Class of 2014 Abstract / Specific Aims: To create and implement an educational presentation on polypharmacy using interactive strategies. Secondly, to assess the effectiveness of the interventional presentation by evaluating its helpfulness in improving polypharmacy awareness among older adults as measured by a retrospective pre-post participant survey. Methods: Residents of select independent senior living facilities in Tucson, Arizona were invited to attend an interactive, educational program entitled "What is Polypharmacy?" presented by fourth-year Doctor of Pharmacy students. This program consisted of a 30-minute PowerPoint presentation, which included various interactive learning approaches, followed by a 10-minute question and answer period. An anonymous retrospective pre-post survey was distributed to the participants after the presentation to evaluate the effectiveness and helpfulness of the program, as determined by the participants’ ratings on Likert-type scales and willingness to confidently engage in medication self-management. Main Results: Of the 73 participants from the six independent living facilities, 55 surveys were collected from the residents and 54 surveys were included in the data analysis. The retrospective pre-post data analysis found that familiarity with the definition of polypharmacy increased (p<0.001), understanding of the risks of polypharmacy increased (p<0.001), and the willingness to manage one’s own medications increased (p=0.045). Overall, 95.9% of the participants found this educational program to be helpful, and 95.8% of the participants would recommend this program to a friend. Conclusion: The interactive, educational program about polypharmacy, created and presented by pharmacy students, was helpful and effective in increasing polypharmacy awareness among older adults residing in independent senior living facilities.

ABSTRACT The relationship between subjective age identity and ideal age, as measured by the Subjective Age Identity Scale (Hubley, 2004), and personality domains and facets, as measured by the NEO-PI-R (Costa & McCrae, 1992), was investigated in a sample of 210 adults ages 19 to 78. Subjective age and ideal age scores were regressed, using multiple standard regressions, on the NEO-PI-R domains and facets, respectively. Results indicated that 22% of the variance in subjective age identity scores was explained by personality domains whereas 27% was explained by personality facets. Specifically, two personality domains (Openness to Experience and Neuroticism) and one personality facet (Aesthetics) made significant unique contributions to the explained variance in subjective age scores. Very little variance in ideal age scores was explained by personality domains and facets (less than 10%). One domain (Openness to Experience) and two facets (Vulnerability to Stress and Values) made significant unique contributions to the explained variance in the ideal age scores. These findings are examined in the context of the previous research on the relationship between personality and subjective age and the importance of conducting both domain and facet level analyses when using the NEO-PI-R is discussed. Implications of the present findings for counselling and clinical work with persons facing age role transitions or other age related concerns (e.g., negative attitudes towards aging) are highlighted. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Walking is the most popular physical activity reported by adults, and the benefits of walking are well documented in the literature (Fox & Hillsdon, 2007). Walkability refers to the friendliness of neighbourhood characteristics the enables pedestrian walking (Grant, Edwards, Sveistrup, Andrew, & Egan, 2010). A well-known and validated perceived walkability scale, the “Neighborhood Environment Walkability Scale” (NEWS; Saelens, Sallis, Black, et al., 2003) was developed in San Diego, California. Several adapted versions of the NEWS have been previously constructed for continued use in warm climates; however, adaptations of the NEWS for climates with winter walkability have not been developed. The main objective of this dissertation was to adapt the NEWS for colder climates and to assess the reliability and validity of the adapted measure, the NEWS-North, by conducting three studies. The first study consisted of two phases. For the first phase, three focus groups reviewed the NEWS questionnaire in a Canadian context and provided feedback on how to adapt the NEWS for use in Canada and other northern climates. The inclusion of a winter walkability section as well as the removal of American spellings and measurements were among some of the suggestions from the focus groups. An initial draft of the NEWS-North was created based on the results from the focus group. For the second phase, this initial draft was sent to a panel of walkability experts to assess content validation. All of the nine subscales were evaluated as highly important during the content validation. In addition, the experts renamed several section titles to improve precision. In the second study and third study, data from an online pilot test in Ottawa, Canada of the NEWS-North was used. The validity based on the internal structure of the questionnaire (i.e., factorial validity) and reliability (i.e., and internal consistency and test-retest reliability) of the NEWS-North was examined in Study Two. In this study, only subscales with the same Likert scale were examined (i.e., seven subscales) following the instructions of the adaptation protocol. Our results suggested a 7-factor model structure based on a multilevel exploratory factor analyses (MEFA). In addition, the 7-factor MEFA model had good test-retest reliability (ICC = 0.85 to 0.93) as well as adequate internal consistency (α = 0.53 to 0.75). In Study Three, the same seven subscales identified by the MEFA were included. In this study, a two-level Hierarchical Linear Modeling (HLM) with spatial dependency analyses was used to examine the convergent validity in the NEWS-North across 64 Ottawa neighbourhoods. The HLM analyses examined each subscale of the NEWS-North with and without any control variables. More specifically, they determined how each subscale of the NEWS-North predicted walking behaviour in the last two weeks at each level. The individual level (Level One) was comprised of the seven subscales of the NEWS-North from self-reported data along with three control variables (i.e., dog ownership, season, and gender). The neighbourhood level (Level Two) was comprised of the six equivalent subscales measured objectively with one control variable. At the time of this study, unfortunately, an equivalent winter subscale was not available at the neighbourhood level. At the individual level without any control variables, only the sidewalk subscale was a marginally significant predictor of walking. However, the sidewalk subscale reached significance while controlling for dog ownership, season, and gender. At the neighbourhood level without controlling for resident median income after tax, two NEWS-North equivalent subscales were found to predict walking behaviours. The sidewalk subscale was marginally significant and the land-use access subscale (via Franks walkability index Frank et al., 2010) was significant. While controlling for neighbourhood resident median income after- tax, both the land-use access subscale and sidewalk subscale were significant predictors of walking over the past two weeks. Overall, this dissertation supports the development for a perceived walkability questionnaire for seasonal climates. In addition, the preliminary results overall provide initial evidence for the reliability and validity of the NEWS-North. Overall implications, limitations, and future applied uses of the NEWS-North are discussed.

