Lee, Man Yuen. / "March 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 103-128). / Abstracts in English and Chinese. / Title Page --- p.i / Acknowledgements --- p.ii / Table of Content --- p.iii / List of Figures --- p.vii / List of Graphs --- p.viii / List of Tables --- p.x / Abbreviations --- p.xii / Abstract --- p.xiii / Abstract (Chinese) --- p.xv / Chapter Chapter 1: --- General Introduction / Chapter 1.1 --- Diabetes mellitus --- p.2 / Chapter 1.1.1 --- Type 1 diabetes mellitus --- p.3 / Chapter 1.1.2 --- Type 2 diabetes mellitus --- p.4 / Chapter 1.1.3 --- Gestational diabetes --- p.5 / Chapter 1.2 --- Diabetic pregnancy --- p.6 / Chapter 1.3 --- Etiology of diabetes-induced malformations --- p.9 / Chapter 1.3.1 --- Hyperglycaemia --- p.10 / Chapter 1.3.2 --- Hyperketonaemia and somatomedin inhibitors --- p.10 / Chapter 1.3.3 --- Oxidative stress --- p.11 / Chapter 1.3.4 --- Deficiency of myo-inositol and arachidonic acid --- p.12 / Chapter 1.4 --- Vitamin A --- p.13 / Chapter 1.5 --- Retinoic acid --- p.14 / Chapter 1.5.1 --- RA signaling on embryo development --- p.15 / Chapter 1.5.2 --- RA teratogenicity --- p.15 / Chapter 1.5.3 --- RA regulation --- p.17 / Chapter 1.6 --- RA and maternal diabetes-induced caudal regression share similar pathogenic mechanisms --- p.19 / Chapter 1.7 --- Strategy of the thesis --- p.21 / Chapter Chapter 2: --- General Materials and Methods / Chapter 2.1 --- Animal --- p.25 / Chapter 2.2 --- Induction of diabetes --- p.25 / Chapter 2.3 --- Preparation of retinoic acid for mouse injection --- p.26 / Chapter 2.4 --- RA responsive cell line --- p.26 / Chapter 2.4.1 --- Cell culture --- p.27 / Chapter 2.4.2 --- Seeding and adding sample to 96-well plate --- p.28 / Chapter 2.4.3 --- Staining of cells --- p.28 / Chapter 2.5 --- Real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR) --- p.29 / Chapter 2.5.1 --- Collection and storage of tissues --- p.29 / Chapter 2.5.2 --- Total RNA extraction --- p.29 / Chapter 2.5.3 --- Reverse transcription --- p.30 / Chapter 2.5.4 --- Polymerase chain reaction --- p.30 / Chapter 2.5.5 --- Preparation of cDNA standard --- p.31 / Chapter 2.5.6 --- Mini-scale preparation of plasmid DNA --- p.32 / Chapter Chapter 3: --- Effects of Maternal Diabetes on RA Catabolism in the Tail Bud Region / Chapter 3.1 --- Introduction --- p.34 / Chapter 3.2 --- Experimental design --- p.37 / Chapter 3.3 --- Materials and methods --- p.38 / Chapter 3.3.1 --- Preparation of RA stock solution for cell culture --- p.38 / Chapter 3.3.2 --- Preparation of RA standard solutions --- p.38 / Chapter 3.3.3 --- Characterization of RA responsive cell line --- p.39 / Chapter 3.3.3.1 --- Determining optimal culture time for maximum response --- p.39 / Chapter 3.3.3.2 --- Testing toxicity of DMSO --- p.39 / Chapter 3.3.3.3 --- Detection of β-galactosidase activity by β_gal Assay Kit --- p.40 / Chapter 3.3.4 --- In vitro assay of enzymatic degradation of RA --- p.41 / Chapter 3.3.4.1 --- Testing toxicity of enzyme cofactor-reducing agent --- p.41 / Chapter 3.3.4.2 --- Collection of tail bud --- p.42 / Chapter 3.3.4.3 --- In vitro enzymatic reaction --- p.43 / Chapter 3.3.5 --- In vivo assay of enzymatic degradation of RA --- p.44 / Chapter 3.3.5.1 --- Determining the optimal time for maximum release of RA from the tail bud into the medium --- p.44 / Chapter 3.3.5.2 --- Monitoring of RA remained in the tail bud after injection of exogenous RA --- p.45 / Chapter 3.3.6 --- Statistical analysis --- p.45 / Chapter 3.4 --- Results --- p.46 / Chapter 3.4.1 --- Optimization of RA responsive cell line --- p.46 / Chapter 3.4.1.1 --- Effect of incubation time with RA on β-galactosidase expression level --- p.46 / Chapter 3.4.1.2 --- Toxicity of RA and DMSO --- p.47 / Chapter 3.4.1.3 --- Comparison of X-gal staining assay and β_gal Assay Kit for detection of β-galactosidase expression --- p.48 / Chapter 3.4.2 --- In vitro assay of RA catabolic activity in the tail bud --- p.49 / Chapter 3.4.2.1 --- Toxicity of enzyme cofactor-reducing agent --- p.49 / Chapter 3.4.2.2 --- RA catabolic activity in lysed and intact tail buds --- p.50 / Chapter 3.4.2.3 --- Effect of enzyme cofactor and inhibitor --- p.50 / Chapter 3.4.2.4 --- Comparsion of in vitro RA catabolic activity of diabetic and non-diabetic groups --- p.51 / Chapter 3.4.3 --- In vivo assay of RA catabolic activity in the tail bud --- p.52 / Chapter 3.4.3.1 --- Optimal time for maximum release of RA from the tail bud into the medium --- p.53 / Chapter 3.4.3.2 --- Comparison of RA remained in the tail bud of embryos of diabetic and non-diabetic mice --- p.53 / Chapter 3.5 --- Discussion --- p.55 / Chapter Chapter 4: --- Analysis of Cyp26 Expression in the Tail Bud Region / Chapter 4.1 --- Introduction --- p.60 / Chapter 4.2 --- Experimental design --- p.63 / Chapter 4.3 --- Materials and methods --- p.64 / Chapter 4.3.1 --- Sample collection --- p.64 / Chapter 4.3.2 --- Real-time quantitative RT-PCR --- p.64 / Chapter 4.3.3 --- Statistical analysis --- p.66 / Chapter 4.4 --- Results --- p.67 / Chapter 4.4.1 --- "Relative expression levels of Cyp26al, Cyp26bl and Cyp26cl" --- p.67 / Chapter 4.4.2 --- Molecular changes in Cyp26al in tail bud region after maternal RA treatment --- p.68 / Chapter 4.5 --- Discussion --- p.72 / Chapter Chapter 5: --- Comparison of Cyp26al Heterozygous and Wild-type Embryos in Diabetic and Non-diabetic Pregnancies / Chapter 5.1 --- Introduction --- p.76 / Chapter 5.2 --- Experimental design --- p.79 / Chapter 5.3 --- Materials and methods --- p.81 / Chapter 5.3.1 --- Animal --- p.81 / Chapter 5.3.2 --- DNA genotyping --- p.81 / Chapter 5.3.3 --- Measurement of RA remained in the tail bud after RA treatment --- p.82 / Chapter 5.3.4 --- Analysis of extent of caudal regression --- p.83 / Chapter 5.3.5 --- Real-time quantitative RT-PCR --- p.83 / Chapter 5.3.6 --- Statistical analysis --- p.84 / Chapter 5.4 --- Results --- p.85 / Chapter 5.4.1 --- Comparsion of pregnancy outcome of mating with ICR or Cyp26al+/- males --- p.85 / Chapter 5.4.2 --- Expression levels of Cyp26al determined by real-time quantitative RT-PCR --- p.85 / Chapter 5.4.3 --- Determination of RA catabolic activity --- p.86 / Chapter 5.4.4 --- Extent of caudal regression --- p.90 / Chapter 5.5 --- Discussion --- p.93 / Chapter Chapter 6: --- Conclusion and Future Perspectives --- p.96 / References --- p.102 / Figures / Graphs

Background and Objectives: In a previous randomized study, we reported the benefits of providing integrated care by the Joint Asia Diabetes Evaluation (JADE) Program consisting of comprehensive assessment (CA) and 3-4 monthly follow up (FU) assessments with personalized feedback reports and decision support on control of cardio-metabolic risk factors through reduced clinical inertia and improved self-care. Further, provision of additional peer support improved psychological well-being and all-cause hospitalization especially in those with negative emotions who tended to have co-morbidities. However, given the multicomponent nature of the program, the differential effects of peer support in different patient subgroups and independent effect of personalized FU reports had not been systematically evaluated.. In this thesis, I used a randomized and case-control design to examine the effects of providing regular FU reports and peer support on metabolic control, psychological health, and all-cause hospitalization in patients with diabetes. / Methods: Between February and December 2013, 1488 Chinese patients with diabetes aged 18-75 years underwent CA using the JADE portal and returned in 4 weeks in groups to receive their personalized CA report with explanation by nurses about their complications, risk factors and treatment targets. Amongst them, I selected 288 high risk patients defined as 1) HbA1c≥8%, 2) obesity (body mass index≥27.5 kg/m² and/or waist≥80cm (women) or ≥90cm (men), and/or 3) chronic kidney disease (CKD, eGFR<60ml/min/1.73m²) and offered them