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published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy

The purpose of this study was to describe involvement in everyday activities for people with opioid replacement therapy. To answer the purpose, an empirical qualitative design was chosen that is appropriate for capturing a person's own thoughts, feelings, experiences, experiences and opinions and the world in which he lives with the person's own words. Data were collected through interviews with people who have opioid replacement therapy. The collected data consisted of six interviews analyzed based on a latent qualitative content analysis. Analysis of data resulted in an overall theme; Living in life does not survive life and four categories; A struggle to adapt to something new and find structure in everyday life. To dare to believe in his ability. To get professional support along the way. The importance of the social environment for breaking old life. The result showed that involvement in everyday activities is a major challenge and a struggle that depends both on the support people receive from care and social services in their change process, their confidence in their own ability and how to succeed in creating a new identity and how the social environment around them look. Conclusions that can be deduced from the results of the study can give implications for people who have opioid replacement therapy to help build new life in addition to receiving medication. It is a struggle to adapt and create a new identity and in that work, occupational therapy can perform an important role. / Syftet med denna studie var att beskriva engagemang i vardagliga aktiviteter för personer med läkemedelsassisterande behandling vid opiatberoende. För att besvara syftet valdes en empirisk kvalitativ design som är lämpligt för att fånga en persons egna tankar, känslor, upplevelser, erfarenheter och åsikter och den värld den lever i med personens egna ord. Data insamlades genom intervjuer med personer som har läkemedelsassisterande behandling vid opiatberoende. Insamlad data bestod av sex intervjuer som analyserades utifrån en latent kvalitativ innehållsanalys. Analys av data resulterade i ett övergripande tema; Att leva i livet inte överleva livet och fyra kategorier; En kamp att anpassa sig till något nytt och finna struktur i vardagen. Att våga tro på sin förmåga. Att få professionellt stöd på vägen. Den sociala miljöns betydelse för att kunna bryta med det gamla livet. Resultatet visade att engagemang i vardagliga aktiviteter är en stor utmaning och en kamp som både beror på vilket stöd personerna får av vård och socialtjänst i sin förändringsprocess, deras tilltro till sin egen förmåga och hur det lyckas skapa en ny identitet samt hur den sociala miljön runt dem ser ut.  Slutsatser som kan dras utifrån studiens resultat kan ge implikationer för att personer som har läkemedelsassisterande behandling vid opiatberoende vill ha hjälp med att bygga upp det nya livet utöver att de får mediciner. Det är en kamp att anpassa sig och skapa en ny identitet och i det arbetet kan arbetsterapi spela en viktig roll.

Christopher John Haines. / Thesis (M.D.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 239-279). / LIST OF TABLES --- p.xviii / LIST OF FIGURES --- p.xxi / LIST OF ABBREVIATIONS --- p.xxii / Chapter CHAPTER1 --- INTRODUCTION --- p.1 / Problems related to the menopause / Research plan / Chapter CHAPTER2 --- OVERVIEW --- p.15 / Introduction / Atherosclerosis and the lipid profile / Coronary artery disease and lipid abnormalities in women / "Exogenous oestrogens, progestogens and coronary artery disease " / Lipoprotein (a) / Chapter CHAPTER3 --- GENERAL METHODOLOGY --- p.134 / Recruitment of cases / Pharmacokinetics / Data collection and analysis of samples / Ethical considerations / Chapter CHAPTER4 --- STUDY I -THE SHORT TERM EFFECTS OF ORAL OESTROGEN --- p.157 / Crossover analysis of effects of oral oestrogen on lipoprotein (a) and other lipoproteins / Relationship between lipoprotein (a) and other lipids and lipoproteins / Chapter CHAPTER5 --- STUDY II -THE SUSTAINED EFFECTS OF ORAL OESTROGEN --- p.186 / Analysis of prolonged effects of oral oestrogen on lipoprotein (a) and other lipids and lipoproteins / Chapter CHAPTER6 --- STUDY III -THE EFFECTS OF COMBINED CYCLICAL HORMONE REPLACEMENT THERAPY --- p.196 / Analysis of effect of combined cyclical hormone replacement therapy on lipoprotein (a) and other lipids and lipoproteins / Comparison between sampling during oestrogen alone and combined phase of treatment / Chapter CHAPTER7 --- STUDY IV -THE EFFECTS OF PERCUTANEOUS OESTROGEN --- p.214 / Analysis of effect of percutaneous on lipoprotein (a) and other lipids and lipoproteins / Chapter CHAPTER8 --- SUMMARY AND CONCLUSIONS --- p.228 / BIBLIOGRAPHY --- p.239

