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Die gesin is die sentrum waarbinne die kind se vorming tot volwaardige volwassenheid plaasvind. Indien een van die ouers met 'n chroniese fisieke siektetoestand gediagnoseer word, mag dit moontlike implikasies inhou vir die ouer, die kind, maar ook ander gesinslede. Die chroniese siektetoestand en die implikasies wat dit vir die siek persoon inhou is bestudeer. Daarbenewens is die dinamiek van die gesin, waarbinne die ouer en die kind met mekaar in interaksie is, ontleed. Om te bepaal wat die effek van die chroniese fisieke siektetoestand van die ouer op die kind is, is 'n literatuurstudie onderneem. Dit is daarna geverifieer met gevallestudies wat ondemeem is. Die gevallestudies het die bevindinge van die literatuurstudie bevestig. Dit blyk dat die chroniese siektetoestand van die ouer 'n invloed op die wording van die kind het. Die siektetoestand is 'n voortdurende stressor binne die gesin, wat veroorsaak dat kind(ers) affektiewe-, kognitiewe-, gedrags- en sosiale probleme manifesteer. Daar moet aanpassings gemaak word om die stres binne die gesin te minimaliseer. Riglyne is saamgestel om die terapeut, wat hierdie kind(ers) en gesinne begelei, te help. / The family is the system within which the child develops and eventually attains maturity. When a patient is diagnosed with chronic disease, it has certain implications not only for the parent, but also for children and other members of that family. A liteature study was undertaken to determine the impact of the chronically ill parent on the child. This study was then verified with specific case studies done by the author. These case studies confinned the findings of the literature study. It would seem that the chronic illness of a parent has a definite impact on the development of a child. The parent's illness is a constant stressor within the family, causing children to manifest affective, cognitive, behavioral as well as social problems. Certain adjustments have to be made to minimize stress within such a family. Guidelines are provided to assist the therapist in dealing with these children and families. / Psychology of Education / M. Ed. (Voorligting)

Thesis (MTech (Business Administration))--Cape Peninsula University of Technology, 2018. / Research findings indicate that between 42% and 56% of people dying between the ages of 25 to 70 are most likely to die out of a preventable cause. Most of these illnesses are chronic illnesses, directly a result of lifestyles that people have adopted over long periods. Whilst it has been difficult to cure some of the diseases, it has been however possible to treat the ailments. Consequently, patients who have followed faithfully the treatment regimes have lived far longer than would have been expected. Because these illnesses needed continued treatment, they are therefore referred to as chronic illnesses. It is expected therefore that the patients should regularly go for medical check-ups as well as take their medicines continuously. Chronic illnesses are an increasing cause of morbidity and mortality in Metro District primarily because most chronic patients die even though their deaths are preventable. The research findings presented here are a result of a survey of 200 chronic-patients in the Metro-District in Cape Town using mixed qualitative and quantitative methods. The objectives of the studies were primarily to establish reasons for the noticed defaulting rate amongst the patients. Because the medication was subsidised by the government and the patients got the treatment at no cost, it was expected that few, if any, would default. The findings indicated that close of 40% of the patients’ default and various reasons were provided ranging from forgetting, no transport money, no one to accompany them to the outlets to absence from town. The findings provide valid information to be used by the district to address the high rate of chronic medicines defaulting.

published_or_final_version / Medicine / Master / Doctor of Medicine

No description available.

[Truncated abstract] Despite significant scientific advances in tracking the complex physiological mechanisms that drive the asthma disease process, worldwide trends in childhood asthma continue to rise. This research sought to describe the relationships between psychosocial stress, psychosocial resources, asthma severity, and health-related outcomes from the standpoints of biopsychosocial and developmental theory. The research consisted of three studies based on a prospective study involving 2573 children from a community-based birth cohort. The cohort has been under active follow-up from birth and this thesis draws on data obtained at the 1, 2, 6, 10 and 13 year follow-ups . . . The final study undertook to describe the mediating influence of specific supportive behaviours provided by family members and peers to adolescents with asthma. Ninety-nine adolescents participating in the 13 year follow-up of the community cohort study completed a semi-structured interview adapted from the Diabetes Social Support Interview (La Greca et al., 1995) to assess supportive behaviours and the KINDL (Ravens-Sieberer & Bullinger, 1998) to assess QOL. It was predicted that illness-specific support would mediate the relationship between family dysfunction and quality of life. Qualitative analyses identified parents as important sources of tangible support, peers as important sources of companionship and emotional support, and siblings bridging the two, by providing tangible, companionship and emotional support to the adolescent. Mediator analyses found that specific parent behaviours perceived as unsupportive by the adolescent mediated the relationship between family dysfunction and self-oriented quality of life. Clinical implications support the integration of medical and psychological expertise in the treatment of asthma. Future research directions are also discussed.

