Thesis (MScMedSc) -- Stellenbosch University, 2001. / ENGLISH ABSTRACT: Osteopenia is a well documented complication of anorexia nervosa (AN). The pathogenesis of this bone loss is presently poorly defined in the literature. Pathogenetic mechanisms that have been implicated include certain nutritional factors, exercise abuse, hypogonadism, hypercortisolism and/or vitamin 0 deficiency. We studied, 59 Caucasian eating disorder patients aged 15-45yr. The eating disorder was classified by a single, qualified psychiatrist according to OSM IV R criteria as either anorexia nervosa (AN: n =25), bulimia nervosa (BN: n = 17) or eating disorder not otherwise specified (EONOS: n = 17). All patients were subjected to a detailed dietary and general history. We assessed the prevalence and severity (OEXA), the nature (osteocalcin, deoxypyridinoline) and site (vertebral versus hip) of osteopenla in these patients. he role of nutritional factors (energy intake, weight, height, BMI, plasma albumin, lipids), physical activity, hypercortisolemia (plasma and urinary free cortisol), vitamin 0 deficiency (plasma 250HD) and hypogonadism (amenorrhoea, E2, LH, FSH) in the pathogenesis of bone loss were also evaluated. Mild osteopenia (BMO decreased by more than 1SO below age-matched controls) was documented in 46% of the total study population, with more marked osteopenia (Z-Score < -2 SO) present in 15%. Both vertebral and hip osteopenia were documented. In the study population those patients with AN (Lumbar BMO (q/cm") = 0.869 ± 0.121) were most likely to develop osteoporosis, although a significant percentage of patients with BN (Lumbar BMO (q/crn") = 0.975 ± 0.16) and EONOS (Lumbar BMO (g/cm2) = 0.936 ± 0.10) were also osteopenic (29% and 35% respectively). Twenty four percent (24%) of the total patient population had a history of fragility fractures. These fractures were reported more commonly amongst patients with AN and EONOS (28% and29.4%). Fracture prevalence was however similar in patients with normal and low bone mass. Conventional risk factors were similar in patients with normal and low bone mass, except for a significantly longer duration of amenorrhoea (p = 0.009), a lower BMI (p = 0.0001) and greater alcohol consumption (p = 0.05) in the osteopenic patients. Nutritional parameters (S-albumin, protein, Ca, and P04 intakes), physical activity, as well as 25(OH) vitamin D levels were similar in AN and BN subjects, as well as in patients with a low versus normal BMD. Plasma and urine cortisol levels were also similar in these subgroups. With the exception of two patients with borderline osteopenia, significant bone loss was only documented in those patients with a past or current history of amenorrhoea. In the total patient population the duration of amenorrhoea was significantly (p<0.009) longer in patients with osteopenia versus those with a normal bone mass. A significant negative correlation between BMD (Z-Score) and duration of amenorrhoea was also documented in the total patient population (r = -0.4, P = 0.001) as well as in all three eating disorder groups (AN r - -0.4, P = 0.03; BN r = - 0.6, P = 0.008; EDNOS r = -0.6, P = 0.005). In the total patient population, those patients with amenorrhoea, had lower BMD and BMI values and lower estrogen levels compared to those with a normal menstrual cycle. We conclude that osteopenia commonly attends AN, as well as BN and EDNOS. Nutritional (with the exception of alcohol consumption) and mechanical factors as well as hypercortisolemia did not appear to contribute significantly