Populations are aging and the prevalence of chronic disease, persisting for many years, is increasing. The most common, non-communicable chronic diseases in developed countries are; cardiovascular disease (CVD), type 2 diabetes, obesity, arthritis and specific cancers. Chronic diseases such as cardiovascular disease, type 2 diabetes and obesity have high prevalence and develop over the course of life due to a number of interrelated factors including genetic predisposition, nutrition and lifestyle. With the development and completion of human genome sequencing, we are able to trace genes responsible for proteins and metabolites that are linked with these diseases. A computerized model focused on organizing knowledge related to genes, nutrition and the three chronic diseases, namely, cardiovascular disease, type 2 diabetes and obesity has been developed for the Ontology-Based Personalized Risk Evaluation for Chronic Disease Project. This model is a Protégé-based ontological representation which has been developed for entering and linking concepts and data for these three chronic diseases. This model facilitates to identify interrelationships between concepts. The ontological representation provides the framework into which information on individual patients, disease symptoms, gene maps, diet and life history can be input, and risks, profiles, and recommendations derived. Personal genome and health data could provide a guide for designing and building a medical health administration system for taking relevant annual medical tests, e.g. gene expression level changes for health surveillance. One method, called transductive neuro-fuzzy inference system with weighted data normalization is used to evaluate personalized risk of chronic disease. This personalized approach has been used for two different chronic diseases, predicting the risk of cardiovascular disease and predicting the risk of type 2 diabetes. For predicting the risk of cardiovascular disease, the National Nutrition Health Survey 97 data from New Zealand population has been used. This data contains clinical, anthropometric and nutritional variables. For predicting risk of type 2 diabetes, data from the Italian population with clinical and genetic variables has been used. It has been discovered that genes responsible for causing type 2 diabetes are different in male and female samples. A framework to integrate the personalized model and the chronic disease ontology is also developed with the aim of providing support for further discovery through the integration of the ontological representation in order to build an expert system in genes of interest and relevant dietary components.

Populations are aging and the prevalence of chronic disease, persisting for many years, is increasing. The most common, non-communicable chronic diseases in developed countries are; cardiovascular disease (CVD), type 2 diabetes, obesity, arthritis and specific cancers. Chronic diseases such as cardiovascular disease, type 2 diabetes and obesity have high prevalence and develop over the course of life due to a number of interrelated factors including genetic predisposition, nutrition and lifestyle. With the development and completion of human genome sequencing, we are able to trace genes responsible for proteins and metabolites that are linked with these diseases. A computerized model focused on organizing knowledge related to genes, nutrition and the three chronic diseases, namely, cardiovascular disease, type 2 diabetes and obesity has been developed for the Ontology-Based Personalized Risk Evaluation for Chronic Disease Project. This model is a Protégé-based ontological representation which has been developed for entering and linking concepts and data for these three chronic diseases. This model facilitates to identify interrelationships between concepts. The ontological representation provides the framework into which information on individual patients, disease symptoms, gene maps, diet and life history can be input, and risks, profiles, and recommendations derived. Personal genome and health data could provide a guide for designing and building a medical health administration system for taking relevant annual medical tests, e.g. gene expression level changes for health surveillance. One method, called transductive neuro-fuzzy inference system with weighted data normalization is used to evaluate personalized risk of chronic disease. This personalized approach has been used for two different chronic diseases, predicting the risk of cardiovascular disease and predicting the risk of type 2 diabetes. For predicting the risk of cardiovascular disease, the National Nutrition Health Survey 97 data from New Zealand population has been used. This data contains clinical, anthropometric and nutritional variables. For predicting risk of type 2 diabetes, data from the Italian population with clinical and genetic variables has been used. It has been discovered that genes responsible for causing type 2 diabetes are different in male and female samples. A framework to integrate the personalized model and the chronic disease ontology is also developed with the aim of providing support for further discovery through the integration of the ontological representation in order to build an expert system in genes of interest and relevant dietary components.

