Systematic reviews were conducted to investigate the relationships between anthropometric assessments of nutritional status (adiposity) and caries experience among preschool and school-age (aged 6-12 years) children. Four relevant databases were searched for publications up to December 2011. Qualitative assessments were conducted and rated according to STROBE statement. Where feasible, quantitative syntheses were conducted. From a total of 2013 studies, 39 effective studies were identified for preschool children and 53 effective studies for school-age children. The mean ‘quality of reporting’ were 20.4 (SD 3.8) for the preschool studies and 21.4 (SD 3.9) for school-age studies. Qualitative syntheses were inconclusive about their relationships. Meta-analyses identified that preschoolers with high BMI had a greater dmfs/defs than those with normal BMI: pooled mean difference 0.93, 95% CI 0.65, 1.22, P < 0.05; and that children with low BMI had a lower dmft than those with normal BMI: pooled mean difference - 0.29, 95% CI -0.42, -0.15, P < 0.05. Among school-age children meta-analyses failed to identify any significant association. Among a random sample of 5-year-old children in Hong Kong, with a response rate of 83.1% (324/390), caries experience was associated with general adiposity (as assessed by W/H) and central adiposity (as assessed by WC). Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that W/H z-score was associated with having caries, OR 1.41, 95% CI1.04, 1.91, P = 0.03; and ‘very high’ caries OR 1.62, 95% CI 1.05, 2.50, P = 0.03. WC z-score was associated with ‘very high’ caries experience, OR 1.72, 95% CI 1.06, 2.81, P = 0.03. Oral hygiene status was not associated with adiposity. Among a random sample of 12-year-old children in Hong Kong, with a response rate of 76.9% (514/668), oral health status was associated with adiposity. Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that WHR z-score was associated with caries experience: ‘high’ (OR 1.33, 95% CI 1.05, 1.70, P = 0.02), and ‘very high’ (OR 1.52, 95% CI 1.10, 2.11, P = 0.01). TRSKF z-score was associated with ‘very high’ caries experience (OR 1.47, 95% CI 1.10, 1.96, P = 0.01). WC z-score was associated with ‘unhealthy’ periodontal status (OR 1.33, 95% CI 1.01, 1.76, P = 0.04). Infant growth during the first year of life was associated with oral health at 12-year-old. Accounting for birth characteristics, socio-demographics and oral health behaviours, those with slow growth trajectories (Ⅰ- smallest birth weight and slow weight gain; and Ⅱ- smallest birth weight and average weight gain) had a greater likelihood of having a ‘high’ caries experience: OR 2.68, 95% CI 1.00, 7.16, P < 0.05 and OR 3.03, 95% CI 1.22, 7.51, P < 0.05, respectively, compared to average growth trajectory subjects. In addition, those with the fastest growth trajectory (heaviest birth weight and accelerated weight gain) had a greater likelihood of having a ‘high’ caries experience, OR 2.64, 95% CI 1.01, 6.91, P <0.05. Growth trajectories were not associated with periodontal health status at 12-year-old (P > 0.05). / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Background: The problem of poverty in Hong Kong is worsening, particularly the disparity between the rich and poor. Although much of the public concern about this problem has concentrated on the physical development of children, the effect of disparity between the rich and poor on their psychological well-being remains relatively underexplored. A review of the literature revealed that most studies on the psychological effect of disparity between the rich and poor have been conducted in Western countries only. This study aimed to bridge this gap. Its objectives were (1) to compare the self-esteem, depressive symptoms and quality of life (QoL) of children from low- and high-income families, (2) to identify the socioeconomic and demographic characteristics affecting the psychological well-being of children, (3) to compare the livelihoods of children from low- and high-income families, and (4) to examine the effectiveness of adventure-based programme in promoting the psychological well-being of children living in poverty. Methods: This study consisted of a survey study and a pilot RCT. The survey study was conducted in 12 primary schools from the three highest and the three lowest median household income districts. A total of 1,725 children were recruited, with 898 from low-income families and 827 from high-income families. The self-esteem, depressive symptoms and QoL of them were assessed and compared. Additional 42 children were chosen to have semi-structured interviews. As for the pilot RCT, it was conducted in two primary schools in Kwai Chung Estate. A total of 120 children were recruited, of whom 56 were randomly assigned to the experimental group to receive adventure-based programme and 64 to the control group to have placebo programme. Results: For the survey study, the results showed that the children from low-income families scored significantly lower on self-esteem and QoL, and higher on depressive symptoms than the children from high-income families. Moreover, the disparity between the rich and poor was found to have the greatest impact on children's self-esteem. Regression analyses showed that housing type made the largest contribution to children's self-esteem, depressive symptoms and QoL. Additionally, the daily lives of children from low-income families were seriously affected in terms of living environment, physical health, social lives and ability to function at school. Concerning the pilot RCT, mixed between-within subjects ANOVA showed that the children in experimental group scored significantly lower on depressive symptoms and higher self-esteem than those in control group. However, such a significant effect was not found on QoL. Conclusion: The survey study provides further evidence that disparity between the rich and poor has a negative effect on children's psychological well-being. Additionally, the pilot RCT demonstrated the effectiveness of adventure-based programme in promoting the psychological well-being of children living in poverty. Implications for practice: It is vital for healthcare professionals to develop and implement appropriate interventions that promote the psychological well-being of this vulnerable group. Moreover, healthcare professionals should go beyond their normal roles to build multidisciplinary partnerships with schools and the community to promote psychological well-being among children living in poverty. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

