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No description available.

Food consumption patterns and their association with nutrient intake in 290 homebound elderly living in Sherbrooke, Quebec were: investigated. Dietary data were collected using three repeated non-consecutive 24-hour recalls and sociodemographic, physical, physiological and psychosocial characteristics were measured. Factor and cluster analyses were used to define food patterns. Due to the homogeneous dietary patterns of this population, neither the five factors nor six clusters formed were distinct. There were few dietary predictors of nutrient intake as mean intakes of energy, folacin, calcium, vitamin D and zinc by subjects in all clusters were inadequate. Protein intakes were also marginal. Eating beef predicted higher intakes of protein, niacin and zinc for women. Smoking predicted both poorer food choices and nutrient intake. A diagnosis of emphysema predicted higher food intakes. Recommended dietary changes for this population include increased consumption of dairy products and other protein sources as well as energy-dense foods in order to increase micronutrient intake and prevent weight loss in some individuals.

Dissertation submitted to the faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, 2007. / The objectives of this study were: To determine how the frequency of manual work contributes to low back pain in nurses in state versus private hospitals in the Durban area. To determine how the frequency of manual work contributes to low back pain in nurses in state versus private hospitals in the Durban area. Hospital nurses have a high prevalence of low back pain (LBP) (Smedley et al., 2003). It has been found that nursing personnel ranked fifth in occupations claiming worker compensation for low back injuries (Owen and Garg, 1994). A number of studies have also indicated a strong association between musculoskeletal disorders and work related factors (Maul, 2002). An epidemiological study by Smedley et al (1997) has suggested that repetitive lifting, frequent bending and twisting play a role in the development of LBP, and that heavy physical workload has played a major role in the development of LBP in nurses. LBP is therefore a serious problem in the nursing field with a relatively high prevalence worldwide. It causes increased absenteeism from work and could impact on patient care. This study was a survey, which was quantitative in nature. Data was collected by means of a questionnaire. The questionnaires were handed out in randomly selected hospitals in the Durban Metropolitan area. The names of all state and private hospitals in the Durban Metropolitan area were put into two boxes and three names were picked from each box. A letter requesting permission to carry out this research was sent out to each hospital and a positive response was received from one state hospital, R.K Khan Hospital and two private hospitals, Westville and Entabeni hospitals. Questionnaires were handed out to the nurses by the researcher, as requested by the hospitals, and collected at a later time by the researcher. Questionnaires were handed out at each ward in the hospitals to nurses who met the criteria for the study and agreed to participate in this study. Questionnaires were also handed out to nurses in the nurses lounge during lunch breaks. The questionnaire was developed as combination of; a pre-validated questionnaire made available by Yip (2001), questions on socio-demographic data, work history, patient handling activities and LBP. The compiled questionnaire was tested for face and construct validity through a focus group, and piloted before being used in the study. A total of 500 questionnaires were handed, 250 to state hospitals and 250 to private hospitals. Participants consisted of nurses (registered, enrolled and student) between the ages of 18 and 45 years, both male and female. Nurses from all hospital wards were allowed to participate in this study. A total of 124 questionnaires were received back, ( 50 from private hospitals and 74 from the state hospital), from the nurses in all the hospitals. Data was then collected from these questionnaires and was analysed using the statistical package SPSS version 13 (SPSS Inc. Chicago, Illinois, USA). A p value of <0.05 was considered as significant. The data collected from the questionnaires was analysed and the results obtained were as follows: The prevalence of work related LBP in this study was 59.7%. Of the 74 nurses with LBP, only 7 (9.5%) reported having LBP before working as a nurse. 35.1% of participants reported that they experienced pain on a daily basis while 62.2% described their LBP as moderate and 27% described their pain as severe. The median duration of LBP was 3.5hours per episode. Of all the participants in this study, 64,9% had needed bed rest due to their LBP with 43.2% having taken sick leave from work for LBP. Back pain in nurses has been found to be a major cause of days lost due to sickness (French et al., 1997). The majority of nurses (93.2%) reported lifting to be the cause of their LBP, standing and bending were also found to be important causes. Low Back injury was reported in 31.1% of participants with up to 51.4% receiving treatment for their injuries, the main choice of treatment was from a hospital or General practitioner. With regards to the frequency of manual work on LBP, there was found to be a slight tendency toward LBP with more frequent manual activity, however this was viii found to be non significant. In those respondents with LBP, the activity associated with the most intense LBP was carrying or lifting patients. Time spent; standing, holding up hands and bending were found to be higher in the group which reported LBP. Having 1-2 children was also associated with increased LBP. The prevalence of LBP was found to be higher in the state hospital (67.6%) than in the private hospitals (48%). The aim of this study was to determine the association between frequency and intensity of manual work on LBP in nurses. The results showed that frequently performed manual activities were associated with LBP but not significantly. In terms of intensity of manual work, carrying or lifting patients was found to be most associated with LBP, standing and bending were also significantly associated with LBP. This study also aimed to determine any difference in LBP between state and private hospitals and a significant difference in LBP prevalence was noted between state and private hospitals. The findings of this study suggest that LBP is a common problem among hospital nurses. The results of this study were also found to be within the same prevalence rates of international studies, which ranged from 35.9% in New Zealand to 66.8% in the Netherlands (Nelson et al., 2003). As was found in the literature (French et al., 1997 and Smedley et al., 1997), lifting was reported to be a major cause of LBP.

