caregivers should be alerted to this risk when choosing foods for their young children. The protective effect of playing in an indoor playroom could be confounded by socioeconomic factors and further investigation is required to better understand its potential implication. There was some support for person-to-person transmission and good family hygiene needs to be emphasised.

Personal and household hygiene measures are important for preventing upper respiratory tract infections (URTIs) and other infectious diseases, including coronavirus disease 2019 (COVID-19). An online survey recruited 414 eligible parents in Hong Kong to study their hygiene knowledge, attitudes, and practices (KAPs) regarding the prevention of URTIs among their children. The average knowledge score was high (10.2/12.0), but some misconceptions were identified. The majority of the participants agreed that good personal hygiene (93.5%) and good environmental hygiene (92.8%) can prevent URTIs. The average score for hand hygiene practices was high (3.78/4.00), but only 56.8% of the parents always performed hand hygiene before touching their mouths, noses, or eyes. In terms of environmental hygiene, only some household items were disinfected with disinfectants (door handles in 69.8% of the households, toilet seats in 60.4% of the households, the floor in 42.8% of the households, dining chairs in 24.2% of the households, and dining tables in 20.5% of the households). A higher knowledge score was associated with parents having tertiary educational levels or above, working as healthcare professionals, living in private residential flats or staff quarters, or having household incomes of HKD 70,000 or above. The results of multiple regression analyses also indicated that parents who were healthcare professionals and with higher household income had a better parental knowledge of hygiene measures after adjusting the attitude score. For hand hygiene, parents who achieved higher attitude scores obtained higher practice scores. Under the fifth wave of the COVID-19 epidemic, there were some misconceptions regarding hygiene among parents. Any health promotion program should target parents regarding taking proper personal and household hygienic measures, especially for those who had relatively lower socio-economic status and/or from a non-healthcare background. Motivating attitudes toward hand hygiene can lead to better practices.

Vitamin D plays an important role in skeletal health throughout life. Some studies have hypothesised that vitamin D may reduce the risk of other diseases. Our study aimed to estimate age-specific and sex-specific serum 25-hydroxyvitamin D (25(OH)D) status and to identify the determinants of serum 25(OH)D status in Hong Kong, a subtropical city in southern China. In 2009–2010, households in Hong Kong were followed up to identify acute respiratory illnesses, and sera from 2694 subjects were collected in three to four different study phases to permit measurement of 25(OH)D levels at different times of the year. A questionnaire survey on diet and lifestyle was conducted among children, with simultaneous serum collection in April and May 2010. The mean of serum 25(OH)D levels in age groups ranged from 39 to 63 nmol/l throughout the year with the mean values in all age groups in spring below 50 nmol/l. Children aged 6–17 years, and girls and women had significantly lower serum 25(OH)D levels than adults, and boys and men, respectively (allP< 0·001). We estimated that serum 25(OH)D levels in Hong Kong followed a lagged pattern relative to climatic season by 5 weeks with lowest observed levels in early spring (March). For children aged 6–17 years, reporting a suntan, having at least 1 servings of fish/week and having at least 1 serving of eggs/week were independently associated with higher serum 25(OH)D levels. Adequate sunlight exposure and increased intake of dietary vitamin D could improve vitamin D status, especially for children and females in the winter and spring.

Despite concerns about the negative effects of social distancing and prolonged school closures on children’s lifestyle and physical activity (PA) during the COVID-19 pandemic, robust evidence is lacking on the impact of the pandemic-related school closures and social distancing on children’s wellbeing and daily life. This study aimed to examine changes in the PA levels, sleep patterns, and screen time of school-aged children during the different phases of the COVID-19 outbreak in Hong Kong using a repeated cross-sectional design. School students (grades 1 to 12) were asked to report their daily electronic device usage and to fill in a sleep diary, recording their daily sleep onset and wake-up time. They were equipped with a PA monitor, Actigraph wGT3X-BT, to obtain objective data on their PA levels and sleep patterns. Students were recruited before the pandemic (September 2019–January 2020; n = 577), during school closures (March 2020–April 2020; n = 146), and after schools partially reopened (October 2020–July 2021; n = 227). Our results indicated lower PA levels, longer sleep duration, and longer screen time among participants recruited during school closures than those recruited before the COVID-19 outbreak. Primary school students were found to sleep on average for an extra hour during school closures. The later sleep onset and increased screen time documented during school closures persisted when schools partially reopened. Our findings illustrate the significant impact of social distancing policies during the COVID-19 pandemic on the sleep pattern, screen time, and PA level in school-aged children in Hong Kong. Professionals should urgently reinforce the importance of improving physically activity, good sleep hygiene, and regulated use of electronic devices for parents and school-aged children during this unprecedented time.

Introduction: Hong Kong SAR (China) achieved measles elimination status in 2016, and the incidence of measles infection had been low over the past few years. However, the Centre for Health Protection (CHP) at the Department of Health was notified on 22 March 2019 of an outbreak of three cases of measles infection among workers at the Hong Kong International Airport (HKIA). Methods: We reviewed notifications of measles received by CHP from 1 January to 17 May 2019. We defined a confirmed case of measles as having laboratory evidence of measles infection. All confirmed cases among airport workers or those with epidemiological information suggesting they had been infected by contact with airport workers were included in the review. We described the epidemiological features and reviewed the control measures against the outbreak. Results: We identified 33 cases, 29 of which were among airport workers. They comprised 22 men and 11 women, aged 20–49 years (median 25 years). The majority of people with confirmed measles presented with fever and rash. All required hospitalization. None developed complications. Control measures, including enhanced environmental hygiene and improved ventilation at HKIA and vaccinations for the airport community, were implemented. Vaccinations were provided to 8501 eligible airport workers, and the outbreak was declared over on 17 May 2019. Discussion: Early recognition of the outbreak and prompt control measures, especially targeted vaccination of the exposed population, effectively controlled the outbreak in just two weeks.

Recent historical investigation into the rise of ‘biopolitical modernity’ in China has shed some surprising light. While it was long thought that British public health initiatives entered China via Hong Kong, the recent work of Ruth Rogaski, Philippe Chemouilli and others has established that it was actually early Japanese colonialism that played the crucial role. It was the Meiji Empire's hygiene reform projects in Taiwan and Manchuria that provided the model for Republican China. Curiously overlooked by medical historians has been one of the major early works of Japanese public health that directly inspired and guided this colonial medical enterprise. This was that of the Japanese health reformer and colonial officer, Gotō Shinpei (1857–1929), and it was undertaken in Munich as a doctoral thesis under the supervision of Max von Pettenkofer. In this article, I focus on the way in which Shinpei dealt in his thesis with the relations between centralisation and local self-administration as one of the key issues facing hygienic modernisation and colonial biopolitical control.

In addition to top-down Health-Emergency and Disaster Risk Management (Health-EDRM) efforts, bottom-up individual and household measures are crucial for prevention and emergency response of the COVID-19 pandemic, a Public Health Emergency of International Concern (PHEIC). There is limited scientific evidence of the knowledge, perception, attitude and behavior patterns of the urban population. A computerized randomized digital dialing, cross-sectional, population landline-based telephone survey was conducted from 22 March to 1 April 2020 in Hong Kong Special Administrative Region, China. Data were collected for socio-demographic characteristics, knowledge, attitude and risk perception, and various self-reported Health-EDRM behavior patterns associated with COVID-19. The final study sample was 765. Although the respondents thought that individuals (68.6%) had similar responsibilities as government (67.5%) in infection control, less than 50% had sufficient health risk management knowledge to safeguard health and well-being. Among the examined Health-EDRM measures, significant differences were found between attitude and practice in regards to washing hands with soap, ordering takeaways, wearing masks, avoidance of visiting public places or using public transport, and travel avoidance to COVID-19-confirmed regions. Logistic regression indicated that the elderly were less likely to worry about infection with COVID-19. Compared to personal and household hygiene practices, lower compliance was found for public social distancing.

AbstractObjectiveThe present study aimed to review the literature on micronutrient deficiency and other factors influencing a deficiency status among children living in China.DesignA systematic review was performed to analyse the literature.SettingStudies were identified through a search of PubMed and secondary references.SubjectsChildren living in China aged less than 18 years.ResultsSixty-one articles were included. The prevalence of vitamin A deficiency decreased to approximately 10 % in 1995–2009. It increased with age but no significant difference was found between genders. The prevalence of thiamin and vitamin B12 deficiency was 10·5 % in Yunnan and 4·5 % in Chongqing provinces, respectively. Higher vitamin D deficiency rates were seen in spring and winter. The incidence of bleeding due to vitamin K deficiency was 3·3 % in 1998–2001 and more prevalent in rural areas. Both iodine deficiency and excess iodine intake were observed. Goitre rates were reported in Tibet, Jiangxi, Gansu and Hong Kong (3·5–46 %). Anaemia rates ranged from 20 % to 40 % in 2007–2011. High Se deficiency rates were found in Tibet, Shaanxi and Jiangsu. High Zn deficiency rates were also found (50–70 %) in 1995–2006. Few studies reported Ca deficiency rates (19·6–34·3 %). The degrees of deficiency for vitamin A, vitamin B12, Fe and Zn were more substantial in rural areas compared with urban areas.ConclusionsThe prevalence of micronutrient deficiency rates varied. Socio-economic status, environmental factors and the Chinese diet may influence micronutrient deficiency. Public health policies should consider implementing programmes of supplementation, food fortification and nutrition education to address these deficiencies among Chinese children.

