published_or_final_version / Social Work / Master / Master of Social Sciences

Pau, Mei Lin Margaret. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 130-152). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese.

Sze Pan Ching. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 162-178). / Abstracts in English and Chinese. / ABSTRACT --- p.i / ABSTRACT (IN CHINESE) --- p.iv / ACKNOWLEGEMENT --- p.vi / TABLE OF CONTENTS --- p.viii / LIST OF FIGURES --- p.xv / LIST OF TABLES --- p.xviii / LIST OF APPENDIX --- p.xx / LIST OF ABBREVIATIONS --- p.xxi / LIST OF DEFINITIONS OF TERMS --- p.xxii / Chapter I. --- INTRODUCTION --- p.1 / Chapter 1.1 --- Epidemiology of hip fracture among elderly worldwide --- p.1 / Chapter 1.2 --- Impact of hip fractures --- p.3 / Chapter 1.2.1 --- Mortality --- p.3 / Chapter 1.2.2 --- Hospitalization and institutionalization --- p.4 / Chapter 1.2.3 --- Morbidity --- p.4 / Chapter 1.2.4 --- Psychological impact and quality of life --- p.5 / Chapter 1.2.5 --- Financial burden --- p.6 / Chapter 1.3 --- Causes of hip fracture --- p.6 / Chapter 1.3.1 --- Mechanisms of hip fracture --- p.7 / Chapter 1.3.2 --- Degenerated protective mechanism --- p.8 / Chapter 1.3.3 --- Poor hip strength indices --- p.9 / Chapter 1.4 --- Prevention of hip fractures --- p.10 / Chapter 1.4.1 --- Reduction of the chance of lateral fall --- p.10 / Chapter 1.4.2 --- Increase hip strength indices --- p.11 / Chapter 1.4.3 --- Limitations of current strategies --- p.12 / Chapter 1.5 --- Hip protectors for prevention of hip fractures --- p.12 / Chapter 1.6 --- Effectiveness of hip protector --- p.14 / Chapter 1.6.1 --- Laboratory studies on effectiveness in force attenuation --- p.14 / Chapter 1.6.2 --- Clinical studies on prevention of hip fractures --- p.16 / Chapter 1.6.3 --- Cost-effectiveness study --- p.17 / Chapter 1.7 --- Problems on the use of hip protectors --- p.19 / Chapter 1.7.1 --- Discomfort --- p.19 / Chapter 1.7.2 --- Extra effort in wearing --- p.20 / Chapter 1.7.3 --- Appearance after wearing --- p.21 / Chapter 1.7.4 --- Urinary incontinence --- p.22 / Chapter 1.7.5 --- Oth er problems --- p.23 / Chapter 1.8 --- Acceptance and Compliance of hip protectors --- p.23 / Chapter 1.8.1 --- Acceptance --- p.23 / Chapter 1.8.2 --- Compliance --- p.24 / Chapter 1.9 --- Strategies to improve compliance of hip protector --- p.25 / Chapter 1.9.1 --- Better design of hip protector --- p.25 / Chapter 1.9.2 --- Encouragement/support to the user --- p.26 / Chapter 1.9.3 --- Support from nursing staff/carer --- p.27 / Chapter 1.10 --- Rationale and objectives of present study --- p.28 / Chapter II. --- METHODOLOGY --- p.36 / Chapter 2.1 --- Development of hip protector --- p.36 / Chapter 2.1.1 --- Design of the pads --- p.36 / Chapter 2.1.2 --- Design of the pants --- p.38 / Chapter 2.1.2.1 --- Fabric materials --- p.38 / Chapter 2.1.2.2 --- Anthropometric measurement --- p.42 / Chapter 2.1.2.3 --- Pattern design --- p.43 / Chapter 2.1.3 --- Trial use of hip protector --- p.43 / Chapter 2.1.4 --- Calculation and statistical method --- p.43 / Chapter 2.2 --- Mechanical test on force attenuation properties --- p.44 / Chapter 2.2.1 --- Testing system --- p.44 / Chapter 2.2.2 --- Simulation of impact force and identification of dropping height --- p.45 / Chapter 2.2.3 --- Testing method --- p.46 / Chapter 2.2.4 --- Calculation and statistical method --- p.47 / Chapter 2.3 --- Compliance study --- p.47 / Chapter 2.3.1 --- Setting --- p.47 / Chapter 2.3.2 --- Subjects --- p.48 / Chapter 2.3.3 --- Study design --- p.49 / Chapter 2.3.4 --- Implementation procedure and intervening Program --- p.49 / Chapter 2.3.4.1 --- Liaison with the heads and responsible staff in the elderly hostels --- p.49 / Chapter 2.3.4.2 --- Education program for hostel staff --- p.50 / Chapter 2.3.4.3 --- Education program for elderly subjects --- p.50 / Chapter 2.3.4.4 --- Fall and fracture risk counseling --- p.51 / Chapter 2.3.4.5 --- Consent and Ethical approval --- p.51 / Chapter 2.3.4.5 --- Provision of hip protector and training program on wearing hip protector --- p.51 / Chapter 2.3.4.6 --- Follow up and encouragement on the use of hip protector --- p.52 / Chapter 2.3.5 --- Outcome measures --- p.52 / Chapter 2.3.5.1 --- Primary outcome --- p.52 / Chapter 2.3.5.2 --- Secondary outcomes --- p.53 / Chapter 2.3.6 --- Measurement method --- p.55 / Chapter 2.3.6.1 --- Compliance --- p.55 / Chapter 2.3.6.2 --- Falls and fractures incidence --- p.56 / Chapter 2.3.6.3 --- Adverse effect and feedback after wearing hip protector --- p.56 / Chapter 2.3.6.4 --- Fear of fall --- p.57 / Chapter 2.3.6.5 --- Fall and fracture history --- p.57 / Chapter 2.3.6.6 --- Medical co-morbidities --- p.58 / Chapter 2.3.6.7 --- Presence of urinary incontinence --- p.58 / Chapter 2.3.6.8 --- Functional level --- p.58 / Chapter 2.3.6.9 --- Hand function --- p.58 / Chapter 2.3.6.10 --- Mobility --- p.59 / Chapter 2.3.6.11 --- Cognitive function --- p.59 / Chapter 2.3.7 --- Sample size calculation --- p.59 / Chapter 2.3.8 --- Calculation and Statistical method --- p.60 / Chapter III. --- RESULTS --- p.73 / Chapter 3.1 --- Design of hip protector --- p.73 / Chapter 3.1.1 --- The design of pants --- p.73 / Chapter 3.1.1.1 --- The fabric materials --- p.73 / Chapter 3.1.1.2 --- The size of the pants --- p.74 / Chapter 3.1.2 --- The design of pads --- p.75 / Chapter 3.1.2.1 --- Thickness of silicon padding --- p.75 / Chapter 3.1.1.2 --- Dimension of the hard shield --- p.75 / Chapter 3.2 --- Mechanical test on force attenuation properties of the pads --- p.76 / Chapter 3.2.1 --- Impact force --- p.76 / Chapter 3.2.2 --- Impact duration --- p.78 / Chapter 3.2.3 --- Selection of th e prototype --- p.78 / Chapter 3.3 --- Compliance study --- p.79 / Chapter 3.3.1 --- Demograph ics --- p.79 / Chapter 3.3.2 --- Primary outcome --- p.79 / Chapter 3.3.2.1 --- Initial acceptance rate --- p.79 / Chapter 3.3.2.2 --- Compliance rate --- p.79 / Chapter 3.3.2.3 --- Percentage of people wearing hip protector across the study period --- p.81 / Chapter 3.3.2.4 --- Percentage of protected fall --- p.81 / Chapter 3.3.3 --- Secondary outcomes --- p.81 / Chapter 3.3.3.1 --- Fall and related injury among the subjects in the study period --- p.81 / Chapter 3.3.3.2 --- Reasons for non-acceptance --- p.82 / Chapter 3.3.3.3 --- Feedback in using hip protector --- p.84 / Chapter 3.3.3.4 --- Factors associated with compliance and non-compliance (feedback in wearing hip