M.Cur. / Statistics prove that the monster called HIV/AIDS invades our country. More women are said to be HIV positive in comparison to men. The midwives are the frontline health workers who have to care for these pregnant HIV positive women and therefore are at occupational risk of HIV infection because of their caring role. The experience of midwives regarding the delivery of the babies of HIV positive women was not well addressed before as limited studies have been undertaken about the experiences of midwives, therefore inspiring the researcher to undertake this study. The purpose of this study was to: • Explore and describe how midwives experienced the delivery of the babies of HIV positive women. • Describe the guidelines for health professionals to support midwives in order for them to render good midwifery care. The paradigmatic perspective of this study was guided by the Theory for Health Promotion in Nursing (Rand Afrikaans University, Department of Nursing Science, 1992:2-15), which reflects the focus on the whole person.

Embora o tratamento anti-retroviral (HAART highly active antiretroviral therapy) tenha reduzido a morbi-mortalidade da AIDS, ele está associado a distúrbios metabólicos e aumento do perfil de risco cardiovascular. Os escores de risco cardiovascular são freqüentemente usados para direcionar os programas de intervenções na redução do risco cardiovascular. O objetivo deste estudo é analisar o efeito de um programa de prevenção primária sobre o risco cardiovascular estimado por três diferentes escores de risco cardiovascular. Analisamos prospectivamente 87 pacientes HIV+ encaminhados ambulatório de cardiologia, com risco cardiovascular elevado. Foram aplicados três escores de risco cardiovascular: Framingham (FR), PROCAM (PR) e ATP III do NCEP (ATP-III) em 4 etapas: Inicial e trinta dias, três meses e seis meses após intervenção por meio de um programa de prevenção. Adotamos para este estudo o conceito de baixo risco os indivíduos que apresentaram valores dos escores abaixo de 10%, para as complicações cardiovasculares nos próximos 10 anos, e risco elevado se os valores dos escores fossem acima de 10%. Todos os pacientes receberam orientações para adoção de estilo de vida saudável (atividade física, combate ao tabagismo, uso de alimentos saudáveis) e terapêutica farmacológica, quando indicado (hipolipemiantes e anti-hipertensivos). A nossa população teve como média das idades 52 anos, 92% eram do sexo masculino, 39,1% tabagistas, 70,1% com hipertensão arterial sistêmica e 18,4% com diabetes mellitus. Todos os pacientes usaram HAART, e 56,3% faziam uso dos inibidores de protease, e nenhum paciente teve sua terapia trocada (switched). O perfil lipídico analisado na fase inicial apresentou os seguintes valores: triglicérides = 298,70 mg/dL ± 242,30 , colesterol total = 224,6 mg/dL ± 47,6 , LDL-colesterol = 129,50 mg/dL ± 44,50 , HDL-colesterol = 43,10 mg/dL ± 12,60. Seis meses após intervenção o perfil lipídico apresentou as seguintes alterações: triglicérides=206,20 mg/dL + 135.3 (p<0,05), colesterol total = 189.8 mg/dL + 38.0 (p<0,001), LDL-colesterol = 109.10 mg/dL + 30.30 (p<0,001), HDL-colesterol = 45.20 mg/dL + 13.30 (p=NS). Observamos uma redução da freqüência de indivíduos com risco cardiovascular elevado segundo o escore de FR, de 92,0% para 27,6% após a intervenção (p<0,0001), com escore ATP-III de 80,5% para 50,6% (p<0,0002) e com o escore PROCAM de 25,3% para 14,9%, (p=NS). O programa de intervenção proposto associou-se a uma redução do risco cardiovascular estimado. Todos os escores, com exceção do PROCAM mostraram-se úteis na prática clinica e para triagem e acompanhamento dos pacientes com risco cardiovascular elevado. Entretanto o escore de Framingham se mostrou como o mais sensível que os outros escores e detectou pequenas variações no risco cardiovascular em curto espaço de tempo, devendo este ser o escore de escolha para esta população / Although HAART therapy has reduced AIDS morbid-mortality, it is associated to metabolic disturbances and increased cardiac risk profile. It is well established in clinical cardiology that cardiac risk scores can predict cardiovascular complications with great accuracy and are useful to guide interventions toward risk reduction. We designed this study to analyze the effect of a primary prevention intervention program on the estimated cardiovascular risk and to compare the power of three different risk scores to detect risk reduction in a short time window. Methods: We prospectively evaluated 87 HIV + patients referred for cardiologic consultation for primary prevention and we assessed their cardiac risk applying 3 risk scores: Framingham (FR), PROCAM (PR) and National Cholesterol Education Program (ATP-III) in four steps: before and 30 days, 3 months and 6 months after intervention. For this study cardiovascular risk was classified as low if it was predicted less than 10% risk of cardiac complications for the next 10 years, or elevated, if it was higher than 10%. All patients were included in a cardiovascular prevention program and received non-pharmacological concealing (diet, physical activity prescription, smoking cessation advice) and pharmacological therapy, when appropriate (hypolipidemic and anti-hypertensive medications). Deviations in risk scores were compared using Fisher`s exact test at a p < .05 significance level. In our population, the mean age was 52 yrs, 92% were male, 39.1% were smokers, 70.1% had hypertension, 18.4% had diabetes. All patients were under HAART therapy, 56.3 % were receiving protease inhibitors, and no patient had his therapy switched. Lipid profile analysis before interventions revealed triglycerides = 298.70 mg/dL + 242.30, totalcholesterol= 224.6 mg/dL + 47.60, LDL-cholesterol = 129.50 mg/dL + 44.50, HDLcholesterol = 43.10 mg/dL + 12.60. Six months after intervention lipid profile change to: triglycerides = 206.20 mg/dL + 135.3 (p<.05), total-cholesterol = 189.8 mg/dL + 38.0 (p<.001), LDL-cholesterol = 109.10 mg/dL + 30.30 (p<.001), HDL-cholesterol = 45.20 mg/dL + 13.30 (p=NS). According to FR score, elevated cardiac risk before and 6 months after intervention was estimated in 92% x 27.6% of our patients, respectively (P = .0001). According to PROCAM score, it was 25.3% x 14.9%, respectively (P = NS). As for ATP-III, it was 80.5% x 50.6%, respectively (P= .0002). The proposed cardiovascular prevention program was associated with a reduction in the estimated cardiovascular risk in patients with HIV infection. All score risk indexes, except PROCAM are useful to the initial and follow-up evaluation of the cardiac risk in HIV infected patients, but the Framingham Risk score performance showed greater sensitivity than the others to detect small variations in a short time window, so it should be the score of choice

