Background: Age-standardised mortality rates for cardiovascular disease (CVD) are generally higher among men than women, prompting suggestions that reproductive factors may be partly responsible. Moreover, there have been major changes in women’s reproductive patterns and CVD rates in China over the last few decades, but the association between them is still poorly understood. Objectives: To start addressing these issues, this thesis examines the secular trends and correlates of age at menarche and menopause (the major physiological events defining a woman’s reproductive window), as well as their association with blood pressure and anthropometry in 302,180 women born in 1930-74 from 10 areas across China using cross-sectional demographic, behavioural, physical and reproductive data from the China Kadoorie Biobank. Results: Mean age at menarche decreased by 2 years over a 44-year period (1930-1974), with the exception of an increase of about 1 year for women exposed to the Great Chinese Famine in early adolescence. No other factor showed as large an effect on age at menarche. Among women aged >57 years at the baseline, mean age at menopause increased by 1.4 years over a 21-year period (1930-1951) and was significantly associated with several reproductive and behavioural factors, notably gravidity (2 years later menopause) and smoking (6 months earlier menopause). Blood pressure and anthropometry were weakly inversely associated with age at menarche (0.2mmHg and 0.2kg/m² lower per year later menarche) and even more weakly positively associated with age at menopause (0.06mmHg and 0.04kg/m² higher per year later menopause). These trends and associations all varied to some extent by area and socioeconomic status. (All p-values <0.0001) Conclusion: This study adds new information on the secular trends and correlates of age at menarche and menopause in a large Chinese population born around the mid-20th century and provides a basis for further prospective work on the association of reproductive history with the incidence of CVD in China.

Thesis (M.Phil.)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: HIV/AIDS is a disease that affects millions of people in South Africa. Various strategies have been implemented to try and curb this epidemic. One of the strategies 'used is the dissemination of information pertaining to the prevention of contracting HIV/AIDS. One of the measures of disseminating such information is through pamphlets and brochures in all eleven official languages of South Africa. This research endeavours to establish whether translated HIV/AIDS brochures are communicative towards its target readers or not. The aim of producing these brochures is to educate people about ways to prevent the spread of HIV/AIDS. On investigating translated Xhosa HIV/AIDS brochures, the researcher established that some brochures are poorly translated and fail to accomplish their purpose. Various factors contribute to the non-communicativeness of these brochures towards their intended target readers. The microstructure as well as the macrostructure of the texts tend to be problematic as far as understanding and reader-friendliness are concerned. In the end the people for whom these texts are intended do not understand the information they so desperately need. The skopos theory has been recommended by functionalist scholars as an appropriate translation approach, as it considers the culture of the target readers as well as the intention of the text. It is also concerned with whether target readers actually understand the target text. Therefore the skopos theory is promoted in this thesis for the translation of informative and instructive medical brochures and pamphlets, especially those translated into Xhosa. / AFRIKAANSE OPSOMMING: MIV/VIGS is 'n toestand wat miljoene mense in Suid-Afrika affekteer. Verskeie strategieë is reeds geïmplementeer om hierdie epidemie te probeer beheer. Een hiervan is die verspreiding van inligting met betrekking tot die voorkoming van MIVNIGS. Inligting oor die voorkoms en beheer van MIV/VIGs word, onder andere, versprei deur middel van pamflette en brosjures in al elf amptelike tale van Suid-Afrika. Hierdie navorsing probeer vasstelof vertaalde MIVNIGS brosjures effektief met hul teikenlesers kommunikeer. Die doel van hierdie brosjures is om mense op te voed oor maniere om die verspreiding van MIVNIGS te bekamp. Deur 'n studie te maak van vertaalde Xhosa MIVNIGS brosjures, het die navorser die slotsom bereik dat sommige brosjures baie swak vertaal word en daarom nie hul doel bereik nie. Verskeie faktore dra by tot die gebrekkige kommunikasie tussen vertalers van hierdie brosjures en hul teikenlesers. Die mikro- sowel as die makrostruktuur van die tekste skep probleme met betrekking tot begrip en lesersvriendelikheid. Uiteindelik kry die persone wat die inligting desperaat benodig, nie toegang daartoe nie. Die skoposteorie word as die aangewese benadering aanbeveel deur kenners van die funksionalistiese vertaalteorie, aangesien dit die kultuur van die teikenlesers sowel as die doel van die teks in ag neem. Hierdie benadering het ook ten doel dat die teikenlesers werklik die teks sal begryp. Die skoposteorie word dus in hierdie tesis voorgehou as die geskikte benadering vir die vertaling van informatiewe en instruktiewe mediese brosjures en pamflette, veral in Xhosa.

