Le vieillissement s’accompagne d’une altération globale des fonctions physiologiques notamment celles de l’immunité :on parle « d’immunosénescence ». Ce processus se traduit entre autre par l’installation d’un état inflammatoire chronique caractérisé par une augmentation des taux sériques de cytokines telles que l’interleukine(IL)-6 et des protéines de la phase aigüe. Cet état proinflammatoire serait incriminé dans le déclin des fonctions physiologiques, la fragilité et les syndromes gériatriques. Par ailleurs, les maladies cardiovasculaires, la dépression et l’infection chronique par le Cytomégalovirus (CMV) sont également associés à un état inflammatoire chronique. La prévalence de ces comorbidités étant importante chez les patients gériatriques, ces maladies pourraient donc contribuer à l’association observée entre marqueurs de l’inflammation et les syndromes gériatriques.<p>Les infections représentent un problème majeur en gériatrie. Les cellules du système immunitaire inné jouent un rôle important dans les défenses contre les agents pathogènes. La reconnaissance de ceux-ci par les cellules dendritiques, les macrophages ou les monocytes fait intervenir une série de molécules telles que les récepteurs de la famille Toll (TLR). Certains travaux suggèrent que la fonction des cellules de l’immunité innée pourrait être perturbée chez les individus âgés mais ces données restent controversées.<p>Dans ce travail, nous souhaitons aborder les hypothèses suivantes :<p>•\ / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

由於慢性疾病的流行程度有著全球性上升的趨勢，它經已成為一個公共衛生的問題，為醫療系統帶來沉重的負擔。慢性疾病的發病率以老年人為最高，慢性疾病對老年人的生理、心理、社交及經濟等，構成尤其嚴重的後果。由於香港的人口持續老化，所以預計患有慢性疾病的人口數目在將來幾十年會不斷增加。但是，現時對患有慢性疾病的老年人所提供的照顧不足，再加上本地老年人擁有的多種特徵，例如社會經濟地位較低，健康讀寫能力較弱，及同時患有多重疾病，都有可能對醫護人員提供的護理造成障礙。提升慢性病患者掌管健康的能力，例如提供自我管理的支援，增強他們的信心，及協助他們作出有關健康的判斷及決策，有機會能解決慢性疾病所引起的問題。雖然過往的研究已經發現自我管理教育課程能夠改善慢性病患者的生理、心理及社交健康，及提升患者的健康行為，可是這類課程對老年人的成效，依然缺乏足夠科研證據的支持。 / 作者在這論文中進行了兩項研究，去探討自我管理教育課程對患有慢性疾病的長者的健康行為、生理、心理、社交、生活質素及醫療服務的使用的影響。甲項研究是一個半實驗性研究，探討¬「慢性疾病自我管理課程」對患有不同種類慢性疾病的長者的效果。乙項研究是一個隨機控制實驗，研究「糖尿病自我管理課程」對患有非胰島素依賴的長者的效果。 / 甲項研究招募了患有一種或以上慢性疾病，及居住在社區的長者進行研究。三百零二名治療組的參加者接受了一個為期六星期的「慢性疾病自我管理課程」，當中包括六課以小組模式進行的課堂，每堂為兩小時三十分。課程由專業人員或非專業的長者義工組長帶領。二百九十八名對照組的參加者則繼續接受六個月慣常的護理。每位參加者都會在基線及六個月後接受測試，測試包括自我管理行為、自我效能感、健康狀況及醫療服務的使用。 / 利用單向共變數分析法，結果顯示治療組的所有的自我管理行為和自我效能感測試都有顯著改善 (p < .05)。在十項健康狀況測試中，有五項有明顯改善 (p < .05)。另外，醫療服務的使用則沒有明顯改變。 / 乙項研究是利用隨機方法，分別把九十位及八十七位患有非胰島素依賴的長者分配到治療組及對照組。治療組的參加者參與了為期八堂，每星期一堂，每堂兩小時的「糖尿病自我管理課程」。對照組參加者則在八星期內繼續接受慣常的護理。所有參加者都會在基線及八星期後接受測試，測試包括身高體重指數、腰臀比例、血糖及血壓水平、糖尿病相關的認識、糖尿病指定及總稱的生活質素、及營養攝取。 / 利用單向共變數分析法，結果顯示治療組的糖尿病相關的認識 (p < .0005)，糖尿病指定生活質素的滿意分類 (p = .045)，及總稱生活質素的精神健康分類 (p = .003)皆有明顯的改善。治療組的總能量 (p = .018)及飽和脂肪攝取 (p = .03)都有明顯減少。在各生理及人體測量指標及其他生活質素測試，則沒有明顯改變。 / 此研究增加對疾病指定及非疾病指定的自我管理教育課程於社區上患有慢性疾病的長者的成效的認識。研究結果發現針對長者而設計的課程有機會改善長者的行為、心理及社交狀況，長者亦可以通過課程學習自我管理技巧及改變健康行為，從而改善健康。由長者義工組長帶領的課程有可能跟由專業人員帶領的課程的效果相近。研究結果象徵著自我管理課程需要融入醫療系統的慣常服務當中，以達致最大的成效。本論文亦為如何於各個護理層面及本地環境推行自我管理課程作出詳細討論。對於將來的研究發展，本論文建議加長跟進測試的時間及利用更大的實驗樣本探討自我管理課程於長者身上的成效，疾病指定及非疾病指定課程的效果亦需要作出比較，個別自我管理課程的特徵對課程成效的影響亦需要詳盡地探討。 / The global epidemic of chronic disease has become a public health issue and created a huge burden on health care systems and societies. Older population is highly susceptible to chronic disease. The high prevalence of chronic disease among older adults results in a series of physical, psychosocial and financial consequences in this patient group. In Hong Kong, as the population continues to age, the number of people having chronic disease is expected to increase rapidly in next few decades. The care for older adults with chronic disease is yet suboptimal. Local older people are predisposed to a number of characteristics, such as low socioeconomic status, poor health literacy and multiple morbidities, which may hinder professionals to provide effective care. Empowering patients through supporting self-management, increasing confidence and assisting decision-making of people with chronic disease has been found to be a solution to the problem. Although literature has suggested that self-management education programmes may improve physical and psychosocial outcomes, and promote health-related behaviours among people with chronic disease, the evidence of the effects of such programmes in older adults is still lacking. / Two studies have been conducted to examine the effects of self-management education programmes in improving health behaviours, physical and psychological status, quality of life