Text in English / Cervical cancer accounts for 34.6% of all the female cancers in Zimbabwe. The purpose of this study was to explore the knowledge, attitudes and perceptions of female student nurses regarding cervical cancer in Zimbabwe using the Health Belief Model (HBM) as a theoretical framework. The ultimate aim was to analyse female student nurses’ risk perception of contracting cervical cancer. A quantitative, cross-sectional descriptive research design was used, using a structured questionnaire for data collection. One hundred and thirty-two (132) respondents were conveniently selected. Descriptive and inferential statistics were calculated using Statistical Package for Social Sciences (SPSS) version 21 software program. The study revealed that 57.9% of the respondents perceive that they are at risk of developing cervical cancer. They believe that screening for cervical cancer is not embarrassing. Knowledge improved with increase in the level of study, there was lack of knowledge of HPV and cervical cancer link. More emphasis on cervical cancer should be put on curricula taught in undergraduate education earlier on in the programme. / Health Studies / M.A. (Nursing Science)

Úlceras por Pressão (UPP) são áreas de necrose isquêmica em partes moles, causadas por uma pressão prolongada maior que a capilar, com ou sem cisalhamento, relacionada à postura e frequentemente localizada junto a uma proeminência óssea em indivíduos com predisposição clínica. Os fatores extrínsecos pressão, fricção, cisalhamento, umidade e alterações de temperatura são relacionados à engenharia biomédica e decorrem da interação do paciente com a superfície de suporte. Já os intrínsecos, notadamente relacionados às condições de saúde, envolvem o desequilíbrio nutricional e as afecções clínicas, tanto as que diminuem a oxigenação tecidual, como as que implicam no comprometimento da mobilidade. Por ser mais prevalente entre os idosos e por decorrer de múltiplas causas e mecanismos patogênicos, as UPP são classificadas como uma Síndrome Geriátrica. Embora associada principalmente a gerontes, o aporte financeiro empregado no grupo de feridas crônicas, como as UPP, remonta o 3o maior bloco de gastos em saúde no mundo. As UPP são frequentes em pacientes hospitalizados, porém ultrapassam este ambiente, havendo expressiva incidência em residentes de Instituições de Longa Permanência para Idosos (ILPIs). No Brasil, as ILPIs são órgãos sociais, o que gera uma lacuna legal quanto à responsabilidade clínica sobre seus residentes e, consequentemente, sobre as afecções que os acometem, particularmente as UPP. Estas feridas são passíveis de prevenção, destacando-se então o cuidador de idosos, ocupação que vem aumentando em número e importância com o envelhecimento da população e que, no entanto, nem sempre é devidamente instruído. Por meio de uma vasta revisão de literatura, esta dissertação objetivou pontuar os fatores relevantes envolvidos na patogenia das UPP, além das especificidades do indivíduo idoso e do ambiente das ILPIs. Neste contexto, o produto final elaborado foi um guia para prevenção de UPP em ILPIs. / Pressure Ulcers (PU) are areas of localized soft tissue ischemic necrosis caused by prolonged pressure higher than the capillary pressure with or without shear, related to posture which usually occurs over a bony prominence in individual with certain clinical susceptibilities. Extrinsic factors – such as pressure, friction and shear, moisture and temperature changes – are related to biomedical engineering and come from the interaction patient-surface. On the other hand, intrinsic factors are related to health conditions and correspond to nutritional imbalance and/or conditions that decrease tissue oxygenation or impair mobility. Since it features different pathogenic mechanisms and it is more prevalent among the elderly, the PU group is classified as a geriatric syndrome. Worldwide, PU are estimated to be the 3rd largest consumer of resources, plus the social burden and consequences of this condition. PU are quite common in hospitals, however there are several cases among the elderly living in Long-Term Care Facilities (LTCFs). In Brazil, these institutions are supported by social organizations, what produces legal gaps with respect to the residents’ clinical responsibility, and reduces the chances of preventing avoidable diseases as PU. The number of elderly caregivers tends to grow accordingly to the population ageing, creating a window of opportunity for continued education of this group of workers. Through an extensive literature review, this thesis aimed to highlight the relevant findings of the different factors involved in PU pathogenesis as well as to ascertain the particularities of elderly individuals and the specific environment of LTCFs. The final product is a PU prevention guide suitable to use in Brazilian long-term care facilities.

