A Model of Behaviour Change in Housework for Women with Upper Limb Repetitive Strain Injury

Upper limb repetitive strain injury (RSI) is a costly disease. Evidence indicates biomechanical risk in housework that contributes to this cluster of conditions among women. Although there is consistent evidence indicating the importance of conducting ergonomic education to monitor the mechanical exposures for better musculoskeletal health, there is limited research on understanding behaviour change in housework for women with upper limb RSI. Occupational therapy has an important role in facilitating behaviour change in housework for women with upper limb RSI, to minimise their exposure to biomechanical risk in housework through ergonomic education. In a hand therapy outpatient clinic in an acute hospital in Singapore, such education is usually conducted by therapists for women with upper limb RSI on a one-to-one basis; planning is based on the clinical experience of individual therapists rather than on a specific theory. The purpose of this thesis is to construct a model of behaviour change in housework for women with upper limb RSI, to guide the planning of such education within a hand therapy outpatient clinic in a Singapore acute care hospital. Framed by a client-centred approach, a central philosophy of occupational therapy, which indicates the importance of ‘listening and communicating’ with clients at all stages of intervention and considering the importance of making therapists’ tacit knowledge explicit while planning an intervention, two grounded theory studies (Study I and Study II) adopting the constructivist approach outlined by Charmaz (2009a) were conducted to construct the model. Both studies collected data through in depth interviewing. Study I investigated the perceptions of 15 women with upper limb RSI who had received ergonomic education on housework conducted by occupational therapists. The study found that even though women perceived a change in housework was necessary and possible, they would not make a change if they perceived it as emotionally unacceptable when it was disruptive to their habits and routines developed according to the meanings they attached to housework. Also, the factors used by each woman to make decisions on housework were different, according to their specific situations and experiences. The study showed the important effect of the women’s self-identity and social role as a homemaker on how they considered advice from the health professionals on making changes in housework. From the findings of the study, a conceptual framework was constructed on their decision making in housework. Study II investigated the clinical reasoning process of 14 occupational therapists who had conducted such education. There were three main findings of this study. First, therapists perceived that clients go through different stages before they finally incorporate recommended changes into their routines. Second, therapists perceived doubts from their clients regarding their credibility to provide advice on housework. Third, therapists found the limited resources within their clinical environment a challenge for them to ‘listen and communicate’ with their clients (a major component of client-centred approach). The study showed the effect of therapists’ professional roles and personal roles on their interaction with their clients, hence their clients’ willingness to change. From these findings, a conceptual framework was constructed on the therapists’ clinical reasoning process. A model of behaviour change in housework for women with upper limb RSI was then constructed by integrating the major concepts from these two frameworks. There are five major constructs in this model. They include the clinical environment, client-therapist interaction, emotional attachment to housework, cognitively informed decisions, and stages of change. With a comparison of the findings from Study I and Study II, a gap in therapists’ clinical reasoning process was identified. The first major issue was that therapists lacked a deeper understanding of the meanings women with upper limb RSI attached to housework. Another issue was the time pressure and space limitation within an acute clinical environment which affected the client-therapist interaction that was crucial in clients’ willingness to make changes in housework, according to the therapists’ advice. Based on the constructs of the model and the findings of the two grounded theory studies of women with upper limb RSI and the occupational therapists who conducted ergonomic education on housework for them, an assessment was then designed as an initial step to address these issues. A pilot study using a quantitative methodology was conducted to implement this tool for a group of women with upper limb RSI, who were referred to a hand therapy outpatient clinic in an acute hospital in Singapore. The pilot study provided preliminary evidence on the validity of the assessment and its consistency with the model of behaviour change in housework for women with upper limb RSI. The present research has identified major findings related to the differences in social roles, identity and values caused by a generational gap between women with upper limb RSI and the therapists who conducted ergonomic education for them. Women who participated in the present research are mainly married with children. They considered their role as a homemaker salient in representing their role as a mother, a wife and a woman. As such, the housework habits and routines they developed through the years become a behavioural representation of these identities. In contrast, therapists who conducted ergonomic education for these women are mostly single, living with their families. They did not attach deep meanings to housework and did not consider housework as representation of their self-identity. The present research found that during ergonomic education, it was mainly the therapists’ professional identity that directed how they interacted with clients. As such, they only started to consider the clients’ perspective of housework when clients refused to change. Therapists may not have considered the full range of meanings that their clients attached to housework when interacting with them. While the present research was framed by a client-centred approach, the findings of the studies in this research confirmed its importance. There are three implications for practice. First, therapists need to be trained to gain a deeper understanding of the meanings their clients attach to housework and how to move their intervention towards a client-centred approach, within a clinical environment that is under time pressure. Second, the use of an assessment to provide information on clients’ perceptions of and readiness to making a change in housework could be a first step towards better interaction between the therapists and their clients. Third, program evaluation could be the next step to gain organisational support for the intervention to move towards a client-centred approach according to the model. This research is significant not only because it provides a framework of intervention for this particular group of women, but it also sets an example of how research could be conducted to improve other interventions within occupational therapy practice, by listening to both the voices of clients and their therapists

