published_or_final_version / Psychiatry / Master / Master of Philosophy

published_or_final_version / abstract / Microbiology / Doctoral / Doctor of Philosophy

published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

Colorectal cancer (CRC) is the second most common cancer in Hong Kong. While high-penetrance germline mutations account for up to 6% of cases, much of the variation in genetic risk may be attributable to multiple low-penetrance variants. Previous genome wide association studies (GWAS) have identified a number of CRC susceptibility alleles in Caucasian populations. Our GWAS investigated the association between genetic variants with CRC risk in the Han Chinese population in Hong Kong. In Stage I, genomic DNA samples from 455 female Chinese CRC subjects were genotyped using the Illumina 610 Quad SNP chip. Association analysis was performed on 439 cases and 771 general population female controls recruited for a study on bone mineral density. Population stratification was examined through principal components analysis using EIGENSTRAT version 2.0. From the association results, 46 SNPs (Group 1) were selected for follow-up replication (Stage II), together with 10 SNPs (Group 2) from previous GWAS studies. Genomic DNA samples from 3,571 Chinese subjects were genotyped using Sequenom MassARRAY system. Association analysis was performed on 1,505 cases and 1,452 controls. 5 SNPs (rs835378, rs2652007, rs2139273, rs2139273 and rs9286410) exceeded the genome-wide significance level in stage I, although none replicated in Stage 2, suggesting genotyping error. Results from stage II showed that the three most significant SNP were among those selected from the previous studies, yet their significance levels in Stage I were very weak . None of the SNPs selected from Stage I was significant at p<0.01 in Stage 2. Two composite scores of genetic susceptibility, one for each group of SNPs, were calculated in stage II genotype data, as the total number of high-risk alleles (according to the direction of effect in Stage I results or previous GWAS) present in an individual. Both composite scores were significantly associated with CRC risk in Stage 2 (Group 1, p=2.38 x 10-5, beta=0.046, SE=0.012; Group 2 p=1.06 x 10-7, beta=0.10, SE=0.019), suggesting that while we had insufficient power to confirm individual SNPs identified in our GWAS and the previous GWAS, these findings indicate that the SNP sets selected from Stage I results, as well as those selected from previous GWAS, contain SNPs with genuine effects on CRC risk. One SNP, rs10795668 (OR = 0.79 [CI] 95%:0.71 – 0.87 p=3.78 x 10-6), was significantly associated with CRC risk in Stage II after adjustment for multiple testing. Two further SNPs, rs6983267 and rs4939827, also achieved suggestive p-values in Stage II. All these SNPs were selected from previous GWAS in the Caucasian population, demonstrating that shared genetic factors operate for CRC in diverse populations. / published_or_final_version / Psychiatry / Master / Master of Philosophy

Thesis (Ph. D.)--University of Hawaii at Manoa, 1991. / Includes bibliographical references (leaves 192-206) / Microfiche. / xi, 206 leaves, bound ill.,maps 29 cm

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Background: Advanced breast cancer (ABC) is affecting substantial number of Chinese women in Hong Kong. Understanding their unmet supportive care needs (SCNs) is important for health care system to precisely allocate resources to areas demanded for help the most and for patients to achieve better quality of life. Objectives: (1) To validate Chinese version of Supportive Care Needs Survey Questionnaire (SCNS-SF34), (2) to address the prevalence of unmet SCNs at baseline (newly diagnosis of ABC) and explore relevant factors associating with baseline unmet SCNs, (3) to identify the trajectories of unmet SCNs from baseline, 6-week, 12-week, 18-week to one-year post-diagnosis of ABC among Hong Kong Chinese women and identify the predictors related to individual resources. Methods: The study consisted of two phases. In Phase I, breast cancer (BC) patients were recruited from six public hospitals and the SCNS-SF34 (which covers five domains of needs) was administered concurrently with measures of psychological distress CHQ-12 (Chinese Health Questionnaire-12), HADS (Hospital Anxiety and Depression Scale), symptom distress (MSAS-SF), and patient satisfaction (ChPSQ-9) to explore factor structure by using Exploratory Factor Analysis (EFA) and to examine internal consistency, and convergent, divergent and discriminant validities of the identified factor structure. In phase II, women newly diagnosed with ABC were recruited and followed up to assess their unmet SCN trajectories one year after diagnosis. Prevalence of initial baseline SCNs and associated demographic, medical and psychological factors were identified. Linear Mixed Modeling (LMM) was performed to assess trajectories for each SCNs domain. Hypothesized variables reflecting personal and social resources (optimism, trait hope, social support, psychological distress and patient satisfaction) were examined for association with the changes of unmet SCNs after adjusting for demographic and medical characteristics. Results: Instead of five-factor structure identified in the original SCNS-SF34, a four-factor structure with 33 items was identified, comprising: 1) Health system, information and patient support needs (HSIPS), 2) Psychological needs (PSYC), 3) Physical and daily living needs (PDL) and 4) Sexuality needs (SEX). The SCNS-SF33-C demonstrated moderate-to-good internal consistency (Cronbach’s alphas=0.75-0.92) across all domains. Acceptable convergent and divergent validity were demonstrated. Discriminant validity was demonstrated in the SCNS-SF33-C’s ability to differentiate between clinically distinct patient groups (ABC vs. localized BC and active treatment vs. no active treatment). Of the top 15 unmet SCNs, all belonged to the HSIPS domain. There were significant linear declines in unmet HSIPS and PSYC needs over the year after diagnosis, but not in PDL and SEX. After adjusting for demographic and medical factors, LMM identified symptom distress, patient satisfaction and patient satisfaction x time are predictors of HSIP. Total symptom distress, optimism, anxiety and anxiety x time predicted PSYC. Total symptom distress was predictor of PDL. Anxiety was predictor of SEX. Conclusions: The SCNS-SF33-C has a suitable factor structure and psychometric properties for the use in assessing unmet psychosocial SCN among Chinese women with BC. Generally, unmet HSIP and PSYC tended to decline, while levels of unmet PDL and SEX tended to persist over time. Specific individual resources predicted the future change of unmet SCNs. / published_or_final_version / Community Medicine / Master / Master of Philosophy

