Fieldwork Summary Report: Reducing Repeat Teenage Pregnancy through Program Planning and Evaluation

This fieldwork summary report provides a synthesis of both my overall fieldwork experience at TAPP, Felton Institute’s Teenage Pregnancy and Parenting Program, and my Master of Public Health knowledge and skill sets. Since researching the huge social and economic impact that teenage pregnancy and parenting has not only on the teens and their children, but also the society at large, I strived to highlight prevention aspects to reduce repeat unwanted teenage pregnancy. So, I chose to intern at TAPP, focused my fieldwork project mainly on program development and evaluation, along with other aspects of improving wellness. I begin this report by providing statistics to substantiate what a huge public health problem teenage pregnancy is, and how essential prevention efforts are. Afterwards, I will describe TAPP’s response to the problem, highlighting TAPP’s mission, educational efforts, provided services, research efforts, engagements in policy and advocacy, and how TAPP measures success. Afterwards, I will describe my fieldwork experience and objectives. Here, I will highlight the theoretical foundations to better understand the problem and to inform potential interventions. Additionally, I will explain the types of interventions that were used in my project. Lastly, I will share my findings about the effectiveness of TAPP’s ability to address the public health problem of teenage pregnancy, along with which lessons learned. I will conclude with sharing the MPH competencies, core knowledge areas, and cross-cutting interdisciplinary values that I addressed during my fieldwork experience. Finally, I will reflect upon my overall fieldwork experience from both a personal and professional viewpoint

The Association Between Self-Rated Mental Health Status and Total Health Care Expenditure: A Cross-Sectional Analysis of a Nationally Representative Sample

Both clinical diagnoses and self-rated measures of mental illness are associated with a variety of outcomes, including physical well-being, health utilization, and expenditure. However, much of current literature primarily utilizes clinically diagnosed data. This cross-sectional study explores the impact of mental illness and health care expenditure using 2 self-rated measures: self-rated measured of perceived mental health status (SRMH) and Kessler Screening Scale for Psychological Distress (K6). Data from the 2011 Medical Expenditure Panel Survey Household Component, a nationally representative sample of noninstitutionalized individuals (n = 18,295), were analyzed using bivariate χ2 tests and a 2-part model (logistics regression and generalized linear model regression for the first and second stages, respectively). Although predictive of any health expenditure, SRMH alone was not highly predictive of the dollar value of that health expenditure conditional on any spending. By comparison, the K6 measure was significantly and positively associated with the probability of any health expenditure as well as the dollar value of that spending. Taken together, both the K6 and SRMH measures suggest a positive relationship between poor mental health and the probability of any health expenditure and total expenditure conditional on any spending, even when adjusting for other confounding factors such as race/ethnicity, sex, age, educational attainment, insurance status, and some regional characteristics. Our results suggest that psychological distress and SRMH may represent potential pathways linking poor mental health to increased health care expenditure. Further research exploring the nuances of these relationships may aid researchers, practitioners, and policy makers in addressing issues of inflated health care expenditure in populations at risk for poor mental health

Construction of a Teaching Package on Promoting Prosocial Internet Use and Preventing Antisocial Internet Use

In the construction of the teaching package on the Internet use, two major moral characters, respect and responsibility, form the core theoretical basis. The respect character consists of respect for others and self-respect while the responsibility character contains social, civil, and global responsibility. There are a total of nine units on the Internet use in the junior secondary curriculum. There are two units in Secondary One curriculum: the first unit deals with cheating behavior and privacy issues concerning the Internet, and the second one discusses the effect of excessive use of the Internet on life and study. In Secondary Two curriculum, we discuss the following social phenomena on the Internet with students: online shopping, pornographic materials on internet, and infringement of a copyright. Finally, we have designed four units on the Internet use in Secondary Three curriculum which focuses more on the relationship between the Internet use and our health. We try to answer the question on how we can use the Internet healthily and also the possibility on how it may hurt us. Similar to the second unit in Secondary One curriculum, we have designed three more units on discussing the effects of excessive use of the Internet with students. We would like to alert students that ineffective use of the Internet will hurt us mentally and physically. For illustrative purposes, two units in the Secondary One and Two curriculums are outlined in this paper

Developmental dyscalculia and low numeracy in Chinese children

Children struggle with mathematics for different reasons. Developmental dyscalculia and low numeracy - two kinds of mathematical difficulties - may have their roots, respectively, in poor understanding of exact non-symbolic numerosities and of symbolic numerals. This study was the first to explore whether Chinese children, despite cultural and linguistic factors supporting their mathematical learning, also showed such mathematical difficulties and whether such difficulties have measurable impact on children's early school mathematical performance. First-graders, classified as dyscalculia, low numeracy, or normal achievement, were compared for their performance in various school mathematical tasks requiring a grasp of non-symbolic numerosities (i.e., non-symbolic tasks) or an understanding of symbolic numerals (i.e., symbolic tasks). Children with dyscalculia showed poorer performance than their peers in non-symbolic tasks but not symbolic ones, whereas those with low numeracy showed poorer performance in symbolic tasks but not non-symbolic ones. As hypothesized, these findings suggested that dyscalculia and low numeracy were distinct deficits and caused by deficits in non-symbolic and symbolic processing, respectively. These findings went beyond prior research that only documented generally low mathematical achievements for these two groups of children. Moreover, these deficits appeared to be persistent and could not be remedied simply through day-to-day school mathematical learning. The present findings highlighted the importance of tailoring early learning support for children with these distinct deficits, and pointed to future directions for the screening of such mathematical difficulties among Chinese children. © 2013 Elsevier Ltd.postprin

Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study

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Retinal Changes in a Mutant Form of Goldfish with Megalophthalmia

The retinal changes of a mutant strain of goldfish with megalophthalmia were studied by histology, electron microscopy and biochemistry. Changes in the morphology of the pigment epithelium, decrease in number of photoreceptors, thinning out of retinal layers and the existence of spaces in the retina were all features as the eyes grew in size. Invasion of macrophages was also evident in the retina. A decrease in leucine uptake per milligram of retina was also detected as the eye grew beyond 0.8 millilitre in volume. These changes, although related to volume changes (i.e., growth) of the eyes, were found to have little relationship with increase of intraocular pressure as intraocular pressures in the growing eyes of the mutant strain did not change much. Goldfish from a control strain with similar eye volumes and sizes (ages) were used for comparison and similar changes as in the mutant were not apparent

Dejian Mind-Body Intervention Improves the Cognitive Functions of a Child with Autism

There has been increasing empirical evidence for the enhancing effects of Dejian Mind-Body Intervention (DMBI), a traditional Chinese Shaolin healing approach, on human frontal brain activity/functions, including patients with autism who are well documented to have frontal lobe problems. This study aims to compare the effects of DMBI with a conventional behavioural/cognitive intervention (CI) on enhancing the executive functions and memory of a nine-year-old boy with low-functioning autism (KY) and to explore possible underlying neural mechanism using EEG theta cordance. At post-one-month DMBI, KY's inhibitory control, cognitive flexibility, and memory functioning have significantly improved from “severely-to-moderately impaired” to “within-normal” range. This improvement was not observed from previous 12-month CI. Furthermore, KY showed increased cordance gradually extending from the anterior to the posterior brain region, suggesting possible neural mechanism underlying his cognitive improvement. These findings have implicated potential applicability of DMBI as a rehabilitation program for patients with severe frontal lobe and/or memory disorders

Efficacy and tolerability of trastuzumab emtansine in advanced human epidermal growth factor receptor 2–positive breast cancer