No description available.

The purpose of the study was to show the variables that influence adolescents' sexual activities that have not been well defined. What leads adolescents to be more sexually active than previous generations? A Survey was conducted at the Fontana Unified School District.

Department of Advanced Nursing Science / MCur

PhD (Mathematics) / Department of Mathematics and Applied Mathematics / In this study, we developed multiscale models of vector-borne diseases. In general, the transmission of vector-borne diseases can be considered as falling into two categories, i.e. direct transmission and environmental transmission. Two representative vector-borne diseases, namely; malaria which represents all directly transmitted vector-borne diseases and schistosomiasis which represents all environmentally transmitted vector-borne diseases were studied. Based on existing mathematical modelling science base, we established a new multiscale modelling framework that can be used to evaluate the effectiveness of vector-borne diseases treatment and preventive interventions. The multiscale models consisted of systems of nonlinear ordinary differential equations which were studied for the provision of solutions to the underlying problem of the disease transmission dynamics. Relying on the fact that there is still serious lack of knowledge pertaining to mathematical techniques for the representation and construction of multiscale models of vector-bone diseases, we have developed some grand ideas to placate this gap. The central idea in multiscale modelling is to divide a modelling problem such as a vector-bone disease system into a family of sub-models that exist at different scales and then attempt to study the problem at these scales while simultaneously linking the sub-models across these scales. For malaria, we formulated the multiscale models by integrating four submodels which are: (i) a sub-model for the mosquito-to-human transmission of malaria parasite, (ii) a sub-model for the human-to-mosquito transmission of malaria parasite, (iii) a within-mosquito malaria parasite population dynamics sub-model and (iv) a within-human malaria parasite population dynamics sub-model. For schistosomiasis, we integrated the two subsystems (within-host and between-host sub-models) by identifying the within-host and between-host variables and parameters associated with the environmental dynamics of the pathogen and then designed a feedback of the variables and parameters across the within-host and between-host sub-models. Using a combination of analytical and computational tools we adequately accounted for the influence of the sub-models in the different multiscale models. The multiscale models were then used to evaluate the effectiveness of the control and prevention interventions that operate at different scales of a vector-bone disease system. Although the results obtained in this study are specific to malaria and schistosomiasis, the multiscale modelling frameworks developed are robust enough to be applicable to other vector-borne diseases. / NRF

MPH / Department of Public Health / Background: Malaria is a public health issue killing more than 435 000 people in Sub Saharan Africa. In South Africa, malaria is endemic in 3 provinces namely: Limpopo, Mpumalanga and Kwazulu Natal. Limpopo Province contributes more cases than the other provinces in the country. Purpose: The purpose of the study was to assess community knowledge and prevention practices of malaria at Masisi village, in Mutale Municipality, Vhembe District. The study was conducted at Mutale municipality, Vhembe District. Methodology: A quantitative cross-sectional descriptive approach was used. Data was collected using a questionnaire with open and close ended questions. The targeted population was made up of males and females between the ages of 18 to 75. Validity and reliability have been ensured in the study and the results for reliability were 0.85. Pretesting was done in 5 household at Sanari village which is near Masisi village as they share the same characteristics. A sample of 152 participants was selected from the target population by means of systematic sampling and then select them randomly. Questionnaires were used to collect data. There after Data were analyzed using SPSS version 24.0. The analyzed data were presented in tables, graphs, and in percentages. Results: The findings revealed that majority of the participants 103(67.8%) have secondary education, and most of them, 103(67.8%) are unemployed. The study revealed that about 77% have knowledge regarding malaria transmission. About 130(85.5%) indicated that malaria is caused by a mosquito bite. About 57(38.51%) indicated that they use mosquito coils and nets in their household. Conclusion: Malaria still poses a threat to the lives of people living in malaria endemic areas. Community members at Masisi village have better insight regarding malaria transmission, causes and signs and symptoms. Although the community shows a better understanding of the prevention method they still has to put this into practice in order to eliminate malaria in the area. Health workers are doing a great job in educating the community regarding malaria related issues. / NRF

Indiana University-Purdue University Indianapolis (IUPUI) / Human papillomavirus (HPV) infection results in serious health issues including cervical, anal, vulvar, penile and oropharyngeal cancers. There are three vaccines against HPV but vaccination rates in the United States remain low. One barrier to uptake is a concern that individuals who are vaccinated may increase their risky sexual behaviors or decrease their use of cervical cancer screenings, an adjustment in perceived level of risk for HPV that can be studied using risk compensation theory. Methods Three distinct studies examined risk compensation after HPV vaccination. A systematic review examined literature from January 1, 2008-June 30, 2015, using three databases. A qualitative study using semi-structured interviews of 22 healthcare providers that assessed their beliefs regarding sexual disinhibition and cervical cancer screening following vaccination. A cross-sectional survey that assessed cervical cancer screening practices, awareness and comfort with recommendations, and knowledge regarding the purpose of a Papanicolaou (Pap) test. Results Twenty articles were included in the systematic review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors after HPV vaccination. Instead, the studies found vaccinated individuals were less likely to report risky sexual behaviors, sexually transmitted infections (STIs), and pregnancy. Qualitative interviews found no healthcare providers believed the HPV vaccine would result in increased risky sexual behavior or decreased cervical cancer screening, and these concerns would not influence their vaccination recommendations. The survey included 291 women 21-35 years old; 62% were non-Hispanic black, 84% had a Pap test in the last three years, and 33% had at least one HPV vaccine. Logistic regression showed that vaccinated women did not have greater odds of having a Pap test in the past three years (OR=1.32; 95% CI=0.66-2.65; p=0.427). However, this odds ratio was significant when controlling for age and race (AOR=3.06; 95% CI=1.37-6.83; p=0.006). Conclusion These studies found no evidence of increased risky sexual behaviors or decreased cervical cancer screening rates after HPV vaccination. Furthermore, vaccinated women showed less evidence of risk compensation. These results should alleviate concerns about administering the HPV vaccination among parents and providers.

The AIDS epidemic affects the capacity of the South African public service to deliver essential services. In response, the Department of Economic Development, Environment and Tourism in Limpopo implemented its HIV/AIDS workplace policy in 2003. This research evaluated the extent to which resources were allocated towards the implementation of the workplace policy, to effectively respond to the impacts of HIV/AIDS on the workplace. A combined quantitative and qualitative approach was used. Data was collected through face-to-face interviews of 43 officers involved in the implementation of the workplace policy, using a semi-structured questionnaire. The results indicated that the resources allocated for the workplace HIV/AIDS policy, namely budget, human resources and materials, were inadequate, with district offices being worse affected. / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

The purpose of this study was to assess the epidemiology of preventable risk factors for NCDs among the adult population in Tigray, Northern Ethiopia. A quantitative descriptive cross-sectional design was employed to describe the distribution of behavioural and biological risk factors for NCDs, assess the status of knowledge, perceptions, attitude and behaviour of the study participants for NCDs and their risk factors, and a matched case-control study to identify the determinants of hypertension. The data was collected using a structured questionnaire for the interview, physical measurements including weight and height scales, non-elastic measuring tape for waist and hip circumferences, Omron digital BP apparatus for blood pressure and heart rate; Accutrend Plus for measuring fasting blood glucose, cholesterol and triglycerides. For the descriptive cross-sectional study a total of 2347 participants were included, and for the matched case control study a total of 117 cases and 235 controls participated. Behavioural and biological risk factors were assessed. Only 0.8% of the study participants used optimal fruit serving per day. The prevalence of low level physical activity (<600 MET-minutes/week) was 44.8%. The magnitude of ever alcohol consumption was 66.8%. However, the magnitude of khat chewing and tobacco smoking among the study participants was not as high as the other risk factors i.e. 3.3% and 2.3% respectively. The magnitude of hypertension, central obesity, hyperglycaemia, hypercholesterolemia and hypertriglyceridemia was 9.9%, 22.2%, 3.5%, 30.3% and 32.2% respectively. Factors associated with the risks aforementioned were gender, age, place of residence, education, knowledge status on NCDs, mental stress and others. The status of knowledge on CVDs, breast and cervical cancers, diabetes and their potential risk factors was low and not comprehensive. Misconceptions on NCDs and body size and shape were pervasive. Risky behaviours underlying NCDs were rampant in the study population. Factors related to poor knowledge on NCDs were gender, age, place of residence, education and misconceptions on NCDs. The determinants of hypertension were physical inactivity, duration of alcohol intake, central obesity and mental stress. Awareness raising interventions on NCDs and their risk factors; improving socio-economic status and accessibility to health care settings have to be in place to curb these formidable problems. / Health Studies / D. Litt. et Phil. (Health Studies)