Research consistently supports that some segments of society are at considerably higher risk for illness and death than the national average. While the existence and extent of poor health outcomes for these "vulnerable populations" are well documented, less research attempts to explain why such inequities persist and how they might be resolved. Thus, many vulnerable individuals fail to get adequate health care. How can health care delivery be improved to better serve those consumers most at risk of poor health? Addressing this issue requires an in-depth understanding of the unique health and social needs of vulnerable consumers and how these needs are being met (or not met) by the health care industry. Based on field research using a variety of methods, this study examined health care delivery to one at-risk population, women in a rural Appalachian coal mining community, with the ultimate goal of envisioning service design and distribution strategies that might better serve disadvantaged populations. Consistent with the change-oriented goal of this research, a feminist approach guided this study. Women's everyday experiences in managing their health needs were explored through an analysis of their health care stories. Health care providers were also interviewed in order to explore both sides of the service encounter dyad. The voices of the women and the providers reveal uneasy tensions in health care delivery and illuminate why the current system does not meet the actual health care needs of the women or their community. A variety of solutions are offered to improve health care delivery. / Ph. D.

Lee, Antionette Marie. / "May 2000." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (p. 153-171). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Human papillomavirus (HPV) infection currently stands as the most common sexually transmitted disease in the world. With an estimated lifetime probability of disease acquisition of 84.6% for females and 91.3% for males with at least one sexual partner, HPV is an aggressive and ubiquitous virus that affects people from all walks of life. The virus generally resolves on its own within 1 year, but successful disease progression leads to complications ranging from genital warts to anogenital cancers. Globally, there are 530,000 new cases of, and 274,000 deaths caused by, cervical cancer in females each year, 99.7% of which are caused by HPV and 70% of which are caused by HPV types 16 and 18. With high rates of infection and 85% of cervical cancer cases concentrated in developing countries, the virus presents an immense threat to public health and global equity. Prophylactic vaccines demonstrate high efficacy against common HPV-related diseases, including cervical cancer, but the high cost and multiple-dose administration of the vaccine limit its full disease-fighting potential. This proposal seeks to determine if a single-dose prophylactic vaccine targeting HPV-16 and -18, when administered in preadolescence, demonstrates long-term efficacy against cervical cancer. Vaccine-induced antibody responses will be measured using geometric mean titers obtained from blood samples, and efficacy of the vaccine will be evaluated by persistent high-risk HPV (HR-HPV) infection, measured through Pap smears and HPV DNA tests. The study will extend 22 years post-vaccination. The single-dose vaccine is expected to provide protection against HR-HPV infection at rates comparable to those of multiple-dose vaccines currently in practice, with the implications of increasing accessibility of the vaccine and, thus, decreasing the global burden of cervical cancer.

Thesis (M.S.W.)--University of Hong Kong, 1986.

Thesis (M.S.W.)--University of Hong Kong, 1985.

This qualitative descriptive (QD) study examined the experience of the woman newly diagnosed with obstructive sleep apnea (OSA). The study employed Leventhal’s Self- Regulatory Theory to understand women’s illness representation of OSA, cognitive and emotional coping, and situational appraisal skills in coming to terms with OSA. The specific aims were to: 1) Describe the illness representation of women with a recent diagnosis (within one year) of OSA; 2) Describe the cognitive perceptions and emotional response to diagnosis and treatment of OSA in this sample of women; and, 3) Describe the meaning of OSA and the coping strategies used by this sample of women. The overarching theme of this study of a life-altering diagnosis required participants to process the health threatening information in both a conceptual and concrete process for dealing with both the physical and emotional aspects. The first two subthemes that emerged were Making sense of it, and Making it work as the women came to terms with their symptoms, diagnosis, and adapted to their treatment. For this sample of women, both acceptance (acknowledging the diagnosis of OSA and embracing treatment), and denial (not convinced of diagnosis or need for treatment, seeking alternatives) were factors in how they made sense of the situation. The making it work subtheme dealt with the women’s experiences adapting to treatment both physically and emotionally, including the appraisal, reconsideration and adjustments when they encountered difficulties and delays. A fluid iterative process included women participants describing how they appraised their situation often moving back and forth between acceptance, denial, seeking alternatives, struggling with treatment and moving forward. In both of these subthemes, family support and the stigma of OSA and CPAP were involved in how the women accepted and adapted to treatment. The third subtheme that emerged was Paying it forward as many women felt the obligation to help themselves by adapting a healthier lifestyle for themselves, their families and to assist others impacted by OSA. Women spoke of paying it forward by offering information and support to others not yet diagnosed, or are struggling with diagnosis and treatment. Many of these women were staunch advocates for other women to be tested, for HCPs to be more aware, to be more attuned to women’s sleep history, and to refer women for treatment. Implications of these findings include enhancing recognition and awareness by women of OSA symptoms, the need for diagnostic evaluation, and partner awareness as an important component of diagnosis and successful treatment for women. Study findings support recognition of women’s presentation of OSA including unusual symptoms for earlier diagnosis and treatment. Sleep partner awareness and support appear to be relevant to women in acceptance of a life altering diagnosis. Further exploration of modifiable factors such as prompt diagnosis and individualized treatment of women with OSA could also impact potential co-morbidities. Provision of further education and awareness by HCPs and insurance companies that women may not present with classic symptoms of OSA is also needed. Targeted interventions specific to women’s experiences with OSA include development of screening tools, care guidelines and treatments that enhance applicability, acceptability, and patient satisfaction. Future advocacy work will also require supporting women in “paying it forward” to help other women diagnosed with OSA.