Populations are aging and the prevalence of chronic disease, persisting for many years, is increasing. The most common, non-communicable chronic diseases in developed countries are; cardiovascular disease (CVD), type 2 diabetes, obesity, arthritis and specific cancers. Chronic diseases such as cardiovascular disease, type 2 diabetes and obesity have high prevalence and develop over the course of life due to a number of interrelated factors including genetic predisposition, nutrition and lifestyle. With the development and completion of human genome sequencing, we are able to trace genes responsible for proteins and metabolites that are linked with these diseases. A computerized model focused on organizing knowledge related to genes, nutrition and the three chronic diseases, namely, cardiovascular disease, type 2 diabetes and obesity has been developed for the Ontology-Based Personalized Risk Evaluation for Chronic Disease Project. This model is a Protégé-based ontological representation which has been developed for entering and linking concepts and data for these three chronic diseases. This model facilitates to identify interrelationships between concepts. The ontological representation provides the framework into which information on individual patients, disease symptoms, gene maps, diet and life history can be input, and risks, profiles, and recommendations derived. Personal genome and health data could provide a guide for designing and building a medical health administration system for taking relevant annual medical tests, e.g. gene expression level changes for health surveillance. One method, called transductive neuro-fuzzy inference system with weighted data normalization is used to evaluate personalized risk of chronic disease. This personalized approach has been used for two different chronic diseases, predicting the risk of cardiovascular disease and predicting the risk of type 2 diabetes. For predicting the risk of cardiovascular disease, the National Nutrition Health Survey 97 data from New Zealand population has been used. This data contains clinical, anthropometric and nutritional variables. For predicting risk of type 2 diabetes, data from the Italian population with clinical and genetic variables has been used. It has been discovered that genes responsible for causing type 2 diabetes are different in male and female samples. A framework to integrate the personalized model and the chronic disease ontology is also developed with the aim of providing support for further discovery through the integration of the ontological representation in order to build an expert system in genes of interest and relevant dietary components.

<b>Background</b> Cardiovascular risk scores are used to estimate absolute risk of disease and identify patients who will benefit most from treatments to lower risk. As a key risk factor for cardiovascular disease, blood pressure is accounted for in many risk scores, but is inherently variable and may be influenced by both biological and measurement factors. This thesis aims to determine how routinely collected blood pressure measurements should best be used for accurate estimation of cardiovascular risk. <b>Methods</b> This thesis describes four main studies. A patient survey and prospective study establish the current practice of blood pressure measurement. Secondary analyses of data from blood pressure monitoring trials determine how risk estimates may be affected by the use of different summary measures of blood pressure. A systematic review evaluates the evidence of an association between blood pressure variability and cardiovascular risk. Finally, a cohort study in the Clinical Practice Research Datalink determines if inclusion of blood pressure variability in cardiovascular risk scores may improve risk estimation. <b>Results</b> Current practice of blood pressure measurement may differ from that in risk score derivation studies. However, these differences have limited effects on cardiovascular risk estimates with few patients reclassified across risk thresholds. Increased long-term variability in blood pressure is in itself a risk factor for cardiovascular disease over and above mean blood pressure but its inclusion in a cardiovascular risk score does not materially improve the accuracy of risk estimates. <b>Conclusions</b> Healthcare professionals should continue to estimate risk for primary prevention of cardiovascular disease using the blood pressure measurements available to them, whether measured at home or in the clinic. There is also no additional benefit of considering measures of long-term blood pressure variability in risk estimation.

Thesis (MTech (Tourism and Hospitality Management))--Cape Peninsula University of Technology, 2007 / The main objectives ofthis research were • To investigate how HIV/AIDS affect Southern African tourism, with specific reference to the tour operators. • To investigate measures taken by the Southern African tour operators and governments to combat HIVIAIDS and the chances of success. • To make some recommendations on what can further be done to fight HIV/AIDS in the Southern African tourism sector. T 0 conduct the literature study, the following methods were used: I. Literature search particularly about Southern Africa and in general, as well as news report has been conducted. H. Review ofHIV statistics. lll. Use of Internet. IV. Journals and government publications. RESULTS: The United Nations (2005: 22) indicates that Southern Africa is experiencing the highest rate of HIV infection in the world. The infection rate is particularly high among the young people (aged 15 - 49). This age group constitutes people who are economically active, and some of them work directly or indirectly in the tourism sector. THETA (2003: 4) conducted a study on a number of tourism and hospitality companies in South Africa. The study results indicate that 92% of the companies surveyed do not have HIVIAIDS educational programmes for their employees, and that 91% of the surveyed companies do not provide HIV/AIDS preventive measures like condoms to their workers at workplace.