and health care utilization in older people with chronic disease. Study One is a quasi-experimental trial exploring the effects of the Chronic Disease Self-Management Programme (CDSMP) in older adults with a wide range of chronic diseases. Study Two is a randomized controlled trial evaluating the effects of the Diabetes Mellitus Self-Management Programme (DMSMP) in older adults with non-insulin-dependent diabetes mellitus. / In Study One, community-dwelling older people with one or more chronic disease were recruited. The intervention group (n = 302) received the 6-week CDSMP, which consisted of 6 group sessions with each session lasting for 2.5 hours. The programme was facilitated either by professional and older lay leaders. The control group (n = 298) continued their usual care for 6 months. Self-management behaviours, self-efficacy, health status, and health care utilization of participants were assessed at baseline and 6 months. / The one-way analysis of covariance showed that the intervention group has significant improvements in all self-management behaviours and self-efficacy outcomes, and 5 out of 10 health status measures (all p < .05). No significant change was detected in the use of health care services. / In Study Two, older people with non-insulin-dependent diabetes mellitus were randomly assigned to either the intervention (n = 90) or control (n = 87) group. The intervention group attended the DMSMP comprising 8 weekly 2-hour sessions. The control group received usual care for 8 weeks. Body mass index, waist-to-hip ratio, blood glucose and blood pressure levels, diabetes-related knowledge, disease-specific and generic quality of life, and nutritional intakes were measured at baseline and 8 weeks. / Using the one-way analysis of covariance, the intervention group found significant improvements in diabetes-related knowledge (p < .0005), the satisfaction subscale score in the diabetes-specific quality of life measure (p = .045), and the mental health score in the generic quality of life measure (p = .003). Significant reductions of total energy (p = .018) and saturated fat intakes (p = .03) were also demonstrated in the intervention group. No significant change was detected in the physiological outcomes, anthropometric indices and other quality of life and nutritional measures. / The present studies enrich the knowledge of the effects of disease-specific and generic self-management education programmes for older adults with chronic disease living in the community. It demonstrated that the programmes specifically tailored for older adults may improve a wide range of behavioural and psychosocial outcomes. Older adults may be able to learn new skills for self-management and change behaviours to improve their health. The effects of using older lay persons to lead such programmes may be similar with those using professional staff. The findings imply that self-management programmes need to be integrated into the routine service of health care systems and community care in order to have maximal effects. The implementation of self-management support at different levels of care and under the local context was discussed. Further studies should be conducted to explore the effects of self-management programmes on older people using prolonged follow-ups and larger sample size. The comparative effects of disease-specific and generic self-management programme should be evaluated. The individual influences of various essential features of self-management interventions need to be determined explicitly. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Lap Sun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 265-302). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / Chapter CHAPTER ONE --- INTRODUCTION / The epidemiology of chronic disease --- p.1 / Causes of the epidemiology of chronic disease --- p.3 / Risk factors of chronic disease --- p.4 / Self-management approach in managing chronic disease --- p.5 / The research problem --- p.8 / Chapter CHAPTER TWO --- LITERATURE REVIEW / Challenges in managing chronic disease --- p.10 / Specific concerns for older people --- p.12 / Chronic disease management --- p.16 / Introduction --- p.16 / Patient-centred care --- p.18 / Frameworks for improving care of chronic disease --- p.20 / Chronic Care Model --- p.20 / Innovative Care for Chronic Conditions --- p.22 / Service delivery model of chronic disease management --- p.24 / Global strategies in chronic disease management --- p.26 / Empirical evidence of the Chronic Care Model --- p.29 / Self-management --- p.34 / Definitions --- p.34 / Conceptualizing self-management --- p.37 / Patient-professional relationship --- p.37 / The goal of self-management --- p.40 / Self-management tasks and skills --- p.41 / Perspectives and barriers of self-management in older adults with chronic disease --- p.44 / Self-management education and support --- p.50 / Introduction --- p.50 / Comparison with traditional patient education --- p.51 / Characteristics of self-management education --- p.53 / Theoretical basis in self-management education --- p.53 / Self-efficacy theory --- p.56 / Teaching problem-solving skills and making action plans --- p.58 / Individualizing self-management education --- p.59 / Continuity of self-management support --- p.60 / Framework of delivering self-management support services --- p.62 / Global implementation of self-management education --- p.65 / Empirical evidence of the effects of self-management interventions --- p.70 / Effects of self-management interventions in general --- p.71 / Effects of self-management interventions for older adults with chronic disease --- p.77 / Effects of self-management interventions for patients with chronic disease in Hong Kong --- p.85 / Methodological issues in self-management studies --- p.88 / Establishing self-management interventions for older adults --- p.90 / Establishing self-management interventions under the local context --- p.93 / Summary of Literature Review --- p.94 / Chapter CHAPTER THREE --- METHODS (STUDY ONE) / Introduction --- p.97 / Methodology --- p.98 / Research objectives --- p.98 / Null hypotheses --- p.99 / Study design --- p.100 / Participants --- p.101 / Recruitment and procedure --- p.101 / Intervention --- p.103 / Adaptations of programme delivery for local older participants --- p.106 / Sample size calculation --- p.107 / Outcome measures --- p.108 / The questionnaire --- p.108 / The Abbreviated Mental Test, Hong Kong version (AMT) --- p.109 / Frailty Index (FI) --- p.109 / Statistical analysis --- p.112 / Primary analysis --- p.112 / Secondary analysis --- p.112 / Focus group --- p.114 / Chapter CHAPTER FOUR --- RESULTS (STUDY ONE) / Participants --- p.116 / Baseline --- p.118 / Comparing baseline and 6 months outcomes of intervention group --- p.123 / Comparing baseline and 6 months outcomes of control group --- p.125 / Comparing outcomes between intervention and control groups at 6 months --- p.127 / Subgroup analysis --- p.130 / Comparison among age subgroups --- p.132 / Comparison among education level subgroups --- p.133 / Comparison among frailty level subgroups --- p.133 / Comparing professional staff-led and older lay-led programmes at 6 months --- p.140 / Focus group --- p.142 / Chapter CHAPTER FIVE --- DISCUSSION (STUDY ONE) / Introduction --- p.145 / Demographics characteristics --- p.145 / Baseline outcomes --- p.147 / Effects of the CDSMP on older adults with chronic disease --- p.148 / Self-management behaviours and self-efficacy --- p.148 / Health status --- p.148 / Health care utilization --- p.149 / Comparing with existing literature --- p.150 / Effects of age, education level and frailty level on the outcomes --- p.154 / Age --- p.154 / Education level --- p.154 / Frailty level --- p.155 / Effects of leaders on the outcomes --- p.156 / Qualitative findings --- p.157 / Feasibility of training older people to be lay leaders --- p.160 / Summary of the discussion --- p.162 / Chapter CHAPTER SIX --- METHODS (STUDY TWO) / Introduction --- p.164 / Methodology --- p.166 / Research objectives --- p.166 / Null hypothesis --- p.166 / Study design --- p.167 / Pilot study --- p.168 / Participants --- p.169 / Recruitment and procedure --- p.170 / Intervention --- p.172 / Educational talks --- p.174 / Exercise practice --- p.174 / Goal setting and problem-solving --- p.177 / Issues of designing self-management programme for local older adults --- p.177 / Sample size calculation --- p.178 / Outcome measures --- p.179 / Diabetes Knowledge scale (DKN) --- p.179 / 24-hour food recall --- p.180 / Anthropometric measurements --- p.181 / Clinical health indicators --- p.182 / Quality of life --- p.183 / Statistical analysis --- p.185 / Primary analysis --- p.185 / Secondary analysis --- p.186 / Focus group --- p.186 / Chapter CHAPTER SEVEN --- RESULTS (STUDY TWO) / Participants --- p.188 / Baseline --- p.190 / Comparing baseline and 8 weeks outcomes of intervention group --- p.193 / Comparing baseline and 8 weeks outcomes of control group --- p.195 / Comparing outcomes between intervention and control group at 8 weeks --- p.197 / Nutritional intakes --- p.200 / Comparing baseline, 8 weeks and 6 months outcomes of intervention group --- p.203 / Focus group --- p.206 / Chapter CHAPTER EIGHT --- DISCUSSION (STUDY TWO) / Introduction --- p.208 / Demographics characteristics --- p.209 / Baseline outcomes --- p.210 / Effects of the DMSMP on older adults with type 2 DM --- p.213 / Knowledge and nutritional intakes --- p.213 / Anthropometric measures and clinical health indicators --- p.214 / Quality of life --- p.217 / Long-term effects of the DMSMP on intervention group participants --- p.219 / Comparing with existing literature --- p.220 / Comparing with a local study --- p.226 / Qualitative findings --- p.227 / Summary of the discussion --- p.231 / Chapter CHAPTER NINE --- CONCLUSION / Overall effects of self-management interventions for older adults with chronic disease --- p.232 / Strengths of the study --- p.238 / Using a more stringent study design --- p.238 / Incorporated essential features of self-management interventions into current programmes --- p.239 / Demonstrated a collaborative model between health and social sectors --- p.240 / Limitations of the study --- p.241 / The integrity of study sample --- p.241 / Issues in the representativeness of study sample --- p.241 / High attrition rate in the longitudinal follow-up (The DMSMP) --- p.243 / Unknown uptake rate --- p.244 / The study design --- p.244 / Non-randomized allocation of participants (The CDSMP) --- p.244 / The lack of control for attention effect --- p.246 / The implementation of study intervention --- p.247 / Using multiple components --- p.247 / The absence of blinding (The DMSMP) --- p.248 / The evaluation and statistical analysis --- p.248 / Short duration of follow-up --- p.248 / Limitations of post-hoc analyses --- p.249 / Diffusion of self-management interventions for older adults --- p.250 / Considerations to the adoption of current self-management interventions --- p.251 / Relative advantage --- p.251 / Compatibility --- p.251 / Complexity --- p.252 / Trialability --- p.252 / Observability --- p.253 / Experience of implementing self-management interventions in the UK and the US --- p.254 / Considerations to the implementation of current self-management interventions --- p.256 / Strategies applied in promoting the adoption and implementation of current self-management interventions --- p.257 / Recommendations for local implementation of self-management interventions --- p.259 / Recommendations for future research --- p.261 / Conclusion --- p.264

M. Tech. (Department of Biotechnology, Faculty of Applied and Computer Sciences), Vaal University of Technology. / Background: Increased serum homocysteine is well known as an independent cardiovascular risk factor. Hyperhomocysteinemia may be due to several factors such as nutritional deficiencies and genetics. The MTHFR C677T polymorphism is associated with increased serum homocysteine. Folate and vitamin B12 play essential roles in lowering homocysteine levels. Limitations have been identified using serum vitamin B12 as a marker for vitamin B12 status due to lack an efficient of test. Holotranscobalamin has been reported as a more accurate marker for vitamin B12 status. Cardiovascular risk due to hyperhomocysteinemia has been confirmed among the elderly in Sharpeville. Knowledge of the prevalence of MTHFR C677T polymorphism among Black elderlies in South Africa is limited. Objectives: The main aim of the study was to evaluate the prevalence of MTHFR C677T polymorphism as a cardiovascular risk in an elderly black population in Sharpeville. Correlations between the presence of MTHFR C677T polymorphism and homocysteine metabolic markers were evaluated. Holotranscobalamin as a diagnostic test for vitamin B12 status was also assessed in this study. Materials and methods: This study was ethically approved by the Vaal University of Technology ethics committee (20140827-1ms). It was an observational, experimental study conducted in 102 elderly (≥60 years) attending the day-care centre in Sharpeville. Real-Time PCR was used to determine MTHFR genotypes. Folate and vitamin B12 were measured with AIA-PACK. Homocysteine levels were determined with an automated Konelab™ 20i and