A literature study was undertaken to investigate the experience of loss and grief in the different developmental stages, as well as to identify characteristics of loss and grief in the young child. Guidelines have been compiled on how to handle loss and grief in young children. The empirical study comprised of workshop presentations. Through these presentations it was also determined as to whether parents and children would benefit from such workshops, as well as if the information regarding loss and grief addressed the parents’ needs. The empirical study found that parents are ignorant about loss and grief in the young child. However, all the parents had questions about loss and grief. After the workshops parents indicated that they became aware of positive changes in their own behaviour towards their children, and also in that of their children. One of the biggest problems in handling loss and grief in the young child seemed to be open and honest communication. / Educational Studies / M.Ed. (Guidance and Counseling)

L'objectif de la présente étude vise à déterminer si la présence de constipation dyssynergique durant la grossesse est un facteur de risque des déchirures du troisième et du quatrième degré lors d'un premier accouchement vaginal. Un dispositif de recherche cas-témoin rétrospectif a été utilisé. La population était constituée de femmes primipares recrutées à l'aide du registre de la salle des naissances selon leur degré de déchirure périnéale. Les participantes ont ensuite été classées en deux groupes. Le premier groupe, les cas, était constitué de femmes ayant eu une déchirure du troisième ou du quatrième degré. Le deuxième groupe, les témoins, était composé de femmes présentant un périnée intact ou une déchirure du premier ou du deuxième degré. La variable dépendante, soit le degré de déchirure périnéale, a été identifiée à l'aide du dossier obstétrical. La variable indépendante principale, soit la présence de constipation dyssynergique, a été documentée à l'aide du questionnaire Knowles-Eccersley-Scott-Symptom (KESS) envoyé par la poste aux femmes primipares. Les autres facteurs de risque des déchirures périnéales ont été documentés à l'aide du dossier obstétrical et d'un questionnaire maison postal. Un modèle de régression logistique, avec le rapport de cote comme mesure d'association et un intervalle de confiance de 95%, a été utilisé afin de déterminer les facteurs influençant les déchirures du troisième et du quatrième degré. Au total, 549 femmes primipares ont participé à l'étude ; 140 étaient dans le groupe des cas et 409 dans le groupe témoin. Dix-sept pourcent des femmes du groupe des cas et 7,6% des femmes du groupe témoin souffraient de constipation dyssynergique (p=0,001). Une régression logistique multiple a démontré que la présence de constipation dyssynergique est associée à 2,94 fois (95%Cl : 1,47 - 5,88) plus de risque de déchirure du troisième et du quatrième degré. En conclusion, cette étude a démontré que la présence de constipation dyssynergique durant la grossesse augmente le risque de subir une déchirure du troisième et du quatrième degré. Une étude prospective devra cependant être conduite afin d'établir la relation de cause à effet entre la présence de l'incoordination des muscles du plancher pelvien rencontrée dans la constipation dyssynergique et les déchirures du troisième et du quatrième degré."--Résumé abrégé par UMI.