to bone loss in this study population. Hypogonadism appeared to be the main cause of the bone loss observed in these patients. / AFRIKAANSE OPSOMMING: Osteopenie is In welbekende komplikasie van anorexia nervosa (AN). Die patogenese van hierdie beenverlies is swak in die huidige literatuur omskryf en nutrisiele faktore, 'n vita mien 0 gebrek, oormatige oefening, hiperkortisolemie en hipogonadisme word onder andere qeimpliseer. Vir die doel van die studie is In totaal van 59 Kaukasier eetsteurnis pasiente patients volledig ondersoek. Die tipe eetsteurnis is deur In enkel gekwalifiseerde psigiater volgens die DSM IV R kriteria geklassifiseer as anorexia nervosa (AN: n =25) of bulimia nervosa (BN: n = 17) of eetsteurnis nie anders gespesifiseer (EDNOS: n = 17). Elke pasient is ook aan In gedetailleerde dieet en algemene risikofaktor vraelys vir osteoporose onderwerp. Die voorkoms en graad (DEXA), die aard (osteokalsien, deoksipiridinolien) asook die tipe (werwelkolom/heup) osteopenie is ondersoek. Die rol van nutrisiele faktore (totale kalorie-inmame, gewig ,Iente LMI, plasma albumien, lipiede) en vitamien 0 gebrek, oefening, hiperkortisolemie (plasma en urinere kortisol) en hipogonadisme (amenoree, plasma E2, LH,FSH) in die patogenese van die beenverlies is ook evalueer. Matige osteopenie (BMD meer as 1 SO onder die van ouderdomskontrole) is in 46% van die totale pasientpopulasie gedokumenteer, met erge osteopenie (Z-Telling < -2) in 15%. Aantasting van beide werwelkolom en heup is aangetoon. In hierdie studiepopulasie kom osteopenie meer algemeen voor in die AN (Lumbaal BMD (g/cm2) = 0.869 ± 0.121) groep (64%) in vergelyking met BN (Lumbaal BMD (g/cm2) = 0.975 ± 0.16) (29%) en (EDNOS) (Lumbaal BMD (g/cm2) = 0.936 ± 0.10) (32%). Vier-en-twintig persent van die totale pasientpopulasie het In geskiedenis van frakture gehad. Frakture het meer algemeen in AN en EDNOS pasiente voorgekom (28% en 29%). Pasiente met 'n lae beenmassa was gekenmerk deur In betekenisvolle laer LMI (p = 0.0001), hoer alkolholverbruik (p = 0.05) en langer duurte van amenoree(p = 0.009). Nutrisiele parameters (s-albumien, protetene, Ca, P04 inname) oefening, asook 25(OH) vitamien 0 vlakke was soortgelyk in AN en BN pasiente. Hierdie parameters het ook nie verskil tussen pasiente met osteopenie en die met In normale BMD nie. Plasma en urinere vry kortisolvlakke was ook soortgelyk in hierdie twee groepe. Betekenisvolle beenverlies (met die uitsondering van twee pasiente met grenslyn osteopenie) het slegs voorgekom in pasiete met 'n huidige of In vorige geskiedenis van amenoree. In die totale pasientpopulasie was die duurte van amenoree (p< 0.009) betekenisvollanger in die pasiente met osteopenie. In Betekenisvolle negatiewe korrelasie tussen BMD (Z-Telling) en die duurte van amenoree in die toale pasient populasie (r = -0.4; P = 0.001) asook in al drie eetsteurnis groepe (AN: r = -0.4; P = 0.03; BN: r = -0.06; P = 0.008; EDNOS: r = - 0.6, P = 0.005) is aangetoon. In die groep as 'n geheel, het die amenoree pasiente In laer LMI, E2vlakke en BMD gehad in vergelyking met die pasiente met normale menses. Opsommend dus, kom osteopenie algemeen in pasiente met AN, asook BN en EDNOS voor. In Betekenisvolle bydrae van nutrisiele (met die uitsondering van alkoholinname) en meganiese faktore asook hiperkortisolemie tot been verlies, kon nie in hierdie tudie populasie gedemonstreer word nie. Hipogonadisme is as die hoofoorsaak van osteopenie in die pasiente qefdentifiseer.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

No description available.