The main objective of the present thesis was to examine whether and how do different aspects of oral language skills have important contribution for the development of reading comprehension among young Chinese children. In Study 1, a three-wave longitudinal study (from K2 to P1) was conducted with 91 Chinese children, to whom measures of oral language (vocabulary, grammar and narrative discourse), word-level skills (phonological, orthographic, and morphological skills), and word reading were administered at all three time points, and reading comprehension at K3 and P1. This study found that K2 oral language skills explained considerable variance in subsequent word reading and reading comprehension two years later, and their longitudinal contribution appeared to be more important than that of K2 word-level skills. Moreover, it was found that the first-graders showed rudimentary abilities in some higher-order text comprehension skills in spoken language (e.g., sentential ambiguity detection and monitoring of textual coherence), and these language skills were highly associated with children’s reading comprehension. Results of multiple regression analyses showed that these skills had unique contribution to reading comprehension at P1 over and above that of word reading, word-level skills, and general oral language skills (i.e., vocabulary, grammatical and narrative discourse skills). The longitudinal data further demonstrated the unique prediction of sentential ambiguity detection over time. Overall, SEM analyses revealed that although the role of word reading ability was prominent to beginning reading comprehension, children’s early oral language skills at preschool were found to make an independent path to later reading comprehension through facilitating the subsequent development of higher-order comprehension skills at both sentence- and discourse-level. Since Study 1 demonstrated the importance of sentential ambiguity detection to reading comprehension, Study 2 focused on examining the emerging development of this skill in Chinese children from K2 to P1. A phase model was proposed which hypothesized that children gradually acquired the three sub-skills of sentential ambiguity detection (i.e., homophone detection, lexical ambiguity detection in sentence, and structural ambiguity detection in sentence) through successive phases. Study 2 further demonstrated the contribution of vocabulary, grammatical, and lexical compounding skills for the early acquisition of ambiguity detection in Chinese children. In Study 3, one of its aims was to determine the extent to which different kinds of preschool cognitive skills significantly predicted later word reading difficulties at the end of first grade. The results highlighted the important predicting role of meaning-related cognitive skills (i.e., vocabulary, lexical compounding, and homophone detection skills) in addition to that of phonological and orthographic skills. Apart from focusing on children’s word reading problems, Study 3 further used K-mean cluster analysis to identify a group of children at first grade, whose reading comprehension fall short of their average or good word reading ability. It was found that these unexpected poor comprehenders showed weaknesses in skills that are specifically related to text comprehension: sentential ambiguity detection, comprehension monitoring, and working memory. The practical implications for early literacy instructional approaches and early identification of children with reading difficulties were discussed. / published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

Recent medical advances in cancer screening and treatments have led to dramatically decreasing mortality rates from cancer among children and adolescents. However, the cancer itself and the adverse effects of treatments remain severely devastating to their physical and psychological well-being, both during and after treatments. Numerous studies have demonstrated that regular physical activity is related to various physiological and psychological benefits for children and adolescents under cancer treatments. Nevertheless, a review of the literature reveals that children and adolescents commonly present declining levels of physical activity throughout their cancer treatments. There is so far no study has investigated the physical activity level and behaviour in particular, the influencing factors affecting the physical activity level among Hong Kong Chinese children and adolescents with cancer. Therefore, this study aimed (1) to assess and compare the physical activity levels and behaviour of healthy children and adolescents with those of children and adolescents undergoing cancer treatments and (2) to explore the various factors that influence the physical activity levels of children and adolescents with cancer in Hong Kong. A cross-sectional study, using both quantitative and qualitative approaches, was conducted. A total of 76 children and adolescents (9-to 18-year-olds) who were admitted for treatment of cancer in a paediatric oncology unit and 148 healthy counterparts who were participated in two health carnivals in Hong Kong were invited to participate in the study. Their physical activity levels, stages of change for exercise, self-efficacy for physical activity and quality of life were assessed and compared. A total of 25 participants with cancer were purposively selected for semi-structured interviews. The results of this study indicated that children and adolescents with cancer in current situation had significantly decreased levels of physical activity when compared with the premorbid situation or the healthy counterparts. The study also showed that children and adolescents with cancer presented significantly lower levels of physical activity, self-efficacy, stage of change for exercise and quality of life than the healthy participants. Furthermore, qualitative interviews revealed that the negative impacts from cancer and its treatments, the discouragement of and misunderstanding concerning physical activity, and the space limitations in Hong Kong were important factors that disengaged these young people from regular physical activity while under treatment. This study has addressed an literature gap by assessing the levels of physical activity, self-efficacy, stage of change, and quality of life among children and adolescents with cancer as compared to their healthy counterparts. The results provide further evidence that cancer and its treatments induce negative impact on the physical, psychological well-being and the quality of life in children and adolescents with cancer. It is essential for healthcare professionals to detect physical inactivity at an early stage so that appropriate interventions can be applied to correct any misunderstandings about physical activity among children and adolescents with cancer and their parents. Most importantly, interventions should be designed to promote the adoption of regular physical activity for these patients, with the aim of enhancing their physical and psychological well-being. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

published_or_final_version / Education / Master / Master of Education

published_or_final_version / abstract / Speech and Hearing Sciences / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Education / Master / Master of Education

published_or_final_version / Education / Master / Master of Education