published_or_final_version / Medicine / Master / Master of Philosophy

As a result of medical advancement and cultural patterns of Western society, traumatic head injury is increasingly a problem for the injured, their families, medical and social services professionals, and the community at large. Head trauma is remarkable because of the complex nature of the residual disabilities which include long lasting cognitive and emotional problems, social isolation, and family disruption. The purpose of this study was to re-examine the phenomenon of recovery after mild to moderate head injury using an ethnographic research approach. The data were based on the experiences of 21 disabled and their families in the community setting. The disabled represented a range of stages of recovery and severity of disability. The data was collected using three field work strategies: extensive semi-structured interviews, participant observation, and non-academic document review. After collection the data was subjected to thematic and content analysis, that resulted in the selection of themes that characterized the experiences for the head injured and their families. The themes for the head injured informants were: dead days, loneliness, and forgetting. The family members' experiences were represented in the themes: responsibility, vulnerability, tough love, gender differences, and reactions to the experience. Next the data were interpreted using five theoretical concepts from cultural anthropology: liminality, personhood, social labelling, sick role and double bind. In addition, the reflexive influence of the investigator on the research process was addressed. The trustworthiness of the ethnography was assessed in terms of credibility, transferability, dependability and confirmability. Several variables were found to be important to the long term outcome of head injury. These variables were: family directed therapy, double bind communication patterns, and lifelong recovery. Two other factors were found to be critical for the recovery of the head injured. These were economic disincentives to the return to employment and the importance of the social and family environment. In the final section the research and policy implications of the study were discussed in relation to management and service provisions.

The purposes of this research were to: (1) describe selected fluid and electrolyte changes that occur during the first four hours after open heart surgery; (2) determine whether significant hourly changes occurred in: blood pH, fluid intake, exogenous potassum chloride replacement, fluid output, or serum and urinary sodium and potassium levels; and finally, (3) delineate which of the above variables were most strongly related to changes in serum and urinary, sodium and potassium levels. Fifty-three patients who had undergone cardiac surgery involving cardiopulmonary bypass were studied. Urine and blood samples were collected every hour for the first four hours postoperatively and were analyzed for sodium and potassium content using flame photometry. Blood pH and exogenous potassium chloride replacement were recorded from the anesthesiologist's and nurse's records. Fluid intake and fluid output were measured directly by the investigator. Analyses included both descriptive and correlational statistics. In addition, a repeated measures procedure (MANOVA) was performed to discern performance trends over time. The data showed that hypokalemia (defined as a serum potassium level less than 4.0 mEq/L) was present in approximately 52 percent of the subjects for the first two postoperative hours and that by the fourth hour only 15 percent of the subjects were hypokalemic. In addition, subjects were noted to retain 2.47 liters of fluid over the four hour period. Significant differences in fluid output were noted across time. Serum sodium levels did not change significantly across time even though serum potassium levels did. The data indicated that the best predictors of hypokalemia were fluid intake and fluid output. Both of these variables had a significance level of p = .000. Regression analysis showed that fluid intake and exogenous potassium chloride replacement explained 11.9 percent of the variance in serum potassium at a significance level of p = .008. Furthermore, fluid output explained 7.3 percent of the variance in urinary potassium (p = .030).

No description available.

This study focused on perceptions and experiences of pregnant women who opted in against those who opted out of voluntary antenatal HIV counseling and testing. The pregnant women's perceptions and experiences were assessed in order to gain insight into their views towards voluntary antenatal counseling and testing.

