The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed. Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used. Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate. Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension. Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.

Background: Iron deficiency (ID) is the most prevalent nutritional deficiency in the world. In children, both inadequate iron and fatty acid (FA) status have been found to have an effect on cognitive and behavioural function, including physical activity behaviour and attention deficit hyperactivity disorder (ADHD)–related behaviour. Aim: To investigate the effects of supplementation with iron and omega–3 fatty acids (n–3 FAs), alone and in combination, on spontaneous motor activity and ADHD–related behaviour in iron deficient primary school children in KwaZulu–Natal. An additional aim was to evaluate the use of the Actical accelerometer as a tool to assess physical activity behaviour. Methods: The study design was a 2x2 factorial, randomized, double–blind and placebo–controlled trial. Iron deficient school children aged six to ten years with or without mild anaemia were included in the study (n = 321). Subjects were randomly assigned to receive one of the following supplement combinations: (1) 420mg docosahexaenoic acid (DHA)/80 mg eicosapentaenoic acid (EPA) + 50mg of iron as ferrous sulphate (Fe); (2) 420mg DHA/80mg EPA + placebo; (3) 50mg of Fe + placebo; (4) placebo + placebo. Supplements were provided four times a week for a duration of 8.5 months (excluding school holidays). Physical activity of a subgroup of subjects (n=98) was recorded on four random school days at baseline, midpoint and endpoint (12 days in total) during three different time periods namely class time 1 (08h00-10h30), break time (10h30–11h00) and class time 2 (11h00–12h00). Classroom behaviour of study subjects was assessed by teachers at baseline and endpoint using the Conners’ Teacher Rating Scale–Revised: Short Forms (CTRS). Iron status indicators and red blood cell (RBC) FA composition were measured at baseline and endpoint. Treatment effects were assessed for activity and CTRS scores. Furthermore, the relationship between activity, CTRS scores and iron/FA status indicators was determined using bivariate correlation and multivariate linear regression analysis. Results: Overall activity of all subjects varied over time from baseline and midpoint to endpoint. A significant cycle x age interaction (P = 0.005) as well as a significant cycle x time period x gender interaction (P = 0.036) was observed on overall activity. There were no significant interactions of cycle or time period with treatment. However, there was a significant main effect of DHA/EPA supplementation for lower class time 1 activity at endpoint (P = 0.014). Biological markers indicating better or poorer iron status were positively and negatively associated with activity at break time, respectively. Subjects in the group receiving both iron and DHA/EPA supplements showed a significant improvement from baseline to endpoint on the cognitive problems/inattention subscale (P = 0.005) of the CTRS. Hyperactivity scores increased iv significantly from baseline to endpoint in all groups (P = 0.006). DHA (r = –.203; P = 0.040) and EPA (r = –.199; P = 0.044) content of RBC were negatively associated with activity at class time 1. No significant associations were observed between activity and CTRS scores at baseline. At endpoint, class time 1 activity was positively associated with all CTRS subscale scores except for the cognitive problems subscale, which only bordered significance (correlation, P = 0.051; regression, P = 0.073). Conclusions: These findings suggest that n–3 FA supplementation may have an influence on ADHD–related behaviour during class time. During school break time when subjects were allowed to move around freely, iron status was positively associated with spontaneous motor activity. Furthermore, the accelerometer might be a useful complimentary tool for assessing both classroom and break time activity behaviour in school children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2012.