Conclusion. We observed a small but independent effect of soy intake and lipid lowering effect, even after taking into account the other important predicting factors - initial cholesterol, body composition, physical activity, dietary intake and age. The beneficial effect between soy protein intake and lipid profile were observed even with this relatively low level of soy protein consumption suggests that the effect of soy protein supplement use on lipid profile may be much greater than those observed here. The results of our study add to the existing evidence that soy protein may be beneficial in human lipid profile. Our data will be useful for planning effective education programs as well as providing background information for further interventional studies to prevent coronary heart disease. / Coronary Heart Disease (CHD) is the major cause of death in most developed countries and is rapidly increasing in developing countries. Recent studies showed that natural menopause confers a threefold increase in CHD risk. While many risk factors, such as hypertension, diabetes mellitus, obesity and physical inactivity contribute to the risk for CHD, lipid abnormalities are the major factor. Hyperlipidemia plays a central role in the atherosclerotic process. Recent studies showed that consuming soy, a food containing large amounts of soy protein, improves the plasma lipoprotein profile by decreasing total cholesterol, LDL cholesterol, triglycerides as well as increasing HDL level. Although soy is a main component of traditional Asian food, many of the studies on soy consumption have been conducted in Caucasian populations (table 1.2), among whom soy intake is rather low or almost nil, it was difficult to explore the association of soy protein intake and lipid profile in those populations. Soy products such as tofu and soymilk are traditional Chinese foods. With the changing dietary pattern, it gives rise to a range of intake from traditional to modern and increasing incidence of cardiovascular disease Hong Kong poses a unique opportunity for the investigation of the relation between soy protein intake and lipid profile. / For baseline age stratified subgroup analysis, our study results showed no association between soy protein intake and lipid pro file in women whose baseline age younger than 55.3 years old, but we did observe a positive association in women belonging to older subgroup. In the 12-month follow up analysis, for women whose baseline age was older than 55.3 years (mean age=58.4+/-2.1), after controlling for the potential confounders, soy protein intake was significantly associated with HDL cholesterol concentration (Linear Regression p=0.033, ANCOVA=0.011, P value for trend p=0.014), total cholesterol/HDL ratio (Linear Regression p=0.045) and LDL/HDL ratio (Linear Regression p=0.037). Similar observation was observed in the yearly change rate of HDL in 24-month follow up (Linear Regression p=0.047, P value for trend p=0.043). / For women whose initial cholesterol level was higher or equal to 200mg/dL, in our 2-year longitudinal analysis, after controlling for the potential confounders, soy protein intake was significantly associated with HDL (Linear Regression p=0.041) and cholesterol/HDL ratio (ANCOVA=0.022). We also observed a statistically significant trend for higher HDL cholesterol (p=0.038), with an increase of 11.4g in soy protein intake between the 1st and 3rd tertiles, our data showed a 3.8% increase in HDL. / In the 12-month longitudinal analyses, after controlling for the potential confounders, soy protein intake was significantly associated with HDL concentration (Linear Regression p=0.036). We also observed a statistically significant trend for higher HDL cholesterol (p=0.036), with an increase of 10.9g in soy protein intake between the 1st and 3rd tertiles, our data showed a 7.9% increase in HDL. / Methods. 307 women aged between 48 to 62 years were recruited from community subjects residing in housing estates in Shatin. Women within the first 12 years of menopause, with no history of malabsorption syndromes, chronic liver kidney diseases, parathyroid diseases, gastric operation or cancer and without currently taking lipid lowering therapy were included in the study. We estimated the dietary intake of soy foods and other key nutrients by using quantitative food frequency method. We recorded serum values of fasting cholesterol, LDL cholesterol, HDL cholesterol and triglycerides as well as other covariance measurement. Soy protein consumption was categorized as tertiles of intake and related to lipid profile. / Objectives. In order to study the relation between soy protein intake and lipid profile in the early postmenopausal Chinese women in Hong Kong, we conducted the study from February 2000 to February 2002, as a part of the population-based soy consumption and bone mineral density study. The hypothesis to be tested