Background: Lifestyle related non-communicable diseases are now the biggest cause of death and burden of disease in Thailand. NANDA is an evidence- based classification system of nursing diagnosis. Aim: The purpose of the study was to identify and describe the nursing needs of a patient group from a low socio-economic background located in an urban primary health-care setting in Thailand by using NANDA. Method: The study is a structured observation study with a quantitative approach. The study was conducted at a health- center in Bangkok, Thailand. Result: 42 different NANDA diagnoses were identified in the observed group. In total 609 nursing diagnoses were distributed among 96 patients of which 76 were women. The most frequent nursing need diagnosis found was; Imbalanced nutrition; more than body requirement. The most frequent nursing risk diagnosis identified was: Risk for decreased cardiac tissue perfusion. Conclusion: The nursing needs observed in the patient group were mainly related to non- communicable diseases. The disease panorama observed in the patient group coherent with findings in international modern research. Significant relationships and patterns between nursing needs could be identified which strengthens the idea of using an instrument such as NANDA. In conducting the study it was evident that some nursing problems did not match with any diagnosis in the NANDA taxonomy. Clinical impact: The study shows the nursing needs among a patient group with low-socio economic backgrounds in an urban primary health care setting in Bangkok. NANDA is a good tool to systematize nursing care in the nursing profession. It can be beneficial for students in similar situations to use a tool like NANDA to categorize their assessments and impressions. / Bakgrund: Livsstil relaterade icke-smittsamma sjukdomar är numera den största dödsorsaken och sjukdomsbördan i Thailand. NANDA är en evidensbaserad klassificeringssystem av omvårdnad diagnos. Syfte: Syftet med studien var att beskriva och identifiera omvårdnadsbehov hos en patientgrupp med låg socioekonomisk bakgrund inom primärvården i Bangkok genom att använda NANDA. Metod: Studien är en strukturerad observationsstudie med en kvantitativ ansats. Studien genomfördes på en primärvårsinstans i Bangkok. Resultat: 42 olika NANDA diagnoser identifierades i den observerade gruppen. Totalt fördelades 609 diagnoser på 96 patienter, varav 76 var kvinnor. Vanligaste omvårdnadnadsdiagnosen var Obalanserad kost, mer än kroppsbehovet. Den vanligaste omvårdnads riskdiagnosen identifierad var Risk för minskad hjärtvävnads perfusion. Slutsats: Omvårdnads behovet i den observerade patient gruppen var främst relaterat till icke smittsamma livsstilsrelaterade sjukdomar. Sjukdomspanoramat i den observerade patientgruppen var i överensstämmelse med resultat i internationell modern forskning. Att använda NANDA visade sig vara använbart för att organisera och systematisera observationer och data oavsett sammanhang. Signifikanta samband och mönster mellan olika omvårdnadsbehov kunde identifieras. Ett antal identifierade omvårdnadproblem matchade inte med någon diagnos i NANDA taxonomin. Klinisk betydelse: Studien visar på omvårdnadsbehovet hos en patientgrupp med låg socioekonomisk bakgrund i en urban primärvårdsinstans i Bangkok. NANDA är ett bra verktyg för att systematisera omvårdnad i sjuksköterskeyrket. Det kan vara fördelaktigt för studenter i liknande situationer att använda ett verktyg som NANDA att kategorisera sina bedömningar och intryck.

Low-skilled, low socio-economic status, young, co-resident, working fathers: Their experience of fatherhood Using open-ended interview techniques, 23 low-skilled, low socio-economic status fathers aged 20-29 were interviewed about their experience of fatherhood. All participants were in unskilled jobs and all lived with and supported their partners and child/children. This population of fathers is generally overlooked by researchers. Because they take responsibility for some of society’s most vulnerable families and children, understanding how they conceive of their role as fathers can promote the welfare of those families and children. Participants were recruited by casual connections, snowballing and advertisement. The interviews explored the participants' experience of fatherhood and their reasons for being active and committed family members. Focus was given to how they made sense of fatherhood in terms of their life course. Participants had two interviews, the first generic and the second idiographic. Interviews were tape-recorded and later transcribed. A social constructionist approach was used: transcripts were analysed by identifying and examining the primary domains in which participants experienced fatherhood. Participants spoke of fatherhood as an affective activity, the primary object of good fatherhood being to maintain an emotional bond with one’s children. Being a good father was thought to involve eschewing deleterious family practices such as those which had marred their own childhoods. In this regard, participants saw themselves as repairing their family-of-origin's dysfunctional style. Providing was described as a core feature of fatherhood – subsidiary to, but corollary on, being an emotionally-engaged father. Good fathers were described as committed providers, albeit participants did not consider their own limited earning capacity to compromise their fatherhood. Obtaining a job and providing for one’s family was one of the ‘pro-socializing’ effects of fatherhood. Participants considered fatherhood to not only improve but to also redeem their lives, giving a purpose and focus they had lacked prior to their becoming parents. Being a good father also involved being a good partner. For many of the participants, this involved adopting non-gendered roles in the home. The sharing of housework and childcare improved home life by reducing the partner's workload. Those who failed to adopt the gender-neutral stance acknowledged this as a personal shortcoming that they planned to remedy. Fatherhood for these 23 interviewees was one of the few means by which they could obtain social value and status as adults. They lacked access to financial resources, education or supportive family connections, but fatherhood was a domain in which they could present themselves as significant members of society. It also provided a network of emotional relationships which promoted their sense of self-worth and their social and emotional wellbeing.

No description available.

Gestalt theory and Positive Psychology formed the underlying theoretical frameworks of this study. Both Gestalt theory and Positive Psychology adopt a positive outlook towards human nature with the possibility of individuals becoming self-supporting and fully functioning. Both theories also regard awareness to be paramount in establishing healthy self-regulation and optimal well-being. Both Gestalt theory and Positive Psychology provided the link between the concepts, and were also used to describe the main concepts in the study. A review of the literature shows that children living in underprivileged communities often face many environmental stressors that can impact on their well-being and optimal psychological, cognitive, emotional and physical functioning. When this occurs, children are often not able to meet very important needs. They may have to find alternative ways to „survive‟ and protect themselves from certain stressors and cope with their environment. Very often these coping strategies are dysfunctional and certain parts within the child can become cut off or pushed aside, severing healthy contact with the environment. The child may also experience a sense of numbing and lack of awareness of senses, emotions and thoughts. The child is therefore living out of awareness. The literature suggests that the process of artmaking can contribute to facilitating awareness, which can enhance selfunderstanding and possibly lead to a greater sense of well-being. The researcher attempted to explore the kinds of awareness that could be facilitated through the artmaking process. A qualitative research design with a phenomenological strategy of enquiry was used for this study. Seven children in middle childhood living in a low socio-economic community took part in the study. They were between the ages of eleven and twelve years and had suffered some form of environmental stress. They had been subjected to substance and alcohol abuse, violence, death and divorce. Focus groups and semi-structured interviews were used in order to understand what awareness may have been facilitated in children during the art-making process. The data collected were analysed thematically. The results revealed that the art-making process enabled the participants to experience certain kinds of awareness. The participants became aware of certain emotions and feelings like happiness, enjoyment, calmness, pride and mastery, as well as feelings of anger, sadness and denial. The participants were able to recognise and express positive emotions, but it appeared that the more complex emotions were recognised although not expressed. The most common emotion experienced by the participants was the sense of happiness and enjoyment they seemed to feel as they worked with the different art materials. It appeared that the playful nature of the art-making process kept them engaged and in contact with the process. The participants also became aware of a range of tactile experiences that each art medium offered; clay, paint, collage, hand printing and texture rubbings. These tactile experiences led them to an awareness of feelings and associations. The findings also indicated that the participants became aware of a sense of agency, as they appeared to have a sense of control and empowerment over the art mediums. This element of control over the art mediums seemed to afford the participants the ability to change what they did not like in their art work. This ability to change things appeared to feed back to, and enhance, their sense of empowerment. Through the findings of the study, as well as from the literature, this quality of empowerment, control and change is important for children in need living in a stressful environment, as it may foster a sense of agency that they may not find from their environment. Another significant finding seemed to be the participants‟ awareness of their context in terms of an unavailability of certain environmental resources to fulfil their needs, namely financial resources and nurturing. The participants‟ awareness centred around basic survival needs, for example lack of sufficient food, but also their awareness of relational needs and challenges, for example overcrowded households, alcohol-abusing parents and divorce. / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013.

Gestalt theory and Positive Psychology formed the underlying theoretical frameworks of this study. Both Gestalt theory and Positive Psychology adopt a positive outlook towards human nature with the possibility of individuals becoming self-supporting and fully functioning. Both theories also regard awareness to be paramount in establishing healthy self-regulation and optimal well-being. Both Gestalt theory and Positive Psychology provided the link between the concepts, and were also used to describe the main concepts in the study. A review of the literature shows that children living in underprivileged communities often face many environmental stressors that can impact on their well-being and optimal psychological, cognitive, emotional and physical functioning. When this occurs, children are often not able to meet very important needs. They may have to find alternative ways to „survive‟ and protect themselves from certain stressors and cope with their environment. Very often these coping strategies are dysfunctional and certain parts within the child can become cut off or pushed aside, severing healthy contact with the environment. The child may also experience a sense of numbing and lack of awareness of senses, emotions and thoughts. The child is therefore living out of awareness. The literature suggests that the process of artmaking can contribute to facilitating awareness, which can enhance selfunderstanding and possibly lead to a greater sense of well-being. The researcher attempted to explore the kinds of awareness that could be facilitated through the artmaking process. A qualitative research design with a phenomenological strategy of enquiry was used for this study. Seven children in middle childhood living in a low socio-economic community took part in the study. They were between the ages of eleven and twelve years and had suffered some form of environmental stress. They had been subjected to substance and alcohol abuse, violence, death and divorce. Focus groups and semi-structured interviews were used in order to understand what awareness may have been facilitated in children during the art-making process. The data collected were analysed thematically. The results revealed that the art-making process enabled the participants to experience certain kinds of awareness. The participants became aware of certain emotions and feelings like happiness, enjoyment, calmness, pride and mastery, as well as feelings of anger, sadness and denial. The participants were able to recognise and express positive emotions, but it appeared that the more complex emotions were recognised although not expressed. The most common emotion experienced by the participants was the sense of happiness and enjoyment they seemed to feel as they worked with the different art materials. It appeared that the playful nature of the art-making process kept them engaged and in contact with the process. The participants also became aware of a range of tactile experiences that each art medium offered; clay, paint, collage, hand printing and texture rubbings. These tactile experiences led them to an awareness of feelings and associations. The findings also indicated that the participants became aware of a sense of agency, as they appeared to have a sense of control and empowerment over the art mediums. This element of control over the art mediums seemed to afford the participants the ability to change what they did not like in their art work. This ability to change things appeared to feed back to, and enhance, their sense of empowerment. Through the findings of the study, as well as from the literature, this quality of empowerment, control and change is important for children in need living in a stressful environment, as it may foster a sense of agency that they may not find from their environment. Another significant finding seemed to be the participants‟ awareness of their context in terms of an unavailability of certain environmental resources to fulfil their needs, namely financial resources and nurturing. The participants‟ awareness centred around basic survival needs, for example lack of sufficient food, but also their awareness of relational needs and challenges, for example overcrowded households, alcohol-abusing parents and divorce. / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013.

