Philosophiae Doctor - PhD / Background: Non-communicable diseases (NCDs) continue to rise in South Africa, accounting for 43% of total deaths in 2012. Smoking and a diet high in salt are among the major modifiable risk factors for NCDs that can be addressed through cost-effective policy interventions in the form of regulation or legislation and active multisectoral engagement. Population-based prevalence and mortality data are necessary for monitoring and evaluation such interventions. South Africa has developed a National Strategic Plan for NCDs but there is limited evaluation of NCD policies. Furthermore, there is a need to explore the availability of population-based data and the role that it can play to monitor interventions. Aim: The overall aim of the thesis is to assess the implementation of policies for reducing risk factors for chronic NCDs in South Africa, and to explore the role of population-based data in supporting environmental and policy approaches to prevent NCDs. The thesis will also examine whether there are differences in urban and rural settings in the implementation of tobacco control and salt reduction regulation as well as the barriers to implement the National Strategic Plan for prevention of NCDs. Methods: Multiple methods of data collection were used. A desk review of policies to address NCDs in South Africa was undertaken and semi-structured interviews with the NCD policymakers and managers in two provinces (the Eastern Cape and Western Cape) were undertaken, to explore challenges and successes of implementation of the NSP. The Cross-sectional baseline questionnaire and quantified food frequency data from the PURE study were used to determine the prevalence of smoking and the intakes of sodium and potassium in a selected urban and a rural community. Data collected using a validated community audit tool was used to assess the physical environment related to tobacco as well as questionnaire data from face-to-face interviews about perceptions about tobacco use in the urban and rural communities. Trends in mortality from tobacco related and high salt consumption related conditions together with prevalence data from national health surveys were reviewed to assess the health impact.

Asthma is a chronic lung inflammatory disease that causes inflammation and narrowing of the airways. Swelling of the airways can be caused by the activation of cytokines that lead to an inflammatory or allergenic-like response. Environmental factors, both indoors and outdoors, have been found to increase the likelihood of asthma in children. Among those found to impact disease are air pollutants such as ozone, nitric dioxide, and particulate matter, as well as home exposures, like cockroaches and rodents. Those who have multiple or increased exposure to these pollutants are more likely to experience exacerbated symptoms and uncontrolled asthma. There currently is no cure for asthma, but effective therapies have been found to treat the symptoms associated with asthmatic episodes. During an asthma attack, due to narrowing of the airways, individuals experience wheezing, chest tightness, and even shortness of breath. To combat these occurrences, physicians use inhaled corticosteroids (ICS), Beta-agonist, or a combination of both to relieve symptoms. In the United States asthma affects 25.8 million people. This number is projected to increase as the US continuously becomes more industrialized and as environmental conditions deteriorate. Research conducted by the Center for Disease Control concluded that the prevalence of asthma increased amongst the general population, however, once the data were disaggregated by race, age, gender, and SES significant increases were noted amongst some groups but not others. Most notably, on average, children, women, Puerto Ricans, and people living in poverty as defined by federal guidelines had the highest asthma prevalence. Chronic diseases like asthma also produce substantial burdens on the healthcare system. Asthmatics on average require three-times as many prescriptions, twice as many emergency room visits and four-times as many hospitalizations as individuals without asthma in the same demographic population. Additionally, when an expenditure analysis was carried out, it revealed that children with asthma cost approximately three-times more per capita per child than adolescents without asthma. Chronic disease occurs over the duration of individual lives. Thus, poorly managed, they will cause preventable increases in disability-adjusted-life years, premature death, and health care expenditure for both the individual and the broader healthcare system. The observed increases will predominantly impact the indicated high-risk populations. The prevalence of asthma in urban settings was anticipated by researchers based on known environmental influences. However, the discovery of a higher prevalence and mortality rate of asthma within impoverished communities, in comparison to other urban communities, is not yet fully understood. Through this research an association between high-risk populations with uncontrolled asthma and a lack of patient education, low socioeconomic status, and utilization of Medicaid insurance was found, which indicates the influence of these factors on asthma control. Improving current asthma interventions by remodeling them to take a broader stance on asthma prevention, treatment and maintenance and through acknowledgement of the impact disparities, asthma will likely be better controlled for all individuals in the Unites States.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Darbo tikslas: Išanalizuoti sergamumą oro-lašinėmis infekcijomis Kauno mieste 2002 – 2007 metais ir nustatyti sąsajas tarp sergamumo oro – lašinėmis infekcijomis ir imunoprofilaktikos. Darbo uždaviniai: 1. Įvertinti oro - lašinių infekcijų (tymai, epideminis parotitas, skarlatina, raudonukė, virusinis meningitas, infekcinsu meningokokas, vėjaraupiai) pasiskirstymą įvairiose amžiaus grupėse Kauno mieste 2002-2007 metais. 2. Palyginti sergamumo kai kuriomis oro- lašinėmis infekcijomis kitimą Kauno mieste 2002 – 2007 metais. 3. Nustatyti sąsajas tarp sergamumo oro – lašinėmis infekcijomis ir imunoprofilaktikos. Metodika: Informacija apie sergamumą oro-lašinėmis infekcijomis gauta iš Kauno visuomenės sveikatos centro. Duomenys apie sergamumą oro-lašinėmis infekcijomis paimti iš Kauno visuomenės sveikatos centro kompiuterinės duomenų bazės ULISAS (užkrečiamųjų ligų informacijos ir statistinės apskaitos sistema). Taip pat buvo naudojamasi 2002-2007 metų mėnesinėmis, pusmetinėmis ir metinėmis atskaitomis. Duomenys apdoroti ir išanalizuoti naudojantis statistine programa SPSS 16. Skaičiuotas vidurkis, SD, PI. Duomenys pateikiami absoliučiais skaičiais ir procentais. Buvo skaičiuojami sergamumo rodikliai 10 000 gyventojų. Rezultatai: Sergamumo pagal amžiaus grupes analizė parodė, kad rečiausiai sirgo 13 – 18 metų vaikai, o dažniausiai – 3-6 metų. Susirgimai vėjaraupiais sudaro didžiausią dalį visų oro – lašinių infekcijų - 80,1 proc. (be ūmių virusinių kvėpavimo takų infekcijų ir... [toliau žr. visą tekstą] / Aim of the study. To analyse morbidity of air-born infections in Kaunas city in 2002–2007 and to assess links between morbidity of air-born infections and immunoprophylaxis. Tasks of the study: 1. To assess prevalence of air-born infections (measles, mumps, scarlatina, rubella, viral meningitis, infectious meningococcus, varicella) in various groups of age in 2002–2007 in Kaunas city. 2. To compare trends of some air-born infections in Kaunas city in 2002–2007. 3. To assess links between air-born infections’ morbidity and immunoprophylaxis. Method: Information about morbidity of air-born infections is got from Kaunas Public Health Center. Data of air-born infections’ morbidity is taken from data basis ULISAS (a system of communicable diseases information and statistical accounting). Also, the monthly, half-yearly and annual records of the years 2002–2007 were used. Data was archived and analyzed by using the statistical programme SPSS 16. An average, SD, PI were counted. Results are submitted in total numbers and percents. Morbidity was calculated to 10000 population. Results: The analysis according to the age groups showed, that children of 13–18 years old were ill most rarely and most frequently – children of 13–16 years old. Ailment of chickenpox makes the biggest part of air-born infections – 81 % (without Acute upper airway infections and influenza), ailments of rubella were registered least – 0,2 %. Of 10698 ill cases, 67 diseases (0,63 %) were registered after... [to full text]

SUMMARY Management of Public Health ORGANIZATION OF DISEASES PREVENTION IN PRIMARY HEALTH CARE Raminta Gečaitė Supervisor Skirmantė Starkuvienė, MD, PhD, Lecturer, Department of Social Medicine, Faculty of Public Health, Kaunas University of Medicine. – Kaunas, 2005. - P.56. Aim of the study – to evaluate patients’ attitude towards the non-communicable diseases (NCD) prevention in primary health care and to clarify the differences of the prevention between general practitioners (GP) and therapeutists. Methods. The anonymous questionnaire survey was performed among adult patients, who visited their family doctor in Kaunas Kalniečiu outpatient clinic, at the Department of General Practitioners and General clinic (the work is organized in a team principal). There were 120 questionnaires distributed to the patients of GP and 101 of them were fulfilled and returned back (response rate – 84.2%). There were also 120 questionnaires delivered to the patients, who visited therapeutists and 98 of them were filled in (response rate – 81.7%). The data was analyzed by the application of statistical package SPSS 11.03 for Windows. The associations between the variables were measured using the Chi-squared and the Student tests. Results. The survey disclosed that 15.6% of the respondents visited the family doctor in order to examine their health preventively. More than half (51.8%) of the patients were satisfied with the organization of diseases prevention carried out by their family... [to full text]