Perceived Importance of Portfolios in a Smart CV after an Education Reform: An Empirical Analysis

Recent developments in recruitment processes have demonstrated that job applicants are increasingly using online Smart CVs instead of traditional approaches like hardcopy or emailing CVs. This study aims at examining perceived importance university undergraduate students of Hong Kong place or put on portfolios of Smart CVs, such as internship experience, exchange experience, scholarships & awards, participation in competitions, academic performance, and extra-curricular activities when building a Smart CV, and on investigating potential effects of the 3+3+4 academic reform in Hong Kong and admission mode. Participants were 256 undergraduate students in BBA majoring either in Information Management or in Electronic Commerce. A survey consisting of 44 items, which measured perceptions on the importance of the 6 proposed portfolios of Smart CVs, was used to collect data. Principal component analysis was used to analyze the items and 34 items were included in the final factor structure out of which 27 items got retained after subsequent reliability analysis. The 6 portfolios were positively inter-correlated. Students who were admitted under the new 4-year undergraduate curriculum using examination results of the new Hong Kong Diploma of Secondary Education (HKDSE) perceived internship experience and participation in competitions as more important in their Smart CVs, which was not the case with those who were admitted under the 3-year undergraduate curriculum using the results of the Hong Kong Advanced Level Examination (HKALE), which is no longer in use since 2012. The admission routes of students did not affect perceived importance in a Smart CV of the 6 proposed portfolios

The Milli-Motein: A self-folding chain of programmable matter with a one centimeter module pitch

The Milli-Motein (Millimeter-Scale Motorized Protein) is ca chain of programmable matter with a 1 cm pitch. It can fold itself into digitized approximations of arbitrary three-dimensional shapes. The small size of the Milli-Motein segments is enabled by the use of our new electropermanent wobble stepper motors, described in this paper, and by a highly integrated electronic and mechanical design. The chain is an interlocked series of connected motor rotors and stators, wrapped with a continuous flex circuit to provide communications, control, and power transmission capabilities. The Milli-Motein uses off-the-shelf electronic components and fasteners, and custom parts fabricated by conventional and electric discharge machining, assembled with screws, glue, and solder using tweezers under a microscope. We perform shape reconfiguration experiments using a four-segment Milli-Motein. It can switch from a straight line to a prescribed shape in 5 seconds, consuming 2.6 W power during reconfiguration. It can hold its shape indefinitely without power. During reconfiguration, a segment can lift the weight of one but not two segments as a horizontal cantilever.United States. Defense Advanced Research Projects Agency. Programmable Matter ProgramUnited States. Defense Advanced Research Projects Agency. Maximum Mobility and Manipulation (M3) ProgramUnited States. Army Research Office (Grant W911NF-08-1-0254)United States. Army Research Office (Grant W911NF-11-1-0096)Massachusetts Institute of Technology. Center for Bits and Atom

Reliable and valid NEWS for Chinese seniors: measuring perceived neighborhood attributes related to walking

Background : The effects of the built environment on walking in seniors have not been studied in an Asian context. To examine these effects, valid and reliable measures are needed. The aim of this study was to develop and validate a questionnaire of perceived neighborhood characteristics related to walking appropriate for Chinese seniors (Neighborhood Environment Walkability Scale for Chinese Seniors, NEWS-CS). It was based on the Neighborhood Environment Walkability Scale - Abbreviated (NEWS-A), a validated measure of perceived built environment developed in the USA for adults. A secondary study aim was to establish the generalizability of the NEWS-A to an Asian high-density urban context and a different age group. Methods : A multidisciplinary panel of experts adapted the original NEWS-A to reflect the built environment of Hong Kong and needs of seniors. The translated instrument was pre-tested on a sample of 50 Chinese-speaking senior residents (65+ years). The final version of the NEWS-CS was interviewer-administered to 484 seniors residing in four selected Hong Kong districts varying in walkability and socio-economic status. Ninety-two participants completed the questionnaire on two separate occasions, 2-3 weeks apart. Test-rest reliability indices were estimated for each item and subscale of the NEWS-CS. Confirmatory factor analysis was used to develop the measurement model of the NEWS-CS and cross-validate that of the NEWS-A. Results : The final version of the NEWS-CS consisted of 14 subscales and four single items (76 items). Test-retest reliability was moderate to good (ICC > 50 or % agreement > 60) except for four items measuring distance to destinations. The originally-proposed measurement models of the NEWS-A and NEWS-CS required 2-3 theoretically-justifiable modifications to fit the data well. Conclusions : The NEWS-CS possesses sufficient levels of reliability and factorial validity to be used for measuring perceived neighborhood environment in Chinese seniors. Further work is needed to assess its construct validity and generalizability to other Asian locations. In general, the measurement model of the original NEWS-A was generalizable to this study context, supporting the feasibility of cross-country and age-group comparisons of the effect of the neighborhood environment on walking using the NEWS-A as a tool to measure the perceived built environment