The purpose of this study was to examine the interrelationships among the themes of Taylor's (1983) Cognitive Adaptation Theory for schoolagers with asthma. In addition, the influence of Taylor's (1983) themes on the children's social behavior was also tested. The three themes of Taylor's (1983) theory included A Search for Meaning, Restoration of Self-Esteem, and Gaining a Sense of Self-Mastery. Two components of A Search for Meaning included the Impact of Disease and the Cause of Disease. Relating Behaviors-Cooperating Behaviors was the index of social behavior. Forty-five Caucasian children between the ages of seven and ten years who had a diagnosis of asthma and did not have any mental disability were the convenient sample. Data were collected in the children's homes. Three questionnaires and two interviews were used to measure Taylor's (1983) themes and Relating Behaviors-Cooperating Behaviors. Descriptive statistics were used to answer the research questions and provide additional findings related to the conceptual framework. Two relationships among Taylor's (1983) themes were significant (p ≤ .05). Children who reported greater impact of asthma upon their lives (Impact of Disease) reported lower self-esteem (Restoration of Self-Esteem). Children who reported greater impact of asthma upon their lives (Impact of Disease) also reported a lesser internal locus of control orientation (Gaining a Sense of Self-Mastery). The Cause of Disease was the only concept which correlated significantly with Relating Behaviors-Cooperating Behaviors and thus, influenced this concept. Children who named a cause for their asthma reported more relating and cooperating skills. The Cause of Disease explained 6.5% of the variance for Relating Behaviors-Cooperating Behaviors. Characteristics of the children's asthma condition and their families were significantly related to the themes of Taylor's (1983) theory and Relating Behaviors-Cooperating Behaviors. Developmental differences were found from age group analyses. The classification of the children's responses for the cause of asthma and reliability and validity estimation for the HIIS were also reported. Five potential sources of error which may have affected the findings included design, instrument, subject, investigator, and specification errors. Suggestions for future research with the conceptual framework were discussed.