The three phased study aimed to develop policy guidelines for workplace health promotion based on an exploration of the current status of health promotion in South African workplaces. In the first phase of the study a case study approach was used to analyse the current situation of health promotion in the workplace. For this phase of the study the particular aim was to determine to what extent the participating workplaces were involved in health promotion, or were salutogenic in nature. A total of 6 organizations participated in the first phase of the study, with a total of 258 participants. The second phase aimed at developing policy guidelines for health promotion in the workplace. The consensus method, using the Delphi technique, was used in this phase, involving seven participants who were experts in the field of occupational health and health promotion. The third phase was an observation of the implementation of the policy guidelines. Implementation analysis, which is part of evaluation research, was the methodology used. Two organizations from phase one participated in the implementation phase. In summarising the findings on the current situation of employee health promotion programs the study showed that none of the participating organizations emerged as health promoting workplaces. Organizations that offered employee health promotion/wellness programs mainly focused on individual health and on HIV/AIDS and none of them was found to provide comprehensive holistic programs that aimed at providing healthy work environments. In phase 2 of the study it emerged that there was a very strong concurrence between the findings from the experts and literature in terms of what needs to be included in health promotion policy guidelines. The key elements for health promotion policy documents were (1) organizational philosophy (2) stakeholder involvement and (3) the description of programs to be included in the policy. During the policy implementation process it emerged that different strategies were used in the policy development process. This process was largely influenced by such factors as organizational size, type and internal structures. Recommendations include an emphasis on more legislative support for health promotion in the workplace, and for more concrete aids such as policy guidelines and educational preparation of occupational health professionals for this component of their role. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

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This study aims to analyse policy and political processes at multiple levels, and examine the consequences for Sexual and Reproductive Health (SRH) care development arising from the engagement of a participatory movement in Peru. I used Associations of Local Community of Health Administration (CLAS) as a core organisation for Peru’s major participatory model at local level. With policy makers, NGOs, health workers and (potential) service users, I explored factors that facilitated/prevented women’s participation in decision-making mechanisms and health practices. I employed a case study and multi-disciplinary approach at national, regional and local levels, focused upon women from multiple aspects in Andean Peru. I studied rural, periurban CLAS and non-CLAS models to compare across the case studies. I conducted semi-structured in-depth interviews with 116 respondents, unstructured observation, and documentary analysis in 2004. My analytical frameworks focused upon: ‘policy content’, ‘context’, ‘actors’, ‘process’, ‘patterns of participation’, and ‘outcomes and impacts’. Political, economic, legal and technical were identified which reflected the stagnant state of the development of SRH and CLAS policies. The central policy focuses on a narrow sense of SRH care, and neglects Reproductive Tract Infections (RTIs). Central government’s weak political leadership and stewardship to CLAS policies reflected that personal leadership (e.g. regional health directors) can define the destiny of regional CLAS development. Facilitating factors were led by NGOs and mixed factors were led by donors. CLAS appeared to create favourable conditions/environment for women’s participation in the community. Local respondents in the CLAS system understood the importance of participation to solve local problems compared to their non-CLAS system counterparts. Nevertheless, women in CLAS model had no influence on changes of SRH agenda, despite difficulties in the acquisition of contraceptives and effective RTIs medicines. The following actors must be incorporated into the decision-making and evaluation/feedback mechanisms in CLAS model to achieve more gender, age-gentle, and ethnically-sensitive Local Health Programmes and strengthen a rights- and trust-based approach: women’s Grassroots organisations, Defence Committees of Women’s Rights, Community Health Agents, Committees of Communal Development or Health (CODECOS)/(COSACOS), and traditional health providers. Alternative relationships (e.g. rapprochement) between CLAS and government authorities must be sought.

