Yeung, Pui Yee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 131-145). / Abstract and some appendixes also in Chinese. / ABSTRACT --- p.i / ABSTRACT (in Chinese) --- p.iii / DECLARATION OF ORIGINALITY --- p.iv / ACKNOWLEDGEMENTS --- p.v / RESEARCH-RELATED PRESENTATIONS AND AWARD --- p.vi / TABLE OF CONTENTS --- p.vii / LIST OF ABBREVIATIONS --- p.xi / LIST OF FIGURES --- p.xii / LIST OF TABLES --- p.xiii / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.3 / Chapter 2.1 --- Incidence and prevalence of falls in older people --- p.4 / Chapter 2.1.1 --- Incidence and prevalence in western countries --- p.4 / Chapter 2.1.2 --- Incidence and prevalence in Hong Kong --- p.4 / Chapter 2.2 --- Causes and risk factors for falls --- p.5 / Chapter 2.2.1 --- Causes for falls --- p.5 / Chapter 2.2.2 --- Risk factors for falls --- p.6 / Chapter 2.3 --- Consequences of falls --- p.7 / Chapter 2.3.1 --- Individual perspective --- p.7 / Chapter 2.3.2 --- Impact on health service and society --- p.9 / Chapter 2.4 --- Intervention and prevention strategies --- p.10 / Chapter 2.4.1 --- Effective interventions and preventive approaches --- p.10 / Chapter 2.4.2 --- Areas of uncertainty for interventions and prevention approaches --- p.19 / Chapter 2.5 --- Existing efforts in intervention and prevention --- p.20 / Chapter 2.5.1 --- Worldwide levels and collaborations among various countries --- p.20 / Chapter 2.5.2 --- Current services for falls prevention in Hong Kong --- p.23 / Chapter 2.6 --- Criteria contributing to successful intervention and risks modification --- p.27 / Chapter 2.6.1 --- Identification of elderly fallers at Accident & Emergency Department --- p.28 / Chapter 2.6.2 --- Selection of the proved effective programme to those likely to benefit --- p.29 / Chapter 2.6.3 --- Uptake and adherence of the target fallers to the selected programmes --- p.30 / Chapter 2.7 --- Current gaps in study of services for elderly fallers in Hong Kong --- p.31 / Chapter CHAPTER 3 --- METHODOLOGY --- p.32 / Chapter 3.1 --- Research objectives --- p.33 / Chapter 3.2 --- Operational definition of falls --- p.33 / Chapter 3.3 --- Study design --- p.34 / Chapter 3.3.1 --- Diagrammatic illustration of the study design --- p.35 / Chapter 3.3.2 --- "Subjects, assessors and setting" --- p.37 / Chapter 3.3.3 --- Sources of data collection --- p.38 / Chapter 3.3.4 --- Questionnaire and assessment instruments --- p.39 / Chapter 3.3.5 --- Referrals and interventions --- p.49 / Chapter 3.4 --- Plan of data analysis --- p.52 / Chapter CHAPTER 4 --- RESULT --- p.55 / Chapter 4.1 --- Progression of elderly fallers --- p.56 / Chapter 4.2 --- Characteristics of all elderly fallers presented to A&E --- p.58 / Chapter 4.2.1 --- Demographics --- p.58 / Chapter 4.2.2 --- Rate of hip fracture --- p.58 / Chapter 4.2.3 --- Seasonal variation for occurrence of falls --- p.58 / Chapter 4.2.4 --- Subsequent one-year mortality --- p.59 / Chapter 4.2.5 --- Subsequent one-year occurrence of falls with presentation to A&E --- p.59 / Chapter 4.2.6 --- Subsequent one-year hospitalization and length of stay --- p.59 / Chapter 4.3 --- Profile of elderly fallers who received comprehensive falls assessment --- p.63 / Chapter 4.3.1 --- Demographics --- p.63 / Chapter 4.3.2 --- "Circumstances, consequences and past history of falls" --- p.67 / Chapter 4.3.3 --- Health and functional profile --- p.75 / Chapter 4.4 --- Uptake of interventions or referrals by elderly fallers --- p.89 / Chapter 4.4.1 --- Uptake rate of various interventions or referrals --- p.89 / Chapter 4.4.2 --- Reasons for refusing interventions or referrals --- p.89 / Chapter 4.5 --- Comparison between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.1 --- Co-morbidity between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.2 --- Functional profile between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.6 --- Comparison between injurious