Úlceras por Pressão (UPP) são áreas de necrose isquêmica em partes moles, causadas por uma pressão prolongada maior que a capilar, com ou sem cisalhamento, relacionada à postura e frequentemente localizada junto a uma proeminência óssea em indivíduos com predisposição clínica. Os fatores extrínsecos pressão, fricção, cisalhamento, umidade e alterações de temperatura são relacionados à engenharia biomédica e decorrem da interação do paciente com a superfície de suporte. Já os intrínsecos, notadamente relacionados às condições de saúde, envolvem o desequilíbrio nutricional e as afecções clínicas, tanto as que diminuem a oxigenação tecidual, como as que implicam no comprometimento da mobilidade. Por ser mais prevalente entre os idosos e por decorrer de múltiplas causas e mecanismos patogênicos, as UPP são classificadas como uma Síndrome Geriátrica. Embora associada principalmente a gerontes, o aporte financeiro empregado no grupo de feridas crônicas, como as UPP, remonta o 3o maior bloco de gastos em saúde no mundo. As UPP são frequentes em pacientes hospitalizados, porém ultrapassam este ambiente, havendo expressiva incidência em residentes de Instituições de Longa Permanência para Idosos (ILPIs). No Brasil, as ILPIs são órgãos sociais, o que gera uma lacuna legal quanto à responsabilidade clínica sobre seus residentes e, consequentemente, sobre as afecções que os acometem, particularmente as UPP. Estas feridas são passíveis de prevenção, destacando-se então o cuidador de idosos, ocupação que vem aumentando em número e importância com o envelhecimento da população e que, no entanto, nem sempre é devidamente instruído. Por meio de uma vasta revisão de literatura, esta dissertação objetivou pontuar os fatores relevantes envolvidos na patogenia das UPP, além das especificidades do indivíduo idoso e do ambiente das ILPIs. Neste contexto, o produto final elaborado foi um guia para prevenção de UPP em ILPIs. / Pressure Ulcers (PU) are areas of localized soft tissue ischemic necrosis caused by prolonged pressure higher than the capillary pressure with or without shear, related to posture which usually occurs over a bony prominence in individual with certain clinical susceptibilities. Extrinsic factors – such as pressure, friction and shear, moisture and temperature changes – are related to biomedical engineering and come from the interaction patient-surface. On the other hand, intrinsic factors are related to health conditions and correspond to nutritional imbalance and/or conditions that decrease tissue oxygenation or impair mobility. Since it features different pathogenic mechanisms and it is more prevalent among the elderly, the PU group is classified as a geriatric syndrome. Worldwide, PU are estimated to be the 3rd largest consumer of resources, plus the social burden and consequences of this condition. PU are quite common in hospitals, however there are several cases among the elderly living in Long-Term Care Facilities (LTCFs). In Brazil, these institutions are supported by social organizations, what produces legal gaps with respect to the residents’ clinical responsibility, and reduces the chances of preventing avoidable diseases as PU. The number of elderly caregivers tends to grow accordingly to the population ageing, creating a window of opportunity for continued education of this group of workers. Through an extensive literature review, this thesis aimed to highlight the relevant findings of the different factors involved in PU pathogenesis as well as to ascertain the particularities of elderly individuals and the specific environment of LTCFs. The final product is a PU prevention guide suitable to use in Brazilian long-term care facilities.

