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.

Introdução: Estudos têm encontrado uma transição da obesidade da população adulta para crianças e adolescentes, que por sua vez, pode acarretar manifestações clínicas, como: doenças coronarianas, diabetes tipo 2, e complicações psicossociais cada vez mais precocemente. Contudo, métodos para avaliação da composição corporal para essa faixa etária, principalmente envolvendo técnicas de baixo custo como as medidas de dobras cutâneas (DC) apresentam imprecisões em estudos brasileiros. Fator o qual pode levar a uma interpretação equivocada da composição corporal dos avaliados. Objetivo: desenvolver novos modelos matemáticos utilizando medidas de DC, tendo como referência a absorciometria de raios-X de dupla energia (DXA), para estimativa de massa de gordura (G) em adolescentes. Métodos: Trata-se de um estudo exploratório descritivo onde foram avaliados 416 adolescentes do gênero masculino de 12 a 17 anos, sendo 42 destinados para compor a amostra de validação da pesquisa. Foram coletadas medidas de massa corporal total, estatura, circunferência da cintura e quadril, nove pontos anatômicos baseados em DC: bíceps, tríceps, subescapular, peitoral, axilar média, abdominal, supra-ilíaca, coxa e panturrilha, além da G e densidade mineral óssea (DMO) aferida com a tecnologia de DXA. Para o desenvolvimento das equações foi utilizado um modelo de regressão linear múltipla através do método de mínimos quadrados ordinários (OLS). Resultados: O grupo apresentou índice de massa corporal (IMC) médio de 21,25±4,12kg/m² e %G = 20,57±5,80%. A partir do %G, a prevalência de excesso de gordura foi verificada em 38,3% dos adolescentes. O impacto da gordura na DMO dos adolescentes indicou uma associação na ordem de r = -0,358; p<0,005, sendo verificada redução de até 14% da DMO para a região da coluna em adolescentes com obesidade em comparação aos eutróficos. O desenvolvimento de novos modelos matemáticos que atendessem critérios de alto coeficiente de determinação (R²), baixo erro padrão de estimativa (EPE), controle de colinearidade, normalidades dos resíduos, homoscedasticidade e praticidade, possibilitaram a apresentação de três opções com R² = 0,932 e EPE 1,79; R² = 0,912 e EPE = 1,78; R² = 0,850 e EPE = 1,87, respectivamente. Em todas as opções, as variáveis idade e estatura foram empregadas, bem como as DC de tríceps e subescapular. Conclusão: Os resultados obtidos evidenciam a possibilidade de desenvolvimento de novos modelos matemáticos para a avaliação da gordura corporal em adolescentes com resultados superiores aos modelos existentes na literatura. / Introduction: Studies have found a transition from obesity of the adult population to children and adolescents, which in turn, can lead to clinical manifestations, such as: coronary diseases, type 2 diabetes, and psychosocial complications increasingly early. However, methods for evaluating nutritional status for this age group, mainly involving low cost techniques such as skinfold thickness measurements (ST), are imprecise in Brazilian studies. Factor which can lead to a mistaken interpretation of the body composition of the evaluated ones. Objective: To develop new mathematical models, based on DC measurements, based on dual energy X-rays absorptiometry (DXA), to estimate fat mass (G) in adolescents. Methods: This was an exploratory descriptive study in which 416 male adolescents aged 12 to 17 years were evaluated, 42 of whom were separated to compose the study validation sample. Measurements of total body mass, stature, waist and hip circumference were obtained, nine anatomical points based on ST: biceps, triceps, subscapular, pectoral, mid axillary, abdominal, suprailiac, thigh and calf muscles, as well as G and bone mineral density (BMD) measured with DXA technology. For the development of the equations, a multiple linear regression model was used by the ordinary least square (OLS) method. Results: The group had a mean body mass index (BMI) of 21.25± 4.12 kg / m² and %G = 20.57 ± 5.80%. From %G, the prevalence of excess fat was verified in 38.3% of adolescents. The impact of fat on adolescent BMD indicated an association in the order of r = -0.358; P <0.005, with BMD reduction up to 14% for the spine region in adolescents with obesity compared to eutrophic. The development of new mathematical models that meet criteria of high coefficient of determination (R²), low standard error of estimation (SEE), control of colinearity, residue normalities, homoscedasticity and practicality, allowed the presentation of three options with R² = 0.932 and SEE 1.79; R² = 0.912 and SEE = 1.78; R² = 0.850 and SEE = 1.87, respectively. In all the options, the variables age and height were employed, as well as triceps and subscapular ST. Conclusion: The results obtained evidenced the possibility of developing new mathematical models for the evaluation of body fat in adolescents with results superior to the existing models in the literature.

No description available.

MPH / Department of Public of Health / The occupational health and safety of coal mine workers is one of the major occupational challenges in the mining industry. Coal mine workers face the looming perils of potential falls of volatile rocks, the ergonomic challenges caused by bending and lifting heavy objects in their daily work, the challenges caused by inhaling coal mine dust which can cause coal workers' pneumoconiosis (CWP) and a plethora of other hazards in both underground and open cast mines on a daily basis. The aim of the study is to assess the knowledge, attitude and practice of coal mineworkers pertaining to occupational health and safety at the Leeuwpan mine in Mpumalanga province of South Africa. The study adopted a quantitative, cross sectional descriptive design. Self-reported questionnaires with closed-ended questions were administered to the eligible participants. The study targeted the 3200 coal mineworkers who were employed at the Leeuwpan mine in Lephalale. A sample of 356 mineworkers was used as derived from Slovin’s formula and data was collected over a period of 5 days at the Leeuwpan mine. Measures to ensure validity and reliability were ensured and ethical considerations were observed. The Statistical Package for Social Sciences (SPSS) version 23.0 was used to analyse the data. Results and recommendations are based on the findings of the study. / NRF

MPH / Department of Public Health / Health and safety issues pertaining to workers are global concerns and a major priority to the employers and government respectively. Employees in general across industries are faced with various health and safety risks. Epidemiological research has shown consistently that waste handlers are mostly exposed to various risks and hazards during their work as compared to other professions globally. This study focused on waste handlers employed by the Thulamela Municipality in the Limpopo Province, South Africa. The study employed qualitative explorative design and targeted all municipal waste handlers. Municipal waste handlers were sampled using non probability purposive sampling. In-depth interviews, using an interview guide, were conducted by the researcher and a voice recorder was used to record data from the participants after obtaining permission from them. The sample size comprised of 18 participants and was determined by data saturation. A thematically analysis technique was used to analyse data. Data from the participants were clustered into main theme, categories and sub-categories. The following themes emerged from data analysis: physical hazards, psychological hazard, biological hazards and chemical hazard. The study revealed that the municipal waste handlers are exposed to various occupational risks and are experiencing shortage of personal protective equipment, ranging from hand gloves, safety helmets, rain coats, overall uniforms, safety jackets and boots, to keep themselves safe from health problems and occupational injury when collecting waste. It is recommended that the Thulamela municipality should prioritise the working conditions for municipal waste handlers, by distributing suitable personal protective equipment such as hands gloves, safety helmet, rain coats, safety jackets and boots) and overalls / NRF

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.

Stakeholder involvement in strategic planning: a strategy to mitigate the effects of HIV and AIDS on secondary education in Botswana. This study explores the involvement of stakeholders in strategic planning to mitigate the effect of HIV and AIDS in secondary education in Botswana. The prevalence of HIV and AIDS-related illness and deaths is high in Botswana and affects both teachers and learners. Education provision has been affected through increased mortality and morbidity and increased absenteeism which affect education-related personnel and the demand for education has been reduced due to growing numbers of orphaned and vulnerable children as a consequence of parent/guardian mortality and morbidity related to HIV and AIDS. The problem was investigated by means of a literature review and an empirical inquiry which combined quantitative and qualitative data collection. Based on the findings, in addition to medical and other interventions, an education management approach is required to mitigate the effects of HIV and AIDS on secondary education in Botswana. The strategies of coping, caring and preventing have been effective in this regard. Some internal stakeholders of the Department of Secondary Education (DSE) are not meaningfully involved in strategic planning. Similarly, most of the selected external stakeholders were not involved in the DSE HIV and AIDS strategic plan. Both external and internal stakeholders should be involved at all stages of planning. Furthermore, inducement-contribution exchanges and teacher credibility should be considered in a strategic plan. To improve the current DSE strategic plan, a stakeholder involvement model to involve internal and external stakeholders was designed. Based on this model and the above findings, recommendations for practice and suggestions for future research are made. / Educational Studies / D.Ed.(Educational Management)

Stakeholder involvement in strategic planning: a strategy to mitigate the effects of HIV and AIDS on secondary education in Botswana. This study explores the involvement of stakeholders in strategic planning to mitigate the effect of HIV and AIDS in secondary education in Botswana. The prevalence of HIV and AIDS-related illness and deaths is high in Botswana and affects both teachers and learners. Education provision has been affected through increased mortality and morbidity and increased absenteeism which affect education-related personnel and the demand for education has been reduced due to growing numbers of orphaned and vulnerable children as a consequence of parent/guardian mortality and morbidity related to HIV and AIDS. The problem was investigated by means of a literature review and an empirical inquiry which combined quantitative and qualitative data collection. Based on the findings, in addition to medical and other interventions, an education management approach is required to mitigate the effects of HIV and AIDS on secondary education in Botswana. The strategies of coping, caring and preventing have been effective in this regard. Some internal stakeholders of the Department of Secondary Education (DSE) are not meaningfully involved in strategic planning. Similarly, most of the selected external stakeholders were not involved in the DSE HIV and AIDS strategic plan. Both external and internal stakeholders should be involved at all stages of planning. Furthermore, inducement-contribution exchanges and teacher credibility should be considered in a strategic plan. To improve the current DSE strategic plan, a stakeholder involvement model to involve internal and external stakeholders was designed. Based on this model and the above findings, recommendations for practice and suggestions for future research are made. / Educational Studies / D.Ed.(Educational Management)

The purpose of the study was to describe the determinants and practice of HIV self-testing among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A descriptive cross-sectional study was conducted to determine the rate of HIV self-testing, explore the factors influencing the practice and describe access to HIV psychosocial support, care and treatment. The study was guided by the concepts of the protection motivation theory. Data was collected from 348 HCWs and analysed by means of logistic regression. Results showed that 65.8% of the HCWs had practiced HIV self-testing among themselves. Age, self efficacy and response efficacy were found to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs. / HIV self-testing among health care workers at Nyeri Provincial Hospital in Kenya / HIV self-testing among health care workers / Public Health / M.A. (Public Health)

This study examines how African American gender scripts influence condom use for disease and pregnancy prevention. One-hundred African American California State University, San Bernardino (CSUSB) students were selected to participate in this study. Fifty African American males and fifty African American females were surveyed for this study to be representative of the African American community on campus.