Background: Iron deficiency (ID) is the most prevalent nutritional deficiency in the world. In children, both inadequate iron and fatty acid (FA) status have been found to have an effect on cognitive and behavioural function, including physical activity behaviour and attention deficit hyperactivity disorder (ADHD)–related behaviour. Aim: To investigate the effects of supplementation with iron and omega–3 fatty acids (n–3 FAs), alone and in combination, on spontaneous motor activity and ADHD–related behaviour in iron deficient primary school children in KwaZulu–Natal. An additional aim was to evaluate the use of the Actical accelerometer as a tool to assess physical activity behaviour. Methods: The study design was a 2x2 factorial, randomized, double–blind and placebo–controlled trial. Iron deficient school children aged six to ten years with or without mild anaemia were included in the study (n = 321). Subjects were randomly assigned to receive one of the following supplement combinations: (1) 420mg docosahexaenoic acid (DHA)/80 mg eicosapentaenoic acid (EPA) + 50mg of iron as ferrous sulphate (Fe); (2) 420mg DHA/80mg EPA + placebo; (3) 50mg of Fe + placebo; (4) placebo + placebo. Supplements were provided four times a week for a duration of 8.5 months (excluding school holidays). Physical activity of a subgroup of subjects (n=98) was recorded on four random school days at baseline, midpoint and endpoint (12 days in total) during three different time periods namely class time 1 (08h00-10h30), break time (10h30–11h00) and class time 2 (11h00–12h00). Classroom behaviour of study subjects was assessed by teachers at baseline and endpoint using the Conners’ Teacher Rating Scale–Revised: Short Forms (CTRS). Iron status indicators and red blood cell (RBC) FA composition were measured at baseline and endpoint. Treatment effects were assessed for activity and CTRS scores. Furthermore, the relationship between activity, CTRS scores and iron/FA status indicators was determined using bivariate correlation and multivariate linear regression analysis. Results: Overall activity of all subjects varied over time from baseline and midpoint to endpoint. A significant cycle x age interaction (P = 0.005) as well as a significant cycle x time period x gender interaction (P = 0.036) was observed on overall activity. There were no significant interactions of cycle or time period with treatment. However, there was a significant main effect of DHA/EPA supplementation for lower class time 1 activity at endpoint (P = 0.014). Biological markers indicating better or poorer iron status were positively and negatively associated with activity at break time, respectively. Subjects in the group receiving both iron and DHA/EPA supplements showed a significant improvement from baseline to endpoint on the cognitive problems/inattention subscale (P = 0.005) of the CTRS. Hyperactivity scores increased iv significantly from baseline to endpoint in all groups (P = 0.006). DHA (r = –.203; P = 0.040) and EPA (r = –.199; P = 0.044) content of RBC were negatively associated with activity at class time 1. No significant associations were observed between activity and CTRS scores at baseline. At endpoint, class time 1 activity was positively associated with all CTRS subscale scores except for the cognitive problems subscale, which only bordered significance (correlation, P = 0.051; regression, P = 0.073). Conclusions: These findings suggest that n–3 FA supplementation may have an influence on ADHD–related behaviour during class time. During school break time when subjects were allowed to move around freely, iron status was positively associated with spontaneous motor activity. Furthermore, the accelerometer might be a useful complimentary tool for assessing both classroom and break time activity behaviour in school children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2012.

Current situation: Standardized terminology of the Omaha system brings new opportunities for nurses providing community care. Objectives: Four objectives have been defined for this study: to implement the Omaha system in the nursing documentation for the purpose of verification of nursing care in community practice - to characterize the problems of patients with gastrointestinal diseases as per the Problem Classification Scheme - to map the links between problems and interventions as per the Intervention Scheme - to evaluate the problem results using the Problem Rating Scale for Outcomes of the Omaha system. Methodology: The research method used was based on the study by Kathryn H. Bowles (2000) addressing problems of patients and nurse interventions. The quantitative research method was implemented by inquiry using nursing documentation with the Omaha system implemented. The data acquired was tested using the software tools SPSS 22.0 and MS Excel. Research set: It consisted of 103 patients with gastrointestinal diseases. The inquiry was carried out by contact persons - nurses of the gastroenterology department. Results: Patients with gastrointestinal diseases suffering from a wide range of problems corresponding to given character of diseases, which predominantly occur in the Physiological Domain and Health-Related Behavior Domain. In terms of mapping of links between problems and interventions, the results have proven a high usability of the objectives defined in the Intervention Scheme in community practice. The interventions were mostly determined in the categories Treatments and Procedures and Surveillance. Statistical differences have been confirmed in the documentation of interventions in individual categories for patient problems as well as for the selection of interventions in individual categories with respect to the type of given gastrointestinal disease. The study results have proven a significant improvement of knowledge, behaviour and status for individual problems, which is shown in comparison of final values with the initial values of problem results. The implementation of the selected interventions as per the Intervention Scheme resulted in a reduction or elimination of ? of problems. Conclusions: The results of the research inquiry clearly show that the Omaha system is an appropriate tool for documentation of all stages of the nursing process in the community care. Implementation of the functional documentation in community practice requires the Czech version of the Omaha system and electronic form of the documentation, which are absent at present.