protector) --- p.84 / Chapter 3.3.3.5 --- Factors associated with compliance and non-compliance (subject characteristics) --- p.85 / Chapter 3.3.3.6 --- Effect on mobility after wearing hip protector --- p.85 / Chapter 3.3.3.7 --- Fear of fall after wearing hip protector --- p.85 / Chapter IV. --- DISCUSSION --- p.123 / Chapter 4.1 --- Development of a hip protector for Chinese elderly --- p.124 / Chapter 4.1.1 --- Successful modifications made to the pads --- p.124 / Chapter 4.1.1.1 --- More comfort to wear with silicon cushioning materials added --- p.124 / Chapter 4.1.1.2 --- Better mechanical properties with semi-flexible plastic and silicon pad --- p.125 / Chapter 4.1.1.3 --- Smaller in dimension of the present model might improve appearance after wearing --- p.127 / Chapter 4.1.2 --- No significant improvement on compliance with modification of the pants --- p.128 / Chapter 4.2 --- Sufficient mechanical properties of hip protector demonstrated --- p.129 / Chapter 4.2.1 --- Mechanical test set up --- p.130 / Chapter 4.2.2 --- Mechanism of force attenuation --- p.132 / Chapter 4.3 --- No significant improvement on compliance shown --- p.134 / Chapter 4.4 --- Compliance at night time better than other studies --- p.136 / Chapter 4.5 --- Determinants of compliance mostly related to subjects' feedback of using hip protector rather than on their characteristics --- p.137 / Chapter 4.6 --- Better compliance observed in hostel with higher staff-to-subject ration and with occupational therapist as contact person --- p.138 / Chapter 4.7 --- Better acceptance rate of hip protector shown in the present study --- p.139 / Chapter 4.8 --- Identification of factors influencing acceptance --- p.139 / Chapter 4.9 --- Percentage of protected fall was higher than mean compliance --- p.141 / Chapter 4.10 --- No hip fracture occurred while subjects wearing hip protector --- p.141 / Chapter 4.11 --- Decreased fear of falling after wearing hip protector --- p.142 / Chapter 4.12 --- Limitation --- p.142 / Chapter 4.13 --- Recommendation --- p.143 / Chapter V. --- CONCLUSION --- p.146 / Chapter VI. --- APPENDIX --- p.148 / Chapter VII. --- BIBLIOGRAPHY --- p.162 / Chapter VIII. --- PUBLICATIONS --- p.179

published_or_final_version / Dentistry / Master / Master of Dental Surgery

張鳳愛. / 論文(社會工作碩士) -- 香港中文大學硏究院社會工作學部, 1996. / 參考文献 : leaves 113-121. / Zhang Feng'ai. / 鳴謝 --- p.i / 論文提要 --- p.iii / 目錄 --- p.v / 表目錄 --- p.vii / 緖論 --- p.1 / Chapter 第一章 --- 文獻探討 --- p.6 / Chapter 第一節 --- 生活滿足感 --- p.6 / Chapter 一、 --- 生活滿足感的定義 --- p.6 / Chapter 二、 --- 生活滿足感的因素 --- p.9 / Chapter 第二節 --- 閒暇 / Chapter 一、 --- 閒暇的定義 --- p.18 / Chapter 二、 --- 閒暇對老人的重要 --- p.21 / Chapter 三、 --- 閒暇活動參與與老人生活滿足感的關係 --- p.27 / Chapter 第三節 --- 健康 --- p.36 / Chapter 一、 --- 健康的定義 --- p.36 / Chapter 二、 --- 健康與老人生活滿足感的關係 --- p.39 / Chapter 第四節 --- 健康及閒暇活動與老人生活滿足感的關係 --- p.42 / Chapter 一、 --- 撤離理論 --- p.43 / Chapter 二、 --- 活躍理論 --- p.46 / Chapter 第二章 --- 理論架構 --- p.51 / 以活躍理論爲基礎探求健康及閒暇活動參與 與生活滿足感之關係 / Chapter 第三章 --- 硏究方法 --- p.58 / Chapter 第一節 --- 操作性定義 --- p.58 / Chapter 一、 --- 生活滿足感 --- p.58 / Chapter 二、 --- 健康 --- p.58 / Chapter 三、 --- 閒暇活動 --- p.60 / Chapter 四、 --- 閒暇活動參與 --- p.60 / Chapter 第二節 --- 研究問題 --- p.61 / Chapter 第三節 --- 研究對象及抽樣範疇 --- p.61 / Chapter 第四節 --- 資料搜集程序 --- p.63 / Chapter 第五節 --- 硏究工具 --- p.65 / Chapter 一、 --- 生活滿足感指標簡表 --- p.66 / Chapter 二、 --- 閒暇參與量表 --- p.66 / Chapter 三、 --- 健康量表 --- p.66 / Chapter 第四章 --- 硏究結果與討論 --- p.68 / Chapter 第一節 --- 資料分析與討論 --- p.68 / Chapter 第二節 --- 硏究結果摘要 --- p.82 / 附表樣本所得的資料分析表 --- p.86 / Chapter 第五章 --- 建議及限制 --- p.97 / 結論 --- p.109 / 註釋 --- p.112 / 參考書目 --- p.113 / 附錄問卷：老人生活滿足感與健康及閒暇活動參與之關係 --- p.122

研究背景：便秘被過往的研究確認為世界各地老年人的一個常見健康問題，尤其是居住在安老院的長者。香港一項人口普查亦指出便秘也是香港老年人的一個常見健康問題。便秘對長者的生理、心理和社會功能等各方面都產生不良影響。此外，醫療體制亦因處理便秘及其衍生的健康問題而面對沉重的負擔。目前所採用的常規方案是生活模式改變及使用軟便劑，但兩者均未能有效地紓緩便秘的徵狀。由於香港老齡人口持續增長，便秘將會是一個具有潛在持續性的老年健康問題，故尋找一個能有效地紓緩便秘徵狀的方案甚為迫切。耳穴療法是一項普及的中醫療法，亦屬於互補療法。過往在中國進行的研究顯示，耳穴療法能有效地治療便秘，惟此等療效尚未被確實。耳穴療法應是一個對處理便秘具有潛在療效的治療方案。現時，香港尚未有研究評價耳穴療法對處理便秘的療效。 / 研究目的：本研究旨在評價耳穴療法的互補療效，對安老院內的長者便秘徵狀及便秘相關的健康生活品質的干預效果。 / 研究方法：本研究是一個採取混合研究法的臨床研究。先進行化研究，評價耳穴療法對安老院內長者的便秘徵狀及便秘相關的健康生活品質的互補療效；接著進行質化研究，探討面談者對接受耳穴療法的經驗及感受。量化研究是一個隨機對照及雙盲的研究。安老院內的院友被取錄為參與者後，便隨機地獲分配一個研究組別。本研究共有三個研究組別，每名組員分別接受一個預定的干預措施，包括磁珠耳貼療法 (干預組)，王不留行籽耳貼療法 (對照A組) 及耳貼療法 (對照B組)，干預措施是在七個選定的耳穴上進行耳穴療法，共維持十天。研究指標包括便秘徵狀及便秘相關的健康生活品質。此等研究指標分別在干預前 (基線資料)、十天後 (干預措施結束) 和二十天後 (干預措施結束後十天) 進行資料蒐集。統計推斷方法是採用廣義估計方程模型檢驗組間和組內在便秘徵狀及便秘相關的健康生活品質之差異。質化研究的面談者必須是完成整個研究過程的干預組組員，並在量化檢驗的便秘徵狀指標中取得最高分及最低分的各四位組員。透過個別面談，探討面談者對接受耳穴療法以處理便秘的經驗及感受。 / 研究結果：本研究共有99名參與者。祇有90名參與者接受干預措施 (干預組=31；對照A組=28；對照B組=31)，其中的81名參與者完成整個療程 (干預組=29；對照A組=25；對照B組=27)。本研究結果顯示耳穴療法在十天 (p=0.016)及二十天 (p=0.016) 的研究時期內，便秘相關的健康生活品質中的滿意度在干預組及對照A組間有顯著的差異 (十天及二十天均是p=0.016)。然而，本研究證實磁珠耳貼療法能顯著地紓緩便秘徵狀 (十天：p=0.013；二十天：p<0.001)，提升與便秘相關的健康生活品質 (十天：p=0.005；二十天：p<0.001)，並於三個研究組別中取得最大的療效。此外，質化研究結果顯示，耳穴療法確是一項安全及具認受性的療法，適用於安老院內的院友，可作為處理便秘的治療方案。 / 研究結論：本研究是香港首個通過隨機對照的臨床研究，以評價耳穴療法對處理便秘的互補療效。研究結果顯示磁珠耳貼療法對安老院內的院友具有正向的臨床價值：磁珠耳貼療法能紓緩便秘徵狀及提升便秘相關的健康生活品質；安老院內的院友認為耳穴療法是一項安全及具認受性的療法；對住在安老院內年長的中國人而言，耳穴療法是一項與其文化相關的照護方式。本研究就處理安老院內院友的便秘問題為護理專業提供了有關耳穴療法的新知，並作為日後於護理實務及護理研究方面的參考和方向。 / Background: Constipation has been identified in previous studies as a worldwide health problem among elderly people, especially those living in residential care homes (RCHs). Similarly, constipation is also reported as a common health problem among elderly people in Hong Kong in a local population survey. Constipation adversely affects the biopsychosocial well-being of elderly people. In addition, heavy burden has been imposed on the health care system in dealing with constipation and its related health problems. Constipation is currently managed by laxatives and lifestyle modification. However, constipation is not effectively relieved by these two management strategies. In Hong Kong, the aging population is seen to have an increasing trend. Constipation will then be a potentially expanding health problem among elderly people. All these data indicate an urgent need for effective alternatives to manage this health problem. Auriculotherapy is one popular treatment modality in Chinese medicine, which is also a form of complementary therapy. Previous studies conducted in Mainland China reported promising results in managing constipation with auriculotherapy, although its effectiveness was not affirmed. Auriculotherapy appears to be a promising management strategy for constipation. Until now, no study has been conducted in Hong Kong to evaluate the effectiveness of auriculotherapy in managing