Background / Hand, foot, and mouth disease (HFMD), in particular those associated with enterovirus 71 (EV71), has caused large outbreaks in the Western Pacific and Southeast Asian countries in the past three decades. There is currently no effective chemoprophylaxis or vaccination for HFMD or EV71 infection. Public health strategies rest on good understanding of the epidemiological features of HFMD. The present series of studies examined the epidemiological characteristics of HFMD in Hong Kong, with a view to better understand the disease epidemiology so as to guide public health actions. / Methods and results of individual studies / Study (1)--characterizing the changing epidemiological features identified from various surveillance systems for HFMD / The trend of HFMD activities from 2001-2009 was analyzed using the sentinel surveillance statistics and HFMD outbreaks. The type of institutions reporting HFMD over time, incidences of outbreaks in 18 districts, and age and sex distribution of affected persons of HFMD outbreaks were analyzed. The clinical presentation, hospitalization rate, complication rate and case fatality of outbreaks were examined. The circulating enterovirues each year were determined by laboratory surveillance findings from 2001-2009 and test for morbidity caused by EV71. Seasonal peak was detected from warmer months of May through July but a smaller winter peak was found from October to December since 2006. An increasing trend of more older children aged above 5 years were infected, from 25.4% in 2001 to 33.0% in 2009 (p=0.01, Mantel-Haenszel Chi-square test). Laboratory surveillance detected a cyclical high activity of EV71 in every 3 to 4 years, which was associated with a higher average hospitalization rate among patients of the HFMD outbreaks reported in corresponding year, although it was only marginally significant (p=0.09, linear regression test). / Study (2)--analyzing the characteristics of EV71 epidemic in 2008 / All EV71 cases diagnosed by PHLC from 1998-2008 were analyzed. The complication and case fatality rates, percentage requiring hospitalization, median duration of hospital care, and the likelihood of being associated with an HMFD outbreak in institution in 2008 were compared with the corresponding rates calculated from cases reported from 1998-2007. Phylogenetic tree was constructed by using the neighbour-joining method and the molecular epidemiology of EV71 detected in 2008 was compared with the past years’ trends. Ninety-eight EV71 cases were reported in 2008, highest in the past decade. The annual incidence was 1.4/100 000 in general population, with highest incidence reported in children aged 0-4 years old (27.9/100 000). 11.2% had complications including meningitis or encephalitis (6.1%), pneumonia (3.1%), acute flaccid paralysis (1.0%), and shock (1.0%). There was only one fatal case (CFR: 1.0%) attributed to interstitial pneumonitis. 45.9% had concurrent HFMD outbreaks in their schools or institutions, and six schools required temporarily class suspension for 14 days. Both the complication rate and CFR werenot significantly different from the corresponding rates of the past 10 years (p=0.12 and 1.00 respectively). Phylogenetic analysis found that most cases reported in 2008 were C4 strains, which were the predominant circulating strains in the past ten years. / Study (3)--examining the association between meteorological parameters and HFMD activity / The sentinel consultation rate of HFMD was tested for any association with the meteorological parameters obtained from the Hong Kong Observatory from 2000-2004. Different regression models were examined to find the best model for predicting HFMD consultation rates from 2005-2009. In multivariate regression analysis, model M2 (in which mean temperature, diurnal difference in temperature, relative humidity and wind speed were positively associated with HFMD) was found to have a higher R2 (0.119) than M0 and M1 models with an R2 of 0.079 and 0.062 respectively, indicating that HFMD consultation rates were better explained using meteorological parameters measured 2 weeks earlier. The predicted trend of HFMD consultation rates for 2005 to 2009 matched well with the observed one (Spearman’s rank correlation coefficient=0.276, P=0.000). Sensitivity analysis showed that the estimated HFMD consultation rates were mostly affected by varying the relative humidity and least affected by wind speed. / Study (4)--determining the basic reproduction number of coxsackievirus A16 and enterovirus 71 using mathematical model / The basic reproduction numbers (R0) of EV71 and CoxA16 from laboratory confirmed HFMD outbreaks reported to DH from 2004-2009 were determined using mathematical model. Thirty four outbreaks were analyzed, 27 due to CoxA16 and seven due to EV71. The median R0 of EV71 was 5.48 with an inter-quartile range of 4.206.51 while median R0 of CoxA16 was 2.50 with an inter-quartile range of 1.963.67. In the sensitivity analysis, R0 of EV71 was significantly higher than that of CoxA16 in whole range of incubation periods, p≦0.025. R0was not associated with outbreak setting, size of the institution or number of persons affected. / Study (5)--assessing the impact of SARS and pandemic influenza H1N1 on transmission of HFMD in Hong Kong / I compared the observed HFMD consultation rates and the projected rates, which were constructed using mathematical model, in defined periods of 2003 and 2009 during which territory-wide public health interventions (including school closure) against Severe Acute Respiratory Syndrome (SARS) and pandemic influenza H1N1 were implemented. There was a reduction of 57.2% (95% C.I.:53.0-60.7%) in observed HFMD consultation rates during SARS period in 2003 and a reduction of 26.7% (95% C.I.:19.5-32.7%) during pandemic influenza H1N1 period in 2009. In 2003, the projected rates were still lower than the observed rates beyond week 31 until almost the end of the year. On the contrary, in 2009, the observed