holotranscobalamin by ELISA. STATA 12 software was used for analysis of descriptive and inferential statistics. Results: The prevalence of MTHFR C677T polymorphism in this sample population was 19%. Heterozygous CT single nucleotide polymorphism was 17% and mutant homozygous TT was 2%. The majority (81%) of the subjects had wild type homozygous CC genotypes. No associations were found between MTHFR C677T genotypes and homocysteine and folate levels. Hyperhomocysteinemia was high (54%) and low (5%) folate deficiency found. No vitamin B12 deficiency was found however 7% were on the category of likely to be deficient. Sensitivity and specificity of holotranscobalamin were 100% and 95% respectively. Conclusion: The conclusions drawn from the study is that the prevalence of MTHFR C677T polymorphism is low within elderly in Sharpeville. There is a high risk of cardiovascular disease as a result of high prevalence of hyperhomocysteinemia. An intervention to lower homocysteine concentration of elderlies residing in Sharpeville is needed. Other genetic predisposing factors of increased homocysteine levels should be investigated.

The purpose of this study was to assess the epidemiology of preventable risk factors for NCDs among the adult population in Tigray, Northern Ethiopia. A quantitative descriptive cross-sectional design was employed to describe the distribution of behavioural and biological risk factors for NCDs, assess the status of knowledge, perceptions, attitude and behaviour of the study participants for NCDs and their risk factors, and a matched case-control study to identify the determinants of hypertension. The data was collected using a structured questionnaire for the interview, physical measurements including weight and height scales, non-elastic measuring tape for waist and hip circumferences, Omron digital BP apparatus for blood pressure and heart rate; Accutrend Plus for measuring fasting blood glucose, cholesterol and triglycerides. For the descriptive cross-sectional study a total of 2347 participants were included, and for the matched case control study a total of 117 cases and 235 controls participated. Behavioural and biological risk factors were assessed. Only 0.8% of the study participants used optimal fruit serving per day. The prevalence of low level physical activity (<600 MET-minutes/week) was 44.8%. The magnitude of ever alcohol consumption was 66.8%. However, the magnitude of khat chewing and tobacco smoking among the study participants was not as high as the other risk factors i.e. 3.3% and 2.3% respectively. The magnitude of hypertension, central obesity, hyperglycaemia, hypercholesterolemia and hypertriglyceridemia was 9.9%, 22.2%, 3.5%, 30.3% and 32.2% respectively. Factors associated with the risks aforementioned were gender, age, place of residence, education, knowledge status on NCDs, mental stress and others. The status of knowledge on CVDs, breast and cervical cancers, diabetes and their potential risk factors was low and not comprehensive. Misconceptions on NCDs and body size and shape were pervasive. Risky behaviours underlying NCDs were rampant in the study population. Factors related to poor knowledge on NCDs were gender, age, place of residence, education and misconceptions on NCDs. The determinants of hypertension were physical inactivity, duration of alcohol intake, central obesity and mental stress. Awareness raising interventions on NCDs and their risk factors; improving socio-economic status and accessibility to health care settings have to be in place to curb these formidable problems. / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of this study was to determine the prevalence and causes as well as the risk factors of visual impairment (VI) and blindness among Black South Africans with diabetes mellitus (DM) aged 40 years and older in Mopani District, Limpopo province, South Africa. This was a cross-sectional study in which Black South Africans with DM aged ≥40 years old were examined for VI and blindness. In addition, anthropometric as well as risk factors for VI and blindness were studied. A total of 225 participants were selected from seven Public Health Facilities in Mopani District. Data was collected using standard optometric instruments, anthropometric instruments and structured interviews. Data analysis was done using the Statistical Analysis System (SAS) and Microsoft Excel software packages. The ages of the participants ranged from 40 to 90 years with a mean of 61.5±10.49 years. There were more females (71.5%) than males (28.4%). The prevalence of uncorrected VI and blindness in the right eyes of the participants was 70.7% and 3.6%, respectively. In the left eyes, it was 72% and 3.1%, respectively. However, following optical correction, the prevalence in right eyes was 41.3% and 3.6%, respectively. In the left eyes, it was 42.2% and 3.1%, respectively. Risk factors that were individually associated with VI and blindness include age, educational qualification, monthly income, knowledge of DM types, oral DM treatment (pills), losing weight, compliance to losing weight, family history of DM, physical activity, and date of last eye examination .When logistic regression was used, knowledge of DM types, pills, and compliance to losing weight, family history of DM, monthly income and physical activity remained associated with VI and blindness. The high prevalence of VI in this diabetes population was not primarily due to DM itself, but due to refractive error and cataract, conditions which have effective and easy treatments. A total of 84% of the participants were visually impaired due to either refractive error or cataract or both and only 3.8% due to diabetes retinopathy. It is therefore recommended that appropriate and affordable refraction and cataract surgical services be made available and accessible to this population / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of this study was to determine the prevalence and causes as well as the risk factors of visual impairment (VI) and blindness among Black South Africans with diabetes mellitus (DM) aged 40 years and older in Mopani District, Limpopo province, South Africa. This was a cross-sectional study in which Black South Africans with DM aged ≥40 years old were examined for VI and blindness. In addition, anthropometric as well as risk factors for VI and blindness were studied. A total of 225 participants were selected from seven Public Health Facilities in Mopani District. Data was collected using standard optometric instruments, anthropometric instruments and structured interviews. Data analysis was done using the Statistical Analysis System (SAS) and Microsoft Excel software packages. The ages of the participants ranged from 40 to 90 years with a mean of 61.5±10.49 years. There were more females (71.5%) than males (28.4%). The prevalence of uncorrected VI and blindness in the right eyes of the participants was 70.7% and 3.6%, respectively. In the left eyes, it was 72% and 3.1%, respectively. However, following optical correction, the prevalence in right eyes was 41.3% and 3.6%, respectively. In the left eyes, it was 42.2% and 3.1%, respectively. Risk factors that were individually associated with VI and blindness include age, educational qualification, monthly income, knowledge of DM types, oral DM treatment (pills), losing weight, compliance to losing weight, family history of DM, physical activity, and date of last eye examination .When logistic regression was used, knowledge of DM types, pills, and compliance to losing weight, family history of DM, monthly income and physical activity remained associated with VI and blindness. The high prevalence of VI in this diabetes population was not primarily due to DM itself, but due to refractive error and cataract, conditions which have effective and easy treatments. A total of 84% of the participants were visually impaired due to either refractive error or cataract or both and only 3.8% due to diabetes retinopathy. It is therefore recommended that appropriate and affordable refraction and cataract surgical services be made available and accessible to this population / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to assess the epidemiology of preventable risk factors for NCDs among the adult population in Tigray, Northern Ethiopia. A quantitative descriptive cross-sectional design was employed to describe the distribution of behavioural and biological risk factors for NCDs, assess the status of knowledge, perceptions, attitude and behaviour of the study participants for NCDs and their risk factors, and a matched case-control study to identify the determinants of hypertension. The data was collected using a structured questionnaire for the interview, physical measurements including weight and height scales, non-elastic measuring tape for waist and hip circumferences, Omron digital BP apparatus for blood