More than one-third of the world population is infected with Tuberculosis (TB). World Health Organization has declared Tuberculosis as a global public health emergency in 1993. The people, affected by TB, are usually living in developing countries. In fact, TB is especially prevalent in Southeast Asia. China has been listed as a country with a high TB burden yet there are 150 “one-way permit” holders, across the border in China, for settlement purposes in Hong Kong. There is neither any health requirement nor obligatory physical examination before entry into Hong Kong. Unlike other developed countries, Hong Kong has no screening policy for people from Mainland China for migration purpose. The aim of this project is to explore the possibilities for different screening policies for new immigrants in Hong Kong, similar to those adopted by developed countries. Objectives include: (a) review of research articles and (b) careful perusal of selected government documents. Electronic databases of research articles for migration screening policy and data from World Health Organization, United Nations and other international and local authorizes were searched and analyzed to suggest practical policies for Hong Kong. Findings indicate that most developed countries have implemented pre-arrival screening policy, which is not practical in Hong Kong. Studies showed no significant difference between ‘pre’, ‘on’ or ‘post’ arrival programmes. Post arrival screening could be considered as the most suitable option for Hong Kong, according to the analyses of the data. Tuberculosis and Chest Service, Department of Health has the capacity to act as the screening authority for settlement purpose and could provide expert recommendation to Immigration Department about the health status of permanent residency applicants. Given the importance of screening, in various countries, to reduce the incidence of TB, Hong Kong could and should adopt a screening policy in order to decrease new notifications and enhance the local public health status. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Radical prostatectomy is the gold-standard treatment for clinically organ-confined cancer of the prostate. However, urinary incontinence and erectile dysfunction are major clinical problems, despite advances in surgical techniques. Pelvic floor muscle training is still the first-line treatment used to restore pelvic floor or bladder function after radical prostatectomy although its role is still inconclusive. Objectives: To determine the benefit of starting pelvic floor muscle training three weeks before radical prostatectomy in order to find by the end of three months after surgery: (1) any degree of continence regained in the intervention group, measured by 24-hour and one-hour pad tests; (2) any positive improvement in the quality of life in that group. Methods: Sixty-six eligible participants were randomised into either the intervention or the control group before radical prostatectomy. The former received three weeks’ pre-operative pelvic floor muscle training from an advanced practice nurse, while the latter received only standard care. Urine loss by 24-hour pad test was compared in the two groups as the primary outcome, and the questionnaires on incontinence impact, functional assessment on prostate cancer and potency satisfaction at one, two, three and six months after surgery were compared as secondary outcomes. Results: The intervention group regained continence significantly (p=0.002) earlier than the control group at the end of three months after surgery, as measured by the 24-hour pad test. The intervention group also reported a significantly better quality of life in the questionnaire on ‘incontinence impact’ than the control group. Interestingly, the Functional Assessment of Cancer Therapy-Prostate questionnaire showed no statistical significant difference between the groups, despite significantly less urine loss in the intervention group, which also had a higher potency satisfaction score on the International Index of Erectile Function (p=0.005) by the end of three months after surgery. Discussion: The present study found that three weeks’ pre-operative pelvic floor muscle training decreased the duration and severity of incontinence after radical prostatectomy, as measured by the 24-hour pad test of urine loss (in grams). Some other studies counted the number of pads used as the comparative data between the groups; however, there might be divergent findings in different studies. In one previous study of pelvic floor muscle training initiated two to four weeks before surgery but showing no benefit, it was found that patients received only one training session before surgery without further monitoring. A limitation of present study is that participants were followed-up for six months after surgery. It is possible that a longer period, perhaps one or two years, of post-prostatectomy follow-up might provide further important information. Conclusions: This is the first comprehensive study in Hong Kong to examine the efficacy of three weeks’ pre-operative pelvic floor muscle training in reducing post-prostatectomy urinary incontinence, and to evaluate the continence-related quality of life and potency satisfaction of intervention and control groups. The results demonstrated that such training not only significantly hastens the recovery of urinary continence after surgery but also leads to a better continence-related quality of life and potency satisfaction in the intervention group. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing

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Errors in health care are one of the leading causes of death and injury in this country, requiring new methods for evaluating and promoting quality in health care services. Concern for patient safety, the foundation for quality services, has prompted national initiatives to examine the most basic premise for health care providers: Do no harm to the patient. Few of these initiatives have examined errors from the perspective of those who have been sanctioned for their errors. This descriptive, exploratory study utilized a survey methodology to examine the perceptions of 62 registered nurses (RNs) who had been sanctioned by a board of nursing to ascertain categories of practice errors and identify individual, health care team, patient, and system threats that contributed to an error and/or patient harm. The Threat and Error Management Model (TEMM) was utilized as a framework for examining the phenomena that promote or hinder patient safety. Using a modified version of the Taxonomy of Error Root Cause Analysis of Practice-Responsibilities (TERCAP) instrument, sanctioned RNs selected types of errors associated with a breakdown in their nursing practice. In addition, they identified factors that contributed to their errors, including individual, health care team, patient, and system threats. Associations between the levels of patient harm and types of error were examined. Two open-ended questions provided an opportunity for the participants to describe changes in their practice since the error event. System and health care team factors were the most common items selected as contributing to the error events, while individual factors were the least often selected items. Two types of errors, clinical evaluation and attentiveness/surveillance, were significantly related to the level of harm to patients. Given the opportunity to discuss individual factors through open-ended questions, responses were comprehensive and many were related to issues with trust. Recommendations for nursing theory, policy, practice, education, and research are reviewed.

Long-term glucocorticoid use leads to glucocorticoid-induced osteoporosis (GIOP) and fractures which require proper management. Little is known about the "real-world," long-term costs and effectiveness of anti-osteoporotic treatments. A retrospective analysis of data from the 1996-2004 Medical Expenditure Panel Survey was conducted to evaluate the "real-world" outcomes. Markov modeling with Monte Carlo simulations was used to yield long-term estimates of these outcomes. A total of 5,461 subjects met the study criteria for long-term glucocorticoid users (LTGS, average prednisone-equivalent dose=11.0 mg/day, average length=237 days), which represents 2.3% of the non-institutional U.S. population. The study subjects tended to be middle-aged (49.7 years old), female (61.4%) and white (86.2%). Overall 22.4% of LTGS users reported use of any anti-osteoporotic agent. Hormone replacement therapy (HRT) was the most frequently used in women followed by bisphosphonates, while bisphosphonates and calcitonin were used by men. Analyses of variance indicated some significant differences in characteristics of LTGS users among treatment groups which suggest a selection bias. Female LTGS users had higher prevalence rates (6.8%) of osteoporosis than males (1.0%), but the prevalence rates of osteoporotic fractures were similar (3.0%). The logistic regression analyses indicated that the use of oral glucocorticoid tablets does not significantly change the odds of osteoporotic fractures in study subjects (relative risk (RR)=1.146, 95% confidence interval (CI) 0.901-1.458 for subjects in the WELL state; RR=0.55, 95% CI 0.188-1.621 for subjects in the GIOP state; RR=1.241, 95% CI 0.532-2.893 for subjects in the GIFX state). The estimated 10-year and lifetime incremental cost per osteoporotic fracture avoided are $27,253-$35,692 (10-year) and $84,942-$91,075 (lifetime) in hypothetical female glucocorticoid users. HRT is the most cost-effective option for hypothetical females except that calcitonin is preferred for 65-year-old females receiving lifetime treatments. When HRT is excluded, calcitonin is the next most cost-effective option except that raloxifene is preferred for 30- and 50-year-old females receiving 10-year treatments. Calcitonin is the most cost-effective option for male glucocorticoid users. Bisphosphonates are less cost-effective which may be due to selection bias. Anti-osteoporotic treatments are recommended for all long-term glucocorticoid users, but the preferred option depends on gender, age, length of treatments and budgets.

published_or_final_version / abstract / toc / Asian Studies / Master / Master of Philosophy

No description available.

