Thesis (M. Nurs.)--University of Hong Kong, 2006.

No description available.

To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).

The purpose of this cross-sectional, descriptive, correlational study was to describe the relationships among demographic factors (age, gender, education, income), perceived severity of illness, perceived barriers to action, perceived self-efficacy, and interpersonal influences (social support) and health-promoting behaviors (HPB) and to identify predictors of HPB. A nonprobability sample of 110 participants with Chronic Renal Failure (CRF) was recruited from the outpatient clinic of Burirum hospital and Surin hospital located in north-eastern Thailand. All participants were individually interviewed by the principal investigator in a private area within an outpatient clinic. Six variables were significantly correlated with the HPB. They were age, education, perceived severity of illness, perceived barriers to action, perceived self-efficacy and social support. According to the results from the analyses of demographic data and HPB, participants who were younger and had higher educational levels practiced more HPB. From the analyses of perceived severity of illness, perceived barriers to action, perceived self-efficacy, and social support and HPB, the results showed that participants with lower levels of perceived severity of illness and lower levels of perceived barriers to action reported better HPB. In contrast, the participants with higher levels of perceived self-efficacy and social support reported better HPB. By using a stepwise multiple regression analysis, two predictors were identified from 8 predictor variables, and those two accounted for 78.2% (p < 0.01) of the variance in HPB. Two variables that contributed significantly to the variance in the HPB were perceived self-efficacy ([beta] =.769, p < 0.01), and social support ([beta] = .162, p < 0.01); whereas age, gender, income, educational level, perceived severity of illness, and perceived barriers did not contribute to the variance in the HPB. The study found that participants who experienced better perceived self-efficacy and social support reported better HPB. In contrast age, gender, income, educational level, perceived severity of illness, and perceived barriers did not enter as predictors in this stepwise regression equation. / text

No description available.

The psychological well-being of end stage renal disease (ESRD) patients and spouses was investigated from a dyadic perspective. The responses of patients and spouses from five groups of couples--illustrating different points in the progression and treatment of ESRD--were compared both across ESRD groups and between patients and spouses. It was hypothesized that those ESRD groups with the highest levels of illness/treatment intrusiveness, i.e. the two dialysis groups, would exhibit the highest levels of marital role strain and concomitantly the lowest levels of psychological well-being. Despite the fact that the ESRD groups did reflect differences in perceived illness/treatment intrusiveness, no significant differences were found between the ESRD groups, or between patients and spouses, in either marital relations or psychological well-being. However, multiple regression analyses did indicate that marital role strain was a significant predictor of psychological well-being. It explained psychological well-being variance above and beyond demographic, physical health, ESRD group membership and psychological defensiveness considerations. Also, the two dialysis groups evidenced significantly greater correlations between marital role strain and psychological distress than the nondialysis groups. These findings were interpreted as being consistent with a General Systems Theory approach to the conceptualization and treatment of chronic illness.

End-stage renal disease (ESRD) and its treatment are generally considered to be highly stressful and the associated loss of control over important life dimensions is believed to induce widespread depression. This situation was employed as a "living stress laboratory" in which to test the reformulated learned helplessness theory of depression. Results indicated that reduced perceived control over a variety of life dimensions was importantly related to increased depression, although the attributional reformulation of helplessness theory was not supported. Moreover, reanalyses of these data from a social learning theory perspective indicated that perceived self-efficacy contributed uniquely to this negative correlation in addition to expectancies regarding response-outcome contingency (Rotter I-E scores). The hypothesis that the negative correlation between depression and perceived control might also be explained in terms of patients' psychological differentiation and the intrusiveness of ESRD was subsequently examined. Results revealed that perceived intrusiveness contributed uniquely to perceived control and to affect, indicating that perceived control and intrusiveness each contribute independently to mood. Surprisingly, a low prevalence of clinical depression was observed, contradicting the general consensus that helplessness and depression are unavoidable psychological sequelae to ESRD. These findings are equally applicable to several other chronic and life-threatened patient populations (e.g., cancer, cardiac, diabetic) and thus underline the need for a general theory of the emotional impact of illness.

Thesis (M.P.H.)--University of Hong Kong, 2007.

Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references. Also available in print.

Thesis (Ph.D.) - University of Glasgow, 2008. / Ph.D. thesis submitted to the Faculty of Medicine, Division of Cardiovascular and Medical Sciences, University of Glasgow, 2007. Includes bibliographical references. Print version also available.