Background: Frailty has an impact on outcomes in the acute care and in the community setting but there is minimal research that examines frailty in the geriatric rehabilitation setting. Purpose: The purpose of this thesis was to answer the question “What is the association between frailty status and rehabilitation outcomes among older adults?” Methods: A systematic review using the Cochrane Handbook’s guidelines and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was completed. Four databases were searched as well as grey literature. Screening, extraction, and quality assessments were completed by two reviewers. Data synthesis was completed through vote counting. Results: Twelve studies met the inclusion criteria from which data were extracted. There is a negative association between frailty and discharge functional status, functional change, discharge to home, and a positive association between frailty and length of stay. Conclusion: Further research is needed on this topic to replicate these findings through meta-analyses. Frailty needs to be addressed in the geriatric rehabilitation setting to improve the functional status of frail patients and reduce extended stays in rehabilitation and decrease discharges to a new place of residence.

MPH / Department of Public Health

HIV/AIDS can affect individuals of any age. Efforts to educate those considered to be most at-risk, based on the age at which the most individuals are infected, are ongoing and public. Less work and mainstream education outreach, however, is being directed at an older population, who can be more likely to contract HIV, is more susceptible to the effects of HIV, and more likely to develop AIDS, than younger persons. Guided by the Health Belief Model theory, research was conducted to determine what, if any, relationship existed between age of an individual and the possibility that an HIV test will be sought. Factors of gender, education, ethnicity and marital status were included in analyses. the research indicated that as age increased, likelihood for getting an HIV test decreased. Overall, most individuals had not been tested for HIV. the implications of an aged and aging population with HIV include a need for coordinated service delivery, increased education and outreach.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (Internal Medicine) / Hodgkin lymphoma (HL) is a malignancy of lymphoid cells that was first described by Thomas Hodgkin in 1832. It is recognized histologically by the presence of the characteristic Reed Sternberg cells, bathed in a reactive cellular background of inflammatory cells. Hodgkin lymphoma is less common than Non-Hodgkin Lymphoma (NHL) and accounts for approximately 10-20 % of all the lymphomas encountered. It is most often seen in young adults, with a peak frequency in the third decade of life. Hodgkin lymphoma is characterized by the orderly spread of disease from one lymph node group to another (contiguous spread and centripetal distribution) and by the development of systemic symptoms, particularly with advanced stage disease. True extra nodal disease is uncommon. Pathologically, Hodgkin lymphoma is categorized into two groups: Nodular lymphocyte predominant Hodgkin lymphoma which accounts for about 5% and Classical Hodgkin lymphoma which accounts for 95%. Classical Hodgkin lymphoma is further subdivided into four subtypes: Nodular sclerosis classical Hodgkin lymphoma, Mixed cellularity classical Hodgkin lymphoma, Lymphocyte rich classical Hodgkin lymphoma and Lymphocyte depleted classical Hodgkin lymphoma. Once the diagnosis is confirmed on a lymph node or tissue biopsy, a complete work up is done, which includes blood investigations, a bone marrow aspirate and biopsy and appropriate radiological investigations. Following on this, the treatment is individualized and includes both supportive care and specific therapy. The specific initial treatment of Hodgkin lymphoma involves combination chemotherapy and where necessary involved field radiotherapy. Cure is a realistic goal in more than 90% of patients with early stage disease. A delicate balance exists vi between optimal initial treatment and