MCur / Department of Advanced Nursing Science / Noncompliance with antihypertensive treatment is a challenge for uncontrolled hypertension in both high income and middle income countries. Compliance to antihypertensive treatment and lifestyle modification plays a significant role in the control of hypertension and reduces the cardiovascular morbidity and mortality rate. The purpose of this study was to explore and describe contributory factors of noncompliance to treatment among patients diagnosed with hypertension in the Vhembe District of the Limpopo Province The study was conducted at the regional Hospital and nine Primary Health Care facilities in the rural community in the Vhembe District of the Limpopo Province. The study population consisted of those patients diagnosed with hypertension receiving treatment from the ten sampled health facilities. In this study, the target population included 134 noncompliant patients diagnosed with hypertension taking treatment at the sampled health facilities. This study used simple random sampling. The instrument used for data collection was self-administered questionnaire. Data was analysed using the Statistical Package for Social Sciences. The results of this current study reveal that participants aged 40 years and above (85.1%) were noncompliant to treatment compared to those of the same or less than 40 years old (14.9%). Also, it indicated that females were more frequently noncompliant to treatment (73.1%) compared to males (26.9%), which was statistically significant. The study revealed that the unmarried participants (64.9%) were more non-compliant with treatment when compared to the married participants (35.1%). The current findings demonstrate that 40.3% of noncompliant participants mentioned the reason being that they were feeling well. Various factors related to participants’ noncompliance with their antihypertensive treatment and lifestyle modification regimen were described. Health education should cover the nature of hypertension specifically emphasising causes, severity and potential complications. / NRF

Magister Scientiae Dentium - MSc(Dent) / Oral epithelial dysplasia (OED) is a growth anomaly which occurs as a result of atypical, abnormal proliferation and a change in the architecture and cytological features of cells of epithelial origin, which ultimately results in the formation of a lesion with disturbed differentiation and maturation The purpose of this study was to describe the OED cases diagnosed at Tygerberg Oral health centre in a 7-year period between 2012 and 2019. The patients’ medical records from Tygerberg Oral Health Centre and National Health Laboratory Service (NHLS) were reviewed. All diagnosed cases of OED were identified and the data retrieved for further assessment and comparison. The individual medical records and follow up data were assessed. Seventy cases of OED were diagnosed in the period assessed. Of those 70 cases, the median age was 58 and the interquartile range was from 48 – 62. Thirty-six of the diagnosed patients were female and thirty-four were males. The majority of lesions diagnosed with OED were found on the tongue, floor of the mouth (FOM) and buccal mucosa. Majority of the lesions were found in non-smokers and non-alcohol consumers. These two categories both presented with mild cases of OED. From the results, it was derived that OED has no intra-oral location predilection. Moreover, OED is not directly associated with smoking.

This dissertation is divided into five chapters consisting of three short essays that concentrate on economic analysis of health, savings and labor. The first essay is aimed at investigating the influence of increased work hours on individuals’ health and how this may differ between males and females. It is expected that increased hours of work will have a negative impact on health but this impact may be stronger for females. In the second essay, the relationship between individuals’ health and savings behavior is analyzed. Healthy individuals are expected to be more productive, earn higher incomes, and have lower medical expenditures compared to unhealthy individuals. It is therefore expected that individuals’ health will have a positive influence on their saving behavior. The third paper analyzes the effect of increased work, as proxied by labor force participation, on health, as proxied by life expectancy, at the macro level. The main aim of the analysis in the third essay is to investigate whether or not increased female labor force participation is a contributing factor to the narrowing gap between the life expectancy of females and males. In the final chapter of this dissertation, I provide a summary of my findings on the relationships between work, health, and savings. I also provide directions for future research.

<p><strong>Purpose</strong></p> <p>Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer death among Canadians. Little is known about the types of supportive care needs (SCNs) that patients with colon cancer experience during the diagnostic phase or whether these needs are met. To inform the development of population specific healthcare services, a needs assessment of patients with newly diagnosed advanced colon cancer was conducted to identify the types, prevalence, severity, and importance of unmet SCNs, as well as to identify any gaps between patient priority needs and their use of supportive care services.</p> <p><strong>Patients and Methods </strong></p> <p>A descriptive cross-sectional survey was conducted. Over one year, all newly diagnosed patients with colon cancer at the Juravinski Cancer Centre were screened for eligibility. Sixty-two of 80 eligible patients completed a self-report written questionnaire prior to starting treatment (response rate = 77.5%). The questionnaire included the Supportive Care Needs Survey-Short Form, Functional Assessment of Cancer Therapy-Colorectal and Health Service Utilization Questionnaire.</p> <p><strong>Results</strong></p> <p>‘Fears about the cancer spreading’ was the most prevalent unmet SCN (n = 52/62 or 84%). Unmet SCNs experienced by 65% or more of participants related to lack of control about treatment outcomes, the uncertain future, and concerns about family member well-being. Patients also rated these needs as being most severe.</p> <p>The two most severe CRC-specific concerns were related to ‘body appearance’ (Mean = 1.77, SD = 1.37) and ‘bowel control’ (Mean = 2.28, SD = 1.37). The most important or priority unmet needs were related to uncertainty about the future (43.5%), fatigue (24.2%), and information (22.6%). Less than 12% of participants had used existing supportive care services in the community.</p> <p><strong>Conclusion </strong></p> <p>Prevalent and priority unmet needs were related to psychosocial support and information. Recommendations for designing colon cancer-specific services are provided along with strategies to improve patient use of existing resources.</p> <p><strong> </strong></p> / Master of Science (MSc)

