Abstract not available

Interventions are needed to improve health outcomes by increasing the practice of evidence based medicine ( EBM ). Patient mediated interventions have been little studied but hold promise : they target identified barriers to EBM and particular types of patient mediated intervention have shown success. Furthermore, consumers are now being given information about evidence but the effects of this on EBM have yet to be properly assessed. The aim of this study was to show whether informing patients about research evidence leads to improved application of that evidence in their medical care. The study trialed a relatively low cost manual, developed using current best practice, which summarised Cochrane Reviews of evidence. The study focused on chronic obstructive pulmonary disease ( COPD ), a high - cost, high - burden chronic disease, showing a large gap between evidence and clinical practice. The study comprised a controlled before - and - after trial and a process evaluation. The trial assessed the success of this manual in changing medical practice for three indicator treatments ( influenza vaccination, bone density testing and pulmonary rehabilitation ) and in changing patient quality of life, knowledge, communication with doctor, satisfaction with information and anxiety. Results were analysed by median split of socioeconomic disadvantage. At 3 months the manual was associated with lower anxiety for participants with lowest socioeconomic disadvantage. At 12 months the manual was associated with higher pulmonary rehabilitation enrolment for participants with greatest socioeconomic disadvantage. Other outcome measures showed no significant change. Limitations included loss of power from unexpectedly good baseline care and adjustments for baseline differences. The process evaluation showed that the manual was read more than a control pamphlet at both 3 and 12 months but a minority of manual recipients reported talking to their doctor about topics from the manual. Very little treatment change was reported. Patient attitudes to evidence and doctor / patient communication norms appeared to be barriers for this patient group. New protocols for the design of behavioural interventions provide a framework for overcoming these barriers in future interventions. / Thesis (Ph.D.)--School of Medicine, 2006.

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

No abstract available. / Thesis (M.Med.)-University of KwaZulu-Natal, 2004.

To investigate the possibility that malnutrition is an important factor that prolongs respiratory failure (PRF), I studied the effects of pharmacologic injections of recombinant human growth hormone (rhGH), an important anabolic stimulus, on nutritional and respiratory parameters in patients requiring mechanical ventilation for more than three days. Patients were excluded from consideration if dominating factors known to prolong ventilatory failure had not been stabilized. Over ten months, 106 patients in PRF were evaluated, but only six met the selection criteria. Three patients were randomized to receive standard nutritional support, and three into a group that received the equivalent nutrition plus 5 mg/day of rhGH for 14 days or until withdrawal of mechanical ventilation. Baseline characteristics of the selected patients were divergent as demonstrated by body mass indexes ranging from 14 to 42 (kg/m$ sp2),$ baseline maximal inspiratory pressures (PI$ sb{ max}$ from $-$15 to $-$70 cm H$ sb2$O, and Day 1 N balances from $-$13.5 to 1.2 g N/day. Despite increased plasma insulin-like growth factor-1 concentrations, the mean daily N balances of the rhGH-treated group were no better than the controls (1.3 $ pm$ 5.0 vs. 0.4 $ pm$ 2.6 g N/day; Mean $ pm$ SD), nor were there differences in PI$ sb{ max},$ level of ventilatory assistance required, and days to weaning. The persistence of respiratory failure in the overwhelming majority of patients in PRF appears to be due to factors already known to prevent weaning from mechanical ventilation. Even the carefully selected patients enrolled in the present study were insufficiently homogeneous or stable enough to allow proper testing of the experimental hypothesis.

