published_or_final_version / Community Medicine / Master / Master of Public Health

Quality of life (QoL) is now firmly recognized as a significant outcome measure in public health, clinical and patient care research (1, 2). Despite a growing trend in conducting longitudinal QoL studies, the longitudinal changes in QoL in the general population remain poorly understood due to the limited number of studies. Furthermore, few studies have discussed the use of different statistical methods in analyzing the longitudinal change in QoL. This paper aimed to discuss the application of traditional statistical approach: R-ANOVA and newer statistical approaches: LMM and LGCA in analyzing the longitudinal change in QoL. The underlying assumptions, characteristics and specifications of each of the statistical methods were explained. Different public health studies that examined the longitudinal change of QoL would be elaborated in order to show how the criterions of each statistical method were fulfilled in the research analysis. Additionally, the limitations of applying the traditional statistical approach: R-ANOVA and the newer statistical approaches: LMM and LGCA in analyzing longitudinal QoL data will be discussed with the emphasis on how each analytical method overcome the weaknesses of one another. The understanding of the application of different statistical approaches in analyzing the longitudinal change in QoL can advance the future development of a robust statistical approach for QoL research. / published_or_final_version / Community Medicine / Master / Master of Public Health

Sub-health has been used to describe an intermediate state between health and disease. The impact of SH on HRQOL deserves more attention because HRQOL is an important goal of health care, and a significant determinant of health service utilization. The aim of this study was to establish the epidemiology of Sub-health and explore the relationship between SH and HRQOL. Two studies were conducted in Hong Kong. The first study was to develop and validate a Sub-health questionnaire (SHQ) for classifying people into Health, SH & Disease. The standard 7-step method of development of a psychometric measure was used to develop the SHQ. The initial SHQ, was then field tested on a sample of 13 Chinese adults. Pilot testing of the final version was conducted on 55 Chinese adults to confirm. Psychometric testing by a longitudinal survey on 353 Chinese adults who completed the SHQ, the SF-12v2 Health Survey and a structured questionnaire on sociodemographic data, and health service utilization at baseline, 2 to 4 weeks and 3-month. All HS items had Content Validity Index (CVI) on clarity and relevance of > 75%. The HS items demonstrated good internal consistency (Cronbach’s alpha=0.82). The overall test-retest reliabilities of classification of the health state were moderate with Kappa > 0.57. The SHQ was responsive in detecting a change in health states in 36.4% subjects in 3 months. Item scores of HS scales had significant correlation (r>0.4) with corresponding SF-12v2 scores, and there were significant differences in SF-12v2 summary scores between SHQ groups. The second was a longitudinal study on Sub-health and HRQOL of general population to evaluate the validity and psychometric property of SHQ, to establish determine the epidemiology SH, and to explore the relationship between HRQOL of SH. 1231 Chinese adults were randomly selected from the general population by telephone survey with the SHQ, SF-12 Health Survey and a structured questionnaire on demographics and service utilization. 353 subjects had completed 3 to 12 months follow up surveys. The prevalence of Sub-health is 40.67% in Hong Kong. There were significant differences in SF-12v2 scores in that SH group had higher scores than those of disease group but lower scores than those of health group. SH was associated with higher use of medical resources than health. Conclusively, the SHQ is a useful screening tool for the diagnosis of SH. There is a linear relationship between change in health status and changes in HRQOL or health service utilizations. It preliminary explored the clinical relevance of the SH to a culture and health care system that is different from that of mainland China where the concept originated. The results would be useful in populations worldwide if the SHQ could be cross-culturally adapted to identify the SH epidemiology. The study has also, provided evidence supporting the conceptual base of SH in the Chinese medicine context, which may be modifiable by treatment based on TCM Body Constitution classification. / published_or_final_version / Family Medicine and Primary Care / Doctoral / Doctor of Philosophy