a telephone-based peer support program, to which 144 (50%) agreed (P+ group) and 144 (50%) refused (P- group). Within each group, they were also randomized to receive 2 JADE FU reports by mail after their clinic visits. These FU reports displayed their trends of ABC (HbA1c, BP, LDL-C) control and body weight with individualized reminders for self-care during a 12-month period. In the remaining patients (n=1200), half were randomized to receive 2 FU reports by mail (R+ group: n=600) while half received usual care (R- group: n=600). Amongst patients not offered peer support, 425 patients (50% received FU report) were matched to the P+ group (52% received FU report) on a 3:1 basis by age, gender, diabetes duration, and baseline HbA1c as a control group. The outcome measures were reduction in HbA1c and all-cause hospitalization at month 12. / Results: Amongst patients not offered peer support, after a median (IQR) follow-up period of 575 (519-646) days, the R+ group had greater reduction in HbA1c (mean [95% CI]: -0.24[-0.35,-0.14]% versus -0.15[-0.24,-0.06]%, p=0.030) with similar hospitalization rate and frequency compared with the R- group. Amongst patients offered peer support, the P+ group and P- group had similar baseline clinical and psychological-behavioral parameters. After 530 (463-575) days, the P+ group (n=138) tended to have greater reduction in HbA1c (-0.75[-0.97,-0.52]% versus -0.42[-0.68,-0.15]%, p=0.106) with significant improvements in mental health and quality of life than the P- group (n=131). In the case-control cohort for peer support,the P+ group tended to have greater reduction in HbA1c than the control group (n=425) (-0.75[-0.97,-0.52]% versus -0.49[-0.64, -0.35]%, p=0.119) with lower rate, frequency and length of hospitalization. On multivariable analysis of the entire cohort (n=1488), peer support (β coefficient [95% CI] -0.31[-0.56, -0.06], p=0.015) and receiving FU reports (-0.14[-0.25, -0.04], p=0.009) were independent predictors for reduction in HbA1c. Peer support (OR [95% CI] 0.36[0.16, 0.79], p=0.011) and CKD with FU reports (0.40[0.18, 0.88], p=0.022) were also associated with reduced hospitalization. / Conclusion: In this real-world quality improvement program, both peer support and regular personalized feedback report by mail were associated with reduced HbA1c in patients with diabetes. Peer support was associated with lower risk of hospitalization, while feedback report was associated with reduced hospitalization only in patients with diabetes and comorbid CKD. / 背景及目的：在一項隨機對照研究中，我們發現通過亞洲糖尿病評估計劃JADE提供整合了全面糖尿病併發症篩查（CA）、定期隨訪（FU）評估、個體化回饋報告及決策支持的綜合護理可通过降低臨床惰性，促進自我管理從而改善糖尿病風險因素的控制。在此基礎上，同伴支持可進一步改善患者的心理健康，降低住院率， 并且在有負面情緒的人群中作用尤其明顯。然而，由於綜合護理由多部分組成，個體的作用並未被系統評估。本文分別採用隨機對照和病例對照研究，評估個體化隨訪報告和同伴支持對糖尿病患者代謝控制、心理健康及住院率的作用。 / 研究方法：2013 年2 月至12 月，1488 位年齡18 至75 歲的糖尿病患者進行了CA，並于4 周後領取個體化CA 報告，由護士說明其併發症和危險因子的控制以及治療有無達標。其中，我邀請了288 位有以下高危因素的患者參加一項基於電話的同伴支持計劃：1）糖化血紅蛋白（HbA1c）≥8%；2）肥胖（體重指數≥27.5 kg/m² 和/或女性腰圍≥80cm/男性腰圍≥90cm；和/或3）慢性腎臟病（CKD，腎小球濾過率<60 ml/min/1.73m²）。其中，144 位（50%）同意（P+ 組）參與，144 位（50%）（P- 組）拒絕參與。每組再隨機抽取一半患者郵寄2 份JADEFU 報告。該報告顯示了患者HbA1c、血壓、低密度膽固醇和體重的控制情況，並附有針對自我管理的個體化建議。餘下的1200 位患者中，隨機抽取一半患者（R+ 組，n=600）郵寄2 份JADE FU 報告，另外一半患者常規護理（R- 組，n=600）。未被邀請參加同伴支持計劃的1200 位患者中，425 位（50%有FU 報告）按年齡、性別、病程和基礎HbA1c 與P+組（52%有FU 報告）匹配成為對照組。研究指標為12 個月後HbA1c 和住院率的改變。 / 研究結果：未提供同伴支援的患者中，經過575（519-646）日的隨訪，R+組HbA1c 降低更多（ 均值[95% 置信區間]: -0.24[-0.35,-0.14]% versus-0.15[-0.24,-0.06]%, p=0.030），但住院率與R-組相同。提供同伴支持的患者中，P+組和P-組研究開始時臨床、心理和行為指標皆相似。530（463-575）日後，與P-組比較，P+組有HbA1c 降低更多的趨勢（-0.75[-0.97,-0.52] % versus-0.42[-0.68,-0.15]%, p=0.106），住院率相似，但心理健康和生活品質均有明顯改善。在病例對照研究中，與對照組比較（n=425），P+組（n=142） HbA1c降低更多（-0.92[-1.25, -0.59]% versus -0.39[-0.58, -0.21], p=0.004），且住院率、住院次數和時間皆有明顯降低。採用多變量回歸分析，同伴支持（β 係數[95% 置信區間] -0.31[-0.56, -0.06], p=0.015）和FU 報告（-0.14[-0.25, -0.04], p=0.009）均是降低HbA1c 的獨立預測因子。同伴支持（0.36[0.16, 0.79], p=0.011） 和CKD伴FU 報告（0.40[0.18, 0.88], p=0.022）與住院风险降低明顯相關。 / 結論：在此項品質改進計畫中，同伴支持和定期郵寄個體化隨訪報告均与糖尿病患者的糖化血紅蛋白降低相關。同伴支持伴隨住院风险降低，但個體化隨訪報告僅在糖尿病伴慢性腎臟病患者中与住院风险降低相關。 / Yin, Junmei. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 209-235). / Abstracts also in Chinese; appendix 4 in Chinese. / Title from PDF title page (viewed on 06, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Thesis (Ph. D.)--York University, 1999. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 243-313. Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004 & res_dat=xri:pqdiss & rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation & rft_dat=xri:pqdiss:NQ39286.

