Thesis (Ph.D.)--York University, 2004. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 197-213). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ99250

Motivation: Cardiovascular disease (CVD) is one of the leading causes of death worldwide, with the greatest mortality rates occurring in low and middle income countries. The increase in the prevalence of risk factors such as hypertension, obesity and diabetes in Sub-Saharan Africa has led in an increase of the prevalence of CVD. It remains largely unclear whether psychological distress and more specifically the perception of own health and / depression may contribute to this observed increase in the prevalence of CVD in this population group. To our knowledge investigations exploring these aspects have not been done in the African context, thus the association between depression as an outcome of psychological distress and cardiovascular dysfunction in Africans is a new frontier that requires further exploration in the population group. Objective: The aim of this study was to investigate the association between psychological distress and cardiovascular function in urbanized black South Africans which included a target population of 200 Africans, men (n=101) and women (n=99). The participants were stratified into a hypertensive (HT) and normotensive (NT) group. Methodology: The manuscript presented in chapter 2 made use of the data obtained from the SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) project. A group of 200 black Africans from governmental institutions of the North West Province of South Africa were recruited. All procedures conducted were approved by the North-West University Ethics Committee and written informed consent was given by all the participants prior to the study. Anthropometric measurements were taken with the assistance of registered biokinetisists. Resting cardiovascular variables such as heart rate (HR), arterial compliance (Cw), total peripheral resistance (TPR) and the mean arterial pressure (MAP) were obtained with the use of a Finometer device. The 24 hours ambulatory blood pressure (BP) (AMBP) measurements were obtained with a Cardiotens apparatus. The resting ECG NORAV PL-1200 data determined left ventricular hypertrophy (L VH) by making use of the Cornell product (RaVL+ SV3) *QRS. Psychological distress questionnaire assessed the perception of health (General Health Questionnaire; GHQ-28) and depression severity (Patient Health Questionnaire; PHQ-9). Participants were stratified into hypertensive and normotensive groups based on the European Society of Hypertension (ESH) 2007 guidelines using the 24hr AMBP as a norm. Results were adjusted for confounders (age, body mass index, smoking, alcohol consumption and physical activity). One way Analysis of Covariance (ANCOVA) was done to determine significant differences between age, body mass index, lifestyle factors cardiovascular variables and psychological parameters. For more detailed description of the subjects, study design and analytical procedures used in this study the reader is referred to the Methods section in Chapter 2. Results and Conclusion: The hypertensive (HT) men and women were more obese (p<0.01) with a larger waist circumference (WC) (p=0.05) and a lower compliance (p</=0.05) compared to their normotensive (NT) counterparts. Only the HT men revealed a higher Cornell product value (p=0.06) compared to NT counterparts. In HT men, somatisation was positively associated with blood pressure (SBP & DBP), while in HT women it was associated with heart rate (HR). Major depression was associated with a left ventricular hypertrophy in HT men and MAP in HT women. Logistic regression analysis followed to predict the strongest contributor to HT in Africans. It was indicated that depressed women are 1.13 times more likely to develop hypertension than men. In conclusion, these results suggest a possible association between depression as an outcome of psychological distress and cardiovascular dysfunction in urbanised Africans. Depression has also been identified as a contributor to HT in African women. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2009.