HFMD consultation rates became comparable to that of the projected rates in August, before the end of the defined intervention period. / Conclusions / This thesis bridges the knowledge gaps regarding epidemiological characteristics of HFMD. The changing epidemiology of HFMD, including the cyclical high activity of EV71 warrants vigilant surveillance of its activity in order to guide preventive measures. I have demonstrated that climate parameters may help predict HFMD activity, which could assist in explaining the winter peak detected in recent years and issuing early warning in the future. The R0 of EV71 and CoxA16 were first determined in the literature and I found that R0 of EV71 was higher than R0 of CoxA16. The reduction of transmission of HFMD during the SARS and H1N1 periods suggested that public health measures are effective in reducing the transmission of enteroviruses. / Ma, Siu Keung. / Thesis (M.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 121-149). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Table of content --- p.ii / Acknowledgements --- p.iv / Abbreviations --- p.v / Caption for Tables --- p.vi / Caption for Figures --- p.viii / Précis --- p.1 / Chapter PART I: --- LITERATURE REVIEW ON HFMD --- p.5 / Chapter Chapter 1. --- Current Understanding of Epidemiology of HFMD --- p.6 / Chapter 1.1 --- Causative agents and virology --- p.6 / Chapter 1.2 --- Clinical presentation and management --- p.8 / Chapter 1.3 --- Geographical distribution and past epidemics --- p.14 / Chapter 1.4 --- Host susceptibility and molecular determinants of neruovirulence --- p.26 / Chapter 1.5 --- Routes of transmission and transmission dynamics --- p.27 / Chapter 1.6 --- Knowledge gap identified from literature review --- p.29 / Chapter PART II: --- STUDIES ON EPIDEMIOLOGY OF HFMD IN HONG KONG --- p.33 / Chapter Chapter 2. --- Study Objectives and Main data source for analysis --- p.34 / Chapter 2.1 --- Aim and objectives of this thesis --- p.34 / Chapter 2.2 --- Sentinel surveillance system for monitoring HFMD activity --- p.35 / Chapter 2.3 --- Institutional outbreaks of HFMD reported to DH . --- p.37 / Chapter 2.4 --- EV 71 infection reported to Department of Health --- p.37 / Chapter 2.5 --- Laboratory surveillance for monitoring enteroviruses --- p.37 / Chapter Chapter 3. --- Study (1)--Characterizing the changing epidemiological features identified from various surveillance systems for HFMD --- p.38 / Chapter Chapter 4. --- Study (2)--Analyzing the epidemic of enterovirus 71 in 2008 and its public health implication to Hong Kong --- p.52 / Chapter Chapter 5. --- Study (3)--Examining the association between meteorological parameters and HFMD activity --- p.67 / Chapter Chapter 6. --- Study (4)--Determining the basic reproduction number of coxsackievirus A16 and enterovirus 71 using mathematical model --- p.85 / Chapter Chapter 7. --- Study (5)--Impact of SARS and Pandemic Influenza H1N1 on transmission of HFMD in Hong Kong --- p.100 / Chapter Chapter 8. --- Conclusion --- p.111 / List of publications related to this thesis --- p.119 / References --- p.121

A model was developed in this study to understand women's cervical screening behaviour. It revealed that the interaction among institutional factors, risk appraisal, coping appraisal, and health beliefs and cultural factors contributed to the complex nature of screening behaviour among Chinese women. The institutional component provided the contextual factors within which women perceived the risk of cervical cancer, perceived the practice of cervical screening, and decided to take or not to take cervical screening. Risk appraisal provided the premise factor that induces women to seek coping strategies to reduce or remove the risk. During the process of coping appraisal, women's motivation to have cervical screening could be increased or decreased as the perceived benefits and costs of screening interacted with each other. The importance of the women's health beliefs and cultural factors was reflected in the way that they were affected by their notions of health behaviour and their cultural beliefs about cervical cancer risk and cervical screening participation. Commitment to participate in screening was a reinforcing factor inducing women to take up an offer of cervical screening. / Aim: To explore the knowledge and the perception of the risk of cervical cancer, identify the factors determining cervical screening behaviour, and develop a model to understand cervical screening behaviour among women in mainland China. / Background: Cervical cancer is the most common type of cancer, and is the second most common cause of cancer death in women in mainland China. Cervical screening is the most important intervention for the secondary prevention of cervical cancer. Theories of health behaviour and empirical research highlight risk perception as a significant factor motivating people to opt for cancer screening. However, little is known about the risk perception of cervical cancer and the factors influencing the screening participation of women in mainland China. / Conclusion: This study provides evidence of the complex factors influencing cervical screening behaviour and contributes new knowledge to the understanding of cervical screening behaviour within the Chinese cultural context. It further informs programmes for the promotion of cervical screening among this population. / Methods: A mixed method design consisting of two phases was used, employing both quantitative and qualitative methods of data collection. First, a cross-sectional survey was conducted to collect a baseline assessment of women's knowledge of cervical cancer and screening, their perceptions of the risk of cervical cancer, and the relationship between these factors and their cervical screening behaviour. Findings from this phase also guided the purposive sampling of participants in phase two. / Results: The findings from phase one demonstrated that the availability of an organized screening programme was a major motivator for women to opt for cervical screening. Multivariate analysis shows that having children (OR=2.57, p=0.026), a perception that visiting doctors regularly is important for health (OR-2.66, p=0.025), average (OR-4.84, 1)=0.006) and high levels of knowledge about cervical screening (OR-9.66, p=0.001) were significantly associated with having been screened in the previous three years. / Then in phase two, qualitative research was conducted using semi-structured interviews of 27 women, 16 of whom had been screened and 11 had not. The interview structure was based on an initial analysis of the data from phase one and from a review of the related literature. The data from the interviews were analyzed using latent content analysis, involving an interpretative reading of the symbolism underlying the surface structure in the text. The audio recordings of the interviews were transcribed verbatim in Chinese, and then the key phrases which were important for the objectives of the study were identified. The key phrases and words were grouped according to their commonality of meaning. Then, these groups of data were sorted and classified to create categories and sub-categories, which were mutually exclusive, explicit and accurate without overlapping. / Two themes emerged from the qualitative data from phase two. Theme I was that perceptions of cervical cancer and cervical screening included five categories: the perceived effects of suffering from cervical cancer; the perception of cervical screening; a lack of understanding about cervical cancer and screening; the perceived risk of cervical cancer; and factors related to the cultural beliefs system. Theme II was that the institutional and health care practitioner system included two categories: availability of an organised physical examination programme and the role of the health care practitioner in encouraging cervical screening utilization. / Gu, Can. / Adviser: Chan, Carmen. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 244-267). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Sea Man Mei. / "September 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 194-218). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest dissertations and theses, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Conclusion. The significance of risk perception in predicting behavioral intention, hence actual future behaviors, is therefore evident. Conditional measures need to be used. HIV prevention can employ conditional risk perception approaches. Health behavioral theories can be strengthened by using such conditional measures on risk perceptions. The results add to this new and growing area of risk behavior research. / Introduction. Risk perception, a core element of key health behavioral theories and health interventions, is assumed to motivate people to avoid risk behaviors. Mixed findings however prevail in the literature due to methodological issues. Many of such studies are cross-sectional, using global risk perception measures that do not condition on type of risk behavior or partnership which may affect the level of risk. / Male injecting drug users (IDU) are driving the HIV epidemic in China and bridge HIV transmission to non-IDU female populations; they may be at risk of both unprotected sex and syringe sharing. HIV prevention targeting male IDU is greatly warranted and would benefit from understanding of the relationships between risk perceptions and behaviors, in the context of health behavioral theories such as the Health Action Process Approach (HAPA) model, which had not been applied to studies targeting IDU. / Objectives. This study refined the concepts and measures of HIV-related risk perception, conditioning on different types of behaviors and partners, and extended it to include others-directed risk perceptions. The relationship between such conditional risk perception measures and both prior risk behaviors and behavioral intention to avoid sex-related and drug-related risk behaviors in the future were investigated and were compared to those involving global unconditional risk perception measures. The nature of the aforementioned relationships, being motivational or reflective was investigated. A longitudinal component validated the predictive power of behavioral intention over actual future behaviors. / Results. Almost 90% of the respondents had had unprotected sex though <20% shared syringes with others in the last 6 months. Prior syringe sharing but not unprotected sex in the last 6 months was significantly associated with global unconditional risk perception measures. The picture is totally different when risk perception measures conditioned on type of sex partner and unprotected sex or syringe sharing were used instead of the global measures---higher levels of the conditional risk perception measures were significantly associated with higher levels of behavioral intention for consistent condom use and avoidance of syringe sharing, thus supporting the motivational hypothesis. Conditional others-directed risk perceptions (perceived risk of transmitting HIV to others via unprotected sex and syringe sharing) were also associated with the aforementioned behavioral intentions to avoid risk behaviors. A pilot longitudinal study showed that behavioral intentions strongly predict actual future behaviors. Other HAPA-based variables such as self-efficacy and outcome expectancies had predictive effects on behavioral intentions, independent from those of risk perceptions. / Subjects and methods. A total of 456 sexually active male IDU were recruited from Dazhou, Sichuan and Hengyang, Hunan, via snowball sampling. With informed consent, anonymous face-to-face interviews were conducted by trained and experienced staff of the local CDC in privacy settings. / Tsui, Hi Yi. / Adviser: Joseph Lau. / Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 118-130). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendix in Chinese.

