There has been significant debate, specifically within the African context, regarding the validity of using HCT data as part of routine surveillance data for the HIV epidemic. The use of HCT data in tracking the prevalence of HIV, as well as in estimating incidence rates for HIV, has been applied in some African countries, and may offer opportunities to strengthen surveillance in the Gauteng Province, South Africa. Literature suggests HCT data are biased as a result of the high proportion of repeat testers, where repeat testing may be related to high risk sexual behaviour. (1–8) It has been suggested that HCT data be separated into first-time- and repeat tester data in prevalence or incidence estimations. (9) The aim of this research was to determine if there are demographic and HIV prevalence differences between first-time- and repeat testers, as suggested in the literature. (9) Existing mobile HCT unit data was used from the Foundation for Professional Development (FPD). The data was collected in the Tshwane Metropolitan Municipality, Gauteng Province, South Africa. An observational, cross-sectional study design was applied. A systematic random sample of 400 first-time testers and 400 repeat-testers was drawn and analyzed. The findings of this study indicated an overall 10.0% (n=80) HIV prevalence rate. When compared to the Gauteng adult prevalence (15+) of 14.4%, the study prevalence is lower. (10) When looking at the characteristics of the first-time tester and repeat tester groups, there was an HIV prevalence rate of 12.5% (n=51/407, p=0.0152) in the first-time tester group, and 7.4% (n=29/393, p=0.0152) HIV prevalence rate in the repeat tester group. Although literature suggests that repeat testers are the more at risk population, the finding in this study clearly demonstrates that there is a difference in HIV prevalence between first-time- and repeat testers. When first-time/repeat tester was used as the dependent variable, it was found that females are 0.6 less times likely to be a first-time tester compared to males (OR=0.6, p=0.001). The finding of a difference in HIV prevalence between first-time- and repeat tester groups was consistent with three other studies in Ethiopia, Uganda and Kenya. In these studies, HIV prevalence in first-time testers was slightly higher than in that of repeat-testers. (3,11,12) It was found that there is a difference in the HIV and demographic profile between those who test for HIV for the first time and those who are repeat testers. The perceived risk and vulnerability to HIV plays a heavy role in motivating individuals to test once, or repeatedly. In regards to disease surveillance, this study did not prove that the population that utilises mobile HCT are representative of the Tshwane population. This study highlighted the need to better understand the sub-groups and characteristics of those who test for the first-time and those who test repeatedly for HIV. In conclusion, this study has provided evidence that there is a difference between the HIV prevalence of first-time- and repeat testers. However, there is good reason to doubt that the prevalence rate of first-time testers is genuine. Copyright / Dissertation (MSc)--University of Pretoria, 2013. / School of Health Systems and Public Health (SHSPH) / Unrestricted

The present work concentrates on a segment of information whose socio-political importance is steadily increasing. Theoretical framework of the study is centred on conceptualization of the term 'information' and social significance of information in the contemporary world. The main part of this study focuses on first-time voters in the elections to the Chamber of Deputies of the Parliament of the Czech Republic that will take place in 2014. The necessary data about this specific group of future voters were acquired through printed, quantitative questioning based questionnaires. The questionnaires were distributed to the first-time voters by their teachers during regular lessons in various types of secondary schools. Subsequently, the collected data served as a basis for confirmation of the pre-stated hypotheses and for conceptualization of the 'model' average first-time voter in the 2014 elections to the Lower House of the Parliament of the Czech Republic. As was revealed by the research, the attitude of the future first-time voters towards politics and political affairs is to a large degree lukewarm. In forming their own political views and opinions they prefer information acquired through internet and television over alternative sources such as school or family. These and many other findings are the result of this study. They can and should serve to public institutions, political representatives, general public and first-time voters themselves as a basis for introducing such measures that would increase participation of younger age-groups in the political discourse. In this respect some elementary suggestions are offered in the end of this paper.