is that high intake of dietary soy protein has a beneficial effect on lipid profile in the early postmenopausal Chinese women in Hong Kong. / Results. In our cross-sectional analysis, our findings showed that habitual dietary soy protein intake had a weak but statistically significant correlation with triglyceride concentration (Linear Regression p=0.045, ANCOVA p=0.045 P value for trend p=0.023), and the soy protein beneficial effects were more pronounced in women whose % of total body fat were higher than 33.4%. After controlling for the potential confounders, soy protein intake was significantly associated with triglyceride concentration (Linear Regression p=0.048, P value for trend =0.021), the average decrease in triglycerides were 24.6% and 29.1 % in the 2nd and 3rd tertile compared with the 1st tertile respectively. / Lam Siu Hung. / "February 2006." / Adviser: Ho Suzanne Sutying. / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6300. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 181-191). / 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, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Background and objective. Ultrasonic evaluation of carotid intima media thickness (IMT) has been widely used as a surrogate of atherosclerosis. Few studies have specifically examined risk factors related to subclinical atherosclerosis (SA) among early postmenopausal women, in particular in the Chinese population. There is also little information on the distribution of IMT in Asian midlife women. We described the prevalence of SA, as determined by IMT and carotid plaque, and the associated risk factors in early postmenopausal Chinese women in Hong Kong. / Conclusions. Our findings showed that age, SBP, HDL-C, and LDL-C were independent predictors of IMT, while age, LDL-C, and abdominal obesity were independent predictors of the presence of plaque. The optimal IMT cutoff of 0.783 mm was defined and that a prevalence of SA (IMT ≥ 0.783 mm) of 38.6% was found among 'healthy' early postmenopausal Chinese women in Hong Kong. / Methods. 518 women aged 50 to 64 years, and within 10 years since menopause were recruited from random telephone dialing. Women with surgical menopause, established cardiovascular diseases (CVD), and severe disease conditions such as cancer and renal failure were excluded. Sociodemographic, anthropometric and lifestyle factors were obtained based on standardized questionnaires. Fasting blood sample was also obtained. B-mode ultrasound was used for measuring IMT at 12 sites of the carotid arteries and plague index, which is the sum of the grades (ranged from 0 to 3) at the 6 segments. The relations between traditional risk factors, and other potential risk factors such as inflammatory markers, as well as lifestyle factors including physical activity, dietary intake, and psychological factors with SA were also assessed. / Results. The mean IMT +/- SD was 0.76 +/- 0.12 mm, with a range from 0.53 to 1.00 mm. IMT was higher on the far wall than on the near wall (P<0.01), and differ among segments (greatest at the bulb and least at the ICA) (P<0.01). One-fifth of women had at least 1 plaque in the carotid artery with most of the plaque occurred in the bulb area. IMT increased with age, and was positively associated with carotid plaque. With the use of receiver operating characteristic curve (ROC) analysis, the optimal cutoff IMT for diagnostic plaque was 0.783 mm, at which sensitivity and specificity was 80.5% and 75.1%, respectively. The prevalence of SA was 38.6%. Among the traditional risk factors, systolic blood pressure (SBP), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were associated with high IMT. Abdominal obesity assessed by waist circumference (WC) and waist hip ratio (WHR) was also found to be positively associated with IMT. Stepwise multiple regression showed that age, SBP, HDL-C, and LDL-C were independent predictors of IMT. Multiple logistic regression showed that women with LDL-C ≥ 130 mg/dL were associated with a 2.4-fold (95% CI 1.5-3.7) higher risk of having plaque compared to those with LDL-C < 130 mg/dL. In addition, women with abdominal obesity (WHR ≥ 0.85) had a 1.7-fold (95% CI 1.08-2.67) higher risk of having plaque than women with WHR < 0.85 after adjustment for age, and potential confounders including physical activity, dietary intakes etc. Significant inverse associations were observed between physical activity and indices of obesity, as well as fasting blood glucose, while psychological perceived stress and trait anxiety were independent risk factors for both total cholesterol and LDL-C. / Yu Ho-yan. / "February 2006." / Adviser: Suzanne C. Ho. / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6350. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 220-256). / 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, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

