Source: Masters Abstracts International, Volume: 47-06, page: 3373. Advisers: Kelly Volcik; Sarah Baraniuk. Includes bibliographical references.

published_or_final_version / Medicine / Master / Doctor of Medicine

Objective: To determine the role of candidate gene polymorphisms in patients who sustained myocardial infarction at a young age and examine their relationship, if any, to risk factors. Since angiotensin II is known to play a pathophysiological role at the myocardial and vascular level, the genes to be studied are those regulating the renin angiotensin system and tissue metabolism. Design: The risk factors and genetic profile is described in 117 young Indians with myocardial infarction recruited over a period of thirty months (Dec 1997 - Jun 1999). Controls comprised 80 normal subjects with no clinical evidence of coronary heart disease (CHD) and with a normal effort response. The key features of this study are the selection of young subjects with myocardial infarction, (mean age 43 ± 6.8 years) in whom the possibility of a genetic basis for the disease was felt to be more likely since the confounding effect of age as a risk factor was reduced. Setting: Patients recruited 3 -12 months after myocardial infarction from Addington Hospital, Durban. This hospital subserves the Indian community in the north of Durban. The majority of patients were from the Phoenix settlement area. Results: 1. The clinical profile of the young Indian with myocardial infarction is a young man, slightly overweight with a high prevalence of risk factors, particularly smoking and diabetes, coupled with sedentary behaviour and risk-prone dietary patterns characterised by high red meat intake and low fruit and vegetable consumption, resulting in increased BMI and W/H ratios. 2. There were no differences in the patterns of gene polymorphism in the reninangiotensin system between the study and control groups. This finding extended across all candidate gene loci studied i.e. those involving aldosterone, G-protein, TGF-B and homocysteine metabolism. Serum triglycerides, haemoglobin AlC and urine microalbumin levels were elevated in the probands together with low HDL-C levels (p = 0.001). 3. A striking finding of this study was the substantial proportion of patients found to have diabetes mellitus, totalling 47% of the proband group. Of the 53 diabetic patients, (45 males and 8 females) four (3 males, 1 female) had impaired glucose tolerance. Cigarette smoking, a positive family history of hypertension/diabetes and a family history for premature CHD emerged as important risk predictors for MI. Conclusion: This study, the first to report candidate gene polymorphisms in young Indians with coronary heart disease, has shown no obvious association between the genetic loci studied and acute myocardial infarction. Instead a high prevalence of risk factors, particularly smoking and diabetes mellitus, coupled with coronary-prone behavioural patterns was observed. In the light of these findings, genome-wide screening of unaffected siblings of subjects with early onset CHD cannot be recommended in this population until common polymorphisms can be clearly identified as risk factors. Indeed this study again supports the dire need for early, school level, education in behavioural lifestyle patterns and disease predisposition. The Indian community is a very high-risk group who should be targeted, not for secondary, but for primordial disease prevention measures. The study does not rule out the role of other candidate gene polymorphisms in the pathogenesis of CHD in these subjects. The high prevalence of diabetes and insulin resistance suggests that studies of genes regulating glucose and lipid metabolism should be pursued. Such candidate genes should include genes for lipoprotein lipase and paraoxonase polymorphisms which may explain the dyslipidaemia patterns in this group. / Thesis (Ph.D.)-University of Natal, Durban, 2000.

Thesis (M. Phil.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 111-127).

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2005. / Vita. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin--La Crosse, 2002. / Includes bibliographical references.

