<p>Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules for assessing the risk of these adverse outcomes following DRF.</p> <p>The first manuscript outlines a theoretical framework (RACE - <strong>R</strong>educing pain, <strong>A</strong>ctivating, <strong>C</strong>ognitive reshaping, <strong>E</strong>mpowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF.</p> <p>The Patient-Rated Wrist Evaluation (PRWE) is a condition-specific measure for DRF used in research as well as clinical practice to measure pain and functions in individuals with different wrist/hand injuries. The second manuscript contributes to the literature by providing the first systematic literature review that synthesizes the evidence regarding the psychometric properties of the PRWE. The review determined that the PRWE has excellent reliability, construct validity, and responsiveness in individuals with DRF.</p> <p>The third manuscript indicates that the baseline pain intensity is an independent predictor of chronic pain in individuals with DRF. The results also suggest that the individuals who score ≥35/50 on the pain scale of the PRWE at baseline have 8 times greater risk for developing chronic wrist/hand pain compared to those who score < 35/50.</p> <p>The fourth and fifth manuscripts describe results of a two step study. The fourth manuscript is a structured literature synthesis that identified suitable measures for predicting the risk of falls and fall-related osteoporotic fractures following DRF. The fifth manuscript summarizes the results of preliminary analysis of psychometric properties of selected fall risk measures identified in the fourth manuscript. The fifth manuscript also provides feasibility and sample size requirements for conducting a fall prevention trial in individuals with DRF.</p> / Doctor of Philosophy (PhD)

<p>Risk factors such as intrauterine and vaginal infection put pregnant women at risk for delivering preterm. Bacterial vaginosis (BV) is a polymicrobial clinical syndrome commonly diagnosed in women of reproductive age, with women of African descent with low socioeconomic status and previous preterm delivery at high risk. Although frequently isolated from healthy women,&nbsp / Gardnerella vaginalis has been most frequently associated with BV. There is limited data available on the prevalence of BV in Southern Africa / therefore, we embarked on a study to determine the&nbsp / prevalence of BV and G. vaginalis in predominantly black communities in the Western Cape, in order to establish the role of G. vaginalis in BV. Women attending various Maternity and Obstetrics&nbsp / units (MOU) in the Cape Peninsula with and without a history of pre-term delivery (PTD) were invited to participate in the study. Several factors were statistically associated with pregnancy history,&nbsp / including location of study population, parity, smoking and presence of clinical symptoms. The presence of G. vaginalis was determined by culture in 51.7% of the preterm delivery group (PTDG)&nbsp / and 44% of the full-term delivery group (FTDG) women. BV was detected in 31.13% of PTDG and 23.67% of FTDG by Gram stained analysis according to Nugent scoring criteria, with age and HIV&nbsp / status posing as risk factors. When comparing PTDG and FTDG for an association between the presence of G. vaginalis and BV, a stronger association was observed in the PTDG but it was not statistically significant. In both PTDG and FTDG, G. vaginalis was isolated significantly more often in women diagnosed with BV at 24.5% (p &lt / 0.05). Antibiogram studies revealed both Metronidazole and Clindamycin resistant strains of G. vaginalis. G. vaginalis Biotype 7 is specifically associated with BV, while Biotype 2 appears to be associated with BV in women with a history&nbsp / of PTD. Accuracy of diagnostic tools were tested and it was determined that Nugent scoring is more sensitive in diagnosing BV (76.04%), but culture for G. vaginalis is more specific (83.21%). Although this study was limited in that we were unable to follow-up pregnancy outcomes, we were able to confirm the perceived role of G. vaginalis in BV.&nbsp / </p>