No description available.

Kunskaps- och attitydprogrammet (KAP) är ett preventivt föräldrastödsprogram för föräldrar till barn med funktionsnedsättning utvecklat av psykolog Thomas Persson. Programmet är utformat utifrån dessa föräldrars specifika förutsättningar och behov av stöd. Dess mål är att öka föräldrars kunskaper om, samt förändra deras attityder till, barnets diagnos och funktionsnedsättning. Målen antas minska riskfaktorer och stärka skyddsfaktorer för psykisk ohälsa hos barnet, i relationen mellan föräldrar och barn. Programmet har sju syften: Förbättra förälderns tolkning av barnets beteende, minska föräldrastress, förbättra föräldrabeteendet gentemot barnet, minska risken för psykiskt ohälsa hos barnet, öka tilltron till den egna föräldraförmågan, ge hjälp i föräldrarollen samt främja samarbetet mellan föräldrar och sjukvårdens personal. Examensarbetet presenterar en pilotstudie av KAP. Utprovningen ägde rum på barn- och ungdomshabiliteringen (BUH) vid Sunderby sjukhus, Norrbottens Läns Landsting, med 12 föräldrar till barn med diagnos inom grupperna autismspektrumtillstånd, cerebral pares samt intellektuell utvecklingsstörning. En enkätundersökning genomfördes i syfte att utvärdera programmets effekt på föräldrarna samt deras uppfattning om dess innehåll. Tio föräldrar svarade på enkäten. Resultatet visade att nio föräldrar upplevde ökad kunskap, sju upplevde förändring i attityd samt fyra upplevde förändring i beteende gentemot barnet. Vidare upplevde samtliga föräldrar hjälp i föräldrarollen och var nöjda med samtalen. Slutsatsen blev att programmet hade effekt på föräldrarnas kunskaper, attityder samt beteende, vilket förhoppningsvis kan hjälpa dem att klara av föräldraskapets utmaningar samt minskar risken för psykisk ohälsa hos barnet. Vidare forskning rekommenderas. Kunskaps- och attitydprogrammet (KAP) har visat sig vara effektivt som föräldrastöd och kan rekommenderas som preventiv insats i verksamheter som möter familjer som har barn eller ungdomar med funktionsnedsättning, framför allt inom barn- och ungdomshabilitering, barn- och ungdomspsykiatri samt barn- och ungdomsmedicinsk mottagning.

This dissertation is concerned with an analysis of the dynamic of West European terrorism and European Community/Union (EC/EU) counter-terrorism as it has evolved since the late 1960s. The first half of the study is devoted to an investigation of the nature of the terrorist phenomenon itself; the factors that were primarily responsible for its escalation from the late 1960s onwards; the new and continuing trends that are likely to affect the future course of terrorism within Western Europe into the 1990s. The main focus of the second half of the project centers on an examination of the effectiveness and appropriateness of the latest EU provision to counter terrorism (and other major threats to internal security) - the Maastricht third "pillar." This assessment is made from a perspective that takes into account questions of both operational anti-terrorist proficiency and liberal democratic acceptability. Police and security forces throughout the EU have strongly endorsed the third pillar as providing an efficient response to serious criminality. However, from a liberal democratic point of view, the Maastricht provisions raise critical questions concerning the underlying ideological rationale that appears to be guiding the Twelve's evolving internal security cooperation, the lack of public debate surrounding this coordination and the absence of any effective means to control closer EU judicial and law enforcement action. All this poses a serious problem for the future of EU counterterrorism cooperation. Close coordination between the EU member states is absolutely necessary if the continuing threat of terrorism in Western Europe is to be effectively quashed in the 1990s. However, one cannot realistically expect this to happen if fundamental fears exist over the desirability and legitimacy of establishing ever closer internal security cooperation. It is therefore vital that in the headlong rush to provide for an enhanced international operational capacity to deal with terrorism critical considerations of democratic control and acceptability (both of which the EU as well as individual member states are sworn to uphold by virtue of their "status" as a liberal democratic entities) are not lost by the Union Twelve.