This research examines sexual health (SH) policies and experiences of youth, using the Maldives as a case study. Youth SH is a controversial and under-researched issue in The Maldives, an Islamic state where premarital sexual activity is a punishable offence. This thesis addresses the question: To what extent, and why is there a mismatch between official Maldivian SH policies, services and data and the lived experiences of youth in Maldives? It is a mixed methods study involving four research methods and sets of data: i) qualitative in-depth interviews (n=61) with youth aged 18-24 years from three sites within the Maldives; ii) key informant interviews (n=17) with policy actors and service providers; iii) a web-based quantitative survey of Maldivian youth (n=480); and iv) secondary analysis of the Maldives DHS 2009. There are four main findings from this research, three of which are substantive, and one of which is methodological. Sociocultural and religious factors heavily influenced policymaking, service provision and youth experiences. Contrary to most theocratic states, the SH policymaking process in the Maldives is shaped by policy actors and institutions whose strengths have more sociocultural basis than religious expertise. Whilst published official data and original secondary analyses of the MDHS suggest that premarital sexual activity among youth is very limited; this thesis finds extensive reporting of sexual activity. This contrast was also reflected in youth’s knowledge of STIs- where official data displayed a higher level of awareness than found through in-depth interviews and the web-based survey- and their experience of unwanted pregnancies and abortions, which appear to be under-reported in official data. Analyses of the web-based survey using the same questions as the DHS show significantly higher levels of reporting of sexual activity, showing a strong modality effect on survey response. Results from the web-based survey demonstrated that if sociocultural factors were removed from questionnaire design (e.g. censorship of certain issues) and administration (e.g., privacy and anonymity- difficult to achieve in small island communities typical of the Maldives); it is possible to improve response rates and quality of the data. Finally, this thesis highlights two key characteristics of the relationship between SH policy, services, data and youth experiences in the Maldives. Firstly, youth SH experiences appear to be disconnected from SH policies, services and data. Secondly, there is a mutually reinforcing relationship between official SH data and policies, where restrictive policies dictate the type and extent of data that may be collected, which then reinforce justifications for the current restrictive policies and limited services. Policy implications of this research include identifying and addressing the links between SH policymaking and religious and sociocultural factors, and addressing the subsequent effect on SH policy and services for youth.

Menstruation is a large problem for females in development countries today. Studies have shown that around 40 percent of menstruating girls have been absent from school due to their menstruation. One of the challenges that need to be solved is the absence of female hygiene products amongst women, especially in low income and developing countries due to the cost of commercial products. In countries where the national economy is unstable or poorly comes a problem with importing products, it would be better if they could produce their own products so that the national economy is supported. Small factories and production sites that produce female hygiene products have started to form in some areas. This shows that it is possible to produce in the context where the product is going to be sold. One of the advantages of this system is from the environmental perspective, many of the local production sites use environmentally friendly materials and some products are up to 95 percent bio-degradable. The purpose of this thesis is to develop a concept for a sustainable female hygiene product that women in developing countries can afford to buy, this so that social effects can be enabled due to the security that a functioning protection can bring. To be able to do so a field study in Uganda has been conducted. During the study users and local producers were interviewed to find out what demands and prerequisites there are to create a female hygiene product that can be produced and used locally. The field study gave a deeper understanding and knowledge about both the subject as whole and the technical aspects to take into consideration when developing a female hygiene product. The study confirmed that female hygiene products, or rather the lack of them, are a big problem that needs to be solved quickly. It also revealed that the possibilities for producing in the context existed but was not developed enough. Through an analysis of the empirical findings as well as theories about, for example, material and production, six concepts were developed. The concepts and already existing products were evaluated and correlated to requirements collected in the field study. One concept was chosen for further development from this evaluation. This concept consists of a disposable napkin that is fastened by putting it in holders sewn in the panty. The panty can be bought as a product with existing holders or the holders can be sewn into the users own panties. The final concept has taken both technical aspects and social effects into account. Lists of requirements on material for the concept as well as the production of it are also included in the work. A prototype of the concept has been sewn and tested. The final concept in this work is not a finished product and needs further developing before being released as a product. More work need to be done on specifying the production and specific materials to implement the concept. For further developing, it is also important to have in mind in what context the product would be used due to the different possibilities and demands that the setting gives.