1,721,651 research outputs found
Cross-cultural validation of the Dartmouth COOP Functional Health Assessment Charts/WONCA on Chinese patients. In Fischer G, Lam CLK, Niederstadt CJ & Saltman DC (ed)
No full textExplore the World of Medicine Vol. IV
No full text《育醫造才：探索醫學世界》第四冊由香港大學李嘉誠醫學院出版，內容豐富，從慢性疾病及老年病、婦兒健康、癌症治療以至健康生活均有所涵蓋，旨在向廣大市民介紹先進醫學新知，以及提高社會對一些重要健康課題的認知。此書內容乃輯錄自 2013 和 2014年間舉辦之「育醫造才：探索醫學世界」公開講座內容。link_to_subscribed_fulltex
Sub-health and health-related quality of life
No full textSub-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_versionFamily Medicine and Primary CareDoctoralDoctor of Philosoph
The association between continuity of care and the risks of cardiovascular diseases and mortality in primary care patients with diabetes mellitus
No full textContinuity of care—providing a consistent source of care, traditionally with a designated physician—has been suggested to be beneficial to diabetes management. However, high patient volume and physician mobility make its implementation in public clinics in Hong Kong challenging. Continuity of care at the clinic or team level, which was evaluated by the patient’s attendance to the same clinic or to a small group of physicians continuously, might offer more suitable alternatives. This thesis examined the associations between cardiovascular diseases (CVD) or all-cause mortality risks of type 2 diabetes mellitus (T2DM) patients in general out-patient clinics (GOPC) in Hong Kong with clinic-based and team-based continuity of care.
This retrospective cohort study used data from the Clinical Management System of the Hospital Authority of Hong Kong. The study included T2DM patients aged 18 or older who had no CVD on or before baseline, which was the date of the earliest GOPC attendance between 1 January 2008 and 31 December 2018. Both team-based and clinic-based continuity of care were evaluated with the usual provider continuity index (UPCI), calculated from the GOPC attendances within two years before baseline. In clinic-based continuity of care, patients were categorised into four groups by UPCI—<0.50, 0.50-0.75, 0.76-0.99 and 1.0— while in team-based continuity of care, patients were divided into quartiles with cut-offs of <0.50, 0.50-0.74, 0.75-0.91 and 0.92-1.0. The group with the lowest UPCI was the reference for relative risk assessments. Propensity score fine stratification weights were applied to improve balance among groups. CVD and all-cause mortality hazard ratios were assessed with multivariable Cox regression adjusted with baseline characteristics.
For clinic-based continuity of care, 311,839 patients were included after weighting. The median follow-up periods for CVD of the four patient groups were 66.5, 72.5, 80.5 and 78.5 months, with incidence rates of 29.9, 27.3, 27.0 and 24.4 cases/1000 person-year respectively. Patients with a clinic-based UPCI of 0.50-0.75, 0.75-0.99 and 1.0 had a 10%, 17% and 24% lower CVD risk and 16%, 24% and 25% lower all-cause mortality risk relative to those with a UPCI <0.50. Being younger and having fewer comorbidities were correlated with a larger reduction in CVD risk in those with a higher UPCI.
For team-based continuity of care, 312,068 patients were included after weighting. The median follow-up periods for CVD in the 1st-4th quartiles were 77.5, 77.5, 77.5 and 78.5 months, while the incidence rates were 26.1, 25.4, 24.6 and 23.6 cases/1000 person-year respectively. Patients in the 2nd, 3rd and 4th quartiles had a 5%, 8% and 13% lower CVD risk and 5%, 7% and 6% lower all-cause mortality risk, respectively, relative to those in the 1st quartile. Reduction in CVD risk was more prominent in those who were male, younger and with fewer comorbidities.