<p>Risk factors such as intrauterine and vaginal infection put pregnant women at risk for delivering preterm. Bacterial vaginosis (BV) is a polymicrobial clinical syndrome commonly diagnosed in women of reproductive age, with women of African descent with low socioeconomic status and previous preterm delivery at high risk. Although frequently isolated from healthy women,&nbsp / Gardnerella vaginalis has been most frequently associated with BV. There is limited data available on the prevalence of BV in Southern Africa / therefore, we embarked on a study to determine the&nbsp / prevalence of BV and G. vaginalis in predominantly black communities in the Western Cape, in order to establish the role of G. vaginalis in BV. Women attending various Maternity and Obstetrics&nbsp / units (MOU) in the Cape Peninsula with and without a history of pre-term delivery (PTD) were invited to participate in the study. Several factors were statistically associated with pregnancy history,&nbsp / including location of study population, parity, smoking and presence of clinical symptoms. The presence of G. vaginalis was determined by culture in 51.7% of the preterm delivery group (PTDG)&nbsp / and 44% of the full-term delivery group (FTDG) women. BV was detected in 31.13% of PTDG and 23.67% of FTDG by Gram stained analysis according to Nugent scoring criteria, with age and HIV&nbsp / status posing as risk factors. When comparing PTDG and FTDG for an association between the presence of G. vaginalis and BV, a stronger association was observed in the PTDG but it was not statistically significant. In both PTDG and FTDG, G. vaginalis was isolated significantly more often in women diagnosed with BV at 24.5% (p &lt / 0.05). Antibiogram studies revealed both Metronidazole and Clindamycin resistant strains of G. vaginalis. G. vaginalis Biotype 7 is specifically associated with BV, while Biotype 2 appears to be associated with BV in women with a history&nbsp / of PTD. Accuracy of diagnostic tools were tested and it was determined that Nugent scoring is more sensitive in diagnosing BV (76.04%), but culture for G. vaginalis is more specific (83.21%). Although this study was limited in that we were unable to follow-up pregnancy outcomes, we were able to confirm the perceived role of G. vaginalis in BV.&nbsp / </p>

>Magister Scientiae - MSc / Risk factors such as intrauterine and vaginal infection put pregnant women at risk for delivering preterm. Bacterial vaginosis (BV) is a polymicrobial clinical syndrome commonly diagnosed in women of reproductive age, with women of African descent with low socioeconomic status and previous preterm delivery at high risk. Although frequently isolated from healthy women, Gardnerella vaginalis has been most frequently associated with BV. There is limited data available on the prevalence of BV in Southern Africa; therefore, we embarked on a study to determine the prevalence of BV and G. vaginalis in predominantly black communities in the Western Cape, in order to establish the role of G. vaginalis in BV. Women attending various Maternity and Obstetrics units (MOU) in the Cape Peninsula with and without a history of pre-term delivery (PTD) were invited to participate in the study. Several factors were statistically associated with pregnancy history, including location of study population, parity, smoking and presence of clinical symptoms. The presence of G. vaginalis was determined by culture in 51.7% of the preterm delivery group (PTDG) and 44% of the full-term delivery group (FTDG) women. BV was detected in 31.13% of PTDG and 23.67% of FTDG by Gram stained analysis according to Nugent scoring criteria, with age and HIV status posing as risk factors. When comparing PTDG and FTDG for an association between the presence of G. vaginalis and BV, a stronger association was observed in the PTDG but it was not statistically significant. In both PTDG and FTDG, G. vaginalis was isolated significantly more often in women diagnosed with BV at 24.5% (p < 0.05). Antibiogram studies revealed both Metronidazole and Clindamycin resistant strains of G. vaginalis. G. vaginalis Biotype 7 is specifically associated with BV, while Biotype 2 appears to be associated with BV in women with a history of PTD. Accuracy of diagnostic tools were tested and it was determined that Nugent scoring is more sensitive in diagnosing BV (76.04%), but culture for G. vaginalis is more specific (83.21%). Although this study was limited in that we were unable to follow-up pregnancy outcomes, we were able to confirm the perceived role of G. vaginalis in BV. / South Africa