falls and non-injurious falls --- p.93 / Chapter 4.6.1 --- Co-morbidity between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.6.2 --- Functional profile between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.7 --- Comparison of the profiles between the elderly fallers and the general older population in Hong Kong --- p.95 / Chapter 4.7.1 --- Comparison in demographics --- p.95 / Chapter 4.7.2 --- Comparison in self-perceived health --- p.95 / Chapter 4.7.3 --- Comparison in lifestyle factors --- p.95 / Chapter 4.7.4 --- Comparison in BMI --- p.96 / Chapter 4.7.5 --- Comparison in morbidity --- p.96 / Chapter 4.7.6 --- Comparison in number of disease --- p.97 / Chapter 4.7.7 --- Comparison in medication use --- p.97 / Chapter 4.8 --- Comparison between fallers attended and those who did not attend the falls assessment clinic in terms of the subsequent one-year results --- p.102 / Chapter 4.8.1 --- Comparison in subsequent one-year mortality --- p.102 / Chapter 4.8.2 --- Comparison in subsequent one-year recurrent falls with presentation to A&E --- p.102 / Chapter 4.8.3 --- Comparison in subsequent one-year hospitalization and LOS --- p.103 / Chapter 4.9 --- Validation of a simple screening tool adopted from the Mr. Os (Hong Kong) study by the result of this study --- p.106 / Chapter CHAPTER --- 5 DISCUSSION --- p.108 / Chapter 5.1 --- Profile of elderly fallers presenting to A&E and its implications to health care planning for the elderly --- p.110 / Chapter 5.1.1 --- Profile of fallers in terms of subsequent one-year results --- p.110 / Chapter 5.1.2 --- Profile of fallers compared with general older population --- p.111 / Chapter 5.1.3 --- Implications on health care planning for the elderly --- p.113 / Chapter 5.2 --- Acceptability of various interventions and referrals by fallers and its implications to health care planning for the elderly --- p.116 / Chapter 5.2.1 --- Uptake rates for various interventions and referrals --- p.116 / Chapter 5.2.2 --- Views towards various interventions and referrals by fallers --- p.117 / Chapter 5.2.3 --- Implications on health care planning for the elderly --- p.117 / Chapter 5.3 --- Discussion of other findings --- p.120 / Chapter 5.3.1 --- Seasonal variation in occurrence of falls --- p.120 / Chapter 5.3.2 --- "Circumstances, consequences and past history of falls" --- p.122 / Chapter 5.3.3 --- Comparison between recurrent fallers and non-recurrent fallers in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.4 --- Comparison between fallers with resultant injury and fallers without injury in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.5 --- Comparison between fallers attended and those who did not attend the falls assessment clinicin terms of subsequent one-year results --- p.124 / Chapter 5.3.6 --- Usefulness of the risk profile of recurrent falling adopted from Mr. Os (Hong Kong) Studyin screening the fallers with high risk of falling --- p.125 / Chapter 5.4 --- Limitations --- p.126 / Chapter 5.5 --- Recommendations for further research --- p.128 / Chapter CHAPTER 6 --- CONCLUSION --- p.129 / REFERENCES --- p.131 / APPENDICES / Appendix 1 Assessment Form used in Falls Assessment Clinic --- p.146 / Appendix 2a Scale for Subjective Socioeconomic Status -English version --- p.151 / Appendix 2b Scale for Subjective Socioeconomic Status -Chinese version --- p.152 / Appendix 3a Simple Physical Activity Questionnaire -English version --- p.153 / Appendix 3b Simple Physical Activity Questionnaire -Chinese version --- p.155 / Appendix 4 Modified Barthel Index --- p.157 / Appendix 5 Rating Form for Impairment in IADL --- p.159 / Appendix 6 Mini-Mental State Examination -Cantonese version (CMMSE) --- p.160 / Appendix 7 Geriatric Depression Scale - Four-item short form (GDS-4) --- p.162 / Appendix 8 Berg Balance Scale - short form (BBS short form) --- p.163

