Wai-ying Tsui. / Thesis (M.Ph)--Chinese University of Hong Kong. / Bibliography: leaves 164-167.

香港醫療衛生發展的論述，通常至1941年便停止，然後由1945年重新探討，跳過了二次大戰期間的日治時代。雖然有大量關於英軍回憶、遊擊隊、一些口述歷史等的研究書籍，但這時期仍未得到充分的關注，尤其在社會發展方面。本文以《香港日報》為主要材料，嘗試析述被忽略的日治醫療衛生史。 / 有關戰前香港醫療衛生的史觀，主要有「殖民醫學」與「殖民現代性」兩套理論。前者認為殖民力量將西醫強加於本地社會；後者則強調殖民統治帶來的正面作用，和殖民地有其獨特形式的現代性。直至日治前夕，香港的中西醫仍較為對等，中醫在民間有極大支持；西醫在政府政策上享有優勢。然而戰後出現的卻是另一景象，無論民間或政府皆接受西醫為主流醫學，中醫則潛藏於民間繼續傳承。這不代表中醫已被淘汰，只是西醫的發展已蓋過中醫，其中原因須追溯日治期間。日治政府承接英國殖民政府推行西醫，社會上有大量西醫常識流通，藥物使用習慣講求科學，日治時期的這些因素都為西醫在戰後普及做準備。 / 本文為過往研究所忽略作補充，藉此重新思考「日治歷史」的意義。誠然這段歷史是傷痛的，但也不可主觀地跳過而不作討論，日治時期是連接香港二戰前後的發展。醫療衛生正是其中一個脈絡，本研究將就此提出新視角。 / The analyses on Hong Kong medical and hygienic history often split into two time slots, one from the beginning as the British colony until 1941 and the other from 1945 to the present, mostly overlooking the period of Japanese occupation from 1942 to 1945. Although there are plenty of books for general readers, for examples, memoirs of British troops and Chinese guerillas, and oral history records about the Japanese occupation in Hong Kong, this period has not yet received due academic treatment. This dissertation, therefore, studies the neglected medical history of Hong Kong under the Japanese occupation using Honkon Nippō (Hong Kong News) as the main reference. / Approaches to the discussion on prewar Hong Kong medical history apparently depend on two theories, namely the “colonial medicine and the “colonial modernity. The former perspective believes that colonial powers forced colonized societies to follow the European modernity, while the latter stresses the positive effects brought by colonizers and formations of own unique modernity among colonies. Before the Japanese occupation, both traditional Chinese medicine (TCM) and Western medicine (WM) enjoyed fair status, with the TCM gaining overwhelming support from the Hong Kong society and the latter receiving administrative advantages from the colonial government. After the WWII, however, both the Hong Kong society and the government recognized the WM to be the mainstream therapy, and thus, the TCM was only praciticed at the bottom level of society without official acknowledgement. Nevertheless, this did not represent the elimination of the TCM and merely revealed the development of WM surpassing the TCM. The reason should be traced back to the period of Japanese occupation when the government sustained the policy of the British colonial government to spread the WM, causing circulation of a large amount of medical knowledge in the society and a trend of scientific drug using. All these factors benefited to the popularization of WM in Hong Kong society after WWII. / This study fills in a missing link of previous research and rethinks the implication of the “history of Japanese occupation. Indeed, the history is painful but one should not subjectively omit it because this period connected the development of Hong Kong between prewar and postwar era. This study sheds new light on medical history as well as history of Japanese occupation. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 李威成. / "2012年8月". / "2012 nian 8 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 193-201). / Abstract in Chinese and English. / Li Weicheng. / 論文摘要 --- p.i / Abstract of thesis entitled --- p.ii / 鳴謝 --- p.iii / 圖表目錄 --- p.vi / Chapter 第一章 --- 導論 --- p.1 / Chapter 第一節 --- 研究動機與目的 --- p.1 / Chapter 第二節 --- 文獻回顧 --- p.5 / Chapter 第三節 --- 研究方法 --- p.12 / Chapter 第四節 --- 論文架構 --- p.17 / Chapter 第五節 --- 研究意義 --- p.19 / Chapter 第二章 --- 戰前香港的醫療衛生發展 --- p.20 / Chapter 第一節 --- 殖民地政府的醫療衛生事業沿革 --- p.21 / Chapter 第二節 --- 民間的醫療衛生常識 --- p.29 / Chapter 第三節 --- 戰前香港醫療衛生與日本人 --- p.37 / Chapter 第四節 --- 《香港日報》的創辦與發展 --- p.43 / Chapter 第五節 --- 小結 --- p.49 / Chapter 第三章 --- 日治香港政府的醫療衛生概觀 --- p.51 / Chapter 第一節 --- 日治政府醫療管理與醫生註冊 --- p.52 / Chapter 第二節 --- 疾病控制與防疫運動 --- p.67 / Chapter 第三節 --- 環境衛生與糞便處理 --- p.76 / Chapter 第四節 --- 區制、戶籍登記與醫療衛生制度 --- p.87 / Chapter 第五節 --- 小結 --- p.97 / Chapter 第四章 --- 從《香港日報》看日治時期醫療衛生常識的傳播 --- p.99 / Chapter 第一節 --- 副刊專欄與醫藥新知 --- p.100 / Chapter 第二節 --- 公共衛生資訊的提供 --- p.116 / Chapter 第三節 --- 小結 --- p.133 / Chapter 第五章 --- 從《香港日報》看日治時期治療藥物的供應 --- p.135 / Chapter 第一節 --- 《香港日報》中的藥物廣告 --- p.136 / Chapter 第二節 --- 流通市面的藥物 --- p.155 / Chapter 第三節 --- 贈醫所及個人醫師的角色 --- p.165 / Chapter 第四節 --- 小結 --- p.173 / Chapter 第六章 --- 總結日治時期的影響──香港醫療的延續與前進 --- p.175 / Chapter 第一節 --- 醫療體制的過渡 --- p.175 / Chapter 第二節 --- 從日治醫療史看日治歷史性質 --- p.187 / Chapter 附錄(一) --- 日治期間各分區新舊名稱轉換、區長副區長及區會員數目表列 --- p.191 / Chapter 附錄(二) --- 香督令第二十一號(1942年)[節錄] --- p.192 / Chapter 附錄(三) --- 香督令第十六號(1944年) --- p.193 / 參考書目 --- p.194

Kuok, Chiu Fai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 139-154). / Abstract and appendix also in Chinese. / Abstract --- p.i / Abstract (in Chinese) --- p.iv / Acknowledgements --- p.vi / Table of Contents --- p.vii / List of Tables --- p.xi / List of Figures --- p.xiv / List of Abbreviations --- p.xv / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- The Impact of Malignant Diseases and Multiple Myeloma --- p.4 / Chapter 1.3 --- Pharmacoeconomics --- p.6 / Chapter 1.4 --- Macao Healthcare System --- p.9 / Chapter 1.5 --- Study Hypothesis --- p.12 / Chapter 1.6 --- Study Objectives --- p.12 / Chapter 1.7 --- Perspective of the Study --- p.13 / Chapter Chapter 2 --- Literature Review / Chapter 2.1 --- Hematopoietic System --- p.14 / Chapter 2.1.1 --- Specific Blood Cell Lineages and Blood Cells --- p.15 / Chapter 2.1.2 --- Bone Marrow Microenvironment --- p.19 / Chapter 2.2 --- The Hematologic Malignancies --- p.20 / Chapter 2.2.1 --- Leukemia --- p.21 / Chapter 2.2.2 --- Lymphoma --- p.23 / Chapter 2.2.3 --- Plasma Cell Disorders --- p.24 / Chapter 2.3 --- Multiple Myeloma --- p.25 / Chapter 2.3.1 --- Epidemiology --- p.26 / Chapter 2.3.2 --- Pathology --- p.29 / Chapter 2.3.3 --- Clinical Presentation and Disease Complications --- p.31 / Chapter 2.3.4 --- Classification and Diagnostic Criteria --- p.35 / Chapter 2.3.5 --- Disease Staging and Prognosis --- p.42 / Chapter 2.3.6 --- Treatment --- p.45 / Chapter 2.3.6.1 --- Treatment Regimens and Strategies --- p.47 / Chapter 2.3.6.1.1 --- Standard Chemotherapy --- p.48 / Chapter 2.3.6.1.1.1 --- Melphalan-based Regimens --- p.51 / Chapter 2.3.6.1.1.2 --- VAD-based Regimens --- p.52 / Chapter 2.3.6.1.1.3 --- High-dose Glucocorticoid Regimens --- p.53 / Chapter 2.3.6.1.2 --- Treatment Strategies --- p.53 / Chapter 2.3.6.1.2.1 --- Initial Chemotherapy --- p.53 / Chapter 2.3.6.1.2.2 --- High-dose Chemotherapy --- p.55 / Chapter 2.3.6.1.2.3 --- Newer Therapeutic Agents for Multiple Myeloma --- p.58 / Chapter 2.3.6.1.2.4 --- Salvage Chemotherapy --- p.60 / Chapter 2.3.6.2 --- Treatment Responses --- p.63 / Chapter 2.3.6.3 --- Treatment for Disease Complications --- p.66 / Chapter Chapter 3 --- Methodology / Chapter 3.1 --- Study Design --- p.69 / Chapter 3.2 --- Patients Selection Criteria --- p.71 / Chapter 3.2.1 --- For Retrospective Cost Analysis --- p.71 / Chapter 3.2.2 --- For Health-related Quality of Life Measurement --- p.71 / Chapter 3.3 --- Patient Screening --- p.72 / Chapter 3.4 --- Data Collection --- p.72 / Chapter 3.5 --- Overview of Assessment Methods --- p.73 / Chapter 3.5.1 --- Outcomes --- p.73 / Chapter 3.5.2 --- Cost Analysis --- p.74 / Chapter 3.5.3 --- Cost Effectiveness Analysis --- p.74 / Chapter 3.5.4 --- Cost Utility Analysis --- p.75 / Chapter 3.5.5 --- Health-related Quality of Life Assessment --- p.75 / Chapter 3.6 --- Statistical Analysis --- p.76 / Chapter 3.7 --- Ethic approval --- p.77 / Chapter Chapter 4 --- Results / Chapter 4.1 --- Study Population --- p.78 / Chapter 4.1.1 --- Cost and Pharmacoeconomic Analysis --- p.78 / Chapter 4.1.2 --- Health-related Quality of Life Assessment --- p.79 / Chapter 4.2 --- Study Results --- p.81 / Chapter 4.2.1 --- Comparison of All Patients --- p.81 / Chapter 4.2.1.1 --- Differences in Treatment Protocols --- p.81 / Chapter 4.2.1.2 --- Differences in Treatment Responses --- p.82 / Chapter 4.2.1.3 --- Differences in Treatment Outcomes --- p.82 / Chapter 4.2.1.4 --- Differences in Treatment Costs --- p.84 / Chapter 4.2.2 --- Comparison for Patients Treated by Melphalan-based Regimens and VAD-based Regimens --- p.90 / Chapter 4.2.2.1 --- Differences in Treatment Responses --- p.90 / Chapter 4.2.2.2 --- Differences in Treatment Outcomes --- p.90 / Chapter 4.2.2.3 --- Differences in Treatment Costs --- p.93 / Chapter 4.2.3 --- Melphalan-based Regimens Versus VAD-based Regimens by Patients with Different DS Staging --- p.96 / Chapter 4.2.3.1 --- Patients in Stage 3-A MM --- p.96 / Chapter 4.2.3.2 --- Patients in Stage 3-B MM --- p.98 / Chapter 4.2.4 --- Melphalan-based Regimens versus VAD-based Regimens in Patients with Different IS Staging --- p.101 / Chapter 4.2.4.1 --- Patients in Stage I MM --- p.101 / Chapter 4.2.4.2 --- Patients in Stage II MM --- p.104 / Chapter 4.2.4.3 --- Patients in Stage III MM --- p.107 / Chapter 4.2.5 --- Comparison for Patients with and without Transplantation --- p.110 / Chapter 4.2.6 --- Cost-effectiveness Assessment --- p.117 / Chapter 4.2.7 --- Cost-utility Assessment --- p.118 / Chapter 4.2.8 --- Sensitivity Analysis --- p.119 / Chapter 4.2.9 --- Health-related Quality of Life Assessment --- p.120 / Chapter Chapter 5 --- Discussion and Conclusion / Chapter 5.1 --- Summary of Results --- p.123 / Chapter 5.2 --- Implication for Treatment --- p.126 / Chapter 5.3 --- Economic Evaluation --- p.129 / Chapter 5.4 --- Health-related Quality of Life --- p.132 / Chapter 5.5 --- Limitations of the Study --- p.134 / Chapter 5.6 --- Conclusion and Implications for Future Studies --- p.135 / Appendix --- p.137 / References --- p.139

The fragmented approaches to delivering health care services in the United States, along with the associated structural inefficiencies and unsustainable increases in health care costs affecting all payers, compel the need for reform. Various federal and state-level delivery system reform models have emerged in response. The Medical Home (MH) is one of such reform models. In 2004 a national initiative entitled "The Future for Family Medicine Project" identified the lack of emphasis on comprehensive primary care, especially for chronic care patients, and