The aim of this research project was to assess and compare cardiovascular disease (CVD) risk in black males and females from an urban, working population in the Makana (Grahamstown) region of the Eastern Cape, South Africa. Two-hundred and ninety one individuals (males: n = 143, females: n = 148) with a mean age of 42.6 (±8.1) years were voluntarily recruited from the greater urban Makana (Grahamstown) area. Eight Cardiovascular disease (CVD) risks were assessed: stature and mass were obtained in order to calculate body mass index (BMI) (mass/stature2). Obesity, defined as a morphological risk, was classified according to the World Health Organisation (WHO) BMI criteria (BMI>30kg.m-2), as well as according to measures of waist circumference (WC) and body composition. Hypertension, hypercholesterolemia and type II diabetes, were grouped as cardiovascular (CV) risks. Hypertension was defined as a blood pressure greater than 140/90mmHg (JNC-7); hypercholesterolemia, as total cholesterol greater than 6.2mmol.L-1 (NCEP); and type II diabetes, as total glucose greater than 12mmol.L-1 (WHO). Physical activity, diet, tobacco use, and alcohol consumption and dependence were grouped as lifestyle-related risks. These were assessed by means of self-reporting through the use of various validated questionnaires. Finally, self-reporting of obesity, hypertension, hypercholesterolemia and type II diabetes was assessed, in addition to perception questions on individuals’ perceived body shape and size (Ziebland figures). Self-reported and perceived responses were then compared to actual measures. Females were significantly (p<0.001) heavier than the males (92.7kg compared to 72.1kg) and had significantly (p<0.001) higher BMIs than their male counterparts (37.6kg.m-2 compared to 25.7 kg.-2). They also recorded significantly (p<0.001) higher waist circumference (WC) values and had significantly (p<0.001) higher percentage and total body fat. Significantly (p<0.001) more females were obese (81%) compared to males (17%). While a higher percentage of males (25 % compared to 22%) presented with stage I hypertension (≥140/90mmHg, <160/95mmHg), significantly (p<0.05) more females (14% compared to 8%) presented with stage II hypertension (>160/95mmHg). The prevalence of hypercholesterolemia at a high level of risk (>6.2mmol.L-1) was relatively low (2.1 % of males, 3.4% of females), but notably more participants (22% of males and 26% of females) presented with the condition at a moderate level of risk (>5mmol.L-1). Type II diabetes was the least prevalent CV risk factor, with no males and only 3% of females presenting with the condition. Males consumed significantly (p<0.05) more in terms of total energy intake (9024 vs. 7234 kJ) and were significantly (p<0.05) more active (3315 compared to 2660 MET-mins.week). A significantly (p<0.05) higher percentage of males smoked (51.1% compared to 3.4%), consumed alcohol (73.4% compared to 46.6%) and were alcohol dependent (40% compared to 33.5%). Both males and females tended to be ignorant of their health status, with both samples under-reporting obesity, hypertension and hypercholesterolemia, while over-reporting type II diabetes. Furthermore, obesity was significantly (p<0.05) underestimated, with both male and female individuals perceiving themselves to be notably smaller than they actually were. Physical activity and diet were important determinants of CVD risk in this black urban sample of individuals. Obesity, in particular central adiposity, was the most notable risk (particularly in females), followed by hypertension (particularly in males). Although some risks presented at a moderate level of risk, a clustering of risk factors was evident in both samples, with 12.6% and 41.2% of males and females presenting with two risk factors, and 2.8% and 8.1% of males and females respectively presenting with three risks.

The purpose of the study was to investigate the cardiovascular disease (CVD) risk profile of black African females in the Makana region, Eastern Cape, South Africa. Baseline measures from 40 participants, who met the criteria, were compared against the 2003 South African Demographic and Health Survey (SADHS) and the 2013 South African National Health and Nutritional Examination Survey (SANHANES-1). The risk factors measured were anthropometric (stature, body mass and body mass index (BMI)), morphological (waist circumference (WC), fat mass and lean mass), cardiovascular (heart rate and blood pressure (BP)), physical activity (step count and energy expenditure), biochemical (glycated haemoglobin and full blood lipid profile) and behavioural (alcohol and tobacco use). Results showed significantly higher (p≤0.05) values for overweight/obesity (BMI 37.60 kg.m⁻²; WC 1130.58 mm; fat mass 45.23%) and high BP (130/88 mmHg) compared to the previous national surveys, highlighting these CVD risk factors as problematic. The subsequent sub-study aimed to assess the efficacy of a pedometer-based walking intervention on high BP. The walking programme (n=25) was based on individual step goals to be completed at a moderate-intensity on five days.week⁻¹ for 12 weeks. The same measurements were taken at monthly intervals, Week 0, Week 4, Week 8 and Week 12, with the addition of dietary intake and fitness level, and the exclusion of the behavioural variables. There were no significant differences (p≤0.05) in systolic and diastolic BP with the exercise intervention, although there was a strong, negative relationship with time for diastolic BP (r²=0.9857). This trend suggests that the lack of significance may be a result of poor compliance and/or the small sample size. Individual results, however, showed no compliance-result relationship for the two risk factors of interest: overweight/obesity and high BP. Future recommendations include supervised or group-based exercise interventions to improve compliance, and the addition of resistance training to the aerobic programme.