Thesis (DTech (Tourism and Hospitality Management))--Cape Peninsula University of Technology, 2010 / Purpose: Botswana is one of the countries with the highest HIV/AIDS prevalence rate in the world. This research aims to investigate the impact of HIV/AIDS on the socio-economic environment in Botswana with special reference to the country’s tourism sector. Tourism plays a vital role in the economy of Botswana. It creates employment, earns foreign exchange, markets Botswana internationally, attracts foreign investments and contributes to Gross Domestic Products (GDP).Methodology: This report explains the HIV/AIDS situation and policy framework relative to the tourism sector in Botswana and in selected African countries through conducting an extensive literature review and empirical surveys. This is a quantitative research in which non-probability method is used to indentify the respondents. Here tourism general managers are identified and asked to identify their subordinates who are available and willing to participate in the survey by answering a self-administered questionnaire.Findings: This study indicates that HIV/AIDS threatens the Botswana tourism and the viability of the socio-economic factors. In general, the Southern African region is experiencing the highest rate of HIV infection in the world. The infection rate is particularly high among the young people (aged 15 – 49). This age group constitutes people who are economically active, and a number of them work directly or indirectly in the tourism sector. HIV/AIDS kills the economically active population – people who hold the skills, do the work, pay taxes, raise children, vote in the elections, and provide leadership. HIV/AIDS results in increased mortality and morbidity rates, and it also results in increased health expenditure. It also results in increased poverty level in the country.Practical implications: When observing the prevalence and impact of HIV/AIDS not only in the tourism sector but in general, it becomes evident that the fight against the disease should be a collaborative approach involving various sectors including tourism. Relying only on government and health sector to address the complex and systematic impact of HIV/AIDS cannot effectively combat the disease and its prevalence rate.Originality/value: This report analyses HIV/AIDS situation in Botswana in a creative way, contributing to the understanding of its impacts on the socio-economic environment as well as identifying strategies that can be used in addressing the impacts. This research is important for public policy makers, government officials, and tourism role-players to be aware of implications HIV/AIDS has on the socio-economic environment and take them into consideration in the policy formulation and implementation, business strategies and processes. It is also imperative to academics who would like to expand their knowledge on HIV/AIDS.

Philosophiae Doctor - PhD / Background: Obesity is increasing worldwide, and cultural perception of body image is considered an important contributor to the obesity epidemic among black Africans. Aim: To explore the association between body image perceptions and perceived obesity threat, change in adiposity, and total cardiovascular disease (CVD) mortality risk. Study Design: This is a mixed-methods study embedded in the PURE longitudinal cohort study involving adults aged 35-78 years in South Africa. Data Collection/Analysis: This included analysis of baseline cross-sectional data, the conduct of a qualitative study and a cross-sectional follow-up survey. Sex-specific logistic regression models of excessive adiposity were determined. Body image perception indexes were obtained based on 'Feel- Ideal' difference (FID) and 'Feel-Actual' discordance (FAD). Bivariate analyses and analysis of variance were used to determine the relationships between body image and adiposity, annual changes in weight and adiposity. The correlations between body image indexes (FID and FAD) and total 10- year CVD risk score were determined – controlling for possible confounders. Qualitative data was managed with ATLAS-ti software and analysed thematically. Results: The prevalence of excessive body fat at baseline and at 5-year follow-up based on body fat percent were 96.0% and 79.6% for women, and 44.3% and 62.2% for men respectively. The majority of the obese (85%) and overweight (79%) participants underestimated their weight, and weight discordance status was inversely associated with the willingness to lose weight. Mean total 10-year CVD risk score was 18.7%, and 61% of men and 26% of women with body mass index (BMI) ≥ 25 kg/m2 had CVD risk scores ≥ 20%. Bivariate analyses indicated that FID and FAD were significantly associated with annual changes in weight and adiposity. FAD index had a significant but weak correlation with total CVD risk score (r = 0.13, p-value = 0.001) when adjusted for covariates. Conclusion: Body image discordance was associated with an annual change in adiposity, total 10- year CVD risk scores, and there was poor obesity risk perception, and low motivation towards weight loss among predominantly obese black adults with negative body image. Interventions to reduce obesity need to address negative body image, poor obesity risk perception, self-efficacy and motivation towards weight loss. / National Research Foundation; Chromnic Disease Initiative for Africa (CDIA); National Institute of Health (NIH)

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 2017. / Background: In spite of the contributions of cardiovascular disease (CVD) to morbidity and mortality in chronic kidney disease (CKD) worldwide, there are no studies that have looked at cardiovascular risk factors (CVRFs) and their association with cardiovascular changes in African children with CKD. Several CVRFs have been implicated in the initiation and progression of cardiovascular changes in children with CKD, and these changes have been reported even in early CKD. This study investigated CVRFs and their association with cardiovascular changes in South African children with CKD. Method: This comparative cross sectional study recruited children (5-18 years) with CKD being followed up at the Division of Paediatric Nephrology of the Charlotte Maxeke Johannesburg Hospital and the Chris Hani Baragwanath Academic Hospital. One hundred and six children with a spectrum of CKD including those on chronic dialysis (34 CKD I, 36 CKD II-IV and 36 CKD V-dialysis) were enrolled over a 12 month study period. All patients had a short history taken along with a physical examination. Blood samples for serum creatinine, urea, albumin, calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase, total cholesterol, haemoglobin and C-reactive protein, Vitamin D, Fibroblast growth factor-23 (FGF-23), Fetuin-A and genomic DNA studies were taken. Where feasible, transthoracic echocardiography and high resolution ultrasonography of the common carotid artery was performed. Results: The overall median age of the patients was 11 years (8-14 years), with a male female ratio of 2.1:1. Several CVRFs detected include hypertension, proteinuria, anaemia, hypercholesterolaemia and dysregulated mineral bone metabolism. The most common CVRF detected was anaemia (39.6%) and its prevalence was highest in the dialysis group when compared with the other CKD groups. The overall median (range) cIMT was 0.505mm (0.380-0.675), and was highest in patients with dialysis dependant CKD (p=0.003). The distribution of left atrial diameter (LAD) and left ventricular mass (LVM) differed significantly (p<0.05) across the different CKD groups. Abnormal LAD was seen in 10% of patients; left ventricular hypertrophy (LVH) in 27%; left ventricular systolic dysfunction in 6% and diastolic dysfunction in one patient. Mean arterial pressure and haemoglobin levels were independently associated with cIMT; hypertension was independently associated with concentric LVH; and age and hypoalbuminaemia were independently associated with eccentric LVH. Overall, the dialysis group had the highest prevalence of vascular changes, cardiac changes and associated risk factors. A skewed pattern of Fetuin-A and FGF-23 levels with medians (range) of 57.7 (0.9-225.2) mg/dL and 28.9 (0-3893.0) pg/ml respectively, were observed. The levels of these two biomarkers varied significantly between the different CKD groups (p<0.05). Fetuin-A was independently associated with abnormal LAD but no similar relationship with other cardiovascular changes and plasma levels of Fetuin-A and FGF-23 was found. Plasma FGF-23 levels correlated better with markers of bone mineralization than Fetuin-A. Eight Fetuin-A SNPs were analysed; rs2248690, rs6787344, rs4831, rs4917, rs4918, rs2070633, rs2070634 and rs2070635. We found an association between log-transformed Fetuin-A levels and the SNP rs4918 G-allele compared to the rs4918 C-allele (p=0.046) and the rs2070633 T-allele when compared to the rs2070633 C-allele (p=0.015). Markers of MBD such as phosphate and PTH levels were associated with Fetuin-A SNPs. The rs6787344 G-allele was significantly associated with phosphate levels (0.042), and the rs4918 G-allele with PTH (p=0.044). Seven deaths were recorded in the dialysis group during the study period and severe hypertension and intracranial bleed were the most common causes of death. Modifiable risk factors such as increased total cholesterol (TC) and decreased albumin levels were more commonly seen among the deceased dialysis patients. Conclusion: A high prevalence of CVRFs and cardiovascular changes were observed in the study groups, even in those with mild to moderate disease. Information obtained from the study highlights the need to address modifiable CVRFs such as hypertension, anaemia and hypoalbuminaemia in children with CKD and also the need to determine new, population specific, paediatric reference values for cIMT in healthy African children. Finally, the study was able to demonstrate differences in the relationship between Fetuin A SNPs and Fetuin-A levels and cardiovascular changes in our study population when compared with previously published data. We postulate that these differences may be due to genetic differences between our population and other population groups previously studied. / LG2018