Orientador: César Eduardo Fernades / Banca: Eliana Petri Nahas / Banca: Paulo Traiman / Banca: Luciano de Melo Pompei / Banca: Paula Andrea de Albuquerque Salles Navarro / Resumo: Avaliar comparativamente a eficácia da terapêutica de reposição hormonal (TRH) de baixa dose isolada ou associada à sinvastatina no comportamento de marcadores de risco cardiovasculares e do perfil lipídico e lipoprotéico em mulheres sintomáticas e com dislipidemia na pós-menopausa. Duzentas e quarenta e duas mulheres na pós-menopausa, sintomáticas e com dislipidemia foram randomizadas em três grupos de tratamento: A) estradiol (E2) 1mg/acetato de noretisterona (NETA) 0,5mg [E2/NETA] + sinvastativa 20mg; B) E2/NETA + placebo; e C) sinvastatina 20mg + placebo. A eficácia de cada tratamento foi avaliada pela melhora do perfil lipídico e lipoprotéico e dos sintomas climatéricos ao final de 16 semanas de tratamento. O colesterol total, o LDL-C, o colesterol não-HDL e a Apo B diminuíram de forma significativa (p<0,0001) ao final de 16 semanas no grupo que utilizou E2/NETA + sinvastatina e naquele tratado com sinvastatina + placebo. A relação Apo B/Apo A1 também apresentou redução significativa nestes dois grupos (p<0,0001 e p=0,0026 respectivamente). A Apo A1 diminuiu apenas no grupo que recebeu E2/NETA + sinvastatina (p=0,0055). O grupo E2/NETA + placebo não apresentou alterações significativas no perfil lipídico e lipoprotéico entre as visitas basal e final. Aquele que utilizou E2/NETA + sinvastatina apresentou redução significativa do HDL-C e da Apo A1 quando comparado às usuárias de sinvastatina + placebo (p=0,0233 e p=0,0231 respectivamente). No alívio dos sintomas climatéricos, os grupos que utilizaram E2/NETA foram superiores a sinvastatina + placebo. Em mulheres na pós-menopausa com dislipidemia, a associação de E2/NETA em baixa dose com sinvastatina aliviou os sintomas climatéricos de forma semelhante à observada com a E2/NETA isolada e melhorou o perfil lipídico e lipoprotéico de modo semelhante ao uso isolado da sinvastatina. O uso de E2/NETA sem ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To evaluate low-dose hormone therapy (HT) + simvastatin for vasomotor symptoms and cardiovascular risk markers. Symptomatic postmenopausal women (n=242) with dyslipidemia were randomized to one of three treatment groups: A) 1mg estradiol/0.5mg norethisterone acetate (E2/NETA) + 20mg simvastatin; B) E2/NETA + placebo; or C) 20mg simvastatin + placebo. Lipid and lipoprotein profiles and menopausal symptoms were evaluated after 16 weeks. Total cholesterol, LDL cholesterol, non-HDL cholesterol and Apo-B decreased (p<0.0001) in groups A and C, as did Apo-B/Apo-A1 (p<0.0001 and p=0.0026, respectively). Apo-A1 decreased only in group A (p=0.0055). HDL cholesterol and Apo-A1 were lower in A than C (p=0.0233 and p=0.0231, respectively). Relief of menopausal symptoms was better in A and B compared to C. HT + simvastatin were effective for the treatment of symptomatic postmenopausal women and improved the lipid profile similar to simvastatin alone. It also delivered an improvement in the simultaneous treatment of menopausal symptoms and dyslipidemia / Doutor

This is a study of a generation of women who are about to enter the climacteric period of their life, the menopause. Born between the years 1946 and 1956 they have been the object of continuous scrutiny by various interest groups. Because they are seen to be unique, many acronyms and titles, the most noted being the 'Baby Boomers' have been attached to them. The women of this generation have been classed as a Very active' generation, leaving a clear mark on society and the re-emerging women's movement. As they near menopause they are approaching a stage that could be seen as their last reproductive transition. For many women there is no cultural ritual, nor a single story to guide them through this period They are however not without advice. The 'big voices' of the drug companies, the medical system and the media, all tender their guidance as the dominant voice. These women have been told what to do by experts throughout their whole lives. It seems 'expert advice' on their reproductive phases have been penned mostly by men in the interests of treating, controlling and saving them. Control of their body remains a key struggle, both physically and linguistically. The purpose of the research was to study the expectations of this post-war, Baby Boom generation of menopause. The study shows that some women have made decisions to embrace non-medical help and accept menopause as an inevitable transition, while others are willing to consider medical help to enhance their 'quality of life '. Believing it is time to look after themselves, it seems many women will take a pragmatic view and accept medical opinion that the menopause is a deficiency disease, even if this requires them to become part of the consumer driven/drug company push for a 'symptom free' menopause. They wish to remain untroubled and express a willingness to do whatever they need to fulfil this. Their fervent hope is that the menopause will not upset their career, family or 'life'. Consequently a large majority of these women will think about or actively pursue hormone replacement therapy.

