Thesis (MBA (Business Management))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: South Africa is on the verge of major changes in the private medical sector. The government’s planned National Health Insurance has far reaching implications for all role players in the industry, as well as for the general public. This paper looks at the changes that have been made since the ANC government came to power in 1994 and then continues to look at possible models for the new National Health Insurance plan. A proposal on practicing cost-effective cardiology within this new system is made. The data of a pilot project between a private service provider and a managed healthcare company is analysed as a basis of this discussion. / AFRIKAANSE OPSOMMING: Suid-Afrika se mediese bedryf staan op die vooraand van groot veranderinge. Die regering se beplande Nasionale Gesondheidsplan het verreikende implikasies vir alle rolspelers in die bedryf, sowel as die algemene man op straat. Die dokument kyk oorsigtelik na die veranderinge wat ondergaan is sedert die ANC regering aan bewind gekom het in 1994 en gaan daarna voort om na moontlike opsies te kyk hoe die nuwe gesondheidsmodel daarna gaan uitsien. Voorstelle word gemaak oor hoe privaat kardiologie in die nuwe sisteem koste-effektief beoefen kan word. ‘n Lootsprojek van ‘n privaat diensverskaffer en ‘n bestuurde gesongheidsorg maatskappy se data word ontleed as basis vir die bespreking.

Thesis (DSc)--Stellenbosch University, 2013. / AFRIKAANSE OPSOMMING: Hierdie DSc is fundeer op ‘n aantal aspekte rondom ‘n sentrale tema naamlik die algemene en streeksfunksie van die normale hart of die hart blootgestel aan die risiko van miokardiale isgemie. Die werk is oor ‘n bestek van 25 jaar gedoen en sluit in eksperimentele werk in groot en kleindiere sowel as data verkry in pasiënte. Hoofstuk 1 handel met globale en streeksfunksie in die normale hart met die klem op die meer moderne benadering tot die koppeling van die hart met die sirkulasie en effek van middels op die twee komponente. Hierdie hoofstuk het waardevolle inligting gegee t.o.v. fisiologie maar ook gehelp om die middels te kies vir daaropvolgende studies. Hoofstuk 2 bevat navorsing wat verwys na die hart met kroonaarstenose. Onder andere word gesteun op ‘n dieremodel van kroonaarstenose. Die hoofstuk sluit data in wat , as eerste en unieke bydrae, gewys het dat inhalasie narkose middels die reperfusie besering van die hart kan verminder. Hierdie data het spesifiek bygedra om die kliniese praktyk van narkose vir hierdie pasiënte te verander. Hoofstuk 3 verwys na werk gedoen om die hart gedurende elektiewe chirurgiese arres te oksigeneer. Die effektiwiteit van verskillende kardioplegiese vloeistofsamestellings is ook krities ontleed. Die vierde hoofstuk handel met ‘n ernstige kliniese probleem naamlik akute pulmonêre hipertensie. By pasiënte met akute long besering is hierdie verskynsel baiemaal die oorsaak van dood en of moeitevolle oksigenasie. Die werk het gelei tot beter insigte t.o.v. pasiënt hantering tot die punt dat baie van die pasiënte vandag gered kan word. / ENGLISH ABSTRACT: This thesis is based on a number of aspects with a central theme of global and regional cardiac function in the normal heart and the heart at risk of ischemia. It summarizes work done over 25 years and includes experimental work in large and small animals as well as data obtained from human clinical practice. Chapter one deals with global and regional heart function and especially the physiological concept of ventriculo-arterial coupling as a mechanism to explain and understand the effects of inter alia commonly used drugs. Chapter 2 summarizes work done in hearts with a coronary artery stenosis. One of the interesting ,and at that time, unique findings was that inhalation anesthetic drugs are effective in limiting the reperfusion injury of the heart. This insight helped to redirect techniques used to anaesthetize patients with coronary artery disease. The third chapter examines methods to improve myocardial oxygenation during elective surgical cardiac arrest. It also includes data showing that not all the cardioplegic solutions are equally effective. Chapter four deals with a significant clinical problem i.e. acute pulmonary artery hypertension. This condition is often responsible for patient death, or contributes to, difficult oxygenation in patients with acute lung injury. The work in this chapter assisted in understanding the pathophysiology of the condition and improved the management thererof. This insight, combined with progress in other areas in the pathology or acute lung injury, has led to many of the patients today surviving their illness.