This study demonstrated that CVD and all-cause mortality risks were lower in T2DM patients with higher clinic-based and team-based continuity of care. These approaches might serve as alternatives to individual-based continuity of care in public clinics to enhance the quality of care for T2DM patients.published_or_final_versionFamily Medicine and Primary CareMasterMaster of Philosoph
Clinical effectiveness and cost-effectiveness of bariatric surgery among patients with type 2 diabetes mellitus and obesity
No full textGiven the surging prevalence of type 2 diabetes mellitus (T2DM) and obesity, an effective, safe, and affordable treatment for both T2DM and obesity is in need. Bariatric surgery has been considered as a preferable alternative for patients with T2DM and obesity who fail to achieve adequate weight loss after non-surgical treatments. This thesis aimed to evaluate the clinical effectiveness and cost-effectiveness of bariatric surgery compared to no surgery from the perspective of healthcare service providers.
This thesis compromised six parts. Firstly, a systematic review and network meta-analysis, including 363 randomized controlled trials and 146,413 patients, was conducted to compare the effects of bariatric surgery, novel glucose-lowering medications, insulin, and usual care on glycemic control and weight management. Secondly, a population-based retrospective cohort study was carried out to evaluate the 5-year effectiveness of bariatric surgery versus non-surgical treatments on diabetes remission and metabolic syndrome improvement among 401 patients with bariatric surgery and 1,894 propensity score-matched controls. Thirdly, incidence rates of end-stage renal diseases (ESRD), cardiovascular diseases (CVD), severe hypoglycemia (SH), cancers, and all-cause mortality were assessed among patients with and without bariatric surgery. Fourthly, a prospective cohort study was performed to measure the health-related quality of life (HRQoL) of 25 patients with bariatric surgery from baseline to 1 year after bariatric surgery. Fifthly, direct medical costs associated with bariatric surgery were calculated over 5 years. Lastly, a cost-effectiveness analysis of bariatric surgery was evaluated over a 5-year horizon.
The network meta-analysis indicated that bariatric surgery was the most efficacious treatment in glycemic control and weight reduction among all available treatments, including novel glucose-lowering medications, insulin, and usual care. Results from retrospective cohort studies showed that patients with bariatric surgery had higher diabetes remission rates (~20%), and experienced greater reductions in HbA1c (~1.0%) and body mass index (~5.0kg/m2) than non-surgical patients from baseline to 5 years. Bariatric surgery was associated with reduced risks of CVD (HR=0.464, P=0.015) and all-cause mortality (HR=0.508, P=0.041). The risks of cancer, severe hypoglycemia, and ESRD between patients with and without bariatric surgery were not significantly different. In addition, significant improvements in HRQoL and decrease in depression scores were observed among patients after bariatric surgery. As to medical costs, patients with bariatric surgery had significantly higher direct medical costs than non-surgical patients in the year of surgery (US6,310 respectively; P < 0·001), mainly owing to the bariatric procedure costs and related hospitalization. However, the medical costs of patients with bariatric surgery were lower than control patients in the subsequent years. The results were cross validated by UK Biobank data. Compared with patients treated with usual care, patients with bariatric surgery gained 0.556 QALY but incurred US49,218/QALY.
Bariatric surgery not only had superior effects in glycemic control and weight management, but also showed cardio- and mortality-protective effects without increasing risks of cancer and SH. Compared with usual care, bariatric surgery may be cost-effective for Hong Kong Chinese patients with T2DM and obesity over 5 years.published_or_final_versionFamily Medicine and Primary CareDoctoralDoctor of Philosoph
Health-related quality of life of Chinese patients with chronic hepatitis B infection
No full textpublished_or_final_versionMedicineDoctoralDoctor of Philosoph
Explore the World of Medicine Vol. V
No full text《育醫造才：探索醫學世界》第五冊由香港大學李嘉誠醫學院出版，內容豐富，從慢性疾病、癌症治療、婦兒健康以至健康生活均有所涵蓋，旨在向廣大市民介紹先進醫學新知，以及提高社會對一些重要健康課題的認知。此書內容乃輯錄自2015和2016年間舉辦之「育醫造才：探索醫學世界」公開講座內容。link_to_subscribed_fulltex
Effectiveness of traditional Chinese medicine in primary care in Hong Kong
No full textpublished_or_final_versionMedicineDoctoralDoctor of Philosoph
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