Bakgrund: Barnmorskans bemötande är av stor betydelse för kvinnans upplevelse av att känna sig trygg och hantera smärtan under latensfasen och förlossningen. Målet är att kvinnan ska vara hemma under latensfasen då sjukhusmiljön kan ha en negativ inverkan på det fysiologiska förlossningsförloppet. Mödrahälsovården har en viktig roll genom att stötta och förbereda den gravida kvinnan inför förlossningen. Syfte: Att undersöka kvinnors upplevelse av att under latensfasen sökt vård på förlossningsavdelningen och sedan fått åka hem. Metod: En kvalitativ intervjustudie har gjorts och baseras på fem enskilda intervjuer med förstföderskor. Datamaterialet analyserades enligt innehållsanalys. Resultat: Kvinnorna kände sig oförberedda och uttryckte en okunskap om latensfasen. Bemötandet från barnmorskan på förlossningen var av betydelse för hur kvinnorna upplevde och kunde hantera latensfasen och förlossningen. Smärtsamma förvärkar och sömnbrist var de huvudfaktorer som gjorde att de besökte förlossningen. Slutsats: Studien visade att  informationen från barnmorskan på mödrahälsovården gällande latensfasen var bristfällig och behöver förbättras. Kvinnorna hade svårt att avgöra när de var i aktiv fas och skulle åka in till förlossningen. Barnmorskan på förlossningen behöver se den enskilda kvinnan och anpassa omhändertagandet individuellt. Även partner/närstående kan vara i behov av råd och stöd från barnmorskan för att lättare kunna hjälpa kvinnan under latensfasen. / Background: The midwife's attitudes are important for a woman’s experience of feeling secure and manage pain during latent phase and delivery. The goal is that the woman should be at home during latent phase, because of that the hospital environment can have a negative impact on the physiological delivery process during this phase. Maternal health care has an important role by supporting and preparing the pregnant woman for birth. Objective: To explore women's experiences of latent phase, sought care at the maternity ward, and then had to go home. Method: A qualitative study has been done and is based on five individual interviews with first-time mothers. The data were analyzed according to content analysis. Results: The women felt unprepared and expressed ignorance about latent phase. The treatment from the midwife at the maternity ward was important for the women and how they could handle their experience of latent phase and delivery. Painful contractions and sleep deprivation were the main factors that made the women visit the maternity ward. Conclusion: The study showed that the information about latent phase from the midwife at the maternal health care center was inadequate and need improvement. The women found it  difficult to determine when they were in active phase and would go into the maternity ward. The midwife at the maternity ward need to see the individual woman and adapt care individually. Partners / relatives may be in need of advice and support from the midwife to make it easier to help the woman in latent phase.

Background Running is a popular form of exercise that more than 55 million Americans actively participate. Endurance running like marathon and half- marathon is getting increasingly popular among active runners. Although the effect of running is considered beneficial to bone health, the direct relationship between strains and strain gradients occurred during long distance running and bone changes is still not clear. Especially, given a high rate of injury associated with the first-time marathon, understanding the direct effect of strain stimuli on bone health is an important issue. Based on the previous studies, we hypothesized that the higher values of strain will induce bone adaptation more effectively and will lead to higher bone osteogenic changes. Since osteocytes sense shear stress caused by the interstitial fluid flow, which is created by the deformations, and regulate activities of osteoblasts and osteoclast that govern bone adaptation, we also hypothesized that the local strain gradient will create pressure differences within the interstitial fluid network and will increase fluid flow. Furthermore, due to that increased fluid flow, the regions with the higher strain gradient will experience a higher amount of bone adaptation. Thus, in this study, our purpose was to define the effect of the strains and strain gradients on bone changes within distal tibia, which is the most prone anatomical site to low risk stress fracture, during training for first-time marathon. Methods High-resolution and low-resolution computed tomographic (CT) images of the distal tibia were obtained before and after a self-selected training from runners who were actively training to participate in their first-time marathon in the next calendar year. The low resolution scan covered a 69.864 mm length of the distal end of the tibia while the high resolution CT scan covered a 9.02 mm region of the distal tibia. Using low resolution CT image based subject specific finite element (FE) models, the strains and strain gradients of the distal tibia at the instance of the peak ground reaction force (GRF) were calculated. The baseline and follow-up high resolution CT scans were used in high resolution peripheral quantitative CT (HRpQCT) analysis and the estimation of bone changes over the training period. Finally, the effect of strains and strain gradients on the distal tibia bone changes was estimated based on the FE model driven strain values and HRpQCT analysis driven bone changes. We used a linear mixed model to define the relationship between strain values and bone changes in the distal tibia. Results The strain values that occurred during marathon training had significant effects on bone changes in the distal tibia. Particularly, the strain gradients showed a higher effect than the strains. In the cortical compartment, the strain gradients, which were calculated as a strain difference of a node from the surrounding nodes (Strain Gradient-1), affected the bone mineral density (BMD) negatively, and per 1000 µε increase resulted in 2.123% decrease in the cortical BMD. The strain gradients, which were calculated as a strain difference of a node from the surrounding nodes normalized to distance to surrounding nodes (Strain Gradient-2), presented a positive effect on the cortical bone volume with a slope of 4.335% / 1000 µε. In the trabecular compartment, the strain gradient-1 showed negative effects on the percent change in BMD and bone mineral density (BMC), whereas the strain gradient-2 showed positive effects on the percent change in BMD and BMC. Conclusion The linear mixed model analysis revealed a statistically significant (p < 0.05) relationship between strain gradients that occurred during running and distal tibia bone changes. The strains, biometrics, and initial parameters of bone did not show any significant effect on the bone changes. The connection between local strain environment and bone changes in the distal tibia investigated in this study is an important step to understand the mechanism of mechanically induced bone adaptation.

>Magister Scientiae - MSc / The study explores the completion rates (the number of years a student takes to complete a degree) of graduates at the University of the Western Cape (UWC) in South Africa. The graduates in the study all did at least one semester of statistics in their final year of study. The students' completion will be described with respect to school results and socio-demographics. Differences between students who finished their studies in the prescribed time of three years and those who took longer than the prescribed time will be highlighted. Factors that aid or hinder students from successfully completing their studies in the prescribed time will be analyzed. An entry selection model will be developed to screen the students. This will assist with an enrolment strategy. The most significant result found was that the political environment played the most significant role in throughput. The next significant result from the study showed that the grade 12 aggregate played a significant role in throughput. It is suggested that UWC be proactive in developing alternative methods of selecting students, since the new Further Education Training (FET) school system, which will be implemented in 2006, will omit the grade 12 aggregate.

Magister Educationis - MEd / When a first-time teacher graduate and start working in a school, the first-time teacher is expected to adapt and adjust to the demands of a daily teaching programme (Carter & Francis, 2001). This can be overwhelming by taking on the same responsibility as the more experienced teachers. This can be a reality shock to first-time teachers as they may often be disadvantaged with the fact that they are often unprepared for the real world (Johnson & Kardos, 2002; Carter & Francis, 2001). Furthermore, many schools have appointed first-time teachers, but not all first-time teachers have been given proper support or introduced a mentor or a mentoring programme to help them adjust to their new career. This can contribute to the fact that first- time teachers are unprepared for their new roles and the challenges they may face (Carter & Francis, 2001). I will therefore look at mentoring and the preparedness of firsttime teachers, the study will focus on a non-governmental Joint Mentoring Project (JMP). This study aims at investigating how the JMP contributed toward first-time teachers’ teaching and learning experiences in selected primary schools.

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers. This study was a quantitative retrospective study design that included data collected from the medical records of 1,000 mothers from Southeast Alabama Medical Center who gave birth between 2013 and 2014. The multiple logistic regression analysis indicated that the odds ratio for initiation of breastfeeding was greater among first-time mothers after implementation of mandatory reporting measures (OR = 2.07; p = 0.0007); however, the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; p = 0.7507). These findings may inform the work of healthcare providers at hospitals, community centers, and public health workers, guiding their maternity care practices to increase the number of first-time mothers who will breastfeed for longer periods of time and improving children's health outcomes.