This review explores the influences of family and school members on children in China, in order to promote healthy eating behaviours among children and prevent childhood malnutrition in the Global South. Family members and school members are defined as parents, guardians (such as grandparents and other relatives), siblings, peers, and teachers. A search of four databases returned 94 articles, 18 of which met the eligibility criteria. Most of the included studies were from mainland China; a few were from Hong Kong and Taiwan. More quantitative than qualitative studies were found, among which, cross-sectional studies were dominant. The 18 papers included in the study explored the influences of family members and school members on the eating behaviours of children, based on seven themes: (1) social–demographic characteristics, (2) food intake of parents, (3) nutritional knowledge and health awareness of family or school members, (4) parents’ perceptions of their children’s body weight, (5) feeding strategies of family members, (6) family relationships, and (7) intergenerational differences of caregivers. In the current analysis, parental education levels, mother’s occupation, health awareness of parents and teachers, and positive feeding styles, such as encouraging healthy eating and controlling overeating, were positively correlated with the healthy eating behaviours of children. Meanwhile, healthy eating behaviours of children were negatively associated with caregivers’ lack of nutritional knowledge, misperception of weight, instrumental and/or emotional feeding, and working on nonstandard shifts. More related research using cross-disciplinary approaches is needed and there should be more discussions about how teachers, siblings, and peers affect the dietary behaviours of children.

SummaryPolycyclic aromatic hydrocarbons (PAHs) in indoor dust are one of the common exposure sources for children worldwide. The aim of this study is to explore PAHs pollution status in indoor dust and estimate health risk on Chinese children with big data. Weighted average concentration was used to analyze source and characterization of PAHs in indoor dust based on peer-reviewed literature. According to specific inclusion criteria, 17 studies were included finally to analyze weighted average concentration. The national average concentration of Σ16PAHs was approximately 25.696 µg/g. The highest concentration of Σ16PAHs was in Shanxi (2111.667 µg/g), and the lowest was in Hong Kong (1.505 µg/g). The concentrations in Shanxi and Guangdong were higher than national level and the over standard rate was 18.18%. The concentrations of individual PAHs varied greatly across the country, and Flu in Shanxi was the highest (189.400 µg/g). The sources of PAHs varied in different regions and combustion processes played a leading role. PAHs exposure through ingestion and dermal contact was more carcinogenic than inhalation. The incremental lifetime cancer risk model indicated that children lived in Shanxi were found in the highest health risk coupled with the highest BaPE concentration (54.074 µg/g). Although PAHs concentrations of indoor dust showed a downward trend from 2005 to 2018, indoor environmental sanitation should be improved with multidisciplinary efforts. Health standard should be possibly established to minimize children exposure to PAHs in indoor dust in China.

Abstract Enterovirus 71 (EV71) is a major pathogen of hand, foot and mouth disease (HFMD). It is highly contagious and usually causes mild disease. However, occasionlly HFMD caused by EV71 would develpoed into severe neurological complications or even deaths in young children. There is no effective anti-viral therapy against EV71 infection. Human Vγ9Vδ2-T cells, as the first line of human immune defense, exhibit antiviral activities against different viruses. However, whether human Vγ9Vδ2-T cells have antiviral activity against EV71 remains unkown. In this study, we used EV71-infected primary human monocyte-derived macrophages (MDMs) to examine the anti-EV71 activity of Vγ9Vδ2-T cells. We found that phosphoantigen pamidronate-expanded Vγ9Vδ2-T cells could kill EV71-infected MDMs, and thus reduce the viral load. The cytotoxicity of Vγ9Vδ2-T cells against EV71-infected MDMs required cell-cell contact and mediated by Fas/FasL pathway. Vγ9Vδ2-T cells also displayed potent capacity to produce IFN-γ and thus inhibit EV71 viral replication. CCR5 pathway was involved in the migration of Vγ9Vδ2 T cells towards EV71-infected cells. These results demonstrated that Vγ9Vδ2-T cells have both cytotoxic and non-cytolytic antiviral activities target EV71. Our data suggests a novel therapeutic approach against EV71 by boosting Vγ9Vδ2 T cell immunity. This work is supported in part by Health and Medical Research Fund, Hong Kong SAR government (13120972) and the General Research Fund (17115015 and 17126317), Research Grants Council of the Hong Kong SAR, China.

e12006 Background: Despite much interest in oral complications in cancer patients and studies reporting their prevalence, aetiology and management, there has been little understanding of how they affect the patients and the family. The aim of this study was, therefore, to assess the impact of oral complications on life quality for children undergoing cancer therapy. Methods: Seventy 6 - 14 years old paediatric patients undergoing cancer therapy in the Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong participated in this study. A clinical examination of the dentition and oral soft tissues was performed using criteria suggested by the World Health Organization. Clinical examination evaluated the status of: i) dental caries (DMFT/dmft Index), ii) periodontal health (CPI Index), iii) infection, such as herpes and candidiasis, iv) thrombocytopathy in the form of oral petechiae and spontaneous gingival bleeding, v) xerostomia, and vi) mucositis (WHO Mucositis Scale). Two questionnaires were filled by the children and their parents: i) the Child Perceptions Questionnaire (CPQ), and ii) a questionnaire contained simple closed questions to collect the information of oral health habits of children and demographic data from the parents. Results: Higher CPQ scores were found in children with mucositis (p < 0.001), dental caries (p < 0.001), children who were born in mainland China (p < 0.05), or parents of lower education or income level (p < 0.05). In multiple regression analyses, mucositis and dental caries were the significant predictors (p < 0.001) of the higher CPQ scores among the various parents and children characteristics collected in this survey. Conclusions: The findings of this study showed that paediatric cancer patients with mucositis and dental caries had poorer oral health-related quality of life.

When facing an infectious disease disaster, nurses’ willingness to work is critical. Nurses’ lack of willingness to work during a pandemic may worsen the shortage of health care personnel. The purpose of this study is to assess the willingness of nurses to participate in the fight against COVID-19 in China and to identify factors associated therewith. This cross-sectional study examines nurses working in 11 Chinese cities including Macau, Hong Kong, Shenzhen, Dongguan, Huizhou, Guangzhou, Zhaoqing, Foshan, Jiangmen, Zhongshan, and Zhuhai. Questionnaires were collected from 19 May to 7 August 2020. A total of 8065 questionnaires were received, of which 8030 valid questionnaires were included for analysis. A total of 53.4% of participants reported that they had signed up to support the COVID-19 pandemic response. Multivariate logistic regression analysis revealed that being single (OR = 0.72, 95% CI: 0.60–0.87), having no children (OR = 0.81, 95% CI: 0.68–0.97), possessing higher professional qualifications (OR = 1.25, 95% CI: 1.14–1.37), having a more prestigious professional title (OR = 1.68, 95%CI: 1.50–1.90), being an administrative supervisor (OR = 0.53, 95% CI: 0.45–0.63), having a higher caring dimensions inventory score (OR = 1.01, 95% CI: 1.01–1.01), working in a hospital (OR = 0.53, 95% CI: 0.39–0.72), and receiving employer-provided care training (OR = 0.77, 95% CI: 0.68–0.87) were predictive of nurses’ willingness to participate in the fight against COVID-19. We suggest that unmarried nurses should be given priority when recruiting to fight an epidemic and, for married nurses with children who are recruited to fight an epidemic, supporting measures should be provided for childcare. We suggest strengthening workplace training of caring for nurses in order to better retain and recruit qualified support for an epidemic outbreak of infectious diseases.

ObjectivesTo identify spatial disparities and demographic characteristics of short stature, we analysed the prevalence of short stature collected in a nationwide health survey.SettingsData were obtained from the 2014 Chinese National Survey on Students Constitution and Health (a cross-sectional study of China). Participants came from 30 provinces, autonomous regions, and municipalities (except Tibet, Hong Kong, Macao, and Taiwan).ParticipantsThere were 213 795 Han school children between 7 and 18 years old enrolled in our study. All participants were sampled by stratified cluster.Primary and secondary outcome measuresShort stature; Chinese and WHO age-specific and gender-specific height growth references were used for short stature assessment.ResultsThe age-standardised and age–gender-standardised prevalence of short stature nationwide was 3.70% and 2.69% according to Chinese and WHO growth references, respectively. The short stature prevalence differed significantly among age groups, urban and rural areas, and regions with different socioeconomic development levels (all p<0.0001). The prevalence was 2.23% in urban versus 5.12% in rural areas (p<0.001). The prevalence was 2.60% in developed, 3.72% in intermediately developed, and 4.69% in underdeveloped regions (p<0.0001). These values were all according to China’s growth reference, but similar patterns were observed on prevalence based on the WHO reference. The spatial distribution of prevalence of short stature presented a clustered pattern. Moran’s I value was 0.474 (p<0.001) and 0.478 (p<0.001) according to the Chinese and WHO growth references, respectively. The southwest part of China showed a higher prevalence of short stature, whereas lower prevalence of short stature was observed mainly in the northeast part of China.ConclusionsThere is an appreciably high prevalence of short stature in rural, underdeveloped areas of China. There are high prevalence spatial clusters of short stature in southwestern China. This provides corroborating evidence for a tailored strategy on short stature prevention and reduction in special areas.

Technology is one of the applicable tools in early childhood education learning, and its use necessitates the teachers to play important roles in the classroom. Hence, this research discusses a systematic review of technology use for learning during early childhood education in Asian countries. Empirical studies published between 2015-2022 and identified through systematic screening were examined to eventually obtain 16 articles with subjects spread across China, Jordan, Taiwan, Turkey, Hong Kong, Malaysia, Kuwait, Indonesia and South Korea. The result of this study show that implemented technology in the class can had a positive effects on teacher and children of self-confidence, curiosity, creativity, motivation, interest in learning, children’s emotional (helping them control emotions and overcome fear, shame, and anxiety), social (increasing their communication and interaction with others), moral (assisting in the development of ethics), and physical/health abilities. Benefits of technology in the classroom, as well as self-efficacy, were the supporting factors, while the inhibitors were their lack of understanding in integrating technology into pedagogy, limited school budgets, and the negative impact on children’s health.

