The purpose of the study was to describe the support services available for nurses who care for patients with human immunodeficiency virus / acquired immune-deficiency syndrome (HIV/AIDS) in Pretoria urban pubic hospitals. Problems faced by nurses in HIV/AIDS care support preferences were also investigated. The study was conducted between March and April 2003, using a descriptive design. Respondents comprised eighty-seven (87) nurses who were conveniently selected from five (5) hospitals. Results reveal that support available is inadequate in both quality and coverage of nurses. Other significant findings are inadequate job preparation, shortage of nurses and that nurses prefer to receive support from both within and outside the hospital. It has been recommended that management should work with nurses to design support interventions that match the identified problems/needs. Nurses need to take an active role in caring for themselves and more in-service training opportunities need to be created for nurses. / Health Studies / MA (Health Studies)

This study investigates, within the current health care situation, the interrelationship of the user, resources and tool in the design of a prototype WELLNESS database-driven web site. A shift has taken place in health care, in which the base of conventional medicine has broadened to integrate other systems, practices and worldviews. These include complementary and alternative medicine, health promotion, disease prevention and wellness. Emphasis is placed on the need to take personal responsibility for one's own health and wellness. The global burden of chronic disease, reaching epidemic proportions, is increasingly linked to risk factors resulting from personal lifestyle choices. The growing evidence of the user's need to make personal, informed, lifestyle choices and their reliance on the Web for health information, required investigation. WELLNESS, a specific orientation to health and wellness, formed the framework within which the user and resources were defined and the tool designed. The user was profiled as the WELLNESS health information seeker, hereby contributing significantly to an understanding of the user in this new context. The user profile informed the establishment of resource selection criteria and tool design. The identification of WELLNESS content selection criteria, within a five-dimensional model, was required to ensure quality, relevant and credible resources. The tool is comprised of the WELLNESS thesaurus and WELLNESS database-driven web site. The WELLNESS thesaurus was constructed based on a combination of relevant thesauri. It will be used as an indexing tool. An investigation of existing health information web sites highlighted the importance of designing a specific WELLNESS database-driven web site. A database host was identified against which the original study's conceptual schema was assessed. A low-fidelity prototype web site was designed as the interface between the WELLNESS health information seeker and the database of WELLNESS health information resources. This study has epidemiological, philosophical, epistemological, sociological and psychological relevance. The provision of access to WELLNESS health information resources, made available in the WELLNESS database-driven web site, for personal, informed lifestyle choice by the WELLNESS health information seeker could potentially contribute to the reduction of the global burden of chronic disease. / Information Science / D.Litt. et Phil. (Information Science)

Voluntary HIV counselling and testing (VHCT) is one of the key strategies in the prevention of HIV in Ethiopia. However, utilization of the VHCT services among adolescents has been reported as low by previous studies. The purpose of this study was to investigate adolescents’ knowledge and attitudes towards VHCT services among adolescents attending high school in Addis Ababa, the capital city of Ethiopia. A cross-sectional school-based design using quantitative methods was employed to attain the objectives of the study. Data collection was done using self-administered structured questionnaires among 378 adolescent high school students. Data was analysed using the Statistical Package for Social Sciences (SPSS). The findings revealed that 75.7% of students are aware of the voluntary HIV counselling and testing services; 62.2% use the services and suggested that VHCT services should be located in schools and youth clubs for better access by adolescents. Thirty-two percent of respondents rated themselves at risk of HIV infection and 35.2% were not willing to disclose their HIV positive status to anybody. The findings of the study clearly indicate a need for a more accessible voluntary HIV counselling and testing services for adolescents. / Health Studies / M.A. (Public Health)

The majority of black South Africans utilize the services of indigenous healers and the new National Health Plan for South Africa makes provision for cooperation between the healers and formal health practitioners. The purpose of this study was to determine the role played by indigenous African healers in the prevention of diseases and the promotion of health, and to design a model which will provide guidelines for cooperation between indigenous healers and formal health workers. This study was ethno-medical, contextual, exploratory and qualitative. It was designed to look into the health care of a specific cultural group to explore in depth the experiences of indigenous healers in providing health care within their cultural context. Data was collected by individual free-type interviews from indigenous African healers, users of formal health services and by observation. It was found that there is dual utilization of both formal and indigenous health service systems by clients. A specific culbrral terminology relating to health was found to be used. Such terminology could result in communication gaps and breakdowns if not known to or used by formal health workers. The findings show that cultural beliefs are still strongly adhered to. These were found to influence the life-styles and health maintenance behaviour of a cultural group. The fmdings show that divination fonns the core of health assessment and health-problem diagnosis. It was found that no health problem could be attended to without first going through a divination session. The findings also show involvement of indigenous healers in primary health care workers at first contact levels of prevention in the field of paediatric preventive care. Diarrhoea and vomiting in children was found to be the preventable disease in which healers specialize. Infertility and impotence were found to be conditions taken to healers for treatment. Other sexually transmitted diseases as well as culture-bound syndromes treated by indigenous healers were found in this study. The use of rituals and rites of passage and the involvement of ancestors were found to form part ofholistic health care. The fmdings show the willingness of healers to collaborate with formal health workers. A model is designed to guide the process of collaboration. / Health Studies / D. Lit. et Phil. (Advanced Nursing Sciences)

This study was done to assess the quality of life (QOL) of people living with HIV and AIDS (PLWHA) in Swaziland who are on antiretroviral therapy (ART). No study has been done on QOL of PLWHA in Swaziland who are on ART since it started to be administered in Swaziland in 2001. A qualitative, exploratory, descriptive, and contextual design was used to assess QOL of PLWHA in Swaziland who are on ART. Twenty-four PLWHA were purposely selected to participate in the study. Methods of data collection used were semi-structured individual in-depth interviews, focus group discussions, and observations. The data (tape-recorded interviews and discussions, and field notes) were transcribed verbatim for data analysis. Data analysed was done using Tesch’s framework of data analysis as described in Creswell (2002:256-283). The research findings are reflected, with the six domains of QOL identified through a literature review and validated by nurses’ expertise. These domains are the physiological, psychological, spiritual, socio-economic, cognitive, and environmental domains.The study revealed that PLWHA in Swaziland are faced with many challenges concerning ART, namely: inability to meet their nutrition needs, non-adherence to ART, experience of disfiguring side effects of ARVs, inconsistent condom use, experience of stigma and discrimination, depression, difficulty in accepting and coping with ARVs, lowered self-esteem, a negative influence of some religions on ART, a lack of financial support, poor support systems, poor understanding of ARVs, negative thoughts about HIV and AIDS and ART, an unsatisfactory health care delivery system, a negative influence of culture on ART, and violation of the rights of PLWHA. These challenges negatively influence the QOL of PLWHA and hence the study concluded that PLWHA in Swaziland who are on ART have a poor QOL. Conclusions drawn from the data analysis reveal that PLWHA in Swaziland are powerless to deal with the above challenges and improve their QOL. The researcher, therefore, developed guidelines to empower PLWHA to deal with these challenges and adhere to ART, thus improving their QOL. Recommendations were made with regard to nursing practice, nursing education, and further nursing research. / Health Studies / D. Litt. et Phil. (Health Studies)

This study aimed at exploring the influence of the home environment of women that were on the prevention of mother-to-child transmission (PMTCT) programme for HIV/AIDS. A qualitative descriptive study was conducted to explore the home environment for the psycho-social support that was available for women on the PMTCT programme and the influence this had on compliance to the programme. Data collection was done using a semi-structured interview guide, with a sample size of 14 participants (n=14). The data was then coded and grouped into categories and major themes. The findings revealed that the common barriers that prevented full disclosure of an HIV positive status included stigma and discrimination, fear of social isolation and financial dependence. A major constraint that affected the women’s full utilisation of the PMTCT preventative strategies and their adherence to treatment was the poor acceptance of people living with HIV in the family and community / Health Studies / M.A. (Health Studies)

