Thesis (M. Phil.)--University of Queensland, 2002. / Includes bibliographical references.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2002. / Includes bibliographical references.

Background: Rapid economic growth in mainland China has been accompanied in recent years by rising levels of inequality and a growing burden of non-communicable disease (NCD), though little is known at present about the relations between these forces. This thesis makes use of data from a large sample of older men and women in Guangzhou, one of China’s most developed cities, to examine the relations between inequality, inequity and non-communicable disease. Objectives: This thesis addresses two research questions: what is the relationship between inequality/inequity and non-communicable disease in China; and what are the implications of this relationship for health policy in China. These two questions lead to two working hypotheses: first, that inequalities may be both a cause and consequence of NCDs in China, potentially creating a vicious cycle which reinforces inequality and inequity; and second, that reducing dependence on out of pocket payments as a source of healthcare finance may help to prevent the continuation of the inequality-NCD cycle. Methods: I used data from the Guangzhou Biobank Cohort Study (GBCS), including 30,499 men and women aged 50 or over from Guangzhou and multi-variable regression methods to examine associations of socioeconomic position at four life stages (childhood, early adulthood, late adulthood and current) with several health outcomes: self-rated health, chronic obstructive pulmonary disease, metabolic syndrome and markers of immunological inflammation (white blood cells, granulocytes and lymphocytes). These analyses related to the hypothesis that inequalities may be a cause of non-communicable disease in China. I also examined whether inequity may be a consequence of non-communicable disease by measuring whether horizontal inequity (deviation from the principle of equal access to healthcare for equal need) was greater for treatment of NCDs than for general healthcare. I tested this using both concentration index methods and multi-variable regression models. For comparative purposes, I conducted these analyses in data from three settings: Guangzhou, Hong Kong and Scotland (UK). Results: I found that socioeconomic deprivation across the life course was associated with poorer self-rated health, higher risk of COPD, higher white cell and granulocyte cell counts and (in women only) higher risk metabolic syndrome and higher lymphocyte cell counts. I also found evidence of pro-rich inequity in utilisation of treatment for three major non-communicable conditions (hypertension, hyperglycaemia and dyslipidaemia) in Guangzhou, whilst there was no evidence of inequity in general healthcare utilisation (doctor consultations and hospital admissions) or treatment of gastric ulcer. Conclusion: My findings gave qualified support for the idea that socioeconomic inequalities may contribute to some, though not all, non-communicable diseases in China. Moreover, the mechanisms which link socioeconomic inequality to NCDs in China remain unclear. My results also supported the suggestion that a rising burden of non-communicable disease may contribute to greater pro-rich inequity in healthcare utilisation, especially for conditions which are chronic and asymptomatic. As rates of NCDs continue to rise in China and other developing countries, policies to prevent and treat common NCDs may be improved by a clearer understanding of how inequality is related to non-communicable disease. / published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Objective: Chronic back pain is highly prevalent in orthopaedic clinics. The aim of the study was to investigate the relationship of psychological factors affecting disability and distress outcomes in chronic low back pain patients. Clinicians shared the impression that chronic pain patients resulted from Injury on Duty (IOD) were particularly difficult to manage. Profiles of IOD patients and non-IOD patients were compared. Methods: The present study is a prospective follow-up study. Fifty-four patients from a public orthopaedic out-patient clinic were assessed with low back pain as their primary complaint. Self-report inventories together with semi-structured interview were used to assess patients’ pain intensity, pain disability, psychological distress, positive and negative affect, as well as relevant pain-related parameters including pain catastrophizing thought, pain-related fear, pain self-efficacy and chronic pain acceptance. Patients were interviewed during their first visit to the orthopaedic out-patient clinic (i.e. Time 1), after 6 months (i.e. Time 2) and after 1 year (i.e. Time 3) of the first consultation. Both qualitative and quantitative analyses were conducted. Results: Chronic pain acceptance predicted mid-term and long-term pain disability and psychological distress at a period of one year after their initial assessment. However, the pain-related parameters of pain catastrophizing, pain-related fear and pain self-efficacy did not show a significant predictive effect on outcomes. Pain rating is an inadequate estimate to assess patients’ level of disability and psychological status. The meaning of pain is important for patients to make sense of their pain experience and employ appropriate coping strategies. Attaching a positive value to pain helps patients to accept their pain. In addition, half of the chronic pain patients showed a need for psychiatric services at one year follow-up, pointing to a high co-morbidity between chronic pain and psychiatric problems. Among the 54 patients, 17 (31.5%) were injured on duty (IOD). More IOD patients than non-IOD patients took sick leaves or were not working during the year. However, there is no significant difference between IOD group and non-IOD group on psychological distress, pain disability and other pain-related measures across 3 time points. Discussion and Conclusion: Pain problems in the context of chronic pain are different from those in the context of acute pain. Intervention focusing on pain relief is inadequate to treat patients’ chronic pain. A multi-factorial perspective is needed to understand and develop suitable models to account for chronic pain experience instead of just relying on the prevalent fear-avoidance model. A more comprehensive assessment that is tailored to patients’ needs is necessary for more effective rehabilitation. Chronic pain patients’ need for psychiatric intervention is also highlighted, with a focus on work-related issues for IOD patients. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