Thesis (M.Ed.)--Memorial University of Newfoundland, 2000. / Includes bibliographical references.

Thesis (M.A.)--York University, 2000. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references (leaves 63-74). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ56198.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

As recently as 1995, sweet blood did not resonate broadly as an urgent transnational concern. This thesis chronicles how diabetes mellitus, sweet blood, became recognized as a social problem besetting Canada, among many other countries. / This ethnographic study brings anthropological theories---developed for the most part to analyze the lives of "non-Western" peoples---to bear on "Western" philosophy, science, medicine, mass media, governments, and commerce. Throughout, this thesis challenges received wisdom about disease, technologies, kinship, commodification, embodiment, and personhood. / This thesis argues that a statistical concept, the population, is the linchpin of both politics and economics in large-scale societies. Statistically-fashioned populations, combined with the conviction that the future can be partially controlled, undergird the very definition of diabetes as a disease. In turn, biomedical knowledge about diabetes grounds the understanding of sweet blood as a social problem in need of better management. The political economy of sweet blood shows that, under "Western" eyes, persons can remain intact while their bodies---down to their very cells---divide and multiply, both literally and figuratively. As members of statistically-fashioned populations, human beings have a patent existence and many "statistical doubles." These statistical doppelgangers help shape feelings, actions, identities, and even the length of human lives. They permit countless strangers and "lower" nonhuman beings---among them, mice, flies, and bacteria---to count as kin. Through the generation and use of statistics, people and their body parts undergo valuation and commodification, but are neither bought nor sold. The use of statistics to commodify human beings and body parts, this thesis finds, inevitably anchors biomedical practice, biomedical research, health policies, and the marketing of pharmaceuticals and all other things known to affect health.

Diabetes Mellitus is a chronic disorder that requires daily adherence to complex regimens for glucose control. The purpose of this study was to examine the relationship between the capability for self-management of diabetes and the practices of health-promoting behaviors. Instruments used were the Health Promotion Lifestyle Profile to measure health-promoting behaviors, the Insulin Management Diabetes Self-Efficacy Scale to measure self-efficacy in diabetes management, and a demographic questionnaire.Fifty participants from the outpatients of a midwestern veterans hospital responded to the questionnaires. Results showed a moderately positive significant correlation between self-efficacy in diabetes management and health-promoting behaviors (r=.52, p<001).The findings of this study point the importance of higher levels of self-efficacy and participation in health-promoting behaviors for more effective management of diabetes and improved health and well-being. / School of Nursing

Thesis (M.S.)--Indiana University, 2006. / Includes bibliographical references. Also available online (PDF file) by a subscription to the set or by purchasing the individual file.