The chapter titled Present state focuses on the problem of gerontology and geriatrics. Other chapters include description of the most outstanding neuropsychical and somatic changes in the old-age. Next chapters deal with functional examine and geriatric rehabilitation problem.The objective of the thesis was assessing the extent of self-reliance and psychical changes affecting all the occupants of using Crichton Geriatric Rating Scale.146 seniors were tested according to the Crichton Geriatric Rating Scale.Three hypotheses were stated. It was expected that the results of the Crichton tests would correlate with the results of MiniMental Test. Another hypothesis was that there would be better results of the test done to the people whose family care for them actively. The last hypothesis expected worse results of the people who have been in the retirement home for more than three years.The research has confirmed that the results of the Chrichton test and MiniMental test correlate. Correlation of the Crichton test with the active care and interest of the family for the senior and the length of their stay was not proved.

Made available in DSpace on 2016-03-15T19:41:23Z (GMT). No. of bitstreams: 1 Lucia Cunha Lee.pdf: 6101361 bytes, checksum: 97fc5563d800b7ac6a05a73e68ddd500 (MD5) Previous issue date: 2014-06-10 / Fundo Mackenzie de Pesquisa / Parent-child interaction is an important interface in psychological assessment. Mediated Learning Experience (MLE) describes a type of directed interaction that influences the development of the child with whom the adult interacts. It is notewerthy the importance of the mediating function that parents can establish with their children and how it can be affected when the child presents any development disorder. Williams Syndrome is caused by a segmental aneusomy due to the deletion of multiple genes in chromosome region 7q11.23. Some indicators for the diagnosis are identified at birth, such as typical facial features and the presence of cardiac and renal alterations. Among behavioral characteristics, it is observed excessive sociability and a cognitive profile with intelectual disability and discrepancies in the manifestation of cognitive skills, such as impaired visuospatial function and preserved language skills, especially expressive ones. Considering these conditions, the present study aimed at analizing mediating actions taken by mothers during semidirected activities (assembling a puzzle and telling and retelling a story), performed with their daughters who have WS. To do so, it was described how mothers manage mediations with their daughters, based on MLE. Three mother-child dyads took part in the study. There were 5 sessions, two between mother and child and three between the mother and the researcher. During the sessions involving mother and child, it was possible to notice that mothers presented qualitatively and quantitatively varied mediating actions during the tasks, exposing differences according to the type and complexity of tasks (such as giving verbal instructions, using a model for the puzzle, drawing attention to parts of the story). Categories of MLE Scale proved adequate for the assessment steps as they offered an overview of the mediator s actions repertoire. It was verified that the shared experience between mother and daughter was a stimulus and a facilitator to situations of reflexion in individual interviews with the mothers. Thus, the association of observation by the mother, interaction with her daughter and individual interview proved effective to achieve a qualitative alteration of mediation strategies and is also promising for the development of children with WS. Therefore we underline the importance of observation of parental interactions as well as reflection upon them as assessment and intervention tools in the field of development disorders. / A interação de pais e filhos configura-se como uma importante interface na avaliação psicológica. A Experiência de Aprendizagem Mediada (EAM) descreve um tipo de interação dirigida que influencia o desenvolvimento das capacidades da criança com a qual o adulto interage. Vale destacar a importância da função mediadora que os pais podem estabelecer com seus filhos e como essa pode ser afetada quando o filho apresenta algum transtorno em seu desenvolvimento. A Síndrome de Williams (SW) é ocasionada por uma aneusomia segmentar devido à deleção de múltiplos genes na região cromossômica 7q11.23. Alguns indicadores para o diagnóstico da síndrome são identificados desde o nascimento, como as características faciais típicas a presença de alterações cardíacas e renais. Na dimensão relacionada ao comportamento, observa-se excessiva sociabilidade e um perfil cognitivo com deficiência intelectual e discrepâncias na manifestação de habilidades cognitivas, como prejuízos visoespaciais e preservação de habilidades de linguagem, especialmente as expressivas. Com base nesses pressupostos, o presente estudo analisa as ações mediadoras apresentadas por mães a partir de atividades semidirigidas (montar quebra-cabeças e contar e recontar histórias), realizadas com suas filhas que apresentam SW. Para isso, foi descrito como essas mães manejam as mediações com suas filhas, tendo por base a EAM. Participaram desse estudo três díades mãe-criança, em cinco encontros consecutivos, sendo dois entre a mãe e a criança e três entre a mãe e a pesquisadora. Nos encontros com os pares mãe-criança, foi possível notar que diante de tarefas, as mães apresentaram ações mediadoras diversificadas no que diz respeito à quantidade e qualidade, expondo diferenças de acordo com o tipo de atividade e a complexidade das tarefas (como dar instruções verbais, utilizar modelo para o quebra-cabeça, chamar atenção para partes da história). As categorias da Escala EAM revelaram-se apropriadas para etapas de avaliação, oferecendo um levantamento do repertório de ações do mediador. Verificou-se que a experiência compartilhada entre a mãe e a filha foi um estímulo e um facilitador para as situações de reflexão nas entrevistas individuais com as mães. Assim, a associação da observação - por parte da mãe - da interação com a sua filha, com a entrevista individual, indicou ser um dispositivo importante para a modificação qualitativa das estratégias de mediação e promissora no desenvolvimento de suas crianças com SW. Logo, enfatiza-se a importância das observações das interações parentais, além de reflexões dirigidas sobre elas, como um recurso na avaliação e na intervenção na área de transtornos de desenvolvimento.