Motivation: Cardiovascular disease (CVD) is one of the leading causes of death worldwide, with the greatest mortality rates occurring in low and middle income countries. The increase in the prevalence of risk factors such as hypertension, obesity and diabetes in Sub-Saharan Africa has led in an increase of the prevalence of CVD. It remains largely unclear whether psychological distress and more specifically the perception of own health and / depression may contribute to this observed increase in the prevalence of CVD in this population group. To our knowledge investigations exploring these aspects have not been done in the African context, thus the association between depression as an outcome of psychological distress and cardiovascular dysfunction in Africans is a new frontier that requires further exploration in the population group. Objective: The aim of this study was to investigate the association between psychological distress and cardiovascular function in urbanized black South Africans which included a target population of 200 Africans, men (n=101) and women (n=99). The participants were stratified into a hypertensive (HT) and normotensive (NT) group. Methodology: The manuscript presented in chapter 2 made use of the data obtained from the SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) project. A group of 200 black Africans from governmental institutions of the North West Province of South Africa were recruited. All procedures conducted were approved by the North-West University Ethics Committee and written informed consent was given by all the participants prior to the study. Anthropometric measurements were taken with the assistance of registered biokinetisists. Resting cardiovascular variables such as heart rate (HR), arterial compliance (Cw), total peripheral resistance (TPR) and the mean arterial pressure (MAP) were obtained with the use of a Finometer device. The 24 hours ambulatory blood pressure (BP) (AMBP) measurements were obtained with a Cardiotens apparatus. The resting ECG NORAV PL-1200 data determined left ventricular hypertrophy (L VH) by making use of the Cornell product (RaVL+ SV3) *QRS. Psychological distress questionnaire assessed the perception of health (General Health Questionnaire; GHQ-28) and depression severity (Patient Health Questionnaire; PHQ-9). Participants were stratified into hypertensive and normotensive groups based on the European Society of Hypertension (ESH) 2007 guidelines using the 24hr AMBP as a norm. Results were adjusted for confounders (age, body mass index, smoking, alcohol consumption and physical activity). One way Analysis of Covariance (ANCOVA) was done to determine significant differences between age, body mass index, lifestyle factors cardiovascular variables and psychological parameters. For more detailed description of the subjects, study design and analytical procedures used in this study the reader is referred to the Methods section in Chapter 2. Results and Conclusion: The hypertensive (HT) men and women were more obese (p<0.01) with a larger waist circumference (WC) (p=0.05) and a lower compliance (p</=0.05) compared to their normotensive (NT) counterparts. Only the HT men revealed a higher Cornell product value (p=0.06) compared to NT counterparts. In HT men, somatisation was positively associated with blood pressure (SBP & DBP), while in HT women it was associated with heart rate (HR). Major depression was associated with a left ventricular hypertrophy in HT men and MAP in HT women. Logistic regression analysis followed to predict the strongest contributor to HT in Africans. It was indicated that depressed women are 1.13 times more likely to develop hypertension than men. In conclusion, these results suggest a possible association between depression as an outcome of psychological distress and cardiovascular dysfunction in urbanised Africans. Depression has also been identified as a contributor to HT in African women. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2009.

Motivation: Abdominal obesity (hereafter referred to as "obesity") is becoming the biggest "global epidemic" of our modern times. It is associated with a range of diseases, including cardiovascular diseases and hypertension. Recent research showed that an increase in sympathetic activity is of central importance in the pathogenesis of obesity-related diseases. Increased leptin levels and impaired baroreflex sensitivity have both been independently associated with abdominal obesity and increased sympathetic activity. A perception of poorer health may also contribute to the physiological characteristics of obesity-related diseases. A lack of data regarding sympathetic activity, leptin levels, baroreflex sensitivity and perception of health in Africans, serves as a motivation for conducting this study. Objective: To investigate the contributions of leptin levels, baroreflex sensitivity and perception of health data to increased sympathetic activity in lean and obese African women from South Africa. Methodology: The manuscript presented in Chapter 2 made use of the data obtained in the POWIRS (Profiles of Obese Women with the Insulin Resistance Syndrome) study. A group of 102 urbanized African women, living in the North-West Province of South Africa, was recruited according to body mass indexes. Only 85 subjects were included for analysis due to incomplete datasets. For this study, subjects were divided into lean and obese groups according to their waist circumferences. Anthropometric measurements were done according to standardized methods. Resting cardiovascular measurements were obtained from Finometer observations. Resting, fasting levels of leptin were calculated after radioimmunoassay analyses. Subjective perception of health was determined by means of the 28-item General Health Questionnaire. Comparisons between the groups were done using analysis of covariance (ANCOVA) whilst adjusting for cardiovascular risk factors (age. smoking, alcohol consumption and physical activity). Correlation coefficients were determined to indicate any associations between leptin, baroreflex sensitivity and perception of health with sympathetic activity (represented by heart rate) and other cardiovascular variables. The study was approved by the Ethics committee of the North-West University and all the subjects gave informed consent in writing. The reader is referred to the Methods section in Chapter 2 for a more detailed description of the subjects, study design and analytical procedures used in this dissertation. Results and conclusion: Results from this study indicate that obese African women, compared to lean African women, were older, reported higher physical activity, and exhibited higher diastolic and mean blood pressure, heart rate, cardiac output, arterial compliance, leptin and hypertension prevalence rate values. In lean African women social dysfunction was positively associated with diastolic and mean blood pressure and arterial resistance, and negatively with arterial compliance. In obese African women baroreflex sensitivity was negatively associated with diastolic blood pressure, which could be an indication of impaired baroreflex sensitivity. In this obese group a perception of social dysfunction was associated with decreased heart rate. Although leptin and heart rate were significantly higher in the obese Africans, no significant correlations existed between these variables to reflect leptin's enhancement of sympathetic activity. However, leptin correlated weakly but positively with cardiac output (p = 0.054, r = 0.32). In conclusion, baroreflex sensitivity (although similar between groups) and leptin seem to contribute to blood pressure and thus hypertension in obese African women, possibly through increased sympathetic activity and volume loading. A perception of poorer health, especially a perception of social dysfunction, could possibly contribute to this image. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2007.

Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2007.