Increasing adverse birth outcome are a major concern in South African maternal care and globally In South Africa, perinatal mortality rate of 40/1000 and maternal mortality ratio of 150/100 000 are poor considering the fact that 95.1 percent of women attend antenatal care and 83.7 percent of women deliver in a medical facility. This study focuses on the effect of lack of adequate antenatal care on adverse birth outcome using data from the 1998 South African Demographic and Health Survey. The analysis is based on univariate and bivariate analysis to examine the effect of socio- demographic characteristics on adverse birth outcomes. In addition, binary logistic regression is used to examine the impact of antenatal and sociodemographic characteristics on adverse birth outcome. The results show majority of women reporting adverse birth outcome are those who delivered though caesarean section (53 percent) and that most of these women are likely to be educated and have better socio economic status and that they are likely to be Non African. It is also shows that the proportion of women attending antenatal care adequately is very high in South Africa. The results show that the use of antenatal care is determined by a range of socio demographic factors including the level of education and the economic status of the mother. Only timing of antenatal care, place of delivery and race had a significant effect on adverse birth outcome. All other variables were not significant. Results from the binary regression analysis show that women who started their antenatal care during second and third trimester (95%CI: 0.211-0.975), were Non African (95%CI: 1.082 to 2.098) and delivered in a private health facilities (95%CI: 0.28 to 0.73) were more likely to have adverse birth outcome compared to their counterparts. Most women choosing caesarean section do so without adequate information on the disadvantages of delivering through caesarean section. Therefore, there is a need to focus maternal health education to all women in South Africa regardless of their socio- economic status background / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.

No description available.

The main purpose of this study is to examine the differences of preventive management utilizations and diabetes complications in Asian Americans and Non-Hispanic whites using multiple years (2002-2013) Behavioral Risk Factor Surveillance System (BRFSS). SAS for complex survey procedures were used to perform the data analysis. Odds ratios (OR) were calculated to compare the prevalence of diabetes complications and preventive management rate in Asian with white. Compared to white, the prevalence of diabetes retinopathy in Asians were higher, while the rates of neuropathy and cardiovascular complications, pneumonia shot, personally management as well as management diabetes with doctors were lower. The prevalence of routine checkup in Asian was not significantly different from the prevalence in white. More attentions should be paid on Asians for diabetes related retinopathy.

Thirty-two silicone breast implant patients scored in the mild to moderate range of impairment on the Halstead-Reitan Neuropsychological Battery. An unusual number of patients had positive tests for antinuclear antibody on immunological testing and a high incidence of EEG abnormalities were found. Personality testing revealed an MMPI profile which is typical for neuropsychologically impaired subjects but components were consistent with extreme emotional distress. None of the subjects were near the cutoff score for malingering or faking bad on the F-K index of the MMPI. There was no apparent relationship between length of exposure and the severity of neurological impairment. Also, explanted subjects performance was not improved when compared to subjects whose implants were still in place.

Class of 2007 Abstract / Objectives: To determine the effect of antihypertensive use on renal function and other diabetic complications in adults over the age of 18 with type 2 diabetes mellitus (DM). Methods: A retrospective secondary analysis of the NIH Pima epidemiologic data included 1,828 individuals with type 2 DM were evaluated for antihypertensive use and DM complications. Statistical analysis was done using general linear model regression (GLM) or logistic regression models controlling for age, sex and DM duration. Three groups were established to evaluate antihypertensive use Group 1 those taking antihypertensives to those not taking antihypertensives, Group 2 those taking more than one (multiple) antihypertensives to those only taking one and Group 3 those taking an angiotensin converting enzyme (ACE) inhibitor to those not taking an ACE. Results: Group 1 those taking antihypertensives were significantly worse for all outcome measures than those taking no antihypertensives as evident with: renal function (ACR 43 mg/mmol versus 15.9 mg/mmol (ρ=0.0003) and albuminuria 55.8% versus 37.6% (p=0.0039), retinopathy, neuropathy and CVD. Group 2 those taking multiple antihypertensives had significantly worse renal function (ACR 69.2 mg/mmol versus 34.5 mg/mmol (p=0.0329) and albuminuria 63% versus 52% (p=0.0396)), CVD while retinopathy and neuropathy were not significantly different. Group 3 those taking ACE had significantly worse renal function (ACR 43.8 mg/mmol versus 35.2 mg/mmol (p=0.0329)) while CVD was improved and no difference was observed in retinopathy and neuropathy. Conclusions: Antihypertensive use had little impact on preventing diabetic complications. This is contrary to well- documented literature that supports the use of antihypertensives to slow disease progression and protect renal function.