Additional information available on a CD stored at the Merensky Library.The purpose of this study was to explore the concept of quality in early learning centres which could serve as the groundwork for the development of an early learning quality assurance framework in South Africa. The data used reflects different beneficiaries‘ experiences of quality in early learning centres. The unique contexts of, and situations at early learning centres were considered. A theoretical framework, based on Woodhead‘s model on quality development, informed the study. The framework consists of input (structural), process and outcome quality indicators. In this explanatory instrumental case study framed within social constructionism, the researcher partnered with 235 teachers, 235 mothers and 235 teacher students from a middle income group, to generate mixed method data using surveys, as well as interviews and reflective journals in a statistical and thematical analysis. Beneficiaries‘ conceptualisations of quality mirrored accepted norms of quality in early learning centres. Beneficiaries indicated the following as indicative of quality: children‘s social-emotional well-being and holistic development, a normative foundation for values and respect, effective infrastructure and accountable learning. Aspects regarded as quality indicators by beneficiaries were available at early learning centres. In this regard early learning centres provided more indoor than outdoor facilities. The latter were mostly static outdoor structures which could negatively impact on sensory- and motor development. The promovenda developed a draft quality assurance framework based on the following criteria: school climate, infrastructure, curriculum, communication, teacher competence, learning environment, and support services. The findings show that aspects perceived by beneficiaries as quality indicators in an early learning centre are predominantly process indicators and hard to ‗measure‘ in a quantitative way. A quality school climate enables emotional and social well-being. In this regard, the findings suggest that for the beneficiaries quality concerns were not about that which early learning centres have provided in terms of facilities (input indicators), but rather about centres that promote children‘s holistic well-being. / Thesis (PhD)--University of Pretoria, 2012. / Educational Psychology / unrestricted

Bakgrund Sväljning bedöms utifrån två aspekter - hur säker och hur effektiv den är. Tidigare studier har visat att vid stigande ålder blir sväljningen mindre effektiv och att förekomst av penetration ökar. Åldrande sväljning har i tidigare studier inte studerats specifikt utifrån säkerhet och effektivitet. Tidigare forskning med avseende på sväljning har enbart fokuserat på äldre individer respektive snävare åldersgrupper.  Syfte Aktuella studiens syfte är att undersöka om det ses en försämring i normal sväljförmåga vid stigande ålder. Studien syftar  även till att undersöka om det finns könsskillnader i hur sväljförmåga förändras vid ökande ålder, men även oavsett ålder. Bedömning av sväljfunktion, sväljningssäkerhet och sväljningseffektivitet genomfördes med Flexibel videoendoskopisk Undersökning av Sväljning (FUS).  Metod Totalt inkluderades 65 deltagare (33 st kvinnor och 32 st män), i åldrarna 21-91 år (median 44 år). FUS genomfördes för att undersöka sväljningen. Vid FUS sväljer deltagarna föda i olika konsistenser. Fynden från FUS bedömdes utifrån standardiserade skalor: The Dysphagia Outcome and Severity Scale (DOSS), Penetration-Aspiration Scale (PAS) och The Yale Pharyngeal Residue Severity Rating Scale (YPRSRS).  Resultat Majoriteten av alla deltagare bedömdes ha funktionell sväljning. Kvinnor uppvisade en bättre sväljfunktion överlag, men inga könsskillander kunde påvisas gällande säkerhet och effektivitet. Deltagare med en högre uppnådd ålder uppvisade en sämre sväljningssäkerhet och sväljningseffektivitet. Ålder kan således vara en påverkande faktor för sväljningssäkerhet och sväljningseffektivitet.   Slutsatser Denna studie visade att sväljfunktionen hos äldre deltagare var sämre än hos yngre deltagare. Sväljningens säkerhet och effektivitet var inte försämrad hos friska äldre deltagare, jämfört med friska yngre deltagare. Det fanns könsskillnader i sväljförmåga avseende sväljfunktion, kvinnor har en högre förekomst av normal sväljning än männen. Könsskillnader gällande sväljningssäkerhet kunde inte konstateras. Könsskillnad för sväljningseffektivitet kunde ses för sinus piriformis, men inte vallecula. Männen uppvisade genomgående en mindre effektiv sväljning, jämfört med kvinnorna.

