Despite the fact that high sodium intake has been linked to high blood pressure and an increased risk for cardiovascular disease (CVD), sufficient and irrevocable evidence to support extremely low dietary sodium intake has been lacking. The best method used for the estimation of daily sodium intake is indirectly by using 24-hour urinary sodium excretion, combined with para-aminobenzoic acid (PABA), which is used for validating completeness of urinary collection. However, the PABA validation method is not favored among researchers and the validity of high-performance liquid chromatography (HPLC) analysis for PABA has not been evaluated in a large-scale study. This study validated an improved PABA HPLC method and applied it in the sub-set of the Prospective Urban Rural Epidemiology (PURE) – 24-hour Urinary Excretion (24USE) Study for the examination of the sodium-blood pressure association. In addition, participants’ self-reported assessment of urinary collection completeness was compared to the PABA method. The HPLC analysis method for measuring PABA levels was downscaled and the reaction time lengthened to achieve higher through-put and reaction yield. By applying the optimized PABA method for evaluating urinary completeness, 612 of 681 participants’ samples contained 70%-110% PABA recovery and were extracted from the PURE24USE Study for further analysis. The average adjusted sodium excretion or intake was 3,673 ± 1,637 mg/day. The participants’ self-reports predict urinary collection completeness as measured by PABA with a sensitivity of 76.9% (95% CI: 74.4%-79.6%) and specificity of 31.7% (95% CI: 27.0%-36.4%). This moderate agreement suggests that PABA still has to be considered the gold standard, until further convincing evidence is available that self-report is more accurate than PABA. / Thesis / Master of Science in Medical Sciences (MSMS)

Aim: To describe medical nurses’ experiences caring for patients and families within an environment with open visiting hours (OVH). Background: OVH is an approach where families and friends can visit patients without restrictions. OVH is a strategy used by hospitals to promote patient-and-family-centered care (PFCC). In an OVH environment, the increased presence of family can alter nurses’ working environments. However, research examining nurses’ perspectives on OVH is limited. As OVH becomes more widely implemented, it is essential to understand the influence of OVH on the nurse. Design: A qualitative descriptive approach was used. Methods: Semi-structured interviews were conducted with 10 registered nurses on two medical units in a large urban Canadian hospital. Thematic analysis was used to analyze the data inductively. Strategies were used to enhance rigour. Results: Four main themes resulted which described participants’ experiences with OVH as they related to the processes and philosophy of OVH, the care of patients and family, and the influence families had on patient care and nurses working environments. An overarching theme of Reliance and Resistance reflected participants’ mixed feelings toward OVH. While OVH facilitated PFCC and alleviated nurses’ work, at times it also hindered opportunities for nurses to get to know patients and added to their work. Further, increased family presence created challenges related to space, overcrowding, increased noise levels, and created concerns about safety. Conclusion: The findings add to an understanding of the clinical realities of OVH from the perspectives of medical nurses, and the potential implications for PFCC and nurses’ working environment. Relevance to clinical practice: OVH creates an environment to foster PFCC. However, nurses may benefit from training to facilitate communication and engagement with families. Organizations who wish to implement OVH should consider how contextual factors may influence nurses’ environments and their practice.

We live in a society dominated by time. It plays a part in nearly everything we do. Time tells us when to wake up, when to eat, when to be at work, when its time to sleep, and so on. Just as people are controlled by time, so are the buildings we use. Th ese buildings oft en times are very narrowly used. As a result, portions of our cities are full of activity during certain times of the day, while at other times become deserted. What happens to the building when it is not being used? Does the building go to sleep? Do buildings need to sleep? Is it possible to design a mixed-use building in our nations capitol that never sleeps? Th ese are just a few of the questions that began this journey to design 24 hours building and the cyclical nature of the people that inhabit them. / Master of Architecture

Involuntary electromyographic (EMG) activity has been recorded in the thenar (thumb) muscles of spinal cord injured (SCI) subjects for only short time periods (minutes), but it is unknown if this motor unit activity is ongoing. Longer duration EMG recordings can investigate the physiological significance of this neuromuscular activity. Analysis of these data is complex and time consuming. Since no software is currently capable of classifying 24 hours of data at a single motor unit level, the goal of this research was to devise an algorithm to automatically classify motor unit potentials over 24-hours. Twenty-four-hour, 2-channel thenar muscle EMG recordings were obtained from four different SCI subjects with cervical level injuries using a data logging device with custom software. The automatic motor unit classification algorithm used to classify the 24-hour recordings was a procedure consisting of four stages that included segmentation, clustering, and motor unit template uniting. All individual potentials were then classified and any superimposed potentials were resolved into their constituent classes. Finally, the algorithm found the firing patterns for each of the stable motor unit classes. The classification algorithm performance was compared to the analysis of a human operator and assessed in 2 ways: Tracking global classes over the 24 hours and correctly classifying individual motor unit potentials as to belonging to particular global classes. The algorithm was able to track an average of 13 global classes in four 24-hour recordings with a mean accuracy of 92 %. It was also able to classify individual potentials with a mean accuracy of 86% over four recordings, greater than the inter-rater reliability of two human operators (79%). The activities of the motor units tracked by the algorithm ranged from tonic firing to sporadic activity. The algorithm could analyze 24 hours of data in 2-3 weeks, while a human operator was estimated to take more than 2 years. In conclusion, the motor unit classification algorithm accomplished its goal of automatically tracking motor unit classes over a 24-hour recording with high accuracy. The 24-hour classification method developed here could be applied towards classifying long term recordings of other biological signals.

Adolescence proves to be one of the most vulnerable development stages in the life of humans and therefore dietary assessment of this group is important, but complex. This is due to rapid growth during puberty and the development of new eating patterns that influence dietary intake. Adequate dietary intake in this age group is crucial, since adverse effects such as iron deficiency anemia, inadequate growth and dental caries can occur. Furthermore, dietary imbalance is a significant risk factor that can lay the groundwork for developing preventable complications in late adolescence and adult life such as non-communicable chronic diseases including obesity and diabetes mellitus type II and certain cancers, all leading causes of morbidity and mortality. Given the vulnerability of adolescents in terms of dietary intake, understanding their dietary intake is crucial. Dietary assessment of adolescents is influenced by social, physiological and psychological changes making accurate measurement of this group difficult. Hence, it is of fundamental importance to find a golden standard in terms of a dietary assessment method to use in this group. Several international studies investigated validity and reproducibility of the dietary intake of adolescents, measured with different dietary assessment methods. However, in South Africa only three validity and reproducibility studies have been published and none of them focused exclusively on adolescents. Since the validity of the results of dietary assessment methods of international studies cannot be extrapolated to South African black adolescents, this study emanated from the need to investigate whether multiple 24-hour recalls are valid and reproducible when used to assess the dietary intakes of black adolescents in a convenience sample of grade eight learners from a high school in a township in the North West Province. The study was nested in the multidisciplinary "Physical, Activity in the Young" (PLAY) study. Firstly, the optimal number of 24-hour recalls was determined by calculation of reproducibility coefficients for energy, selected nutrients and food groups. Results showed that four repeated 24-hour recalls provided the optimal reproducibility for black peri-urban South African adolescents. Secondly, the search for a reference method to compare energy intake against energy expenditure led to an investigation into basal metabolic rate equations and physical activity factors with the intention of estimating the energy expenditure. Validity of reported energy intake assessed by multiple 24-hour recalls and estimated energy expenditure was tested using the Pearson correlation coefficient and the dependent t-test. The Pearson correlation test revealed low associations between energy intake and energy expenditure for boys (0.32) and girls (0.17), while the dependent t-test of the energy intake between the different measured occasions showed little difference, which could be explained by the high within participant variation and lower variation between the different participants. The low correlation coefficients showed that there was no association between reported energy intake and mean estimated energy expenditure; thus also no agreement. As a result, multiple 24-hour recalls measured over two years with only five 24-hour recalls did not give a valid measurement of the energy intake of black peri-urban adolescents. Lastly, the ratio of reported energy intake over energy expenditure was evaluated against the energy cut-off points, specifically calculated for age and ethnic group. It indicated that 85% of the participants underreported their energy intake. These results could have been influenced by the estimated basal metabolic rate equations that could have estimated the basal metabolic rate of this group incorrectly or could be due to the inability of the group to recall their physical activity levels correctly. Therefore it is recommended that further validity studies regarding dietary intake need to be performed on adolescents. It is suggested that energy expenditure as a reference method should be measured by using a calorimeter or the doubly labeled water method and then compared with the reported energy intake. Analysing different biochemical determinants of nutritional intake could also be used as an objective reference method to assess the validity of dietary data obtained from questionnaires. / Thesis (Ph.D. (Dietetics)--North-West University, Potchefstroom Campus, 2009.

Adolescence proves to be one of the most vulnerable development stages in the life of humans and therefore dietary assessment of this group is important, but complex. This is due to rapid growth during puberty and the development of new eating patterns that influence dietary intake. Adequate dietary intake in this age group is crucial, since adverse effects such as iron deficiency anemia, inadequate growth and dental caries can occur. Furthermore, dietary imbalance is a significant risk factor that can lay the groundwork for developing preventable complications in late adolescence and adult life such as non-communicable chronic diseases including obesity and diabetes mellitus type II and certain cancers, all leading causes of morbidity and mortality. Given the vulnerability of adolescents in terms of dietary intake, understanding their dietary intake is crucial. Dietary assessment of adolescents is influenced by social, physiological and psychological changes making accurate measurement of this group difficult. Hence, it is of fundamental importance to find a golden standard in terms of a dietary assessment method to use in this group. Several international studies investigated validity and reproducibility of the dietary intake of adolescents, measured with different dietary assessment methods. However, in South Africa only three validity and reproducibility studies have been published and none of them focused exclusively on adolescents. Since the validity of the results of dietary assessment methods of international studies cannot be extrapolated to South African black adolescents, this study emanated from the need to investigate whether multiple 24-hour recalls are valid and reproducible when used to assess the dietary intakes of black adolescents in a convenience sample of grade eight learners from a high school in a township in the North West Province. The study was nested in the multidisciplinary "Physical, Activity in the Young" (PLAY) study. Firstly, the optimal number of 24-hour recalls was determined by calculation of reproducibility coefficients for energy, selected nutrients and food groups. Results showed that four repeated 24-hour recalls provided the optimal reproducibility for black peri-urban South African adolescents. Secondly, the search for a reference method to compare energy intake against energy expenditure led to an investigation into basal metabolic rate equations and physical activity factors with the intention of estimating the energy expenditure. Validity of reported energy intake assessed by multiple 24-hour recalls and estimated energy expenditure was tested using the Pearson correlation coefficient and the dependent t-test. The Pearson correlation test revealed low associations between energy intake and energy expenditure for boys (0.32) and girls (0.17), while the dependent t-test of the energy intake between the different measured occasions showed little difference, which could be explained by the high within participant variation and lower variation between the different participants. The low correlation coefficients showed that there was no association between reported energy intake and mean estimated energy expenditure; thus also no agreement. As a result, multiple 24-hour recalls measured over two years with only five 24-hour recalls did not give a valid measurement of the energy intake of black peri-urban adolescents. Lastly, the ratio of reported energy intake over energy expenditure was evaluated against the energy cut-off points, specifically calculated for age and ethnic group. It indicated that 85% of the participants underreported their energy intake. These results could have been influenced by the estimated basal metabolic rate equations that could have estimated the basal metabolic rate of this group incorrectly or could be due to the inability of the group to recall their physical activity levels correctly. Therefore it is recommended that further validity studies regarding dietary intake need to be performed on adolescents. It is suggested that energy expenditure as a reference method should be measured by using a calorimeter or the doubly labeled water method and then compared with the reported energy intake. Analysing different biochemical determinants of nutritional intake could also be used as an objective reference method to assess the validity of dietary data obtained from questionnaires. / Thesis (Ph.D. (Dietetics)--North-West University, Potchefstroom Campus, 2009.