© 2018, Hong Kong Academy of Medicine Press. All rights reserved. Introduction: The management of human epidermal growth factor receptor 2 (HER2)–positive breast cancer has changed dramatically with the introduction and widespread use of HER2-targeted therapies. There is, however, relatively limited real-world information about the effectiveness and safety of trastuzumab emtansine (T-DM1) in Hong Kong Chinese patients. We assessed the efficacy and toxicity profiles among local patients with HER2-positive advanced breast cancer who had received T-DM1 therapy in the second-line setting and beyond. Methods: This retrospective study involved five local centres that provide service for over 80% of the breast cancer population in Hong Kong. The study period was from December 2013 to December 2015. Patients were included if they had recurrent or metastatic histologically confirmed HER2+ breast cancer who had progressed after at least one line of anti-HER2 therapy including trastuzumab. Patients were excluded if they received T-DM1 as first-line treatment for recurrent or metastatic HER2+ breast cancer. Patient charts including biochemical and haematological profiles were reviewed for background information, T-DM1 response, and toxicity data. Adverse events were documented during chemotherapy and 28 days after the last dose of medication. Results: Among 37 patients being included in this study, 28 (75.7%) had two or more lines of anti-HER2 agents and 26 (70.3%) had received two or more lines of palliative chemotherapy. Response assessment revealed that three (8.1%) patients had a complete response, eight (21.6%) a partial response, 11 (29.7%) a stable disease, and 12 (32.4%) a progressive disease; three patients could not be assessed. The median duration of response was 17.3 (95% confidence interval, 8.4-24.8) months. The clinical benefit rate (complete response + partial response + stable disease, ≥12 weeks) was 37.8% (95% confidence interval, 22.2%-53.5%). The median progression-free survival was 6.0 (95% confidence interval, 3.3-9.8) months and the median overall survival had not been reached by the data cut-off date. Grade 3 or 4 toxicities included thrombocytopaenia (13.5%), raised alanine transaminase (8.1%), anaemia (5.4%), and hypokalaemia (2.7%). No patient died as a result of toxicities. Conclusions: In patients with HER2-positive advanced breast cancer who have been heavily pretreated with anti-HER2 agents and cytotoxic chemotherapy, T-DM1 is well tolerated and provided a meaningful progression-free survival of 6 months and an overall survival that has not been reached. Further studies to identify appropriate patient subgroups are warranted.Link_to_subscribed_fulltex

Renal screening in children after exposure to low dose melamine in Hong Kong: cross sectional study

Objective To investigate the renal outcomes of children after exposure to low dose melamine in Hong Kong

Cost-Effectiveness of Biosimilars vs Leflunomide in Patients With Rheumatoid Arthritis

Importance: Among patients with rheumatoid arthritis (RA) who had an inadequate response to methotrexate, a treatment sequence initiated with biosimilar disease-modifying antirheumatic drugs (DMARDs) provides better clinical efficacy compared with conventional synthetic DMARDs recommended by current treatment guidelines; but its cost-effectiveness evidence remains unclear. Objective: To evaluate the cost-effectiveness of the treatment sequence initiated with biosimilar DMARDs after failure with methotrexate vs leflunomide and inform formulary listing decisions. Design, Setting, and Participants: This economic evaluation's cost-effectiveness analysis was performed at a Hong Kong public institution using the Markov disease transition model to simulate the lifetime disease progression and cost for patients with RA, using monetary value in 2022. Scenario and sensitivity analyses were performed to test the internal validity of the modeling conclusion. Participants included patients diagnosed with RA from 2000 to 2021 who were retrieved retrospectively from local electronic medical records to generate model input parameters. Statistical analysis was performed from January 2023 to March 2024. Interventions: The model assesses 3 competing treatment sequences initiated with biosimilar infliximab (CT-P13), biosimilar adalimumab (ABP-501), and leflunomide; all used in combination with methotrexate. Main Outcomes and Measures: Lifetime health care cost and quality-adjusted life-years (QALYs) of the simulated cohort. Results: In total, 25 099 patients with RA were identified (mean [SD] age, 56 [17] years; 19 469 [72.7%] women). In the base-case analysis, the lifetime health care cost and QALYs for the treatment sequence initiated with leflunomide were US $154 632 and 14.82 QALYs, respectively; for biosimilar infliximab, they were US$152 326 and 15.35 QALYs, respectively; and for biosimilar adalimumab, they were US $145 419 and 15.55 QALYs, respectively. Both biosimilar sequences presented lower costs and greater QALYs than the leflunomide sequence. In the deterministic sensitivity analysis, the incremental cost-effectiveness ratio (US$/QALY) comparing biosimilar infliximab sequence vs leflunomide sequence and biosimilar adalimumab sequence vs leflunomide sequence ranged from -15 797 to -8615 and -9088 to 10 238, respectively, all below the predefined willingness-to-pay threshold (US $48 555/QALY gain). In the probabilistic sensitivity analysis, the probability of treatment sequence initiated with leflunomide, biosimilar infliximab, and biosmilar adalimumab being cost-effective out of 10 000 iterations was 0%, 9%, and 91%, respectively. Conclusions and Relevance: In this economic evaluation study, the treatment sequences initiated with biosimilar DMARDs were cost-effective compared with the treatment sequence initiated with leflunomide in managing patients with RA who experienced failure with the initial methotrexate treatment. These results suggest the need to update clinical treatment guidelines for initiating biosimilars immediately after the failure of methotrexate for patients with RA