Alcohol consumption, the third largest contributing risk factor towards global morbidity, has increased in the past 5 years despite global calls for action to reduce its significant impact on public health. Compared to most developed nations, Hong Kong has been shown to have lower levels of alcohol consumption by previously conducted research. However, Hong Kong’s low alcohol taxes, wide availability of alcohol, and lax restrictions on marketing practices have the potential to increase the prevalence of alcohol use and binge drinking particularly among young adults 18-25 of age, lending them towards increased risks of neurological damage, unsafe sex, intentional and unintentional injuries, and impacts on school and work performance in addition to chronic health harms in the future. This thesis employs a mixed-methods approach to comprehensively examine the behavioral and environmental contexts of Chinese young adult drinking behavior, as well as to generate feasible, effective strategies at the health promotion and policy levels to reduce alcohol-related harm among this population subgroup. / Cantonese-speaking young adults of Hong Kong (n=684) were invited between April and September 2011 to participate in a cross-sectional random telephone survey, during which they were asked about their drinking patterns and perceptions on a set of alcohol expectancy statements. Twelve focus groups (n=63) were then conducted between June 2012 – May 2013 to explore individual motivations to drink as well as possible environmental and social facilitating factors. A series of interviews conducted in January – April 2014 with key policy stakeholders, including representatives of law enforcement, education, government, food and beverage sectors, non-governmental organizations, and the alcohol industry, (n=16) then aimed to produce appropriate, actionable policies and interventions which can be undertaken as a means to reduce alcohol-related harm among young adults in Hong Kong. / At the behavioural level, positive outcome expectancies were found to be significantly associated with various levels of alcohol use. Those who held social facilitation of drinking to a high regard were significantly more likely (OR=6.67; 95% CI: 2.87,15.49) to have had at least one binge drinking episode in the past month. Qualitative investigations also illustrated drinking among Hong Kong young adults as heavily focused on planned socializing and self-presentation in personal and business situations, and further enabled by the availability of local drinking games and granting and losing face, a Chinese cultural concept based on dignity with competitive undertones. Drinking occasions were also facilitated by the convenience of bars and lounges, viewed as accommodating alternatives to homes for social gatherings. Point-of sale promotions providing inexpensive or free drinks further strengthened alcohol use as a convenient and normal practice among young adults. / Instead of adopting strategies to limit access to alcohol as recommended by global alcohol experts, key policy stakeholders of alcohol issues in Hong Kong expressed preference for softer approaches such as health education campaigns to properly inform young adults about the physical harms of alcohol. For legislative actions, only those that aim to limit alcohol’s physical availability, restrictions on discounted drink specials, and bans on event-centric promotions were favored as viable options. / This series of studies marks the first attempt in alcohol research to comprehensively establish a profile of drinking behavior of Chinese young adults at individual, social, and environmental levels. Based on these findings, a deeper understanding of the previously unexplored cultural context of Chinese drinking, particularly those involving face-based interactions and business situations, is warranted in future behavioral research on alcohol use among this ethnic subgroup. Health campaigns and community interventions