On t.p.: Master of Arts (Clinical Psychology) / Thesis (MA)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Progress has been made in the approach to combating the spread of HIV/AIDS with regards to the Department of Health's presentation of the HIV/AIDS/STD Strategic Plan for South Africa. However, deep concem exists with regards to specific marginalized groups such as disabled persons within the South African sector threatened by the spread of HIV/AIDS. The aim of this paper was to review published academic papers on the specific ways in which disabled people are at risk for contracting HIV/AIDS, and the existence of primary prevention programmes designed and specifically aimed at the disability sector. The roles of non-governmental and other organisations were also looked at. The first section of the review focused on high-risk behaviour among disabled persons for contracting HIV/AIDS. Existing literature covered mainly areas of intellectual disability and psychiatric disability. Disabled persons struggle with the same issues of good education, workers' rights, gender equality, health care and social support and well-being as the general population. These issues are however exacerbated by struggles unique to those living with a disability. Inadequate public and social support increase disabled people's vulnerability to issues such as poverty, lack of resources, and inadequate education, heightening their risk of contracting HIV/AIDS. The second section of the review discusses the area of primary prevention, explaining why prevention programmes should be tailormade for specific needs such as those of disabled persons. Examples of prevention programmes from the literature are looked at, as well as a prevention initiative launched in South Africa. / AFRIKAANSE OPSOMMING: Vooruitgang is gemaak op die gebied van die voorkoming van die verspreiding van MIVNIGS met die bekendstelling van die Departement van Gesondheid se MIVNIGS/STD Strategiese Plan vir Suid-Afrika. Daar is wel steeds kommer oor spesifieke gemarginaliseerde groepe, soos gestremde persone, binne die Suid- Afrikaanse sektor wat bedreig word deur die verspreiding van MIVNIGS. Die doel van die studie was om 'n oorsig te kry van akademiese materiaal wat gepubliseer is oor die spesifieke wyses waarop mense met 'n gestremdheid in gevaar verkeer om MIVNIGS op te doen, asook primêre voorkomingsprogramme wat spesifiek ontwerp en gemik is op die gestremde sektor. Daar is ook gekyk na die rol van nie-regerings- en ander organisasies. Die eerste deel van die studie fokus op hoë risiko gedrag van gestremde persone wat hulle in gevaar mag stel vir die opdoen van MIVNIGS. Bestaande literatuur handel meestaloor die areas van intellektuele gestremdheid en psigiatriese siektes. Gestremde persone moet dieselfde uitdagings oorkom as diegene in die algemene populasie, soos byvoorbeeld die gebrek aan goeie onderwys, arbeidsregte, diskriminasie op grond van geslag, gesondheidssorg, asook sosiale steun en algemene welsyn. Gestremde persone se kwessies word egter vererger deur sekere uitdagings wat uniek is aan 'n lewe met 'n gestremdheid. Gestremde persone ontvang meestalonvoldoende publieke en sosiale steun wat dikwels armoede, gebrek aan hulpbronne en onvoldoende opvoeding tot gevolg het. Laasgenoemde verhoog gestremde persone se kanse om MIVNIGS op te doen. Die tweede deel van die studie bespreek primêre voorkomingsprogramme en waarom dit noodsaaklik is om voorkomingsprogramme te ontwerp wat uitsluitlik gemik is op spesifieke populasies. Daar word dan ook gekyk na voorbeelde van primêre voorkomingsprogramme in die literatuur, asook 'n voorkomingsinisiatief wat in Suid-Afrika geloods is.

The purpose of this study was to generate a grounded theory explaining the social and psychological processes employed by gay men in living with the threat of Acquired Immunodeficiency Syndrome (AIDS). As members of the high risk group for AIDS, gay men are living with a prolonged threat of unprecedented complexity which has unknown demands on health. An exhaustive preliminary literature review revealed a dearth of theoretical or empirical data addressing this problem. Theory discovery was accomplished using the grounded theory methodology. Two major data collection procedures were utilized: The conduct of increasingly structured interviews of healthy gay men, and an ongoing, progressive literature and media search. Data were sampled theoretically, as guided by the emergent theory. The constant comparative method of analytic induction was used for the analysis of data, in order to identify the elements and structure of the theory. Multiple procedures were incorporated into the analysis to ensure its trackability and credibility. A basic social process, Surviving Survival, was identified as the core category of the theory. Surviving Survival is the continuous process used by gay men to ensure mortal survival as well as outlive the extremity of the AIDS threat. The process is comprised of three subcategories: Vigilance, Safeguarding, and Balancing. The subcategory of Vigilance explains the work of monitoring the threat of AIDS and has both personal and social components. Safeguarding explains the behavior of protecting self and others from the AIDS threat, including AIDS' eventuality. The subcategory of Safeguarding contains Safer Sex, Reassuring Others, and Forecasting. The subcategory of Balancing explains efforts to conserve energy required to sustain affirmation of life and living in spite of the AIDS threat. In continuous interaction, the subcategories of Surviving Survival are interwoven into multiple aspects of gay living. This theory explains the profound impact AIDS has on the mental health of gay men, who both survive and perceive the extremity of the AIDS threat on a daily basis. These findings provide a knowledge base for the nursing discipline in becoming an informed and informing resource for the men who are outliving the threat of AIDS.

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.

There are estimated to be 840,000 people living with HIV in China (1) of whom 65% are estimated to be in the 16-29 year age group. Since the end of the Cultural Revolution and the opening of China to Western influence, traditional cultural norms have rapidly eroded and China is described as being in the middle of a sexual revolution (2). People are increasingly engaging in behaviours exposing them to the risk of contracting HIV which is spreading from the traditionally high risk populations to the general population via the heterosexual route (3). Comprehensive prevention strategies are necessary to prevent further spread (4). There is evidence that the observed increase in sexual activity is not accompanied by adequate knowledge of HIV transmission. 79% of 18-25 year olds know that HIV/AIDS can be transmitted by sexual intercourse, but a mere 30% know that correct and consistent condom use can protect against HIV transmission (5).<br /> <br /> This exploratory study investigated the factors that influence safe sexual practices amongst female Chinese university students, enabling or preventing them from taking responsibility for their reproductive health. The literature search revealed this to be a largely unexplored area. The study was undertaken amongst third year male and female students, recruited from the Department of Comparative Literature and Media Studies at the Zhongshan University in Guangzhou, China. Data was predominantly collected using two male and two female focus group discussions. Three key informant interviews supported and contextualised the findings. The study revealed that the factors influencing female students&rsquo / ability to adopt safe sexual practices are complex. The recognised shortcomings of sex education in China (6) are compounded by the taboo of sex and the pressure placed on students for the achievement of good grades.<br /> <br /> The university environment exerts a powerful influence. The ease with which mutually beneficial same sex friendships develop in the dormitory can be contrasted with the difficulties faced by couples attempting to conduct relationships. The restrictive university environment has the effect of driving relationships underground. Gender roles are deeply entrenched. The need to conform to the ideal pure, na&iuml / ve, and non-inquiring female stereotype affects a female student&rsquo / s ability to source sexual health information, negotiate safe sex, and to adopt safe sexual practices. Two distinct male stereotypes emerged: the traditional more gender equal male, and the liberal male who believes in an earlier age of sexual initiation and condones multiple sexual partners. All students are aware of HIV but have misconceptions about the specifics of HIV transmission, believing that HIV can be transmitted by kissing, from unclean baths and from doctors. Some students were of the belief that poor personal hygiene is an indicator of possible HIV positive status. Students were confused by condom quality issues. As they had received no formal condom training students relied on reading the package instructions or working it out for themselves.<br /> This small exploratory study resulted in the production of rich and surprising findings. These are incorporated into recommendations for future research and a comprehensive sex education programme at the university. Abstinence and mutual monogamy should be emphasised. Gender stereotypes that influence behaviour and choice of sex education materials should be acknowledged. Negotiation skills training should be incorporated together with condom and contraceptive advice. A sexual health page on the student website and a training programme for students to become peer-to-peer sex educators should be introduced.