the development of late complications of the disease, mainly related to treatment. The last decade has witnessed the emergence of Hodgkin lymphoma occurring with increasing frequency in association with the Human Immunodeficiency virus (HIV) infection. The relative risk is 10-20 fold higher with HIV seropositivity, compared to the general population. HIV associated Hodgkin lymphoma is generally more aggressive, presents with advanced stage disease, frequent ‘B’ symptoms, less favorable histology, more frequent bone marrow involvement and overall a poorer prognosis compared to Hodgkin lymphoma in HIV seronegative individuals. This study was aimed at exploring and defining the changing pattern of Hodgkin lymphoma at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2005 to December 2012. Other objectives were to review: (i) the impact of HIV on the clinical pattern of disease and (ii) the different treatment options and the outcome of the patients. Patients and Methods This was a retrospective review of all adult patients with Hodgkin lymphoma seen at the Clinical Hematology Unit, Department of Medicine from January 2005 to December 2012 at CHBAH. Descriptive analysis was conducted through the computation of frequency tables for categorical variables and appropriate measures of central tendency i.e. mean ± SD/median (IQR) for continuous variables. Kaplan Meier survival curves were plotted to determine the survival probability of the patients based on demographic and clinical characteristics. vii Results A total of 150 patients with a confirmed diagnosis were included in the study. Ninety three percent of the patients were of black ethnicity. There were 84 males (56%) and 66 females (44%), with a male to female ratio of 1.27:1. The median age of the patients was 37 years, with a peak frequency in the third and fourth decades of life. HIV seropositivity was noted in 90 patients (60%), with the remaining 60 patients (40%) being seronegative. For the whole group of 150 patients, lymphadenopathy was the most common presenting feature (92.7%). ‘B’ symptoms were present in 74.7% of the patients. Advanced stage disease was noted in 74% of the patients and a performance status of ≥2 was evident in 66.7% of the patients. A comparison of the HIV seropositive and HIV seronegative patients shows that there is a statistically significant difference between the histological subtypes (mixed cellularity with HIV seropositivity and nodular sclerosis with HIV seronegativity), TB association (higher with HIV seropositivity) and more bone marrow involvement with HIV seropositivity. However, the median survival was shorter in HIV seropositive compared to HIV seronegative individuals. Conclusion As compared to the current literature on Hodgkin lymphoma (particularly from the developed world), our study showed a high prevalence of HIV and TB, in association with Hodgkin lymphoma. There is a paradigm shift at our institution, from an early period in the 1980’s with no HIV seropositivity in association with HL, to <50% in the 1990’s and early 2000’s, to > 50% in the last decade. The association between HIV and HL has an impact on the clinical presentation and outcome of the patients. Therefore, health care workers need to be aware of this emerging and increasing association between HIV and Hodgkin lymphoma. / GR2018

A dissertation submitted in partial fulfilment of the requirements for the degree of Master of Arts (Clinical Psychology) in the Department of Psychology, Faculty of Arts at the University of Zululand, 2018. / In this study, the qualitative approach was used to study the experiences of growing up as a stepchild. The aim of the study was to explore the experiences of growing up as a stepchild for young adults at university level. Half of the participants were male and half were females between the ages of 18 and 25. The results were presented as themes that were found to be common amongst the participants’ narratives. The themes are discussed and recommendations were made for functional stepfamily relationships and environment.

Thesis (M.S.)--Boston University

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