challenging the perceives social benefits of drinking among young adults may be useful at the community level in reducing alcohol-relates harms among Chinese youth, but further research is required to ascertain their actual effectiveness in Hong Kong. The government-endorsed Liquor Licensing Board may also expand its current role in limiting the physical availability of alcohol in Hong Kong by imposing a licensing system on outlets that sell alcohol for consumption outside of their premises (off-premise sales), and restricting point-of-sale promotions of alcoholic beverages at licensed venues. / 飲酒為全球發病率的第三大危險因素。儘管酒精危害對公共衛生的影響何其嚴重，世界在過去五年飲酒量始終持續上升的趨勢。傳統來說，香港飲酒的份量與大多數發達國家相對較低。然而，香港針對酒類飲品的價格、供應、和營銷的限制極為寬鬆，這種情況有機會增加18-25歲青少年飲酒和暴飲的流行性，神經損傷、不安全性行為、和蓄意及非蓄意的傷害的風險亦有機會因此增加，在學校和工作表現也會受到影響。有見及此，本論文內描述的研究旨在採取混合研究方式，分析青少年飲酒行為的個人和環境因素，導出在健康促進和政策層面內可行、有效的措施，從而減少香港青少年酒精相關危害。 / 本研究首先採用電話問卷方式於2011年四月至九月之間對本地青少年作一項橫斷式調查(n=684)，主要調查他們的酒精使用頻率以及對使用效果的期望。此外亦於2012年六月至2013年九月之間經十二組的焦點團體訪談(n=63)探討青少年使用酒精飲品的個人動機，以及任何社會或環境層面的促進因素和影響。最後是項研究於2014年一月至四月之間進行一系列的採訪(n=16)，了解相應持份者對在香港實施減少青少年酒精相關危害的社區或政策行動的可行性與預期影響。。 / 在行為層面上，飲酒正向使用效果的期望與各級酒精頻率顯著相關。對酒精在社交帶來的正面效果抱著頗高期望的人士更有較大機會於一個月內有暴飲的情況(OR = 6.67; 95% CI: 2.87,15.49)。質性調查亦顯示，香港青少年飲酒行為很大程度上圍繞於酒精在社交場面上的表現和自我映照所需的正面影響，並透過本地式飲酒遊戲和面子的基礎上進一步引生出競爭式暴飲行為。飲酒場合（例如酒吧及類似的休憩場所）的方便及舒適程度，更令他們取代住所成為社交聯歡的主要地點。酒精飲品的特惠和特別促銷活動亦經常提供廉價或免費的飲料，進一步加強了酒精使用於青少年群組當中成為一種方便及正常行為。 / 相對於國際酒精使用研究專家提出的適當策略來限制人們和酒精的接觸，相應持份者傾向採取較柔和的應對方法，例如健康教育活動以正確地告知青少年酒精對身體的危害。使用法律手法當中，只有管制酒精供應和禁止特惠及特別促銷活動是被看好為本地可行的選擇。 / 這一系列的研究代表了學術界中首次在個人、社會、和環境層面上探究中國的年輕人飲酒行為。根據是項研究的結果，未來中國人飲酒行為的研究可針對未曾探索的文化背景作更深層的了解，特別是涉及面子和為工作而需應酬的飲酒場合。針對青年人認為飲酒的社交效果的健康及社區教育計劃也可能是有效的干預方向，但仍需作進一步研究以確定在香港的有效性。政府認可的酒牌局也能擴大現有的管制系統來限制零售店舖的酒精供應，以及任何售酒處所的銷售方式。本論文亦基於研究結果對未來行為的研究、健康促進的實踐、和政策發展的影響作進一步的討論。 / Wong, Ho Cheuk Alvin. / Thesis Ph.D. Chinese University of Hong Kong 2014. / Includes bibliographical references (leaves 194-230). / Abstracts and appendixes also in Chinese. / Title from PDF title page (viewed on 18, October, 2016). / Wong, Ho Cheuk Alvin. / 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.

背景: 香港和廣州市是華南兩大發達城市，都面臨著人口老化的嚴峻形勢。由於醫療水準的提高，癡呆成為一個非常嚴重的公共健康問題。由於缺乏有效的治療手段，早期發現和干預成為減少認知功能損害及癡呆發病的最有效的措施。研究怎樣保護長者的認知功能對於公眾健康具有越來越重要的意義。越來越多的證據表明休閒活動有益於認知功能。研究表明體育鍛煉，腦力活動以及社會活動有益於認知健康，可以減少癡呆發病的風險。然而由於概念上的差異和研究方法的不同，使得目前的研究結果很難進行比較。由於社會背景會顯著影響休閒活動的參與，研究社會背景怎樣影響休閒活動對於長者認知功能的作用具有重要的意義。香港和廣州為華南兩大城市，其人口種族，基因，健康狀況及人口學特徵相似。然而在過去的一百多年中，由於歷史發展的不同，兩城市有著不同的社會系統。以上這些因素對於研究不同設計背景下的認知功能的對照研究提供了方便。研究兩地認識休閒活動與認知功能的關係，有助於評價不同社會環境對於休閒活動影響認知功能的以及社會因素對認知功能的影響。 / 研究目的: 本研究對於兩地長者認知功能的特點以及休閒活動的參與情況進行了比較。研究的主要目的是評估休閒活動與認知功能的關係，以及兩個城市中休閒活動與認知功能的關係。 / 方法: 這是一個橫斷面研究。557名非癡呆住在社區的長者參與了研究，其中香港260名，廣州297名。兩組長者在年齡，性別以及教育程度上沒有差異。休閒活動分為體育活動，智力活動，社會活動以及消遣活動。休閒活動的參與通過三種方式進行評估：種類，次數以及每週參與的小時數。一組評估量表包括：簡短精神狀態量表，詞語記憶，延遲回憶，詞語流暢性測驗，連線測驗，數位劃消測驗及Stroop測驗，用於評估兩地長者的認知功能。 / 兩地長者的人口學特徵，認知功能以及休閒活動的參與進行了比較，多元線性回歸用於分析每一類休閒活動與認知功能的關係，同時控制可能的混雜因素包括年齡，性別，教育程度，職業，婚姻狀況，居住情況，吸煙、酒情況，慢性疾病以及精神狀態。分層回歸用於分析每類休閒活動與認知功能的關係，同時控制其他三類休閒活動以及與認知功能顯著相關的混雜因素。 / 結果: 多元回歸分析表明與家人居住在一起者休閒活動的總類較多 (p=0.01)，休閒活動的時間較長 (p=0.02)。协方差分析檢驗顯示除了每週看電視的時間 （p=0.07），香港長者參與的休閒活動在種類，次數以及每週參與的小時數都明顯多於廣州長者，差異具有顯著性。兩地長者的認知功能測驗的分數未見顯著差異。體育活動（腦-身體鍛煉及有氧鍛煉）的種類與延遲回憶及詞語分類測驗顯著相關。智力活動與所有的認知功能測驗顯著相關。社會活動與語詞回憶和詞語流暢性測驗顯著相關。休閒活動與語詞回憶及連線測驗顯著相關。 / 多元線性回歸分析了休閒活動與認知功能的關係的同時，控制了其他三類休閒活動以及與認知功能顯著相關的協變數。分析結果顯示智力活動的種類與簡易精神狀態量表，語詞回憶，延遲回憶，詞語流暢性測驗以及數位劃消測驗顯著相關 （p<0.001）。體育活動和社會活動與認知功能未見明顯相關。消遣活動的時間與連線測驗顯著相關 （p=0.01）。休閒活動與認知功能的相關性兩地未見明顯顯著差異。 / 結論: 香港的長者參與了較多的休閒活動，但是認知功能測驗的分數與廣州長者卻沒有顯著差別。結果可能與之前的研究結果相矛盾，即參與較多的休閒活動與良好的認知功能相關，這可能與兩地的社會人口學的差異相關。以前的研究證明晚年的婚姻狀態與癡呆或者認知功能的下降相關。未婚或者喪偶的長者罹患癡呆症或者認知功能下降的風險性較高。香港未婚或喪偶長者較廣州多，或許這可以解釋為什麼香港長者參與較多的休閒活動，但是認知功能測驗卻未明顯優於廣州長者。同時也表明，除了休閒活動，社會因素（婚姻及居住狀況）對認知功能也有影響。 / 我們的研究表明參與智力活動尤其是參與各種各樣的智力活動與長者良好的認知功能相關。智力活動與認知功能的相關性在兩地沒有顯著差別，表明智力活動可在不同的社會環境中用於保護長者的認知功能。其他三類的活動與認知功能未發現有顯著相關性，這可能與智力活動的混雜效應有關，也可能與各活動之間其構成成分的重疊有關。儘管這樣，休閒活動對於認知功能的保護作用扔值得進一步研究。 / Background: The two most developed cities in southern China, Hong Kong (HK) and Guangzhou (GZ), are facing rapid population aging. As a result of improvements in medical care, dementia has emerged as a crucial public health problem. With limited treatment options available, early detection and intervention are likely to be the most effective strategies to reduce subsequent impairments and morbidity. Research into the prevention of cognitive decline among older persons is crucial for public health. There is increasing evidence that participation in leisure activities has a favorable effect on cognitive function. Studies have reported that physical exercise, cognitive activity and social engagement are beneficial for cognitive health and may reduce the risk of dementia. However, interpretation of the available evidence is hampered by conceptual discrepancies and methodological variations. As the social context may significantly influence leisure activity participation, it is interesting to explore how social contexts play a role in modulating the effects of leisure activity on cognitive function in older adults. HK and GZ are two major cities in southern China, and they share very similar ethnic, genetic, health and demographic characteristics. However, owing to differences in historical development, the two cities have been run with different social systems over the past few decades. This provided a natural case-control experiment for studying the effect of the social context on cognition. Hence, this study examined the association between leisure activity participation and cognition in the two cities to evaluate the cognitive modulating effects of leisure activities in different social environments. / Objectives of the studies: The main study objectives were to compare the cognitive characteristics and leisure activity participation of the two groups; to examine the association between leisure activity participation and cognitive function and the specific associations in HK and GZ; and to explore the modulating effect of social factors on cognitive function. / Methodology: This was a cross-sectional study. Convenience sampling was used to recruit 557 participants aged 60 years and over without dementia. Of these, 260 were recruited in HK and 297 in GZ. The two groups were recruited with similar demographic characteristics (age, gender and education). Leisure activities were classified as physical, intellectual, social and recreational activities. Leisure activity participation was measured in terms of the total number and total hours of participation per week for each category of activities. A battery of cognitive tests including the Cantonese version of the Mini Mental State Exam (CMMSE), word list learning test, delayed recall test, Category Verbal Fluency Test (CVFT), trail making test, digit cancellation test and Stroop test were used to measure participants’ cognitive function. / Differences in the participants’ demographic characteristics, cognitive performances and leisure activity participation were computed. A multiple linear regression of cognitive performance on leisure activity was performed, while controlling for other categories of activities and potential confounders that were significantly associated with cognitive function. / Results: The multiple linear regression revealed that living arrangement had a significant positive association with the total number of leisure activities (p=0.01) and total hours of leisure activity participation (p=0.02). Analysis of covariance showed that participants in HK participated in more leisure activities than those in GZ, as measured by the total number of subtypes and hours per week, except total hours of recreational activities per week (p=0.07). No significant differences were found between the cognitive performances of the older persons in the two cities. Pearson’s correlation and x² tests were performed to identify the leisure activities and potential confounders that were significantly correlated with cognitive performance. The total number and total hours of intellectual activity were significantly correlated with CMMSE scores (p<0.001 and p<0.001).The total number of subtypes and total hours per week of intellectual activity (p<0.001 and p<0.001), social activity (p<0.001 and p<0.01) and recreational activity (p<0.001 and p<0.01) were significantly correlated with the word list learning test. The total number of physical activities (p<0.01), total number of intellectual activities (p<0.001) and total hours of intellectual activity (p<0.01) were significantly correlated with the delayed recall test. The total number of physical and intellectual activities (p<0.01 and p<0.001), and total hours of intellectual and social activity (p<0.01 and p<0.001) were correlated with the CVFT. The total number of intellectual activities (p<0.01)and total hours of recreational activity (p<0.01) were significantly correlated with the trail making test (p<0.001). The total number and total hours of intellectual activity were significantly correlated with the digit cancellation test (p<0.001 and p<0.001). The total number and total hours of intellectual activity were significantly correlation with the Stroop test (p<0.01 and p<0.001). / Multiple linear regression using the enter method was conducted to measure the association between leisure activities and cognitive performance. The results showed that the total number of intellectual activities was significantly associated with better performance on cognitive tests, including the CMMSE (p<0.001), word list learning test (p<0.001), delayed recall test (p<0.001), CVFT (p<0.001) and digit cancellation test (p=0.01). Total hours of recreational activity was significantly associated with the trail making test (p=0.01). Multiple linear regression using the enter method also revealed that marital status was significantly associated with the CMMSE (p=0.002), word list learning test (p=0.003), delayed recall test (p=0.002), trail making test (p<0.001) and digit cancellation test (p=0.01). / Conclusions: HK participants participated in more leisure activities than GZ participants. However, HK participants did not show better cognitive performance than GZ participants. This finding appears to be inconsistent with previous studies that found that participation in more leisure activities predicted better cognitive functioning. This inconsistency might be explained by socio-demographic differences between the two cities. Some previous studies have found an association between late-life marital status and the risk of cognitive impairment. Older persons who were unmarried or widowed were at higher risk of dementia or cognitive decline. There were more unmarried or widowed participants among HK participants. The results indicate that in addition to leisure activities, social factors (marital or living status) might also contribute to the preservation of cognitive function among the elderly. / Our results underscore the significance of intellectual activity, especially participation in a variety of intellectual activities, in maintaining better cognitive functioning in older persons. Furthermore, a similar significant association between intellectual activity and cognitive function was found for participants in both HK and GZ, suggesting that the protective effect of intellectual activity could be generalized to different social environments. We failed to find significant associations between physical, social and recreational activities and cognitive function. However, the protective effect of leisure activity participation is recommended for further investigation in future studies. / 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. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Su, Xiufang. / Thesis (Ph.D.) Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 88-94). / Abstracts also in Chinese; appendixes in Chinese.