<p>The HIV and AIDS epidemic is deemed the single greatest threat to South Africa's future and its growth in one of the most rapid in the world. The South African government has marked 2006 as the year of accelerated HIV and AIDS prevention. It was against this background that the leadership role of principals was articulated as the focus of this research. This study was aimed at gaining an understanding of the challenges facing school principals and of the unique role they could play in addressing the HIV and AIDS epidemic.</p>

This study explores whether and how Mabutho’s (The UCCSA men’s organization) teachings on masculinities can mediate HIV prevention in the Mozambique Synod of the United Congregational Church of Southern Africa (UCCSA). It begins by showing the importance of Mabutho in church and society in order to establish whether this male-dominated Christian organization can play a role in HIV prevention. The study is premised on the growing literature which suggests that organized religion (especially Christianity and Islam)*[¹], which are the main religious institutions in the world, and in Africa in particular, have been the birth place for the patriarchal ideologies which are critical in the promotion of the HIV pandemic. Through a close analysis of Mabutho’s teachings, the study will show that though most of Mabutho’s teachings are sustained by a patriarchal ethos, Mabutho have agency, and can be an asset in the prevention of the HIV pandemic. It further argues that Mabutho, just like other men’s organizations which play a pivotal role in the life of many churches, can be used as a space for the liberation of harmful notions of masculinities in the era of the HIV pandemic. The study concludes by recommending that the UCCSA in Mozambique improve in the pre- and post-marital teachings on marriage and sexuality. *[¹] See Manda, D. (2009). “Religion and the Responsibility of Men in Relation to HIV and Gender Based Violence: An Ethical Call”. In Journal of Constructive Theology: Gender, Religion, and Theology in Africa, 15 (2). 23-40; and Camody, D. (1994). Response to 101 Questions about Feminism. Great Britain, 95. / Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

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

Cardiovascular risk scores predict an individual’s risk of developing cardiovascular disease. Many were developed and validated in study cohorts on risk-factor lowering treatment – a cause of inaccuracy. In addition, risk scores are criticised as being biased towards the elderly due to the prominence of age as a risk predictor. Although present guidelines advocate the use of short-term (5-10 year) absolute risk scores, other approaches to redress this perceived imbalance such as lifetime risk scores are being considered. The overall objective of this thesis is to identify the most appropriate cardiovascular risk score for use in general practice, taking account of the impact of treatment and time on assessed risk. This objective was met by three different methods. First, a systematic review of cardiovascular risk scores was conducted. This explored the derivation of each score, including the extent of treatment. Next, doctors were interviewed in depth to understand their perception and use of risk scores. Finally, mathematical models were devised to determine whether a true difference in life expectancy exists at different ages but the same short-term cardiovascular risk. The models incorporated age-specific case fatality rates, competing risks and time preference to estimate the potential years of life lost due to a five-year treatment delay in different age groups with the same short-term coronary heart disease risk. The findings demonstrate that cardiovascular risk scores do not take account of treatment effects. This significantly affects their application in clinical practice. In addition, there is little difference in potential life years lost between ages at the same risk level because of higher case-fatalities in older people. When time preference is considered, any residual case for treating the same level of short-term risk differently at different ages is abolished. The overall conclusion is that the five to ten-year absolute cardiovascular risk score is the most appropriate approach to primary cardiovascular disease prevention. By overestimating risk in the young, other approaches benefit the few at the expense of the many.