The purpose of this study was to assess the epidemiology of preventable risk factors for NCDs among the adult population in Tigray, Northern Ethiopia. A quantitative descriptive cross-sectional design was employed to describe the distribution of behavioural and biological risk factors for NCDs, assess the status of knowledge, perceptions, attitude and behaviour of the study participants for NCDs and their risk factors, and a matched case-control study to identify the determinants of hypertension. The data was collected using a structured questionnaire for the interview, physical measurements including weight and height scales, non-elastic measuring tape for waist and hip circumferences, Omron digital BP apparatus for blood pressure and heart rate; Accutrend Plus for measuring fasting blood glucose, cholesterol and triglycerides. For the descriptive cross-sectional study a total of 2347 participants were included, and for the matched case control study a total of 117 cases and 235 controls participated. Behavioural and biological risk factors were assessed. Only 0.8% of the study participants used optimal fruit serving per day. The prevalence of low level physical activity (<600 MET-minutes/week) was 44.8%. The magnitude of ever alcohol consumption was 66.8%. However, the magnitude of khat chewing and tobacco smoking among the study participants was not as high as the other risk factors i.e. 3.3% and 2.3% respectively. The magnitude of hypertension, central obesity, hyperglycaemia, hypercholesterolemia and hypertriglyceridemia was 9.9%, 22.2%, 3.5%, 30.3% and 32.2% respectively. Factors associated with the risks aforementioned were gender, age, place of residence, education, knowledge status on NCDs, mental stress and others. The status of knowledge on CVDs, breast and cervical cancers, diabetes and their potential risk factors was low and not comprehensive. Misconceptions on NCDs and body size and shape were pervasive. Risky behaviours underlying NCDs were rampant in the study population. Factors related to poor knowledge on NCDs were gender, age, place of residence, education and misconceptions on NCDs. The determinants of hypertension were physical inactivity, duration of alcohol intake, central obesity and mental stress. Awareness raising interventions on NCDs and their risk factors; improving socio-economic status and accessibility to health care settings have to be in place to curb these formidable problems. / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Anthocyanins are naturally occurring pigments responsible for the colour of many natural products, including grapes and wine. These pigments are important to the food industry and have been recognised for their nutritional value since they play an important role in the reduced risk of various chronic diseases in humans. Anthocyanins also play an important role in the aesthetic perception and quality of red wine. However, due to the large structural diversity of grape-derived anthocyanins and the many derivatives formed from these during wine ageing, the accurate analysis of wine pigments is extremely challenging. Reversed-phase liquid chromatography (RP-LC) is mostly used for anthocyanin analysis, although the technique often provides insufficient resolving power for complex mixtures of anthocyanins. In addition, the lack of commercially available standards and identical mass spectral characteristics hampers identification of these compounds. The coupling of multiple orthogonal separation systems in comprehensive 2-dimensional liquid chromatography (LC×LC) offers a more powerful approach for the separation of complex mixtures. The current work therefore focussed on exploring the potential of LC×LC for the improved analysis of anthocyanins and derived pigments in natural products and wine. The first part of this work focussed on developing a hydrophilic interaction chromatography (HILIC) method as an alternative to RP-LC for the anthocyanin analysis. Following extensive optimisation, the method proved suitable for the analysis of a diverse range of anthocyanins in natural products. Significantly, it also showed alternative selectivity compared to RP-LC. The optimised HILIC method was then used in combination with RP-LC to develop an off-line LC×LC approach for anthocyanins. For this purpose, half-minute fractions of the HILIC effluent were collected and reinjected onto a RP-LC column. The off-line HILIC×RP-LC method demonstrated exceptionally high resolving power, as measured in terms of the practical peak capacity, with many compounds separated in two dimensions that co-eluted in 1-dimensional HPLC. Interestingly, group-type separation was also observed based on the degree and/or nature of glycosylation and acylation of anthocyanins. In the final part of the work, a systematic approach was used for the development and optimisation of and on-line HILIC×RP-LC method by using a 10-port switching valve to automatically transfer fractions between the two columns. This method was then coupled to high resolution mass spectrometry (MS) to allow the detailed investigation of anthocyanins and derived products in wine. Ninety four pigments were identified in one- and six-year old Pinotage wines based on HILIC×RPLC separation in combination with accurate mass MS data and fragmentation information. Significant differences in especially the content of derived pigments were observed between the wines. In summary, the methods developed in this work provide the means to improve anthocyanin analysis, and therefore also show promise for the detailed investigation of these important compounds and their alteration in natural products and their derived commodities. / AFRIKAANSE OPSOMMING: Antosianiene is natuurlike pigmente wat verantwoordelik is vir die kleur van baie natuurlike produkte, insluitende dié van druiwe en wyn. Hierdie pigmente is belangrik vir die voedsel industrie en word gereken vir hul voedingswaarde aangesien hulle 'n belangrike rol speel in die verlaagde risiko van verskeie chroniese siektes onder die mens. Antosianiene speel ook 'n belangrike rol in die estetiese persepsie en kwaliteit van rooiwyn. Desnieteenstaande, as gevolg van die groot strukturele diversiteit van druifgeproduseerde antosianiene en die vele chemiese afgeleides wat uit hulle gevorm kan word tydens wyn bereiding en veroudering, is die akkurate analise van natuurlike wyn-pigmente uiters uitdagend. Omgekeerde-fase vloeistofchromatografie (RP-LC) word meestal gebruik vir die analise van antosianiene. Dié tegniek bied egter dikwels onvoldoende skeidingsvermoë vir komplekse mengsels van antosianiene en verwante molekules. Verder belemmer die onbeskikbaarheid van kommersiële standaarde en identiese massa spektrale eienskappe die identifikasie van hierdie verbindings. Die kombinasie van verskillende ortogonale skeidings meganismes in omvattende 2- dimensionele vloeistofchromatografie (LC×LC) bied egter 'n baie kragtiger benadering vir die skeiding van komplekse mengsels. Die huidige werk fokus dus op die ontginning van die potensiaal van LC×LC vir die verbeterde ontleding van antosianiene en verwante afgeleide pigmente in natuurlike produkte en wyn. Die eerste deel van hierdie werk het gefokus op die ontwikkeling van 'n hidrofiliese interaksie chromatografiese (HILIC) metode as ʼn alternatief vir RP-LC analise van antosianiene. Na uitgebreide optimisering, is gevind dat die metode geskik is vir die ontleding van 'n verskeidenheid van antosianiene in natuurlike produkte. Van groot belang is dat dit ook alternatiewe selektiwiteit in vergelyking met RP-LC demonstreer. Hierdie geoptimiseerde HILIC metode word dan voorts gebruik in kombinasie met RP-LC vir die ontwikkeling van ʼn af-lyn LC×LC benadering vir die analise van antosianiene. Hiervoor is half-minuut fraksies van die HILIC uitvloei opgevang en her-ingespuit op 'n RP-LC kolom. Dié af-lyn HILIC×RP-LC metode toon buitengewoon hoë skeidingsvermoë, gemeet in terme van die bereikbare praktiese piek kapasiteit, met baie verbindings wat geskei is in die twee dimensies wat saam elueer in 1-dimensionele HPLC. Interessant genoeg is groep-tipe skeiding ook waargeneem gebaseer op die graad en / of aard van glukosilasie en asilering van die antosianiene. In die laaste deel van die werk, is 'n sistematiese benadering gevolg vir die ontwikkeling en optimisering van ʼn aan-lyn HILIC×RP-LC deur gebruik te maak van 'n 10-poort oorskakelingsklep wat fraksies outomaties oordra tussen die twee kolomme. Die bogenoemde metode is ook verder gekoppel aan hoë resolusie massaspektrometrie (HR-MS) om ʼn gedetailleerde ondersoek van antosianiene en hulle afgeleide verbindings in wyn moontlik te maak. Vier en negentig pigmente is in een- en ses jaar oue Pinotage wyne geïdentifiseer gebaseer op HILIC×RP-LC skeiding in kombinasie met akkurate massa MS data en fragmentasie inligting. Beduidende verskille in veral die inhoud van antosianien-afgeleide pigmente is tussen die wyne waargeneem. Ter samevatting, die metodes ontwikkel in hierdie werk baan die weg om antosianien ontleding te verbeter en stel gevolglik die moontlikheid van selfs meer gedetailleerde studies van hierdie belangrike verbindings in natuurlike produkte in die vooruitsig.