The overall aim of the study was to gain some understanding of the lived experience of the care-giving spouses regarding their experiences of the manifestations of the disease, perception of their own health, the possibility of influencing the interpretation of the past, the present and future, outlook on life, surrounding contacts and intimate relationships with their sick partners. The spouses (n=13) of Alzheimer victims were followed with the help of personal interviews, diaries and telephone interviews during a two-years period. The texts was analysed according to a phenomenological-hermeneutic method. The main findings in the study showed that the spouses own health remained quite stable over time. Their perception of the development of their own health seemed to be influenced by how they saw their power to influence their situation, which seemed to be determined by how they interpreted the cause of their health problems.The social network was another important factor for understanding the spouses' experiences. The findings imply that spouses' images of themselves in relation to others were important for their perception of the overall social network. The spouses mostly regarded their relationships positively and their social networks were described as quite stable over time. The spouse's marital relationships, in most cases, seemed to undergo changes with the progress of the disease. Some spouses could maintain feelings of love but mostly the relationships were transformed into ones of tenderness, pity and estrangement. The spouses' valuation of their demented partner was mostly in the form of one of two divergent perspectives. On the one hand, spouses who seemed to perceive their partner as a person separate from the disease, could function as complementary ego aids. On the other hand some spouses were unable to make a distinction between the spouse as a person and the disease.The spouses' experiences regarding their previous relationship with parents, value system, philosophy of life, competence and autonomy seemed to be critical in their experiences of their caring situation. It appears that there is a sub-group of vulnerable carers, as suggested by the concurrence of psychological, physical, and social morbidity, along with deterioration in their marital relationship.The findings are discussed in relation to searching for meaning, the importance of significant others, perceiving and valuing the other, and caring relationships within a life-span perspective. / digitalisering@umu

Motivation: Abdominal obesity (hereafter referred to as "obesity") is becoming the biggest "global epidemic" of our modern times. It is associated with a range of diseases, including cardiovascular diseases and hypertension. Recent research showed that an increase in sympathetic activity is of central importance in the pathogenesis of obesity-related diseases. Increased leptin levels and impaired baroreflex sensitivity have both been independently associated with abdominal obesity and increased sympathetic activity. A perception of poorer health may also contribute to the physiological characteristics of obesity-related diseases. A lack of data regarding sympathetic activity, leptin levels, baroreflex sensitivity and perception of health in Africans, serves as a motivation for conducting this study. Objective: To investigate the contributions of leptin levels, baroreflex sensitivity and perception of health data to increased sympathetic activity in lean and obese African women from South Africa. Methodology: The manuscript presented in Chapter 2 made use of the data obtained in the POWIRS (Profiles of Obese Women with the Insulin Resistance Syndrome) study. A group of 102 urbanized African women, living in the North-West Province of South Africa, was recruited according to body mass indexes. Only 85 subjects were included for analysis due to incomplete datasets. For this study, subjects were divided into lean and obese groups according to their waist circumferences. Anthropometric measurements were done according to standardized methods. Resting cardiovascular measurements were obtained from Finometer observations. Resting, fasting levels of leptin were calculated after radioimmunoassay analyses. Subjective perception of health was determined by means of the 28-item General Health Questionnaire. Comparisons between the groups were done using analysis of covariance (ANCOVA) whilst adjusting for cardiovascular risk factors (age. smoking, alcohol consumption and physical activity). Correlation coefficients were determined to indicate any associations between leptin, baroreflex sensitivity and perception of health with sympathetic activity (represented by heart rate) and other cardiovascular variables. The study was approved by the Ethics committee of the North-West University and all the subjects gave informed consent in writing. The reader is referred to the Methods section in Chapter 2 for a more detailed description of the subjects, study design and analytical procedures used in this dissertation. Results and conclusion: Results from this study indicate that obese African women, compared to lean African women, were older, reported higher physical activity, and exhibited higher diastolic and mean blood pressure, heart rate, cardiac output, arterial compliance, leptin and hypertension prevalence rate values. In lean African women social dysfunction was positively associated with diastolic and mean blood pressure and arterial resistance, and negatively with arterial compliance. In obese African women baroreflex sensitivity was negatively associated with diastolic blood pressure, which could be an indication of impaired baroreflex sensitivity. In this obese group a perception of social dysfunction was associated with decreased heart rate. Although leptin and heart rate were significantly higher in the obese Africans, no significant correlations existed between these variables to reflect leptin's enhancement of sympathetic activity. However, leptin correlated weakly but positively with cardiac output (p = 0.054, r = 0.32). In conclusion, baroreflex sensitivity (although similar between groups) and leptin seem to contribute to blood pressure and thus hypertension in obese African women, possibly through increased sympathetic activity and volume loading. A perception of poorer health, especially a perception of social dysfunction, could possibly contribute to this image. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2007.