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / toc / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Medicine / Doctoral / Doctor of Philosophy

The purpose of the research was to describe the relationships between social support and role strain and preventative health behaviors. The sample consisted of 62 critical care nurses employed in three southwest acute care facilities. Subjects completed instruments measuring social support, role strain, and four preventative health care behaviors. Pearson correlations revealed significant positive relationships between social support and personal/household roles women perform and ways women handle stress. Additional significant negative relationships existed between marital/relationship roles women perform and leisure physical activities, a subset of preventative health behaviors. The parental roles, obligations, and responsibilities women perform were also significantly related with leisure physical activities. Conclusions drawn indicate that the critical care nurses did not perceive themselves susceptible to cardiovascular disease and therefore did not participate in preventative health care activities, regardless of perceived helpful social support and an absence of role strain.

The purpose of this study was to describe the relationships among perceptions of privacy, powerlessness, and subjective sleep characteristics in hospitalized adults with coronary heart disease. Thirty subjects, 48 to 92 years old who were hospitalized for suspected or confirmed coronary heart disease, completed three questionnaires. Negative relationships were found between patient privacy and powerlessness (r = -.44) and between powerlessness and the subjective sleep characteristics of sleep effectiveness (r = -.30). Feelings of powerlessness were negatively related to total number of days of (r = -.50) and number of days in the Coronary Care Unit (CCU) (r = -.41). The number of days in the CCU was positively related to sleep disturbance (r =.30). Age was negatively related to patient privacy (r = -31) but positively related to powerlessness (r =.33) and sleep supplementation (r =.35). A better understanding of the hospital environment enhances the planning of nursing care for hospitalized patients.

The purpose of this study was to evaluate whether the current CDC/ACSM physical activity recommendation, ("30 minutes or more of accumulated moderate-intensity activity, most if not all, days of the week") would improve women's health through a reduction ofcoronary heart disease (CHD) risk factors. Twenty-one sedentary females (ages 49 ± 7 yrs.) with one or more CHD risk factors underwent baseline laboratory including: resting heart rate and blood pressure, resting electrocardiogram, body mass index, bioelectrical impedance, skinfold measures, waist-to-hip, blood lipid profile, and V02max. The VO2 was determined by an exercise treadmill test using the Ball State University Ramp protocol. The subjects were instructed on the CDC/ACSM recommendation, the physical activity survey, and given examples of moderate-intensity activity. The survey data was collected bimonthly over the six month period. The subjects reported participating in >_ 30 min. of moderate-intensity activity an average of 4 f 1 days/week with an average duration of 54 ± 26 min. On the remaining days, the subjects reported doing an average of 14 ± 6 minutes per day. Also, 90% of the women reported doing the activity in continuous bouts. Following the six month study period, the women were retested in the laboratory. Sixteen subjects completed the post-testing. The results of the sixteen women showed a significant improvements in HDL-cholesterol (51 ± 15 vs.56 ± 15 mmHg; p=<.05) and TC/HDL ratio (4.5 ± 1 vs.4.25 ± 1.3; p=<.05). There were no significant changes in the other risk factor variables examined or their V02,„.. It was concluded that the majority of previously sedentary, middle aged women can not meet the CDC/ACSM recommendations for daily activity and total energy expenditure. Additionally, it appears that when given the choice, these women choose to do activity in continuous time blocks versus breaking the daily activities into shorter time periods. / School of Physical Education

Coronary heart disease rates show substantial geographic variation in England, which could be due to environmental variables (e.g. climate, air quality) or behavioural risk factors for coronary heart disease within populations. Previous work investigating this geographic variation has either used ecological analysis (i.e. areas as units of observation) or individual-level analysis. Ecological studies have been unable to account adequately for differences in behavioural risk factors within populations; individual-level studies have been under-powered at the area-level to include all potentially explanatory environmental variables. This thesis reports on ecological multi-level and spatial error regression analyses of coronary heart disease mortality and hospitalisation rates for all wards in England using environmental variables and synthetic estimates of the prevalence of behavioural risk factors as explanatory variables. Existing sets of synthetic estimates were subjected to studies of their validity. Validated synthetic estimates of the prevalence of smoking, low fruit and vegetable consumption, raised blood pressure, obesity and raised cholesterol were combined into a single index of unhealthy lifestyle to take account of collinearity between them. Final models successfully explained around 80% of large scale geographic variation (i.e. variation between wards in different areas of the country) in mortality rates for coronary heart disease and 60% in hospitalisation rates, and around 20% of the small scale geographic variation (i.e. variation between wards in close proximity) in mortality rates, and 30% in hospitalisation rates. The climate explained around 15% of large scale geographic variation in coronary heart disease rates after adjustment for the index of unhealthy lifestyle and socioeconomic deprivation. Urbanicity and air pollution explained a small amount of small scale geographic variation in coronary heart disease rates. The majority of explained geographic variation was due to the index of unhealthy lifestyle and deprivation. The results of this thesis confirm and extend findings from the British Regional Heart Study, report on the validity of synthetic estimates currently used to guide healthcare resource allocation, and introduce an index of unhealthy lifestyle that could be used in future ecological studies of chronic disease.