Evidence shows epigenetic factors influence fetal development and the size of the infant at birth. This study was seeking to find what foods and nutrients or deficits thereof, in the diets of pregnant Mexican-American, Non-Hispanic White, and Non-Hispanic Black women in the United States might be contributing to the delivery of low birth-weight infants. From this study, the researcher can make three conclusions. First, the lack and/or excess of one or many nutrients may cause low birth weight. It cannot be concluded that the absence or lack of one nutrient alone is the primary cause of low birth weight based on these analyses. Second, this research shows deficits of dietary fiber are associated with low birth weight. Third, the increased consumption of regular fruit drinks and ades and rice is associated with an increased prevalence of low birth weight in the United States. / Department of Anthropology

Background: Cigarette smoking is a leading preventable factor associated with complications in pregnancy including preterm birth and low birthweight. Past interventions have raised cessation rates by approximately 6% overall (Lumley et al. 2009). Methods: A three-part literature review, two qualitative studies with a total of 36 participants, and the development of an intervention to promote smoking cessation during pregnancy were completed. Central to the design of the research was the creation of the theoretical basis which was developed in line with recommendations from the MRC Framework for Complex Interventions (Craig et al. 2008, Campbell et al. 2000). For part one of the literature review, 24 qualitative and 44 quantitative studies were re-analysed to complete a mixed-methods secondary analysis of the active ingredients in interventions to promote smoking cessation during pregnancy. Part two consisted of an exploration of psychological models and constructs which are likely to predict or influence smoking behaviour during pregnancy. The final part was a discussion regarding the modes of delivery by which an intervention could feasibly be delivered. Qualitative interviews were carried out with participants from stakeholder groups to fill in gaps in literature and determine the acceptability and feasibility of the proposed intervention. The intervention was created using the theoretical basis developed from the findings. Further qualitative interviews, a focus group, and heuristic evaluation were used to determine the acceptability and usability of the intervention for the target group of pregnant smokers. Results and Conclusions: Findings from this work are potentially relevant for a wide range of behaviours and behavioural interventions. An intervention which has a strong grounding in theory and evidence, and is acceptable and feasible for the target group and in clinical practice was developed using evidence gathered in this thesis.

A dose response relationship between carbohydrate (CHO) ingestion and exercise performance has not been consistently reported. Additionally the underlying metabolic and neuromuscular explanations for an improvement in performance with increasing doses of CHO have not been fully explained. In Chapter 2 of this thesis 20 male cyclists completed 2 h of submaximal exercise followed by a time trial task (531 ± 48KJ). Three CHO electrolyte beverages, plus a control (water), were administered during a 2 h ride providing 0, 20, 39 or 64 g CHO·h-1 at a fluid intake rate of 1 L·h-1. Performance was assessed by time to complete the time trial task, mean power output sustained, and pacing strategy used. Mean task completion time (min:sec ± SD) for 39 g·h-1 (34:19.5 ± 03:07.1, p=0.006) and 64 g·h-1 (34:11.3 ± 03:08.5 p=0.004) of CHO were significantly faster than control (37:01.9 ± 05:35.0). The mean percentage improvement from control was -6.1% (95% CI: -11.3 to -1.0) and -6.5% (95% CI: -11.7 to -1.4) in the 39 and 64 g·h-1 trials respectively. The 20 g·h-1 (35:17.6 ± 04:16.3) treatment did not reach statistical significance compared to control (p = 0.126) despite a mean improvement of -3.7% (95% CI -8.8 to 1.5%). These data demonstrate that consuming CHO at a rate between 39 to 64 g·h-1 is likely to be optimal for most individuals looking to utilise a single source CHO as an ergogenic aid during endurance performances lasting less than 3 hrs. Attempts have been made to try and understand the acute metabolic regulation that occurs when ingesting increasing amounts of CHO. However, no one study has fully investigated the metabolic mechanisms underlying graded increments of CHO ingestion. In Chapter 3 we aimed to utilise stable isotopes and blood metabolite profiles to examine the integrated physiological responses to CHO ingestion when ingested at rates throughout the range where performance gains appear greatest. Twenty well-trained male cyclists completed 2 h constant load ride (95% lactate threshold, 185 ± 25W) where one of three CHO