Abstract.The Western Pacific Region (WPR) is comprised of 37 countries such as China, Japan, Mongolia, Republic of Korea, The Socialist Republic of Vietnam, Papua-New Guinea, Australia, including Pacific Island Countries and Territories (21 countries of PICTs, approx. 3 million people) etc., with a population of 1.85 billion people. Among them, China is the largest and most populous (1.3 billion people) country of the Region. Large measles outbreaks were documented to occur in the Region. In 2003, the Regional Committee announced officially about the WPR action plan on measles elimination 2005, which, however, failed. Since 2012, WPR countries joined the WHO 2012–2020 Global Measles and Rubella Strategic Plan performing a routine measles vaccination (national immunization schedule) or within Expanded Programme on Immunization (EPI). Basically, a two-dose immunization strategy is followed in the WPR countries. Since 2002, measles supplementary immunization activities (SIAs) in children were conducted in the following countries: Japan, Laos, Vietnam, Philippines, Mongolia, Cambodia, Papua New Guinea, and China. Starting from 2005, measles management was considerably improved, demonstrating by 2012 decreased measles incidence rate down to 5.9 cases per million population. In last years, a decreased measles immunization coverage in decreed population groups was noted in the WPR countries that resulted in 2013–2015 measles epidemic involving almost all regional countries. In particular, in China measles incidence rate was 19.6 cases per million population, whereas in the Vietnam Papua New Guinea and Philippines it progressively increased reaching 182.8, 345.9 and 548.0 cases per million population, respectively. Early children not vaccinated according to schedule, adolescents and young adults dominated among measles patients. It was found that measles outbreaks were due to missed vaccination and increased level of vulnerability to measles. Children under one, adolescents and young adults who did not receive a two-dose measles vaccination were in risk group. Analyzing WPR measles epidemiology demonstrated that refusal of parents to vaccinate children, poor knowledge of advantages related to vaccination, insufficient immunization coverage in immigrants, travelers, subjects changing place of residence, workers of healthcare and educational facilities require special attention. In 2017–2018 season, the following measles genotypes were found in the WPR: D8 — Australia, New Zealand, Republic of Korea, Singapore, Japan; Н1 — China; В3 — Philippines, Australia and Japan; D9 — Singapore, Australia, Macau (China), Malaysia and Japan, Н2 strains endemic in Vietnam. According to the WHO, measles endemic transmission has been successfully interrupted; Australia, Macau, Mongolia and Republic of Korea are being verified to eliminate measles; Hong Kong (China) and Singapore (based on available information) are ready to verify measles elimination. Thus, in the Western Pacific Region measles elimination is achievable after solving current issues such as increasing and maintaining high-level routine vaccination and conducting measles supplementary immunization campaigns in epidemically important contact clusters.

Background: While a number of population preventive measures for COVID-19 exist that help to decrease the spread of the virus in the community, there are still many areas in preventative efforts that need improvement or refinement, particularly as new strains of the virus develop. Some of the key issues currently include incorrect and/or inconsistent use of face masks, low acceptance of early screening or vaccination for COVID-19, vaccine hesitance, and misinformation. This is particularly the case in some vulnerable populations, such as older people with chronic illnesses, ethnic minorities who may not speak the mainstream language well and children. The current protocol introduces a large programme of research through five interrelated studies that all focus on social and behavioural interventions to improve different aspects of community-related preventative indicators. Hence, the specific objectives of the overall programme are to (1) increase early testing for COVID-19 and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase COVID-19-related health literacy and vaccine literacy and promote improved preventative measures in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public’s motivation to stay at home and avoid nonessential high-risk activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5). Methods: We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short- and long-term, including, for example, the 8-item self-reported eHealth Literacy Scale (eHEAL) and objective measures such as vaccine uptake. Discussion: Theory-driven interventions will address each study’s focus (e.g., social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Improvements are expected to be seen in the outcomes of vulnerable and high-risk groups. Decreased infection rates are expected due to improved preventative behaviours and increased vaccine uptake. Long-term sustainability of the approach will be achieved through the CBPR model. The publication of this protocol can assist not only in sharing a large-scale and complex community-based design, but will also allow all to learn from this, so that we will have better insight in the future whether sharing of study designs can elicit timely research initiatives.

On 31 December 2019 the Wuhan Health Commission reported a cluster of atypical pneumonia cases that was linked to a wet market in the city of Wuhan, China. The first patients began experiencing symptoms of illness in mid-December 2019. Clinical isolates were found to contain a novel coronavirus with similarity to bat coronaviruses. As of 28 January 2020, there are in excess of 4,500 laboratory-confirmed cases, with > 100 known deaths. As with the SARS-CoV, infections in children appear to be rare. Travel-related cases have been confirmed in multiple countries and regions outside mainland China including Germany, France, Thailand, Japan, South Korea, Vietnam, Canada, and the United States, as well as Hong Kong and Taiwan. Domestically in China, the virus has also been noted in several cities and provinces with cases in all but one provinence. While zoonotic transmission appears to be the original source of infections, the most alarming development is that human-to-human transmission is now prevelant. Of particular concern is that many healthcare workers have been infected in the current epidemic. There are several critical clinical questions that need to be resolved, including how efficient is human-to-human transmission? What is the animal reservoir? Is there an intermediate animal reservoir? Do the vaccines generated to the SARS-CoV or MERS-CoV or their proteins offer protection against 2019-nCoV? We offer a research perspective on the next steps for the generation of vaccines. We also present data on the use of in silico docking in gaining insight into 2019-nCoV Spike-receptor binding to aid in therapeutic development. Diagnostic PCR protocols can be found at https://www.who.int/health-topics/coronavirus/laboratory-diagnostics-for-novel-coronavirus.

Background: Emerging Internet technologies are now creeping into the game arena. Increased incidence of gaming addiction is felt in the world, and no doubt in Indonesia could have an impact as well, especially in an adolescent. In Makassar, found the incidence of internet games disorders by 30% in high school children. Therefore, internet games eventually became an important issue in the world of health to the WHO (World Health Organization) and making it the responsibility of the world. The state has a duty and responsibility in preventing health problems caused by the development of internet gaming in Indonesia. Internet Gaming Disorder is a mental problem that should be considered in adolescents, and even no single governing restrictions on the use of internet gaming and prevention programs for adolescents in Indonesia. Purpose: The purpose of this study is to explore the problem of Internet Gaming disorder by describing programs that have been implemented by countries outside Indonesia in terms of health promotion for adolescents. Methods: This study was a literature review of several journals, thesis, as well as patient data reports Internet Gaming disorder in Indonesia and the world. Result: The result is a necessary regulation involving adolescents, parents, schools, governments, and public health officials to regulate Internet gaming restrictions to prevent Internet Gaming Disorder as has been done in China, Hong Kong, Iran, and Switzerland which can be adopted in Indonesia. Conclusion: The problem of Internet gaming disorder being ordered must be a concern of government and cross-sectoral to prevent the development of this problem in Indonesia as a protective way for adolescents.

Influenza virus (H5N1) is highly contagious disease, which attacks the respiratory tract in humans. The deaths of six people in Hong Kong in 1997 from an H5N1 virus infection was the first indication that a purely avian influenza virus could cause respiratory disease and death in human. The aim of current study was to observe changes of epidemiological parameters of the infected patients, and the behaviour of virus outbreak over two decades of avian influenza virus (H5N1) from 1997 to April 2017. Data of the current study was obtained from WHO (World Health Organization) daily outbreak reports and then computerized and analyzed. It included 826 cases from 1997 to last case in April 2017 for this study. Most of the studied cases, their ages were less than 16 years (n=366), and spread in 16 countries, the top three countries prevalence were Egypt (n= 356), Indonesia (n= 175), and Vietnam (n=87) respectively. The most years of cases incidence were 2015 (n= 147) and 2006 (n=122). Most of cases were recorded in January (n=180), February (n=149), and March (n=143) respectively. Case fatality rates were 50.7%. In conclusion most cases were in second decade than first decade of (H5N1) outbreak, but death were more in first decade, Also most cases were in low temperature seasons and in very young children but death were more in adults. In first decade, morbidity were more in Asia countries like China, Vietnam, and Indonesia but in second decade, mortality were more in North Africa (Egypt). However, cases were more in Egypt than Indonesia but deaths were more in Indonesia. H5N1 virus must be currently studied and its controlling is highly requested.