The purpose of the study was to investigate the structure of coping with chronic pain and to develop a standardised, reliable and valid ~t to measure coping with chronic pain. The use of this instrument as a measure of change in the evaluation of a local Pain Management Programe was investigated. The Pain Coping Questionnaire was developed from analysis of responses of 298 chronic pain patients to a self-report questionnaire concerned with coping with chronic pain. Following empirical psychometric investigations of reliability and validity, four psychologically meaningful dimensions were identified. One dimension, the General Coping Measure, was a measure of psycho-social adjustment to chronic pain. Three dimensions measured beliefs in the use of cognitive and behavioural pain coping strategies. One dimension, Active Coping Strategies, measured active pain coping strategies. Two dimensions, Avoidance and Use of Drugs, measured passive pain coping strategies. Belief in the use of active pain coping strategies was predictive of good psycho-social adjustment. Belief in the use of passive pain coping strategies was predictive of poor psycho-social adjustment. The results from outco~e studies indicated that the Pain Coping Questionnaire was a sensitive measure of change. The Pain Manag~.ment Programne had beneficial effects with respect to short-term outcome. Limitations were discussed. It was concluded that the Pain Coping Questionnaire represents an original contribution that is likely to have broad applications in the assessment and treatment of chronic pain patients.

Chronic inflammation in response to Aß peptide deposits is a pathological hallmark of Alzheimer's disease (AD). The inflammatory environment includes populations of reactive and proliferating microglia and astrocytes and perturbed vasculature. However, the association between activated glial cells and cerebrovascular dysfunction remain largely unknown. This study has used Aß1-42 intrahippocampal injection as an animal model of inflamed AD brain to characterize mechanisms of glial-vasculature responses as a basis for chronic inflammation. Preliminary findings suggested Aß1-42-injected brain demonstrated vascular remodeling including evidence for formation of new blood vessels (angiogenesis). This result led to study of the effects of the anti-angiogenic/anti-inflammatory compound, thalidomide on activated glial cells and perturbations in the vasculature in an Aß1-42 peptide-injected rat model. First, Aß1-42 injection was found to cause perturbations in vasculature including new blood vessel formation and increased BBB leakiness. Second, thalidomide decreased the vascular perturbations and the glial reactivity and conferred neuroprotection. Overall, these results suggest that altered cerebral vasculature is integral to the overall inflammatory response induced by peptide. Experiments then examined the level of parenchymal plasma proteins in brain tissue from AD and nondemented (ND) individuals. AD, but not ND, brain tissue demonstrated high levels of fibrinogen immunoreactivity (ir). Aß1_42 injection into the rat hippocampus increased the level of parenchymal fibrinogen, which was reduced by treatment with the defibrinogenating agent, ancrod. In addition, ancrod also attenuated microglial activation and prevented neuronal injury. Overall, these results demonstrate that extravasation of blood protein and a leaky BBB are important in promoting and amplifying inflammatory responses and causing neuronal damage in inflamed AD brain. Microglial chemotactic responses to VEGF (vascular endothelial growth factor) receptor Flt-1 were next studied. Treatment with a monoclonal antibody to Flt-1 (anti-Flt-1 Ab) in the peptide-injected hippocampus diminished microglial reactivity and provided neuroprotection. Secondly, anti-Flt-1 Ab inhibited the AI3142-induced migration of human microglia. These results suggest critical functional roles for Flt-1 in mediating microglial chemotaxis and inflammatory responses in AD brain. The overall conclusion from my work is that AP deposits induce microglial reactivity which subsequently causes vascular remodeling resulting in an amplified inflammatory microenvironment which is damaging to bystander neurons.

No description available.

No description available.

No description available.

Introduction: There is a need for a health-related quality of life questionnaire in COPD that fulfills the advantages of both, generic and disease-specific questionnaires. Objective: To finalize the development of a new, hybrid questionnaire (disease-specific items supplemented with items from the SF-36), the McGill COPD Quality of Life Questionnaire and to evaluate its psychometric properties (reliability, validity, responsiveness) in COPD subjects. [...] / Introduction: Il y a nécessité d'avoir accès à un questionnaire de qualité de vie qui pourrait offrir les avantages d'un questionnaire générique et ceux d'un questionnaire spécifique à la MPOC. Objectif: Finaliser l'élaboration d'un nouveau questionnaire hybride le 'McGill COPD Quality of Life Questionnaire' (éléments spécifiques à la maladie complémentés d'éléments génériques issus du SF-36) et évaluer ses propriétés psychométriques (fiabilité, validité, réponse au changement) chez les sujets atteint d'une MPOC. [...]