beverages, or a control (water), were administered every 15 min, providing participants with 0, 20, 39 or 64 g CHO·h-1 at a fixed fluid intake rate of 1L·h-1. Dual glucose tracer techniques (6,6,2H2 glucose and U13C labelled glucose) were used to determine glucose kinetics and exogenous carbohydrate oxidation (EXO) during exercise. Endogenous CHO contribution was suppressed in the second hour of exercise when consuming 39 and 64 g·h-1 in comparison to 0 g·h-1 (-7.3%, 95%CI: -13.1 to -1.6 and -11.2%, 95%CI: -16.9 to -5.5 respectively). Additionally, consuming 64 g·h-1 suppressed the endogenous CHO contribution by -7.2% (95%CI: -1.5 to -13.0) compared to the 20 g·h-1 treatment. Exogenous CHO oxidation rate increased by 0.13 g·min-1 (95%CI: 0.10 to 0.15) and 0.29 g·min-1 (95%CI: 0.27 to 0.31) when consuming 39 and 64 g·h-1 in comparison to 20 g·h-1 of CHO. Peak exogenous CHO oxidation rates were 0.34 (0.06), 0.54 (0.09) and 0.78 (0.19) g·min-1 for 20, 39 and 64 g·h-1 respectively. Plasma NEFA concentration was 0.10 (95%CI: 0.07 to 0.13), 0.12 (95%CI: 0.10 to 0.16) and 0.16 (95%CI: 0.13 to 0.19) mmol.L-1 higher when consuming 0 g·h-1 in comparison to 20, 39 and 64 g·h-1 respectively. Both 39 and 64 g·h-1 were effective at sparing endogenous CHO stores of which it is estimated that most of this is liver glycogen sparing, but the measured response was highly variable between individuals. Consuming 39 g·h-1 of CHO appears to be the minimum ingestion rate required to have a significant metabolic effect that results in an increase in performance. Recent research has indicated a key role of endogenous CHO sensing and oral glucose sensing in maintaining central drive and peripheral function during endurance exercise tasks. Consuming 39 and 64 g·h-1 of CHO elicits the greatest improvements in performance and also demonstrate a similar metabolic response. The improvement in subsequent time trial performance when consuming 39 and 64 g·h-1 coincided with significant alterations in whole body substrate usage that lead to endogenous CHO sparing at the same ingestion rates. In Chapter 4 we aimed to utilise gold standard neuromuscular function assessment techniques, alongside novel measures, to investigate the effect of consuming different rates of CHO on neuromuscular function during and following prolonged cycling exercise. In a double-blind, randomised cross-over design, well-trained male cyclists (n=20, mean±SD, age 34 ± 10 y, mass 75.8 ± 9 kg, peak power output 394 ± 36 W, V̇O2max 62 ± 9 ml·kg-1·min-1) completed 2 familiarisation trials then 4 experimental trials. Trials involved a 2 h submaximal ride followed by a high intensity time trial task lasting approx. 35 min with each of 0, 20, 39 and 64 g·h-1 CHO ingestion rates during submaximal exercise. Each trial involved pre and post exercise assessments (MVC, Mwave twitch potentiation and force, motor unit recruitment and firing rate assessment using high density EMG) and during exercise (gross EMG amplitude). MVC peak torque values were reduced post exercise by -20.4 nM (95%CI: -26.5 to -14.4) in comparison to pre value on all trials with no differences between trials. The firing rates of early recruited motor units significantly increased by 1.55 pps (95%CI: 0.51 to 2.59) following exercise in comparison to pre-exercise rates. Gross EMG during the 2 h cycling bout revealed a main effect of treatment (p<0.01) but post hoc comparisons provided no clarity and likely reflect methodological issues. Consuming CHO at ingestion rates between 20 and 64 g·h-1 had little to no impact on the neuromuscular function of well-trained cyclists when comparing pre and post fatiguing exercise values. Despite differences in time trial completion time between trials, following exercise to fatigue in an endurance task, no post exercise differences were detected.

M. Tech. (Department of Hospitality, Faculty of Human Sciences) Vaal University of Technology / Introduction: The education, training and development (ETD) industry has developed fast over the past few years in our country. One need only read the national weekend papers and see all the ETD vacancies advertised to realise that ETD issues are being given increased coverage in this country. The reason for this increased focus on ETD is the need for skilled workers in organisations. Reports on our competitiveness in the world have consistently identified the lack of people development as a major stumbling block for the South African economy in competing in the global market. Objectives: The main objective of this study was to measure the impact of a training programme for the food service workers providing meals to 300 elderly people attending the Sharpeville Care of the Aged centre, in terms of a skills development programme, in order to contribute to increased productivity and provide nutritious meals to the elderly. Methods: A baseline survey was undertaken to determine the nutritional status, food consumption patterns and nutrient intake in a random sample of 300 elderly people attending the care centre five days a week. Socio-demographic and health questionnaires, as well as 24-hour recall questionnaires were completed with the assistance of trained fieldworkers. Anthropometric measurements included weight, height, and Mid-Upper Arm Circumference. Furthermore, the existing menus served to the elderly were theoretically analysed using FoodFinder® version 3 program to determine the energy, carbohydrate, protein and fat content. A developed and tested questionnaire was used to gather information from ten volunteer food service workers at the care centre to determine the training needs. The results of the baseline survey, the menu analysis and training needs assessment were used to develop a training programme that was implemented for a period of ten weeks. Learning was measured after the training programme by administering the same knowledge questionnaire, as well as by a portfolio of evidence and practical assessment. Data analyses: Data for the baseline survey was captured on an Excel spreadsheet. Data analysis was done using the Statistical package for Social Sciences (SPSS) for Windows version 10.0 program for all variables except dietary intake data. Dietary intake and food consumption data were analysed by a registered dietician using the FoodFinder® version 3 program, developed by the Medical Research Council (MRC). Daily nutrient intakes were reported as means and standard deviations and compared to RDAs. Paired t tests were done to determine correlations between knowledge of the food service workers before and after the implementation of the training programme. Results: The results indicated that the majority of the elderly had an income of between R500 and R1 000 per month and most of them reported an occasional lack of funds to meet basic household needs, confirming the presence of food insecurity. Daily dietary intakes (mean ±Standard Deviation [SD] were 5 041,2 ± 2 299,6 kilojoules (kJ) energy, 50,4 ± 28,2 gram (g) protein, 38,9 ± 28,2 g fat and 149,0 ± 76,6 g carbohydrates. The majority (29.5%) were overweight (body mass index [BMI] ~25) or obese (BMI ~30) whilst 33.5% had a mid-upper arm circumference (MUAC) of ~21.7 centimetres (em). Mean intakes of micronutrients were low in comparison with the reference standards. The volunteer food service workers were literate as the majority had higher than grade 10-12 training and 80% had previously received on-the-job training. The training programme was successfully implemented and the knowledge of the voluntary food service workers improved after the training programme was implemented. However, because of the small sample size no significance could be determined. Conclusions: The findings of this study confirmed that poverty, malnutrition, both under- and over-nutrition, as well as household food insecurity and poor health were the major problems observed in this elderly community. These findings correspond to other studies, however limited, conducted amongst the elderly in South Africa. The results indicated that, although the food service workers were literate and had received prior training, they still had a poor knowledge of appropriate food preparation method and practices, as well as nutrition, especially related to the elderly. On completion of the training programme, the knowledge of the food service workers improved. This study emphasises the importance of continued on-the-job training Recommendations: The recommendations of further research include: 1) A more detailed study to evaluate the influence of the training programme not only on knowledge and skills, but also on behaviour and attitude. 2) Periodically measuring such influence over a year to measure knowledge retention. 3) Implementation of a NEP for the elderly and its impact on nutrition knowledge and dietary intake behaviour tested. / National Research Foundation (NRF

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-09-13T12:51:04Z No. of bitstreams: 1 Nicole Debia .pdf: 937336 bytes, checksum: bad36ec63406f017da7cd5fac9bf7eb3 (MD5) / Made available in DSpace on 2018-09-13T12:51:05Z (GMT). No. of bitstreams: 1 Nicole Debia .pdf: 937336 bytes, checksum: bad36ec63406f017da7cd5fac9bf7eb3 (MD5) Previous issue date: 2018-08-21 / Pontifícia Universidade Católica de São Paulo - PUCSP / Aging is a process that incorporates changes not only biological, but also sociocultural, psychic and historical, characterized by its heterogeneity. With the advance of several sectors of Brazilian society, including primary and secondary health care systems, we experience the progression of longevity and the amount of elderly reaching the eighth decade of life and beyond. However, as the amount of years lived increases, so does the probability of vulnerability and disability. Behaviors involving appropriate eating habits, physical exercise