“The family” has long been a focus of cross-party attention. While family is perceived as foundational to society’s success, how parents rear their children is perhaps the most conservative or persistent part of concern. While Chinese immigrant families and Chinese families in Asia – in Hong Kong, Macau, Taiwan, mainland China, and elsewhere – are struggling with a socialization process that has emphasized support for traditional values, they are also simultaneously being confronted by modern ideologies and technologies. Professionals have a growing interest in addressing the culturally diverse needs and the gender issues of Chinese families. The theme of this issue of The Open Family Studies Journal, then, is “Gender, family and parenting in the Chinese context”. The heart of this special issue lies in a concern for families, in particular for the challenges posed to families and parenting practices in a changing world. The family, like any social group, is a product of history, culture and context. Because of economic and technological changes, and the increasingly pluralistic nature of our society, both gender relations and family structures have undergone tremendous change, and many challenges await elucidation. The seven papers in this special issue thus feature new perspectives on family, gender and parenting issues. The issue opens with a paper on scale validation. Since intimacy is a construct that has received limited attention in the Chinese context, the first paper, “Intimacy as a distinct construct: validating the intimacy scale among older adults of residential care homes in Hong Kong”, aims to develop a valid measurement for the quality of the relationship between older adults and family caregivers in the Hong Kong Chinese context. The study results demonstrate the reliability and validity of the instrument across samples of older adults. Paper 2 and 3 that follow are qualitative studies adopting cultural perspectives to understand Chinese American immigrant adults and older female survivors of intimate partner violence in Taiwan. In paper 2, “Understanding family connections and help-seeking behavior in Chinese parental lives. These findings illustrate how existentialism provides a new frame of reference and new practice directions for conducting parent-education programs. The final paper titled “Internet supervision and parenting in the digital age: The case of Shanghai” echoes the technological advancement and its impact on parenting. In a changing world, and in a society permeated by the Internet and by nearly instantaneous communication, families constantly need to adapt to different and changing ways of parenting. The paper explores the issue of parenting confidence in supervision of children’s Internet use in Shanghai, China. Multiple-regression models are used to identify factors affecting parents’ confidence about their own parenting. The findings suggest that efforts to assist parents should help them review their attitudes towards the Internet. American immigrant adults who attempt suicide”, the authors investigate beliefs, values and norms in the Chinese family culture and examine Chinese cultural influences on attitudes and beliefs about mental health and mental health services in the immigrant context. Paper 3, “Older female survivors of intimate partner violence in the Taiwanese cultural context” examines the needs of older female IPV survivors in another Chinese cultural context. The findings of both studies reflect the importance of family and the influence of Chinese family culture; they make it clear that traditional family beliefs are still highly valued and hold a prominent position in Chinese culture. The authors of these two papers question the efficacy of service-delivery models based on Western cultures, and they call for ethnically sensitive intervention approaches that incorporate cultural premises into developing viable options for service recipients. Paper 4 is titled “The Macau family-in-transition: the perceived impact of casino employment on family relationships among dealer families”. This paper draws on findings from a qualitative study to explore the impacts of casino employment on family life and family relationships. The family, like other social group, is a product of culture and context, and the specific socio-economic context of Macau poses challenges to dealer families and casino workers in performing their parental role. The paper sheds much-needed light on our understanding of Macau dealer families. The final three papers in this special issue all address the issue of parenting. Paper 5, “Reflective inquiry on professionals’ view on parents and about parenting”, examines professionals’ views of parents, their attitudes and beliefs about parenting, and the values underpinning their practice. The study’s findings on the theme of parent blaming provide an impetus for professionals to reflect on the attitudes and assumptions they hold, and their impact on parents. The paper calls for reflection on parenting work to recognize the difficulties and challenges faced by contemporary families. Paper 6, “Reviving parents’ life momentum: A qualitative evaluation of a parent education program adopting an existential approach”, reports the results of a qualitative analysis of the participants’ perceptions of a parent-education program. The findings of this study demonstrate that a program of this nature can make parents aware of the existential dimensions of being a parent and help them understand the significance of creating meaning in their In fact, family, parenting and gender are vastly contested terms which encompass a range of topics. The seven varied papers recommended for publication in this special issue reflect the considerable attention that we have placed on family, parenting and gender, and also the vision of this special issue. These papers add to the growing body of research and literature, and they provide both food for thought and a platform for discussion. In the last, I offer both my sincere thanks to the authors who have contributed to this special issue, and my gratitude to those who have participated as blind peer reviewers. Their thoughtful comments and criticisms have certainly improved the quality of each and every paper in this special issue.