<p> </p><p> </p><p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p></p><p><p>The thesis will provide a description of the previous Swedish NRT marketing mix, a description of the present plans of Swedish NRT marketers for the marketing mix of their products, and the present marketing mix of the previously deregulated pharmacy markets in Finland and Norway. The purpose is to develop conclusions on how marketers of NRT products could change their marketing mix in response to the deregulation of the Swedish pharmacy market. </p><p> </p><p>This thesis relies on a descriptive method. Interviews are used as the source of primary data. This is because some of the information sought after is not readily available and cannot be found through secondary data.</p></p><p>Markets are mature only in the minds of the actors on the market. Due to the deregulation the market seems to be a window of opportunity for any innovative, aggressive marketing entrepreneur who wants to radically change his or her position in the market. NRT marketers could attempt to design a new, more aggressive strategy and work with the remaining Ps to unhinge what seems to be regarded a mature market. NRT marketers should work more actively to create an effective market feedback loop. NRT marketers should consider using the Internet to sell their products to consumers, thus opening a new channel.</p>

The thesis will provide a description of the previous Swedish NRT marketing mix, a description of the present plans of Swedish NRT marketers for the marketing mix of their products, and the present marketing mix of the previously deregulated pharmacy markets in Finland and Norway. The purpose is to develop conclusions on how marketers of NRT products could change their marketing mix in response to the deregulation of the Swedish pharmacy market.    This thesis relies on a descriptive method. Interviews are used as the source of primary data. This is because some of the information sought after is not readily available and cannot be found through secondary data. Markets are mature only in the minds of the actors on the market. Due to the deregulation the market seems to be a window of opportunity for any innovative, aggressive marketing entrepreneur who wants to radically change his or her position in the market. NRT marketers could attempt to design a new, more aggressive strategy and work with the remaining Ps to unhinge what seems to be regarded a mature market. NRT marketers should work more actively to create an effective market feedback loop. NRT marketers should consider using the Internet to sell their products to consumers, thus opening a new channel.

In Canada, nicotine replacement therapy (NRT) is a best practice for adult smoking cessation, but it is not recommended for use by youth smokers. Previous research has indicated that more than 20 percent of high school-aged smokers in Canada had used NRT, despite the cross-Canada requirement that youths under the age of 18 have a physician’s prescription to purchase NRT. The goal of this study was to examine both student and school-level characteristics associated with use of NRT by youths. Data from 29,296 grade 9 to 12 students who participated in the 2008-2009 National Youth Smoking Survey (YSS) were combined with Canadian census and built environment data in multilevel logistic regression models. The associations between lifetime and current NRT use with student characteristics (i.e., smoking status, social smoking connections) were examined alongside school environment factors such as urban/rural location and pharmacy density within a one kilometre radius of schools. In 2008-2009, 21.1% of youth smokers in Canada had ever used NRT and 5.1% were currently using NRT. Odds of NRT use were highest among daily smokers, boys, youths who had made multiple quit attempts, and youths who self-identified as smokers. Attending a school located within an urban area increased youths’ odds of NRT use, whereas higher density of pharmacies surrounding a school was inversely associated with NRT use. This study is the first to identify significant between school differences in NRT use. It also reveals that many youths are using NRT in the absence of a quit attempt. Further research is needed to identify school characteristics that impact NRT use, and understand how youths are accessing NRT.

There is an increasing awareness in the food industry about the role that proper nutrition plays in maintaining health and preventing disease. Women especially have always been interested in nutrition and its impact on their well-being. This awareness has placed more pressure on the food industry to provide a greater variety of nutritious and wholesome products which has led to the development of a new field in the food industry, called functional foods. These are food products that apart from the micro- and macronutrients that it already provides have additional important physiologically active functions that enhance health. These active components, called phytochemicals (from plant sources) and zoochemicals (from animal sources) have changed the role of diet in health. Functional foods can, by nature or design, bridge the traditional gap between food and medicine and thereby provide consumers with the opportunity to become involved in their own health care. One of these functional foods that have been receiving increased attention and research is soy. Apart from other health benefits of soy, such as cholesterol reduction and bone strengthening, scientific evidence has shown that soy can be used as an alternative for hormone replacement therapy (HRT). The increased interest in the latter can be ascribed to the changed attitude of women, as well as evidence of the side effects of conventional hormone replacement therapies. Consumer research in the nutraceutical area is, however, still in its infancy stage. Objective: The main objective of this study was thus to assess South African consumers' opinion of the potential health benefits of soy and soy products as an alternative for HRT. To attain this main objective, the following specific objectives were stated: To determine, by means of a consumer questionnaire, the percentage of South African consumers who are aware of soy. To determine, by means of an attitude scale, the attitudinal disposition of South African consumers towards the potential health benefits of soy and soy products as an alternative for HRT. To determine South African consumers' opinions regarding the menopausal related health benefits of soy. To determine whether there is a relation between respondents who Eat/drink soy and their opinion of the potential health benefits of soy. To determine whether there is a relation between respondents who never use soy and their opinion of the bone strengthening benefit of soy. To determine whether there is a relation between respondents' opinion of the health benefits of soy and their opinions of soy as an alternative for HRT and reliever of menopausal symptoms, respectively. Methods: In this study, consumers' opinion regarding the health benefits of soy was evaluated using a questionnaire. Respondents were randomly selected from nine metropolitan, as well as rural areas in South Africa, representing the four main race groups, namely whites, blacks, coloureds and Indians. The total sample size of the metropolitan and rural subjects was 3001. A sub-dataset was created which included female respondents that have heard of soy before and were premenopausal (35-44 years) and post-menopausal (50-59 years) of age. Thus, the total number of respondents used for further statistical analyses was 825. The respondents expressed their opinions of the health benefits of soy on a five-point hedonic (Likert) scale which was adapted to a three-point scale for easier interpretation of the tables. Results: 1. Of the 3 001 respondents, 2 437 (80%) were aware of soy. 2. A mean attitudinal disposition score of 2.47 on a three-point scale indicated a neutral to positive attitudinal disposition of the South African consumer population towards the potential health benefits of soy and soy products as alternative for HRT. No practically significant differences were found between the mean values of each statement, which indicated that no specifically strong opinions were expressed between different races or between different age groups. 3. Of all the consumers surveyed and those who did express a specific opinion, 72% agreed that soy has many health benefits compared to only 7% who disagreed. Although 34% of South Africans expressed a positive opinion when asked if soy can be used as alternative for HRT, the majority (46%) of the population had a neutral opinion. Forty-two percent of the consumers who held an opinion regarding soy as reliever of menopausal symptoms were positive, 35% had a neutral opinion and 23% of South Africans did not agree that soy can relieve menopausal symptoms. 4. A relation, although not of practical significance, was found between respondents who eat/drink soy and their opinion of the health benefits of soy. Of the respondents who indicated that they eat/drink soy, the majority agreed that soy has many health benefits. The respondents who disagreed when asked if they eat/drink soy, still expressed an overall positive opinion when asked whether soy has many health benefits. 