M.Sc. (Psychology) / Please refer to full text to view abstract

M.A. / Chronic degenerative disease is responsible for a high percentage of deaths in industrialised westernised communities. These findings are not surprising if viewed in the light that most people consider physical activity not to be a priority in their daily activities. During the last decade, it would seem that employers have realised that the health status of an employee can have a direct influence on productivity, efficiency and absenteeism in the working environment. In an attempt to lower health-related costs, reduce absenteeism and improve productivity, some employers have started implementing a variation of total wellbeing and workers’ support programmes as part of their employee assistance programmes. A pressing question is, however, how effective these wellness programmes are. In order to evaluate the effect of such a programme, the present study used a sample of 76 employees in middle- to top management at a big corporate company. During 2002, tests were performed on twelve CAD risk factors, after which an intervention programme was introduced. Twelve months later (2003), the first intermediate test was conducted, using the same protocol. The second intermediate test followed in 2004, duplicating the procedures. The post-test and data analysing were conducted four years after the first evaluations. Subjects were monitored for changes in: total cholesterol, HDL-cholesterol, LDLcholesterol, triglycerides, TC/HDL ratio, LDL/HDL ratio, fasting blood glucose, systolic blood pressure, diastolic blood pressure, body mass index, waist-to-hipratio and waist circumference. The Repeated Measures General Linear Model Test was used to determine significance (P ≤ 0.05) from pre- to post-test. A novel CAD risk score was also iv developed from peer-reviewed literature by considering each of the 12 CAD risk factors measured. The results demonstrated that the wellness programme decreased CAD risk by 26% amongst the 76 participants in this study. The TC, LDL-C, LDL/HDL-C ratio, TC/HDL-C ratio, fasting blood glucose, resting systolic blood pressure, resting diastolic blood pressure and waist-to-hip ratio improved significantly, while triglycerides showed a non-significant improvement. The three CAD risk factors that deteriorated significantly during the study period were high-density lipoprotein cholesterol, BMI and waist circumference. The major finding of this investigation thus suggests that a corporate wellness programme has long-term beneficial effects on CAD risk and that the reduction in CAD risk is mainly attributed to the beneficial effects of regular exercise.

M.Cur. (Intensive General Nursing Science) / "Patient experiences in a critical contextual, qualitative research phenomenological method to obtain and objectives of the study are: care unit" is a study using the analyse data. The - to establish and describe how myocardial infarction patients experience the critical care unit (CeU) environment, and - to propose guidelines for optimal nursing care. The Nursing for the Whole Person Theory forms the paradigmatic framework of the study. The central proposition states that the myocardial infarction patient's experience of the CCU as his external environment, will have direct impact upon his quest for health. Five participants were interviewed. The interviews were coded by the researcher and an independent nursing specialist, using the Kerlinger method of content analysis. The findings were compared to relevant available literature. Data obtained revealed that certain aspects of the CCU environment generate anxiety and therefore impede the quest for health in myocardial infarction patients! Guidelines for optimal nursing care of myocardial infarction patients were proposed.

Coronary Artery Disease (CAD) is one of the most common cardiovascular disorder in adults. CAD often results in myocardial infarction or angina (Wilson, 2003:21). It is an accepted fact that the incidence of CAD has reached endemic proportions in South Africa (Venter, 1993:15). Coronary Artery Bypass Graft (CABG) surgery, Percutaneous Transluminal Coronary Angioplasty (PTCA) and insertion of a coronary stent are major therapeutic approaches to the treatment of CAD. However, these procedures do nothing to correct the underlying disease process (Hunt, Hendrata, Myles, 2000:389; Venter, 1993:15). Due to physiological changes patients suffering from CAD are expected to make lifestyle adaptations, in order to improve quality of life and prevent further damage to coronary arteries (Gotto, 1987:29). It is suspected that patients do not always adapt their lifestyle when they suffer from CAD, or if they do, do not maintain these adaptations. The following question emerges: • Do patients with coronary artery disease adapt their lifestyle and if they do, do they maintain these adaptations? The purpose of this study is to explore and describe the extent to which patients with CAD who underwent CABG, PTCA or insertion of a coronary stent adapt their lifestyles and to what extent they maintain these adaptations. Secondly, the purpose is to set guidelines to help with the improvement of lifestyle adaptations and contingency of adaptations. The objectives of the study is to explore and describe the extent to which patients with CAD adapt their lifestyles following CABG surgery, PTCA or insertion of a i coronary stent, the comparison of the extent of these lifestyle adaptations after two and four months and to set guidelines to improve the extent and contingency of lifestyle adaptations. An explorative and descriptive study was done in order to explore and describe the extent to which patients with CAD, who underwent CABG surgery, PTCA or insertion of coronary a stent, adapted their lifestyle, and to determine the maintenance of these lifestyle adaptations. For the purpose of this study questionnaires, based on a conceptual framework, were designed. The questionnaires enabled the researcher to explore and describe the lifestyle adaptations that patients with CAD underwent. The study was conducted in five private hospitals in Gauteng. The data obtained confirmed that patients suffering from CAD do adapt their lifestyle after having CABG surgery, PTCA or insertion of a coronary stent. Data also showed that the presence of a cardiac rehabilitation centre at the hospital where participants were treated, has a significant influence on patients’ ability to adapt their lifestyle and to maintain this new lifestyle. / Dr. W.O.J. Nel Ms. W. Jacobs