Pulmonary Tuberculosis (TB) is a significant cause of morbidity in Uganda. TB control in the Ugandan district of Butaleja remains poor, characterised by TB case detection and cure rates below national targets. A qualitative exploratory and descriptive study was conducted to identify factors associated with health-seeking behaviour of TB patients in Butaleja district; with an aim to present recommendations for promoting positive health-seeking behaviour amongst the patients. Data was collected through individual in-depth interviews with seven diagnosed TB patients and analysed using Creswell’s (2009:186) analytic spiral steps. The findings revealed three major themes, namely; the nature of health-seeking behaviour, factors associated with the health-seeking behaviour and advice to others experiencing similar symptoms. The health-seeking behaviour of participants was generally poor, characterised by delay in seeking proper medical treatment for TB. Health system, individual and social factors contributed to poor health-seeking behaviour among the participants. The study recommends health system and community interventions targeted at individuals to improve health-seeking behaviour for Pulmonary TB / Health Studies / M.A. (Public Health)

Os transtornos mentais na infância são prevalentes e causam prejuízo para o indivíduo, família e sociedade. Informações acerca do custo dos transtornos mentais na infância são úteis para o planejamento do sistema de saúde, para auxiliar tomadas de decisão de gestores acerca de investimentos na área e para determinação de prioridades no orçamento público. No entanto, não há dados sobre o custo dos transtornos mentais na infância no Brasil. Já dados sobre o custo dos transtornos mentais na infância em nível subclínico são inexistentes na literatura nacional e internacional. Os objetivos centrais da presente tese de doutorado, dividida em Estudo I e Estudo 11, foram: estimar a média do custo do transtorno mental na infância em níveis subclínico e clínico, e estimar o custo total destes para o Brasil. O Estudo I teve como desfecho clínico qualquer diagnóstico de transtorno mental na infância; o Estudo 11, o transtorno obsessivo- compulsivo na infância (TOC), ambos em nível subclínico e clínico. A presente pesquisa é uma avaliação econômica de custo de doença de transtornos mentais na infância com utilização de método bottom-up retrospectivo. Foi baseada em dados de prevalência de um estudo populacional transversal de 2.512 estudantes de escolas públicas de Porto Alegre e São Paulo, selecionados por meio de duas técnicas: a) seleção aleatória de crianças e b) seleção de crianças com alto fiSCO para desenvolvimento de transtornos mentais (baseado no histórico psiquiátrico familiar). Para avaliação de transtornos mentais na infância, foi utilizado o instrumento Development and Well Being Assesment (DAWBA). Os custos de doença foram estimados a partir dos seguintes componentes: tratamentos em saúde mental (uso de medicamentos, psicoterapia, hospitalização), uso de serviços sociais (assistência social, conselho tutelar, medidas socioeducativas) e problemas escolares (suspensão, abandono e repetência escolar). A amostra final foi de 2.512 crianças, de 6-14 anos de idade. Resultados do Estudo I: o transtorno mental infantil em nível subclínico e clínico teve média de custo total ao longo da vida de $1.750,86 e $3.141,21, respectivamente (todos os valores em PPP, purchasing power parity). O custo nacional estimado do transtorno mental subclínico foi de $9,92 bilhões, enquanto do transtorno mental clínico foi de $11,65 bilhões (baseado nos dados de prevalência do presente estudo). Resultados do Estudo lI: o TOC subclínico e clínico apresentaram médias de custo total ao longo da vida de $1.651,81 e $3.293,38, respectivamente. O custo nacional do TOC subclínico foi de $6,71 bilhões, enquanto do TOC clínico foi de $2,02 bilhões (baseado nos dados de prevalência do presente estudo). Os dados apresentados nesta tese de doutorado fornecem evidências de que transtornos mentais subcltnicos e clínicos na infância têm grande impacto econômico na sociedade. O conhecimento acerca do grande impacto econômico dos transtornos mentais na infância pode informar gestores e políticos sobre a magnitude do problema, de forma que seja possível planejar um sistema efetivo de cuidados com programas de tratamento e prevenção. Recomenda-se que gestores públicos aumentem os recursos para os setores da saúde e educação no Brasil, para promover prevenção e assistência em saúde mental da infância / Child mental disorders are prevalent and impairing, negatively impacting families and society. lnformation on child mental disorders costs is important to plan the health system and to show policy makers how plan and prioritize budgets. However, there are no child mental disorders cost studies in Brazil. The main objectives of the present thesis were to estimate the mean costs of subthreshold and clinical mental disorders in children living in Brazil and to estimate its national costs. Outcome of Study I was any child mental disorder, outcome of Study II was child obsessive-compulsive disorder (OCD), both subthreshold and clinical. The present study it is cost-of-illness study of child mental disorders using a retrospective bottom-up methods, based on prevalence data from a cross-sectional study of children registered at public schools in Porto Alegre and Sao Paulo. A total of 8,012 families were interviewed, providing information about 9,937 children. From this pool, two subgroups were further investigated using random- selection (n=958) and high-risk group selection procedure (n=I,514), resulting in a total sample of 2,512 subjects 6-14 years old. Mental disorder assessment was made using the Development and Well-Being Assessment (DAWBA). The cost of child mental disorders was estimated from the following components: use of mental health services, social services and school problems. Costs were estimated for each child and the economic impact at the national levei was calculated. Study I results: subthreshold and clinical disorder showed lifetime mean total cost of $1,750.86 and $3,141.21, respectively. The national lifetime cost estimate of clinical mental disorders in Brazil was $11.65 billion, whereas for subthreshold mental disorder it was $19.92 billion (alI values in PPP, purchasing power parity). Study 11: subthreshold and clínical OCD showed lifetime mean total cost of $1,651.81 and $3,293.38, respectively. The national lifetime cost estimate of clinical OCD in Brazil was $2.03 billion, whereas for subthreshold OCD it was $6.71 bilIion. The present study provides evidence about the economic impact of child mental disorders. This knowledge can inform about the magnitude of the problem, so that policy makers can make adjustments to better address these problems with cost-effective programs of treatment and prevention. It is recommended that health and education budgets in Brazil should increase to enhance prevention and treatment of children with childhood mental disorders

