Submitted in fulfillment of the requirements of the Degree of Master of Technology: Chemistry, Durban University of Technology. 2014. / Peptide folding is a very complicated and dynamic process taking place in all living systems. The understanding of a bioactive conformation of the peptides is very important to understand their biological functions and underlying mechanism of action. However, the high flexible nature of peptides makes this process difficult as they can adopt thousands of conformations within the fraction of a second. The usage of experimental techniques in the characterization process is also limited due to several associated complications including synthesis, isolation and crystallization of peptides. The present computational methodologies, on the other hand, are solid enough to provide detailed complementary information about the intrinsic conformational features of peptides by mimicking their physiological conditions. In the present work, molecular dynamics (MD) computational method was used to explore the configurational space of three Aurein peptides, namely Aurein 2.3, Aurein 2.4 and Aurein 2.5. These peptides are secreted by the amphibian skin when they are exposed to external stimuli. These peptides have been reported to possess anti-cancer and anti-bacterial activity with minimum resistance compared to the available drugs. However, despite their medicinal significance, the precise three dimensional structures of Aurein 2.4 and Aurein 2.5 are not as yet known. First, a validation study was performed on Aurein 2.3 to check the efficiency of the computational protocol. The results obtained revealed the presence of -helicity in all residues of the Aurein 2.3, in accordance with its experimental structure. A similar protocol was further used to explore the conformational profiles of the remaining two peptides (Aurein 2.4 and Aurein 2.5) under implicit and explicit solvent conditions. The results obtained revealed that both these peptides exhibit -helical character in all residues although in varying percentages. The -helical region in the case of Aurein 2.4 was localized predominantly in the central residues extending towards its N-terminal residues, whereas it was flanked by N-terminal and the central residues in Aurein 2.5. However, -helicity was completely absent in the explicit solvents, and the peptides preferred to stay either in -turns or extended forms. Hence, the present work provides comprehensive information about the conformational preferences of Aurein peptides which could lead to a better understanding of their native conformations for future investigations and point the way towards developing their new agonists.

Skin cancer is the most commonly diagnosed cancer in the United States; it is estimated that the number of Americans who have had a skin cancer in the last three decades is higher than the number for all other cancers combined. Fortunately, there are known prevention methods, effective treatments available for early-stage cases, and behavioral practices that can reduce the risk of secondary and recurrent cancer. However, in spite of these, skin cancer incidence continues to increase and mortality still exists, making skin cancer prevention of the utmost importance. Outlined in this dissertation are factors identify as associated with the development, diagnosis, and prognosis of skin cancer that could be targeted during primary, secondary, and tertiary skin cancer control and prevention interventions in Arizona. Utilizing the 2013 Arizona Behavior Risk Factor Surveillance System survey, aim one of this dissertation investigates factors associated with UVR exposure (as measured by sun protection use and sunburn history) that could be targeted during primary prevention efforts in order to reduce the disease burden. The results of this research are that approximately 20% of Arizona adults are protecting their skin with sunscreen or protective clothing every time they go outdoors and 28% of Arizona adults experienced one or more sunburns in the past 12 months. Compared with males, females were more likely to report that they protect their skin. Other factors associated with use of sun protection were higher education, higher income, good general health, and living in a more urban area. A recent history of sunburns was associated with being non-Hispanic white and a history of indoor tanning. Given that melanoma diagnosed in the earlier progression of the disease is associated with improved prognosis and significantly higher survival rates, secondary prevention interventions are essential to skin cancer control efforts. The second aim of this dissertation was to gain a better understanding of patient and community factors associated with late-stage melanoma diagnosis in Arizona. Based on Arizona Cancer Registry and community-level data, among melanoma patients there is evidence for significant associations between late-stage of diagnosis and being male (OR 1.22 [95%CI1.09-1.37]), non-white (OR 3.15 [95%CI 2.01-4.95]), and Hispanic (OR 2.13 [95%CI 1.61-2.81]). Additionally, access to care was found to influence stage of diagnosis. Residence in a rural area, compared to an urban area, was associated with late-stage melanoma diagnosis. Similarly, zip codes with a dermatologist density of less than 6 dermatologists per 100,000 persons, when compared to zip codes with greater than 12 dermatologists per 100,000 persons, were associated with late-stage melanoma diagnosis. A travel distance to the reporting hospital or clinic of over 40 miles, as compared to travel distance of 20 miles or less, was also associated with melanoma cases being diagnosed at a late-stage. Even after the progression of the disease, skin cancer survivors' prognosis and quality of life can be improved by following healthy lifestyle recommendations. The final aim of this study was to examine at what levels skin cancer survivors are meeting the recommended healthy lifestyle behaviors. Skin cancer survivors' behaviors were similar, with the exception of increased sun protection use, to behaviors among survivors of other non-skin forms of cancer. However, skin cancer survivors were more likely to practice healthy lifestyle behaviors than individuals without a reported history of cancer. Although skin cancer survivor did report better behaviors than non-cancer controls, there was still a considerable amount of survivors not practicing the recommended behaviors. Over 25% of skin cancer survivors only protected their skin during the summer or not at all. Additionally, low levels of other healthy lifestyle behaviors were noted among skin cancer survivors: slightly over half of skin cancer survivors met the physical activity recommendations, approximately half reported receiving their annual influenza vaccination, and less than 20% consumed 5 fruit or vegetable servings daily. This research suggests that there are opportunities for improved clinical and public health interventions targeted at increasing sun protection use, preventing sunburns, reducing disparities associated with late-stage melanoma, and improving healthy lifestyle behaviors among skin cancer survivors.