Introduction Trauma and emergencies contribute to the quadruple burden of disease in South Africa and being prepared for an emergency requires rapid access to emergency equipment, drugs and emergency trolleys to optimally manage an emergency. This is the first descriptive study looking specifically at essential emergency equipment, drugs and the emergency trolley required for the provision of optimal emergency care at Community Health Centres (CHCs) in the Western Cape Metropole. Aims and Objectives The aim of the study was to evaluate whether eight 24 hour emergency units at CHCs in the Western Cape Metropole had the appropriate and essential emergency equipment, drugs and emergency trolleys necessary for the delivery of optimal emergency care, using the Emergency Medicine Society of South Africa (EMSSA) guidelines as the audit tool. Objectives included: 1. To assess availability of essential emergency equipment 2. To assess availability of essential emergency drugs 3. To assess the functionality of existing emergency trolleys Methodology EMSSA guidelines were used as the evaluation audit tool to perform a survey of emergency equipment, drugs and emergency trolleys at eight 24 hour CHCs in the Western Cape Metro pole. Data collection for the study was conducted at the eight 24 hour CHCs over a 3 month period during the months of June 2012 to August 2012. The data was analyzed using the Statistical Package for Health Sciences (Statistica, version 10 of 2012) and Microsoft Excel. Results A total of 81 emergency equipment items, 43 emergency drug items (37 emergency drugs, 6 intravenous fluids) and 78 emergency trolley items were required to be in each emergency unit. An average of 62% of all recommended emergency equipment items, 80% of all emergency drugs and 52.4% of all emergency trolley items were found to be present in this survey. Essential emergency paediatric equipment including bag ventilation devices, Magill’s forceps, masks, intraosseous needles and appropriate blood pressure cuffs were found to be absent at 2 CHCs. All CHCs had access to a defibrillator and ECG machine but these were found to be dysfunctional at 2 CHCs due to expired batteries and no tracing paper being available. Expired first line emergency drugs (adrenaline and atropine) were found at certain CHCs. The recording of emergency trolley checklists and stocking of essential emergency items were found to be incongruent, inconsistent and not up to the recommended standard. Conclusion Essential emergency equipment and drugs and the functionality of emergency trolleys were found to be generally inadequate. Considerable deficiencies of essential emergency items were found, particularly paediatric equipment and drugs and this may negatively impact on resuscitative efforts and outcome in both paediatric and adult emergency care at CHCs in the Western Cape Metropole.

Obesity research remains a high priority worldwide, given the sustained high levels of obesity (body mass index ≥30 kg/m2) and class III obesity (body mass index ≥40 kg/m2) across many demographic groups. One component of obesity research is the study of how diet can contribute to obesity, and thus it is crucial to evaluate how existing dietary assessment methods perform for people with obesity, and to develop or refine methods to enhance their accuracy. Researchers should be prepared to include more individuals with obesity and class III obesity, a growing demographic, in studies that assess dietary intake. With the inclusion of these groups, it is vital to consider the potential impact of weight bias and weight stigma on dietary research. Weight bias is negative attitudes and stereotypes about people with obesity, while weight stigma is how these attitudes collectively devalue people with obesity, which could result in acts of discrimination. This dissertation: 1) defined the issues of weight bias and weight stigma, and how they affect dietetics practice, including research, 2) determined the representation of participants with class III obesity in studies validating self-reported measures of dietary assessment using doubly-labeled water, and 3) explored how weight bias and weight stigma might impact misreporting of energy intake among people with overweight and obesity. Findings include that: 1) weight bias and weight stigma are important issues when working with people with obesity, and dietetics professionals can address these in many areas of practice; 2) in studies validating self-reported dietary assessment methods using doubly-labeled water, people with class III obesity are underrepresented, and thus the validity of existing methods to assess diet among people with class III obesity requires further research; 3) in a sample of participants with self-reported overweight and obesity, previous experiences of weight stigma were common, though internalized weight bias, weight bias toward others, and experiences of weight stigma were not predictive of the validity of energy intake reporting. Researchers should consider the potential impact of weight stigma on recruitment, retention, and participant experience when working with participants with obesity. / Doctor of Philosophy / One part of obesity research is the study of how food intake can contribute to obesity. It is crucial to evaluate how well existing methods perform that measure what and how much people eat, especially in people with obesity. As obesity levels rise, researchers should be prepared to include more people with obesity (body mass index ≥30 kg/m2) and class III obesity (body mass index ≥40 kg/m2) in studies that measure dietary intake. When including people with obesity in studies, it is important to consider