The purpose of this study is to assess the effect of explanatory style on the coping strategies of women in recovery from addiction to alcohol and other substances.

In Australia, as in other industrialised countries, rates of childlessness amongst women are rising. This has been attributed, in part, to a rise in the number of women choosing never to give birth; however, women’s perception of what constitutes choice in remaining childless is under-investigated. The aim of this study was to investigate Australian women’s experience of childlessness at mid age and explore the role of choice in this reproductive outcome. It investigated the determinants of childlessness, considered the consequences of never giving birth, and explored how choice affects childless women’s evaluation of non-motherhood. / A cross-sectional study of the experience of never giving birth was conducted, which comprised two components. The minor component was a secondary analysis of survey data (collected in 1996) from the Women’s Health Australia (WHA) project. WHA is a longitudinal study which recruited a nationally representative sample of 14,099 women born between 1945 and 1952. These women are amongst the first to have lived all their reproductive lives since the introduction of the oral contraceptive. This study compared demographic characteristics, self-rated health, and life satisfaction between 1,069 mid-aged childless women (exclusive of known adoptive and step-mothers) and 12,643 of their peers who are mothers. It was found that at mid-age, childless women have higher levels of education and are more extensively engaged in the paid workforce than mothers, however, there were no differences in health status between mothers and childless women. Life satisfaction differences between the two groups are complex and mediated by marital status. / The major component of the investigation was a study-specific survey (October 2002) completed by 426 nulliparous women who were all participants in the mid-aged cohort of Women’s Health Australia. This component investigated the determinants of childlessness, the role of choice, and the experience of non-motherhood. / In contrast to existing studies into childlessness, this large quantitative investigation has a sample which comprises a broad selection of nulliparous women irrespective of their marital status, medical history, or level of choice in never giving birth. Using an original classification system, women were categorised into three childless groups which describe three levels of choice in never giving birth: 37.1% of respondents chose childlessness actively (Active Choice), 15.4% chose childlessness given their personal circumstances (Constrained Choice), and 47.5% felt denied the opportunity to give birth (Denied Choice). The predominant reason for childlessness amongst the Active Choice women was not experiencing a strong ‘maternal instinct’, the Denied Choice group mainly cited infertility or the lack of a husband/partner, whilst the Constrained Choice group gave a mixture of voluntary and involuntary explanations. / This study developed a balance sheet approach to assessing both the positive and negative aspects of non-motherhood – the Consequence of Childlessness Balance Sheet (CCBS). It also introduced a technique for measuring ambivalence that was developed within social psychology. In contrast to the public discourse that depicts childlessness as a negative life outcome, participants in this study gave a favourable evaluation of their lives. Even so, more than half (55.6%) of the participants experienced moderate levels of ambivalence. Comparisons between the three childless groups revealed that as choice increased participants were more likely to give a higher rating to the positive aspects of their lives, a lower rating to the negative ones, and experience lower levels of ambivalence. However, Denied Choice women generally did not find childlessness a devastating experience. / Therefore, amongst the mid-aged participants in this study the experience of childlessness was complex and diverse, varying with the level of choice women had in never giving birth. Childlessness was not, however, a burdensome or detrimental life outcome for these women.