The impact of acculturation and poor social support as potential risk factors for cardiovascular and metabolic disease amongst Mexican immigrants to the United States (U.S.) is a developing area of research. One theory is that acculturation to U.S. society is negatively associated with health due to the stress of immigration as well as the less healthy diet and lifestyle in the U.S. It is also theorized that positive social support is associated with better health during immigration due to the buffering effect relationships have on stress. Despite these theories, mixed findings have been found regarding the associations between acculturation and social support to health outcomes in this population. Some research has also noted that significant differences exist between the manner in which men and women experience social support and their acculturation patterns. Consequently, the primary purpose of this study was to test the associations between acculturation and health as well as assess gender, social support, and acculturation for potential moderator effects in a sample of Mexican immigrants in Provo, Utah. Acculturation was measured using the Acculturation Rating Scale for Mexican Americans-II (ARMSA-II) which consists of the Anglo Orientation Scale (AOS) and Mexican Orientation Scale (MOS). Social support was determined using both the Interpersonal Support Evaluation List (ISEL) and Sarason Social Support Questionnaire (SSSQ) which has two dimensions: satisfaction with support network and size of support network. Hierarchical multiple regression did not find significant associations between acculturation or social support and health outcomes as measured by ambulatory blood pressure or blood draw values including triglycerides, Hemoglobin A1c (HbA1c), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). A significant association was observed between Anglo Orientation and social support as measured by the ISEL-II. A moderation effect was observed between gender and Anglo orientation with satisfaction in one's support network. No other moderation effects were observed in this study. Implications of the findings, limitations, and directions for future research are discussed.

Studies have identified metabolic health factors to be a major concern in Mexican-Americans, including Mexican immigrants to the United States (U.S.). Acculturation stress has been hypothesized to be a factor in the development of many health-related concerns in this population. Specifically, previous studies have shown that acculturation stress contributes to health concerns, including metabolic health concerns (e.g., diabetes, metabolic syndrome). The primary purpose of this study was to examine the relationship between cultural orientation, a measure of acculturation designed to provide more information than traditional acculturation measures, and metabolic health outcomes. Specific acculturation-related stressors (social support, job-related stress, and depression) were hypothesized mediators in this relationship among a convenience sample of 98 foreign-born Mexicans living in Utah County, Utah controlling for age, gender, socio-economic status (SES), and years in the U.S. Data were collected twice with a three year interval to examine change over time. Changes in these constructs were examined through the use of Growth Modeling with Bayesian estimation. The Acculturation Rating Scale for Mexican-Americans (ARSMA-II) was used to measure Anglo Cultural Orientation and Mexican Cultural Orientation. Standard blood analyses were used to measure metabolic health outcomes, which included glycosylated hemoglobin (HbA1c), insulin, and glucose. The Interpersonal Support Evaluation List (ISEL-12) was used to measure social support, the Job Content Questionnaire (JCQ) was used to measure job-related stress, and the Center for Epidemiological Studies-Depression Scale (CES-D) was used to measure depression. No change was identified in Anglo Cultural Orientation or Mexican Cultural Orientation over time in the majority of subjects. A positive relationship between Anglo Cultural Orientation and HbA1c was found, as was a negative relationship between Mexican Cultural Orientation and HbA1c. Mediation analyses showed a mediation effect of depression on the relationship between Anglo Cultural Orientation and glucose. Implications of findings, limitations, and directions for future research are discussed.