M.Cur. / The problems women in our community are faced with are multi-dimensional and there is absolutely no community that can be declared problem-free. Many women face the pressure of having a number of responsibilities namely working, being a wife and mother, taking care of their families and perhaps caring for aging parents. Sometimes the pressure can be too overwhelming to manage. As a result, many women become depressed. The genuine life events that most often appear in connection with depression are various, but there is one distinguishing feature that appears in many cases, over and over: loss of self-esteem, of empowerment, of self confidence accompanied by feelings of worthlessness. In general, any life change, often caused by events beyond one's control, will damage the structure that gave life meaning. The likelihood of becoming depressed is increased by the lack of supportive, confiding relationship with a partner, spouse, friend, stressful life events and poor communication patterns within relationships. Studies on depression among Black-African women could not be traced. Despite the fact that considerable research on the women and depression has been done in other parts of the world, no studies have been done on similar subjects in Namibia. It was therefore considered necessary to find out how women suffering from depression from this part of the world tell their life stories. The purposes of the study were two-fold. Firstly, to explore and describe the life stories of adult depressed women in perk urban Namibia. Secondly, to use the information obtained to describe guidelines for the compilation of a health education support program for psychiatric nurses working with these patients at psychiatric outpatient clinic as well as in the community. The research questions that were generated are: how do adult depressed women tell their life stories, and then how can the information be utilised to describe guidelines to support psychiatric nurses to assist depressed women in their quest for mental health? The researcher used an exploratory, descriptive, contextual and phenomenological qualitative design to answer these research questions. Phenomenological interviews were conducted with ten (10) respondents who have been purposively selected. This was done after obtaining the necessary permission from the Ministry of Health and Social Services and informed consent from the research participants. The interviews were conducted by the researcher in Oshiwambo and English. Steps were taken throughout the course of the study to ensure trustworthiness. All the interviews were transcribed verbatim. Data was analysed following Tesch's method and the service of an independent coder was obtained. The results indicate that impaired interpersonal interactions and stressful life events have a negative influence on the daily life of women leading to the development of depressive symptoms. Guidelines intended to support psychiatric nurses were drawn up based on the themes that emerged from the raw data. These guidelines are strategies to be used by psychiatric nurses working with depressed women to assist them in managing their own depression. Possibilities for the application of the results in nursing education, nursing practice, nursing research are discussed. It is concluded that women suffering from depression need support from the psychiatric nurses in order to facilitate the promotion, maintenance and restoration of their mental health, which is an integral part of health.

M.A. / Parkinson's disease is a progressive neurological disorder. Symptoms such as tremor, muscular stiffness and slowness of bodily movement are prevalent in the disease. Early research studies have investigated emotional difficulties experienced by Parkinson's disease patients. Most research studies have focused on depression in Parkinson's disease. However few studies have investigated other emotional concomitants of Parkinson's disease, for example anxiety, self-esteem and impulse control. The aim of the present study was to investigate emotional concomitants of Parkinson's disease and to explore problematic emotional symptoms experienced by patients suffering from Parkinson's disease. The aim of the study was to compare a group of 10 male Parkinson's disease patients with a group of 10 healthy males (non-Parkinson's disease males) regarding the six subscales (Thought/Behaviour disorder, Impulse Control, Anxiety, Depression, Low Self-esteem and Total Pathology) of the Emotional Problems Scales (EPS). In the second part of the present study a group of six male Parkinson's disease patients completed the Millon Clinical Multiaxial Inventory (MCMI). The Millon Clinical Multiaxial Inventory consists of 22 clinical scales. The results indicated that there were statistically significant differences between the Parkinson's disease patients and the non-Parkinson's disease males regarding the Anxiety, Depression and Total Pathology subscales of the Emotional Problems Scales. The results further indicated that the Parkinson's disease patients had elevated scores above the 75 and 85 base rate scores of the Millon Clinical Multiaxial Inventory. The elevated scores were on the Schizoid, Compulsive, Self-defeating, Anxiety and Dysthymia scales. The results obtained in the present research study support previous studies regarding emotional concomitants in Parkinson's disease. Although effort has been made to ensure the present research study is methodologically sound, the study had a few shortfalls and limitations. The questionnaires (EPS and MCMI) used in the present study have not been standardised for the South African population. The present research study was interesting but a larger sample would be needed that would be more representative of the South African population. The present study did not discriminate between tremor dominant Parkinson's disease and rigid Parkinson's disease. Incidence of depression seems to be higher in Parkinson's disease patients with prominent features of bradykinesia and gait instability. It is recommended that future research studies distinguish between rigid Parkinson's disease and tremor dominant Parkinson's disease. Future research should also include measuring instruments that have been standardised for the South African population. Combined gender studies regarding emotional concomitants of Parkinson's disease will contribute to understanding the problematic emotional symptoms experienced by patients suffering from Parkinson's disease.

Ce travail est une contribution au renforcement des capacités de recherche et de l'identification des stratégies et des perspectives afin de promouvoir une meilleure recherche en santé bucco-dentaire en Afrique grâce à la production de l'avis d'un panel d'experts lors d'une consultation Delphi. Ceci d'autant plus que les systèmes de santé bucco-dentaire et les connaissances scientifiques évoluent rapidement. Le continent africain est confronté à de nombreux défis parmi lesquels figurent le fardeau des maladies bucco-dentaires et les besoins élevés en soins des populations. Afin de satisfaire la demande en soins et de poser des actions de santé publique efficaces, les décideurs ont besoin d'outils, de capacités et d'informations pour évaluer et suivre les besoins de santé, choisir des stratégies d'intervention, des options politiques appropriées pour la conception de leurs propres stratégies en vue améliorer la performance des systèmes de soins bucco-dentaires. Dans ce contexte, il est nécessaire de concevoir une approche cohérente de la politique de santé bucco-dentaire dans la Région africaine ce qui implique une meilleure connaissance de la situation. Car l'avancement de l'Afrique est tributaire de sa capacité à générer, à adapter et à utiliser des connaissances scientifiques pour satisfaire aux besoins locaux en matière de santé et de développement. C'est pourquoi il y a un besoin de former la prochaine génération de scientifiques africains. Les universités doivent promouvoir, soutenir la recherche ainsi que la formation de sorte que les étudiants puissent participer aux recherches et bénéficier de l'enseignement de chercheur tout au long de leurs formations. La collecte de données sur la santé bucco-dentaire est par conséquent essentielle pour obtenir une vision précise de la situation en Afrique et ainsi mesurer les progrès réalisés. L'objectif de ce travail de recherche est de produire l'avis d'un panel d'experts sur différents items lors d'une consultation Delphi à deux phases. Ceci dans l'optique d'évaluer l'état actuel de la recherche, d'identifier les stratégies afin de promouvoir une meilleure recherche en santé bucco-dentaire en Afrique et de dégager des perspectives pour son progrès. Les analyses soulignent les priorités aux actions à privilégier tout en impliquant un certain nombre de recommandations pour renforcer et promouvoir les capacités de la recherche en santé bucco-dentaire. En fin de compte la solution qui s'imposerait serait de favoriser et d'optimiser la culture de la recherche dans les programmes nationaux de santé bucco-dentaire et d'assurer une large diffusion des résultats de la recherche pour les utiliser à des fins de planification / This work is a contribution to the strengthening of research capacity and the identification of strategies and opportunities to promote better research in oral health in Africa through the filing of the notice of a panel of experts at a Delphi consultation. This especially as systems oral health and scientific knowledge evolves rapidly. However, the African continent is facing many challenges, including the burden of oral diseases and the needs of populations that are huge. To meet these challenges care and ask actions effective public health policy makers need tools, skills and information to assess and monitor health needs, choose intervention strategies, policy options appropriate for the design of their own circumstances and improve system performance oral care. In this context, it is necessary to develop a coherent policy approach to oral health in the African Region, but this implies a better knowledge of the situation. For the advancement of Africa depends on its ability to generate, adapt and use scientific knowledge to meet local needs in health and development. That is why there is an urgent need to build the next generation of African scientists. Universities should promote and support research and training so that students are exposed to research and be taught by researchers throughout their courses. The collection of data on oral health is essential to get an accurate picture of the situation in Africa and to measure progress. Thus the objective of this research is to produce the opinion of a panel of experts on various items at a Delphi consultation two phases. In order to assess the current state of research, identify strategies to promote better research in oral health in Africa and prospects for its development. Analyzes give priorities to focus on the actions and involve a number of recommendations to strengthen and promote the capacity of research in oral health. Ultimately, we must promote a culture of research in national programs of oral health, ensure wide dissemination of research results and use them for planning purposes

D.Ed. (Nursing) / This research aims at the description of a therapeutic approach relevant to the youth suffering from chronic fatigue syndrome and includes his family, school and peer group. According to relevant literature it appears that chronic fatigue impacts negatively upon the total functioning of the youth. The physical demands of the condition leads to continual school-absenteeism, dysfunctional socialising and variable familial relationships. The condition is not easily diagnosed in youth as symptoms are often ascribed to school-phobia, deviant behaviour and/or psychological problems. In view of the fact that the researcher is of the opinion that the condition of the youth is not readily understood by his peers, family and school, the researcher aims at examining the experience of the youth who manifests chronic fatigue syndrome. The youth forms part of a specific system which is also affected by the chronic-fatigue-syndrome. Thus the research is aligned to a systemic approach. The researcher has decided to follow a qualitative research approach, with the deliberate choice of two youths subjected to the utilisation of multiple data-gathering sources. Multiple data-gathering includes interviews, document analysis and observation. The data has been analysed with the assistance of two independent coders and central themes have been established. Case study reports have been complied according to processed data. Hereafter a literature-control was applied to compare the results of this research with other available research and to point out new insights into chronic-fatigue syndrome gained from this research.

Health information networks continue to expand under the Affordable Care Act yet little research has been done to query and analyze multiple patient populations in parallel. Differences between hospitals relating to patient demographics, treatment approaches, disease prevalences, and medical coding practices all pose significant challenges for multi-site analysis and interpretation. Furthermore, numerous methodological issues arise when attempting to analyze disease association in heterogeneous health care settings. These issues will only continue to increase as greater numbers of hospitals are linked. To address these challenges, I developed the Shared Health Research Informatics Network (SHRINE), a distributed query and analysis system used by more than 60 health institutions for a wide range of disease studies. SHRINE was used to conduct one of the largest comorbidity studies in Autism Spectrum Disorders. SHRINE has enabled population scale studies in diabetes, rheumatology, public health, and pathology. Using Natural Language Processing, we de-identify physician notes and query pathology reports to locate human tissues for high-throughput biological validation. Samples and evidence obtained using these methods supported novel discoveries in human metabolism and paripartum cardiomyopathy, respectively. Each hospital in the SHRINE network hosts a local peer database that cannot be overridden by any federal agency. SHRINE can search both coded clinical concepts and de-identified physician notes to obtain very large cohort sizes for analysis. SHRINE intelligently clusters phenotypic concepts to minimize differences in health care settings. I then analyzed a statewide sample of all Massachusetts acute care hospitals and found diagnoses codes useful for predicting Acute Myocardial Infarction (AMI). The AMI association methods selected 96 clinical concepts. Manual review of PubMed citations supported the automated associations. AMI associations were most often discovered in the circulatory system and were most strongly linked to background diabetic retinopathy, diabetes with renal manifestations, and hypertension with complications. AMI risks were strongly associated with chronic kidney failure, liver diseases, chronic airway obstruction, hemodialysis procedures, and medical device complications. Learning the AMI associated risk factors improved disease predictions for patients in Massachusetts acute care hospitals.

Fine particulate matter (PM2.5) is the leading public health risk factor of global disease burden, which has caused 4.2 million deaths in 2015. This thesis aims to improve the scientific understanding on the sources and health impacts of PM2.5 in Hong Kong. Various chemical and biological analytical techniques were applied to characterize the chemical and toxicological properties of PM2.5 samples collected in Hong Kong during 2011-2012. Positive matrix factorization (PMF), together with the quantified chemical markers and water-soluble PM2.5-induced reactive oxygen species (ROS) activity as the input matrix, was performed to apportion the source-specific contributions to ambient organic carbon (OC) and the oxidative potential of water-soluble PM2.5. Zebrafish was applied as in-vivo model to evaluate the PM2.5-induced differential expression genes (DEGs). An L2-normaliztion integrated PMF was developed and applied to quantitatively assess the ability of PM2.5 to induced DEGs in relation to various sources and chemical compositions of PM2.5. The main findings are summarized below: (1) Thirty nine primary organic aerosol (POA) and secondary organic aerosol (SOA) markers of various anthropogenic (i.e. biomass burning (BB)) and biogenic sources (i.e. isoprene, monoterpenes and β-caryophyllene) were identified and quantified. High levels of OC and SOA markers were observed on regional pollution days than long regional transport (LRT) pollution and local emissions days. A kinetic model (Kintecus) was applied to explore the major formation channels of isoprene SOA, and it was found that isoprene SOA was mainly formed through the ring-opening reaction of isoprene epoxydiols (IEPOX) in Hong Kong. (2) PMF analysis, together with the chemical markers measured in Chapter 1 &2, was performed to evaluate the sources of OA in Hong Kong. Sea salt, marine vessels, vehicle emissions, BB/SOA, SOA, and secondary sulfate (SS) were apportioned as the major sources of ambient OC in Hong Kong. Secondary formation, including SOA, BB aging and SS sources, was found to be the major contributor to OC (~51%) throughout the whole year. BB was the major anthropogenic contributor to OC on regional days (28.8%); while marine vessel was the dominated primary source of OC on local days (33.2%). SOC concentrations were estimated using a tracer-based method (SOCTBM) and PMF (SOCPMF). Both SOCTBM and SOCPMF showed highest concentrations on regional days (SOCTBM: 0.74 µg m-3; SOCPMF: 3.27 µg m-3). Among all SOA precursors, monoterpenes had the most abundant contribution (40.9%) to SOCTMB during the whole year. Moreover, sulfate has significant impacts on SS-related SOC and SOA from monoterpenes and naphthalene. Particle acidity (HP+) showed correlation with SOC from BB aging. These results provide us a quantitative understanding on the SOA origins in the region, which lays a foundation for the source apportionment of PM2.5-induced toxicity in the following chapters. (3)Cell-free dithiothreitol (DTT) and ·OH generation assays were applied to measure the ROS activity induced by water-soluble PM2.5 collected in Hong Kong during 2011-2012. Different levels of ROS activity were observed for different chemical fractions of PM2.5 and PM2.5 from various sources. Six factors, i.e. SS, BB, SOA, vehicle emissions, marine vessels and metal factors were apportioned by PMF as the major sources of water-soluble PM2.5 induced ROS potential. Metal factors was found to be the major contributor to both DTT activity (39.1%) and ·OH generation ability (84.5%) throughout the year, especially on LRT (DTT: 54.8%; ·OH generation: 91.1%) and regional days (DTT: 53.9%; ·OH generation: 87.7%). On local days, contribution of marine vessels to DTT oxidation become more significant (48.7%), however its contribution to ·OH generation is negligible. Metal factors is by far the most significant contributor to ·OH generation, even on local days (73.1%). It is interesting to note that all six PMF-resolved sources are associated with DTT oxidation, however only three sources (i.e. metal factor, vehicle emissions and SOA) showed contributions to ·OH generation. Moreover, among these six sources, marine vessels exhibited the highest intrinsic DTT ability; while metal factor was the most effective source in ·OH generation. (4) Zebrafish embryo (AB strain) was applied as the in-vivo model to assess PM2.5 toxicity in Hong Kong through genome-wide gene transcriptional analysis. The results showed that embryonic exposure to PM2.5 could induce remarkable changes in gene expression patterns in zebrafish. DEGs between PM2.5 extract treated and untreated zebrafish embryo samples were identified, and they were found mainly associated with responses to xenobiotic stimulus, and muscle and heart development and functions. The correlation analysis between co-expressed gene modules and chemical species of PM2.5 implied the different chemical compositions and sources of PM2.5 have significant influences on the PM2.5-induced biological responses. (5) An L2-normalizaiton integrated PMF was developed to analyze the high throughput biological and chemical data simultaneously, which quantitatively evaluated the ability of PM2.5 to induce DEGs in relation to sources and compositions. In this chapter, nine sources associated with PM2.5-induced DEGs were well apportioned, i.e. fresh sea salt, aged sea salt, SS, SOA, BB, coal combustion, vehicle emissions, marine vessels and metal factors. Among these sources, metal factors (annual mean: 26.5%, range: 17.6-39.3%) and vehicle emissions (annual mean: 16.3%, range: 0.0-25.3%) are the two leading contributors to PM2.5-induced DEGs levels. PM2.5 from combustion related sources (e.g. vehicle emissions, metal factors, BB) and sea salt exhibited stronger ability to induce DEGs than those from secondary sources. Although secondary formation (including SOA and SS) has a significant contribution to ambient PM2.5 (12 μg m-3, 40%), its capacity of DEGs induction is quite low. Moreover, several biological functions and pathways influenced by PM2.5 from various sources have also been well evaluated. In this study, large scales of biological and chemical data were analyzed for the first time by a L2-normalizaiton integrated PMF to apportion the PM2.5-induced DEGs, and this thesis work firstly reported the major sources of water-soluble PM2.5-induced ROS in Hong Kong. Results from this study provide a scientific basis for the prediction of PM2.5-associated adverse health outcomes and can help the policy makers to formulate cost-effective and targeted PM2.5 mitigation strategies to protect public health.;Fine particulate matter (PM2.5) is the leading public health risk factor of global disease burden, which has caused 4.2 million deaths in 2015. This thesis aims to improve the scientific understanding on the sources and health impacts of PM2.5 in Hong Kong. Various chemical and biological analytical techniques were applied to characterize the chemical and toxicological properties of PM2.5 samples collected in Hong Kong during 2011-2012. Positive matrix factorization (PMF), together with the quantified chemical markers and water-soluble PM2.5-induced reactive oxygen species (ROS) activity as the input matrix, was performed to apportion the source-specific contributions to ambient organic carbon (OC) and the oxidative potential of water-soluble PM2.5. Zebrafish was applied as in-vivo model to evaluate the PM2.5-induced differential expression genes (DEGs). An L2-normaliztion integrated PMF was developed and applied to quantitatively assess the ability of PM2.5 to induced DEGs in relation to various sources and chemical compositions of PM2.5. The main findings are summarized below: (1) Thirty nine primary organic aerosol (POA) and secondary organic aerosol (SOA) markers of various anthropogenic (i.e. biomass burning (BB)) and biogenic sources (i.e. isoprene, monoterpenes and β-caryophyllene) were identified and quantified. High levels of OC and SOA markers were observed on regional pollution days than long regional transport (LRT) pollution and local emissions days. A kinetic model (Kintecus) was applied to explore the major formation channels of isoprene SOA, and it was found that isoprene SOA was mainly formed through the ring-opening reaction of isoprene epoxydiols (IEPOX) in Hong Kong.

Addiction has been a global health crisis over recent decades and worsened substantially during COVID-19 lockdowns. We report on the development, validation, and findings from an instrument developed to assess the readiness of churches in the Appalachian Highlands to address addiction. The Church Addiction Response Scale (CARS) is a 41-item, three section measure assessing “What are your views about addiction?” (14 items), “What are your views about interacting with people who are addicted to drugs?” (11 items), and “What do you think the church’s role is in addressing addiction?” (16 items). The CARS was found to be unidimensional with strong internal consistency and initial evidence of construct validity was positive. Most respondents reported willingness to assist people living with addiction, but many reported that they felt underprepared, thus were not ready. Areas of preparation were largely those that could be addressed through training, such as understanding the physiology and psychology of addiction, available treatment options, and how to avoid doing harm. Thus, with adequate training, the likelihood of equipping a church-based workforce to provide support for people living with addiction seems attainable.

Background: The Ebola virus disease (EVD) outbreak 2014 received extensive news media coverage, which faded out before the outbreak ended. News media coverage impacts risk perception; it is, however, unclear if the components of risk perception (affective and cognitive responses) change differently over time. Methods: In an online panel, we asked participants (n = 1376) about EVD risk perceptions at the epidemic's peak (November 2014) and after news media coverage faded out (August 2015). We investigated worry (affective response), perceived likelihood of infection, perceived personal impact, and coping efficacy (dimensions of cognitive response), and knowledge about transmission. Differences between the surveys with respect to manifestations of affective and cognitive dimensions were tested using the Wilcoxon signed-rank test. The association between individual change in knowledge and worries about EVD in the first survey was investigated using linear regression. Results: In November 2014, the survey was filled in by 974 participants. Ten months later, 662 of them were still members of the online panel and were invited to the follow-up survey. Among the 620 respondents, affective response decreased between the surveys. Knowledge about EVD also decreased; however, participants worried about EVD in 2014 had increased knowledge in 2015. Perceived likelihood of infection decreased over time, while perceived personal impact and coping efficacy did not. Conclusions: Risk communication appealing to cognitive reactions by informing clearly on the risk of infection in unaffected countries may decrease inappropriate behaviors.

Research suggests that stakeholder investment is maximized when partnerships understand the assumptions held by partners of the benefits to be derived and contributions to be made to the partnership. In 2011, representatives from seven rural county high schools and five university departments participated in a planning workshop designed to identify elements of an effective community-academic partnership to address adolescent obesity disparity in Southern Appalachia. The purpose of this investigation was to examine key elements of partnership building by way of the Give-Get Grid partnership tool. Content analysis was conducted to identify emerging themes. University representatives consistently identified more proposed program contributions as well as benefits than their high school partners. University personnel responses generally pertained to their level of participation and investment in the partnership, whereas high school personnel tended to identify contributions fundamental to both partnership and program success. Additionally, content analysis uncovered programmatic facilitators and potential barriers that can be instrumental in program planning and forming program messages. Findings suggest that although partners often share common goals, perceptions of the value of investment and benefits may vary. The Give-Get Grid can be used during the program-planning phase to help identify these differences. Implications for practice are discussed.

Research suggests that stakeholder investment is maximized when partnerships understand the assumptions held by partners of the benefits to be derived and contributions to be made to the partnership. In 2011, representatives from seven rural county high schools and five university departments participated in a planning workshop designed to identify elements of an effective community-academic partnership to address adolescent obesity disparity in Southern Appalachia. The purpose of this investigation was to examine key elements of partnership building by way of the Give-Get Grid partnership tool. Content analysis was conducted to identify emerging themes. University representatives consistently identified more proposed program contributions as well as benefits than their high school partners. University personnel responses generally pertained to their level of participation and investment in the partnership, whereas high school personnel tended to identify contributions fundamental to both partnership and program success. Additionally, content analysis uncovered programmatic facilitators and potential barriers that can be instrumental in program planning and forming program messages. Findings suggest that although partners often share common goals, perceptions of the value of investment and benefits may vary. The Give-Get Grid can be used during the program-planning phase to help identify these differences. Implications for practice are discussed.