<p>The main purpose of this qualitative study was to describe clients’ descriptions of the professional role case manager and how it relates to the job description provided from a project in which both case managers and clients were participating. Both what case managers do and are expected to do were explored. The project involved case management in the purpose to strengthen and enhance the care and quality of life for clients who are dually diagnosed. Interviews were conducted with five clients and the result was analyzed with theoretical concepts from role theory. The clients’ descriptions of the case manager corresponded fairly well to the job description and former studies that have captured client descriptions. The role of the case manager was described as being available, flexible, outreach oriented, motivating, supportive, committed, giving immediate assistance and doing a lot of tasks. Furthermore as someone who activates the clients, goes by car, represents, clarifies, co-ordinates and should work professionally and individual-based.</p>

No description available.

The main purpose of this qualitative study was to describe clients’ descriptions of the professional role case manager and how it relates to the job description provided from a project in which both case managers and clients were participating. Both what case managers do and are expected to do were explored. The project involved case management in the purpose to strengthen and enhance the care and quality of life for clients who are dually diagnosed. Interviews were conducted with five clients and the result was analyzed with theoretical concepts from role theory. The clients’ descriptions of the case manager corresponded fairly well to the job description and former studies that have captured client descriptions. The role of the case manager was described as being available, flexible, outreach oriented, motivating, supportive, committed, giving immediate assistance and doing a lot of tasks. Furthermore as someone who activates the clients, goes by car, represents, clarifies, co-ordinates and should work professionally and individual-based.

Pulmonary Tuberculosis (TB) is a significant cause of morbidity in Uganda. TB control in the Ugandan district of Butaleja remains poor, characterised by TB case detection and cure rates below national targets. A qualitative exploratory and descriptive study was conducted to identify factors associated with health-seeking behaviour of TB patients in Butaleja district; with an aim to present recommendations for promoting positive health-seeking behaviour amongst the patients. Data was collected through individual in-depth interviews with seven diagnosed TB patients and analysed using Creswell’s (2009:186) analytic spiral steps. The findings revealed three major themes, namely; the nature of health-seeking behaviour, factors associated with the health-seeking behaviour and advice to others experiencing similar symptoms. The health-seeking behaviour of participants was generally poor, characterised by delay in seeking proper medical treatment for TB. Health system, individual and social factors contributed to poor health-seeking behaviour among the participants. The study recommends health system and community interventions targeted at individuals to improve health-seeking behaviour for Pulmonary TB / Health Studies / M.A. (Public Health)