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Immigrants of Sweden are suffering from various non-communicable diseases more than Swedish natives which becomes a major public health concern nowadays. The objective of this systematic review is to investigate the physical activity level of Swedish immigrants compare to Swedish-born, their physical and mental health outcomes, and barriers and facilitators of being physically active. Electronic database CINAHL PLUS, PUBMED, EBSCOhost, SWEPUB was searched and 17 articles were included which was peer-reviewed, English language, based on physical activity of immigrants living in Sweden. Findings of these articles revealed that immigrants had a higher prevalence of non-communicable, anxiety, depression more than Swedish natives. Lack of motivation, weather, cultural and language barriers, environmental, infrastructure, and economic barriers are identified as barriers. Self-motivation, family and social support, culturally appropriate strategies, government-induced programs, community support are identified as facilitators of being physically active. The quality of evidence of outcomes scored by using GRADE. In conclusion, the available evidence support that immigrants are less physically active than Swedish-born and lack physical activity associated with their physical and mental health outcomes and there are several barriers and facilitators for being physically active.

Bakgrund: Isolering kan leda till psykosociala biverkningar och negativa känsloupplevelser, vilket tidigare forskning har uppmärksammat. Utifrån de identifierade omvårdnadsproblemen designades en litteraturstudie för ytterligare undersökande av patienters upplevelser vid isoleringsvård.    Syfte: Syftet var att undersöka patienters upplevelser av isolering i samband med allmänfarlig sjukdom på sjukhus.    Metod: Allmän litteraturöversikt med deskriptiv design.    Resultat: I patienternas upplevelser identifierades fem olika teman: stigmatisering, känslor, miljö, socialt liv och vård. I resultatet framkom det att patienter i isolering har många negativa upplevelser relaterat till vården och miljön i isoleringen. Även det sociala livet och känslolivet påverkas och många upplever stigmatisering. Förutom de negativa upplevelserna framkom även vissa positiva upplevelser, främst relaterat till relationen med vårdpersonal samt fördelarna med det utökade privatlivet ett eget rum innebar.    Slutsats: Syftet med studien var att undersöka patienters upplevelser av isoleringsvård. I resultatet framkom det flera negativa och positiva upplevelser som till stor del stämde överens med tidigare forskning inom området. Studien gav en fördjupad förståelse för patienters situation under isoleringsvård. Denna ökade medvetenhet och kunskap behövs för att vårdpersonal genom riktade omvårdnadsåtgärder ska kunna förbättra omvårdnaden av isolerade patienter i framtiden. / Background: Isolation can lead to a variety of psychosocial problems and negative emotional experiences, which previous studies have shown. Based on the identified nursing problems, a literature study was designed to further explore patients experiences in source isolation.    Aim: The aim was to investigate patients experiences of being isolated with a disease dangerous to public health in a hospital setting.    Method: A general literature review with descriptive design.    Result: The patients experiences were identified and categorized into 5 themes: stigma, feelings, enviornment, social life and care. The results showed that patients in isolation have a lot of negative experiences related to care and the environment in the isolation ward. The social life and feelings of the patients were also affected, and many reported that they experienced stigmatization. Aside from the negative experiences there were also some positive ones, mainly related to the relationship between the patients and the hospital staff and the extended privacy of having your own room in the ward.    Conclusion: The aim was to investigate patients experiences of source isolation. This study shows both negative and positive experiences among patients in source isolation, which mainly aligned with already existing studies. The result of this study gave a better understanding of patients experiences in source isolation. This knowledge and awereness is needed by healthcare workers to be able to improve the care of patients in isolation with targeted nursing care measures.

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