During physical distancing, children do not meet their peers to play or talk together. Peer relationships have a crucial influence on all child development, especially for social skills or behaviour during early childhood. This study aims to determine changes in children's social behaviour during physical distancing during the Covid-19 pandemic. This research method is a descriptive quantitative study designed with the percentage value was used as a score for measuring the results of parental observations of children concerning the child's social behaviour instrument. Quota sampling (150 parents) was used to reach participants from various cities in Indonesia to see cultural differences. Data on children's social behaviour was obtained using the Preschool and Kindergarten Behaviour Scale (PKBS) tests. The data were then analysed using descriptive statistics. The results show that there are changes in children's social behaviour during physical distancing. Children who are less independent (58.9%) are the biggest decline in social behaviour reported by parents, while the one who changes the least is cleaning up the mess that has been made (38.7%). The implication of the results of this study is that parents should continue to pay attention to their children's social behaviour by providing opportunities for children to interact with peers in the house while still paying attention to health protocols. Keywords: Early Childhood, Social Behaviour, Physical Distancing References: Aksoy, P., & Baran, G. (2010). Review of studies aimed at bringing social skills for children in preschool period. Procedia - Social and Behavioural Sciences, 9, 663–669. https://doi.org/10.1016/j.sbspro.2010.12.214 Al-Tammemi, A. B. (2020). The Battle Against COVID-19 in Jordan: An Early Overview of the Jordanian Experience. Frontiers in Public Health, 8(May), 1–6. https://doi.org/10.3389/fpubh.2020.00188 Arkorful, V., & Abaidoo, N. (2015). 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The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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STEAM-based learning is a global issue in early-childhood education practice. STEAM content becomes an integrative thematic approach as the main pillar of learning in kindergarten. This study aims to develop a conceptual and practical approach in the implementation of children's education by applying a modification from STEAM Learning to R-SLAMET. The research used a qualitative case study method with data collection through focus group discussions (FGD), involving early-childhood educator's research participants (n = 35), interviews, observation, document analysis such as videos, photos and portfolios. The study found several ideal categories through the use of narrative data analysis techniques. The findings show that educators gain an understanding of the change in learning orientation from competency indicators to play-based learning. Developing thematic play activities into continuum playing scenarios. STEAM learning content modification (Science, Technology, Engineering, Art and Math) to R-SLAMETS content (Religion, Science, Literacy, Art, Math, Engineering, Technology and Social study) in daily class activity. Children activities with R-SLAMETS content can be developed based on an integrative learning flow that empowers loose part media with local materials learning resources. Keyword: STEAM to R-SLAMETS, Early Childhood Education, Integrative Thematic Learning References Ali, E., Kaitlyn M, C., Hussain, A., & Akhtar, Z. (2018). the Effects of Play-Based Learning on Early Childhood Education and Development. Journal of Evolution of Medical and Dental Sciences, 7(43), 4682–4685. https://doi.org/10.14260/jemds/2018/1044 Ata Aktürk, A., & Demircan, O. (2017). A Review of Studies on STEM and STEAM Education in Early Childhood. Journal of Kırşehir Education Faculty, 18(2), 757–776. Azizah, W. A., Sarwi, S., & Ellianawati, E. (2020). 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How Creativity & Motivation Interacts with Inquiry-based Learning. Creativity Research Journal, 31(3), 284–295. https://doi.org/10.1080/10400419.2019.1641678 Cook, K. L., & Bush, S. B. (2018). Design thinking in integrated STEAM learning: Surveying the landscape and exploring exemplars in elementary grades. School Science and Mathematics, 118(3–4), 93–103. https://doi.org/10.1111/ssm.12268 Costantino, T. (2018). STEAM by another name: Transdisciplinary practice in art and design education. Arts Education Policy Review, 119(2), 100–106. https://doi.org/10.1080/10632913.2017.1292973 Danniels, E., & Pyle, A. (2018). Defining Play-based Learning. In Encyclopedia on Early Childhood Development (Play-Based, Issue February, pp. 1–5). OISE University of Toronto. DeJarnette, N. K. (2018). Implementing STEAM in the Early Childhood Classroom. European Journal of STEM Education, 3(3), 1–9. https://doi.org/10.20897/ejsteme/3878 Dell’Erba, M. (2019). Policy Considerations for STEAM Education. Policy Brief, 1–10. Doyle, K. (2019). The languages and literacies of the STEAM content areas. Literacy Learning: The Middle Years, 27(1), 38–50. http://proxy.libraries.smu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eue&AN=133954204&site=ehost-live&scope=site Edwards, S. (2017). Play-based learning and intentional teaching: Forever different? Australasian Journal of Early Childhood, 42(2), 4–11. https://doi.org/10.23965/ajec.42.2.01 Faas, S., Wu, S.-C., & Geiger, S. (2017). The Importance of Play in Early Childhood Education: A Critical Perspective on Current Policies and Practices in Germany and Hong Kong. Global Education Review, 4(2), 75–91. Fesseha, E., & Pyle, A. (2016). Conceptualising play-based learning from kindergarten teachers’ perspectives. International Journal of Early Years Education, 24(3), 361–377. https://doi.org/10.1080/09669760.2016.1174105 Finch, C. R., Frantz, N. R., Mooney, M., & Aneke, N. O. (1997). Designing the Thematic Curriculum: An All Aspects Approach MDS-956. 97. Gess, A. H. (2019). STEAM Education. STEAM Education, November, 2011–2014. https://doi.org/10.1007/978-3-030-04003-1 Gronlund, G. (n.d.). “ Addressing Standards through Play-Based Learning in Preschool and Kindergarten .” Gronlund, G. (2015). Planning for Play-Based Curriculum Based on Individualized Goals to Help Each Child Thrive in Preschool and Kindergarten Gaye Gronlund. Gull, C., Bogunovich, J., Goldstein, S. L., & Rosengarten, T. (2019). Definitions of Loose Parts in Early Childhood Outdoor Classrooms: A Scoping Review. The International Journal of Early Childhood Education, 6(3), 37–52. Hapidin, Pujianti, Y., Hartati, S., Nurani, Y., & Dhieni, N. (2020). The continuous professional development for early childhood teachers through lesson study in implementing play based curriculum (case study in Jakarta, Indonesia). International Journal of Innovation, Creativity and Change, 12(10), 17–25. Hennessey, P. (2016). Full – Day Kindergarten Play-Based Learning : Promoting a Common Understanding. Education and Early Childhood Development, April, 1–76. gov.nl.ca/edu Henriksen, D. (2017). Creating STEAM with Design Thinking: Beyond STEM and Arts Integration. Steam, 3(1), 1–11. https://doi.org/10.5642/steam.20170301.11 Inglese, P., Barbera, G., La Mantia, T., On, P., Presentation, T., Reid, R., Vasa, S. F., Maag, J. W., Wright, G., Irsyadi, F. Y. Al, Nugroho, Y. S., Cutter-Mackenzie, A., Edwards, S., Moore, D., Boyd, W., Miller, E., Almon, J., Cramer, S. C., Wilkes-Gillan, S., … Halperin, J. M. (2014). Young Children’s Play and Environmental Education in Early Childhood Education. PLoS ONE, 2(3), 9–25. https://doi.org/10.1586/ern.12.106 Jacman, H. (2012). Early Education Curriculum. Pedagogical Development Unit, FEBRUARY 2011, 163. https://www.eursc.eu/Syllabuses/2011-01-D-15-en-4.pdf Jay, J. A., & Knaus, M. (2018). Embedding play-based learning into junior primary (Year 1 and 2) Curriculum in WA. Australian Journal of Teacher Education, 43(1), 112–126. https://doi.org/10.14221/ajte.2018v43n1.7 Kennedy, A., & Barblett, L. (2010). Supporting the Early Years Learning Framework. Research in Practise Series, 17(3), 1–12. Keung, C. P. C., & Cheung, A. C. K. (2019). Towards Holistic Supporting of Play-Based Learning Implementation in Kindergartens: A Mixed Method Study. Early Childhood Education Journal, 47(5), 627–640. https://doi.org/10.1007/s10643-019-00956-2 Keung, C. P. C., & Fung, C. K. H. (2020). Exploring kindergarten teachers’ pedagogical content knowledge in the development of play-based learning. Journal of Education for Teaching, 46(2), 244–247. https://doi.org/10.1080/02607476.2020.1724656 Krogh, S., & Morehouse, P. (2014). The Early Childhood Curriculum : Inquiry Learning Through Integration. Liao, C. (2016). From Interdisciplinary to Transdisciplinary: An Arts-Integrated Approach to STEAM Education. Art Education, 69(6), 44–49. https://doi.org/10.1080/00043125.2016.1224873 Lillard, A. S., Lerner, M. D., Hopkins, E. J., Dore, R. A., Smith, E. D., & Palmquist, C. M. (2013). The impact of pretend play on children’s development: A review of the evidence. Psychological Bulletin, 139(1), 1–34. https://doi.org/10.1037/a0029321 Maxwell, L. E., Mitchell, M. R., & Evans, G. W. (2008). Effects of Play Equipment and Loose Parts on Preschool Children’s Outdoor Play Behavior: An Observational Study and Design Intervention. Children, Youth and Environments, 18(2), 37–63. McLaughlin, T., & Cherrington, S. (2018). Creating a rich curriculum through intentional teaching. Early Childhood Folio, 22(1), 33. https://doi.org/10.18296/ecf.0050 Mengmeng, Z., Xiantong, Y., & Xinghua, W. (2019). Construction of STEAM Curriculum Model and Case Design in Kindergarten. American Journal of Educational Research, 7(7), 485–490. https://doi.org/10.12691/education-7-7-8 Milara, I. S., Pitkänen, K., Laru, J., Iwata, M., Orduña, M. C., & Riekki, J. (2020). STEAM in Oulu: Scaffolding the development of a Community of Practice for local educators around STEAM and digital fabrication. International Journal of Child-Computer Interaction, 26, 100197. https://doi.org/10.1016/j.ijcci.2020.100197 Moomaw, S. (2012). STEM Begins in the Early Years. School Science and Mathematics, 112(2), 57–58. https://doi.org/10.1111/j.1949-8594.2011.00119.x Peng, Q. (2017). Study on Three Positions Framing Kindergarten Play-Based Curriculum in China: Through Analyses of the Attitudes of Teachers to Early Linguistic Education. Studies in English Language Teaching, 5(3), 543. https://doi.org/10.22158/selt.v5n3p543 Pyle, A., & Bigelow, A. (2015). Play in Kindergarten: An Interview and Observational Study in Three Canadian Classrooms. 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Reinventing the STEAM Engine for Art + Design Education. Art Education, 69(4), 4–7. https://doi.org/10.1080/00043125.2016.1176848 Sancar-Tokmak, H. (2015). The effect of curriculum-generated play instruction on the mathematics teaching efficacies of early childhood education pre-service teachers. European Early Childhood Education Research Journal, 23(1), 5–20. https://doi.org/10.1080/1350293X.2013.788315 Sawangmek, S. (2019). Trends and Issues on STEM and STEAM Education in Early Childhood. Képzés És Gyakorlat, 17(2019/3-4), 97–106. https://doi.org/10.17165/tp.2019.3-4.8 Science, A. I. (n.d.). STEM Project-Based Learning. Spencer, R., Joshi, N., Branje, K., Lee McIsaac, J., Cawley, J., Rehman, L., FL Kirk, S., & Stone, M. (2019). Educator perceptions on the benefits and challenges of loose parts play in the outdoor environments of childcare centres. AIMS Public Health, 6(4), 461–476. https://doi.org/10.3934/publichealth.2019.4.461 Taylor, J., Bond, E., & Woods, M. (2018). A Multidisciplinary and Holistic Introduction. Varun A. (2014). Thematic Approach for Effective Communication in Early Childhood Education Thematic Approach for effective communication in ECCE. International Journal of Education and Psychological Research (IJEPR), 3(3), 49–51. https://www.researchgate.net/publication/289868193 Wang, X., Xu, W., & Guo, L. (2018). The status quo and ways of STEAM education promoting China’s future social sustainable development. Sustainability (Switzerland), 10(12). https://doi.org/10.3390/su10124417 Whitebread, D. D. (2012). The Importance of Play. Toy Industries of Europe, April, 1–55. https://doi.org/10.5455/msm.2015.27.438-441 Wong, S. M., Wang, Z., & Cheng, D. (2011). A play-based curriculum: Hong Kong children’s perception of play and non-play. International Journal of Learning, 17(10), 165–180. https://doi.org/10.18848/1447-9494/cgp/v17i10/47298 Zosh, J. M., Hopkins, E. J., Jensen, H., Liu, C., Neale, D., Hirsh-Pasek, K., Whitebread, Solis, S. 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AbstractThis study investigates the relative importance of living with adult children and social participation for the elderly's subjective wellbeing (happiness) in three Chinese societies (Hong Kong, urban China and Taiwan). We use data from the 2011 wave of the Hong Kong Panel Study of Social Dynamics (N = 1,658), the 2010 China Family Panel Studies in mainland China (N = 3,198) and the 2010 wave of the Taiwan Social Change Survey (N = 790). The ordinary least squares regression shows that, as the family value of society moves forward on a traditional–modern continuum, the elderly benefit more psychologically from social participation and less from living with children. The older people in Hong Kong who live independently with a spouse are in a significantly better emotional state than those living with adult children. Social participation is positively associated with subjective wellbeing among the aged in Hong Kong but not among those in urban China and Taiwan. The findings suggest that encouraging social involvement is important for effective public policy to tackle rapid population ageing in Chinese societies.

Early childhood caries is common in Hong Kong, and parental practices on maintaining good oral health of their young children are far from satisfactory. This article reports on the effectiveness of a randomized controlled trial on family-centered oral health promotion to new parents in establishing proper feeding habits and oral hygiene practices and in reducing caries risk among 3-y-old toddlers. At baseline, pregnant mothers and their husbands were recruited and randomly allocated into 2 groups. The test group received individualized oral health education (OHE) via a behavioral and educational counseling approach while the control group received the OHE pamphlets only. Information related to the feeding habits, oral hygiene practices, and oral health of the toddlers was collected by parent-completed questionnaires and oral examination annually via home visits. A total of 580 families were recruited at baseline, and 436 toddlers were followed up when they reached 3 y old (test, n = 228; control, n = 208; follow-up rate, 75.2%). The proportions of toddlers who held food in the mouth, fell asleep when milk feeding, had prolonged use of the nursing bottle, ate before bed, and consumed a sweet snack daily were significantly lower in the test group than in the control group (all P < 0.05). Significantly higher proportions of toddlers brushed their own teeth twice daily, were brushed by their parents twice daily, and used fluoride toothpaste than in the control group (all P < 0.001). Toddlers in the test group had better oral health status with a lower level of visible plaque, Streptococcus mutans, white spot lesion, and cavitated lesion (all P < 0.05). Family-centered oral health promotion and individualized OHE for parents via a behavioral and educational counseling approach are more effective in establishing good feeding habits and parental toothbrushing practices and in decreasing the caries risk of their toddlers than the distribution of OHE pamphlets alone (ClinicalTrials.gov NCT02937194).