Background: The challenges in the utilization of scientific findings in the fields of prevention and mental health are well documented. Scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Studies have suggested that about half of the patients receive the recommended care for their medical condition. In order to address this gap, health systems at global, national, regional and local levels have made diverse efforts to facilitate the uptake of research for example through evidence-based health policy processes. In Sweden, government agencies and health policy actors such as the National Board of Health and Welfare support and control the health care system through evidence-based policies amongst other steering tools. The overall aim of this thesis is to explore evidence-based policy processes, and to further understand barriers to implementation of policies in the fields of preventive and mental health services. Methods: A multiple case study approach was used, and data were collected from several sources. Qualitative content analysis methodology was used. Case 1 comprises the development and early implementation of national guidelines for methods of preventing disease managed by the National Board of Health and Welfare during 2007–2014. Case 2 covers the effort to improve health care for the older population that was undertaken through an agreement between the Swedish government and the Swedish Association of Local Authorities and Regions during 2009–2014. Case 3 involves an effort to implement an adapted version of a systematic review from the Swedish agency for health technology assessment and assessment of social services on treatment of depression in primary health care. Data was collected between 2007 and 2010. In Paper 1, the policies from Case 1 and 2 were studied using a longitudinal, comparative case study approach. Data were collected through interviews, documents and observations. A conceptual model was developed based on prior frameworks. The model was used to organize and analyse the data. In Paper 2, the guideline development process (Case 1) was studied through interviews and the collection of documents. A prior framework on guideline quality was used in order to organize the data. Paper 3 investigated decision-making processes during guideline development using a longitudinal approach. Qualitative data were collected from questionnaires, documents and observations and analysed using conventional and summative content analysis. In Paper 4, the barriers to implementation were investigated through interviews and the collection of documents. Data were analysed using qualitative content analysis with a conceptual model to structure the analysis. Results: The sources and procedures for policy formulation differed in Case 1 and 2, as did the approaches to promote the implementation of the policies. The policy processes were cyclical, and phases overlapped to a large degree. The policy actors intended to promote implementation, both during and after the policy formulation process. The thesis shows variation in how the key policy actors defined and used research evidence in the policy processes. In addition, other types of knowledge (e.g. politics, context, experience) served as alternative or multiple sources to inform the health policies. The composition of sources that informed the policies changed over time in Cases 1 and B. During the policy formulation and implementation process, efforts to integrate research evidence with clinical experiences and values were associated with tension and recurrent dilemmas. On the local level (i.e. primary health care centres), barriers to implementation were found related to the innovation and among health professionals, patients, in social networks as well as in the organizational, economic and political contexts. Conclusion: The concept of evidence holds a key position in terms of goals and means for knowledge based policymaking in the Swedish health system. Broad definitions of evidence – including research and non-research evidence - were requested and to various extents utilized by the policy actors in the studied cases. An explicit terminology and systematic, transparent methodology to define, identify, and assess also non-research evidence in policy processes would potentially strengthen the clarity and validity of these processes and also enhance policy implementation. Particular determinants to implementation, such as the interventions characteristic, are to a considerable degree established early in the policy process, during agenda setting and policy formulation. This early phase offers unique opportunities to assess and build capacity, initiate and facilitate implementation. Early analysis and considerations of target populations and contexts and other implementation determinants related to the specific policy scope (e.g. disease preventive guidelines) could enhance the forth-coming implementation of the policy.