Chan, Yun Kwan. / Accompanying CD-ROM contains appendix H, I, J, and K. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 161-170). / Abstracts in English and Chinese; three appendixes in Chinese only. / Library's copy: lacks accompanying CD-ROM. / Acknowledgement --- p.i / Abstract --- p.ii / Abstract (Chinese) --- p.iv / List of publications --- p.vi / Table of Contents --- p.viii / List of Figures --- p.xvi / List of Tables --- p.xvii / List of Abbreviations --- p.xxv / Chapter CHAPTER ONE: --- INTRODUCTION --- p.1 / Chapter 1.1 --- Global prevalence of childhood overweight --- p.1 / Chapter 1.2 --- Preschool health situation in HK --- p.2 / Chapter 1.2.1 --- Breastfeeding --- p.2 / Chapter 1.2.2 --- Diet and physical activity patterns --- p.3 / Chapter 1.2.3 --- Prevalence of childhood overweight --- p.5 / Chapter 1.2.3.1 --- Definition of childhood overweight --- p.5 / Chapter 1.2.3.2 --- Local prevalence of childhood overweight --- p.6 / Chapter 1.3 --- Consequences of childhood overweight --- p.7 / Chapter 1.3.1 --- Health consequences of childhood overweight --- p.7 / Chapter 1.3.2 --- Economic consequences of childhood overweight --- p.9 / Chapter 1.4 --- Risk factors of childhood overweight and obesity --- p.11 / Chapter 1.4.1 --- Family Socioeconomic status --- p.11 / Chapter 1.4.2 --- Parental overweight --- p.11 / Chapter 1.4.3 --- Breastfeeding --- p.12 / Chapter 1.4.4 --- Birth order --- p.13 / Chapter 1.4.5 --- Breakfast consumption --- p.13 / Chapter 1.4.6 --- Beverage consumption --- p.14 / Chapter 1.4.7 --- High calcium intake --- p.15 / Chapter 1.4.8 --- Fruit and vegetable consumption --- p.15 / Chapter 1.4.9 --- Physical inactivity --- p.15 / Chapter 1.4.9.1 --- Physical activity recommendations for preschoolers --- p.17 / Chapter 1.4.9.2 --- Screentime recommendations for preschoolers --- p.18 / Chapter 1.5 --- Child development --- p.18 / Chapter 1.5.1 --- Onset of overweight --- p.18 / Chapter 1.5.2 --- Early establishment of lifelong habits at preschool age --- p.19 / Chapter 1.5.3 --- Interaction with parents --- p.20 / Chapter 1.6 --- Justification of preschool multi-component health intervention in Hong Kong --- p.22 / Chapter 1.6.1 --- Local health promotion initiative at preschool --- p.22 / Chapter 1.6.2 --- Justification for DRAGON2006 modifications --- p.23 / Chapter 1.6.2.1 --- Inclusion of family-home component in school- based health intervention --- p.24 / Chapter 1.6.2.2 --- Child BMI monitoring and health report to parents --- p.24 / Chapter 1.7 --- Present school-based preschool health intervention --- p.25 / Chapter 1.8 --- Summary --- p.27 / Chapter 1.9 --- Aims and objectives --- p.27 / Chapter CHAPTER TWO: --- METHODOLOGY --- p.28 / Chapter 2.1 --- Recruitment of preschools and preschoolers --- p.28 / Chapter 2.2 --- Development of DRAGON2006 --- p.33 / Chapter 2.2.1 --- Ethics approval --- p.35 / Chapter 2.2.2 --- Focus groups with parents --- p.35 / Chapter 2.2.3 --- Amendment and pretest of the questionnaires --- p.35 / Chapter 2.2.4 --- Health lessons --- p.36 / Chapter 2.2.4.1 --- Development and adaptation of the health lessons --- p.36 / Chapter 2.2.4.2 --- Improvement of the teaching materials --- p.37 / Chapter 2.2.4.3 --- Lyrics reproduction and CD production --- p.37 / Chapter 2.2.4.4 --- Worksheets --- p.38 / Chapter 2.2.4.5 --- Process evaluation --- p.38 / Chapter 2.2.5 --- Teachers´ة training --- p.38 / Chapter 2.3 --- Intervention Activities and Components --- p.39 / Chapter 2.3.1 --- Opening ceremony --- p.39 / Chapter 2.3.2 --- Health Talks --- p.40 / Chapter 2.3.3 --- Health report --- p.40 / Chapter 2.3.4 --- Parental newsletters --- p.41 / Chapter 2.4 --- Outcome evaluation --- p.42 / Chapter 2.5 --- Data collection --- p.43 / Chapter 2.5.1 --- Recruitment of subjects --- p.43 / Chapter 2.5.2 --- Anthropometric measurements --- p.43 / Chapter 2.5.3 --- Parental baseline and evaluation questionnaire administration --- p.44 / Chapter 2.5.4 --- Teachers´ة pre- and post-intervention evaluation and process evaluation --- p.44 / Chapter 2.6 --- Data management --- p.44 / Chapter 2.6.1 --- Verification of data from the questionnaires --- p.44 / Chapter 2.6.2 --- Data coding --- p.45 / Chapter 2.6.3 --- Data entry and verification --- p.45 / Chapter 2.6.4 --- Data analysis --- p.45 / Chapter 2.5.4.1 --- Descriptive and association analysis --- p.45 / Chapter 2.5.4.2 --- Construction of BMI-for-age percentile and z- score curves --- p.46 / Chapter 2.5.4.3 --- Evaluation of the effectiveness of the program --- p.47 / Chapter CHAPTER THREE: --- RESULTS --- p.48 / Chapter 3.1 --- Organization of the results --- p.48 / Chapter 3.2 --- Baseline comparability between the EG and CG --- p.48 / Chapter 3.2.1 --- General sociodemographic characteristics --- p.48 / Chapter 3.2.2 --- Preschoolers' diet and meal behaviors --- p.54 / Chapter 3.2.3 --- Preschoolers´ة dental health --- p.61 / Chapter 3.2.4 --- Parental child feeding behaviors --- p.62 / Chapter 3.2.5 --- Preschoolers´ة physical activity and sedentary behaviors --- p.66 / Chapter 3.2.6 --- Summary --- p.67 / Chapter 3.3 --- Baseline comparability between the completes and dropouts --- p.69 / Chapter 3.3.1 --- Participant flow in the EG and CG --- p.69 / Chapter 3.3.2 --- General sociodemographic characteristics --- p.70 / Chapter 3.3.3 --- "Preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.74 / Chapter 3.3.4 --- Summary --- p.75 / Chapter 3.4. --- Evaluation of the effectiveness of the DRAGON2006 --- p.76 / Chapter 3.4.1 --- General demographic characteristics --- p.76 / Chapter 3.4.2 --- Effects on preschoolers´ة anthropometry and weight status --- p.77 / Chapter 3.4.3 --- Effects on preschoolers' diet and meal behaviors --- p.79 / Chapter 3.4.4 --- Effects on parental child feeding behaviors --- p.89 / Chapter 3.4.5 --- Effects on preschoolers´ة physical and sedentary activities --- p.92 / Chapter 3.4.6 --- Summary --- p.94 / Chapter 3.5 --- "Teaching staff members´ة attitudes, perceptions and practices with respect to addressing childhood overweight" --- p.95 / Chapter 3.5.1 --- General demographic characteristics --- p.95 / Chapter 3.5.2 --- Teachers' attitude toward addressing childhood overweight --- p.98 / Chapter 3.5.3 --- Teachers' behaviors toward addressing childhood overweight --- p.99 / Chapter 3.5.4 --- Teachers' perceived abilities to deal with some childhood overweight topics --- p.100 / Chapter 3.5.5 --- Teachers´ة reported helpful factors to implementing a new preschool health program --- p.101 / Chapter 3.5.6 --- Teachers´ة reported helpful factors for and barriers to parents´ة participation --- p.102 / Chapter 3.5.7 --- Comparisons between staff with and without self-reported weight and height --- p.103 / Chapter 3.5.8 --- Summary --- p.105 / Chapter 3.6 --- EG teachers´ة evaluation of the program --- p.106 / Chapter 3.6.1 --- Teachers' perception of DRAGON2006 program before the intervention --- p.106 / Chapter 3.6.2 --- DRAGON teachers´ة process evaluation of the DRAGON2006 curriculum --- p.113 / Chapter 3.6.3 --- DRAGON teachers´ة evaluation of DRAGON2006 program after the intervention --- p.118 / Chapter CHAPTER FOUR: --- DISCUSSION --- p.127 / Chapter 4.1 --- "Baseline findings about the preschoolers' weight status, diet, meal and physical and sedentary activity situation" --- p.127 / Chapter 4.1.1 --- Preschooler and parental overweight and obesity --- p.127 / Chapter 4.1.2 --- Preschoolers´ة diet and meal behaviors --- p.128 / Chapter 4.1.3 --- Preschoolers´ة physical and sedentary activity behaviors --- p.130 / Chapter 4.2 --- "Gender associations with preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.131 / Chapter 4.2.1 --- Gender associations with preschoolers´ة diet and meal behaviors --- p.132 / Chapter 4.2.2 --- Gender associations with parental child feeding behaviors --- p.134 / Chapter 4.2.3 --- Gender associations with preschoolers´ة physical and sedentary activity behaviors --- p.135 / Chapter 4.3 --- "Age associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.136 / Chapter 4.3.1 --- Preschoolers' age associations with their anthropometry --- p.137 / Chapter 4.3.2 --- Preschoolers´ة age associations with their diet and meal behaviors --- p.137 / Chapter 4.3.3 --- Preschoolers' age associations with their dental health --- p.139 / Chapter 4.3.4 --- Preschoolers´ة age associations with parental child feeding behaviors --- p.139 / Chapter 4.3.5 --- Preschoolers´ة age associations with their physical and sedentary activity behaviors --- p.140 / Chapter 4.4 --- "Family income associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.141 / Chapter 4.4.1 --- Family income associations with some general demographic characteristics of the sample --- p.143 / Chapter 4.4.2 --- Family income associations with preschoolers´ة diet and meal behaviors --- p.144 / Chapter 4.4.3 --- Family income associations with parental child feeding behaviors --- p.147 / Chapter 4.4.4 --- Family income associations with preschoolers' physical and sedentary activity behaviors --- p.148 / Chapter 4.5 --- Factors associated with preschool overweight and obesity --- p.148 / Chapter 4.5.1 --- Preschooler overweight and obesity associations with some general demographic characteristics of the baseline participants --- p.149 / Chapter 4.5.2 --- Preschooler overweight and obesity associations with parental overweight and obesity --- p.150 / Chapter 4.5.3 --- Preschooler overweight and obesity associations with preschoolers' meal behaviors --- p.150 / Chapter 4.5.4 --- Preschooler overweight and obesity associations with their physical and sedentary activity behaviors --- p.150 / Chapter 4.6 --- The evaluation of the effectiveness of DRAGON2006 --- p.151 / Chapter 4.6.1 --- Baseline comparison between the education (EG) and control group (CG) --- p.151 / Chapter 4.6.2 --- Baseline comparison between completers and dropouts --- p.151 / Chapter 4.6.3 --- Follow up comparison between the education (EG) and control groups (CG) --- p.152 / Chapter 4.6.3.1 --- The changes in preschooler anthropometry --- p.153 / Chapter 4.6.3.2 --- The changes in preschooler diet and meal behaviors --- p.154 / Chapter 4.6.3.3 --- The changes in preschooler physical and sedentary activity behaviors --- p.155 / Chapter 4.6.3.4 --- Parental child feeding behaviors --- p.156 / Chapter 4.7 --- The teachers´ة evaluation results of DRAGON2006 and of Color Me Healthy --- p.156 / Chapter 4.7 --- Strengths and limitations of the study --- p.157 / Chapter 4.8 --- Suggestions for improvement of DRAGON --- p.159 / Chapter CHAPTER FIVE: --- CONCLUSION --- p.160 / References --- p.161 / Appendices / Chapter AI --- Invitation letter for preschool (English) --- p.171 / Chapter AIII --- Invitation letter for preschool (Chinese) --- p.172 / Chapter AIII --- Invitation letter for CG preschool (Chinese only) --- p.173 / Chapter BI --- Research proposal (English) --- p.174 / Chapter BII --- Research proposal (Chinese) --- p.178 / Chapter CI --- Purpose and structure of DRAGON2006 health lessons (English) --- p.181 / Chapter CII --- Purpose and structure of DRAGON2006 health lessons (Chinese) --- p.185 / Chapter DI --- Teacher evaluation Part A (pre-intervention) (English) --- p.189 / Chapter DII --- Teacher evaluation Part A (pre-intervention) (Chinese) --- p.191 / Chapter EI --- Teacher evaluation Part B (process evaluation) (English) --- p.193 / Chapter EII --- Teacher evaluation Part B (process evaluation) (Chinese) --- p.205 / Chapter FI --- Teacher evaluation Part C (post-intervention) (English) --- p.218 / Chapter FII --- Teacher evaluation Part C (post-intervention) (Chinese) --- p.222 / Chapter GI --- Child health report (English) --- p.224 / Chapter GII --- Child health report (Chinese) --- p.226 / Chapter H --- Teaching kit --- p.228 / Chapter I --- Music sound track --- p.228 / Chapter J --- Curriculum worksheets (Chinese only) --- p.228 / Chapter K --- Parents´ة newsletters (Chinese only) --- p.228 / Chapter LI --- Focus group study questions (English) --- p.229 / Chapter LII --- Focus group study questions (Chinese) --- p.231 / Chapter MI --- Consent form for EG parents (English) --- p.233 / Chapter MII --- Consent form for EG parents (Chinese) --- p.235 / Chapter MII --- Consent form for CG parents (English) --- p.237 / Chapter MI --- Consent form for CG parents (Chinese) --- p.238 / Chapter NI --- Pre-internvetion parental questionnaire (English) --- p.239 / Chapter NII --- Pre-intervention parental questionnaire (Chinese) --- p.245 / Chapter OI --- Post-intervention parental questionnaire (English) --- p.250 / Chapter OII --- Post-internvetion parental questionnaire (Chinese) --- p.256 / Chapter PI --- Post-intervention staff survey (English) --- p.262 / Chapter PII --- Post-intervention staff survey (Chinese) --- p.264 / Chapter Q --- "Gender differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.266 / Chapter R --- "Age differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.296 / Chapter S --- "Income differences in preschoolers' diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.313 / Chapter T --- Factors associated with preschooler weight status --- p.334 / Chapter U --- "Maternal education level differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.352 / Chapter V --- "Maternal birth place differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.374 / Chapter W --- Test-retest reliability of DRAGON2006 questionnaire --- p.394

Chong, Ka Chun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 125-141). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

INTRODUÇÃO: Em 1999 e 2000, a ocorrência de surtos de rubéola, com maior acometimento entre adultos jovens, refletiu no aumento da síndrome da rubéola congênita. Como estratégia de controle da doença, foram realizadas campanhas de vacinação contra a rubéola em mulheres em idade fértil em vários Estados do País. Em razão das controvérsias existentes na literatura geradas quanto ao emprego da vacina de vírus vivos atenuados em gestantes, não se recomendou sua utilização durante a gravidez e até um mês após a aplicação da vacina. No entanto, 6.473 mulheres foram inadvertidamente vacinadas no Estado de São Paulo, sendo encaminhadas a serviços de referência para acompanhamento dessas gestações, dentre eles, o HCFMUSP. OBJETIVO: Este estudo buscou descrever as características clínicas e epidemiológicas das gestantes atendidas no HCFMUSP e obter os resultados dessas gestações. MÉTODO: Foi realizado um estudo epidemiológico descritivo, utilizando-se como fonte de dados as notificações das gestantes inadvertidamente vacinadas contra a rubéola e atendidas no HCFMUSP entre novembro de 2001 a dezembro de 2002. Para obter o desfecho das gestações, utilizou-se a base de dados dos nascidos vivos do Município de São Paulo (SINASC). RESULTADOS: No HCMFUSP, foram atendidas e notificadas 409 gestantes. Destas, 49,1% foram vacinadas no primeiro mês de gravidez e 26,2% engravidaram até um mês após a vacinação. Em relação a condição sorológica durante o pré-natal, 16,9% das gestantes apresentaram sorologia reagente para rubéola. Do relacionamento com a base de dados do SINASC, foram localizados os dados do parto de 63,3% das gestantes, sendo detectadas duas malformações congênitas no SINASC e um abortamento, porém, não se pode atribuir estes resultados à vacina, pois, as sorologias das mães não permitem determinar se estas mulheres eram realmente suscetíveis. CONSIDERAÇÕES FINAIS: O estudo apresentou o fluxo de informação estabelecido frente a um evento inusitado. Além disso, o uso de bases de dados secundárias contribuiu para o aprimoramento dos dados coletados, resultando na melhora da qualidade das informações. Os Núcleos de Epidemiologia Hospitalar são fundamentais na articulação entre a equipe assistencial e o Sistema de Vigilância e colaboram para discussão na padronização de Sistemas de Informação para permitir melhor integração entre as informações geradas pelos Serviços de Saúde. / INTRODUCTION: In the years 1999 and 2000, rubella outbreaks reaching mostly young adults resulted in an increased number of cases of Congenital Rubella Syndrome in Brazil. State Vaccination Campaigns aiming at women at childbearing age were promoted around the country to control the disease, recommending that vaccination of pregnant women should be avoided and pregnancy should be postponed for at least a month after vaccination. Despite the recommendations, 6.473 pregnant women were accidentally vaccinated in the State of São Paulo and therefore sent to reference obstetrical services for prenatal care. A study was conducted to describe the cases assisted at the University of São Paulo, School of Medicine, General Hospital and notified to Public Health and also to obtain information on the pregnancy outcomes. METHODS: This descriptive epidemiological study used notification by the Hospital Epidemiology Service as source of information on pregnant women accidentally vaccinated against rubella that received care from November 2001 to December 2002 at the School of Medicine, General Hospital. The City of São Paulo Newborn Database was searched for pregnancy outcomes. RESULTS: Among the 409 notified cases, 49,1% were women accidentally vaccinated during fist trimester of pregnancy and 26,2% women that became pregnant within less than a month after vaccination. Positive serological tests were found in 16,9% of women during prenatal care. Newborn data base search yielded pregnancy outcome for 63,3%. The findings of 2 cases of Congenital Rubella Syndrome and 1miscarriage cannot be surely attributed to vaccination because immediate previous immunization status was unknown. CONCLUSIONS: The study described the information flow established for an unexpected adverse event and the use of secondary data to improve quality of information. Hospital Epidemiology Services have a fundamental role in connecting health assisting professionals to Public Surveillance Systems and in setting standards for information generated by Health Assistance.