The thesis topic ?Social exclusion among the homeless and its subsequent impact on health" provides the deeper understanding of the problematic regarding homeless people who are without family/social connections and often suffer from lack of social and health care. The theoretical part of the thesis called ?Current Status? elaborates on the study of the fundamental ideas and concepts In addition the thesis defines the objective and subjective factors of homelessness, health problematic and its determinants, trying to provide an insight into somatic and psychological complications, which are linked to the system of health care provided towards the homeless people. The aim was to detect and define the elements of social exclusion among the homeless and find their conditionality in relation to subjective health perception Basic data for the research were based on the following research questions: V1: What causes played a significant role in respondents becoming homeless? V2: How homeless people evaluate their current health? V3: How the homeless people perceive assistance to improve their situation? The subject of research part is the link between environmental (social) situation of selected group of people and their subjectively perceived health status. To determine the necessary data the qualitative method, semi-controlled interview technique supplemented by observation were used. The research was conducted in the St. Pauls shelter in České Budejovice. The interviews were done with 10 respondents and the results of the research are summarized in form of case studies divided into categories and presented according to the similarities/differences in the respondent?s claims. This work can be used as a basis for further research to quantify the social determinants of health associated with homelessness. I, together with the social worker of the St. Paul shelter, perceive lack of linking health and social services for the homeless. This issue should be further strengthened, so that eventually could be used to influence public policy in shaping the environment affecting our health.

Objective: To examine the perception of patient safety culture amongst health care workers in Libyan Hospitals. Study Design: The study adopted a mixed methods approach with 2 phases. Phase 1 was conducted prior to the Libyan revolution. This was a quantitative research study, which used the Survey of Hospital Patient Safety Culture (HSOPSC) that was developed by the US Agency for Health Care Research and Quality (AHRQ, 2004). Phase 2 was conducted post revolution and it was a qualitative research study, which used semi-structured interviews. Setting: The three largest hospitals which were located in the Northeast of Libya were involved in the study. Participants and sampling: Phase 1 of the study included a stratified sample of 346 health care workers who were working as Doctors, Nurses, Technicians, Pharmacists and Managers. Phase 2 of the study used a purposeful sample which involved 27 health care workers from those took part in the survey study. Main Outcome Measures: The survey measured twelve Patient Safety Culture dimensions. It indicated that ten of the twelve dimensions were weak and need to be improved. The interview findings also showed that the 12 patient safety culture dimensions were very weak and shed light on some of the reasons for this sub-optimal practice. Findings: The respondents who took part in the study were from different departments in the three hospitals. The survey showed the dimensions with acceptable positive ratings were teamwork within hospitals and organizational learning and continuous improvement, while those with lowest ratings included frequency of reporting errors, non-punitive response to error and communication and openness. Approximately 60% of health care workers perceived patient safety culture practice in Libya negatively. Twenty respondents (5.8%) who gave an excellent grade for patient safety in their hospitals. Furthermore, the interviews results revealed that patient safety culture dimensions were very weak. The interview explored further factors and issues of poor safety culture in the 3 hospitals; which had not been identified in the survey. These were related to results of the political changes, administrative factors, environmental issues, organisational system issues, and health care workers matters. Conclusions: The study identified that the current state of patient safety culture in Libyan hospitals is very weak and there is a need for improvement to safety practice and for promotion of this important issue amongst those health care workers and health managers working at the frontline of health care delivery. Furthermore, the study found that the level of patient safety in the 3 hospitals was below an unacceptable level according to the perceptions of the health care staff. It was noted that there was no effective patient safety system in any of the 3 hospitals to deal with patient safety issues and there were no proactive patient safety measures in place to reduce the level of risk to patients. Furthermore, the study revealed other significant aspects that represent a serious threat to patient safety in the 3 hospitals, which were mainly due to poor hospital management, ineffective emergency services and a lack of training programmes. Moreover, poor organisation of monitoring systems for the licensing of medical practice of health care workers was shown to have a significant impact on patient safety culture. Lastly, the study showed the political change in Libya had affected patients’ safety sharply as result of the military conflict and the lack of hospitals’ preparedness to cope with such emergency events.

The thesis focuses on the analysis of health in terms of health marketing, which is identified as the broad term that includes public health branding, as well as the commercial health branding. Emphasis is placed on the Slovak market. The theoretical part deals with the concept of health, the value of health and health literacy. This part consists of a situation analysis of the Slovak market of health, its demographic and health characteristics as well as the description of health and health care in Czechosovakia. The core of the theoretical part of the thesis is a comprehensive analysis of the health marketing. The practical part with qualitative market research method ZMET examines perception of health of Slovak respondents, connects gained information from the theoretical part of the thesis and gives recommendations for the health marketing by taking limitations of the used qualitative research method in consideration. The aim of my Master's Thesis is to show the importance of penetration into the minds of consumers by creating marketing campaigns and revealed deep metaphors apply to product design, advertising and marketing communication in general.