5. A relation, although not of practical significance, was found between respondents who never use soy and their opinion of the bone strengthening benefit of soy. Of those who indicated that they use soy, the majority agreed that soy has a bone strengthening benefit. On the contrary, only 43% of those who agreed that they never use soy were positive about the bone strengthening benefit of soy, whereas 37% held a neutral opinion and 20% expressed a negative opinion. 6. The relation between respondents' opinion of the overall health benefits of soy and their opinion of soy as alternative for HRT and reliever of menopausal symptoms was of practical significance. Of the respondents who did not agree that soy has many health benefits, the majority expressed a negative opinion of soy as an alternative for HRT. Of those who agreed that soy has many health benefits, 45% expressed a neutral opinion and 44% a positive opinion of soy as alternative for HRT. Almost half (47%) of the respondents who agreed that soy does have many health benefits, expressed a neutral opinion when asked if soy can relieve menopausal symptoms, whereas only 30% had a positive opinion in this regard. The majority (86%) of the respondents who disagreed that soy has many health benefits, also expressed a negative opinion of soy as reliever for menopausal symptoms Conclusion: The results of this study indicate that 80% of the South African consumer population are aware of soy and that South African consumers have a neutral to positive attitudinal disposition towards the potential health benefits of soy. Respondents did not express a particularly strong opinion regarding several health benefits of soy. It may be hypothesized that they are not informed well enough on the health benefits of soy as to take a stand and to form a definite opinion. Neither different race groups, nor pre- or post-menopausal women differ significantly in the frequency of their opinions, indicating that in this study, race and age did not have a practical significant influence on opinion of the health benefits of soy. Of all those surveyed and who did express a specific opinion, 72% agreed that soy has many health benefits, which is almost the same percentage (74%) as American consumers who perceive soy products as healthy as according to the United Soybean Board (USB) National Report (2003-2004:4). A survey by Adams (2001:433) reported that 71% of American consumers believed that plant-derived HRT have fewer risks and can thus be used as a safe alterative for conventional HRT. According to the results of the present study only 34% of South African consumers expressed a positive opinion when asked if soy can be used as an alternative for HRT. Insufficient evidence on the safety and efficacy of the potential health benefits of soy, as well as a lack of consumer education in South Africa, could be the reason for this uncertainty among XIV South African consumers. While only 26% of American consumers are aware that soy might relieve menopausal symptoms (USB National Report, 2003- 2004:4), results of the current study found that 42% of South Africans were of opinion that soy can relieve menopausal symptoms. A relation, although not of practical significance, was found between respondents who eat/drink soy and their opinion of the health benefits of soy. This can be an indication that whether or not the South African consumer population consume soy doesn't have an influence on their opinion of soy's health benefits in practice. The relation found between respondents who never use soy and their opinion of the bone strengthening benefit of soy were not of practical significance. This can be an indication that whether or not South Africans use soy does not influence their opinion of the bone strengthening benefit of soy in practice. Furthermore, a practically significant relation was found between respondents' opinion of the overall health benefits of soy and their opinion of soy as alternative for HRT and reliever of menopausal symptoms, respectively. Interestingly, respondents who expressed a positive opinion regarding the health benefits of soy did not have a convincingly positive opinion of soy as alternative for HRT and as reliever of menopausal symptoms. They expressed a more neutral opinion. As expected, consumers that were not of opinion that soy has certain health benefits, also disagreed when asked if soy can be used as an alternative for HRT or as reliever of menopausal symptoms. Although the causes for the respondents' opinion or uncertainty were not determined in this study, it can be hypothesised that it may be due to lack of standardisation of evidence on the safety and efficacy of alternative hormone replacement therapies. Further studies are still needed to determine the contributing factors which influence consumers' opinion or lack of opinion on soy. If consumers are not educated about the benefits and disadvantages of soy as alternative for HRT, they cannot make intelligent decisions and choices as to whether or not to use soy as alternative for HRT. / Thesis (M. Consumer Science)--North-West University, Potchefstroom Campus, 2004.