Doctor of Philosophy / This study explores the health beliefs and preventive health behaviours of older Hong Kong Chinese people resident in Australia. Participation in physical activity was used as the case study. There were two frameworks used to shape the research. Because of their perceived influence on the health beliefs and practices of Hong Kong Chinese people, the traditional Chinese philosophies of Confucianism, Taoism, and Buddhism provided the philosophical framework. The Theory of Planned Behaviour provided a theoretical framework for understanding the target group's preventive health behaviour. Data was collected by means of in-depth interviews, participant observation and case study. Twenty-two informants were interviewed, their transcripts analysed, summarised and typologised, identifying six states of physical activity participation. Findings demonstrated that this target group possessed a holistic view of health, with food taking a special role in preventive care and self-treatment at times of illness. The Cantonese terms used to denote “physical activity” caused confusion among the target group. Most interpreted it as meaning deliberate planned body movement, strength-enhancing activities or exercise, although some did see it as including mundane daily activities and chores. Lack of time, no interest and laziness were reported as the main reasons for low participation in deliberate planned physical activity. Cultural, social and environmental determinants were the intrinsic and extrinsic factors influencing attitudes toward physical activity, as well as perceived social supports and perceived control over physical activity participation barriers. To a large extent, these interactive determinants of health were rooted in the three traditional Chinese philosophies mentioned above. The thesis concludes by arguing that rather than simply advocating activities designed for other populations, health promotion strategies and education need to create links to the traditions of this target group and also clarify their conception of physical activity.

Doctor of Philosophy / This study explores the health beliefs and preventive health behaviours of older Hong Kong Chinese people resident in Australia. Participation in physical activity was used as the case study. There were two frameworks used to shape the research. Because of their perceived influence on the health beliefs and practices of Hong Kong Chinese people, the traditional Chinese philosophies of Confucianism, Taoism, and Buddhism provided the philosophical framework. The Theory of Planned Behaviour provided a theoretical framework for understanding the target group's preventive health behaviour. Data was collected by means of in-depth interviews, participant observation and case study. Twenty-two informants were interviewed, their transcripts analysed, summarised and typologised, identifying six states of physical activity participation. Findings demonstrated that this target group possessed a holistic view of health, with food taking a special role in preventive care and self-treatment at times of illness. The Cantonese terms used to denote “physical activity” caused confusion among the target group. Most interpreted it as meaning deliberate planned body movement, strength-enhancing activities or exercise, although some did see it as including mundane daily activities and chores. Lack of time, no interest and laziness were reported as the main reasons for low participation in deliberate planned physical activity. Cultural, social and environmental determinants were the intrinsic and extrinsic factors influencing attitudes toward physical activity, as well as perceived social supports and perceived control over physical activity participation barriers. To a large extent, these interactive determinants of health were rooted in the three traditional Chinese philosophies mentioned above. The thesis concludes by arguing that rather than simply advocating activities designed for other populations, health promotion strategies and education need to create links to the traditions of this target group and also clarify their conception of physical activity.

This study was designed to explore how Chinese elderly informants with diabetes experience and manage their illness at home. The method used in conducting this study was the phenomenological perspective of qualitative research. The Intent of the study was to understand the human experience of living with diabetes and the sociocultural context in which it is lived. Data collection and analysis ran concurrently. Data were collected through a series of interviews with nine Chinese informants who were diagnosed with late onset diabetes and were undergoing insulin treatment at home. Informants' ages ranged for a 69 to 90 years old. All informants are first generation immigrants in Canada. The specific questions that directed this study addressed the Chinese elderly informants' experience of living with diabetes, the meanings they assigned to living with diabetes, and the ways Chinese informants managed their diabetes. Theoretical sampling guided sample selection and determined sample size. The data were constructed based on a total of 21 interviews with the nine informants. As the researcher explored how the informants lived with diabetes, informants gave detailed accounts of how they viewed diabetes. Within the context of how they viewed diabetes, informants described an entire process they went through to make decisions in everyday life as they sought help and managed their illness. Based on informants' accounts, a decision making model was formulated. Informants gave detailed accounts of each step of the decision-making process, together with descriptions of meanings they assigned to each step. The data showed how informants made sense of their experience as they went through each phase of the decision-making process. The descriptions also revealed an "inner logic" used by informants to direct choices they make regarding health matters. In terms of nursing practice, these findings support the need to attend to client decision-making, from the clients' perspectives. The findings also address nurses' need to reevaluate their professional role in relation to clients' needs and expectations. With regard to nursing research, the findings suggest the need to further explore the topic of decision making from both the clients' and nurses' perspectives. / Applied Science, Faculty of / Nursing, School of / Graduate