Hong Kong dentists' preparedness for medical emergency in dental clinics

Aim: The aim of this study was to investigate the Hong Kong dentists’ and dental clinics’ preparedness for medical emergency in the dental clinic. Methods: Two custom designed questionnaires were developed, one for dentists and another for dental clinics, to collect the required information. The sampling frame for participants was the list of registered dentists published by the Hong Kong Dental Council on its website in January 2016. A total of 434 dentists and 143 dental clinics were selected from the list by systematic random sampling. The latter sample was supplemented by 10 randomly selected government dental clinics. The questionnaires were mailed the selected dentists together with a cover letter and a stamped return envelope. A reminder letter and another copy of the questionnaire were sent out two weeks after the first mailing. Results: 167 (38%) completed dentist questionnaires and 53 (35%) clinic questionnaires were collected. Most of the respondent dentists had some deficient knowledge on basic life support (BLS), their mean score was 3.5 out of a maximum of 5. Most (>60%) of the respondents thought they were competent in performing medical emergency procedures except giving intravenous injection. Moreover, most (>60%) of them held positive attitude towards having immediate availability of essential medical emergency equipment and drugs in their clinic. Dentists who were more recent graduates, those with postgraduate qualifications, and those who work with accompaniment generally had higher mean BLS knowledge scores. In the dental clinics, the most commonly kept medical emergency equipment/drug was instant glucose (70%) and followed by antihistamine (62%). Only a quarter of the clinics were equipped with AED, and 45% were equipped with oxygen cylinder. For 8 out of the 11 items, a higher proportion of the bigger clinics (>2 dental chairs) than the smaller clinics had the medical emergency equipment/drug available (Chi-square test, p<0.05). Conclusion: Hong Kong dentists have a moderate level of knowledge on BLS which should be enhanced through regular attendance at CE courses. Their knowledge level is affected by a number of their background and professional activities factors. Most dental clinics in Hong Kong have only few of the essential medical emergency equipment and drugs while the larger clinics are better equipped than the smaller clinics.published_or_final_versio

Community-based HIV-1 Early Diagnosis and Risk Behavior Analysis of Men Having Sex with Men in Hong Kong

The increasing prevalence of HIV-1 among men having sex with men (MSM) calls for an investigation of HIV-1 prevalence and incidence in MSM by early diagnosis to assist with early preventive interventions in Hong Kong. The participants were recruited randomly from MSM communities within a one-year period. Rapid HIV Test (RHT) and real-time dried blood spot (DBS)-based quantitative polymerase chain reaction (DBS-qPCR) were used for the early diagnosis of 474 participants. Risk behavior analysis was performed by studying information obtained from the participants during the study period. The HIV-1 prevalence and incident rates in the studied MSM population were 4.01%(19/474) and 1.47% (7/474), respectively. Three infected participants were found at the acute phase of infection by DBS-qPCR. Only 46.4%(220/474) MSM were using condoms regularly for anal sex. HIV infection significantly correlated with unprotected receptive anal sex and syphilis infection. An increased number of infections was found among foreign MSM in Hong Kong. This study is the first to use DBS-qPCR to identify acutely infected individuals in a community setting and to provide both the prevalence and incident rates of HIV-1 infection among MSM in Hong Kong. The risk analysis provided evidence that behavior intervention strengthening is necessary to fight against the increasing HIV-1 epidemic among MSM in Hong Kong and surrounding regions in Asia.published_or_final_versio

The development of universal retirement policy in Hong Kong : a study of political and administrative dynamics

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

Growth-differentiation factor-8 (GDF-8) in the uterus: its identification and functional significance in the golden hamster

Transforming growth factor-beta superfamily regulates many aspects of reproduction in the female. We identified a novel member of this family, growth-differentiation factor 8 (GDF-8) in the 72 h post coital uterine fluid of the golden hamster by proteomic techniques. Uterine GDF-8 mRNA decreased as pregnancy progressed while its active protein peaked at 72 h post coitus (hpc) and thereafter stayed at a lower level. At 72 hpc, the GDF-8 transcript was localized to the endometrial epithelium while its protein accumulated in the stroma. Exogenous GDF-8 slowed down proliferation of primary cultures of uterine smooth muscle cells (SMC) and endometrial epithelial cells (EEC). In addition, GDF-8 attenuated the release of LIF (leukaemia inhibiting factor) by EEC. As for the embryo in culture, GDF-8 promoted proliferation of the trophotoderm (TM) and hatching but discouraged attachment. Our study suggests that GDF-8 could regulate the behavior of preimplantation embryos and fine-tune the physiology of uterine environment during pregnancy

Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomised controlled trial

Background: Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD). Aims: To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive–behavioural therapy-based psychoeducation and usual care. Method: In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months. Primary outcomes were anxiety and worry levels. Results: Linear mixed models demonstrated significant group × time interaction (F(4,148) = 5.10, P = 0.001) effects for decreased anxiety for both the intervention groups relative to usual care. Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only. Conclusions: These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms