Analysis of current pastoral care practice, particularly of Christian pastoral care providers and chaplains, reveals a contemporary lacuna in Christian theological frameworks which contributes to North American Christians’ inability to connect a theological understanding of death with the experience of their human finitude despite the presence of considerable literature on death and dying. This gap deprives many Christians of the possibility of finding a unique and specific source of hope and strength within their own faith tradition for facing crisis. This thesis provides a methodology and theological foundation for a uniquely Christian contribution for facilitating hope, resilience--even transformation--throughout the various stages of life until the time of death. Extensive analysis of Christian views of death, as contrasted with non- Christian views, examined through early Christian writings, late Medieval and early Reformation texts, and the late twentieth century work of Moltmann contributed insights into theological frameworks to remedy the gap and also uncovered themes, metaphors, and language that could be important as Christians interpret life experience and dying. The thesis then utilized three contemporary fields of study to apply the insights into a practical ministry model: (1) research in resilience; (2) Narrative Therapy as developed by White and Epston and utilized by Christian therapists; and (3) hermeneutic theory from Capps, Browning, and Gerkin. Insights from these sources were critically evaluated for application in pastoral counselling, support, and education to help people, both in crisis and when facing death, find a substantial hope that transcends the reality of what they are experiencing. This thesis proposes a distinctively Christian response to death that enables people to retain a sense of their own worth and dignity in order to live meaningful lives until they die. Many people find 21st Century healthcare impersonal and non-empathetic; the work of this theses is intended to be important for helping people regain their sense of self and identity, thereby supporting healing and resilience. In addition, the thesis proposes pedagogic and theological reflection methods that would enhance the practice of chaplains in a rapidly changing healthcare environment that will increasingly require them to demonstrate how their practice enhances the wellbeing of those they serve and provides a contribution that is unique and has value to the healthcare system.

Magister Public Health - MPH / Background: Maternal mortality is a significant public health problem world-wide,as it is an important indicator for the functioning of the health system. The maternal mortality ratio for Botswana is higher than other countries with comparable economic growth, despite impressive access to health services. In order to develop relevant programs and policies to reduce maternal mortality, the factors associated with maternal mortality were studied. The study aimed to describe the maternal and health services factors associated with maternal mortality in South East Botswana. Methodology: A quantitative case-control study was used to retrospectively review medical records for 71 cases of maternal deaths and 284 controls randomly selected from mothers who delivered in the same year and at the same health facility, in South East Botswana from 2007 to 2009. Information was collected on the maternal and health services characteristics of the cases and controls including age, level of education, marital status, parity, utilization of health facilities that consist of antenatal care (ANC), type of delivery, complications during pregnancy, type of health facility and ANC provider. Data was analyzed using Predictive Analysis Software (PASW) Version 18.Two-sample t- test, Pearson’s Chi-square test and the Fisher’s exact test were used to test the difference between the proportions of the various categories of variables in cases and controls. Univariate logistic regression analysis was applied to identify the risk factors associated with maternal deaths. A multivariate logistic regression model was estimated to see the joint effects of the identified risk factors for maternal mortality. Hosmer and Lemeshow test was used to test the goodness of fit of the model. Results: The mean age of the maternal deaths was 28.0 ± 5.3 years and they had taken place at a hospital (100%). A large number of deaths occurred before delivery(59.0%). The causes of maternal death included both direct (73%) and indirect causes (27%). Direct causes were the leading causes of death and they were abortion(22.5%) and haemorrhage (18.3%). The maternal characteristics associated with maternal mortality were having complications at delivery (OR=20.91), not receiving ANC (OR=6.31) and delivering by caesarean section (OR= 2.66). The health facility characteristics associated with maternal mortality were delivering outside the health facility (OR=14.78), having been referred from another facility (OR=8.62) and delivering at a general hospital (OR=5.91). The data produced a model with good fit that included one maternal risk factor and three health facility risk factors. These were being admitted with preterm labour, delivering at a general hospital or before arrival at the health facility and having been referred from another health facility. Conclusion: Maternal mortality was associated with both maternal and health facility risk factors. The model developed may be used to identify and manage highrisk women to reduce the number of maternal deaths. It was recommended that, the current system should continue to be monitored and evaluated through the Maternal Mortality Monitoring System (MMMS). Furthermore, the referral and management of complications needs to be strengthened through a multi-sectoral approach.

