<p> HIV infection is a leading cause of morbidity and mortality in our country today with nearly 1.2 million Americans living with HIV infection. Early recognition of infection is imperative for appropriate initiation of treatment to prevent comorbidities. Additionally, identification of infection can serve as a primary preventative measure to reduce spread of the disease. National organizations have supported the initiation of routine screening policies for HIV in health care settings. Primary care providers are uniquely positioned to be able to offer HIV screenings and identify infected persons very early in the course of the disease. Despite support for routine testing in the literature and by national evidence-based guidelines, testing is still not offered routinely in the primary care setting. The purpose of this project was to explore if a clinical reminder improves the frequency of HIV screening offered in a rural primary care clinic (PCC) located in Central Louisiana. Results of the project did show a statistically significant increase in the frequency of HIV screening offered following implementation of the clinical reminder system.</p>

<p> This dissertation, composed of three manuscripts, provides a foundation for sleep disorders screening in primary care. The first manuscript presents a concept analysis of sleep to guide nurses&rsquo; understanding of how sleep impacts patients. The first manuscript is currently under review in the Nursing Forum journal. A framework for sleep disorders screening in primary care is presented, and followed by a systematic review of the literature to identify questionnaires that might be suitable to screen for sleep disorders in primary care. Several candidate questionnaires are identified, but none of those meet both thoroughness and brevity criteria postulated as necessary for use in primary care practices. The second manuscript is currently under review in Sleep Medicine Reviews. The third manuscript introduces the sleep disorders screening checklist (SDS-CL), previously used for research. The SDS-CL meets both thoroughness and brevity criteria but has not yet been validated for primary care application. Psychometric properties of the SDS-CL are evaluated with data from a sample of n=694 adults representative of the primary care population. Psychometric properties of the SDS-CL are favorable for primary care application. The third manuscript is currently being prepared for submission to a journal focusing on primary or preventive care medicine. Finally, future studies are recommended.</p>

Background: South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their perspectives and experiences on end of life and its related care. Aim: To explore and critically examine views and perceptions about end of life issues among older South Asians living in East London. Methodology and methods: After gaining ethical approval, five focus groups and 29 in-depth, semi-structured interviews were conducted with total of 55 older adults (24 men and 31 women) aged between 52 to 78 years. Participants from six South Asian ethnic groups were recruited through 11 local community organisations. Where possible the focus groups and interviews were conducted in the participants' preferred language. Tape recorded multilingual data were translated and transcribed into English. Using a constructive grounded theory approach, data analysis resulted in the development of a theory of “continuity and reconstruction” that captured three categories of ‘home’; ‘family’ and ‘trust’ at end of life. Findings: The theory of “continuity and reconstruction” is explored in three ways. Firstly, the theory is explored through examination of beliefs, attitudes and expectations about the place of ‘home’ and ‘homeland’ in care of the dying. Secondly, the theory is explored as accounts of “family” in terms of how family are bound towards caring for their dying relatives at end of life and the importance of support from social networks in family care giving. Finally, the theory is explored in terms of how participants place “trust” in their family and medical professionals to lead any related discussion and to make decisions related to their death and dying. Conclusion: The theoretical framework of “continuity and reconstruction” explains how older South Asians make efforts to adhere to important social and cultural values relating to death and dying, while rebuilding and adapting those values during the challenges of living in an emigrant society. This study highlights the need for further exploration of family care giving needs among South Asian population and concludes by drawing attention to some practical implications for health professionals who are responsible for initiating end of life discussions and are involved in end of life decisions when caring for people from these ethnic minority groups.

This thesis presents a pluralistic evaluation of the services provided for women with long-term mental health problems receiving care and support within the Rehabilitation and Community Care Service (RCCS) in Nottingham. The thesis is grounded in data collected within an evaluative research framework and developed within a mental health policy framework. The evaluation consists of a series of six studies which are informed by a set of evaluation criteria which reflect a range of stakeholder perspectives. The first study examines the socio-demographic and psychiatric characteristics, social functioning and service use of all 480 clients registered with the RCCS. The clients' characteristics are similar to those described in previous studies. There are some• differences between the men and the women, notably that the women are under-represented amongst those receiving a high level of input from the services. The second and third studies explore the extent and adequacy of services for women with long-term mental health problems in the Nottingham district through interviews with small groups of service providers working throughout the RCCS, and through a postal questionnaire to thirty eight organizations outside the RCCS. Special provision made for women is patchy, and there is no overall strategy to ensure even provision throughout the RCCS and the organizations outside the service, or co-ordination between them. The fourth study assesses the initial socio-demographic and psychiatric characteristics, social functioning, satisfaction with services, and quality of life of 31 men and 10 women at their time of entry into the RCCS and one year later, and their use of all services during this time. The women experienced a greater number of life events than the men, changed their accommodation more frequently, and the services appear to be less responsive to their particular needs. The outcome after twelve months shows that overall the social functioning and quality of life of the clients had not improved. There were some changes in service use, notably the greater number of clients living independently. The fifth study uses semi-structured interviews to explore the problems service providers experience in planning and delivering a service to women with long-term mental health problems. Two overriding themes emerge from the data; service providers as empathic women, and service providers as professionals, which lead them to experience a conflict between respecting the rights of women with long-term mental health problems and protecting them. The final study uses focus groups to explore the impact of mental health problems on the lives of women with long-term mental health problems, and their views of the services they currently receive. Three themes emerge from the data; loss, hope and views about services. Despite overwhelming losses many of the women retain hopes and aspirations for the future. The women identify negative and positive aspects of the services they are receiving together with some recommendations for change. The thesis contributes to current knowledge about the experiences of women with long-term mental health problems in a number of ways. First, the findings of the six studies which make up the evaluation highlight the ways in which the RCCS was successful in meeting these women's needs, and the many gaps in existing provision. Second, women with long-term mental health problems can give coherent and comprehensive accounts of their experiences. Third, the findings illuminate the current predicament of women with long-term mental health problems which is that they remain excluded and marginalised from the communities where they are now living.

In the United Kingdom (UK), an estimated 107,800 people were living with HIV in 2013, of whom 55% were heterosexual men and women. Black African men and women accounted for the majority of heterosexuals living with HIV in the UK in 2013. In this PhD by prospective publication my research question is “How is the epidemiology of heterosexually-acquired HIV infection evolving, particularly among black Africans, in England, Wales and Northern Ireland?”. I conducted a quantitative analysis of national surveillance datasets and undertook literature searches. Most of my analysis was based on data from the three national HIV surveillance systems which constitute the HIV and AIDS Reporting System (New HIV Diagnoses database; Survey of Prevalent HIV Infections Diagnosed; CD4 Surveillance Scheme). I published the results of my analyses in six peer-reviewed papers between 2007 and 2014. My key findings were as follows: over the last decade an increasing proportion of black African heterosexuals born abroad but diagnosed with HIV in the UK acquired HIV whilst living in the UK; outward migration from the UK may explain why some black African heterosexuals were lost to follow-up from HIV care; the proportion of black African heterosexuals diagnosed late with HIV has not changed substantially; the uptake of HIV testing among black African heterosexuals has increased over time but remains low compared with that among MSM. To minimize the risk of HIV transmission and to maximise the benefits of earlier detection my key recommendation is to promote regular HIV testing among black African women and men in a range of healthcare and community settings in E,W&NI, particularly in primary care.

Alzheimer’s disease (AD) is a devastating neurodegenerative disorder which is thought to affect 26.6 million individuals worldwide. There is growing concern over a worldwide dementia epidemic that is predicted to develop over the coming decades. The evidence thus far suggests that increased levels of oxidative stress and vascular risk factors are two major contributors, amongst others, to AD development. The thesis aimed to investigate markers of oxidative stress in AD plasma. Moreover, the oxidative status of specific proteins was investigated using both hypothesis driven and proteomic approaches. Results presented in this thesis suggest that global plasma protein oxidation levels are not different when AD and control subjects are compared, but that individual plasma proteins are specific targets for oxidative modification in AD. The thesis explores different methodologies to assess oxidative changes in AD. In addition it demonstrates that emerging novel and powerful mass spectrometry techniques can be employed successfully to identify several proteins modified by oxidation, providing an initial starting point for further investigation.

Thesis (M.A.(Applied))--Victoria University of Wellington, 2006. / Includes bibliographical references.

Thesis (Ph. D.)--University of Chicago, Department of History, December 1999. / Includes bibliographical references. Also available on the Internet.

Thesis--Københavns universitet. / Summary in English. Bibliography: p. [149].

Antimicrobial resistance is an international public health problem and is associated with increased morbidity, mortality, and healthcare costs. Antibiotic consumption, particularly indiscriminate use of these agents, is recognised as a major cause of resistance. Clinical guidelines recommend that in otherwise healthy individuals, antibiotics should not be used in the management of acute dental conditions, in the absence of spreading infection and systemic upset. Instead, a surgical intervention should be the first-line treatment for such problems. This thesis describes the use of antibiotics for acute dental conditions in primary care in the UK, and explores factors that influence prescribing for dental problems using a mixed methods approach.