Introduction: Migrant and mobile seasonal farm workers face multiple challenges in preventing sexual transmission of HIV. They also fall beyond direct reach of district health promotion services and national HIV prevention communication interventions. HIV prevalence rates in rural farming communities are significantly higher than provincial averages. An integrated health promotion intervention was initiated in 2005 on commercial farms in Hoedspruit, Limpopo province, through the International Organization for Migration. In terms of HIV prevention the Hlokomela project’s key innovation was to employ a local process of participatory communication, with and within the farm worker community, in order to create a local context enabling of health promotion and within which efforts to prevent HIV could be more effective. The research sought to explore the social processes and actions related to the on-going process of dialogue at the core of the participatory communication process. The objective was to describe and analyse the role of dialogue during regular purposive face to face interactions with farm worker change agents, in promoting health and addressing vulnerability to HIV. Method: The study population comprised Hlokomela coordinators, farm worker change agents (Nompilos and Gingirikani) and key farm stakeholders from the 59 partner farms. Research was conducted in Hoedspruit, at the Hlokomela Wellness Centre and on a partner farm. A grounded theory approach was used for sampling: participants were selected through purposive sampling for the initial study sample, and theoretical sampling for the balance. Data was gathered monthly, in three stages between August and November 2010, through: 10 semi-structured in-depth individual interviews; 5 focus group discussions, and observation of 2 monthly meetings and a special event organised by the change agents. Data was analysed using a grounded theory approach. Findings: Farm workers perceive and experience the process of on-going dialogue in face to face interactions as being intertwined with other aspects of the intervention, in particular identification and action to enable access to health services. Hlokomela Coordinators guide and support the process as a means to empower a corps of primary farm worker Change Agents (Nompilos). Nompilos, in turn, apply the system to benefit and empower a wider group of farm worker as second level change agents (Gingirikani). Through this system farm workers have found ways to negotiate HIV-related stigma and cultural taboos on speaking about sex, and to address interpersonal tensions and violence, often gender related, on farms. They have come to consider themselves leaders and role models. Individuals have been enabled to define for themselves appropriate HIV-protective behaviours, and new HIV protective social norms which enable protective behaviours, have gained local currency. These norms include placing value on the opportunity and ability to communicate, to learn from each other, to develop different views, and to attain or protect family, physical and spiritual wellness. Discussion: The process of engagement and regular dialogue, nested in processes related to the other elements of the projects, has positively altered the material, experiential and symbolic context on partner farms. It constitutes effective communication for social change, and has enabled health promotion, as described by the Ottawa Charter, to be realised. This demonstrates that an on-going, participatory process of local communication can create an enabling environment for health promotion. A community of communication practice has been developed in the farming community; this constitutes a reservoir of social capital and capacity to communicate and addresses the need for innovative communication in rural settings. A discursive space and public of discourse around wellness and HIV has been created, and new leaders and alternative narratives, which constitute self and collectively defined “AIDS competency” in a marginalised setting, are becoming visible, suggesting pathways for future interventions to enable equivalent responses in similar settings. Conclusion: An opportunity exists to make more effective use of the power of face to face communication in defined local settings, in order to enable disempowered individuals to claim their human and health rights, to protect themselves from HIV, and to help activate and realise synergies in health and development objectives such as the Millennium Development Goals.

Hypertension (HTN) is highly prevalent globally among low- and middle-income countries (LMICs). By 2020, cardiovascular disease (CVD) deaths related to HTN in LMICs are projected to increase by 75%. HTN control in LMICs is hindered by an acute shortage of physicians, limited diagnostic medical equipment, and a dearth of disease management resources. Despite the increasing prevalence of HTN in LMICs, scalable, evidence-based interventions to reduce morbidity and mortality attributed to HTN are rarely applied in these settings. The TAsk-Shifting Strategy for Hypertension (TASSH), a 5-year cluster-randomized controlled trial that has been implemented in community health centers in the Ashanti region of Ghana, is an evidence-based example of a scalable intervention strategy for LMICs that can effectively control HTN. The aims of this study were to: (a) conduct a systematic review of interventions for HTN control implemented in LMICs and assess the effect on blood pressure control as demonstrated in RCTs that stated “scale-up”; (b) identify the WHO/ExpandNet scale-up components (i.e., Inputs, Outputs, Outcomes, Impact, Cost effectiveness, Equity, Embedded within current health organization policy, Monitoring and evaluation, Sustainability); and (c) investigate the community health nurse stakeholders’ (n = 27) perceptions of the evidence-based TASSH cluster-randomized controlled trial in Ghana. Twenty-nine randomized-controlled trials describing potentially scalable HTN control intervention strategies and WHO/ExpandNet components were identified. Studies reported clinically significant differences in blood pressure, with 16 studies reporting statistically significant mean differences in BP (p < 0.05). Multicomponent interventions, including drug therapy and health education, provided the most benefit to participants. However, there was limited reporting on translation into existing institutional policy, cost effectiveness, stakeholder engagement, and sustainability. Patient goal setting, leadership engagement, and availability of resources, all of which were mentioned by TASSH nurses as important for successful implementation and eventual TASSH scale-up, emerged as major themes. LMICs need context-specific metrics and indicators to effectively evaluate and standardize the reporting of scale-up components and processes. In addition, infrastructure development, including capacity building at the individual, institutional, and systems levels, as well as stakeholder engagement (i.e., leadership), are necessary to address HTN-related morbidity and mortality and other diseases.

Zhang, Dexing = 階梯式治預防焦慮癥和抑鬱癥的效果和可性的研究 / 張德杏. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 181-205). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese; appendixes includes Chinese. / Zhang, Dexing = Jie ti shi zhi yu fang jiao lü zheng he yi yu zheng de xiao guo he ke xing de yan jiu / Zhang Dexing.

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Thesis (M. Sc.(Microbiology)) -- University of the North, 1987 / Refer to the document

Purpose: Pediatric dentists could serve a role in care of children with leukemia. Oral sequelae of cancer therapies are well documented. The purpose of this study is to assess the feasibility and effectiveness of the pediatric dentist in the care of patients with leukemia. Methods: Pediatric Hematology and Oncology at Virginia Commonwealth University was educated on the proposed protocol and administered a questionnaire to assess feasibility of implementing prevention education by the pediatric dentist. Patients were randomized into two groups at diagnosis: one receiving current oral health protocol and those receiving one-on-one prevention education with the pediatric dentist at three points during treatment. Data was collected through clinical intraoral examination and salivary sample. Results: All respondents reported this would address a known problem for patients. They agreed it is feasible and would be a valuable addition to care of these patients. Subject recruitment is ongoing for the effectiveness portion of the study. Conclusion: The addition of the pediatric dentist to the pediatric oncology care team is warranted and feasible.

Thesis (M.A.) (Development Studies) --University of Limpopo, 2009. / HIV/AIDS poses a challenge to every person, community and organization to such an extent that nearly every organization should have some policies and programmes to deal with the epidemic. The church as one of the organizations seems to be exempted from the fight against the disease whereas it is the only organization that is more in touch with people in the community than any other organization. The purpose of this study is to explore the role that churches can play in HIV/AIDS prevention in order assist the Bushbuckridge churches on how they can fight against HIV/AIDS so as to help reduce the high rate of infections as well as stop the new infections.

Alcohol and cannabis are the two most commonly used licit and illicit drugs in most developing countries including Australia. The burden of disease, social costs and harms associated with the use of these drugs is considerable. As such, the need for prevention is clear. Although an array of school-based drug prevention programs exist, the majority of these show minimal effects in reducing actual drug use. The most common impediments to their success concern obstacles to implementation and dissemination of programs, and a lack of sequential and developmentally appropriate messages. The aim of this thesis was to address these limitations by developing and evaluating an integrated school-based prevention program to reduce alcohol and cannabis use. The innovative program known as the Climate Schools: Alcohol and Cannabis Course is founded on current evidence-based research, adopts a harm-minimisation approach to drug prevention and is embedded within the school health curriculum. The core content of the program is delivered over the internet using novel cartoon storylines to engage students. The early development of the course consisted of a cross-validation trial to test the feasibility and generalisability of an existing Climate Schools program for alcohol prevention. Extensive collaboration with teachers, students and health professionals was later conducted to extend and modify the Climate Schools framework to include the prevention of cannabis use. To date, this is the first time an internet-based harm-minimisation cannabis prevention program has been developed for use in schools. To establish the efficacy of the comprehensive Climate Schools: Alcohol and Cannabis Course, a cluster randomised controlled trial was conducted with 10 schools in Sydney (n = 764). Results from this trial demonstrated the innovative course to be effective in increasing knowledge regarding alcohol and cannabis use, and in decreasing the use of these drugs six months following the intervention. This novel approach was found to be acceptable to students and teachers as a means of delivering drug education in schools. This thesis provides support for the more widespread dissemination of the Climate Schools model in schools. The barriers to dissemination require further research and are discussed.

Nurses espouse a caring ethic and demonstrate effectiveness in prevention of patient falls but are often observed taking risks with patients’ safety. These actions reflect poor congruence between espoused values and behaviours. Attitudes, values and involvement in decision- making are factors that influence work behaviours. Nurses’ attitudes are held to be a definitive factor in prevention work; however, few studies have focused on adherence with best practice principles of fall prevention. Yet nurses claim no authority to change their work. It was assumed that increased adherence would be achieved by improving nurses’ attitudes through participation in decision- making surrounding fall prevention practice. This study aimed to tes t this assumption by empowering nurses working in two medical wards with high numbers of patient falls to improve their ownership of practice by utilising critical social theory and action research. Nurses’ attitudes, including self-esteem, professional values and work satisfaction were established before and after a practice development project using action research. Mixed methods were employed by praxis groups meeting fortnightly for a year reflecting on, and re-engineering practice. Action research occurred in cycles focusing on assessment, communication, everyday work, and performance. Nurses’ work was re-organised to gain time to spend in prevention work. Patients’ environments were made safer and more patient-centred. New and effective ways of assessing risk to fall, communication of risk and monitoring nurses’ performance of prevention work were created and evaluated. Analysis demonstrated that nurses had good self-esteem and professional values but were not satisfied with their work. Self-esteem and professional values were unaffected by participation in work-related decisions however, nurses expressed increased sense of ownership, more satisfaction and were observed to engage in more prevention work. In conclusion, manipulation of attitudes and values is not warranted if attitudes and values are good. However, participation in work-related decision- making engages practitioners and leads to greater congruence between values and behaviour. The “unspoken rules” constraining practice that were exposed in the action research oblige nurses to assume authority, confronting and dispelling these constraints to enable more therapeutic care to emerge. Recommendations include promoting practice development as the preferred means for cultural change and improving person-centred care whilst recognising its fragile nature and dependence on clinical leadership.

Aboriginal Australians have some of the world�s highest rates of rheumatic fever. Two approaches to reducing the burden of rheumatic fever are discussed in this thesis. The B cell antigen D8/17 has a strong association with rheumatic heart disease and may be a universal marker of inherited susceptibility to rheumatic fever. Identifying a population at increased risk of rheumatic fever provides an opportunity to focus primary prevention measures. In part one of the thesis I evaluate the accuracy of D8/17 as a marker of past rheumatic fever amongst Australians from the Northern Territory. D8/17 levels were measured and compared in patients with acute rheumatic fever, rheumatic heart disease or past rheumatic fever, first-degree relatives and healthy, unrelated controls. The mean percentage of B cells positive for D8/17 was 83.7%, 38.9%, 20.2% and 11.6% respectively. The difference between the groups was significant (p-value less than 0.0001). A receiver operator curve analysis indicated that 22.1% of B cells positive for D8/17 was the most accurate cut-off to distinguish patients with acute or past rheumatic fever from healthy subjects. These results indicated that the B cell antigen D8/17 is an accurate marker of past rheumatic fever in Aboriginal Australians and could be a helpful addition to the Jones Criteria for strengthening or excluding a diagnosis of acute rheumatic fever. The intermediate levels of D8/17 expression in the relatives of index cases supports the hypothesis that D8/17 is a marker of an inherited susceptibility to rheumatic fever, although prospective trials are required to provide conclusive proof of this hypothesis. Non-compliance with secondary prophylaxis was suspected to be the cause of increasing rates of rheumatic fever in the Top End. In part two of the thesis I discuss the �problem of compliance� with respect to Aboriginal patients, and investigate the factors that affected the delivery and uptake of prophylaxis for rheumatic fever in an Aboriginal community. Patients, relatives and health practitioners were interviewed on the topic of the care of patients with rheumatic heart disease. The data were analysed using the principles of grounded theory. The main finding was the desire for more personalised care and support for patients with rheumatic heart disease from the community clinic, rather than simple medical care. These ideas crystallised through two Yolngu terms to describe care: djaka (to physically care for) and gungayun (to encourage). Thus even from the outset there was divergence in the focus of the �consumer�- holistic care - and that of the health-care professional/ researcher � improving the rate of secondary prophylaxis coverage. With regards to service provision, a significant reason for failure to receive secondary prophylaxis was the differing approaches of urban and community health services, patient mobility, and a differing understanding of the responsibilities of patients and health service providers in the different settings. Other factors pertaining to service provision, such as staff motivation, administrative issues and program coordination affected the uptake of secondary prophylaxis to a lesser extent. With regards to treatment uptake, individual patient factors inhibiting uptake of treatment were apparent in some cases, but treatment refusal was rare. Pain was not found to be a deterrent. No simple relationship was found between treatment compliance and biomedical knowledge of the disease. There was no simple relationship between patient passivity and sense of responsibility that guaranteed compliance. This study demonstrated that the failure to achieve good uptake of prophylaxis for rheumatic fever related as much to factors of service provision as patient factors and that providing holistic care within a familiar and supportive framework is important to Yolngu patients. However, there are real difficulties for health services as they are currently structured to meet the expectations of patients and families.