Osteoarthritis (OA) is a prevalent and progressive musculoskeletal condition characterized by the degradation of the cartilage and bone and is often comorbid with cardiovascular disease (CVD), with both disease prevalence’s increasing with age. Several factors, such as the site of OA and the menopause transition, are known to independently influence both conditions. OA and CVD share overlapping risk factors and proposed mechanisms, though it is not well understood how these mechanisms influence the risk of comorbidity. This thesis examines the relationship of CVD risk factors, sites of OA, and menopausal variables on CVD risk in individuals with OA. The first aim of this thesis was to examine preclinical markers of CVD risk, namely the carotid intima-media thickness (cIMT) and cardiovascular risk scores, the Framingham risk score (FRS) and the InterHeart risk score (IHRS), in individuals with and without OA to examine differences in CVD risk profiles. Additional considerations were given to the site of OA, as well as non-specific CVD risk factors (such as social disadvantage and frailty). Risk factors were compared between age- and sex-matched individuals with and without OA and between weight-bearing and non-weight bearing OA. Individuals with OA had significantly greater cIMT, FRS, and IHRS, though no differences were found when comparing the site of OA. Unadjusted and multivariate adjusted odds ratios (OR) calculated odds of CVD at 3-year follow-up in the same cohorts. There was a significantly unadjusted (p<0.001, OR:1.70) and adjusted (p<0.001, OR ranging from 1.67-1.70) influence of OA diagnosis on odds of CVD at 3-year follow-up. There was no significant unadjusted or adjusted difference in odds of CVD at 3-year follow-up when comparing different sites of OA (p ranging from 0.24-0.75, OR ranging from 0.69-0.71). The second aim of this thesis was to study CVD risk in post-menopausal women. CVD risk factors and the IHRS were used to calculate differences between age-matched post-menopausal women. Unadjusted and multivariable adjusted ORs calculated odds of CVD at 3-year follow-up. There was a significant unadjusted influence of OA diagnosis (p=0.03, OR:1.34) on CVD outcomes, though the effect of OA diagnosis became non-significant after adjusting for the IHRS (p=0.25, OR:1.36) and the IHRS with menopausal variables (p=0.22, OR:1.40). Although OA is a multifaceted condition, it has often been viewed as a joint-centric disease. The elevated risk of CVD individuals with OA suggests that additional aspects of the OA pathology, such as inflammation and frailty, may drive the increase in risk of CVD independent of age, sex, or menopausal status. / Thesis / Master of Science (MSc) / Osteoarthritis (OA) and cardiovascular disease (CVD) are two of the most prevalent comorbidities that affect the aging population. Surrogate measures of CVD, such as CVD risk scores and carotid intima-media thickness, have rarely been examined in individuals with OA despite studies showing elevated CVD risk in individuals with OA. We used baseline and 3-year follow-up data collected by the Canadian Longitudinal Study on Aging to study CVD risk factors in older individuals with and without OA, with considerations given to the site of OA and to menopause, which are additional non-modifiable factors known to influence vascular outcomes. We hypothesized that individuals with OA have greater CVD risk and odds of developing CVD compared to individuals without OA. We found that individuals with OA have greater CVD risk and odds of developing CVD at 3-year follow-up, with no influence of OA site on CVD outcomes, and post-menopausal women with OA have greater odds of developing CVD than post-menopausal women without OA. Our findings suggests that aspects of the OA pathology play a role in increasing CVD risk, which are partially explained through shared risk factors and etiology.

No description available.