Current cancer research is beginning to address the psychosocial implications of a prostate cancer (PCa) diagnosis from not just the perspective of quality of life of the patient, but of his partner as well. Such inquiries have created novel intervention programs aiming to alleviate the adverse side effects that a PCa diagnosis may inflict on the couple. Assessing efficacy of couple-based interventions, however, has been a difficult task due to the lack of homogeneity between studies regarding the operationalization process of primary outcome variables, as well as the instruments being used to measure them. This thesis, in response, aims to provide a detailed assessment of how previous interventions operationalized their targeted variables, the reported psychometric analysis of the instruments of measurement, and which instruments yielded statistically significant results. A narrative review was conducted using a database search strategy to collect articles regarding couple-based interventions that focused on outcomes related to PCa diagnosis, treatment, and survivorship. Out of the ten articles that passed the screening method, forty-two outcomes were identified, ranging from physical, social, and mental well-being of the couple, to the impact PCa had on their relationship quality. The outcomes were grouped into eight categories: quality of life, appraisal of PCa outcomes, sexual/physical well-being, relationship assessment, coping, mental health, knowledge, and distress. Various scales were used to measure similar outcomes with some articles failing to report on the psychometric properties of their chosen instruments. This assessment aims to provide future researchers with an indication as to what outcomes have been previously targeted and their corresponding methods of operationalization, categorization, and analysis. The multitude of assessed outcomes, the lack of uniformity on best practices in PCa couple intervention research, and the general failure to report on reliability and validity of measures may serve as significant barriers to producing high-quality evidence that can inform the development of future research and practice. This review provides the research community an aid in the development of behavioral interventions, and potentially, practice, via offering recommendations on certain outcomes that remain underreported within interventions. It is the ultimate aim of this project to assist in fostering a true public health for all.

Yes / Aim of research: to describe TV viewing trajectories from age 5 to 40 months

The research in this thesis has been undertaken to develop statistical tools for monitoring adverse events in hospitals that adjust for varying patient risk. The studies involved a detailed literature review of risk adjustment scores for patient mortality following cardiac surgery, comparison of institutional performance, the performance of risk adjusted CUSUM schemes for varying risk profiles of the populations being monitored, the effects of uncertainty in the estimates of expected probabilities of mortality on performance of risk adjusted CUSUM schemes, and the instability of the estimated average run lengths of risk adjusted CUSUM schemes found using the Markov chain approach. The literature review of cardiac surgical risk found that the number of risk factors in a risk model and its discriminating ability were independent, the risk factors could be classified into their "dimensions of risk", and a risk score could not be generalized to populations remote from its developmental database if accurate predictions of patients' probabilities of mortality were required. The conclusions were that an institution could use an "off the shelf" risk score, provided it was recalibrated, or it could construct a customized risk score with risk factors that provide at least one measure for each dimension of risk. The use of report cards to publish adverse outcomes as a tool for quality improvement has been criticized in the medical literature. An analysis of the report cards for cardiac surgery in New York State showed that the institutions' outcome rates appeared overdispersed compared to the model used to construct confidence intervals, and the uncertainty associated with the estimation of institutions' out come rates could be mitigated with trend analysis. A second analysis of the mortality of patients admitted to coronary care units demonstrated the use of notched box plots, fixed and random effect models, and risk adjusted CUSUM schemes as tools to identify outlying hospitals. An important finding from the literature review was that the primary reason for publication of outcomes is to ensure that health care institutions are accountable for the services they provide. A detailed review of the risk adjusted CUSUM scheme was undertaken and the use of average run lengths (ARLs) to assess the scheme, as the risk profile of the population being monitored changes, was justified. The ARLs for in-control and out-of-control processes were found to increase markedly as the average outcome rate of the patient population decreased towards zero. A modification of the risk adjusted CUSUM scheme, where the step size for in-control to out-of-control outcome probabilities were constrained to no less than 0.05, was proposed. The ARLs of this "minimum effect" CUSUM scheme were found to be stable. The previous assessment of the risk adjusted CUSUM scheme assumed that the predicted probability of a patient's mortality is known. A study of its performance, where the estimates of the expected probability of patient mortality were uncertain, showed that uncertainty at the patient level did not affect the performance of the CUSUM schemes, provided that the risk score was well calibrated. Uncertainty in the calibration of the risk model appeared to cause considerable variation in the ARL performance measures. The ARLs of the risk adjusted CUSUM schemes were approximated using simulation because the approximation method using the Markov chain property of CUSUMs, as proposed by Steiner et al. (2000), gave unstable results. The cause of the instability was the method of computing the Markov chain transition probabilities, where probability is concentrated at the midpoint of its Markov state. If probability was assumed to be uniformly distributed over each Markov state, the ARLs were stabilized, provided that the scores for the patients' risk of adverse outcomes were discrete and finite.

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