Thesis (MPhil)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Theological positions are usually considered as coterminous with ethical considerations. That which the Church has earnestly considered in the light of what is believed to be God's will, as elucidated in religious texts and through prayerful contemplation, are considered to be ethical without contradiction. Recently the Roman Catholic Church adopted a position forbidding the use of condoms as protection from contracting HIV/AIDS. Instead, the Church has declared that the way to controlling the AIDS pandemic is via sexual abstinence for the unmarried and sexual faithfulness within marriage. It is acknowledged that it is not possible for all the church's theological positions to be driven by pragmatic concerns within society. Nor can a church easily be seen to be promoting sex outside of marriage by recommending the indiscriminate use of condoms. However, the Roman Catholic Church, by forbidding the use of contraception, puts itself in an ethically questionable light relative to other Christian churches. The Catholic Church needs to reconsider its stance on contraception from first principles, divorced from dogmatic beliefs and practices which were derived by men and which have endured beyond their usefulness or theological veracity. It is evident that a church should not adhere to dogmas that are ungodly in their impact and ethically questionable in their import. If a church needs to revise its dogmatic stance on such issues, it should have the courage to do so. This research considers whether the stance of the Catholic Church on condoms can be considered ethical. The position of the Catholic Church is considered critically from a variety of philosophical, empirical and ethical viewpoints. In so doing, it highlights the principled and practical problems of resolving differing moral positions that cross the religious and secular divide. The approach adopted is one of an applied ethical nature, given the probable effects of participating in unprotected sex. Pregnancy and contracting HIV/AIDS are the likely outcomes of not using condoms, and these conditions will create enormous problems for the individual concerned, her, or his, family, as well as for the greater society. The position taken in this research is that the Catholic Church's stand on abstinence before marriage and faithfulness in marriage, as the answer to the HIV/AIDS crisis, would be a realistic ethical position, if, and only if, it was at all feasible and realisable in practice. However, it is the contention of the author, based on empirical considerations, that the idealistic stance taken by the Catholic Church is out of touch with the realities in our contemporary South African society and is doomed to failure. Given this perspective, the Catholic stance is morally questionable, as, if sexual relationships continue to occur outside of marriage, and if condoms are not used, the result will be unwanted pregnancies, HIV infections of both mothers and their babies, crises for families and society at large, and ultimately widespread death from AIDS. Given the pandemic facing South Africa, the Catholic position in banning the use of condoms, is ethically questionable and morally suspect. The Church needs to be called to account for the implications of its dogmatic stance. The HIV/AIDS pandemic is simply too serious for a public institution, such as the Catholic Church, to be involved in perpetuating theological niceties and holding idealised positions. The Church is not divorced from the society it exists in and a realistic, responsible and accountable response is needed in the current context of hundreds of thousands of persons facing death from AIDS and its related diseases. / AFRIKAANSE OPSOMMING: Teologiese standpunte word gewoonlik beskou as gelyktermig met etiese oorwegings. Dit wat die Kerk met erns beskou het word sonder weerspreking as eties aanvaar in die geloof dat dit die wil van God is wat belig word in religieuse geskrifte en deur gebedsoordenking. Onlangs het die Rooms-Katolieke Kerk 'n standpunt aanvaar wat die gebruik van kondome verbied as beskermingsmiddel teen MIV/VIGS-besmetting. Daarteenoor het die Kerk verklaar dat die VIGS-pandemie beheer moet word via seksuele weerhouding vir ongetroudes en seksuele getrouheid binne die huwelik. Daar word toe gegee dat dit nie moontlik is om al die die kerk se teologiese standpunte aan pragmatiese kwellinge binne die gemeenskap te onderwerp nie. Daarmee saam kan die kerk ook nie buite-huwelikse seks aanmoedig deur aan te beveel dat kondome onoordeelkundig benut word nie. Relatief tot ander Christelike kerke plaas die Rooms- Katolieke Kerk homself egter in 'n etiese bevraagtekenbare posisie deur die gebruik van voorbehoedmiddels te verbied. Die Katolieke Kerk behoort sy standpunt oor geboortebeperking te heroorweeg in die lig van primêre prinsiepe - geskei van dogmatiese oortuigings en bedrywe wat deur mense bedink is en wat hulle bestaansreg as nuttigheid of teologiese waarheid oorskrei. Dit is duidelik dat 'n kerk nie dogmas behoort aan te hang wat onverantwoord in haar impak en eties bevraagtekenbaar in hulle belangrikheid is nie. Indien 'n kerk sy dogmatiese standpunte oor sulke sake moet hersien, behoort dit die moed te hê om dit te doen. Hierdie navorsing skenk oorweging aan die vraag of die Katolieke Kerk se standpunt oor kondome as eties beskou kan word. Die posisie van die Katolieke Kerk word krities beskou vanuit 'n verskeidenheid filosofiese, empiriese en etiese standpunte. Dit verlig die beginsels en praktiese probleme wat verband hou met die resolusie van die verskillende morele posisies wat die kloof tussen die religieuse en sekulêre moet oorbrug. Die benadering wat benut word is van 'n toegepas etiese aard, gegewe die waarskynlike gevolge van deelname aan onbeskermde seks. Swangerskap en besmetting met MIV /VIGS is die waarskynlike resultate indien kondome nie benut word nie. Dit lei gevolglik tot enorme probleme vir die betrokke individu, familie en die breër samelewing. Die aanspraak van hierdie navorsing is dat die Katolieke Kerk se standpunt - dat weerhouding van seks voor die huwelik en getrouheid binne die huwelik as antwoord dien vir die MIV /VIGS krisis - 'n realistiese etiese posisie verteenwoordig indien, en slegs indien, dit toepasbaar en haalbaar binne die praktyk is. Dit is egter die bewering van hierdie skrywer, gebaseer op empiriese oorwegings, dat die idealisriese standpunt van die Katolieke Kerk uit voeling is met die realiteite van ons kontemporêre Suid-Afrikaanse samelewing en dat dit gedoem is tot mislukking. Gege hierdie perspektief, word dit duidelik dat die Katolieke standpunt moreel verdag is, veral as in gedagte gehou word dat - indien seksuele verhoudings buite huweliksverband voortduur en kondome nie gebruik word nie - die resultaat onbeplande swangerskap, MIV besmetting van beide moeders en babas, krisisse vir families en die samelewing en uiteindelik wydverspreide sterftes as gevolg van VIGS sal wees. Gegewe die pandemie wat Suid-Afrika in die gesig staar word die Katolieke standpunt waarin die gebruik van kondome verbied word eties bevraagtekenbaar asook moreel verdag. Die Kerk moet tot verantwoording geroep word vir die implikasies van sy dogmatiese standpunt. Die MIV /VIGS'pandemie is eenvoudig te ernstig vir 'n openbare instansie soos die Katolieke Kerk om betrokke te bly in die voorsetting van teologiese kieskeurigheid en die verkondiging van geïdealiseerde standpunte. Die Kerk is nie los van die samelewing waarbinne dit bestaan nie en 'n realistiese, verantwoordelike en toerekenbare respons word benodig binne die huidige konteks waarbinne honderde duisende mense dood as gevolg van VIGS in die gesig staar.