A cross-sectional epidemiologic survey of the respiratory health status was conducted in the adult (15 years and older) Indian South African population resident in Lenasia, Johannesburg to study the distribution and determinants of respiratory symptoms, disease and lung function level. A slightly modified self-administered version of a standardised respiratory health questionnaire and a wedge spirometer was used. There were a high proportion of current smokers among men. Although women smoked less than men in other communities they nevertheless smoked on average more heavily than other Indian South African women. Indian men and women who smoked had a high prevalence of respiratory symptoms. The women also demonstrated an increased susceptibility to the effects of cigarette smoking when compared with women in other communities. Indians in this study had spirometric lung function levels that were lower than that recorded in recent studies in Blacks and Whites in South Africa. Respiratory symptoms, disease and lung function level were examined in a multiple logistic regression model which contained all the potential determinants recorded in the present study. Voluntary tobacco smoking, recent chest illnesses and any kind of heart trouble was associated with a significant risk for having most of the respiratory symptoms and diseases in men and women. In addition exposure to dust in the work environment, little or no exercise,>Std. 8 education a history of any kind of chest trouble and respiratory trouble before the age of 16 years was associated with an increased risk for having respiratory symptoms in men in this model. An increased risk for respiratory symptoms was demonstrated in women only with age. Age and standing height were the most important determinants of lung function level in men and women in the regression model. Dust exposure in the work environment was associated with a significantly lower lung function level in men. Alcohol consumption and a history of whooping cough was also independently associated with a lower lung function level in men but were of borderline significance. In women involuntary /passive tobacco smoke exposure and respiratory trouble before the age of 16 years were associated with a lower lung function level. Women who spent most of their lives in a rural area and those who had a university education had a higher lung function level. The deleterious effects of smoking on lung function were minimal in this study possibly because lung function was performed only in subjects in the 18-45 year age category. A "healthy smoker" effect was demonstrated in men. Men who ever smoked and were without cardiorespiratory symptoms had significantly higher lung function levels compared to men who never smoked and were without symptoms. / Thesis (M.D.)-University of Natal, Durban, 1992.

Introduction: Respiratory tract symptoms (RTS), common in athletes during heavy training and after events, result in impaired readiness for events and race times. Since the 1980’s exercise immunologists have investigated the aetiological factors surrounding the development of exercise induced RTS in order to develop effective preventative strategies. A number of theories have been put forward and explored, such as increased susceptibility to infection, ‘run-away’ inflammatory response and reactivation of prior viral infection. It has been suggested that the mechanisms producing exercise induced inflammation could potentiate allergic responses in sensitized individuals and recently allergic response has been proposed as a potential contributor to exercise induced RTS. Certainly allergic reactions can produce a range of respiratory symptoms; however the relationship between allergic sensitization, allergic reaction and the incidence of post-exercise RTS has not been well defined. Objectives: The primary objective of this study was to document the incidence of RTS for two weeks before and two weeks after a three-day trail run and relate these to the general systemic and salivary immunological profile as well as atopic status of the participants. The secondary objective was to validate the use of the Phadiatop® assay as a predictor of allergy-associated post-race RTS in trail runners. Study Design and Methods: The study formed part of a larger, descriptive field study examining the physiological responses of trail runners during the Three Cranes Challenge, a multi-day 95 km event divided into three stages, in Karkloof, KwaZulu-Natal. Outcome measures examined included self- reported RTS over a 31 day period (pre, during and post race), as well as pre-race Phadiatop® status, salivary IgA (sIgA) concentrations and changes in concentrations of serum IgE (sIgE), cortisol, high sensitivity C-Reactive Protein (hs-CRP) and differential leukocyte counts. The haematological and salivary parameters were obtained at 8 time points before, during and after the event. A convenience sample of 22 individuals was used and two separate analyses were conducted on the data. The inclusion criteria of the first analysis were met by 14 participants. In this analysis, the incidence of RTS was related to each participant’s general immunological profile. Sixteen of the subjects met the inclusion criteria for the second analysis, in which their Phadiatop® status was related to their sIgE and blood eosinophil and basophil concentrations in order to establish the validity of the Phadiatop® assay in predicting the development of allergy–associated postexercise RTS in trail runners. Results: In the first analysis, 78.6 % (n=11) of subjects met the criteria for positive diagnosis of upper respiratory symptoms (URS) during the two week post-race period. In four subjects (36.4 %), URS appeared to be of inflammatory origin, but these were not linked to systemic markers of an allergic response. Of the URS positive subjects, six (54.5 %) presented with markers of infection, three (27.3 %) with markers of a de novo infection and three (27.3%) with a profile suggestive of reactivation of previous infection. Of those presenting with markers of infection 66.7 % (n=4) had concomitantly elevated levels of IgE suggestive of allergic response. There was, however, no evidence of isolated allergic reaction independent of other causes amongst the symptomatic subjects. In the second analysis, 75% (n=12) of runners presented with post-race RTS and seven of these were Phadiatop® positive. In four of the Phadiatop® positive RTS subjects, symptoms appeared to be of allergic origin. Although total IgE concentrations were significantly higher (p< 0.01) in Phadiatop® positive group, there was no significant difference between the eosinophil and basophil concentrations or post-race RTS of the positive and negative groups (p>0.05). Of the four subjects who did not develop RTS, three were Phadiatop® positive. Conclusion: Respiratory tract symptoms in trail runners have a multi-factorial aetiology. A link between concurrent markers of an allergic response and infection is common in symptomatic trail runners. The Phadiatop® assay does not accurately predict the incidence of allergic postexercise RTS in trail runners. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Westville, 2012.

Aim The aim of this study was to determine the contribution of occupational exposures to the burden of Chronic Obstructive Pulmonary Disease (COPD) among a sample of hospital based patients. Methods Cases (n=110) with specialist physician diagnosed COPD from the three public sector specialist respiratory clinics in KZN and controls (n=102) from other nonrespiratory chronic ailment specialist clinics at the same institutions were selected. An interviewer administered questionnaire and exposure history was obtained for each participant. In addition, a valid lung function test was obtained for each case. Data was analysed using STATA version 10. Multivariate regression models were developed to examine the relationship between COPD and occupational exposures while adjusting for age, sex, smoking and previous history of tuberculosis. The relationship of FEV1 and occupational exposures, adjusted for age, height, previous history of tuberculosis and smoking history, was investigated among cases. Results Cases and controls were similar with respect to age and sex distribution. Cigarette smoking differed significantly between cases and controls with a larger proportion of cases having ceased to smoke compared to controls (72% vs 46%, p<0.01). A higher proportion of controls reported employment in administrative, managerial and quality control positions (21.3% vs 12.0%, 7.7% vs 2.6% and 5.4% vs 0.3% respectively). Employment in the construction and shoe manufacturing industries was reported more frequently by cases (10.3% vs 3.2% and 10.0% vs 4.9% respectively). Cases were more likely than controls to have been exposed to dust (72% vs 28%, p<0.001) or to chemicals, gas or fumes (74% vs 25.5%, p<0.001) and reported exposure durations 3-4 fold higher than that of controls (p<0.001). Dust and chemical, gas or fume exposure was associated with an increased odds of developing COPD. Exposure to dusts (OR 7.9, 95% CI 3.9-15.7, p<0.001), chemicals, gas or fumes (OR 6.4, 95% CI 3.2-12.8, p<0.001) were significantly associated with odds of developing COPD. In addition, previous history of tuberculosis, as well as smoking were associated with an increased odds of COPD (OR 5.7, 95% CI 1.2-27.4 p<0.001 and OR 6.4, 95% CI 2.3-17.7, p<0.001). Discussion and Conclusion This is one of the first hospital based case-control studies looking at occupational contribution to COPD undertaken in South Africa. In this sample of participants, strong associations were observed between self-reported occupational exposures to dust, and chemicals, gas or fumes, and physician’s diagnosis of COPD. The study also demonstrated a strong association between smoking and previous history of tuberculosis, and risk of COPD. The findings suggest that persons with known occupational exposures to respiratory irritants should be monitored to detect the onset of respiratory ill-health and that preventive strategies should reduce exposure to these agents in the workplace. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2009.