O conhecimento de que o exercício é benéfico na doença aterosclerótica é baseado principalmente em estudos epidemiológicos. O objetivo deste trabalho foi investigar se o treinamento físico preventivo ou terapêutico altera a evolução da placa aterosclerótica. Camundongos LDLr-/- com 16 semanas de vida foram separados em dois programas: preventivo e terapêutico. Animais do programa preventivo receberam dieta normal ou aterogênica por 14 semanas. O treinamento físico foi iniciado concomitantemente ao início da dieta. Animais do programa terapêutico receberam dieta normal ou aterogênica por 28 semanas. O treinamento físico foi iniciado após 14 semanas do início da dieta, com placas bem estabelecidas. O treinamento físico aeróbico moderado foi realizado em esteira rolante, por 60 min, 5 dias/sem, durante 14 semanas. Massa corporal, pressão arterial caudal e freqüência cardíaca foram registradas. Lipoproteínas plasmáticas foram separadas por FPLC e colesterol total foi dosado por métodos enzimáticos. Foram quantificados tamanho, conteúdo de gordura e de colágeno da placa por coloração de oil-red O e picro-sirius. Citocinas TNF-, IL-6 foram medidas por Elisa. MMP-9 plasmática foi medida por zimografia. Marcadores inflamatórios teciduais, MMP-9, CD40/CD40L e nitrotirosina, foram medidos na placa por imunohistoquímica. O treinamento físico não modificou o tamanho da placa, mas tornou a placa mais estável por aumentar o conteúdo de colágeno. O treinamento físico diminuiu o conteúdo de gordura da placa, os fatores de risco e o CD40 somente no programa preventivo. Nenhuma alteração foi notada nos marcadores inflamatórios circulantes e na expressão de MMP-9 e formação de nitrotirosina na placa aterosclerótica. / The knowledge that exercise exerts beneficial effects on atherosclerotic disease is mainly based on epidemiological studies. Our aim was to investigate the effect of preventive and therapeutic exercise programs on atherosclerotic plaque formation and development. Sixteen-week-old LDLr-/- mice were randomly divided into preventive and therapeutic programs. Preventive programs mice received normal or atherogenic diet for 14 weeks. Exercise training started at the same time of dieting. Therapeutic programs mice received normal or atherogenic diet for 28 weeks. Exercise training started after 14 weeks of dieting when atherosclerosis plaques were already established. Moderate intensity aerobic exercise training was performed on a motor treadmill for 60 min, 5 days/wk, during 14 weeks. Body mass, caudal blood pressure and heart rate were registered. Plasma lipoproteins were separated by FPLC and total cholesterol was determined by enzymatic methods. Cross sections of aortic root were stained with oil-red O for plaque size and fat content. Aorta longitudinal sections were stained with picro-sirius for collagen content. TNF- and IL-6 cytokines were measured by Elisa. Plasmatic MMP-9 was determined by zimography. Inflammatory tissue markers, MMP-9, CD40/CD40L and nitrotirosine, were measured by immunohistochemistry. We concluded that exercise training did not modify plaque size, but turned it into a more stable one by increasing its collagen content. Exercise training reduced plaque fat content, risk factors and plaque CD40 expression only in the preventive program. No difference in systemic inflammatory markers, and in plaque MMP-9 expression and nitrotirosine formation was noted.

Thesis (M.S.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 56 pages. Includes bibliographical references.

Thesis (M.S.P.H.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 57 pages. Includes bibliographical references.

Thesis (M.A.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 55 pages. Includes bibliographical references.

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 107 pages. Includes vita. Includes bibliographical references.

Made available in DSpace on 2015-12-06T23:47:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2007 / O câncer de colo de útero é o mais comum entre as mulheres no mundo. No Brasil, estima-se que seja a terceira neoplasia maligna encontrada entre mulheres. Pode ser prevenido se for detectado precocemente, há necessidade de sua conscientização por meio da educação em saúde, que pode auxiliar as mulheres a terem maior autonomia sobre seu corpo e saúde. Com o propósito de contribuir para a melhoria na promoção da saúde de mulher, este trabalho teve o objetivo de construir e validar material educativo com orientações passo a passo sobre a importância e realização do exame de Papanicolaou para usuárias de serviços públicos de saúde da cidade de São Paulo/Brasil. Trata-se de pesquisa descritiva, exploratória e observacional que se propôs construir um folder com orientações para prevenção do câncer cérvico-uterino para mulheres, tendo como referencial teórico a educação de adultos. Sua construção foi realizada com as mulheres, utilizando-se linguagem e desenhos de fácil compreensão. Foi avaliado por oito profissionais especialistas na área. Realizadas as modificações sugeridas, ele foi reproduzido e validado por 96 usuárias de unidades básicas de saúde da cidade de São Paulo. Os resultados da validação revelam que as mulheres consideraram por unanimidade o texto interessante com frases de fácil compreensão, ilustrações simples que facilitaram seu entendimento. A grande maioria teve o interesse em ler o folder até o final que as fez repensar sobre sua saúde. As mulheres expressaram a boa qualidade do material, verbalizando o interesse em levá- lo para casa. Concluiu-se que o material educativo construído e validado