Sammanfattning Fotboll är världens mest utövad idrott och korsbandsskador är vanliga inom fotboll där kvinnor har en markant ökad risk jämfört med män att skada sig. Dessa skador medför ofta lång tids frånvaro från idrottande och är kostsamma för både individ och samhälle. Det är därför viktigt att undersöka hur dessa skador kan förhindras. Syfte och frågeställningar: Denna studie har utförts med syftet att kritiskt granska och jämföra träningsprogram för prevention av främre korsbandsskada för kvinnliga fotbollsspelare. Studien har två frågeställningar: Ger ett preventivt träningsprogram för kvinnliga fotbollsspelare en minskad incidens av främre korsbandsskador? Finns det evidens för vilket av träningsprogrammen är bäst? Studiens hypotes är att preventionsträning minskar incidensen av främre korsbandsskador hos kvinnliga fotbollsspelare. Metod: Det är en litteraturstudie. Litteratursökning genomfördes på PubMed februari-maj 2016. Nio original studier som kvalificerades utifrån inklusions- och exklusionskriterierna hittades. Information blev hämtad från varje enskild studie för att jämföra studierna, räkna fram den totala effekten av preventionsprogrammen samt riskreduction ration (RRR) och number needed to treat (NNT). Resultat: Resultatet stämmer överens med studiens hypotes. Den sammanlagda riskreduceringen av preventionsträningen mättes 69,3%. Tre av nio studier visade signifikant minskad incidens av främre korsbandsskador. Skillnaden i studiernas design, kvalitet och styrka gör det svårt att avgöra vilket av programmen är bäst. Slutsats: Det finns evidens för att preventiva träningsprogram kan ge minskad incidens av främre korsbandsskador. Fler studier av bra kvalitet behövs för att studera riskfaktorer samt vilka övningar som kan påverka dessa för att kunna skapa optimala träningsprogram. / <p>Kurs Idrott III vt 2016</p>

Bakgrund: Samhället står inför förändringar som innebär att andelen personer över 65 år har ökat och över tid även de närmsta åren kommer att öka. För att möta den ökande andelen äldre i samhället behövs förebyggande insatser. Ett sätt att arbeta förebyggande är att göra hembesök som syftar till att bibehålla självständighet och god hälsa. Osby kommun har sedan 2006 arbetat förebyggande med att besöka 75 åringar i ordinärt boende. För att kunna utvärdera effekten av verksamheten i Osby behövs det kunskap om hur personerna förhåller sig till rekommendationer som ges och vilka åtgärder de vidtar. Syfte: Denna studie syftade till att undersöka vilka åtgärder äldre personer utfört efter att de fått ett förebyggande hembesök. Metod: En kvantitativ ansats valdes för att utföra studien. Enkäter sändes ut till 147 personer som fått förebyggande hembesök under 6 månader. Frågorna som ställdes handlade om säkerhet i hemmet, träning och rörelse, mat och måltider samt kontakter angående hälsa. Svarsfrekvens var 83 personer vilket motsvarar 56%. Analyser av enkäten gjordes i analysverktyget SPSS utifrån signifikansprövning enligt McNemar och logistisk regression. Statistik togs fram på hur många som utfört åtgärder innan besöket och hur åtgärderna ökade efter rekommendationerna som lämnats under samtalet. Resultat: Resultatet visade att signifikans uppmättes på flera områden runt säkerhet i hemmet och träning och rörelse. Flera av de som fått förebyggande hembesök utförde åtgärder efter besöket inom dessa områden. Majoriteten av de äldre rörde på sig aktivt efter besöket och flertalet genomförde åtgärder som förbättrade säkerheten i hemmet. Ingen signifikans framkom i de logistiska regressionerna mellan kön, ålder, ensam/sammanboende eller läge på bostaden och de beroende variablerna, det vill säga insatser gällande säkerhet i hemmet, träning och rörelse, mat och måltider samt kontakter angående hälsa. Diskussion: Studien har ett litet urval vilket gör det svårt att dra slutsatser utifrån de framkomna resultaten. På det antal individer som besvarat enkäten framkom att samtalet hade effekt och att åtgärder utfördes efter de rekommendationer som gavs. Distriktssjuksköterskorna påverkar de som besökts till att bli delaktiga runt förändringar i sin vardag. Vidare behövs fler studier för att resultatet ytterligare ska kunna säkerställas.

published_or_final_version / Sociology / Doctoral / Doctor of Philosophy

published_or_final_version / Business Administration / Master / Master of Business Administration

published_or_final_version / abstract / toc / Educational Psychology / Master / Master of Social Sciences

published_or_final_version / abstract / Conservation / Master / Master of Science in Conservation

published_or_final_version / Public Administration / Master / Master of Public Administration