published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Background: One of the common complications of stroke is dysphagia. Dysphagia can be a disabling problem with negative psycho-social consequences. The effect of dysphagia on quality-of-life is not well understood among the stroke survivors. The Chinese version of Swallow Quality-of-Life Questionnaire can be a reliable instrument to provide a multidimensional evaluation on the impact of post-stroke dysphagia in the population of Hong Kong Chinese older adults. Objective: To investigate factors associated with the swallowing-related quality-of-life in Hong Kong Chinese older adults with the history of stroke during the post-acute phase, using a disease-specific quality-of-life questionnaire (CSWAL-QOL). Method: This was a cross-sectional study of 92 stroke survivors, aged over 55. They were recruited from the inpatient wards and out-patient clinics. They were assessed for any dysphagia and its severity by the bedside swallow assessment. The Mini-Mental State Examination and the Chinese version of Swallow Quality-of-Life Questionnaire were used for cognitive and quality-of-life assessment respectively. Results: The test-retest reliability of the test was moderately correlated (Spearman’s rho 0.62).Participants on modified diet/fluid, on tube-feeding, older age and post-stroke for 1-2 years were observed to have lower CSWAL-QOL score across scales. Conclusion: The effect of ageing appeared to be a factor affecting swallowing-related QOL in stroke survivors, with better QOL in younger participants(age ranged from 55 to 69) and similar QOL in old (age ranged from 70 to 85) and very old (age above 85)participants. No gradual change of QOL was found as post-stroke duration increases. The oral feeding mode and normal food and fluid consistency resulted a better QOL in stroke survivors. / published_or_final_version / Medicine / Master / Master of Medical Sciences

OBJECTIVES: The primary objective of this study was to evaluate the efficacy of fluoride varnish in caries prevention and arrest on coronal and root surfaces of teeth over a 24-month period in Chinese Sjögren’s syndrome (SS) patients. Secondary objective was to investigate the effect of fluoride varnish on oral microorganism (Candida and lactobacilli). METHODS: This study was a randomized, double-blind, placebo-controlled clinical trial. A total of 85 SS patients participated in this study. They were randomly assigned to two groups to receive either fluoride varnish or placebo gel quarterly. Dental examination, and assessment of the sicca symptoms, oral hygiene, salivary flow / pH / buffering capacity and oral microbiological profiles were carried out at the baseline, 12-month and 24-month visits. RESULTS: Seventy-eight patients (92%) completed the 24-month trial. At the 24-month visit, no statistically significant differences (Mann-Whitney test, P > 0.05) were found between the fluoride and the placebo groups regarding their mean numbers of coronal surfaces with new enamel caries lesions (fluoride: 1.6; placebo: 1.6), arrested caries lesions (fluoride: 0.6; placebo: 0.7), and also root surface caries lesions (fluoride: 0.3; placebo: 0.1). SS patients who had received application of fluoride varnish were significantly less likely to develop dentin caries in coronal surfaces over the 24-month study period (P = 0.035). The mean numbers of coronal surfaces with new dentin caries lesions found at the 24-month visit in the fluoride and placebo groups were 1.4 and 2.7, respectively (Mann-Whitney test, P > 0.05). The caries prevented fraction of fluoride varnish for coronal dentin caries was 33.3%. No significant differences in the mean counts of Candida and lactobacilli between fluoride and placebo groups were detected (Mann-Whitney test, P > 0.05). Results of the logistic regression analysis showed that SS patients who had high baseline DMFS scores (P = 0.050), harbored more species of Candida in the dental plaque samples (P = 0.019), or had low pH of unstimulated whole saliva (P = 0.005) were significantly more likely to develop dentin caries in coronal surfaces over the 24-month study period. CONCLUSIONS: Fluoride varnish may be efficacious in preventing coronal dentin caries in Chinese patients with SS. However, it may not be efficacious in preventing root caries and has no effect on oral microorganism. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Down syndrome (DS) is the most common chromosomal disorder in humans. It is associated with various medical, social and developmental issues affecting all stages of life. Most people with DS now live to adulthood. However, limited data is available on the medical and social concerns and the impacts on their quality of life. In this study, my primary aim was to study the health-related quality of life (HRQoL) of Chinese with DS in Hong Kong. Secondarily, 2 other important aspects of medical care and counseling for people with DS were explored: the level of satisfaction in the transition from paediatric to adult medical care, and how language choice in medical settings can be of great significance to caretakers and families. In collaboration with Hong Kong Down Syndrome Association, a proxy-assessment survey was designed and administered to parents or caregivers of people with DS. I used the Health Utilities Index (HUI) to measure the HRQoL of people with DS. Logistic Regression Model was employed to estimate the associations between HRQoL scores and various physical and developmental-behavioural morbidities. The findings on the survey of service satisfaction and sensitive language are summarized quantitatively. I recruited 116 Chinese people with DS (n = 63 male; age ranged from 5 to 53). More than 50% of the subjects scored in the severe range on the HUI disability scale. Behavioural problems (HUI2) and hearing problems (HUI2 and HUI3) were statistically significant predictors (p-value<0.05) for a less favorable HRQoL score. A statistically significant inverse dose response relationship was observed between the HRQoL scores and the number of developmental-behaviour problems, as well as the number of chronic health problems. Satisfaction of service rated by caretakers reveals that >80% felt accessibility and coordination of both medical and social service were better when the subjects were in their childhood. Sixty percent felt that transition care is lacking and nearly 90% felt that caring for a person with DS is more difficult as they age. For the exploratory survey on language choice in medical setting, most participants rated ‘成為負擔 become a burden’ (82%), ‘冇用 useless’ (77%), ‘冇希望 hopeless’ (77%) and ‘唔正常 abnormal’ (76%) as offensive. Alternative words suggested include ‘可能需要特別指導及訓練 may need special guidance and training’ and ‘特殊 special’ instead of ‘成為負擔 become a burden’ and ‘唔正常 abnormal’ respectively. On the other hand, the least rated offensive words were ‘染色體異常 chromosome deviant’ (35%), “發育遲緩 growth delay” (35%) and ‘傷殘人士 handicapped person’ (34%). Medical and social issues addressed will be useful for health care providers, genetic counselors, and parents or caregivers to gain a broader perspective of the realistic outcome of individuals with DS under the healthcare infrastructure available in Hong Kong. This knowledge is important to inform expectations of families, improve communication between families and health care professionals, and to facilitate the design of targeted interventions to improve quality of life for people with this common genetic disorder. / published_or_final_version / Obstetrics and Gynaecology / Master / Master of Medical Sciences

published_or_final_version / Transport Policy and Planning / Master / Master of Arts in Transport Policy and Planning

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice