Background: With the aging of the global population, the prevalence and incidence of Alzheimer’s disease or related dementia are increasing. Most mild or moderate dementia clients are taken care of at home by informal caregivers, which leave a heavy burden to the caregivers. Researchers have found out that with good intervention services and programmes for the caregivers, their burden, emotional distress and even the care recipients’ symptoms and institutionalization rates would be improved. Objectives: This project is to review these researches to evaluate whether the interventions are effective and/ or cost-effective and how the decision-makers could use the results for evidence-based policy. Methods: A literature search was performed on randomized controlled trials in education, information/ support intervention programmes published from October 2005 to July 2012. Electronic databases (EBSCO, PubMed and CNKI) were searched until July 2012. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized controlled trials was used as the guideline to evaluate the quality of identified papers. Results: 16 papers (15 studies) were included in this review and classified into three groups, as home-based, individual-based and group-based interventions. This review found that the intervention programmes had various outcomes and showed some evidence of effectiveness. Most of the papers had good quality. The home-based programmes showed cost-effectiveness in the identified studies. Conclusion: There was some evidence that the home- and group-based interventions were effective and the home-based interventions could be cost-effective. Further studies are recommended and a meta-analysis on the studies and more researches on economic analysis are needed. A community-based long-term dementia management should be built up for better outcomes. / published_or_final_version / Public Health / Master / Master of Public Health

Optimal effect of medical treatment requires patients' adherence to those treatments, which plays a even greater role than the medical decision made by physicians. With the epidemiological dynamic evolving, chronic disease becomes the major burden of healthcare, such as AIDS, hypertension, COPD, tuberculosis, asthma, epilepsy, schizophrenia, depression and diabetes, which make the adherence especially medication adherence a sightworthy issue because the risk of poor adherence with the complexity and duration of treatment with both of them are inherent to chronic diseases. Among patients with hypertension, medication nonadherence contributes to poorly controlled blood pressure as an significant yet unrecognized role. With the mediator of negative outcomes of further development of vascular disorders, including stroke, heart failure, renal insufficiency and coronary diseases, medication nonadherence to antihypertensives become the root of all devil in terms of healthcare. In terms of healthcare utilization, it costs approximately 396 to 792 million dollars per year and creates a significant burden. Effect factors for medication nonadherence among hypertension patients include knowledge about hypertension, beliefs about hypertension, perceived beliefs about medication, inadequate self-management behaviors, physician-patient relationship, social support and healthcare policy. The achievements of current single level interventions are not satisfactory, therefore multiple level interventions are calling for attention.Everyone in the healthcare system are responsible to alter the situation. A comprehensive healthcare system that consummates all the effect factors is the effective and efficient solution. / published_or_final_version / Public Health / Master / Master of Public Health

　　The experience of cancer challenges the body and the mind. A solid body of evidence has amassed on what help breast cancer patients cope with adversities. In the field of positive psychology, the concepts of hope and optimism further our understanding of the role future expectancies play in goal-directed pursuits and in psychological adjustment to adverse events. 　　Snyder’s theory of hope (2002) conceptualizes that goal directed behaviours have two components -- pathways and agency thinking. Pathways thinking is associated with finding the routes to achieve a desired goal. Agency thinking provides the mental energy to initiate and persist in pursuing goals. Hope is consistently linked with better outcomes in academics, athletic, health care and community settings (Snyder et al., 2005). 　　The literature on optimism (Scheier & Carver, 1985) describes the characteristics of optimists and pessimists. Optimists hold positive future expectancies with positive emotions keeping individuals actively engaged in their goals despite frustrations. Pessimists are more inclined to use avoidant coping in response to the negative emotions engendered in their negative expectancies. 　　In the present project, hope and optimism are investigated in a group of breast cancer patients who are recently diagnosed with recurrent, advanced or metastatic disease in Hong Kong. To the best of the author’s knowledge, no other studies have investigated future expectancies in advanced breast cancer patients in a longitudinal design. Findings suggested that agency hope and optimism together account for 27 - 29% of the variation in concurrent distress; and 52 - 54% of the distress three months later. Optimism was an independent predictor of concurrent and three-month psychological distress. However agency hope was not an independent predictor. The results of the present study are compared with a published study (Ho, et al., 2011) of hope and optimism in a group of oral cavity cancer survivors, who did not have an active disease. In both the advanced breast and oral cavity cancer patient groups, hope and optimism together predicted distress. But optimism was a stronger predictor relative to agency hope in the advanced breast cancer patients whose disease outcome was less certain. 　　The present study also attempts to decipher the cognitive processes postulated to be mediators in the relationship between future expectancies and psychological adjustment. In the advanced breast cancer group, attention to negative information mediated the relationship between optimism and concurrent anxiety and depression. In the oral cavity cancer survivors, negative cancer-related rumination mediated in the relationship between agency hope and depression, and in the relationship between optimism and anxiety and depression. The implications of the findings are discussed in light of the possible different cognitive processes of patients who are faced with two different disease conditions. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

Aggressive behavior has been repeatedly observed in patients with schizophrenia and related psychotic disorders. However, there is little known about the underlying psychological mechanisms, especially the role of social cognition, in contributing to the exhibition of aggression. The aim of this study was to investigate whether aggression was associated with theory of mind (ToM) deficiency and the presence of hostility bias. Thirty individuals with a DSM-IV-TR diagnosis of schizophrenia or other psychotic disorders were asked to complete the Faux Pas Recognition Test, the Ambiguous Intentions Hostility Questionnaire, and the Conflict Tactic Scale. Results suggested that psychotic patients with predominately referential or persecutory delusions were more susceptible to theory of mind anomalies and hostility bias, and had a higher frequency of the demonstration of aggressive behavior relative to patients with auditory hallucination and remitted patients. Correlational analysis revealed significant associations among ToM, hostility bias, and aggression. Multiple regression analyses showed that hostility bias was neither a mediator nor a moderator in the relationship between ToM and aggression. The present study provided preliminary evidence that social cognition and social-cognitive attributional styles are related to the demonstration of aggressive behavior. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Breast cancer patients consistently reported psychosocial adjustment difficulty in their sense of femininity after breast removal surgery. In view of this, the present study aimed to explore the effects of three femininity-related concepts on emotional reactions towards breast removal surgery – femininity schema, femininity loss appraisals, and femininity contingency of self-worth. 212 women without breast cancer history participated in this study. They completed a questionnaire which included a hypothetical scenario of breast removal. Results showed that women who considered the breast of a high relative importance in femininity schema, and depended their self-worth highly on sense of femininity, reported greater increase in negative emotions after hypothetical breast removal. This effect was mediated by femininity loss appraisals. Implications and future directions were discussed. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

End stage renal failure refers to an irreversible kidney dysfunction in which the kidneys fail to remove toxins from the blood stream. Haemodialysis is an effective treatment modality to sustain the lives of patients with end stage renal failure by removing waste products like urea, creatinine, and excess fluid. It involves a challenging regimen including dietary restrictions to ensure long-term survival. Failure to adhere with the regimen can result in fatal consequences. Renal patient discomfort related to non-adherence is commonly seen in clinical settings; however, there is currently no evidence-based fluid or dietary education program available to haemodialysis patients. This dissertation aims to identify and evaluate current evidence for the effectiveness of dietary and fluid control programs in the treatment of haemodialysis patients, to assess the transferability and feasibility of implementing a nurse-led education program regarding dietary and fluid control in haemodialysis patients, and to develop an evidence-based, nurse-led fluid and dietary control program for haemodialysis patients. Four electronic bibliographical databases including PubMed, Cochrane library, PsycInfo and CINAHL and two searching engines including Google scholar and ProQuest were used to identify studies that examined the effectiveness of educational programs or interventions on fluid or dietary control for patients on haemodialysis. Forty-five unique studies were identified as potentially relevant. Eleven of those studies met the selection criteria and were evaluated in this dissertation. Appraisal instrument was used to evaluate the quality of the selected studies. Six studies and three studies showed statistically significant in reduction of serum phosphate level and interdialytic weight gain respectively after educational intervention. Critical evaluation of the available studies led to an evidence-based, nurse-led, fluid and dietary control program for haemodialysis patients that followed the guideline development process of the Scottish Intercollegiate Guideline Network. Comparison on the similarity of patient characteristics, staff competence, and organizational settings of the evaluated studies were similar to those of the target unit. Therefore, the proposed program may be transferable and feasible. Furthermore, a cost-benefit analysis showed that the benefit of the fluid and dietary control program to patients outweighs the cost needed to implement the program. This dissertation outlines a proposed twenty-week program including marketing of the program, training of staff in the targeted renal unit, pilot testing, and application of the proposed program. Evaluation of the program will focus on three categories: patient outcome, health care provider outcome, and organization outcome. Clinical effectiveness of the program is defined by an overall reduction in patients’ mean interdialytic weight gain and mean serum phosphate level, improvement in knowledge test scores by patients, satisfactory nurses’ attendance rate in the renal training sessions, high nurse satisfaction with the educational program, and reduction of admission rate related to non-adherence. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: Researchers have addressed the extraordinarily high rate of unemployment in patients with psychotic disorders for many years, but few have focused on these patients’ subjective experience of employment in the recovery process. Method: A thematic analysis was performed by conducting six semistructured interviews with young patients diagnosed with psychotic disorders. Results: The interviewees agreed on the importance and benefits of employment in their recovery. Acceptance, financial support, and a meaningful life can be secured throughout the working process. However, the interviewees mentioned certain barriers to seeking and sustaining employment. Stigma and low motivation were common problems in searching for a job. Cognitive deficit, the side effects of medication, and interpersonal challenges in the workplace increased the difficulty of sustaining a job. Most of the interviewees participated in vocational rehabilitation programmes, and they expressed the belief that these programmes can help them enter the labour market at a certain level, but the programme design can be improved further to meet individual needs. Conclusion: Consistent with previous findings, the patients faced various difficulties in open employment. Employability training, psychoeducation at the corporate level, and self-efficacy development can be considered interventions for improving patients’ vocational outcomes. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

54 local secondary school teachers from two different secondary schools at same district were invited to participate in the study. A 67-item self-reported Chinese questionnaire was filled in by the 54 participants in order to test their knowledge about early psychosis, attitude towards students with early psychosis and also the school re-entry of young patients. It was found that there was no statistical significance correlation between the years of teaching experience of teachers and their attitude towards students with early psychosis and school re-entry of young patients. There was no significance gender difference in the attitude towards young patients and their school re-entry. Plus, a one-way ANOVA was used to further examined the significant difference across teachers had no religion, Christian teachers, Buddhist teachers and also Catholic teachers, F (3, 50) =4.628, p= .009, n^2=.042. Tukey’s post hoc procedure indicated that Christian teachers (M=95.7, SD=18.26) hold significance less negative attitude towards young patients than those who were Buddhist (M=92.6, SD=18.60), Catholic (M=80.25, SD=5.80) and those teachers who had no religion (M=74.71, SD=18.76). The feelings and attitude of participants towards psychosis was quite negative such as unpredictable (21%), violence and dangerous (16.7%), abnormal (13.6%), uncontrollable (14.2%) and madness (11.1%). Participants also were found that they were lack of enough basic knowledge on the average age of onset as most of them chose middle age is the age of onset of psychosis in Hong Kong. It was suggested that more structured mental health trainings session should be provided to educational professionals including teaching assistants. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

In view of the increasing prevalence of female breast cancer in the global and local arenas, this disease has become a critical problem affecting women’s physical, psychological, spiritual and social conditions. With medical technology advancements, women can receive early diagnosis and effective treatment. However, maladjusted rehabilitation affects women’s long-term recovery. In order to improve women’s rehabilitation, more attention is being paid to breast cancer survivorship care after treatment. Therefore, how women experience and perceive breast cancer during the transition period is the important information for us to understand women’s breast cancer survivorship. The present study aims to explore how women perceive their breast cancer experiences during the transition period from a holistic perspective. This study adopted the qualitative inquiry approach. Movement-based focus group design was the present research design, in which dance/movement activities and group discussions were included. It is based on the belief that expressing through dance/movement enables an individual to reveal the experiences which have been stored in the body. Four focus groups were used, with a total of twenty recruited informants. Data collected from the focus group interviews included verbal (transcriptions) and non-verbal (writing/drawing and created body shapes) expressions. Interviews were transcribed verbatim and analyzed using the ATLAS.ti 7 qualitative data analysis software. The findings indicated that women's descriptions of their experiences during the transition period were associated with bodily, emotional, cognitive, spiritual, and self and social relational perspectives. Five domains (bodily, emotional, cognitive, spiritual and self and social relational experiences) were generated after data processing. Analysis of the contents in each domain reveals the body-mind-spirit connection. During this period, women consider their health and exercise to be important, they were relaxed and happy, they reflected more, they searched for purpose and meaning in life, and they appreciated developing relationships with others and self. Furthermore, the results showed that these women attained self-growth through their breast cancer experiences. Nevertheless, the self-growth areas and pace were different for each individual. The results also revealed that the non-verbal information (writing/drawings and created body shapes) enriched the women’s expression by illustrating their in-depth or hidden breast cancer experiences. The results provide practitioners with insight and direction into designing rehabilitation programmes for breast cancer survivors. Therefore, the contents of the programme include not only psychosocial aspects but also bodily, cognitive and spiritual perspectives. Furthermore, the present movement-based focus group demonstrated the use of non-verbal expressions, as well as dance/movement, to enhance communication. To conclude, this study sheds light on our understanding of women’s breast cancer experiences during the transition period, as well as on the use of the movement-based focus group research method. The present practice and experiences may contribute to qualitative research and psychosocial oncology research. Further research with larger sample size is recommended. The present methodology can also be extended to other cancer populations such as cervical cancer survivors. Furthermore, studies examining the additional benefits of using movement in focus group interview are also recommended. / published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

Context: Dementia impairs daily functional ability and independence through negatively affecting cognitive function. As the prevalence of dementia increases, the burden on healthcare facilities and families grows, pointing to the need for providing further options available for the management of dementia in the community context. Of these options, physical exercise interventions are easily modifiable and relatively simple to implement. The primary objective of this review is to investigate the effectiveness of exercise for improving cognitive function in elderly people with dementia living in the community. Methods: A systematic review of 2 databases (PubMed and EMBASE) was carried out for all studies investigating the effects on cognition of a physical exercise intervention among home-dwelling elderly patients with dementia. Data was extracted on baseline characteristics of study participants, type of exercise intervention, length of follow up, and changes in cognitive outcome measures. Results: Seven studies were included. Three provided statistically significant results that showed an association between exercise and cognition in community-dwelling dementia patients.!The remaining four studies could not establish an association. Conclusions: The effectiveness of exercise for improving cognition in community-dwelling people with dementia is unclear based on the conclusions of this review. Small sample size and methodological quality limited the results. Further well-designed studies are needed that investigate appropriate community-based exercise interventions for people with dementia. / published_or_final_version / Public Health / Master / Master of Public Health