proposed the introduction of MHs to improve comprehensive primary care delivery for every patient. Oregon's MH variant, the Patient-Centered Primary Care Home (PCPCH), was introduced in 2009 as part of a state-wide health reform initiative ushered in by the passage of House Bill 2009 to promote the Triple Aim. Since 2011, over 600 primary care clinics have been recognized as PCPCHs. Proponents of the model argued that it will help improve comprehensive primary care services upstream and reduce inappropriate utilization of Emergency Department (ED) and Inpatient (IP) care and expenditures downstream. Evidence on the model's application to reduce ED and IP utilization and expenditures have so far been mixed. Based on growing interests in the effects of the model's application to provide care for different types of patients, this research was designed to evaluate the policy effects of the application of PCPCHs, with a focus on PCPCHs that treat greater proportions of chronic care patients, to answer the following questions: (1) What is the average chronic disease burden of PCPCHs, and how does their average chronic disease burden compare to the communities PCPCHs are in pre-post PCPCH recognition? (2) How do primary care expenditures change based on the chronic disease burden of PCPCHs? (3) Do PCPCHs that engage more high chronic disease burden patients have more reductions in ED and IP expenditures? For this research, a chronic disease burden measure was developed from 10 markers of chronic conditions. This measure was then used to stratify PCPCH clinics and their comparators into high and low chronic disease burden clinics. The research was designed as a natural experiment, utilizing difference-in-difference methods to measure outcome differences pre-post PCPCH policy implementation and comparing outcome differences between PCPCHs and their control groups. The unit of analysis was PCPCH clinics. The theoretical perspectives that informed this research were Risk Selection and Complex Adaptive Systems (CAS). Data from Oregon's All Payer All Claims (APAC) data system, which included 16 quarters of claims and eligibility data from fourth quarter 2010 to third quarter 2014, as well as PCPCH attestation data on 525 clinics were utilized for this research. The results suggest that the chronic disease burden for PCPCHs was significantly lower than their comparator groups before clinics recognition as PCPCHs, but the chronic disease burden did not change after clinics recognition as PCPCHs. Average primary care expenditures did not change after PCPCH recognition. Average ED and average IP expenditures for high chronic disease burden PCPCHs did not change but rather decreased significantly for low chronic disease burden PCPCHs. The results imply that the distribution of chronic disease burden in PCPCHs is important and related to ED and IP expenditures, but in a different direction than expected. The results also suggest that focusing on low chronic disease burden patients in PCPCHs could help reduce ED and IP expenditures in the short and medium terms. Policies to engage a broader mix of chronic disease burden patients in PCPCHs could help increase savings from ED and IP utilization. The results also suggest the need for more research to improve current understanding of how PCPCHs are impacting health care trajectories in the current delivery system environment.