Thesis (M.A. (Psychology))--University of South Africa,2002

Thesis (DPhil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: It is a general assumption in psychology that past social relationships and experiences influence present social behaviour. With attachment theory and current social-cognitive theory as conceptual basis, the present study focused on the association between past experiences with significant others and the current processing of interpersonal information. By means of a 2x3x4 experimental design the study investigated the influence of chronic accessibility and subliminal priming (of significant other representations) on the accuracy and speed of processing scripted interpersonal information. One hundred and thirty seven university students took part in two sessions no more than two weeks apart. In session one they completed the Attachment Style Questionnaire (ASQ; Feeny, Noller & Hanrahan, 1994), and provided the names of positive and negative significant others. According to a median split of the Confidence Scale of the ASQ, they were assigned to a chronic positive or a chronic negative group, assuming that the information based on predominantly positive or negative experiences with positive or negative significant others will be chronically more accessible. In session two, in an individual computer task, they were subliminally primed (33 ms) with a control word or the name of the positive or negative significant other to increase the accessibility of the appropriate memory structures. They were then asked to read a positive, negative, mixed or ambiguous script of an interpersonal event and complete a memory test of 36 interpersonal statements (nine positive, nine negative, nine ambiguous and nine filler statements). The accuracy and response time for every statement was recorded, and the response times of accurate responses for positive and negative scripts were included in the main analysis. Separate univariate analyses of the differences between positive and negative priming per polarity of chronic group and script supported the priming hypothesis. The average response time of the chronic negative group was fastest when they received a negative prime (p = .039), and the positive group was fastest when they received a positive prime (p = .000). The results of a two-way analysis of variance for chronic group and script showed a highly significant interaction effect between chronic group and script (p = .000). When the primes were congruent to the scripts, the chronic groups were significantly faster in recognising statements from a congruent script. The results supported the conjunctive model of priming. The implications of these findings for the understanding of the cognitive structures and processes involved in processing interpersonal information are discussed, with specific reference to relational schemas and attachment working models. Possible directions for future research as well as the application of the results are also described. / AFRIKAANSE OPSOMMING: Dit is ‘n algemene aanname in die sielkunde dat sosiale verhoudinge en ervarings uit die verlede ‘n invloed het op huidige sosiale gedrag. Vanuit die bindingsteorie en die huidige sosiaal-kognitiewe teorie as konseptuele uitgangspunt, fokus die huidige studie op die assosiasie tussen ervaringe met betekenisvolle persone in die verlede en die huidige prosessering van interpersoonlike inligting. Met behulp van ‘n 2x3x4 eksperimentele ontwerp is ondersoek ingestel na die invloed van chroniese toeganklikheid en subliminale opwekking (van geheuevoorstellings van betekenisvolle ander) op die akkuraatheid en spoed waarmee interpersoonlike tekste verwerk word. Eenhonderd-sewe-en-dertig universiteitstudente het deelgeneem aan twee sessies wat nie meer as twee weke na mekaar plaasgevind het nie. Tydens sessie een het die deelnemers die Attachment Style Questionnaire (ASQ; Feeny, Noller & Hanrahan, 1994) voltooi en die name van positiewe en negatiewe betekenisvolle persone voorsien. Op grond van die mediaan-verdeling van die Selfvertroue Skaal van die ASQ is die deelnemers toegewys aan ’n chronies positiewe of chronies negatiewe groep, met die veronderstelling dat inligting gebaseer op oorwegend positiewe of negatiewe ervarings met positiewe of negatiewe betekenisvolle ander deurlopend meer toegankilk sal wees. Tydens sessie twee, wat ’n individuele rekenaartaak behels het, is ’n subliminale stimulus (33 ms) van ’n kontrole-woord, of die naam van ’n positiewe of negatiewe betekenisvolle ander aan hulle aangebied om die toeganklikheid van die toepaslike geheue-strukture verder te verhoog. Daarna is hulle versoek om ‘n positiewe, negatiewe, gemengde of dubbelsinnige teks van ’n interpersoonlike gebeurtenis te lees en ’n geheuetoets van 36 stellings te voltooi wat bestaan het uit nege positiewe, nege negatiewe, nege dubbelsinnige en nege neutrale stellings. Die akkuraatheid en reaksiespoed van elke stelling is gemeet en die reaksietyd van die akkurate response op stellings uit positiewe en negatiewe tekste is in die primêre ontleding ingesluit. Die resultate van onafhanklike eenveranderlike ontledings van die verskille tussen positiewe en negatiewe opwekking per polariteit van chroniese groep en teks, het die hipotese van opwekking ondersteun. Die gemiddelde responstyd van die chroniese negatiewe groep was die vinnigste wanneer hulle die negatiewe stimulus ontvang het (p = .039) en die van die positiewe groep was die vinnigste wanneer hulle die positiewe stimulus ontvang het (p = .000). Die resultate van ’n tweerigting variansieontleding van chroniese groep en teks het ‘n beduidende interaksie tussen chroniese groep en teks aangedui (p = .000). Wanneer die opwekkingstimuli kongruent met die tekste was, was die chroniese groepe betekenisvol vinniger in die herkenning van stellings van die kongruente teks. Die resultate ondersteun ’n konjunktiewe model van opwekking. Die implikasies van die bevindinge vir die verstaan van die kognitiewe strukture en prosesse betrokke by die verwerking van interpersoonlike inligting word bespreek, met spesifieke verwysing na verhoudingskemas en die gebruiksmodelle in bindingsteorie. Riglyne vir toekomstige navorsing op die gebied word verskaf, en die implikasies vir die praktiese toepassing van die resultate word bespreek.