Abstract Background Preschool-aged children’s physical activity (PA) and screen time (ST) are important health-related behaviours likely influenced by PA opportunities, parental perceptions of neighbourhood safety and parenting practices pertaining to PA and ST. How these factors interact to impact on young children’s PA and ST, and whether their effects are generalisable across cultures and geographical location is not known. This study addressed these knowledge gaps by conducting pooled analyses of comparable data from two culturally and geographically diverse samples – Chinese parent-child dyads from an ultra-dense city (Hong Kong, China) and Latino parent-child dyads from a low-density city (Houston, USA). Methods The analytical sample consisted of 164 Hong Kong Chinese and 84 US Latino parent-child dyads with data on socio-demographic characteristics, parent-perceived neighbourhood destinations and facilities for children’s PA, physical and social safety-related neighbourhood attributes, PA-related parenting practices and child’s ST and accelerometer-assessed PA. Generalised linear models with robust standard errors accounting for neighbourhood-level clustering were used to estimate associations and interaction effects. Results Hong Kong Chinese children accumulated less PA than US Latino children, although the latter had more ST. Hong Kong Chinese parents reported more parenting practices promoting inactivity. Neighbourhood PA opportunities were positively related to children’s PA only if parental perceptions of neighbourhood safety were favourable, and the associations of physical neighbourhood environment characteristics with children’s PA and ST depended on PA-related parenting practices. Community cohesion was positively related to children’s PA and negatively related to ST, while parental promotion of ST was positively associated with children’s ST. Correlates of children’s PA and ST did not differ by city. Conclusions The substantial differences in activity patterns between Hong Kong Chinese and US Latino preschool-aged children observed in this study are likely due to a combination of cultural and built environmental factors. However, the fact that no between-city differences in correlates of PA and ST were detected indicates that both populations of children are equally affected by parent-perceived neighbourhood environmental characteristics and parenting practices. Overall, this study highlights the importance of considering how various individual-, home- and neighbourhood physical and social factors interact to influence young children’s health-promoting activity levels.

Australia — Australia Ends Ban on Embryo Cloning for Research. Australia — Australia Government Allocates A$500 million for Science. Australia — Gardasil Immunization Program in Australia from Next Year. China — AIDS Patients to be Compensated for Blood Infection. China — New AIDS Therapy More Effective. China — Changzhou National Hi-Tech District Creates Alliance with Samara Province in Russia For Joint Construction Of Science & Technology Park. Hong Kong — New CRO in Hong Kong to Feed China. Hong Kong — Botanical Medicine Company Chi-Med Collaborates with Merck. India — Indian Pharmaceuticals Agree to Supply Cheaper Drugs for Children with AIDS. India — British Pharmacopoeia Officials to Hold Talks with Indian officials. India — Indian Government to Set Up Five Institutes to Boost Pharma R&D. South Korea — South Korea Reports on its Second Outbreak of Bird Flu. Singapore — Scientists will Perform Research Work on New Stem Cell Bank. Singapore — Scientists Discover New Path for Malaria Drug. Singapore — Singapore's Fusionopolis Phase 2A Sells Out. Singapore — Singapore Ministries to Tackle Rise in AIDS Number. Singapore — A*STAR-Karolinska Symposium on Immunology. Singapore — Singapore to Set Up Two Biomed R&D Centers. Singapore — Human Embroynic Stem Cells Research in Singapore. Thailand — Thai Health Ministry To Issue Compulsory License For Merck's HIV/AIDS Drug Efavirenz. Others — Gardisil Research in Britain. Others — World Bank Says More Funding Needed to Fight Bird Flu.

AUSTRALIA — A Web-based Tool to Predict Bone Fracture Risk AUSTRALIA — World's First Stem Cell Screening Facility to Target Brain Tumors CHINA — Agro-Technology to Build Biodiesel Refinery CHINA — TCM Development Strategy Established CHINA — Folic Acid Prevents Stomach Cancer CHINA — A Major Nanobiology Research Project is Initiated at CAS CHINA — Scientists to Sequence Giant Panda Genome CHINA — Biotech Company Announces World's First Genetically Modified Phytase Corn CHINA — Smoking — A Major Risk Factor of Stroke in China HONG KONG — ASB Biodiesel to Build Hong Kong Plant INDIA — CCRAS Identified 39 Formulations for Eight Specific Disease Conditions INDIA — First Hi-tech TomoTherapy System Installed INDIA — Government Research Labs Develop 28 New Drugs for Chronic Ailments INDIA — BIOTRONIK Home Monitoring Cardiac Devices Launched in India INDIA — Biotech Incubation Center to Become a Reality Soon JAPAN — Radiation Exposure in utero and in Young Children Increases Adult Cancer Risk JAPAN — Anchoring Protein Variant Associated with Increased Breast Cancer Risk JAPAN — Stem Cells Develop New Organs in Mice NEW ZEALAND — New Diabetes Treatment Now Available in New Zealand NEW ZEALAND — Trans-Tasman Scientists Study Livestock Methane PHILIPPINES — Philippines Bioethanol Capacity to Expand SINGAPORE — Asia's First Research Center for Palliative Care Opens in Singapore SINGAPORE — Millipore Corporation (MIL) Announces New Facility in Singapore SINGAPORE — Patients Under Chronic Disease Management Program Show Better Disease Control SINGAPORE — NTUC Childcare Issues Health Alert Following Hong Kong Flu Outbreak TAIWAN — Gene Screening Used in IVF for Healthy Babies TAIWAN — Researchers Tout Progress in Vaccine to Combat HIV TAIWAN — Taipei Program to Help Cardiac Arrest Victims

Background: Classroom is where children spend much of their time in; this study aimed to identify the concentration of heavy metals in the classroom dust based on the results of various studies in the world using the published data up to years 2018. Methods: Fifteen studies were selected for the study according to the inclusion and exclusion criteria. The mean concentration of 11 heavy metals including arsenic, barium, cadmium, cobalt, chromium, copper, iron, lead, manganese, nickel, and zinc was extracted. Results: The highest mean concentration of heavy metal (mg/kg) in classroom dust was related to iron (3904.7, 95%CI: 3657.1-8154.3), zinc (429.9, 95%CI: 182.8-677.1) and barium (419.2, 95%CI: 274.7-253.7), respectively. Subgroup analysis showed the maximum concentration (mg/kg) of iron in Iran (16945.5), zinc in Hong Kong (2293.5), barium in China (979.8), manganese in Iran (288.9), lead in Iran (258.8), chromium in Ghana (381.3), copper in Hong Kong (274.4), nickel in Iran (50.1), cobalt in China(43.4), arsenic in China(13.7) and cadmium in Hong Kong(8.7). Conclusion: Even safe and healthy classrooms can threaten children’s health by heavy metals. These metals are important since they are naturally found throughout the earth’s crust, accumulate in the food chain and contaminate drinking water as well as alloys in school equipment.

Abstract Background Residual dried blood spots (rDBS) from newborn screening programmes represent a valuable resource for medical research, from basic sciences, through clinical to public health. In Hong Kong, there is no legislation for biobanking. Parents’ view on the retention and use of residual newborn blood samples could be cultural-specific and is important to consider for biobanking of rDBS. Objective To study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents. Methods A mixed-method approach was used to study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents of children 0–3 years or expecting parents through focus groups (8 groups; 33 participants) and a survey (n = 1012, 85% mothers) designed with insights obtained from the focus groups. We used framework analysis to summarise the themes as supportive factors, concerns and critical arguments for retention and secondary use of rDBS from focus group discussion. We used multiple logistic regression to assess factors associated with support for retention and secondary use of rDBS in the survey. Results Both in focus groups and survey, majority of parents were not aware of the potential secondary use of rDBS. Overall secondary use of rDBS in medical research was well accepted by a large proportion of Hong Kong parents, even if all potential future research could not be specified in a broad consent. However parents were concerned about potential risks of biobanking rDBS including leaking of data and mis-use of genetic information. Parents wanted to be asked for permission before rDBS are stored and mainly did not accept an “opt-out” approach. The survey showed that parents born in mainland China, compared to Hong Kong born parents, had lower awareness of newborn screening but higher support in biobanking rDBS. Higher education was associated with support in rDBS biobanking only among fathers. Conclusion Long-term storage and secondary use of rDBS from newborn screening for biomedical research and a broad consent for biobanking of rDBS are generally acceptable to Hong Kong parents given their autonomy is respected and their privacy is protected, highlighting the importance of an accountable governance and a transparent access policy for rDBS biobanks.

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions.Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country.Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0–5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA).Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.

AUSTRALIA — Lung Cancer Cases on the Rise. AUSTRALIA — Cantox Announces the Launch of Ashuren Health Sciences Pharmaceutical Division. CHINA — Biotech Crops Exhibit Impressive Double-digit Growth. CHINA — World Genomes Project to Promote Research on Human Diseases. HONG KONG — New Anti-Hepatitis Drug Found. INDIA — Pneumonia Kills More Than 1000 Children Daily in India. INDIA — PepsiCo to Open Carrageenan Biopolymer Plant in India. INDIA — Medical Tourism Insurance Covers Will Soon be Available in the West. JAPAN — Green Tea May Reduce Prostate Cancer Risk. SINGAPORE — QIAGEN to Supply Avian Flu Surveillance Solutions to Singapore. TAIWAN — NTU Discovery May Help Cardiovascular and Cancer Experiments. VIETNAM — Bird Flu Hits Poultry Farm in Northern Vietnam.