Subjective quality of life (QOL) has been measured as one of the important clinical outcomes of schizophrenia. Many studies on examining the relationship between subjective QOL and symptomatology as well as neurocognitive functions were reported. Consistent data have suggested that the severity of depressive symptoms contributed to poor subjective QOL of schizophrenia. However, reports on the relationship of subjective QOL with negative symptoms, neurocognitive functions, and duration of untreated psychosis were largely inconsistent. The current study on the examination of subjective QOL in schizophrenia, is to emphasize the importance of inner experiences of schizophrenia but do not treat them as Freedman (1974) called “average schizophrenic”, in order to find out a more effective intervention for improving subjective QOL of schizophrenia. The purpose of the present cross-sectional study was to replicate these previous studies on investigating factors related to subjective QOL of schizophrenia including, positive symptoms, negative symptoms, neurocognitive functions, as well as duration of untreated psychosis. Besides, as most previous studies focused on chronic schizophrenia, this study involved first episode remitted psychosis patients, and to test whether it was the same phenomenon between chronic schizophrenia and first episode remitted psychosis on subjective QOL. The study result can contribute to propose suitable treatment for improving QOL of persons with schizophrenia. In this study, 140 subjects with first episode remitted schizophrenia were examined. Significant associations between subjective QOL and psychopathology, neurocognitive functions were found; modest correlation of duration of untreated psychosis was also reported. Also, subjective QOL was associated with self-perception on the illness outlook in the first episode population. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Background Dental prostheses have seen a major change since the advent of dental implants in 1965. The osseointegration property of titanium fixtures enables dentists to place a dental prosthesis at almost everywhere intra-orally provided there is sufficient bone to support it. The novel treatment modality had attracted attention of clinicians who had made multiple innovations on their use. Meanwhile, there has also been a shift of focus in the medical field from disease-centered outcome to subjective patient-centered outcome in the measurement of health status. Quality of Life (QoL) measurements are one of the subjective measurements of health status. They provided a means for clinicians to compare different prostheses, including dental prostheses. Aim and Objectives This systematic review seeks to identify evidence that proves the superiority of the new treatment modality in improving QoL or Oral Health Related QoL and to briefly discuss their implications for public health policies in Hong Kong. Methods Researches which compare conventional removable dental prostheses and the fixed alternatives in terms of improving QoL were identified. The evidence was scrutinized, critically analyzed and a summary was made. Results Current evidence is only strong enough to support the superiority of the new implanted supported prostheses over the conventional type for patients without lower teeth. Discussion and Conclusions It is concluded in this systematic review that the new implant-fixed or supported dental prostheses are superior to conventional removable dental prostheses for patients without lower teeth. However, it is so far inconclusive as to whether dental implants have greater impact on QoL of partially dentate patients than conventional removable dental prostheses. The cost-effectiveness of this treatment modality in improving QoL is also unclear yet. / published_or_final_version / Medicine / Master / Master of Public Health

Objective This review aims to investigate (i) the concentrations of air pollutants/bacteria in the underground mass-transportation in comparison to the above-ground environment; and (ii) the health implications upon exposure to the underground mass-transportation environment. Methods A systematic review was conducted using keyword searches in Medline, PubMed and ScienceDirect. After screening for relevance, 25 papers are extracted and critically reviewed. Results A number of air pollutants/bacteria/fungi were found having higher concentrations in the underground mass-transportation as compared with those in the above-ground environment. Air quality in the underground mass-transportation is influenced by factors like the service years of subway since operation, train specifications, sampling time, and sampling location. No acute implications were identified, but irritations, human cell damages and anti-inflammatory responses were identified. Conclusion Air quality in underground is worse than in the above-ground environment except for the more recently built subway systems. Research for health implications upon long-term exposure to underground environment is recommended. / published_or_final_version / Public Health / Master / Master of Public Health