Advancements in clinical care have led to a growing cohort of preterm-born individuals now entering adulthood. Before birth, such adults were often exposed to a suboptimal intrauterine environment, and after delivery, key developmental stages that would normally occur in utero during the third trimester had to take place under ex utero physiological conditions. Through detailed cardiovascular phenotyping, this thesis investigates the cardiovascular changes in preterm-born young adults, utilising a cohort of individuals with data collection since recruitment at birth. The detailed perinatal information was first used to design nested case-control studies to investigate the effects of early lipid and glucocorticoid exposure on long-term cardiovascular physiology in individuals born preterm. It was demonstrated that intravenous lipid administration leads to an artificial elevation of total cholesterol levels in immediate postnatal life, which is associated with long-term changes in aortic and left ventricular function proportional to the degree of cholesterol elevation. Additionally, exposure to antenatal glucocorticoids relates to a regional increase in aortic arch stiffness in young adulthood, as well as changes in glucose metabolism. It was then shown that young adults born preterm have increased left ventricular mass, out of proportion to blood pressure, and a unique three-dimensional left ventricular geometry, with reduced systolic and diastolic function compared to term-born controls. Similarly, they also show distinct differences in the right ventricle, with increased right ventricular mass and a proportion having clinically impaired right ventricular systolic function. Finally, it was demonstrated that preterm-born individuals have increased circulating levels of antiangiogenic factors in young adulthood, which relate to capillary rarefaction and blood pressure elevation. These findings are of considerable public health relevance given that nearly 10% of births are now preterm. Understanding whether modification of these variations in cardiovascular structure and function prevent the development of cardiovascular disease in this growing subgroup of the population will be of future interest.

Voluntary HIV counselling and testing (VHCT) is one of the key strategies in the prevention of HIV in Ethiopia. However, utilization of the VHCT services among adolescents has been reported as low by previous studies. The purpose of this study was to investigate adolescents’ knowledge and attitudes towards VHCT services among adolescents attending high school in Addis Ababa, the capital city of Ethiopia. A cross-sectional school-based design using quantitative methods was employed to attain the objectives of the study. Data collection was done using self-administered structured questionnaires among 378 adolescent high school students. Data was analysed using the Statistical Package for Social Sciences (SPSS). The findings revealed that 75.7% of students are aware of the voluntary HIV counselling and testing services; 62.2% use the services and suggested that VHCT services should be located in schools and youth clubs for better access by adolescents. Thirty-two percent of respondents rated themselves at risk of HIV infection and 35.2% were not willing to disclose their HIV positive status to anybody. The findings of the study clearly indicate a need for a more accessible voluntary HIV counselling and testing services for adolescents. / Health Studies / M.A. (Public Health)

This chapter reviews the literature applying health behavior theories to indoor tanning. Few studies have tried to fit full versions of health behavior models to indoor tanning. Theoretical models from the family of theories referred to as the reasoned action approach (e.g., theory of planned behavior, behavioral alternative model, prototype willingness model, etc.) have been most commonly used to study indoor tanning. Results indicate that these models fit indoor tanning data moderately to extremely well. Two lesser known models, problem behavior theory and the terror management health model, have also demonstrated a reasonable fit. Two other common models, the health belief model and social cognitive theory, have never been fully tested with indoor tanning. However, key constructs from these models (e.g., perceived susceptibility and threat, modeling) have been used to understand indoor tanning. Empirical research conducted represents a solid start toward developing strong, comprehensive models of indoor tanning that can guide intervention efforts. This initial work needs to be expanded by conducting longitudinal studies and by including a broader age range in studies because the majority of existing work has focused on young adults. Incorporating findings related to tanning dependency, peer group affiliation, media influences and other constructs into these foundational models will also improve our understanding and ability to develop efficacious interventions to reduce engagement in this health risk behavior.