the potential impact of weight bias and weight stigma on nutrition research. Weight bias is the idea of negative attitudes and stereotypes about people with obesity, while weight stigma is how these attitudes collectively devalue people with obesity. This dissertation 1) defined the issues of weight bias and weight stigma, and how they affect dietetics practice, including nutrition research, 2) determined the representation of people with class III obesity in studies testing the accuracy of methods collecting information about food intake and 3) explored how weight bias and weight stigma might affect how accurately people with overweight and obesity report the number of calories that they eat. This work found: 1) weight bias and weight stigma are important emerging issues when working with people with obesity, and dietetics professionals can address weight bias and weight stigma in many areas of practice; 2) in studies testing the accuracy of measures that collect food information, people with class III obesity are underrepresented, and more research is needed to determine how accurate these measures are in this group; and 3) in a group of people with overweight and obesity, previous experiences of weight stigma were common, though internalized weight bias, weight bias toward others, and experiences of weight stigma did not predict how well a person reported their calorie intake. Future studies should include more people with class III obesity. Researchers should consider how weight stigma might affect a person's willingness to participate in nutrition studies. Minimizing weight stigma in research may decrease participation barriers for people with obesity in research about nutrition, weight, and health.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25184号 / 医博第5070号 / 新制||医||1072(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 石見 拓, 教授 大鶴 繁 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Investigou-se a validade do método recordatório de 24 horas, comparando-o com o método de pesagem dos alimentos. A comparação levou em conta alguns atributos do entrevistado (idade, sexo, nível de instrução e ocupação) e do entrevistador (técnico e não técnico) considerando, ainda, o tempo de duração das entrevistas do método recordatório de 24 horas. Verificou-se, além disso, a capacidade desse método na identificação de fatores de risco. Para isso, pesquisou-se o consumo de alimentos, obtendo-se energia e macronutrientes e alguns micronutrientes de 100 indivíduos de 19 anos e mais, de ambos os sexos, residentes no Distrito de Caucaia do Alto, Municipio de Cotia, Estado de São Paulo. Foi elaborado, especificamente para este trabalho, material de apoio, que constituiu de álbum de fotografias de alimentos (com porções diversificadas em vários tamanhos) preparados de acordo com os hábitos alimentares levantados na mesma comunidade, em estudo piloto, acompanhado de lista de equivalência de medidas caseiras e pesos. Considerando energia e nutrientes, os resultados no método recordatório subestimaram a energia, glicídios, ferro e proteínas, para o sexo masculino em alguns grupos etários. Considerando a diferença entre os dois sexos, estas foram significantes para proteínas e glicídios no sexo masculino do grupo etário de 41 a 60 anos. Verificou-se na comparação dos dois métodos, quanto às características do entrevistado, que seu desempenho no recordatório está mais relacionado à idade e sexo do que ao grau de instrução e ocupação. Quanto aos entrevistadores, os não técnicos apresentaram maior percentual de discordâncias no almoço e no jantar. Entrevistas realizadas em tempo inferior a 15 minutos propiciaram mais erros, tanto por omissão como por adição de alimentos. Na identificação de fatores de risco dietético, o método recordatório de 24 horas não conseguiu identificar todos os individuos com alto grau de sensibilidade, como o método de pesagem. / The validity of the 24-hours recall method was investigated compared with the method of the direct weighing of the foodstuffs consumed. The comparison took into consideration some of the data regarding the person interviewed (age, sex, schooling and occupation) and of the interviewer (technician or non-technician) and also considered the duration of the interviews of the 24-hours recall method. Further, the ability of this method to detect risk factors was also taken into consideration. For this purpose, the actual consumption of foodstuffs was researched, thus identifying energy, macro-nutrients and some micro-nutrients, of 100 individuals of 19 years or more of age, of both sexes, resident in the Caucaia do Alto district, Cotia county, São Paulo State. Was prepared especially for this research, pictures of food portions and the list of domestic measures and weight correspondent got from the same community by a previous study. With regard to energy and nutrients, the results of the recall method, underestimated energy, carbohydrates, iron and proteins for the male sex for some age groups. As for the difference between the sexes, there were significant differences for proteins and carbohydrates for the male sex age group of 40 to 60 years. It was discovered that the person interviewed performance in the 24-hours recall method, in terms of age and sex, was better than terms of schooling and occupation. Among the interviewers, the non-technicians showed more errors in lunch and dinner data. The interviews carried out in under 15 minutes contained more errors, whether by omission or by additioin of foodstuffs. In the identification of dietetic risk factors, the 24 hours - recall method didn\'t show a high degree of sensibility as the method of the direct weighing of food.