practice and smoking abstention may contribute to prevent diseases and promote longevity. However, assimilation of proper feeding in routine depends on several sociocultural and economic factors. The central aim of this study was to investigate perceptions and representations of long-living older adults about their food habits, considering the relationship between food, longevity and their sociocultural meaning, more specifically: To systematize conceptual-theoretical basis of analysis to compose the references about aging, old age, culture and feeding; To outline the profile of the elderly respondents; and To characterize eating habits and their representations about food and longevity. This is an exploratory study with qualitative approach through content analysis and interviews with thirteen long-living older adults in São Paulo city. The sample profile consisted in high prevalence of women, widows, foreign and domestic (countryside inhabitants) immigrants, in cohabitation with other relatives, presence of chronic disease, Catholics, absence of smoking and financial vulnerability, in addition to low illiteracy level. All respondents reported changes in eating habits during their life course, mainly the ingestion of a greater sort of food. Among the main factors which influenced this practice, were included: information about the relationship between feeding and longevity received by media sources; food restriction from religious or cultural conceptions and the trivial food consumed over the years. It´s considered that beyond relationship between food consumption and life expectancy, conceptions related to other aspects were significant, among them, lifestyle and religiosity, illustrating aging complexity, as well as the need of multiprofessional engagement when thinking in health promotion. The importance of family proved to be significant and immigrant status was a preponderant factor in feeding patterns changes. Taboo-breaking shows itself essential, in view of new trials in feeding and nutrition sector. Finally, this research contributes to the development of new studies on the interface between nutrition and aging, as well as emerges as new a proposal in public policies in food sector and nutrition education programs focusing the elderly population / O envelhecimento é um processo que incorpora mudanças não somente biológicas, mas também socioculturais, psíquicas e históricas, caracterizando-se por sua heterogeneidade. Com o avanço de diversos setores da sociedade brasileira, incluindo saúde primária e secundária, nos deparamos com a progressão da longevidade e do número de idosos que atingem a oitava década de vida ou mais. Porém, juntamente com o aumento dos anos vividos, aumenta a probabilidade de vulnerabilidade e dependência. Atitudes que envolvam hábitos alimentares adequados, prática de exercícios físicos e abstenção do tabagismo podem contribuir para a prevenção de doenças e favorecer a longevidade. Entretanto, incorporar alimentação adequada na rotina depende de diversos fatores de ordem econômica e sociocultural. O objetivo central desta pesquisa foi investigar percepções e representações de idosos longevos sobre seus hábitos alimentares, considerando a relação entre alimentação, longevidade e seu significado sociocultural, mais especificamente: sistematizar a base teórico-conceitual das análises para composição de referências sobre envelhecimento, velhice, cultura e alimentação; delinear o perfil dos idosos entrevistados; caracterizar hábitos alimentares e suas representações sobre alimentação e longevidade. Trata-se de um estudo exploratório de abordagem qualitativa por meio da análise de conteúdo e entrevista com treze idosos longevos residentes no município de São Paulo. O perfil da amostra consistiu em maior prevalência de mulheres, viúvas, imigrantes estrangeiros e internos (zona rural), em coabitação com outros parentes, presença de doença crônica, católicos, ausência de tabagismo e de vulnerabilidade financeira, além de baixo nível de analfabetismo. Todos os entrevistados referiram mudança de hábitos alimentares ao longo da vida, principalmente em relação à ingestão de maior variedade de alimentos. Dentre os principais fatores que influenciaram nessa prática, foram incluídos: informações sobre a relação entre alimentação e longevidade recebidas principalmente pela mídia; restrição alimentar a partir de concepções religiosas ou culturais e o trivial consumido ao longo dos anos. Considera-se que, mais do que a relação do consumo alimentar com o longeviver, concepções relacionadas a outros aspectos vividos se fizeram expressivas, entre elas, o estilo de vida e religiosidade, demonstrando a complexidade do envelhecer, bem como a necessidade de engajamento multiprofissional ao se pensar na promoção da saúde. A importância da família mostrou-se significativa e a condição de imigrante foi fator preponderante na mudança de padrões alimentares. A quebra de tabus mostra-se essencial, tendo em vista novas experimentações no campo da alimentação. Coloca-se como possível contribuição da presente pesquisa o desenvolvimento de novos estudos com interface entre nutrição e envelhecimento, além da proposição de políticas públicas na área da alimentação e programas de educação nutricional voltados para o segmento idoso

