Clinically isolated syndromes and multiple sclerosis: prospective clinical and MRI follow up after 30 years and features at earlier time-points

This thesis is based on a 30-year follow-up study of a cohort of people who initially presented, in the 1980’s, with clinically isolated syndromes (CIS), suggestive of relapse-onset multiple sclerosis (MS). The main aims were: 1) to study the very long-term outcome of the cohort, with particular attention on those who have fared well over time, 2) review the idea and definition of ‘benign’ MS, a controversial entity, and 3) to identify any potential early clinical and radiological features, of 30-year outcome. MS is a very heterogenous condition and biomarkers of long-term prognostication remain limited. With the increasing range of disease modifying therapies available, it is important that treatment decisions should, as far as possible, involve a personalized risk-benefit analysis. At 30 years, I found that the clinical outcomes of the cohort were diverse. Approximately a third remained CIS, and two thirds developed MS. Within the MS group, who were largely untreated, ~40% remained ambulatory, ~35% had developed significant disability, and 20% had died related to their MS. Comparisons between the ambulatory MS group and CIS group, showed that the groups were not significantly different across several clinical measures. In this cohort, the strongest early predictors of 30-year outcomes identified were radiological features. The presence of MRI white matter lesions in specific locations in the brain, within one year of presentation, were able to predict 30-year clinical outcomes with accuracies in the 70-75% range. These results could potentially be applied in a clinical setting and help inform treatment decisions

The regulation of the residential property market in Hong Kong : a study of government strategies and tools

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

Public healthcare financing and provision in Hong Kong : a public-private partnership approach

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

Validation and application of health utilities index in Chinese subjects with down syndrome

Objectives: The objectives of the study were (1) to validate the Chinese version of Health Utilities Index (HUI-Ch); (2) to examine the Health-related Quality of Life (HRQoL) of Chinese subjects with Down syndrome (DS); and (3) to study the impact of chronic health conditions on HRQoL of Chinese with DS. Methods: The multiple choice questionnaire for scoring Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) was translated and validated. In addition to the HRQoL scores from HUI2 and HUI3, proxy-data on socio-demographics, and 10 common chronic health conditions for people with DS were collected and analyzed. Data analysis involves multiple imputation and multiple regression analysis to predict variations in HRQoL in relation to different factors. Lastly, a gradient interval was constructed on the number of chronic health conditions in relation to HRQoL. Results: HUI-Ch was validated according to standard guidelines. People with DS were found to have a lower HRQoL as compared to the general population, with the majority categorized as moderate or severe on the scale. Behavioral and hearing problems on HUI2, and hearing problems on HUI3 were found to be statistically significant predictors of a lower HRQoL score. A significant gradient relationship existed showing when the number of health problems increased, the HRQoL scores decreased. Conclusions: HUI-Ch is a valid instrument to assess HRQoL. It can have broad application in Chinese subjects with DS including the study of the impact of different chronic health conditions on their quality of life. The quantifiable nature of HUI-Ch will facilitate longitudinal study on the well-being of subjects with DS and evaluation of effectiveness of intervention programs in the near future

Factors contributing to the psychological well-being for Hong Kong Chinese children from low-income families: A qualitative study

© 2016 The Author(s). Background: Despite compelling evidence demonstrating the negative impact of poverty and income disparity on children's psychological well-being, there has been a lack of qualitative information which addresses its contributing factors. This study aimed to shed light on this area by comparing the experiences toward daily life between children living in low- and high-income families. Methods: A qualitative study using a phenomenological approach was conducted from May 2012 to January 2013. A random sample of 42 children aged 10-13, with 25 from low- and 17 from high-income families were asked to voluntarily response to a demographic sheet and undergo individual semi-structured interviews which lasted about 25-30 min. Content analysis was used to analyze the data. Approval for the study was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference UW 12-237). Results: The findings of this study revealed that the living environment, physical health, social life and ability to function at school of children from low-income families are severely impaired. Conclusions: It fills a gap in the literature by showing how poverty and income disparity affect the daily lives of children from low-income families on different levels. Also, adopting a sedentary lifestyle and unhealthy eating habits are possible factors mediating the effects of poverty and income disparity on the psychological well-being of children from low-income families. It is vital for healthcare professionals going beyond their normal roles to give advice on healthy lifestyles and behaviors by building multidisciplinary partnerships with schools and the community. Additionally, healthcare professionals should also target on these two possible factors to develop and implement appropriate interventions for promoting the psychological well-being among children living in poverty. Trial registration NCT02877719. 19 August 2016 retrospectively registeredpublished_or_final_versio

Play interventions to reduce anxiety and negative emotions in hospitalized children

© 2016 LI et al. Background: Hospitalization is a stressful and threatening experience, which can be emotionally devastating to children. Hospital play interventions have been widely used to prepare children for invasive medical procedures and hospitalization. Nevertheless, there is an imperative need for rigorous empirical scrutiny of the effectiveness of hospital play interventions, in particular, using play activities to ease the psychological burden of hospitalized children. This study tested the effectiveness of play interventions to reduce anxiety and negative emotions in hospitalized children. Methods: A non-equivalent control group pre-test and post-test, between subjects design was conducted in the two largest acute-care public hospitals in Hong Kong. A total of 304 Chinese children (ages 3-12) admitted for treatments in these two hospitals were invited to participate in the study. Of the 304 paediatric patients, 154 received hospital play interventions and 150 received usual care. Results: Children who received the hospital play interventions exhibited fewer negative emotions and experienced lower levels of anxiety than those children who received usual care. Conclusion: This study addressed a gap in the literature by providing empirical evidence to support the effectiveness of play interventions in reducing anxiety and negative emotions in hospitalized children. Findings from this study emphasize the significance of incorporating hospital play interventions to provide holistic and quality care to ease the psychological burden of hospitalized children. Trial registration: ClinicalTrials.gov NCT02665403. Registered 22 January 2016.published_or_final_versio