constipation. / Aim: The current study aims to evaluate the complementary effects of auriculotherapy in relieving constipation symptoms and in promoting disease-specific health-related quality of life (HRQOL) among elderly RCH residents. / Methods: The present study is a clinical trial that adopts the mixed-method design. A randomized placebo-controlled trial was first conducted to evaluate the complementary effects of auriculotherapy in relieving symptoms of constipation and in promoting disease-specific HRQOL in elderly RCH residents. After the completion of the randomized placebo-controlled trial, the qualitative approach was conducted to explore the participants’ experience and perceptions on the use and complementary effects of auriculotherapy with magnetic pellets in managing constipation. The randomized placebo-controlled trial was a double-blind study. The participants were recruited from elderly RCH residents and then randomly assigned to one of the three study groups. The participants received the assigned intervention, namely, auriculotherapy using auricular plaster with magnetic pellet (experimental group), auriculotherapy using auricular plaster with Semen Vaccariae (placebo-controlled group A), or auriculotherapy using only auricular plaster (placebo-controlled group B). Auriculotherapy was applied onto seven selected auricular acupoints for 10 days. Two outcome variables, namely, constipation symptoms and disease-specific HRQOL, were measured before the implementation of intervention (baseline), on Day 10 (at the completion of the intervention), and on Day 20 (at the 10th-day follow-up after the intervention). The generalized estimating equation model was adopted to evaluate the between-group and within-group differences in the complementary effects of auriculotherapy on constipation symptoms and disease-specific HRQOL. In the qualitative approach, the informants were recruited from participants of the experimental group who had successfully completed the study with mean scores in constipation symptoms at the top- or bottom-four ranking. The informants were individually interviewed to explore their experience and perceptions on the use and complementary effects of auriculotherapy in managing constipation. / Results: Ninety-nine participants were recruited in the study. Ninety participants received the intervention as assigned, and eventually, 81 participants completed the intervention. When the interaction effects of time and group were simultaneously considered, statistical significant differences were only found in the satisfaction subscale of the disease-specific HRQOL between the experimental group and placebo-controlled group A on both Day 10 (p=0.016) and Day 20 (p=0.016). For the experimental group, significant time effects were found in constipation symptoms (Day 10：p=0.013; Day 20：p<0.001) and disease-specific HRQOL (Day 10：p=0.005; Day 20：p<0.001) after receiving auriculotherapy. Most importantly, the participants who received auriculotherapy with magnetic pellets showed the greatest improvement in constipation symptoms and disease-specific HRQOL after the intervention compared with the two placebo-controlled groups. The qualitative findings further revealed that auriculotherapy is a safe, well-accepted therapy in managing constipation among elderly RCH residents. / Conclusion: The current study is the first known randomized placebo-controlled trial that evaluates the complementary effects of auriculotherapy in managing constipation in Hong Kong. The current findings indicate positive clinical value of auriculotherapy with magnetic pellets in managing constipation in elderly RCH residents. Auriculotherapy with magnetic pellets was found to provide favourable therapeutic effects in relieving constipation symptoms and in promoting disease-specific HRQOL among elderly RCH residents. This therapy is also considered by elderly people as a safe and acceptable therapy with minimal side effects. In addition, auriculotherapy is considered as a culturally relevant care modality for Chinese elderly RCH residents. The current study contributes new knowledge to nursing for future reference and directions in both nursing practice and nursing research with regard to the complementary effects of auriculotherapy in managing constipation among elderly RCH residents. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Mei Kuen. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 273-305). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Introduction --- p.1 / Background of the study --- p.2 / Aim and significances of the study --- p.6 / Overview of the thesis --- p.6 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Introduction --- p.8 / Constipation: Potentially expanding health problem in elderly population --- p.9 / Prevalence of constipation --- p.9 / Definition of constipation --- p.11 / Physiology and pathophysiology of defecation --- p.13 / Effects of constipation --- p.15 / Adverse individual health consequences --- p.15 / Economic burden in health care system --- p.18 / Contributory factors for constipation --- p.20 / Roles of nurses in managing constipation in current practice --- p.22 / Cautious use of laxatives --- p.24 / Lifestyle modification --- p.24 / Promoting dietary fiber intake --- p.25 / Encouraging oral fluid intake --- p.26 / Promoting physical activity --- p.26 / Integration of complementary therapy into nursing practice in managing constipation --- p.28 / Auriculotherapy --- p.30 / Historical overview of auriculotherapy --- p.30 / Conceptual framework of auriculotherapy --- p.31 / Approaches of auriculotherapy --- p.36 / Mechanism of auriculotherapy --- p.37 / Clinical applications of auriculotherapy in managing constipation --- p.39 / Complementary effects of auriculotherapy in managing constipation: Review of previous studies --- p.41 / Subject characteristics --- p.41 / Intervention protocol --- p.45 / Therapeutic outcome criteria and effectiveness --- p.50 / Strengths and limitations of the reviewed studies --- p.56 / Recommendations for future studies --- p.59 / Significances of the current study --- p.60 / Summary --- p.61 / Chapter CHAPTER 3 --- METHODS / Introduction --- p.63 / Overview of study design --- p.65 / Mixed-method study design --- p.66 / Quantitative approach --- p.66 / Qualitative approach --- p.68 / Research aim and objectives --- p.68 / Research aim --- p.68 / Research objectives --- p.68 / Null hypotheses --- p.69 / Operational definitions --- p.71 / Rationale of the study design --- p.73 / Rationale for adopting the mixed-method design --- p.73 / Rationale for adopting the randomized controlled trial design --- p.75 / Rationale for adopting double-blindness --- p.75 / Rationale for adopting random assignment --- p.76 / Rationale for adopting a pretest and repeated post-test design --- p.78 / Rationale for recruiting placebo-controlled groups --- p.79 / Quantitative approach --- p.81 / Sample --- p.81 / Accessible population --- p.81 / Sampling method and selection of participants --- p.82 / Sample size determination --- p.85 / Experimental intervention --- p.87 / Content of the experimental intervention --- p.87 / Integrity of experimental intervention --- p.92 / Qualification of the intervener --- p.92 / Consistency of implementation of intervention --- p.93 / Compliance of the participants to study instructions --- p.84 / Data collection --- p.95 / Study Instruments and records --- p.95 / Patient Assessment of Constipation Symptom Questionnaire (Cantonese Chinese for Hong Kong) (PAC-SYM) --- p.96 / Patient Assessment of Constipation Quality of Life Questionnaire (Cantonese Chinese for Hong Kong) (PAC-QOL) --- p.97 / Abbreviated Mental Test (Hong Kong version; AMT) --- p.98 / Physical Activity Questionnaire (Hong Kong version; PAQ) --- p.98 / Screening for eligibility of the participant --- p.99 / Demographic and Clinical Data Sheet --- p.99 / Assessment of Clinical Syndrome of Constipation --- p.99 / Assessment of oral intake of Fruits and Vegetables (AFV) --- p.100 / Bowel Movement Record (BMR) --- p.100 / Drug Administration Record (DAR) --- p.101 / Data collection procedure --- p.101 / Qualitative approach --- p.104 / Rationale for adopting criterion sampling --- p.105 / Pilot Study --- p.106 / Feasibility of the sampling method --- p.107 / Feasibility of the data collection instruments and procedure --- p.107 / Feasibility of implementation of the study intervention --- p.108 / Characteristics of the pilot sample --- p.109 / Sample size recalculation --- p.113 / Appropriateness of the interview guide --- p.114 / Recommendations for the main study --- p.115 / Data Analysis --- p.115 / Quantitative data --- p.115 / Assessment of accuracy of data entry --- p.116 / Description of sample characteristics --- p.117 / Assessment of homogeneity of the study groups --- p.117 / Detection of the intervention effect --- p.118 / Justification for choosing parametric statistical tests over non-parametric statistical tests --- p.118 / Adoption of the Generalized Estimating Equations (GEE) model --- p.119 / Rationale for adopting the GEE model --- p.119 / Choosing the appropriate link function and working correlation matrix --- p.121 / Control of possible covariates in data analysis --- p.123 / Qualitative data --- p.124 / Ethical considerations --- p.125 / Principle of respect for persons --- p.126 / Principle of beneficence --- p.127 / Principle of justice --- p.128 / Summary --- p.129 / Chapter CHAPTER 4 --- RESULTS / Introduction --- p.132 / Recruitment and characteristics of participants --- p.133 / Recruitment of participants --- p.133 / Characteristics of the participants --- p.137 / Characteristics of the study sample and homogeneity among study groups --- p.140 / Characteristics of the study sample --- p.141 / Homogeneity of the characteristics of participants who received and those who did not receive the intervention in the study --- p.145 / Homogeneity of the characteristics of participants in the experimental and the placebo-controlled groups --- p.145 / Complementary effects of auriculotherapy in managing constipation --- p.149 / Adopting the GEE model --- p.152 / Checking the missing data --- p.152 / Identifying the covariates --- p.152 / Choosing the appropriate link function --- p.153 / Choosing the appropriate working correlation matrix --- p.160 / Complementary effects of auriculotherapy on constipation symptoms and disease-specific HRQOL --- p.160 / Complementary effects of auriculotherapy on constipation symptoms --- p.161 / Constipation symptoms (PAC-SYM) --- p.161 / Subscales of constipation symptoms --- p.165 / Abdominal symptoms subscale --- p.165 / Rectal symptoms subscale --- p.168 / Stool symptoms subscale --- p.172 / Summary of the complementary effects of auriculotherapy on constipation symptoms --- p.175 / Complementary effects of auriculotherapy on disease-specific HRQOL --- p.177 / Disease-specific HRQOL (PAC-QOL) --- p.177 / Subscales of disease-specific HRQOL --- p.181 / Physical discomfort subscale --- p.181 / Psychosocial discomfort subscale --- p.185 / Worries and concerns subscale --- p.186 / Satisfaction subscale --- p.190 / Summary of the complementary effects of auriculotherapy on disease-specific HRQOL --- p.193 / Effect size calculation --- p.196 / Findings revealed from study records --- p.197 / Monitoring of the intervention dose --- p.198 / Change of bowel movement pattern --- p.198 / Change in drug administration --- p.200 / Reporting of side effects associated with auriculotherapy --- p.202 / Reporting of unexpected beneficial effects after receiving auriculotherapy --- p.202 / Qualitative findings revealed from interview --- p.203 / Recruitment of informants --- p.203 / Characteristics of the informants --- p.204 / Qualitative findings --- p.207 / Benefits of auriculotherapy in managing constipation --- p.208 / Minor discomforts associated with auriculotherapy --- p.210 / Life as usual with the use of auriculotherapy --- p.210 / Willingness to adopt and recommend auriculotherapy to others --- p.213 / Summary of the qualitative findings --- p.214 / Summary --- p.215 / Chapter CHAPTER 5 --- DISCUSSION / Introduction --- p.217 / Profile of participants --- p.217 / Demographic and clinical characteristics of the participants --- p.218 / Baselines outcome variables of the participants --- p.224 / Clinical value of auriculotherapy with magnetic pellets in managing constipation --- p.226 / Summary of the key findings --- p.226 / Complementary effects in relieving constipation symptoms and in promoting disease-specific HRQOL --- p.228 / Safe and well-accepted intervention --- p.236 / Culturally relevant care modality --- p.239 / Challenges associated with recruiting elderly participants --- p.241 / Strengths and limitations of the current study --- p.246 / Strengths of the study --- p.246 / Limitations of the study --- p.253 / Summary --- p.257 / Chapter CHAPTER 6 --- CONCLUSION / Introduction --- p.258 / Contribution of new knowledge to nursing --- p.258 / Implications for nursing practice --- p.259 / Clinical application of auriculotherapy in nursing practice --- p.261 / Strategies to promote integration of auriculotherapy into nursing practice --- p.263 / Implications for nursing research --- p.266 / Recommendations for further studies --- p.268 / Conclusion of the whole study --- p.269 / REFERENCES (ENGLISH) --- p.273 / REFERENCES (CHINESE) --- p.303