Class of 2012 Abstract / Specific Aims: The objectives of this study were to determine the financial impact and mortality of CLL and Richter’s transformation in CLL in the inpatient setting in the payer’s perspective, the common diagnoses at discharge for patients with CLL, and to compare demographics, hospital characteristics, and co-morbidities for CLL cases versus Richter’s only cases. Methods: This study was a retrospective cohort of inpatient hospital charges and mortality of CLL patients and CLL patients with Richter’s transformation in the United States in the perspective of the payer. Using weighted statistical methods, results of this investigation yielded nationally-representative findings. The hospital charges were analyzed with a gamma regression with log link, and mortality was analyzed with a generalized linear regression. Main Results: There were total of 391,287 cases and 7% (27,259) were Richter’s cases. The overall hospital charges for CLL and CLL patients with Richter’s transformation from 2005 to 2009 were $38,735 (±58859) per case and $53,118 (±77993) per case, respectively. The mortality was 6.3% (24,520 deaths) overall and 9.1% mortality (2,485 deaths) for Richter’s transformation patients. The significant predictors (p < 0.05) that were associated with an increase the hospital charges for Richter’s patients was sepsis while sepsis and weight loss were associated with an increase in mortality. Conclusions This study adds to the few studies published to show the impact of CLL and Richter’s. However, due to the limitation on pharmacotherapies, it was not possible to determine therapeutic cost drivers for these cases. Future studies are warranted to determine the cost of therapies associated to the different stages of CLL.

The aim of this thesis was to analyse detailed data on the development of infant mortality for different countries and their comparison. The countries were selected from several parts of Europe to provide high quality data for analysis. Different components of infant mortality with respect to data availability were examined as well as infant mortality by gender. Comparisons among selected countries were made based on different variability measures. Largely, the thesis deals with infant mortality depending on the level of development of the countries. Using regression and correlation analysis, infant mortality dependence was determined on various determinants with prerequisites to explain part of the infant mortality variability. The selected determinants include, for example, GDP per capita, unemployment rate or life expectancy.

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Introduction.: The evaluation and improvement of the quality of health care services begins with the knowledge about the trends and causes of diseases. Purpose: To describe the morbidity and mortality patterns for the under-5 year old children who were admitted in 11 district hospitals in Eastern Cape Province from 2000 to 2004. Methods: Descriptive study where a multi-stage sampling technique was used to select 11 district hospitals. There were 25,122 causes of paediatric ward admissions (2000 to 2004) among under-5 children from ward register were reviewed and ICD-10 coded. Findings: Pre-transitional causes were the leading causes of morbidity (68.4%) and mortality (74.2%) especially diarrhoeal lower respiratory tract infections and protein-energy malnutrition. There was particularly among male high infant morbidity and mortality rates observed from 2000 to 2004. Non-communicable diseases (8% morbidity and 4.2% mortality) and injuries (10% morbidity and 4.4% mortality) appeared to be of less public health concern among the under-5 children. Majority of under-5 mortality (43.4%) occurred within 24 hours of admissions (23.7% died on arrival). Influential variables for morbidity and mortality were region (Eastern), age (infants), year admitted and broad classification of the diseases (group I causes). There was a constant increase in morbidity and mortality which was observed during studied period. Conclusion: Pre-transitional causes (especially diarrhoeal, lower respiratory tract infections and protein energy malnutrition) were of public health concern among the under-5 children and their magnitude has increased over the years studied. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Clinical Epidemiology / unrestricted

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Background Previous measurements of preventable death in hospital do not account for the uncertainty of preventability ratings. Objective To determine the proportion of deaths in hospital that a have high probability of being prevented with high quality care. Methods We created summaries for every death at a tertiary care hospital over 4-months. Four reviewers assigned preventability ratings to each death and latent class analysis was used to classify deaths into high and low preventability categories. Results There were 480 decedents with mean age of 73.9. Inter-rater reliability was poor with an intra-class correlation of 0.14. The best latent class model found that 6.2% (95% CI 0.00 – 15.2%) of deaths had a 31.0% probability of being rated more likely preventable than not by each reviewer. In contrast, 93.8% (95% CI 84.8 - 100.0%) of deaths had a 0.8% probability of being rated more likely preventable than not by each reviewer. The incidence of truly preventable deaths is less than the 6.2% that are deemed possibly preventable. xi Conclusion Very few deaths in hospital are preventable. The low incidence of preventable deaths and low inter-rater reliability means that peer review methodology is only sensitive to large differences in preventable death rate.

The objective of this thesis is to find patterns trends and assumptions for mortality vs. age prediction. Based on the analysis of trends in the already extinct cohorts, the most suitable models for estimating the future development of mortality among surviving cohorts are selected. This thesis compares real data extinct cohorts with balanced data Gompertz-Makehamovy function. The research and analysis is focused on the specifics of cohort mortality from the age of 90. The last part of this thesis illustrates comparison between real data of extinct cohorts with DeRaS model outputs. The selection of Kannisto and Thatcher as the optimal model is presented in the form of graphical outputs indicating the cohort life expectancy of men and women aged 90 years.

The survival data for two hundred patients who underwent coronary bypass surgery are subjected to quantitative analysis. The questions of interest are: (i) the long-term survival rates of these patients, (ii) the prognostic factors influencing survival, and (iii) the importance of types of grafting in long-term survival. Statistical methods used to ascertain the important prognostic variables include contingency table analysis and discriminant analysis. It is found that left ventricular function, age, risk classification, and extent of occlusion of the diseased artery are the most influential variables. The relationship of these variables to survival is analysed in detail using the proportional hazards model discussed by Cox (1972). / Science, Faculty of / Statistics, Department of / Graduate