Health inequity refers to differences in health status between populations ( health inequalities ) that are unnecessary and avoidable and, additionally, are considered unfair or unjust. The history of the concept is reviewed and the mechanisms by which inequity affects health surveyed, with a focus on multi - level models of health production. The origins and development of the Primary Health Care approach is then considered with an emphasis on the Australian setting and on HIV / AIDS policy. The construct of homosexuality is then explored and concepts of sexual attraction, ' orientation ', identity and behaviour differentiated. What is known about the health characteristics of homosexually active men in the First World is then surveyed by means of a systematic literature review. It is concluded that there is evidence that they are affected by substantial health inequality in a range of areas including mortality, suicidality, depressive disorders, anxiety disorders, report of childhood sexual abuse and problematic substance use. Few of these inequalities have been confirmed in the Australian context, however, and almost none have been confirmed specifically in South Australia. The background to the development of a Primary Health Care programme focused on homosexually active men, is then described. The baseline health characteristics of the programme ' s cohort of 542 homosexually active South Australian men ( including their sexual behaviour in the context of HIV transmission ) are described and compared with other samples of men to identify inequalities. It is concluded that men in the cohort were subject to health inequality in a wide range of health parameters including mortality, suicidality, sexually transmitted infections, depressive and anxiety disorders, levels of substance use and self - rated health on the short - form 36 ( sf36 ) instrument. The relationships between these characteristics and factors indicative of disadvantage and victimisation are then explored. It is concluded that many of the health inequalities identified were related to sociohistorical factors such as emotional withdrawal by one ' s father, low income, unemployment, reduced educational attainment, and recent experience of violence and abuse from strangers. It is argued that some of these factors can be considered to be examples of unfairness and injustice and that, as a consequence, at least some of the health inequality experienced by this population is also health inequity. The elements of the Primary Health Care programme devised to meet the needs of homosexually active men is described and the trajectory of health characteristics of its participants over three time points is examined. 210 homosexually active men had reached Second Review, an average of thirty - six months after enrolment, by the time of analysis. Among this group, significant sustained improvement in a range of health outcomes, including prevalence of depressive disorders, sf36 scores and rate of recent suicidal ideation, is reported in association with involvement in the programme. Participant ' s subjective satisfaction with the programme is then described and their beliefs about the causes of their improved health explored using a qualitative methodology. It is concluded that the programme had largely met the needs of participants and they believed that it had been responsible for their improved health. Limitations of the study are considered and discussed. Limitations of the investigation to identify health inequality include questions of external validity arising from the absence of a perfect comparator group and concerns with construct validity related to the possibility of geographical and cultural variation in definitions of ' homosexually active men '. In the investigation to determine the extent to which health inequalities were also examples of inequity, issues of conclusion validity are discussed particularly in relation to multiple comparisons and the balance between Type I and Type II errors. In the evaluation of the impact of the Primary Health Care programme, there are concerns about internal validity resulting from the absence of randomisation and an uncontrolled design. The components of this issue are discussed and some support for internal validity is found in the reported subjective beliefs of participants about the cause of their health improvement and the outcomes of critical reflection by the programme team. The implications of the findings for policy, practice and further research are explored. It is argued that the health inequity experienced by people of sexual diversity will require profound social change for complete resolution. In the meantime, however, focused Primary Health Care with a community of sexual diversity has the potential to mitigate the health inequity its members experience and to help them to survive and function while they wait for a fairer and kinder society. / Thesis (Ph.D.)--School of Population Health and Clinical Practice, 2005.

University of Macau / Faculty of Business Administration / Department of Management and Marketing

No description available.

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences