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published_or_final_version / Public Health / Master / Master of Public Health

Thesis (Ph. D.)--University of Hawaii at Manoa, 1994. / Includes bibliographical references (leaves 146-162). / Microfiche. / xiii, 162 leaves, bound ill. 29 cm

The purpose of this research was to examine some of the factors which may affect body composition of postmenopausal women. The effect of estrogen, physical activity, diet and lifestyle were examined in 9 women receiving estrogen replacement therapy and 11 women not using this drug. For 3 consecutive days, the subjects collected 24-hour urine samples and recorded their dietary intake. Body fat was estimated by obesity indices based on height and weight and a regression equation based on abdominal skinfold, abdominal circumference and bideltoid diameter (Young, 1964). Lean body mass (LBM) was estimated from urinary excretion of creatinine (Forbes & Bruining, 1976). Physical activity and lifestyle were assessed by a self-administered questionnaire. Age, height, physical activity, diet and lifestyle were similar for the two groups. Estrogen users were heavier than non-users (p < 0.05) and as a group had a higher prevalence of obesity. Percent body fat and LBM also tended to be higher in the estrogen users than in the non-estrogen users. The weight difference between the two groups was already present at age 25 years and persisted through the subsequent 30-year period. All 20 subjects maintained their weight between ages 25 and 35 years, thereafter, increasing in weight significantly (p < 0.05) by decade through age 55 years. For all 20 subjects no correlation was found between energy intake and any measure of obesity or body fatness. Obesity was unrelated to energy consumption. Physical activity did not correlate significantly with any estimate of body composition. Energy intake showed an inverse correlation with hours spent watching television (r = -0.82, p < 0.002). Nutrient intake for most women was adequate; however, calcium intake in women not receiving estrogen replacement therapy may be insufficient. / Graduation date: 1987

No description available.

Graduation date: 1994

Objective: Pregnancy has been recognized as a risk factor for severe pandemic influenza illness and this “vulnerable” group is suggested to be heightened alertness to the disease by WHO. This systemic review aims to identify the factors affecting the uptake of influenza vaccination among pregnant women as the immunization uptake among this particular group of population is low or suboptimal worldwide. Methods: Systematic literature reviews were conducted by using MEDLINE and PubMed with the key words: “influenza vaccination uptake” and “pregnant women” in the period of January 2004 to January 2013. It was further supplemented by a manual search for literatures and articles on the WHO website, Centers for Disease Control and Prevention (CDC) website, Google Scholar, and reference lists of reviews captured by initial searches. Results: Of the 222 articles identified, 10 studies were found to be relevant in this system literature review. Influenza vaccine coverage among pregnant women was highly diverse (6.2-76%) among the 10 studies. Overall, pregnant women were more likely to take the vaccination against influenza if they: (1) believed the benefits of the vaccine outweighed the potential barriers, (2) believed the influenza was severe and they were highly susceptible to the disease, and (3) were influenced by the positive cues to action such as recommendation from health care professionals and the experience of the influenza vaccination uptake. Conclusion: Overall, greater emphasis on vaccine effectiveness and safety, and the recommendation from health care providers is needed to increase the number of pregnant women influenza immunization in the future public health campaigns. / published_or_final_version / Medicine / Master / Master of Public Health

Despite the World Health Organization identifying pregnant women as the highest priority group for seasonal influenza vaccination, many pregnant women remain unaware of the recommendation and have substantial concerns about the adverse effects of the vaccine on them and their unborn foetuses. Few interventions have been conducted to improve influenza vaccine uptake among pregnant women. Among these studies, the results are inconsistent and the quality is generally low. Brief education has been previously shown to improve women’s health practices during pregnancy. An open-label randomized control trial was conducted to assess the effect of providing brief education on influenza vaccine uptake among pregnant women. A total of 163 unvaccinated pregnant women in at least their second trimester were recruited from antenatal clinics of four public hospitals in Hong Kong. They were randomized to receive standard care or a one-to-one brief education session that provided an overview of the safety and benefits of the vaccine to both pregnant women and their foetuses. Participants were followed up by telephone at two to three weeks postpartum to ascertain vaccination status. The primary study outcome was the influenza vaccine uptake rate and the second study outcomes were the proportion of participants initiating discussion about influenza vaccine with their health care providers, the proportion attempting to be vaccinated, and their knowledge of influenza infection and vaccination. A total of 163 participants were recruited with 155 (95%) participants completing follow-up. The overall influenza vaccine uptake rate was 17.8%. When compared with those receiving standard care, the vaccination rate was higher among participants who received the intervention (23.5% vs. 12.2%; p=0.06). In addition, the increase in the rate of self-initiated discussion with HCPs before and after the intervention was significantly higher in intervention group (26.7% vs. 9.3%; p<0.001) but not in standard care group (13.3% vs. 8%; p=0.481). Among participants who did not receive influenza vaccine, pregnant women in intervention group were substantially more likely to have made an unsuccessful attempt to be vaccinated (39.3% vs. 9.2%; p<0.001). Almost one-third of the pregnant women who had attempted to receive the vaccine (n=13) reported they received advice against vaccination during pregnancy from HCPs. If participants had not been advised against influenza vaccine and were successfully vaccinated, the overall difference in the vaccine uptake rate between the two treatment groups would have been statistically significant (34.6% vs. 18.3%; p=0.02). Brief education can be one strategy to improve vaccination uptake rates among pregnant women. In addition, it is clear from this and other studies that recommendations from HCPs substantially influence vaccination behaviours among pregnant women, both positively and negatively. Therefore, multicomponent approaches should be considered in future vaccination programmes and the synergistic effect of both brief education and HCP recommendations should be further evaluated. / published_or_final_version / Nursing Studies / Master / Master of Philosophy