309 research outputs found
Independent determinants of disease-related quality of life in COPD - scope for non-pharmacological interventions?
Full text linkPurpose: Quality of Life (QoL) scores in COPD have a weak relationship with physiological impairment. We investigated factors associated with poor QoL, focusing on psychological measures potentially amenable to intervention.Patients and methods: We utilised a pre-existing Birmingham (UK) COPD cohort to assess factors associated with QoL impairment (CAT scores). Univariate and multivariate regression models were constructed from three categories of variables: demographic, lung function/COPD-related symptoms, and psychosocial/behavioural factorsResults: Analyses were based on self-report questionnaire data from 735 participants. The multivariate model of variables independently associated with COPD Assessment Test (CAT) included: depression, dysfunctional breathing symptoms (Nijmegen score) and illness perception, in addition to COPD symptoms (wheeze, cough), exercise capacity, breathlessness, exacerbations and deprivation; this model explained 72% of CAT score variation. In a dominance analysis assessing the relative contribution of variables, similar contributions were made by breathlessness (20.2%), illness perception (19.8%), dysfunctional breathing symptoms (17.5%) and depression (12.5%) with other variables contributing < 5%. Conclusion: Psychological factors significantly contribute to disease-specific QoL impairment in COPD, and potentially explain the mismatch between objective physiological impairment and patients’ experience of their disease. Interventions targeting psychological factors, illness perception and dysfunctional breathing should be assessed. </p
Cervical cancer screening: public health implications for Hong Kong
No full textThis thesis examines issues related to cervical cancer epidemiology and prevention through screening, with the aim of informing policy regarding setting up an organised cervical screening programme in Hong Kong.
There are five studies described here. The first, a case control study, indicated that screening is effective in preventing invasive cervical cancer among Chinese women. In addition, the main risk factors identified in other studies, were confirmed as risk factors in this population.
Secondly, a cross-sectional study examined the pattern of cervical screening in Hong Kong. The screening system at that time achieved poor coverage, was inefficient, inequitable and potentially harmful.
Thirdly, a cross-sectional study of practitioners showed the diversity in provision of services and the lack of consensus among practitioners in the management of abnormal smears.
Fourthly, the use of an industrial quality management technique in monitoring quality, using inadequate smear rates as an indicator is assessed. It demonstrated that this is an efficient and useful method that can be applied to monitoring a screening programme.
The last study was a randomised controlled trial showing that when women are given balanced information on cervical screening, with information on both the harms and benefits, relatively fewer chose to attend.
The implications of these studies in relation to setting up a screening programme are discussed
What and how childhood obesity prevention interventions should be delivered in China: a qualitative study
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