心肺功能是其中一項體能特質，而對於進行較長時間的中至高劇烈程度運動十分重要，也會影響日常活動和健康。但是，還沒有研究香港華裔長者心肺功能水平及其與體能活動參與程度和健康的關條。 / 招募對象是從現有的兩個追蹤研究來的[男女骨折研究(n=998 和884 )和頸動脈粥樣硬化研究( 191 名婦女)， 70 - 79 歲年長男士最大攝氧量的參考範圖為22.3-23.0 毫升/分鐘/公斤(95%信賴區間) , 80 歲以上為19.2-20.2 毫升/分鐘/公斤。80 歲以上女性的參考範園為17.0-18.3 毫升/公斤/分鐘， 70-79 歲為19.3-20.0毫升/公斤/分鐘， 60-69 歲為2 1. 7-23.0 毫升/公斤/分鐘和年齡55-59 歲為22 .1 -23.8毫升/公斤/分鐘。男性的心肺功能與腰圍有相關性。<.0001) ，而女性的相關性還要加上體重(p<.02) ，與年齡有關的最大攝氧量衰退在男性為0.368 毫升/公斤/分鐘/年，而女性為0 .238 毫升/公斤/分鐘/年。 / 70 - 79 歲年長男士6 分鐘步行距離的參考範圍為453.3-466 公尺， 80 歲以上為382.6-403.3 公尺。80 歲以上女性的參考範圍為333.9-357.2公尺和年齡70-79 歲為396.1-406.8 公尺。6 分鐘步行距離與腰圍、身高和學歷有相關性(p:S:.05) ，與年齡有關的6 分鐘步行距離衰退在男性為9.06 公尺/年，而女性為7.35 公尺/年。從長者活動評估量表得出的體能活動參與程度被認為是與最大攝氧量成正相關(男性:r=.241，'女性:r=.214 )和6 分鐘步行距離(男性: r=.257，女性:r=.1 84) 。長者日常步行時間越長最大攝氧量和6 分鐘步行距離較佳(p≤01) ，進行劇烈運動的女性有正常最大攝氧量的機會較高(p=.041) 。男性能符合美國運動醫學學院或香港衛生署指引的明顯比不能達到指引的有較好的心肺功能。能達到指引的男性有1. 68 倍的概率有正常的心肺功能。回溯性研究追查過去的PASE 分數與現在最大攝氧量的相關性，反應出過去的體能活動參與程度對現在的心肺功能影響隨時間減少(男性由目前回到7 年前: r=0.241、0.168、0.120; 女性: r= .214、0.106、0.069 )。 / 患有高血壓男性的最大攝氧量和6 分鐘步行距離較差(p=.014) ，曾患有心肌硬塞或心絞痛男性和糖尿病女性的6 分鐘步行距離較差(p<.04) 。最大攝氧量分別與由社區認知篩選工具評估的男性認知水平（r=.107)和男女長者憂鬱量表分數男性:r=-.112 ，女性: r=-.123) 有相關性。另一方面， 6 分鐘步行距離被發現分別與簡易智能狀態測驗p<.02) 、男性的社區認知篩選工具(p=.046)的認知級別和男女長者憂鬱量表的抑鬱狀態p<.04)有差別。 / 最大攝氧量和6分鐘步行距離的年齡調整相關性連中高程度(男性:R=.459、女性: R=.425) 。除了與最大攝氧量有滿意的相關性，6分鐘步行距離與精神健康有比較密切的相關性。6分鐘步行距離可作為香港華裔長者最大攝氧量的體能代表值。 / Cardiorespiratory fitness (CRF) is one of the main attributes which is important toper form moderate-to-high intensity exercise for prolonged periods which affects daily activities as well as health. However, there are no studies among HK Chinese Elders' CRF and the relationship between this important parameter of physical fitness, PA participation and health outcomes. / By recruiting subjects from two existing cohort studies, the Osteoporetic Fractures in Men & Women Study (n=998 & 884 respectively) and the Carotid Atherosclerosis Study (191 women), the reference ranges of VO₂ peak for men were 22.3-23.0ml/min/kg (95% C.I.) at age 70-79y, and 19.2-20.2 ml/min/kg at age ≥80y. Forwomen, the reference range at age ≥80y was 17.0-18.3 ml/kg/min, 70-79y was19.3-20.0 ml/kg/min, 60-69y was 21.7-23.0 ml/kg/min and for age 55-59y was22.1-23.8 ml/kg/min. Men's VO₂ peak was associated with waist circumference(WC, p<.000l) while women's VO₂ peak additionally associated with weight (p<.02).There was an age-related decline in VO₂ peak at 0.368 ml/kg/minly in men and 0.238ml/kg/minly in women. / The reference ranges of 6MWD for men were 453.3-466.6m (95% C.I.) at age 70-79y, and 382.6-403.3m at age ≥80y. For women, the reference range at age 80≥y was 333.9-357.2m and for age 70-79y was 396.1-406.8 ml/kg/min. 6MWD was associated with WC, height and education (p≤.05). There was an age-related decline in 6MWD at 9.06m/y in men and 7.35m/y in women. / Elders' participation in PA assessed by the Physical Activity Scale for Elderly (PASE), was positively correlated with VO₂ peak (r=.241 in men, r=.214 in women) and 6MWD (r=.257 in men, r=.184 in women). Elderly walked more everyday have better VO₂peak and longer 6MWD (p≤ .0l). Women did more strenuous sport had higher chance of having normal CRF (p=.041). Men who met the guidelines by American College of Sports Medicine (ACSM) & Department of Health (DH), HK had better VO₂ peak than those who failed to meet that guidelines (p<.005). By following the PA guidelines, men had a 1.68-fold probability having normal CRF. A novel approach to retrospectively explore the correlation between the past PASE score and the present VO₂ peak revealed that the effect of past PA participation diminished with time (correlations for men from present, 4y and 7y ago: r=.241, .168, .120; for women r=.214, .106, .069). / Men with hypertension had significantly lower V02 peak and shorter 6MWD (p<.03). Men with history of myocardial infarction and angina also walked shorter in 6MWT while women only with diabetes had shorter 6MWD (p<.04). CRF was found to be correlated with cognitive level in men estimated by CSI-D (p<.0001) and GDS-15 score in both genders (r=-.112 in men, r=-.123 in women). On the other hand, 6MWD was found to be different across cognitive status estimated by MMSE (p<.02) & CSI-D (p=.046 in men only), and depression status estimated by GDS-15 (p<.04) in both genders. / Age-adjusted correlation between VO₂ peak & 6MWD was moderately high (R=.459 in men; R=.425 in women). In addition to the satisfactory correlation with VO₂ peak, stronger associations were found 6MWD, cognitive and mental health. It was suggested 6MWD might be a feasible surrogate for VO₂ peak as a physical fitness measure among HK Chinese elderly. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Yau, Chung Fai Forrest. / "December 2011." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 215-237). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendix in Chinese. / ABSTRACT (IN ENGLISH) --- p.I / ABSTRACT (IN CHINESE) --- p.IV / ACKNOWLEDGEMENT --- p.VI / LIST OF CONTENTS --- p.VII / LIST OF TABLES --- p.XII / SELECTED ABBREVIATIONS --- p.XV / Chapter 1 --- BACKGROUND & OBJECTIVES --- p.1 / Chapter 1.1 --- INTRODUCTION --- p.1 / Chapter 1.2 --- OBJECTIVES OF THE STUDY --- p.3 / Chapter 1.3 --- OUTLINES OF THE THESIS --- p.4 / Chapter 2 --- LITERATURE REVIEW --- p.6 / Chapter 2.1 --- ELDERLY POPULATIONS --- p.6 / Chapter 2.1.1 --- Health --- p.6 / Chapter 2.1.1.1 --- Hypertension, Coronary Heart Disease & Stoke --- p.8 / Chapter 2.1.1.2 --- Diabetes --- p.10 / Chapter 2.1.1.3 --- Chronic Obstructive Pulmonary Disease --- p.11 / Chapter 2.1.1.4 --- Cognitive Function --- p.12 / Chapter 2.1.1.5 --- Depression --- p.13 / Chapter 2.2 --- THE RELATIONSHIP BETWEEN PA & HEALTH --- p.15 / Chapter 2.2.1 --- Participation in PA --- p.22 / Chapter 2.2.1.1 --- PA Recommendation --- p.24 / Chapter 2.2.2 --- Indirect Estimation ofPA Participation --- p.25 / Chapter 2.2.2.1 --- Physical Activity Scale for Elderly. --- p.26 / Chapter 2.3. --- PHYSICAL FITNESS & HEALTH. --- p.28 / Chapter 2.3.1 --- Definition of Physical