pressure and heart rate; Accutrend Plus for measuring fasting blood glucose, cholesterol and triglycerides. For the descriptive cross-sectional study a total of 2347 participants were included, and for the matched case control study a total of 117 cases and 235 controls participated. Behavioural and biological risk factors were assessed. Only 0.8% of the study participants used optimal fruit serving per day. The prevalence of low level physical activity (<600 MET-minutes/week) was 44.8%. The magnitude of ever alcohol consumption was 66.8%. However, the magnitude of khat chewing and tobacco smoking among the study participants was not as high as the other risk factors i.e. 3.3% and 2.3% respectively. The magnitude of hypertension, central obesity, hyperglycaemia, hypercholesterolemia and hypertriglyceridemia was 9.9%, 22.2%, 3.5%, 30.3% and 32.2% respectively. Factors associated with the risks aforementioned were gender, age, place of residence, education, knowledge status on NCDs, mental stress and others. The status of knowledge on CVDs, breast and cervical cancers, diabetes and their potential risk factors was low and not comprehensive. Misconceptions on NCDs and body size and shape were pervasive. Risky behaviours underlying NCDs were rampant in the study population. Factors related to poor knowledge on NCDs were gender, age, place of residence, education and misconceptions on NCDs. The determinants of hypertension were physical inactivity, duration of alcohol intake, central obesity and mental stress. Awareness raising interventions on NCDs and their risk factors; improving socio-economic status and accessibility to health care settings have to be in place to curb these formidable problems. / Health Studies / D. Litt. et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / Given the numerous benefits of a healthy diet and exercise for cancer survivors, there has been an increase in the number of lifestyle intervention trials for this population in recent years. However, the extent to which adherence to a diet and exercise intervention predicts health-related outcomes among cancer survivors is currently unknown. To address this question, data from the Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW) diet and exercise intervention trial were analyzed. RENEW was a yearlong telephone and mailed print intervention for 641 older (>65 years of age), overweight (body mass index: 25.0-39.9), long-term (>5 years post-diagnosis) survivors of colorectal, breast, and prostate cancer. Participants were randomized to the diet and exercise intervention or a delayed-intervention control condition. The RENEW telephone counseling sessions were based on determinants of behavior derived from Social Cognitive Theory (SCT) (e.g., building social support, enhancing self-efficacy). These factors have been hypothesized to improve health behaviors, which in turn should improve health outcomes. Thus, drawing on SCT and prior diet and exercise research with cancer survivors, I hypothesized that telephone counseling session attendance would be indirectly related to health-related outcomes (i.e., physical function, basic and advanced lower extremity function, mental health, and body mass index) through intervention-period strength and endurance exercise and dietary behavior (i.e., fruit and vegetable intake, saturated fat intake). The proposed model showed good fit to the data; however, not all of the hypothesized relationships were supported. Specifically, increased telephone counseling session attendance was related to engagement in all of the health behaviors over the intervention period. In turn, (a) increased endurance exercise was related to improvement in all of the health-related outcomes with the exception of mental health; (b) increased strength exercise was solely related to improved mental health; (c) increased fruit and vegetable intake was only related to improved basic lower extremity function; and (d) saturated fat intake was not related to any of the health-related outcomes. Taken together, these findings suggest that SCT determinants of behavior and the importance of session attendance should continue to be emphasized in diet and exercise interventions. Continued exploration of the relationship between adherence to a diet and exercise intervention and health-related outcomes will inform the development of more cost-effective and efficacious interventions for cancer and other medical populations.