poderá colaborar na produção do conhecimento das mulheres que freqüentam unidades de saúde e contribuir para o recrutamento da população para realização desse exame simples e indispensável para prevenção do câncer cérvico-uterino com o objetivo de contribuir para diminuição dos índices de morbimortalidade feminino por câncer. / The cancer of the cervix of the uterus is the most common among the women in the world. In Brazil, it is supposed to be the third malignant neoplasia found among women. It can be prevented if detected precociously. It is necessary to aware people through health education so that it can help women to be more autonomous concerning their body and health. With the purpose of contributing to improvement in women health promotion, this paper had the aim of building and validating educational material with step by step orientations about the importance and accomplishment of Papanicolaou exam to public health service users of São Paulo city in Brazil. It is a descriptive, exploratory and observational research with the purpose of developing a folder with orientation about the cancer of the uterine cervix to women, having as theoretical reference the adults' education. Its production was done with women, using language and drawings easily understood. It was analyzed by eight specialists in the area. After the proper changes, the folder was printed and validated by 96 users of the basic health units of São Paulo city. The results of acceptance reveal that all the women considered the text interesting with easy understandable sentences and simple illustration which helped their comprehension. The majority was interested in reading the text until the end which made them to rethink their health. The women expressed the good quality of the material when they said they were interested in taking it home. It was concluded that the educational material produced and validated will be able to help in the knowledge production of women that usually go to health public bases and contribute to the population recruiting and accomplishment of this simple and indispensable exam to uterine cervical cancer that must help a lot to minimize the female diseases and mortality rates by cancer. / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2014-06-11T19:33:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-03-07Bitstream added on 2014-06-13T21:05:40Z : No. of bitstreams: 1 brighenti_fl_dr_araca.pdf: 927914 bytes, checksum: df4ad06d38d262a61b9312138e94b9a9 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Produtos naturais têm sido estudados com relação ao controle químico da microbiota patogênica do biofilme bucal. O objetivo desse estudo foi esclarecer o efeito do extrato da folha de Psidium cattleianum no metabolismo de S. mutans, no biofilme formado in situ e na capacidade em inibir a desmineralização do esmalte. O extrato foi obtido por decocção das folhas em água deionizada. O efeito do extrato foi avaliado in vitro com relação à viabilidade, expressão protéica e produção de ácido de biofilmes de S. mutans. No estudo in situ, blocos de esmalte bovino foram fixados em dispositivos acrílicos palatinos de dez voluntários. A fase experimental consistiu de três etapas de 14 dias cada, separadas por intervalo de sete dias. Os voluntários gotejaram solução de sacarose 20% (8x/dia) e a solução de tratamento (água, extrato ou um enxaguatório comercial; 2x/dia). O biofilme dentário foi analisado quanto à acidogenicidade, quantidade microorganismos e presença de polissacarídeos álcali-solúveis. Nos blocos de esmalte, foram realizadas as análises de microdureza superficial e em secção longitudinal. O extrato foi capaz de afetar a viabilidade, a produção de ácidos e a síntese protéica do biofilme formado in vitro. No biofilme formado in situ, o extrato foi capaz de diminuir a queda do pH, o acúmulo de microorganismos, a formação de polissacarídeos extracelulares e a desmineralização do esmalte. Conclui-se que o extrato foi capaz de diminuir a expressão de proteínas envolvidas no metabolismo bacteriano, a patogenicidade do biofilme bucal e a desmineralização do esmalte in situ. / Natural products have been studied with relation to chemical control of pathogenical microorganisms of dental biofilm. The aim of this study was to clarify the effect of Psidium cattleianum leaf extract on S. mutans metabolism, on in situ biofilms and on enamel demineralization. The extract was obtained by decoction in deionized water. The extract was studied in vitro with relation to viability, protein expression and acid production of S. mutans biofilms. On the in situ study, enamel bovine blocks were placed in palatal appliances of ten volunteers. The experimental phase consisted of three stages with a duration of 14 days each and a washout period of seven days. The volunteers dripped 20% sucrose (8x/day) and the treatment solution (water, extract or a marketed mouthwash – 2x/day) on the enamel blocks. The dental biofilm was analyzed regarding the amount of microorganisms and presence of alkalisoluble polysaccharides. On the enamel blocks, surface and cross-sectional microhardnessess were evaluated. The extract was able to affect the viability, acid production and protein synthesis of the in vitro biofilm. On the in situ biofilm, the extract was able to decrease pH drop, microorganism accumulation, extracellular polysaccharides formation and enamel demineralization. It can be concluded that the extract was able to reduce the expression of proteins involved on bacterial metabolism, the pathogenicity of dental biofilm and in situ enamel demineralization.