Renal replacement therapy, in the form of dialysis or transplantation, is the cornerstone of management for end-stage renal disease. UK renal registry shows nearly half of those needing renal replacement therapy are treated by dialysis – predominantly by haemodialysis. Patients on renal replacement therapy have increased mortality risk compared to age matched general population. Moreover, some specific subgroups of patients on haemodialysis have increased risk of mortality than expected. The survival benefit seen in women in the general population is attenuated resulting in similar survival for men and women on haemodialysis therapy. In addition, obese individuals and those of non-Caucasian origin have better survival outcome. Though the underlying reason for these findings is not clear and is likely to be multi-factorial, it has been hypothesised that this paradox could be due to the current practice of normalising dialysis dose to total body water. A number of metabolic factors – body surface area, resting energy expenditure and total energy expenditure – have been proposed as alternative to total body water for scaling dialysis dose. There were two overarching aims of this work – one was to study the effect of declining renal function on resting and total energy expenditure and to study the influence of various energy expenditure measures on uraemic toxin generation. The second was to study the impact on survival outcome of using these alternate parameters for normalising dialysis dose and to derive dialysis dose adjustments based on these metabolic parameters. In order to study these aims, studies were designed to explore different aspects of energy expenditure measures along with a longitudinal study to examine the impact of these parameters on survival outcome. The relationship between energy metabolism, body composition and uraemic toxin generation was studied with a retrospective analysis of 166 haemodialysis patients in whom urea generation rate was used as surrogate marker of uraemic toxin generation. It was found that total energy expenditure and fat-free mass predicted uraemic toxin generation after adjustment for other relevant variables. This study provided the preliminary data which was useful in designing further studies for this work. The effect of renal function on resting and total energy expenditure was studied in 80 patients with varying stages of chronic kidney disease who were not on renal replacement therapy. Resting and total energy expenditures were measured directly using gold-standard methods. It was found that declining renal function did not have a significant influence on either of these measures. This supports the hypothesis that metabolic rate is the driving force for glomerular filtration rate and not vice-versa. The directly measured energy expenditure measures were also found to have a moderately strong relationship with urea generation rate in these patients not on renal replacement therapy. The impact of physical activity on uraemic toxin generation, and thereby dialysis requirement, was studied in a prospective cross-sectional study of 120 haemodialysis patients in whom the physical activity was measured by an accelerometer device. Results from the study showed physical activity level to be a significant predictor of uraemic toxin generation after adjustment for gender and body size differences. This study results stressed the importance of adjusting dialysis dose based on individual’s physical activity level. To study the impact of using metabolic factors as normalising parameter for scaling dialysis dose on survival outcome, a large-scale longitudinal study was conducted with 1500 maintenance haemodialysis patients recruited for the study. Dialysis dose-related parameters and survival outcomes were collected at baseline and at various time points during the follow-up period of 18 months. Study results were analysed in two parts - the theoretical basis for using these metabolic factors as scaling parameters was explored which showed that current minimum target dialysis dose risks under-dialysis in certain subgroups of patients and using these alternative parameters may provide a more equivalent dialysis dose across individuals of different body sizes and gender. With these results arguing for potential use of the alternative parameters, the impact on survival of using them were examined. It was found that all three parameters performed better than the current parameter (total body water) with regards to predicting mortality. Total energy expenditure was found to be the best parameter with the lowest hazard ratio for risk of death. The study data was also analysed to derive an algorithm for adjustment of minimum target dialysis dose based on body size and physical activity level. This newly derived minimum dose target was also shown to impact on survival with those underdialysed based on this criteria having poorer survival outcomes. To understand the impact of whole body protein turnover on resting energy expenditure and uraemic toxin generation, a cross-sectional study was conducted on 12 patients with advanced CKD – 6 each in pre-dialysis CKD and haemodialysis group. It was found that haemodialysis patients had higher rate of protein turnover compared to pre-dialysis patients. Whole body protein turnover was found to contribute significantly to resting energy expenditure and had a moderately strong relationship with urea generation rate. In the course of these studies, two questionnaire tools have been validated for use for clinical and research purposes – one is a self-report comorbidity questionnaire and the other, the Recent Physical Activity Questionnaire. The comorbidity questionnaire was developed as part of this work and was validated against Charlson Comorbidity Index. The Recent Physical Activity Questionnaire was validated for physical activity data collection and energy expenditure calculation against the gold-standard doubly labelled water method. In conclusion, it has been demonstrated that metabolic factors such as body surface area, resting energy expenditure and total energy expenditure are more closely related to uraemic toxin generation compared to total body water. It has also been demonstrated that physical activity contributes to metabolic waste production and may necessitate changes in dialysis requirement. It has been shown that these metabolic factors, when used as scaling parameter for dialysis dosing, may predict survival better than the current parameter in use. The algorithm for dialysis dose adjustment and the questionnaires validated in this work have provided novel tools for further research studies and clinical practice. The central hypothesis of this work is that some metabolic factors may be better markers of uraemic toxin generation compared to total body water. It is hypothesised that modifications in dialysis practice based on these factors may improve the quality of haemodialysis and favourably impact on survival outcome for patients with end-stage renal disease. The work presented here largely supports this hypothesis.

The aim of the present study was to develop and validate a Swedish questionnaire assessing conditions of actual work flexibility and its determinants. Data was collected by qualitative Think aloud- interviews with three persons, and through discussions with a reference group. The results from the interviews and discussions showed that corrections were needed for some of the concepts, questions, design and number of items. Next, a cross-sectional study was performed by sending the adjusted questionnaire to three companies in Sweden (N = 266), which was answered by 92 employees. The results supported the adjustments and the questionnaires’ content validity and face validity (> 95 % of the employees agreed). Three Principal component analyses showed comprehensible factors for the three main areas of questions: determinants of actual flexibility, technology use, and work-non-work balance, indicating structural validity of the questionnaire. Furthermore, hypothesis testing showed as expected that the most index variables of actual work flexibility could significantly separate the groups with varying extents of regulated work, indicating construct validity. To conclude, this Master thesis has revealed several question domains valid for inclusion in future surveys regarding actual work flexibility and associations with health and wellbeing at work. / Dagens teknik möjliggör för anställda att arbeta mer flexibelt i tid och rum, men forskningen ger ännu en oklar bild över om det har en positiv eller negativ inverkan på de anställdas hälsa och välbefinnande. Den här oklarheten kan ha att göra med att det inom forskningen funnits en brist på tillförlitliga enkätbaserade mätinstrument som kan fånga upp hur flexibelt arbete läggs upp och tillämpas i olika företag. Syftet med den här uppsatsen var att utveckla och validitetstesta ett svenskt frågeformulär som kan fånga upp determinanter för- och förekomsten av faktisk flexibilitet hos tjänstemän med olika grad av reglerat arbete. En enkät utvecklades och dess innehålls- och ytvaliditet prövades genom kvalitativa intervjuer med tre personer, samt i diskussioner med referenspersoner. Enkäten skickades därefter ut till 266 tjänstemän inom tre företag med olika grad av flexibelt arbete och besvarades av totalt 92 anställda. En enkel kvalitativ innehållsanalys av intervjuerna och diskussionerna visade att enkäten behövde korrigeras utifrån de fyra temaområdena, begrepp, frågor, struktur/enkätupplägg och omfattning. Efter korrigeringarna indikerade svaren från de anställda på företagen att frågor och begrepp nu hade god innehållsvaliditet och ytvaliditet (> 95 %), men att frågornas struktur/enkätupplägg kunde tydliggöras (16,3 %). Tre Principalkomponentanalyser på enkätdata visade även att tydliga faktorer kunde dras ut för determinanterna, samt för de två delområdena inom faktisk flexibilitet (teknik och uppkoppling; balans mellan arbete- och privatliv), vilket stödjer strukturell validitet. Vidare visade hypotesprövningen att merparten av frågorna om faktisk flexibilitet gav signifikanta skillnader mellan grupper som har olika grad av reglerat arbete, vilket stödjer begreppsvaliditet. Resultaten bör betraktas som ett första steg i utvecklingen av ett svenskt frågeformulär om flexibelt arbete. Den här uppsatsen har genererat flera valida frågeområden som kan inkluderas vid framtida kartläggningar av flexibilitetens samband med hälsa och välbefinnande i arbetet.

Syfte: Syftet med denna enkätstudie var att kartlägga hur dental implantatbehandling påverkar livskvaliteten avseende upplevd tuggförmåga, smak, talet, utseendet och munhygienvanor samt själförtroendet. Material och metod: En empirisk enkätstudie med kvantitativ ansats utfördes på tre olika tandkliniker i Stockholm under perioden feb - april 2012. Enkät med följebrev och frankerat svarskuvert sändes ut genom konsekutivt urval till 83 patienter. Fyrtio patienter varav 15 män och 25 kvinnor, med medelåldrar 66,5 år (34 – 89 år), valde att delta i studien. Analys av svaren utfördes i statistikprogrammet IBM® SPSS® 19. Resultat: Andelen deltagare som upplevde en förbättring i upplevd tuggförmåga uppgick till 42,5 %, talet och smaken upplevdes inte ha förändrats av 85,0 % efter implantatbehandling. Vad gäller utseendet upplevde 27,5 % att det hade blivit bättre och 62,5 % att det inte var någon förändring. Det var 22,5 % som upplevde att självförtroendet hade blivit bättre, medan 75,0 % av deltagarna inte upplevde en förändring i självförtroendet efter implantatbehandlingen. Majoriteten (85,0 %) av deltagarna tyckte inte att deras sociala liv hade förändrats efter behandlingen, medan 7,5 % av patienterna rapporterade att det hade blivit bättre. I resultatet kunde noteras att 17,5 % av patienterna tyckte att det var enklare/lättare att utföra munhygienen medan 75,0 % upplevde ingen förändring med att utföra munhygien efter implantatbehandlingen. Konklusion: En förbättring i oral hälsorelaterad livskvalitet avseende alla studerade faktorer kunde ses hos en del patienter efter implantatbehandling. Flertalet patienter upplever dock ingen förändring i oral hälsorelaterad livskvalitet. / Purpose: The purpose of this survey study was to identify how dental implant treatment affects quality of life regarding chewing ability, taste, speech, appearance, oral hygiene habits, and self-confidence. Materials and methods: An empirical survey study with quantitative data was performed on three different dental clinics in Stockholm during the time period Feb - April 2012. Questionnaire with a covering letter and stamped envelope was sent to a consecutive sample of 83 patients. Participants, 40 patients, 15 men and 25 women, mean age 66.5 years (34 - 89), voluntarily chose to participate in the study. Analyses of responses were performed in statistical software IBM ® SPSS ® 19. Results: The proportion of participants who experienced an improvement in perceived chewing ability was 42,5 %, speech and the taste was perceived not to have changed by 85,0 % after dental implant treatment. Regarding the appearance, 27,5 % said it had improved and 62,5 % that there was no change. There were 22,5 % who felt that their self- confidence had improved, while 75,0 % of participants did not experience a change in self- confidence after dental implant treatment. The majority (85,0 %) of participants did not think their social life had changed after treatment, while 7,5 % of patients reported that it had become better. The result could be noted that 17,5 % of patients found it simpler/ easier to perform oral hygiene while 75,0 % experienced no change in the performance of oral hygiene after dental implant treatment. Conclusion: An improvement in oral health- related quality of life for all studied factors could be observed in some patients after dental implant treatment. Most patients experience no change in oral health- related quality of life after dental implant treatment.

The overall aim of this thesis was to develop knowledge about how to promote health in children treated for cancer and how health promotion interventions based on such knowledge can be evaluated. In this thesis, a descriptive and explorative design has been used, comprising both qualitative (Papers I-III) and quantitative (Papers I and IV) methods. A nationwide cohort of 144 childhood cancer survivors (24-42 years) answered a questionnaire about the support they had received from health care services (Paper I). Fifteen children (8-12years), with experience of cancer treatment, participated in five focus groups with two sessions per group (Paper II and III). The focus group methodology was combined with participatory and art-based techniques, such as draw and tell and photography. The children discussed what promotes health and what friendship is about. A methodological design was used to psychometrically test the Swedish version of the Minneapolis-Manchester Quality of Life instrument (MMQL) (Paper IV). The study included 950 pupils in grade 6 and 9 from seven primary schools. In addition to this, a comparison of the MMQL instrument with the health-promoting factors described by children in the focus groups was performed. The findings showed that there is a need for health-promoting factors, such as knowledge and psychosocial support, from health care services for childhood cancer survivors. Their family and friends may contribute with support and then serve as health-promoting factors. Health-promoting factors, according to children 8-12 years of age and with experience of cancer treatment, are meaningful relationships, recreational activities and a trustful environment. The children expressed a holistic view of what promotes their health. Friendship, from the perspective of the children, is a process of equal and mutual commitment that develops over time and with interactions occurring face-to-face and digitally. The MMQL instrument may be valid and reliable in a sample of healthy children. However, less than one-third of the items in the MMQL instrument could be linked to the health-promoting factors that the children participating in the focus groups highlighted. In conclusion, the findings in this thesis contribute knowledge from a participant perspective regarding the needs and the experiences of health-promoting factors for those who have received treatment for cancer. This knowledge could form a basis for development of health promotion interventions aimed at children who have received treatment for cancer. It is suggested that if the MMQL instrument is used to evaluate health promotion among children who have received treatment for cancer, the MMQL should be complemented with items that capture aspects of health that are important to the children.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: A comprehensive food frequency questionnaire (FFQ) was developed to assess the daily total flavonoid intake over the past fortnight within a 14-week intervention that consisted of four periods to determine the effect of rooibos consumption on oxidative stress in adults (n=40) at intermediate to high coronary heart disease (CHD) risk. Within the intervention the comprehensive FFQ validity (against six estimated dietary records and biomarkers), reproducibility (on administrations in the washout and control periods six weeks apart as these periods had similar flavonoid intake restrictions) and responsiveness (across the four intervention periods of changed dietary conditions) was evaluated. The baseline period dietary record and FFQ dietary sources found to contribute most to the participants’ daily total flavonoid intake, considering the percentage contribution, and the between-person variation in intake, considering the stepwise multiple regression analysis, formed the food list of the resultant abbreviated FFQ. The validity, reproducibility and responsiveness of the latter were also evaluated within the intervention and its validity (against dietary records) and reproducibility (on re-administration two weeks apart) in an additional group (n=90) being at low and intermediate CHD risk to evaluate its external strength. The validity and reproducibility evaluations of the comprehensive and abbreviated FFQs in the intervention and abbreviated FFQ within the additional group comprised paired difference tests (to establish the ability to estimate group intakes), correlation coefficients (to establish the ability to rank individual