Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Consumer Science: Food and Nutrition in the Faculty of Applied Sciences at the Cape Peninsula University of Technology 2014 / The prevalence of nutrition-related chronic diseases of lifestyle (CDL) is escalating in South Africa (SA). Studies suggest that poor nutrition plays a major role in the aetiology of these diseases. Phytochemicals present in plant foods, namely fruit, vegetables, whole grains and tea, may prevent the onset of CDL. Most South African diets appear to be deficient of these plant foods. Achieving enhanced phytochemical intake amongst South Africans may therefore have to be supported in other ways. The objectives of this research were to determine whether consumers in the professional sector in the City of Cape Town would be (i) likely to consume proficient home-cooked category prepared dishes and (ii) purchase and consume commercially manufactured category prepared dishes for enhanced phytochemical intake and, if so, (iii) which dietary source adjustment category/categories and (iv) food vehicle category/categories they would be likely to consume, and (v) who would be likely to consume them. After obtaining ethical approval, a survey was conducted amongst 184 white collar workers (87% response rate) representing the professional sector (professional, technician and associate professional) occupational groups. The respondents were approached for voluntary participation based on their occupation and age, representing adulthood to the elderly life stage as a risk factor for the development of lifestyle diseases. A pilot-tested questionnaire was used to obtain information regarding the respondents awareness of phytochemicals, whether or not they were involved in the preparation of food at home, their degree of ‘likelihood’ to consume proficient home-cooked and commercially manufactured category prepared dishes for enhanced phytochemical intake, their current daily intake of fruit, vegetables, whole grains and tea, and demographic, health and lifestyle information. The frequencies of the respondents’ consumption of phytochemical-rich dietary sources pertaining to the stages of change model were assessed using Pearson’s chi-squared analysis to determine significant associations/differences (p < 0.05) between the data sets. The repeated measure analysis of variance (ANOVA) on Bonferroni correction was used to assess the ‘likeliness’ scale (from ‘extremely unlikely’ as ‘1’ to ‘extremely likely’ as ‘5’) for the household and commercial dietary source adjustment and food vehicle categories. The respondents were mostly female (58.7%), 31 to 44 years of age (67.9%) and of White ethnicity (72.3%). The majority (61.5%) had obtained grade 12 and a diploma (29.4%) or a degree (32.1%). Almost half were married or living together with children (48.9%) and were English (48.9%) or Afrikaans (47.3%) speaking. The majority of respondents were non-smokers (69%), and approximately half (54.4%) consumed alcohol less than three times per week (54.4%). About fifty percent used dietary supplements (50.5%) and exercised (59.2%) regularly. A small percentage of the respondents were obese (7.6%), had diabetes mellitus (4.4%) or cardiovascular disease (CVD) and cancer (2.2% or four respondents each). Cancer was most prevalent (36.4%) within the respondents’ family, followed by diabetes mellitus (29.9%), CVD (26.6%) and obesity (7.6%). The majority (77.7%) were not aware of phytochemicals and about half (55.4%) could not indicate the role these compounds play in the human diet. Half of the respondents consumed the recommended two to four servings of fruit daily, very few (10.9%) consumed the recommended three to five servings of vegetables daily, only about 10% (9.2% or 17 respondents) consumed the recommended three servings of whole grains daily, and about a third (36.4%) consumed two to three cups of tea daily. The respondents who considered phytochemicals to be very necessary to support health were more likely to consume rooibos herbal tea added to category prepared dishes than those who considered phytochemicals to be necessary to support health (p < 0.05) and those who did not know the role phytochemicals played in the diet (p < 0.05). The likelihood to consume category prepared dishes with added vegetables and added fruit respectively was lower (p < 0.05) amongst those respondents who consumed none to one serving of vegetables daily than amongst those who consumed two to four servings of vegetables daily. The respondents who did not consume tea were less likely to consume category prepared dishes with added rooibos herbal tea than those who consumed one cup (p < 0.05) or two to three cups (p < 0.001) daily. Furthermore, the respondents who