Fitness. --- p.28 / Chapter 2.3.1.1 --- Cardiorespiratory Fitness --- p.30 / Chapter 2.3.2 --- Direct Assessment of Physical Fitness --- p.33 / Chapter 2.3.2.1 --- Cardiopulmonary Exercise Test --- p.33 / Chapter 2.3.2.1.1 --- Affordable Device for CPET --- p.35 / Chapter 2.3.2.2 --- Six Minutes Walk Test --- p.36 / Chapter 3 --- MATERIALS & METHODS --- p.39 / Chapter 3.1 --- SUBJECTS --- p.39 / Chapter 3.1.1 --- Subjects Source --- p.39 / Chapter 3.1.1.1 --- The Osteoporetic Fractures in Men & Women Study --- p.39 / Chapter 3.1.1.2 --- Carotid Atherosclerosis Study --- p.40 / Chapter 3.1.2 --- Follow up Situation --- p.40 / Chapter 3.1.3 --- Ethical Consideration --- p.41 / Chapter 3.2 --- INSTRUMENTATION --- p.41 / Chapter 3.2.1 --- Questionnaire --- p.41 / Chapter 3.2.1.1 --- Medical History --- p.41 / Chapter 3.2.1.2 --- Smoking Habit --- p.41 / Chapter 3.2.1.3 --- Cognitive & Mental Health --- p.42 / Chapter 3.2.1.3.1 --- Cantonese Mini Mental State Examination & Community Screening Instrument for Dementia --- p.42 / Chapter 3.2.1.3.2 --- Geriatric Depression Scale-15 --- p.42 / Chapter 3.2.1.4 --- Physical Activity Scale for Elderly --- p.43 / Chapter 3.2.1.5 --- Veteran Specific Activity Questionnaire --- p.44 / Chapter 3.2.2 --- Physical Measurements --- p.45 / Chapter 3.2.2.1 --- Height, Weight & Fat Percentage --- p.45 / Chapter 3.2.2.2 --- Waist, Hip Circumferences & WHR --- p.45 / Chapter 3.2.2.3 --- Blood Pressure --- p.45 / Chapter 3.2.2.4 --- Electrocardiograph --- p.46 / Chapter 3.2.3. --- Fitness Tests --- p.46 / Chapter 3.2.3.1 --- Cardiopuhuonary Exercise Test --- p.46 / Chapter 3.2.3.1.1 --- Exclusion Criteria --- p.46 / Chapter 3.2.3.1.2 --- PreTest Consideration --- p.47 / Chapter 3.2.3.1.3 --- Test Sequence & Measures --- p.48 / Chapter 3.2.3.1.4 --- Test Tennination Criteria --- p.49 / Chapter 3.2.3.2 --- Six Minutes Walk Test --- p.50 / Chapter 3.2.3.2.1 --- Six Minute Walk Test Sequence --- p.50 / Chapter 3.3 --- STATISTICS --- p.52 / Chapter 3.3.1 --- Description of Variables --- p.52 / Chapter 3.3.2 --- General Statistical Method --- p.53 / Chapter 3.3.3 --- Comparison between VO₂ peak & 6MWD Relationship with other Variables --- p.54 / Chapter 4 --- RESULTS --- p.56 / Chapter 4.1 --- RESPONSE & PARTICIPATION OF SUBJECTS --- p.56 / Chapter 4.2 --- DEMOGRAPHIC PROPERTIES --- p.63 / Chapter 4.2.1 --- Men --- p.63 / Chapter 4.2.2 --- Women --- p.68 / Chapter 4.2.3 --- Sample Representativeness --- p.71 / Chapter 4.2.4 --- Physical Measurements --- p.75 / Chapter 4.2.4.1 --- Peak Oxygen Uptake --- p.75 / Chapter 4.2.4.2 --- Correlations with Demographic Properties --- p.82 / Chapter 4.2.4.2.1 --- Mean VO₂ peak in Different WC Status --- p.83 / Chapter 4.2.4.2.2 --- Reference Range across Age Groups 98 --- p.84 / Chapter 4.2.4.2.3 --- Mllltivariat Analysis of VO₂ peak --- p.86 / Chapter 4.2.4.3 --- Six Minutes Walk Test --- p.88 / Chapter 4.2.4.3.1 --- UnivariateAnalysis with Demographic Properties --- p.90 / Chapter 4.2.4.3.2 --- Mean 6MWD by WC Status --- p.92 / Chapter 4.2.4.3.3 --- Reference Range by Age Groups --- p.92 / Chapter 4.2.4.3.4 --- Multivariate analysis of 6MWD --- p.94 / Chapter 4.2.5 --- Physical Activity Scale for Elderly --- p.96 / Chapter 4.2.5.1 --- Univariate Analysis with Demographic Properties --- p.97 / Chapter 4.2.5.2 --- Reference Range across Age Groups --- p.98 / Chapter 4.2.5.3 --- Reference Range of PASE --- p.99 / Chapter 4.2.5.4 --- Multivariate Analysis of PASE --- p.100 / Chapter 4.2.6 --- Cognitive & Mental Scores --- p.101 / Chapter 4.2.6.1 --- Community Screening Instrument for Dementia --- p.101 / Chapter 4.2.6.2 --- Mini-Mental State Examination --- p.102 / Chapter 4.2.6.3 --- Geriatric Depression Scale-15 --- p.103 / Chapter 4.3 --- CORRELATIONS OF CRF TESTS --- p.104 / Chapter 4.3.1.1 --- Relationship between 6MWD & VO₂ peak --- p.104 / Chapter 4.3.1.1.1 --- Pearson Correlation between 6MWD & VO₂ peak --- p.104 / Chapter 4.4 --- CRF & LIFESTYLES --- p.106 / Chapter 4.4.1 --- How PA correlates with CRF --- p.107 / Chapter 4.4.1.1 --- Relationship between PASE& VO₂ Peak --- p.107 / Chapter 4.4.1.1.1 --- Pearson Correlation between PASE & V02 peak. --- p.107 / Chapter 4.4.1.1.2 --- Mean VO₂ peak by Quartiles of PASE --- p.109 / Chapter 4.4.1.1.3 --- Mean PASE scores by VO₂ peak status --- p.110 / Chapter 4.4.1.1.4 --- Relationship between PASE leisure activities & VO₂ peak --- p.111 / Chapter 4.4.1.1.5 --- Time spent daily on PASE leisure activities by VO₂ peak status --- p.113 / Chapter 4.4.1.2 --- Relationship between PASE & 6MWD --- p.116 / Chapter 4.4.1.2.1 --- Mean 6MWD by Quartiles of PASE --- p.118 / Chapter 4.4.2 --- Relationship between CRF & Recommended PA Guidelines --- p.119 / Chapter 4.4.2.1 --- ACSM Guidelines --- p.119 / Chapter 4.4.2.2 --- HKDH Guidelines --- p.121 / Chapter 4.4.3 --- Does PASE in the Past Predict Present Maximal Oxygen Uptake --- p.122 / Chapter 4.4.3.1 --- Pearson Correlation between PASE at 3y before & Present VO₂ peak --- p.122 / Chapter 4.4.3.2 --- Pearson Correlation between PASE at 7y before & Present VO₂ peak --- p.124 / Chapter 4.5 --- CRF & HEALTH --- p.126 / Chapter 4.5.1 --- CRF & Physical Health --- p.126 / Chapter 4.5.1.1 --- Relationship between VO₂ peak & Medical History --- p.126 / Chapter 4.5.1.2 --- Relationship between 6MWD and medical history --- p.129 / Chapter 4.5.1.2.1 --- Mean 6MWD of men by chronic diseases --- p.130 / Chapter 4.5.1.2.2 --- Mean 6MWD of women by diabetes --- p.134 / Chapter 4.5.1.3 --- Comparison between VO₂ peak & 6MWD relationship with medical history --- p.135 / Chapter 4.5.2 --- CRF & Cognitive Function --- p.137 / Chapter 4.5.2.1 --- Relationship between MMSE& VO₂ Peak --- p.137 / Chapter 4.5.2.1.1 --- Pearson Correlation betweenMMSE & VO₂ peak --- p.137 / Chapter 4.5.2.1.2 --- Mean VO₂ peak by MMSE Status --- p.139 / Chapter 4.5.2.2 --- Relationship between MMSE & 6MWD --- p.141 / Chapter 4.5.2.2.1. --- Pearson Correlation between MMSE & 6MWD --- p.141 / Chapter 4.5.2.2.2 --- Mean 6MWD by MMSE category --- p.143 / Chapter 4.5.2.3 --- Relationship between CSID & VO₂ peak --- p.144 / Chapter 4.5.2.3.1 --- Pearson Correlation between CSID & VO₂ peak --- p.144 / Chapter 4.5.2.3.2 --- Mean VO₂ peak by CSID Classification --- p.146 / Chapter 4.5.2.4 --- Relationship between CSID & 6MWD --- p.147 / Chapter 4.5.2.4.1 --- Pearson Correlation between CSID & 6MWD --- p.147 / Chapter 4.5.2.4.2 --- Mean 6MWD by CSID Classification --- p.149 / Chapter 4.5.2.5 --- Comparison