participants), category agreement and gross misclassification next to the weighted kappa statistic (to establish the ability to classify the participants into tertiles and quintiles of intake) and Bland-Altman plots (as representation of the limits of agreement between the two dietary assessment methods). Correlation coefficients were also used for biomarker validity evaluations in the baseline period. The repeated measures analysis of variance (ANOVA) (Bonferroni correction) was used for the responsiveness evaluations of the comprehensive and abbreviated FFQs across the intervention periods alongside that of the biomarkers as evidence for the changed dietary conditions. The study demonstrated that the comprehensive FFQ could be modified to a format with a brief food list as few items contributed appreciably to the total flavonoid intake and of which most also contributed to the between-person intake variability. The comprehensive and moreover the abbreviated FFQ in the validity evaluations provided sufficiently accurate daily total flavonoid intake estimates. They could determine the intake at group level in correspondence with that of the dietary records. The participant intakes could additionally be categorized and in particular ranked greatly alike to the dietary record intakes. The Bland-Altman plots revealed proportional bias regarding overestimation at the higher intake level. The reproducibility also appeared to be greatly satisfactory although seasonal fruit exclusions from the abbreviated FFQ food list may hamper its repeated administration. Both FFQs also confirmed the changed total flavonoid intakes across the intervention periods in relation to changes in the expected direction concerning the plasma total polyphenol, conjugated diene and thiobarbituric acid reactive substance concentrations. / AFRIKAANSE OPSOMMING: ‘n Omvattende voedsel frekwensie vraelys (VFV) is ontwikkel om die daaglikse totale flavonoïed inname oor twee agtereenvolgende weke te beraam te midde van ‘n 14-week intervensie. Die intervensie het uit vier periodes bestaan wat die effek van rooibosinname op oksidatiewe stres in volwassenes (n=40), met ‘n intermediêre tot hoë koronêre hartsiekte (KHS) risiko, bepaal het. Binne die intervensie is die geldigheid (teen ses geskatte dieetrekords en biochemiese merkers), herhaalbaarheid (op aanwending ses weke uitmekaar in die uitwas en kontrole intervensie periodes met dieselfde flavonoïed inname bepalings) en waarneembaarheid (oor vier intervensie periodes van veranderde dieet bepalings) van die omvattende VFV geëvalueer. Die dieetbronne in die basislyn periode dieetrekords en vraelyste wat die meeste tot die deelnemers se daaglikse totale flavonoïed inname (baseer op die persentasie bydrae) en die tussen-persoon variasie in inname (baseer op die stapsgewyse meervuldige regressie analise) bygedra het, het die voedsellys van die voortvloeiende verkorte VFV gevorm. Die geldigheid, herhaalbaarheid en waarneembaarheid van dié VFV is binne die intervensie geëvalueer en die geldigheid (teen dieetrekords) en herhaalbaarheid (heradministrasie twee weke later) daarvan in ‘n verdere groep (n=90) met lae en intermediêre KHS risiko as evaluasie van die eksterne vermoë van die VFV. Die geldigheid en herhaalbaarheid evaluasies van die omvattende en verkorte VFV in die intervensie en die verkorte VFV in die verdere groep het bestaan uit gepaarde verskil toetse (bepaling van die groepinname skattingsvermoë), korrelasie koëffisiënte (bepaling van individuele deelnemer rangorde skattingsvermoë), kategorie ooreenstemming en erge wanklassifikasie naas die aangepaste kappa statistiek (bepaling van die vermoë om die deelnemer innames in derdes en vyfdes te klassifiseer) en die Bland-Altman karterings (verteenwoordiging van ooreenstemmingslimiete tussen die twee dieetinname metodes). Korrelasie koëffisiënte is ook gebruik vir biochemiese merker geldigheid evaluasies in die basislyn periode. Die herhaalde metings analise van variansie (ANOVA) (Bonferroni regstelling) is gebruik om die waarneembaarheid evaluasies van die omvattende en verkorte VFV oor die intervensie periodes naas dit van die biochemiese merkers te evalueer as bewys van die veranderde dieet bepalings. Die studie het aangedui dat die omvattende VFV gewysig kon word tot ‘n formaat met ‘n verkorte voedsellys omdat slegs ‘n aantal items merkbaar tot die totale flavonoïed inname bygedra het en die meeste hiervan ook tot die tussen-persoon variasie in inname. Die omvattende en die verkorte