Background and Objectives Menopause is a natural transition, an important life event that represents the end of reproductive phase in women at age of 50. Menopausal symptoms or hormone replacement treatment (HRT) may influence women’s quality of life (QOL). Different health-related quality of life (HRQOL) scales are developed to demonstrate the effects of menopausal symptoms or treatment. The aim of this review is to identify the menopause-related measures and evaluate the psychometric properties of these scales. Method Literature search using the keyword: “menopause” or “menopausal” or “perimenopausal” or “climacteric symptoms” or “vasomotor symptoms” AND “menopause-related quality of life measures” or “menopause-related quality of life instruments” or “menopausal health-related quality of life measures” or “menopausal health-related quality of life instruments” or “menopause-related health status measurement” or “menopause-related health functioning” AND “women”. Results Total 5 menopause-related quality of life measures were identified: -the MENCAV Quality of Life Scale (MENCAV) -Menopause-specific QOL Questionnaire (MENQOL) -Menopause-specific QOL Questionnaire-Intervention (MENQOL-Intervention) -Menopausal Quality of Life Scale (MQOL) -Utian Quality of Life Scale (UQOL) All measurement scales have good internal consistency shown. Construct validity was reported in all measures. Known-groups validity was evaluated in MQOL and MENCAV. Content validity was shown in MQOL and UQOL by focus group meeting with menopausal women. Construct validity was reported in all measures. Convergent validity was reported in MQOL, MENCAV, UQOL and MENQOL-Intervention, the relationships between scores were evaluated. Discriminant validity was assessed in MENQOL. All measures reviewed either convergent or discriminant validity and no measure reviewed both. All measures except UQOL have reported responsiveness. Conclusion MENCAV is the best measure and supposed to be the most updated one developed in 2008. This measure is not as popular as UQOL, MENQOL etc. It demonstrated the highest psychometric quality score in this review. Standardization of measurement scales for comparison of the menopausal symptoms and QOL can reduce the anxiety of participants who answer different questionnaires with same domain. Further research on extensive psychometric evaluation across ethnicities may be beneficial to menopausal women. / published_or_final_version / Public Health / Master / Master of Public Health

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Thearubigins are polyphenolic oligmers which contribute to the quality of black tea: it is necessary to learn more of their origin and structure in order to understand their function, and to utilise opportunities to influence their development during processing to meet market demand. Tea samples were manufactured under controlled conditions, by methods parallel to commercial production in Malawi. Leaf handling, withering, fermentation and drying were manipulated. Conditions selected could be used in current commercial tea factories with only minor modifications. Non-volatile water-soluble components of black tea were analysed in an attempt to identify the critical points in the process. Solvent partition, adsorption chromatography or caffeine precipitation followed by size..exclusion HPLC were used to further separate the thearubigins and estimate molecular mass. Reverse-phase HPLC was also used; both methods were monitored by UV-VIS spectroscopy. Eluate was collected and portions challenged with chemical probes to identify functional groups within the oligmers. Theafulvin was shown to be heterogeneous in both chemical composition and mass. Prolonged fennentation in the presence of air promoted the development of theafulvin, caffeine-precipitable thearubigin, and hump unresolved by reverse-phase HPLC. This is the first evidence that theafulvin is a product of fermentation rather than a plant artefact. Leaf handling and fermentation conditions have a greater impact on liquor colour and perceived quality than withering or well-controlled drying. Modified dryer operating conditions preserved product composition and quality. Opportunities to manipulate product composition to meet market demand were identified.

Abstract Flaxseed oil cake from a South African factory was screened for proximate composition, mineral content, fatty acid profile and storage stability. The oil cake was included at 10 and 15% levels (w/w) in brown bread and evaluated using a 96-member consumer panel. The oil cake contained between 38.0 and 47.3% protein, 12.8 and 26.1% crude fat and 3.7 and 5.1% ash. The total carbohydrates were mostly dietary fiber. Calcium, magnesium, phosphorus and potassium were in the range of 3.3 to 3.8, 4.8 to 5.9, 6.4 to 8.2 and 9.0 to 10.1 (mg/g), respectively. The oil from the flaxseed oil cake contained 58.5 to 59.7% of C18 omega-3 fatty acids. Peroxide levels of the flaxseed oil cake were below the threshold limits after 6 months storage. Thiobarbituric acid threshold values were exceeded after 5 months aerobic storage at 20C. Bread samples with inclusion levels of 10 and 15% flaxseed oil cake were acceptable to the consumer sensory panel.