The inmate population is increasing, aging and generally in poorer health than the non-incarcerated population. Providing healthcare to inmates is constitutionally mandated, and expensive. Little published research exists to assist corrections health policy makers strategically plan for future inmate healthcare needs. This research provides an extensive description of the healthcare utilization patterns of a sample of 577 male and female inmates incarcerated at state-operated prisons in Kentucky during the period January 1, 2007, to December 31, 2007 and who have at least one of the chronic conditions of diabetes, hypertension or hyperlipidemia. The primary outcome measures were a count of the number of encounters documented in the inmate‟s electronic health record by 1) medical doctors and advanced registered nurse practitioners (medical care utilization) and 2) psychiatrists and psychologists (mental healthcare utilization), and 3) a dichotomous variable indicating if the inmate had received care from a health provider located outside the prison. The explanatory variables included demographic variables, health status variables, health risk factors, sentence-related variables, facility characteristics, inmate to corrections and medical staff ratios and quality of care indicators. Differences in healthcare utilization between various groups of inmates were tested using Pearson‟s chi-squared test for categorical variables and Student t-test for continuous variables. In the bivariate analysis increasing age, being female, having comorbidities, having a diagnosis of mental illness, being obese, not adhering to diet, exercise and medications, refusing or missing treatment, being at a facility with more corrections or medical staff and having better quality of care were all associated with greater healthcare utilization. Negative binomial regression was used to analyze the count outcomes, and multivariate logistic regression analysis was used to analyze the dichotomous outcome. Regression analysis revealed that the number of problems an inmate had recorded in their electronic health record and increasing age were the two greatest predictors of within facility and secondary healthcare utilization. Carrying out case management and disease management for inmates with comorbidities may have benefits for Departments of Corrections and inmates.