Indiana University-Purdue University Indianapolis (IUPUI) / Rates of chronic disease and physical inactivity are disproportionately high among African American women. Despite the known benefits of physical activity and an increasing number of programs designed to increase activity, attendance rates to many exercise programs remain low. There is much to learn about program types, such as healthy lifestyle programs (HLP); individual factors, such as self-efficacy; and mediating variables that may influence exercise program attendance. An observational study design was used to compare exercise self-efficacy and attendance in a community-based exercise program in African American women who were enrolled in a HLP (N = 53) to women who were not (N = 27). Exercise program attendance was gathered across six months; demographics, self-efficacy and physical activity behaviors were assessed through surveys; and physiological variables (resting heart rate and blood pressure, height, and weight) and physical fitness (muscular strength and endurance and cardiovascular endurance) were measured at baseline. Descriptive statistics were used to describe participants and groups were compared using T-tests, chi-square and non-parametric statistics. Finally, mediation analyses were conducted using multiple regression models to assess self-efficacy as a potential mediator to exercise program attendance. Women who enrolled in this study were of low income (61% having an annual income less than $20,000), obese with a mean (standard deviation) body mass index (BMI) of 37.7 (7.6), pre-hypertensive with a mean (standard deviation) systolic blood pressure of 125.9 (14.4), and scored poorly and marginally on two fitness tests. On average, women reported being Moderately Confident in their ability to exercise regularly, yet had low attendance in the exercise program with a median number .5 days over six months and there were no significant differences in exercise self-efficacy (p = .23) or attendance in the exercise program between groups (p = .79). Additionally, exercise self-efficacy was not a mediating variable to program attendance. Women in this study had little discretionary income and several chronic disease risk factors, yet exercise program attendance was low even in those enrolled in a HLP. Identifying factors that increase exercise self-efficacy and factors that influence attendance beyond self-efficacy may help future program design and attendance.

Indiana University-Purdue University Indianapolis (IUPUI) / Given the numerous benefits of a healthy diet and exercise for cancer survivors, there has been an increase in the number of lifestyle intervention trials for this population in recent years. However, the extent to which adherence to a diet and exercise intervention predicts health-related outcomes among cancer survivors is currently unknown. To address this question, data from the Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW) diet and exercise intervention trial were analyzed. RENEW was a yearlong telephone and mailed print intervention for 641 older (>65 years of age), overweight (body mass index: 25.0-39.9), long-term (>5 years post-diagnosis) survivors of colorectal, breast, and prostate cancer. Participants were randomized to the diet and exercise intervention or a delayed-intervention control condition. The RENEW telephone counseling sessions were based on determinants of behavior derived from Social Cognitive Theory (SCT) (e.g., building social support, enhancing self-efficacy). These factors have been hypothesized to improve health behaviors, which in turn should improve health outcomes. Thus, drawing on SCT and prior diet and exercise research with cancer survivors, I hypothesized that telephone counseling session attendance would be indirectly related to health-related outcomes (i.e., physical function, basic and advanced lower extremity function, mental health, and body mass index) through intervention-period strength and endurance exercise and dietary behavior (i.e., fruit and vegetable intake, saturated fat intake). The proposed model showed good fit to the data; however, not all of the hypothesized relationships were supported. Specifically, increased telephone counseling session attendance was related to engagement in all of the health behaviors over the intervention period. In turn, (a) increased endurance exercise was related to improvement in all of the health-related outcomes with the exception of mental health; (b) increased strength exercise was solely related to improved mental health; (c) increased fruit and vegetable intake was only related to improved basic lower extremity function; and (d) saturated fat intake was not related to any of the health-related outcomes. Taken together, these findings suggest that SCT determinants of behavior and the importance of session attendance should continue to be emphasized in diet and exercise interventions. Continued exploration of the relationship between adherence to a diet and exercise intervention and health-related outcomes will inform the development of more cost-effective and efficacious interventions for cancer and other medical populations.

Cultural factors have been shown to play a role in human decision making and behaviour. The main objective for this research was to identify and evaluate the possible influence of Shangaan cultural beliefs, myths and behaviours, on the spread of HIV within the Mnisi tribe. A qualitative method of investigation was followed; interviews with three participants and observations of the Mnisi culture were used in the construction of the investigation and findings. Through the information obtained two cultures influencing the spread of HIV in the Mnisi tribe were identified, they are (1) The culture of power-rule and fear, and (2) The culture of poverty. / Psychology / M.Sc. (Psychology)

Cultural factors have been shown to play a role in human decision making and behaviour. The main objective for this research was to identify and evaluate the possible influence of Shangaan cultural beliefs, myths and behaviours, on the spread of HIV within the Mnisi tribe. A qualitative method of investigation was followed; interviews with three participants and observations of the Mnisi culture were used in the construction of the investigation and findings. Through the information obtained two cultures influencing the spread of HIV in the Mnisi tribe were identified, they are (1) The culture of power-rule and fear, and (2) The culture of poverty. / Psychology / M.Sc. (Psychology)