Magister Psychologiae - MPsych / Substance abuse is recognised as one of the greatest health and social problems in South Africa (SA). There is a need to explore the problem of substance use in the South African context in terms of the Bio-ecological Systems Theoretical Framework. All of the reviewed local and international studies on instruments that are used to measure factors associated with adolescent substance use, while yielding useful information; do not adequately address the issues of an instrument that successfully includes all the levels of the Bio-ecological Systems Theoretical Framework at the dimension level. As a result, a need for an applicable instrument exists. The overall purpose of the current study was to evaluate the content validity of the dimensions of the proposed self-administered questionnaire in terms of the Bio-ecological Systems Theoretical Framework, which will assist the factors associated with youth at risk of substance abuse in low socio economic status communities in the South African context. The study was framed in psychometric test theory focusing specifically on the procedures for content validation. It is being increasingly recognized that the development of a valid test requires multiple procedures, which are employed sequentially, at different stages of test construction. Validity is thus built into the test development from the outset. Participants were selected by means of purposive sampling. The sampling method was appropriate since the participants were required to meet certain inclusive criteria. The participants comprised of two groups of community leaders within two different communities on the Cape Flats. An adapted version of the Nominal Group Technique method was employed to collect data. The data for aim one was collected using a self administered questionnaire (Content Validity Questionnaire) consisting of two sections. The first section was presented in the form of a ranking scale with all relevant factors associated with adolescent substance use. The second section of part 1 was in the form of open-ended questions. The second aim was collected in the form of focus groups. Data was analysed quantitatively and qualitatively in the relevant sections. Data collected from the Content Validity Questionnaire (CVQ) was analysed quantitatively by means of statistical analysis making use of frequencies, and the open-ended questions of the content validity and data from the focus groups was analysed qualitatively by means of thematic analysis. The study concluded that all factors presented in the CVQ are important factors associated with adolescent substance use in the two low socio-economic statuses communities that were analysed in both the quantitative and qualitative components of the study.

Philosophiae Doctor - PhD / The purpose of the study was to gather validity evidence for a South African developed instrument designed to measure individual and contextual factors associated with adolescent substance use in low socio-economic status communities in the Western Cape, South Africa. Studies report high rates of substance use in these communities. This possibly points towards the impact of typical post-apartheid contextual factors on the development of adolescent substance use. The South African Substance Use Contextual Risk Questionnaire (SASUCRQ) measures adolescents’ subjective experiences of their own psycho-social and their communities’ functioning.

Educators can no longer simply look at student totals to distribute instructional dollars. Databased decision-making must be instituted to overcome achievement gaps between white and non-white students. In low-socioeconomic (SES) settings, districts must increase expenditure per pupil (EPP) as low-SES rates rise for all students as district administrators must be in a position to show product rather than process. It was attempted to determine if a positive or negative relationship existed between Anglo, Hispanic, and African-American student test scores and wealth factors on the Texas Assessment of Academic Skills tests in 2000 and 2002. Wealth factors studied included EPP and SES. Data analysis was carried out on 974 independent and consolidated school districts in Texas. Low-SES was found to be a negative predictor of higher test performance on standardized reading and mathematics tests. To varied degrees, low-SES affected all students from all ethnicities as well as affluent students. EPP was attributed with a positive effect on student test performance. Increases of $1,000 or more at one time produce performance increases from 0.20 to 0.40 points. In making specific recommendations, the researcher advises increasing expenditures low-SES districts, schools, and classrooms through the creation of specific district linear equations exhibited in this study. Funds must be earmarked for those students that are affected by poverty. It is also recommended to decrease the number of low-SES students by merging high-SES and low-SES students to dilute poverty's effects. Additional correlation studies that address instructional strategies and outside factors are needed. Finally, a replicating study using Texas Assessment of Knowledge and Skills data over a period would be beneficial.

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015