between VO₂ peak & 6MWD relationship with Cognitive Function --- p.150 / Chapter 4.5.2.5.1 --- Pearson Correlation between MMSE & 6MWD --- p.151 / Chapter 4.5.2.5.2 --- Mean 6MWD by MMSE category --- p.151 / Chapter 4.5.2.5.3 --- Pearson Correlation between CSID & 6MWD --- p.152 / Chapter 4.5.2.5.4 --- Mean 6MWD by CSID Classification --- p.153 / Chapter 4.5.3 --- CRF & Depression --- p.154 / Chapter 4.5.3.1 --- Relationship between GDS & VO₂ peak --- p.154 / Chapter 4.5.3.1.1 --- Speannan Correlation between GDS & VO₂ peak --- p.154 / Chapter 4.5.3.1.2 --- Logistic Regression Analysis --- p.154 / Chapter 4.5.3.2. --- Relationship between GDS & 6MWD --- p.156 / Chapter 4.5.3.2.1. --- Spearman Correlation between GDS & 6MWD --- p.156 / Chapter 4.5.3.2.2. --- Mean 6MWD by depression status. --- p.156 / Chapter 4.5.3.3. --- Comparison between VO₂ peak & 6MWD relationship with GDS --- p.158 / Chapter 4.5.3.3.1. --- Pears on Correlation between GDS & 6MWD --- p.158 / Chapter 4.5.3.3.2. --- Mean 6MWD by depression status --- p.158 / Chapter 5 --- DISCUSSION --- p.160 / Chapter 5.1 --- INTERPRETATION OF RESULTS --- p.160 / Chapter 5.1.1 --- Physical Fitness --- p.160 / Chapter 5.1.1.1 --- Cardiorespiratory Fitness --- p.160 / Chapter 5.1.1.1.1 --- Mode for CPET --- p.160 / Chapter 5.1.1.1.2 --- Criteria for VO₂ peak --- p.161 / Chapter 5.1.1.1.3 --- Reference Range of VO₂ peak among HK elderly --- p.164 / Chapter 5.1.1.1.4 --- Age Related Decline in VO₂ peak --- p.169 / Chapter 5.1.1.1.5 --- Repeatability of Measurements using FitMate[superscript TM] Pro --- p.170 / Chapter 5.1.1.1.6 --- Smoking --- p.170 / Chapter 5.1.1.2 --- Six Minutes Walk Test --- p.171 / Chapter 5.1.1.2.1 --- Reference Range of 6MWD among HK Elderly --- p.172 / Chapter 5.1.2 --- How Estimated PA Level Correlated to CRF --- p.173 / Chapter 5.1.2.1 --- CRF &PA --- p.174 / Chapter 5.1.2.2 --- CRF & Leisure Activities --- p.176 / Chapter 5.1.3 --- Elderly CRF of those who met Recommended PA Guidelines --- p.177 / Chapter 5.1.4 --- Could Past PA Participation Predict Present CRF --- p.180 / Chapter 5.1.5 --- Health --- p.181 / Chapter 5.1.5.1 --- Physical Health --- p.181 / Chapter 5.1.5.2 --- Dementia --- p.185 / Chapter 5.1.5.2.1 --- Community Screening Instrument for Dementia --- p.186 / Chapter 5.1.5.2.2 --- Mini-Mental State Examination --- p.188 / Chapter 5.1.5.2.3 --- Possible Mechanisms of Cognitive Decline & Benefits ofPA --- p.191 / Chapter 5.1.5.3. --- Depression --- p.193 / Chapter 5.1.5.3.1 --- Possible Mechanism of Depression & Benefits of PA --- p.197 / Chapter 5.1.6 --- 6MWD, a Better Physical Fitness Surrogate than VO₂ peak --- p.200 / Chapter 5.2 --- LIMITATIONS AND STRENGTH --- p.205 / Chapter 5.3 --- FUTURE STUDIES --- p.210 / Chapter 6 --- CONCLUSION --- p.211 / Chapter 7 --- REFERENCES --- p.215 / APPENDIX --- p.238

Background & Objective: Acute gastroenteritis (AG) outbreak in elderly homes is common in Hong Kong, especially during the winter. Although mainly a self-limiting condition, the associated short-term as well as long-term medical and social costs can be extensive. This case-control study aims to investigate the hygienic risk factors related to infectious AG in elderly homes at both institutional and individual levels. Predictor variables under investigation include hand wash practice, infection control practice, routine institutional hygienic practice, food handling practice, and environmental factors such as the home setting, ventilation measures and isolation room setting. / Conclusions: This study found that 'sometimes or never wash hands after toilet' was a significant personal hygienic risk factor for AG transmission. This indicated that toilet may be the most susceptible place and hands are the most susceptible vehicle for AG transmission in Hong Kong elderly homes. A higher percentage of the NOHs had a more frequent routine cleaning practice than the OHs, demonstrating that routine cleaning practice may be an economical and an effective way to prevent AG infection. / Methods: All the elderly homes in the New Territories East were invited to take part in the study. A total of 34 homes and 2,995 residents were recruited in the study sample. The data collection period was from Dec 2007 to May 2009. Cases were notified within one week after a reported AG case, either by a report from the elderly home in question, the weekly check up with the New Territories East Community Geriatric Assessment Teams (NTE CGATs), regular contact with the elderly homes by the research assistant and case referrals from the Accident and Emergency Department from the Prince of Wales Hospital (PWH). One hundred and forty cases and 280 matched controls were recruited. For every AG case reported, two sex and age (within 5 years) and elderly home matched controls were selected. Structured questionnaires were conducted in face-to-face interviews in the elderly homes by trained interviewers. Information about the ventilation and the environmental hygiene of the elderly homes was collected by observation from the research team at the beginning of the study. Descriptive analysis was performed for the characteristics of cases and controls. Multivariate and multilevel logistic regression models were applied and odds ratios (ORs) were calculated for the potential hygienic risk factors. / Results: Multiple conditional logistic regression analysis revealed 'sometimes or never wash hands after toilet' OR:3.09 (95%CI: 1.28 -- 7.42) [ref gp: wash hands every time after toilet] was the major significant risk factor for AG in elderly homes, indicating the possible route of person-to-person transmission. Other significant risk factors included: Self-nutrition evaluation as 'not enough' (OR: 2.07; 95%CI: 1.05 -- 4.06), 'Being hospitalized in past month before the interview' (OR: 2.86; 95%CI: 1.16 -- 7.05), 'Simplified Barthel Index scored &lt;15" (OR: 2.63; 1.06 -- 6.53), and 'Alzheimer's' (OR: 2.75; 95% 1.18 -- 6.40). The institutional hygiene factors were investigated based on the descriptive analysis between the outbreak homes (OHs) and the non-outbreak homes (NOHs). The results indicated that the health worker (HW) to resident ratio was much lower in OHs than NOHs (50% OHs: 1:30-55 vs > 80% NOHs:1:10-29), and a higher percentage of the NOHs had a more frequent routine cleaning practice than the OHs. / Fung, Pui Kwan. / Adviser: Ho Suzanne Sutying. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 182-206). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Wong, King Moses. / "August 2010." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 158-172). / Abstracts in English and Chinese. / Chapter Chapter One: --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2 --- Research objectives --- p.5 / Chapter 1.3 --- Research hypothesis --- p.7 / Chapter 1.4 --- Research questions --- p.7 / Chapter 1.5 --- Research structure --- p.9 / Chapter Chapter Two: --- Literature Review --- p.10 / Chapter 2.1 --- "Health geography: knowledge of population, people, places and health" --- p.10 / Chapter 2.2 --- Understanding geographies of diseases: mapping and modeling diseases and health --- p.17 / Chapter 2.3 --- Healthcare services provision and utilization --- p.22 / Chapter 2.4 --- Hong Kong: facts and context --- p.31 / Chapter 2.4.1 --- Demographics --- p.32 / Chapter 2.4.2 --- Key challenges arising from population ageing --- p.37 / Chapter 2.4.2.1 --- Implications to medico-social agenda --- p.38 / Chapter 2.4.2.2 --- Implications to health status --- p.38 / Chapter 2.4.2.3 --- Implications to disease pattern --- p.39 / Chapter 2.4.3 --- Healthcare service delivery system in Hong Kong --- p.41 / Chapter 2.4.3.1 --- Financing and expenditure --- p.42 / Chapter 2.4.3.2 --- Organizational framework and healthcare policy --- p.44 / Chapter 2.4.3.3 --- Healthcare resources --- p.49 / Chapter 2.4.3.4 --- Utilization and provision of public healthcare services --- p.50 / Chapter Chapter Three: --- Material & Methods --- p.55 / Chapter 3.1 --- Background of main source of data --- p.55 / Chapter 3.2 --- Sources of data --- p.57 / Chapter 3.2.1 --- Hospital services utilization data --- p.57 / Chapter 3.2.2 --- Healthcare resources data --- p.61 / Chapter 3.2.3 --- Population data --- p.62 / Chapter 3.3 --- Spatial scale of analysis --- p.62 / Chapter 3.4 --- Statistical analyses --- p.63 / Chapter 3.4.1 --- Service utilization ratios --- p.63 / Chapter 3.4.2 --- Provision of healthcare resources to population --- p.65 / Chapter 3.4.3 --- Adequacy of healthcare services provision --- p.65 / Chapter 3.4.4 --- Mortality analysis --- p.67 / Chapter 3.4.5 --- Multi-level analysis --- p.69 / Chapter 3.4.6 --- Mapping of health services utilization ratio and mortality ratio --- p.70 / Chapter 3.5 --- Statistical packages used --- p.73 / Chapter 3.6 --- Cautions on interpretation --- p.74 / Chapter 3.6.1 --- Confounding and ecological fallacy --- p.74 / Chapter 3.6.2 --- Problem with the use of Standardized Mortality Ratio --- p.75 / Chapter 3.6.3 --- Problem with mapping and visualization --- p.76 / Chapter Chapter Four: --- Results --- p.78 / Chapter 4.1 --- Socio-spatial variation in mortality --- p.78 / Chapter 4.2 --- Statistical analysis and mapping of health services utilization ratio --- p.80 / Chapter 4.3 --- Statistical and cartographic analysis in Standardized Mortality Ratio --- p.88 / Chapter 4.4 --- Provision of healthcare resources to population --- p.91 / Chapter 4.5 --- "Multi-level analysis of hospital services utilization, provision and mortality" --- p.92 / Chapter 4.6 --- Further analysis --- p.95 / Chapter Chapter Five: --- Discussion --- p.100 / Chapter 5.1 --- Geographic variations in health services utilization ratios --- p.101 / Chapter 5.2 --- Geographic variation in Standardized Mortality Ratio --- p.107 / Chapter 5.3 --- "Multi-level models on health services utilization, provision and mortality" --- p.121 / Chapter 5.3.1 --- Socio-demographic characteristics of health services utilization --- p.121 / Chapter 5.3.1.1 --- Age --- p.121 / Chapter 5.3.1.2 --- Gender --- p.124 / Chapter 5.3.2 --- Health services utilization in relation to services provision --- p.129 / Chapter 5.3.3 --- Health services utilization in relation to mortality --- p.132 / Chapter 5.3.4 --- Adequacy of healthcare services provision --- p.134 / Chapter 5.3.4.1 --- Adequacy of hospital care provision --- p.134 / Chapter 5.3.4.2 --- Adequacy of primary care provision --- p.139 / Chapter 5.4 --- Implications --- p.143 / Chapter 5.5 --- Strengths of study --- p.146 / Chapter 5.6 --- Limitations of study --- p.148 / Chapter 5.7 --- Recommendations for future research --- p.151 / Chapter Chapter Six: --- Conclusion --- p.154 / References --- p.158

A large body of empirical research has documented strong beneficial effects of educational attainment on a wide range of health outcomes. In addition, there has been growing interest in the links between religion and health, and some studies have suggested that the benefits of religious involvement on health are strongest for persons with low-to-moderate levels of education. To date, however, the bulk of this work has been conducted in the U.S. or other nations in the developed West. Although researchers have called for more comparative and cross-cultural studies on these topics, few if any studies have focused on the interplay of education, religion, and multiple health outcomes in China, particularly among its most elderly citizens. This project aims to address this gap in the research literature, with the following objectives: (1) to examine whether and how education is related to emotional and cognitive well-being, and reflects possible gender differences; (2) to explore whether and how religious participation is associated with various health indicators; and (3) to examine whether religious practice may complement or moderate the association between individual-level SES or community-level SES and health in this distinctive population. To investigate these issues, I use data from the Chinese Healthy Longevity Survey, a nationwide survey of the oldest old adults in China; my analyses involve the 1998 baseline survey, as well as data from the 2000 and 2002 follow-up surveys. Findings suggest that: (1) education impacts emotional and cognitive well-being through different mechanisms; (2) the indirect effects of religion on health are primarily mediated by psychological resources and lifestyle, but not by social resources; (3) females report higher levels of religious participation and get more cognitive benefits from it than males; (4) individual-level SES is negatively associated with religious participation, whereas community-level SES is positively associated with religious participation; and (5) the beneficial effects of religion on psychological wellbeing are more pronounced for residents in poorer areas. The theoretical and policy implications of the findings are discussed and elaborated.