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Det övergripande syftet med den här avhandlingen har varit att, inom området läkemedelsinformatik, studera utvecklingen av elektroniska stöd inom läkemedelsförskrivning; för klinisk praxis, uppföljning och forskning. Under århundraden har det handskrivna receptet varit det sätt, med vilket läkare förmedlat sina läkemedelsordinationer till apotekare, vilket också för patienten blivit en informationskälla för hur läkemedel ska användas för att göra bästa nytta. Nu genomgår receptet en förändring från pappersbaserat till elektroniskt meddelande och att anpassa en traditionell process till en ny elektronisk era innebär både möjligheter och utmaningar. Studierna som ingår i avhandlingen har visat att exponeringen av förskrivna läkemedel i en allmän befolkning har ökat under de senaste tre decennierna. Risken för potentiella interaktioner mellan läkemedel, varmed avses den risk som finns att olika läkemedel kan påverka varandras effekter och biverkningar, har också visat sig öka starkt desto fler läkemedel som används av en individ. Denna ökade samtidiga användning av flera olika läkemedel, så kallad polyfarmaci, medför att det finns en större anledning för förskrivare och farmacevter att uppmärksamma risken för potentiella interaktioner mellan läkemedel. De nyinrättade nationella receptregistren över uthämtad receptförskriven medicin bör användas bland annat för att upptäcka potentiella läkemedelsinteraktioner, såväl i vårdens utövning som inom läkemedelsepidemiologisk forskning. Den svenska läkemedelsförteckningen, som omfattar information om uthämtade receptförskrivna läkemedel för huvuddelen av den svenska befolkningen, bedöms ha en stor klinisk potential. Den enskilde individens historiska information om uthämtade läkemedel är tillgänglig för individen på Internet med hjälp av e-legitimation; även förskrivare och farmacevter på apotek kan ta del av informationen med den enskildes samtycke. Brist på tillgång till enhetliga och säkra autenticeringsmetoder inom hälso- och sjukvården kan dock fördröja tillgången på individuell läkemedelsinformation för förskrivare. I och med att de flesta recepten i Sverige nu skrivs och överförs elektroniskt är det viktigt att kvalitetsmässiga aspekter tas tillvara så att en iakttagen ökad risk för receptförskrivningsfel inte överförs i informationskedjan. Avhandlingens slutsats är att e-förskrivning, med kommunikation och användning av lagrad information om receptexpeditioner, möjliggör att läkemedelsbehandling som process kan följas och studeras på ett helt nytt / The thesis aimed to study the developments, in the area of pharmacoinformatics, of the electronic prescribing and dispensing processes of drugs - in medical praxis, follow-up, and research. For hundreds of years, the written prescription has been the method of choice for physicians to communicate decisions on drug therapy and for pharmacists to dispense medication. Successively the prescription has also become a source of information for the patient about how to use the medication to maximize its benefit. Currently, the medical prescription is at a transitional stage between paper and web, and to adapt a traditional process to the new electronic era offers both opportunities and challenges The studies in the thesis have shown that the exposure of prescribed drugs in the general population has increased considerably over three decades. The risk of receiving potentially interacting drugs was also strongly correlated to the concomitant use of multiple drugs, polypharmacy. The pronounced increase in polypharmacy over time constitutes a growing reason for prescribers and pharmacists to be aware of drug interactions. Still, there were relatively few severe potential drug interactions. Recently established national prescription registers should be evaluated for drug interaction vigilance, both clinically and epidemiologically. The Swedish National Pharmacy Register provides prescription dispensing information for the majority of the population. The medication history in the register may be accessed online to improve drug utilization, by registered individuals, prescribers, and pharmacists in a safe and secure way. Lack of widespread secure digital signatures in healthcare may delay general availability. With a relatively high prevalence of dispensed drugs in the population, the National Pharmacy Register seems justified in evaluating individual medication history. With a majority of prescriptions transferred as ePrescriptions, the detected increased risk for prescription errors warrants quality improvement, if the full potential of ePrescriptions is to be fulfilled. The main conclusion of the studies was that ePrescribing with communication of prescribed drug information, storing and retrieving dispensed drug information, offers new opportunities for clinical and scientific

Vinte e seis pacientes com cardiomiopatia hipertrófica e fatores de risco de morte súbita, foram submetidos a implante de cardioversor-desfibrilador implantável de dupla-câmara, com seguimento médio de 19 meses. Observou-se quatro choques em arritmias letais, 4 pacientes apresentaram TVNS e 5 taquiarritmias supraventriculares. Ocorreu um óbito.Conclusões: Observamos: TPSV em 19,2%; TVNS em 15,4% e TVS/FV em 15,4%. Nenhuma variável clínica ou demográfica, discriminou o comportamento clínico ou funcional pós-implante de CDI; a recorrência de síncope pós implante de CDI, não se associou à presença de eventos arrítmicos e a hipertrofia maior que 30 mm se associou à choque precoce do CDI (p=0,003). / During 19 months of average follow-up period, we followed 26 patients with hypertrophic cardiomyopathy and high risk for sudden death, all treated by dual chamber implantable cardioverter-defibrillator. 4 patients had received appropriate ICD discharge, 4 patients with NSVT and 5 supraventricular arrhythmias. One death had occurred. Conclusions: we observed: supraventricular arrhythmias in 19,2%; NSVT in 15,4% and VT/VF in 15,4%. The clinical or demographic outcomes did not suggest any clinical or functional results after ICD implantation; syncope may occur after ICD implantation and no arrhythmias recordered by intracardiac electrograms and left-ventricular-wall thickness greater than 30 mm is associated with early ICD shocks (p=0,003).