The psychosocial adjustment of nine adolescents with end-stage renal disease (ESRD) was described by two standard psychologic tests; Piers-Harris Self-Concept Scale and Nowicki-Strickland Locus of Control. Life Events were recorded to evaluate the effect of stress at the time of testing. The mean self-concept scores were higher (p = .009) for the ESRD adolescents than the normative sample. However, the individual's scores did not differ significantly. The Life Events were comparable to the healthy population for age. The family members were assessd on the Family Assessment Measure (FAM) to assess the influence of family functioning on adolescent psychosocial adjustment. The standardized FAM scores were comparable to a normative sample. Cluster analysis of the ESRD adolescents revealed three groups differing significantly on: self-concept, locus of control, FAM self-rating and number of years from diagnosis to dialysis. Significant differences were maintained across the family members on FAM General Scale and FAM Self-Rating Scale. The adequate psychosocial adjustment of the adolescents with ESRD is consistent with recent studies suggesting that chronically ill children and adolescents do not differ from healthy children. However, the results also suggest that within the study group, a number of individuals may be experiencing problems of adjustment. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Doctor Educationis / Background: South Africa has the largest burden of HIV in the world with 7.9 million people living with HIV and 4.4 million registered on antiretroviral therapy (ART) in 2017. KwaZuluNatal is hardest hit by the HIV epidemic with a prevalence of 27% among adults aged 15 to 49 years old. With the widespread ART uptake, the spectrum of HIV related admissions in hospitals has changed over the last decade. Hypertension, diabetes, cardiovascular disease, and renal failure have become significant reasons for inpatient care. Increased life expectancy, rising non-communicable diseases (NCDs) and easier access to ART have played a significant change in the landscape of inpatients as compared to the pre-ART era. To provide integrated healthcare to the patient, it is necessary to understand the prevalence and patterns of HIV comorbidities for efficient and effective service delivery to HIV patients at facility-level. Aim: The current study aimed to describe the prevalence and patterns of HIV-related comorbidities in adult hospital admissions in iLembe, KwaZulu-Natal. Methodology: A retrospective, cross-sectional survey was conducted of all adult HIV-related admissions between 1st October and 31st December 2019. Clinical and demographic characteristics were extracted from admission and discharge records, and laboratory data was collected via the National Health Laboratory Services using Labtrack. Summative and inferential analyses were done using SPSS v 23.

No description available.

The nutritional needs of the renal patient vary as the renal function decreases. Little information exists concerning energy requirements for patients on hemodialysis. Renal failure has been called a wasting disease as evidenced by decreased body weight, body fat, arm circumference and serum proteins. This research was designed to help precisely define energy requirements for the hemodialysis subject. Resting energy expenditure (REE) was measured by indirect calorimetry in 17 male hemodialysis subjects whose mean age was 55 years at the Veterans Administration Medical Center in Hampton, Va. The Beckman MMC Horizon System, a portable device which permits the determination of heat production from gas exchange, oxygen consumption and carbon dioxide production was used. By regression analysis, the measured REE was compared to the basal energy expenditure (BEE): the ideal weight based on the Metropolitan Life Insurance tables, the current weight taken on day of indirect calorimetry, a non-dialysis day, and the post dialysis weight taken immediately after dialysis. A correlation analysis of the dependent variable, IEE, with the current, ideal and post dialysis BBE variable resulted in correlation coefficients of .3783, .0003, and .3946 respectively. None of these correlation coefficients were significantly correlated with the REE. The post dialysis variable had the highest correlation coefficient, and thus the strongest relationship to the REE. While any of the weights studied could be used to determine energy needs for the hemodialysis subject, post dialysis weight may be the most desirable choice. / M.S.

The scope of this project is an examination of medical compliance for the Hispanic patient with End State Renal Disease.

published_or_final_version / Social Work / Master / Master of Social Work

End-stage renal disease (ESRD) introduces physical, psychological, social, emotional and spiritual challenges into patients’ lives. Spirituality has been found to contribute to improved health outcomes, mainly in the areas of quality of life (QOL) and well-being. No studies exist to explore the influences of spirituality on the health outcomes and general well-being in patients with end-stage renal disease receiving haemodialysis (HD) treatment in Scotland. This study was therefore carried out to examine and explore spirituality in the day-to-day lives of patients with ESRD receiving HD treatment and how it may influence their health outcomes and, in particular, QOL and general well-being. The study described in this thesis employed a sequential mixed method approach over two stages: quantitative and qualitative. Following ethical approval, a cross-sectional survey was conducted with 72 patients from 11 dialysis units recruited from four Health Boards in Scotland. The participants in the study were regular patients attending the dialysis units three times per week. Data on patients’ quality of life, general well-being, and spirituality were collected using self-administered questionnaires including demographic information: the Short Form Medical Outcome Study Questionnaire (SF-36v2), the General Health Questionnaire, and the Spiritual Well-Being Questionnaire. The data were analysed using the Predictive Analytics Software for Windows. The findings highlighted that patients’ quality of life was markedly lower than the United Kingdom general population average norms of 50. Increasing age was associated with better mental health but worse physical health. The survey also found that there were no significant associations between spirituality and patients’ quality of life and general well-being. However, it was considered important to complement and enrich the survey findings by gaining a deeper understanding of the influences of spirituality on patients’ health outcomes and general well-being by carrying out the qualitative component of the study. Qualitative data were collected using semi-structured interviews with a subsample of 21 patients from those who participated in the survey. A thematic approach using Framework Analysis informed the qualitative data analysis. Four main themes emerged from the qualitative interviews: ‘Emotional and Psychological Turmoil’, ‘Life is Restricted’, ‘Spirituality’ and ‘Other Coping Strategies’. The findings from the interviews confirmed that patients’ quality of life might be affected because of the physical challenges such as unremitting fatigue, disease unpredictability, or being tied down to a dialysis machine, or the emotional and psychological challenges imposed by the disease into their lives such as wholesale changes, dialysis as a forced choice and having a sense of indebtedness. The findings also revealed that spirituality was an important coping strategy for the majority of participants who took part in the qualitative component (n=16). Different meanings of spirituality were identified including connection with God or Supernatural Being, connection with the self, others and nature/environment. Spirituality encouraged participants to accept their disease and offered them a sense of protection, instilled hope in them and helped them to maintain a positive attitude to carry on with their daily lives, which may have had a positive influence on their health outcomes and general well-being. The findings also revealed that humour was another coping strategy that helped to diffuse stress and anxiety for some participants and encouraged them to carry on with their lives. The findings from this study contribute knowledge to increase our understanding of the influence of spirituality on the health outcomes and general well-being of patients with end-stage renal disease currently receiving haemodialysis treatment. Based on the findings from this thesis, recommendations are made for clinical practice, patient and nurse education and for future research.

The purpose of this study was to examine health literacy and treatment adherence among Latinos with end stage renal disease. Health literacy has been overlooked as one of the factors that affects one's ability to comply with the physician's prescribed medical treatment.

This study looked into paients’ experiences of end stage renal disease (ESRD) and renal replacement therapy (RRT). A qualitative me thodology was employed involving fifteen patients between the ages of 20 – 60 years that were interviewed on their experiences using the semi structured approach to interviewing. The knowledge gained was analysed thematically. The study was explored within two theoretical frameworks, namely the biopsychosocial and the ecological models. Results of the study revealed that ESRD and RRT posed many psychosocial challenges at a micro and macro level, as patients attempted to reconcil e these experiences with their lifestyles and lives. Challenges were expressed in the areas of functional capacity, work and sexuality. Family life was seriously affected when patients had to make themselves available for life long tr eatment that depended on machines. Recommendations included mobilisatio n of positive support networks, religion/spirituality, and pr ofessional support playing an interrelational role in enabling patients to cope through the long term process so that they may emerge from it with a modicum of quality in their life. Thus a team approach was key to optimal living for the patient. From an ecological perspective, macrosystemic change was also considered important for government to introduce policies that ensure economically productive living for persons with kidney dysfunction. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

DISSERTATION (PH.D.)--THE UNIVERSITY OF MICHIGAN / CO-CHAIRMEN: ARNOLD MONTO; GENE HIGASHI