did not consume tea were also less likely to consume category prepared dishes with added herbs than those who consumed one cup (p < 0.05), two to three cups (p < 0.001) or four to six cups (p < 0.05) daily. The likelihood to consume category prepared dishes with fruit additions was lower amongst those respondents who did not consume tea than amongst those who consumed two to three cups (p < 0.05) or four to six cups (p < 0.05) daily. The respondents were more likely (p < 0.05) to consume herb, vegetable and fruit additions respectively than rooibos herbal tea addition, and more likely to consume vegetable additions than herb (p < 0.05) or fruit (p < 0.001) additions as dietary source adjustment options. Furthermore, vegetable additions to category prepared dishes were more likely to be consumed by the respondents than fruit additions (p < 0.001), and starch-based dishes more likely to be consumed than vegetable-based dishes (p < 0.001) or fruit-based dishes (p < 0.05) for the addition of rooibos herbal tea. The respondents were likely to consume the food vehicle categories egg and chicken for added herbs in comparison to other starch (p < 0.05) and vegetables (p < 0.001) respectively. Chicken was a likely option over pasta for added broccoli (p < 0.05). Crêpe was a likely option over compote for added mixed berries (p < 0.001). Potato was a likely option over vegetables (p < 0.05) as well as other starch over vegetables (p < 0.05) for added herbs. Carrot salad with raisins was a likely option above carrot salad with raisins and parsley (p < 0.05). Poached pear in red grape juice was a likely option over poached pear in rooibos herbal tea (p < 0.001). Tomato (p < 0.001) and broccoli (p < 0.05) were more likely to be consumed than spinach, while spinach (p < 0.05) and roasted butternut (p < 0.05) respectively were likely options over onion as vegetables added to a quiche. Onion was a less likely option over broccoli (p < 0.001), tomato (p < 0.001) and roasted butternut (p < 0.001) as respective vegetables in a soup. Tomato soup was a likely option over tomato soup with rooibos herbal tea (p < 0.001). Roasted butternut soup was a likely option over butternut and orange soup (p < 0.001) and butternut and rosemary soup (p < 0.001). Berries as fruit addition were a likely option over pome fruit as pear (p < 0.05) and citrus fruit (p < 0.001), and furthermore citrus fruit over pome fruit as pear (p < 0.05). Raw apple with its skin on was a more likely option over chicken breast salad with apple pieces (p < 0.001), and chicken breast salad with apple a likely option over chicken and apple casserole (p < 0.001). Parsley was a likely option over basil (p < 0.001), and mixed herbs (p < 0.001) and rosemary (p < 0.001) respectively were likely options over basil as herb addition. Commercially manufactured category prepared dishes likely to be purchased and consumed by the respondents included category prepared dishes with added fibre more than added herbs (p < 0.05), fruit (p < 0.001), vegetables (p < 0.001) or tea (p < 0.001), and added herbs than added vegetables (p < 0.05) or tea (p < 0.05). Pizza/pasta was a likely option over beverages (p < 0.05), grains/bake (p < 0.001) and dairy (p < 0.001) respectively, and baked goods than grains/bake (p < 0.001), dairy (p < 0.001) and beverages (p < 0.05) respectively as food vehicles. A baked dish with added fibre was more likely to be consumed than with added fruit (p < 0.001), tea (p < 0.001) or vegetables (p < 0.001), and added fruit more likely to be consumed than added vegetables (p < 0.05). Pasta incorporating vegetables was a more likely option than pasta incorporating fruit (p < 0.001). Shortbread with added fruit was a likely option over added herbs (p < 0.05), and a muffin with bran (p < 0.001) or blueberries (p < 0.001) a likely option over a muffin with spinach. Fruit juice incorporating rooibos herbal tea (p < 0.001) or herbs (p < 0.001) were likely options over fibre incorporation. The female respondents were more likely to consume category prepared dishes with added fruit than the male respondents (p < 0.05), while the older respondents (55 to 64 years) were more likely to consume category prepared dishes with added herbs than the younger respondents (31 to 44 years) (p < 0.05). The older respondents were also more likely to consume category prepared dishes with fruit additions than the younger respondents aged 31 to 44 (p < 0.05) and 45 to 54 (p < 0.05) respectively. The respondents involved in the preparation of food at home were more likely to consume category prepared dishes with the addition of rooibos herbal tea (p < 0.05), herbs (p < 0.05) and fruit (p < 0.05) respectively than those who were not involved in preparing food at home.

In general, people prefer information that makes them look and feel good. This is information that is consistent with, or supportive of, their desires, beliefs, and behaviors. Much research has been devoted to examining biases in how we selectively seek some information and avoid other information as well as different factors that can mitigate or intensify these tendencies. The present project explored the impact of feeling powerful—a psychological experience shown to influence cognitions and behavior—on decisions about what information people choose to consume in a health context. Specifically, this was investigated in two different domains of health information consumption—selective exposure (Studies 1 & 2) and information avoidance (Studies 3 & 4). The first two studies investigated if feeling powerful affects selection of, or interest in, information known to be consistent or inconsistent with beliefs and behaviors. It was predicted that power would increase interest in belief-consistent (i.e., non-threatening) information. The final two studies examined how power impacts decisions about whether to receive or avoid an uncertain piece of health information that is potentially threatening. Contrary to selective exposure hypotheses, it was predicted that power would increase interest in this uncertain (i.e., threatening) information. All four studies revealed null largely effects of power, suggesting that feeling powerful may not influence how people chose to consume potentially threatening health information. A discussion of the potential limitations of these studies and the scope of this conclusion are included.

Yes / Purpose: Most patients report being highly satisfied with the outcome of cataract surgery but there are variable reports regarding the impact of cataract surgery on some real-world activities, such as fall rates. We hypothesised that adaptations to changed refractive correction and visual function may cause difficulties in undertaking everyday activities for some patients and used a series of focus groups to explore this issue. Method: Qualitative methods were used to explore patients’ experiences of their vision following cataract surgery, including adaptation to vision changes and their post-surgical spectacle prescription. Twenty-six participants took part in five focus groups (Mean age = 68.2 ± 11.4 years), and the data were analysed using thematic analysis. Results: We identified three themes. ‘Changes to Vision’ explores participants’ adaptation following cataract surgery. While several had problems with tasks relying on binocular vision, few found them bothersome and they resolved following second eye surgery. Participants described a trial and error approach to solving these problems rather than applying solutions suggested by their eyecare professionals. ‘Prescription Restrictions’ describes the long-term vision problems that pre-surgery myopic patients experienced as a consequence of becoming emmetropic following surgery and thus needing spectacles for reading and other close work activities, which they did not need before surgery. Very few reported that they had the information or time to make a decision regarding their post-operative correction. ‘Information Needs’ describes participant’s responses to the post-surgical information they were given, and the unmet information need regarding when they can drive following surgery. Conclusion: The findings highlight the need for clinicians to provide information on adaptation effects, assist patients to select the refractive outcome that best suits their lifestyle, and provide clear advice about when patients can start driving again. Patients need to be provided with better guidance from clinicians and prescribing guidelines for clinicians would be beneficial, particularly for the period between first- and second-eye surgery. / Dunhill Medical Trust. Grant Number: RTF1806/53.

This work describes the design and implementation of the Disease Control System DiCon (pronounced [ˈdaɪkɒn]), providing a general framework for solving optimization problems on distributed computer systems. The central aspects of DiCon are discussed, as are decisions made while realizing the system. Several implementation-specific details are highlighted. Real-world applications show the system's flexibility and demonstrate the potential impact DiCon has on public-health decision making. / text

The rate of adolescent unintended pregnancy in the United States is high compared to other developed countries. While past research and interventions have largely focused on young women, the role of young men in pregnancy prevention has increasingly been recognized. Studies have assessed young men’s knowledge and attitudes toward pregnancy prevention as well as their role in male-controlled methods of birth control like condoms or withdrawal. However, less is known about how young men can contribute to or participate in decision-making with female partners about contraception other than condoms. The purpose of this systematic review was to explore how young men communicate with their partners and its impact on contraception use to prevent pregnancy. A systematic review of five databases was conducted to identify English-language articles published from January 1, 2002, through July 7, 2018. The review specifically explored how male partner communication affects female partner use of contraception other than condoms among young men ages 11-24 years. The systematic review explored additional questions, including those pertaining to the timing of partner communication in a relationship, strategies employed by young men, and which dynamics of partner communication are measured in studies. Of the 15 articles identified as exploring areas of communication, five of the articles used quantitative analysis to measure any association between partner communication and contraception use, and three of those produced statistically significant findings suggesting that communication increases the use of contraception other than condoms. Three qualitative studies provided supporting narratives of how young men have communicated with partners and influenced their contraception use with female partners. The remaining seven articles explored the other research questions of timing, strategies, and dynamics identifying topics, prompts, and communication cues among young men. Measurements of both communication and contraception varied across studies. With the small number of studies identified in this systematic review, it is recommended that future research seek to corroborate the relationship between partner communication and contraception use with more robust and precise measurements of both communication and contraception.

South Africa continues to have the highest HIV-prevalence in the world, in addition to other sexual health-related issues. A vast majority of its population is also religiously affiliated with Christianity. This study sought to understand how young women living in Khayelitsha experience the relationship between sexual health and religion within the context of uncertainty and socio-economic deprivation. How their sexual health-decision making unfolds given the tensions that arise between religious expectations and socio-economic realities and how they perceive the partnership between religious organisations and public health facilities offering sexual health services was also explored. Data collection consisted of ethnographic field notes, 11 semistructured interviews and 3 focus group discussions with 6 people in each group. Data were then analysed using a thematic analysis approach. The findings reveal that young women experience the tension between religious expectations and their socio-economic realities through the “moral dichotomisation of right and wrong” and that this, in addition to the ‘dynamics of hypervulnerability’ consisting of gender inequalities and economic vulnerability, leads to a sense of lacking control over sexual health decision-making. The call for church involvement in sexual health-related matters reveals a deeper desire for various forms of support as they transition to adulthood in the context of uncertainty and socio-economic marginalisation. The article argues that young people navigating uncertainty and dealing with the complexities of transitioning to adulthood may perceive religion and the church to play the role of a custodian in sexual health issues, however, expectations of the church are difficult to live up to and sit in tension with socio- economic realities. Thus, a division of duties between religious organisations and public health facilities should be established to strengthen sexual health promotion and prevention efforts.

No description available.

Estimates suggest that about eight million American teens and young adults experience clinical symptoms of mental illness. For many, these mental health challenges will develop into a diagnosable and potentially life-long psychiatric disorder. Together they form a large population of adults who enter their prime reproductive age as psychiatric patients. Though individuals with mental illness enjoy the same reproductive rights as those without psychiatric conditions, social and medical discourses often portray their parenthood as risky and undesirable. Women with mental illness are in a particularly difficult position. As women, they are subjected to the gendered expectation that they become mothers. Yet at the same time, their mental illness results in their motherhood being frowned upon. Carrying these contradicting values, this study asks how women with psychiatric disorders make reproductive decisions. Do these women think of their reproductive capacity through the psychiatric framing of risk, or through gendered narratives of desired motherhood? Using open ended interviews with women with a psychiatric diagnosis, this study shows that women with mental illness approach their reproductive decision-making by utilizing narratives of both normal reproduction and disability. Some women portray their mental illness as an obstacle to motherhood while others create a separation between their mental and reproductive health. Still others defy the distinction between psychiatry and normalcy and describe their reproduction as a way to bring the two together. Despite the difference in framing, all the women in this study engage with the discourse of risk(s) that is brought on by their mental illness. To weigh risk and act upon it, they visit their and their peer’s biographical stories of illness, assess their fitness into normative ideas of good motherhood, and evaluate the worth of medical and scientific information. They question the way medical information is created, distributed, and made applicable to the idiosyncrasy of their reproductive life. In doing so, these women draw boundaries around trust as well as redefine medical neutrality. Finally, we show that women with mental illness and their health providers rely on a vaguely defined stepwise plan to approach reproduction. This plan brings normativity – and desirability - to their reproduction at the same time that it threatens to exclude them from motherhood. By bringing these arguments together we arrive at the overall conclusion that women with mental illness do not approach their reproduction as a monolithic group. Nor do they organize along diagnosis lines. This study shows that women across psychiatric diagnoses share similar reproductive desires, some hoping to have children and others wishing to avoid motherhood altogether. The popular idea that certain psychiatric diagnoses render women unsuitable for motherhood is not echoed by the women in this study. Instead, their embodied experience of mental illness allows them to embrace the newfound reproductive choice of psychiatric patients and highlights the stigma that perpetuates fears of motherhood with mental illness.

Every year, approximately 21 million girls aged 15 to 19 living in low- and middle-income countries (LMICs) become pregnant and over 12 million of these girls give birth. Complications from pregnancy are the leading cause of death for girls aged 15 to 19 in LMICs and adolescent mothers face an elevated risk of life-long morbidities due to pregnancy and childbirth. The risk of early childbearing and its associated consequences vary significantly depending on age, socioeconomic status, and place of residence. Adolescents affected by conflict or natural disasters are often recognized as one of the most vulnerable groups in this regard; among the countries with the highest adolescent birth rates globally, most are affected by conflict or fragility. This dissertation aimed to fill a critical gap in the literature on adolescent pregnancy in humanitarian settings. The three studies in this dissertation utilize qualitative and quantitative research to better understand the myriad drivers of adolescent pregnancy and, in the context of protracted conflict in Democratic Republic of the Congo (DRC), how exposure to armed conflict may or may not modify certain risk and protective factors. The findings of this dissertation confirm that risk and protective factors for adolescent pregnancy are numerous, interrelated, and complex; preventing early and unintended pregnancy requires multi-level interventions that build the protective assets of adolescents while also engaging with male partners, parents and caregivers, and community members. The research deepens this understanding by demonstrating the extent to which long-standing and deeply rooted sociocultural norms influence adolescents’ individual and inter-personal behaviors in diverse contexts, including settings affected by armed conflict. Thus, instead of considering how standalone risk and protective factors for adolescents differ depending on the context, the research highlights the importance of understanding linkages between environmental, inter-personal, and individual factors and the pathways through which these linkages influence reproductive health decision-making among adolescents. This dissertation also provides new evidence as to how the presence of armed conflict does not uniformly influence risk and protective factors for adolescent pregnancy. Instead, it finds that, in the case of DRC, underlying social norms and differences in social, demographic, and economic characteristics outweigh the effect of armed conflict on incidence of adolescent pregnancy. This finding does not mean that armed conflict does not have any impact on adolescent pregnancy; rather, it confirms the need for continued research in different humanitarian contexts and informs how to apply best practices from development settings to improve sexual and reproductive health (SRH) outcomes among adolescents affected by humanitarian crises. Meeting the SRH needs of adolescents requires going beyond service provision and understanding the numerous, interrelated risk and protective factors that exist at the individual, inter-personal, and community levels. Situations of conflict and displacement may present additional complexities for understanding and meeting the SRH needs of adolescents. However, this dissertation shows the feasibility of conducting research and utilizing existing data to understand some of the root causes of adolescent pregnancy in a conflict-affected setting. Moreover, the studies highlight how more robust evidence can challenge some of our longstanding assumptions about adolescents affected by humanitarian crises. Continued rigorous research and taking the time to listen to adolescents and their communities can lead to more responsive adolescent SRH programs and services that contribute to adolescents’ healthy transitions to adulthood.

Objetivo: Analisar as fontes de informação científica e os fatores concorrentes a estas que influenciam a prescrição de residentes médicos num hospital universitário. Método: Foi realizada pesquisa exploratória que envolveu observação não participante em campo, entrevistas orientadas por questionário semiestruturado e análise de conteúdo após transcrição das falas. O estudo foi conduzido no Hospital da Universidade Federal da Bahia entre dezembro de 2013 a março 2014 e contou com a participação de profissionais das áreas de clínica médica, onco-hematologia, pediatria e psiquiatria. O instrumento COREQ foi utilizado para guiar a apresentação dos achados dessa pesquisa. Resultados: Doze médicos foram entrevistados, sendo 8 residentes, 2 preceptores e 2 professores. Os entrevistados indicam que fatores relacionados aos pacientes norteiam a tomada de decisão sobre prescrever medicamentos, associados às evidências científicas, a preceptoria ou tutoria médica e farmacêuticos. A insegurança dos residentes em prescrever, especialmente, no primeiro ano e a falta de autonomia dos mesmos também foram fatores identificados. As fontes de informação mais citadas para esclarecer dúvidas foram UpToDate, Portal de Periódicos da CAPES, PubMed, artigos e bula do medicamento, sendo as fontes de informação nacionais menos citadas do que as internacionais. O preceptor ou professor apareceu como importante fonte de informação, principalmente, devido aos anos de experiência pessoal. Conclusões: Apesar da facilidade de acesso a diversas fontes de informação de qualidade, os residentes não as utilizam com frequência. A prescrição médica sofre influência multifatorial, sendo a opinião do médico mais experiente uma das mais importantes nesse processo. / Objective: To analyze the sources of scientific information and competitors to these factors that influence the prescription of medical residents in an university hospital. Method: Exploratory research was performed involving non-participant observation in the field, interviews guided by semi-structured questionnaire and content analysis after transcription of the speeches. The study was conducted at the Hospital of Federal University of Bahia between December 2013 to March 2014 and included the participation of professionals from the internal medicine, oncohematology, pediatrics and psychiatry. The COREQ instrument was used to guide the presentation of the research findings. Results: Twelve doctors were interviewed: 8 residents, 2 professors and 2 preceptors. Interviewees indicate that patient-related factors associated with scientific evidence, medical preceptorship or mentoring and pharmacists guide the decision-making about prescribing medicines. The insecurity of residents in prescribing, especially in the first year and the lack of autonomy of them were also identified. The most cited sources of information to answer questions related to drugs were UpToDate, CAPES Portal of Periodicals, PubMed, articles and package leaflet. National sources were cited less than international. The preceptor or professor appeared as an important source of information, mainly due to their years of personal experience. Conclusions: Despite of the ease of access to many quality information sources, residents do not use them frequently. The prescription suffers multifactorial influence, and the opinion of the most experienced doctor is one of the major influent factor in this process.