Objective: This study examined the epidemiology of scarlet fever in Hong Kong based on notifiable disease surveillance data, in a period where a 10-fold upsurge in scarlet fever incidence occurred. High risk groups and important factors associated with scarlet fever transmission were identified.Introduction: Scarlet fever is a notifiable disease in Hong Kong for over 40 years. There was relatively low activity of scarlet fever until an outbreak in mid-2011 which resulted in two deaths and more than 1,500 cases. Scarlet fever incidence remained elevated since then with >10-fold increase comparing to that before the upsurge (1, 2). Reemergence of scarlet fever was also reported in China in 2011 and the United Kingdom in 2014 (3). We analyzed the patterns in scarlet fever incidence in Hong Kong using the notifiable disease surveillance data from 2005–2015.Methods: We analyzed 7,266 scarlet fever cases aged 14y or younger from 2005-2015, who were notified to the Department of Health. Hierarchical multivariable negative binomial models were fitted to the data to study the effects of age, sex, school holidays, and other meteorological parameters, accounting for autocorrelation, seasonal and long-term trend. Separate models were fitted to the data before and after the upsurge in 2011, excluding data in 2011 to allow for a 1-year window period.Results: We observed seasonal pattern throughout the study period (Figure). Among children aged ≤5y, the average scarlet fever incidence was 3.3 per 10,000 children in 2005-2010, which increased substantially to 18.1 per 10,000 children in 2012-2015.The final model included age, sex, school holidays in the preceding week, temperature, relative humidity, rainfall, long-term and bimodal seasonal trend. Based on the model, we identified no significant long-term trend before the upsurge in 2011, but there was a mild decreasing trend of about 8% (95% CI=6-11%) per year after the upsurge. A major peak was identified in December to January, with a milder peak in May to June.We found that the most affected groups were kindergarten students (3-5y), followed by primary school students (6-11y). Comparing to girls aged 0-2y, boys had significantly higher risk than girls except for the 0-2y age group, and boys aged 3-5y had the highest risk (adjusted incidence rate ratio (IRR)=1.47, 95% CI=1.32-1.65). School holidays were significantly associated with lower incidence of scarlet fever, with an adjusted IRR of 0.58 (95% CI=0.51–0.65) after the upsurge in 2011. Temperature was found to be negatively associated with scarlet fever incidence (adjusted IRR=0.963, 95% CI=0.940-0.987) after the upsurge.Conclusions: Our study showed that elevated activity of scarlet fever was sustained for more than 5 years after the upsurge in 2011. We found that younger children who started schools, especially for boys aged 3-5 years, had a higher risk of scarlet fever, and there was significant effect of school holidays in reducing scarlet fever incidence. Combining these findings, school-based control strategy is likely to be effective. Sustained and consistent surveillance of scarlet fever allows continued monitoring of potential change in high risk group to drive updated and effective control strategy.

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The World Health Organization recommends young children receive influenza vaccination (IV) annually. Stratified by children’s previous IV status, this study investigated the associated factors of parental intention to let their children aged 24 to 59 months receive IV in the next 12 months in Hong Kong, China. We conducted a cross-sectional population-based telephone survey among 540 Chinese parents of children aged 24 to 59 months. The prevalence of parental intention regarding their child’s IV was 68.9% and 19.8%, respectively, in the ever-vaccinated and never-vaccinated groups. Adjusted for background factors, perceived susceptibility (adjusted odds ratio [ORa] = 3.20, 95% confidence interval [CI] = 1.07-9.54), perceived benefit (ORa = 4.77, 95% CI = 2.52-9.05), perceived barrier (ORa = 0.38, 95% CI = 0.17-0.84), cue to action (ORa = 3.57, 95% CI = 1.88-6.78), subjective norm (ORa = 11.23, 95% CI = 6.17-20.46), and having family members vaccinated (ORa = 1.79, 95% CI = 1.09-2.96) were associated with parental intention for ever-vaccinated children’s IV, while only perceived benefit (ORa = 8.85, 95% CI = 3.36-23.34) and subjective norm (ORa = 21.66, 95% CI = 9.25-50.71) were significant for never-vaccinated children. Our findings showed that the identified factors and applicability of the health belief model varied according to child’s vaccination status. Health promotion should consider segmentation principles. Besides modifying related cognitions like perceived benefit and barrier (only for the ever-vaccinated group), such programs should improve cue to action involving health professionals and family members and create supportive subjective norms.

BackgroundOral health literacy (OHL) has been recognized as a component of oral health disparities; however, the precise relationship between literacy and oral health outcomes has not been established. To explore the role of parents' OHL for their own subjective oral health, related behavior, and for the proxy assessment of their child's oral health, oral health-related behavior.MethodsSurvey data were collected from 406 parents of 4- to 7-year-old children in Beijing, China. The background characteristics, oral health assessment, oral health-related behavior, knowledge and attitudes, and diet-related questions of parents and their children were surveyed by a questionnaire. OHL was assessed with the Hong Kong Rapid Estimate of Adult Literacy in Dentistry (HKREAL-30) Scale and a revised version that asked the respondents to indicate if they understood the words (HKREALD-30-Understand).ResultsThe HKREALD-30 responses correlated with the HKREALD-30-Understand responses. The higher the parents' HKREALD-30-Understand scores, the better they described the health of their own teeth and gums, the greater their child's diet was influenced by the protein, sugar and calories of the food, and the more positive their oral health-related attitudes were. The higher the parent's HKREALD-30 scores, the healthier they described their child's teeth and gums.ConclusionsBoth the HKREALD-30 and HKREALD-30-Understand Scores correlate with parents' self and proxy oral health-related responses. Chinese parents could understand that the word would add predictive value to the prediction of how parents' oral health literacy affects their own oral health care, children's oral health and other related aspects.

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.

PurposeTo review the association between children's behavioral changes during the restriction due to the pandemic of Coronavirus disease (COVID-19) and the development and progression of myopia.DesignA literature review.MethodWe looked for relevant studies related to 1) children's behavioral changes from COVID-19 restriction and 2) children's myopia progression during COVID-19 restriction by using the following keywords. They were “Behavior,” “Activity,” “COVID-19,” “Lockdown,” “Restriction,” and “Children” for the former; “Myopia,” “COVID-19,” “Lockdown,” “Restriction” for the latter. Titles, abstracts and full texts from the retrieved studies were screened and all relevant data were summarized, analyzed, and discussed.ResultsChildren were less active and more sedentary during COVID-19 restriction. According to five studies from China and six studies, each from Hong Kong, Spain, Israel, South Korea, Turkey and Taiwan included in our review, all countries without myopia preventive intervention supported the association between the lockdown and myopia progression by means of negative SER change ranging from 0.05–0.6 D, more negative SER change (compared post- to pre-lockdown) ranging from 0.71–0.98 D and more negative rate of SER changes (compared post- to pre-lockdown) ranging from 0.05–0.1 D/month. The reported factor that accelerated myopia is an increase in total near work, while increased outdoor activity is a protective factor against myopia progression.ConclusionThe pandemic of COVID-19 provided an unwanted opportunity to assess the effect of the behavioral changes and myopia in the real world. There is sufficient evidence to support the association between an increase in near work from home confinement or a reduction of outdoor activities and worsening of myopia during the COVID-19 lockdown. The findings from this review of data from the real world may help better understanding of myopia development and progression, which may lead to adjustment of behaviors to prevent myopia and its progression in the future.