VFV het in die geldigheid evaluasies daarvan voldoende akkurate daaglikse totale flavonoïed inname skattings opgelewer omdat groep innames bepaal kon word in ooreenstemming met dit verkry van die dieetrekords en die deelnemer innames bykomend kategoriseer en in besonder grootliks eenders rangeer kon word as met hul dieetrekord innames. ‘n Proporsionele oorskatting by die hoër inname vlakke is wel vir al twee getoon in die Bland-Altman karterings. Die herhaalbaarheid was ook grootliks aanvaarbaar, alhoewel seisoenale vrugte uitsluitings in die verkorte VFV voedsellys die heruitvoering kan bemoeilik. Al twee vraelyste kon ook die veranderinge in die daaglikse totale flavonoïed inname oor die intervensie periodes bevestig in ooreenstemming met veranderinge in die verwagte rigting van die plasma totale polifenool, konjugaat diëne en tiobarbituursuur reaktiewe stof konsentrasies.

INTRODUCTION: Child maltreatment is a significant public health problem that affects all countries and cultures alike. Child maltreatment, which includes neglect, physical abuse, emotional abuse and sexual abuse, can result in negative consequences that are lifelong and irreversible. Previous studies have shown the prevalence of all forms of child abuse in India, which is also home to one fifth of the world’s children. However, adequate resources and efforts are not being made to understand the true scope of this problem. AIM: The present study utilized an existing measure, the Childhood Trauma Questionnaire (CTQ), to understand how parents from the South Indian culture defined acceptable child rearing practices and physical and emotional child abuse. The items from the physical and emotional abuse subscales on the CTQ were also tested for validity and reliability. It was hypothesized that fathers would report higher scores on the physical abuse subscale and mothers would report higher scores on the emotional abuse subscale. It was also hypothesized that parents would find spanking to be an acceptable form of discipline and note that both child physical and emotional abuse are not prevalent in the South Indian community residing in the United States. METHODS: This study recruited 41 participants (21 mothers and 20 fathers) to complete the CTQ. Of the total number of participants, ten were randomly assigned to participate in an in-depth interview, which focused on how parents in the South Indian community in Georgia interpreted the items on the CTQ and how parents defined child physical and emotional abuse. Reliability and validity testing was conducted using data analysis software SPSS 23.0. Qualitative analysis of the interviews involved Consensual Qualitative Research, identifying common themes among all ten interviews. RESULTS: Quantitative analysis revealed low to moderate internal consistency for the emotional abuse scale (α = 0.65) and moderate to high internal consistency for the physical abuse scale (α = 0.88). Independent t-test results showed that fathers reported higher scores on both the physical and emotional abuse subscale; however, these results were not significant. Using the Consensual Qualitative Research method, six domains were determined from the interviews. These included: (a) parent perspectives on child rearing practices, (b) spanking as a discipline practice, (c) country differences between India and the United States regarding discipline, (d) prevalence of abuse among the South Indian community in the United States, (e) reporting child abuse, and (f) parents’ awareness of resources to develop parenting skills. A majority of participants reported spanking as an acceptable form of discipline and believed that neither child physical nor emotional abuse was prevalent in the South Indian community in the United States. CONCLUSION: This study serves as formative research and encourages further investigation of different forms of child abuse in Indian populations, specifically child physical and emotional abuse. Understanding how a culture views children and child rearing practices is important in determining how abuse is defined within said culture. Societies that are more lenient and accepting of violence in general are at a greater risk for perpetrating the maltreatment of children. Establishing a concise definition of child abuse will aid in the development of valid measures that will determine the actual scope of the problem and create solutions, such as laws and policies that will shift a society’s view on appropriate interactions with children.