Family and Consumer Sciences (FCS) Extension faculty members are increasingly involved in offering couple and relationship education (CRE), but some have limited background in this format of family life education. This study used a phenomological approach to examine the experiences of Extension faculty members who offered CRE in their respective counties for their first time. Data were collected through face-to-face and telephone interviews. Four themes emerged from the interview data. First, considerations for offering this type of education included valuing CRE, having sufficient and specific knowledge about the needs of the county for CRE, and access to other forms of resources (mentors, previous training, or funding). Second, successes were discussed in terms of creating positive partnerships, successful recruitment strategies, and resources (utilization of funds and getting trained in CRE for the event). Third, faculty members described challenges including a lack of partnerships, limited resources, recruitment struggles, and lack of sufficient funds. Fourth, the reflections from the faculty members included plans and changes for future programming as faculty members reflected back on their actual experiences. These findings provide guidance for Extension faculty members with limited experience who are interested in offering CRE.

This study examined some of the factors that influence father involvement for first time parent s. These variables included: general or cultural attitudes of father involvement, personal expectations for father involvement, and level of satisfaction with the marriage. A secondary purpose was to examine factors that buffer the decline of marital satisfaction associated with the transition to parenthood. It was proposed that marital satisfaction was associated with having similar expectations for father involvement, having father involvement that met or exceeded personal expectations, and accurately perceiving spousal identity. A final purpose was to create a model of father invol vement, originally represented by the level of time, awareness, and support a father provides for his child. Ninety-six couples enrolled in two prenatal classes participated in this study. Both mothers and fathers were given nearly identical surveys for the prenatal (or the third trimester of pregnancy) and postnatal (when the target child was between 3 and 6 months old) phases of the study With a 29% attrition rate, the final sample consisted of68 couples. The results indicated that postnatal father involvement was predicted by the level of marital satisfaction and also by the personal expectations that both spouses have for father involvement. Results failed to support the hypotheses that father involvement would be significantly related to prenatal general attitudes of father involvement. However, there was some support that general (or cultural) attitudes change as a fun ction of personal experience for father s; the standard set for other fathers seems to be based from and conform to their own level of involvement. As expected, postnatal marital satisfaction for both spouses was strongly related to father involvement. Although postnatal marital satisfaction was slightly related to the similarity in spouses' expectations for father involvement, the exploratory analysis shows that spouses with high personal expectations for father involvement (during the prenatal phase) tend to experience high levels of postnatal marital satisfaction, regardless of similarity of expectations between spouses. There was a general trend for postnatal marital satisfaction to be high when father involvement met or exceeded personal expectations, and low when father involvement fell short of personal expectations. The exception is when expectations were high; spouses with high expectations tend to report high levels of postnatal marital satisfaction regardless of whether father involvement met, surpassed, or fell short of those expectations. Contrary to expectations, accurately perceiving spousal identity was not related to marital satisfaction. Implications are given.

Background: To date, little is known about the perspectives of healthcare and social service providers on the acceptability of long-term home visiting programs serving low-income, first-time mothers within a community. The present study reports on the experiences and perspectives of community professionals who participate in program referrals or deliver auxiliary services to these mothers who are enrolled in the Nurse-Family Partnership (NFP), a targeted nurse home visitation program. Methods: The present study comprised two phases. In phase one, a secondary qualitative data analysis was conducted to analyze a purposeful sample of 24 individual interviews with healthcare and social service providers, which was part of a larger qualitative case study examining adaptations required to increase the acceptability of NFP for families and service providers in Hamilton, Ontario, Canada. In phase two, identified themes from phase one were further explored and confirmed through individual, semi-structured interviews with service providers using a qualitative descriptive approach. Findings: Healthcare and social service providers recognized the added value of NFP to existing community services for low-income, first-time mothers. The public health nurses (PHNs) who delivered the NFP intervention were perceived as playing a crucial role in connecting the first-time mothers to community services, preparing them for motherhood, and for preventing or ending the involvement of child protection services. NFP services were not perceived as interfering with the logistics of existing services being delivered; they were viewed as addressing an important service gap. Discussion: This is the first qualitative study to examine the acceptability of a home visiting intervention from the perspectives of healthcare and social service providers in a community context. The study findings have relevance for policymakers by informing the general understanding of how a new early childhood prevention program is integrated among existing community-based supports servicing low-income, first-time mothers. / Thesis / Master of Health Sciences (MSc)