"Background: Nasopharyngeal carcinoma (NPC) is endemic in southern China. Despite the improvement in radiotherapy (RT) technology, NPC patients still suffer from numerous and simultaneous distressing symptoms. / Aims: The aim of the study was to explore the feasibility of an intervention program (an educational intervention program) in managing the most distressing symptom cluster (nutrition impact symptom cluster) in NPC patients during RT. / Methods: The study was carried out in two parts. Part I consisted of groundwork research (n = 130) using a cross-sectional design to identify the most distressing symptom cluster. An instrument validation was also conducted at this point. Part II covered the development process and pilot testing of an educational intervention program, guided by the Medical Research Council (MRC) framework, to manage the nutrition impact symptom cluster identified in Part I. First, to inform development of the intervention, a systematic review was conducted to evaluate the effectiveness of psychoeducational intervention (PEI), which includes the educational intervention, in managing symptom clusters in patients with generic cancers. Second, a descriptive qualitative study was conducted through face-to-face semi-structured interviews with 25 NPC patients and 16 health professionals, separately, to provide further help in developing the intervention by investigating patients’ self-care experience and current clinical practice in managing the nutrition impact symptom cluster. Third, the feasibility and estimated effectiveness of the educational intervention program was explored in a pilot randomized controlled trial (RCT) (n = 40). Outcome measures, including severity of the nutrition impact symptom cluster, body weight, functional performance and quality of life (QOL), were assessed at baseline, week 3 of RT and at the end of RT. Inferential statistics, such as independent t-test, Chi-square test, Fisher’s exact test and the generalized estimating equation (GEE) model, were used to compare the baseline and various outcome variables between groups. / Results: In Part I, the Chinese version of the MD Anderson Symptom Inventory - Head and Neck Module (MDASI-HN-C) was found to be a reliable and valid instrument. The same dataset then revealed four symptom clusters in NPC patients during RT; the nutrition impact cluster was identified as the most distressing, and was thus chosen as the target outcome of the intervention. In Part II, the systematic review found that PEI, in particular, patient education, was a promising intervention to manage cancer symptom clusters. Then, the findings of the qualitative study further informed and guided the development of an educational intervention program. The pilot RCT found that the conducting the program in a clinical setting was feasible and well received by patients. It also had some favorable effects on managing the nutrition impact symptom cluster, in terms of relieving the cluster itself (Cohen’s d = -0.37), and improving the physical well-being (Cohen’s d = -0.15) and head and neck cancer (HNC) specific QOL (Cohen’s d = -0.05). / Conclusion: The implementation of the educational intervention program appears to be feasible with NPC patients during RT, showing some effect in improving the nutrition impact symptom cluster. A future full-scale study with an adequate sample is warranted." / 研究背景：鼻咽癌在中國南部高發。儘管放療技術在進步，鼻咽癌病人在接受放療期間仍然存在著各種同時出現的症狀困擾。 / 研究目的：本研究旨在測試一個健康教育干預項目在管理鼻咽癌病人放療期間最嚴重的營養相關症狀群的可行性。 / 研究方法：本研究分為兩個部分。第一部分採用橫斷面的研究方法（n = 130），目的是為了找出最嚴重的症狀群，包括檢驗一個量表的信效度。第二部分包括健康教育干預專案的設計和預實驗。首先，研究者做了一個系統評價來評估心理及健康教育干預對管理癌症病人症狀群的效果。然後，研究者又做了一個質性研究，通過與25名鼻咽癌放療病人和16名醫護人員面對面訪談來瞭解目前營養相關症狀群的管理現狀，以便為干預的設計提供進一步線索。最後，研究者做了一個隨機對照試驗的預實驗（n = 40），來評價本研究所設計的健康教育干預專案的可行性。研究指標包括營養相關症狀群的嚴重性、體重、功能水準以及生活品質，並於干預前、放療第3周以及放療結束進行測量。統計推斷方法包括獨立樣本t檢驗、卡方檢驗、Fisher確切概率法和廣義估計方程模型，用以比較組間差異。 / 研究結果：第一部分的研究結果表明，中文版的M. D. Anderson症狀調查表（頭頸）的信效度良好。此外，四個症狀群被發現，其中以營養相關症狀群最為嚴重，因此被選為本研究的干預目標。第二部分，通過系統評價，研究者發現心理及健康教育干預，尤其是健康教育對管理癌症病人的症狀群有一定效果。接著，質性研究的結果進一步提示了健康教育干預項目的必要性，並為該專案的設計提供了具體方案。最後，預實驗表明本研究所設計的健康教育干預專案是可行的並受病人歡迎。該項目在減輕營養相關症狀群（Cohen’s d = -0.37）以及提高與身體（Cohen’s d = -0.15）和頭頸癌相關（Cohen’s d = -0.05）的生活品質上有一定效果。 / 研究結論：本研究所設計的健康教育干預專案是可行的，並對管理鼻咽癌病人放療期間的營養相關症狀群有一定效果。將來需要做一個大規模的研究來驗證該項目的有效性。" / Xiao, Wenli. / Thesis Ph.D. Chinese University of Hong Kong 2016. / Includes bibliographical references (leaves 226-250). / Abstracts also in Chinese. / Title from PDF title page (viewed on 01, February, 2018). / 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.

Bibliography: leaves 148-163.