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Photo by Sangharsh Lohakare on Unsplash ABSTRACT The public should debate the ethical and social challenges arising from heritable human genome editing (HHGE). The notorious case involving He Jiankui may have led to the disfavor of gene editing and a precautionary approach. While the de facto global moratorium on HHGE is clearly justified considering our current inability to implement it safely and effectively, the difficult ethical considerations should be addressed prior to the ability to initiate widespread HHGE. This piece argues that prospective patients and other members of society beyond the scientific community must be included in the conversation. It emphasizes the potential role of those not directly participating in HHGE science, calling the broader academic community not simply to wait for scientists’ results and only afterward react. Pointing to key historical examples, I contend that scientific progress is intrinsically linked with the surrounding societal discussion and that it is not only scientists who can influence where the HHGE story ends. INTRODUCTION l. Rogue Scientists Chinese biophysicist He Jiankui announced the world’s first genetically modified babies in 2018. Naturally, the treatment aroused the attention of the world’s media, which focused on He’s reckless actions. Indeed, in setting up and carrying out the procedure in question, he flouted norms of good scientific practice on a range of levels—errors paid with time in prison. Since the He controversy, few scientists have aggressively approached heritable human genome editing (HHGE) and challenged the current research norms. The most outspoken exception is the Russian molecular biologist Denis Rebrikov of the Pirogov Russian National Research Medical University. He publicly declared his intention to apply clustered regularly interspaced short palindromic repeats (CRISPR) to embryos to help couples avoid passing serious medical conditions to their children. However, Rebrikov met fierce opposition both inside and beyond Russia and, with leading CRISPR scientists and bioethicists abroad describing him as a “cowboy” who had “weak data” and was trying to “grab some attention.”[1] So far, Rebrikov’s plans have failed to come to fruition. Although there are 126 entries listed in a registry of HHGE research recently created by the World Health Organization (WHO),[2],[3] it seems that clinical HHGE has been paused for the time being. ll. Steering the Conversation A section of the scientific community has been trying to steer the ethical debate on HHGE away from the actions of rogue scientists and back to an issue that is central to the matter—the interests of patients. The majority would agree that the most compelling potential application of germline genome editing is for the prevention of devastating genetic conditions, for example, when both parents carry Huntington’s disease, for which “genome editing offers the only prospect of bearing a healthy, genetically related child.”[4] Despite such justification for scientists to continue pursuing research in the area, there has been a notable reticence in the wider academic community regarding making the ethical case for HHGE and clarifying in which medical situations such a technique might be reasonably applied. Even among those who recognize that the HHGE cases' controversies should not be a reason for panic over designer babies, some believe that starting the ethical debate is premature. A key part of the argument is that the current technological and scientific knowledge available is far from ready to deliver on treatments. A similar stance preventing debate in the wider society is that “difficult questions” about cost, accessibility, and social justice remain.[5] Whether intended or not, the implication is that the position of wider society in the HHGE story should be a reactive one, namely waiting to see what the scientists throw at them and then dealing with it. I argue that there is not only an immediate need for broader academic and societal input on the ethical and social aspects of the HHGE debate but that there is a deep symbiosis between scientific progress and its surroundings, whereby science both shapes and is shaped by the societal environment in which it takes place. The WHO published a position paper, recommendations, and a framework for governance. The framework for governance describes global standards for the governance and oversight of HHGE.[6] The position paper emphasized the importance of global and inclusive dialogue,[7] and many other boards have also called for broad public engagement.[8] It is imperative that WHO’s governance framework meets everyone’s needs. After all, as with any medical treatment, it is not the scientist who developed the treatment or the doctor who delivers it that is most important– that honor falls to the patient. In the case of HHGE, the beneficiaries include those members of society who hope to reproduce. Yet HHGE has the potential to impact society. We all should have an opportunity to be a part of world-changing decisions that lead to the creation are made and feel a responsibility to participate. lll. Shutting Down the Academic Debate At the 30th Annual Conference of the Japanese Association for Bioethics, which took place in late 2018 after He’s experiment, the discussion about HHGE was shut down quickly. Notwithstanding the understandable issues raised with He’s case, one participant after another stood up to voice support for an outright and complete ban on the use of CRISPR.[9] The ban was based on the grounds that editing the human genome would result in a cascade of unforeseen and irreversible consequences for future generations. One participant forcefully argued that “the deoxyribose nucleic acid (DNA) rubicon should never be crossed for above all, it was deeply immoral to do so when there was no way of obtaining the consent of those who would actually stand affected—our descendants.”[10] Another saw it as putting humanity on a slippery slope toward enhancements, and some feared the catastrophic mistakes that might result from their use.[11] While the above event provides just one snapshot of the debate that was taking place around the world at the time, it captures the strong reservations in the scientific community. It is a common view, not only in Japan, that the human genome is something sacred, a relic handed down from generations, that we ought to treasure and preserve. In support of such a view, religious and other more pragmatic reasons are offered. For example, some may fear the disasters that might befall us if we choose to intervene in the process through which we pass our genetic code from one generation to another. Such arguments are certainly still at the heart of the ethical debate, but the foundations upon which they are built are by no means universally accepted. Stanford University bioethicist Henry Greely writes, “the human germline genome” does not exist; instead, each of us has a unique genome.[12] Greely argues that HHGE is no different from the changes our genomes have undergone through numerous medical interventions. For example, synthetic insulin has increased the number of people with DNA variations that lead to diabetes. Those with this condition would have died as a child in the past. However, now they live long enough to be able to reproduce. Similarly, the transition from hunting to farming centuries ago resulted in a greater number of copies in our gene pool of starch-digesting genes. Yet Greely suggested that, practically, HHGE is “not very useful in the near- to midterm” (by which he means “the next several decades”)[13] “mainly because other technologies can attain almost all the important hoped-for benefits of [HHGE], often with lower risk,” citing embryo selection and somatic gene editing as two alternative options. Greely argued that applying HHGE for enhancement beyond disease prevention and is currently not a realistic option because we lack the necessary knowledge. In Greely’s opinion, “how worried should we be [about HHGE]…? A bit, but not very and not about much.”[14] Greely’s assertions that other scientific debates should take precedence and that the concerns are not ripe for debate yet are concerning. lV. Why Shutting Down the Debate Might Not be a Good Idea First, the timeframe described by Greely seems somewhat out of line with that described by leading scientists. As far back as 2018, at the same Summit where He made his revelations, George Q. Daley stressed that HHGE is scientifically feasible here and that the ethical considerations can no longer be put off: “…a number of groups have applied gene editing now to human embryos in the context of in vitro fertilization and attempting to determine variations of a protocol that would enhance the fidelity and reduce mosaicism. I think there has been an emerging consensus that the off-target problem is manageable, and in some cases even infinitesimal. There are some interesting proofs of principles, like diseases such as beta-thalassemia that could potentially be approached with this strategy.”[15] It would also be possible to challenge Greely on various other aspects. One of which would be the number of cases to which HHGE would be relevant and the kinds of moral allowances that might be made, and each case concludes that more urgency is required in the ethical debate. Greely suggests that most people can use preimplantation genetic testing (PGD), which is the embryo selection process, and that perhaps HHGE could apply to couples where both have the same autosomal recessive gene.[16] Greely rules out considering HHGE in cases where PGD is applicable. Greely concedes PGD does not already represent the answer on this topic, as it often fails to provide couples with enough healthy embryos to transfer. As a resolution to this issue, he points to the creation of eggs using induced pluripotent stem cell (iPSC) techniques, whereby eggs can potentially be created from other cells.[17] However, given the extremely limited success of iPSCs in the clinical arena to date, in vitro gametogenesis is a highly speculative solution. Certainly, the progress of iPSC research is not such a safe bet that placing all our hopes on it at the expense of HHGE techniques is currently justified. (Also, it should be noted that making eggs using the iPSC technique is hardly an ethical problem-free area itself.) In summary, the cases of couples looking to conceive that Greely rules out by pointing to PGD should be kept on the HHGE table, as various other scholars have suggested.[18] Many of us debating HHGE are not scientists, so the best we can do is draw from the information we glean from those more technically capable. As a society, we are not just passive observers of science; we should have influence over decisions that impact society. Indeed, even if the available science is not yet at a place where we should be worried about large-scale ethical and social concerns, the story will continue to unfold in the future. While Greely is happy to see the human race “muddle through” the ethical challenges of scientific breakthroughs, such a position fails to recognize that society at large is far from powerless. V. Society Influencing Scientific Progress There are some notable examples of society’s impact on scientific progress. For example, political policies led to the development of nuclear technology for war and strategic deterrence, despite societal objections seen through demonstrations of people protesting using the slogan “no nukes.” Furthermore, the Bush administration drastically limited the use of embryonic stem cells in the 2000s due to a strong religious and cultural influence on policy.[19] Societal debate potentially serves as a powerful factor in guiding science. Where societal acceptance is ambiguous, science tends to operate on its own. But where science would impact life’s fundamental issues like war, how embryos should be valued, or the end of life, society should weigh in and influence the role of science. Societal views on the current global moratorium on HHGE could lead to a ban, as has been advocated.[20] On the other hand, societal views that value HHGE as a way to expand reproductive autonomy may justify permitting its use. Opening an ethics debate about it would enable scientists to pursue technologies that society deems justifiable as well as set limits for where they should stop. Making this process more difficult, the He affair has clearly colored public discourse on HHGE in a way that inhibits debate. In Japan, a sequence of questionnaires in 2016, 2018, and 2019 showed that the widely publicized HHGE scandal led to a significant decline in the acceptance of genome editing technology in general, particularly for human reproduction. Specifically, the surveys revealed a stark rise in disapproval of the technology’s use on fertilized human eggs—from 12 percent in 2018 to 29 percent in 2019.[21] The three scientists that conducted these surveys suggested that “the news of the twin babies in China had a substantial influence on the Japanese public,” damaging the reputation of HHGE.[22] It seems likely that the public distaste for HHGE was prompted by He’s research rather than considerations about the scientific potential of HHGE The change in public opinion may also make politicians and scientists more hesitant when it comes to taking the lead in the HHGE debate. Ultimately, this can restrict the public discussion of the central ethical challenges of the technology and hinder efforts to determine whether there is a responsible path forward other than an outright ban. Stressing the importance of the issue again to potential patients and failing to engage further with the HHGE debate is surely not something society should allow. While there are many important ongoing debates about genetics, like biohacking and DIY hobbyists, HHGE deserves attention as well. In fact, attention to the ethics of HHGE should help — more awareness of how these tools can be applied and what germline genome editing is will make people more alert to the existing danger and better understand how to mitigate it. Perhaps more importantly, a clear message from society to researchers about what objectives are reasonable to pursue regarding the HHGE technologies will facilitate good science. Having a publicly determined criterion would allow scientists to not live in fear that they might be blacklisted for seeking progress in grey areas and instead confidently chase progress where it is allowed. Vl. What Now? HHGE is here (or will be soon) and brings many ethical and social challenges. However, the challenges should not be left to individual scientists and couples in desperate situations to manage alone. Moving toward how these challenges can be met practically, it is helpful to draw a parallel with the issue of implementing human rights. In the early 21st century, political philosopher Michael Freeman of the University of Essex lamented that implementing human rights had been left to lawyers. Although legal experts were clearly essential in putting together the global human rights framework, Freeman’s concern was that they were not best placed to understand implementing human rights in various contexts. Setting out a broader, interdisciplinary approach, he called for social scientists to tackle these difficult questions, ultimately moving human rights forward around the world. Similarly, in medical technology like HHGE, scientists are crucial to the story, but at the same time, they are not trained to deal with all the accompanying challenges. Bioethicists are also important, clarifying the arguments that society needs to resolve. There is a need for even wider input from across the scholarly community. For instance, as with human rights, international and domestic regulation is required, and clearly, the legal community has a role here. Moreover, as described by Freeman, since all law is political in its creation and has impacts across society, political scientists and sociologists can provide impactful input. CONCLUSION We are in it together, and we have roles to play in the discussion of HHGE. Societal discourse does not always trail the scientific reality, but rather, it can condition the path that science will follow. Given the importance of what is at stake, not only for the potential patients, but for humanity, we should not leave the HHGE debate only to scientists, and we should not leave it until later. - [1] Cohen J. “Embattled Russian scientist sharpens plans to create gene-edited babies,” Science, 21 Oct. 2019. doi:10.1126/science.aaz9337. [2] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News release, 12 July 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [3] World Health Organization. “Human Genome Editing Registry,” https://www.who.int/groups/expert-advisory-committee-on-developing-global-standards-for-governance-and-oversight-of-human-genome-editing/registry. [4] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504. [5] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504 [6] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News Release, July 12, 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [7] WHO 2021. Human Genome Editing: Position Paper, WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing. 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