Doctor of Philosophy / School of Family Studies and Human Services / Sandra M. Stith / Intimate partner homicide (IPH) is a serious problem throughout the world. Research has identified a history of intimate partner violence (IPV) as a risk factor for IPH (Campbell et al., 2007). However, we know that not all individuals who perpetrate IPV end up perpetrating IPH, and not all victims of IPV end up becoming victims of IPH. There is a need to identify additional risk factors for IPH in order to potentially help identify individuals who may be at a greater risk for IPH perpetration or victimization. In this study, we conducted a meta-analysis on risk factors for male IPH perpetration and female IPH victimization. This meta-analysis examined results from 17 studies, which included 148 effect sizes to be used in the analysis. The overall sample size included in the study was 10,143. This study compared IPV samples and IPH samples as a means to aid in identifying risk factors that may place individuals who are victims or perpetrators of IPV at a greater risk for IPH perpetration or victimization. Results of our analyses indicated that the strongest risk factors for male IPH perpetration were the perpetrator having direct access to a gun, perpetrator’s’ previous threats with a weapon, perpetrator’s previous non-fatal strangulation, perpetrator’s previous rape of the victim, perpetrator’s demonstration of controlling behaviors, perpetrator’s previous threats to harm the victim, and the perpetrator’s previous stalking of the victim. We found that the strongest risk factors for female IPH victimization were the victim being abused by the perpetrator while pregnant, the victim’s substance abuse, the victim having less than a high school education, being separated from the perpetrator, and having children from a previous relationship (not with the perpetrator). Implications for law enforcement personnel, victim advocates, mental health professionals, as well as other professionals who may be in contact with potential IPH perpetrators and victims are discussed.

Background Mental health of the adolescents is an important global public health concern as a leading cause of illness and disability not only for the adolescents, but also their family, and the community. In recent years the broader definition of mental health suggests an overall improved well-being as well as absence of illness. Despite the global recognition of the significance of adolescents’ mental health it remains a seriously neglected area in research and policy in Pakistan. This thesis attempts to understand the epidemiology of mental health among Pakistani adolescents by drawing from developmentally informed framework. This thesis proposes that perceptions of relationship with parents and attachment underlie the adolescents’ successful ability to regulate emotions and perceive social support. It also attempts to understand the role of cultural orientation in the pathway of associations between the factors mentioned above. Objectives A quantitative cross sectional design was applied to investigate the state of mental health among Pakistani adolescents. The study also aimed at investigating the validity of constructs of attachment, parental bonding, emotion regulation, social support and cultural orientation in Pakistan and how these factors interrelate in relation to adolescents’ mental health. Methods A sample of eleven hundred and twenty four was recruited from eight secondary schools from the district of Rawalpindi, Pakistan after formal approval from concerned authorities. A battery of self-report measures was administered in class-room setting. Confirmatory factor analysis (CFA) and Structural equation modelling (SEM) were used to analyse the data. Results Prevalence of depression and anxiety among this sample was 17.2% and 21.4% respectively. Results from the CFA of the Urdu versions of the instruments used in the current study replicated the original factor structures in case of well-being, depression, anxiety, parental bonding, emotion regulation, and social support with minor modifications. However, a two factor model of cultural orientation is supported in the current study. In case of parental bonding, a second order factor was found for mother and father bonding showing that both form common factors of parental warmth, protectiveness and authoritarianism. Present study found support for the hypothesized structural equation model examining pathway of association between attachment, parental bonding, social support, emotion regulation and cultural orientation in understanding depression, anxiety and well-being among Pakistani adolescents. Discussion Findings of this study suggest that parental bonding, attachment, emotion regulation, social support and cultural orientation play a crucial role to further our understanding of adolescents’ depression, anxiety and well-being in Pakistani cultural context. Therefore, these are central constructs within a developmental framework and are important when considering long-term psychosocial functioning of individuals. Further implications are discussed regarding the recommendation of promoting and utilizing a developmentally informed approach when working with adolescent population. These findings may be used as base line information in making policy level decisions regarding evaluation, prevention and intervention and of mental health problems among Pakistani adolescents.

Magister Chirurgiae Dentium - MChD / Aim: To determine the prevalence of peri-implant mucositis and the association between systemic and local risk factors

Magister Artium (Psychology) - MA(Psych) / There is widespread evidence that exposure to community violence is escalating at an alarming rate, not only in South Africa, but worldwide. The literature indicates that the cohort affected is primarily children and adolescents. Whilst a significant amount of empirical research focuses on exposure to community violence and the identification of risk and protective factors, there is a paucity of initiatives providing in-depth investigations into the dynamics of these factors. An explorative study grounded in the meanings which adolescents assign to risk and protective factors is essential to provide comprehensive and sensitive care to adolescents exposed to community violence. The aim of this study was to explore adolescents’ perceptions and understandings of the risk and protective factors related to community violence exposure in a low-income community in Cape Town. The current study utilised the PPCT model as it allowed the researcher to explore the way in which risk and protective factors function within different systems. Data was collected from 50 adolescents between the ages of 12 and 15. Five focus groups were used to collect the data, consisting of ten participants each, both males and females. Participants were purposively selected from a high school located in a low-income community in Cape Town. The ethical guidelines stipulated by the UWC and the WCED were strictly followed. Prior to the focus group interviews, informed consent and assent were obtained from both parents and participants. Participants were informed of their rights in the research process. The information collected from participants was analysed by means of a theoretical thematic analysis. This type of thematic analysis aims to identify information gathered, examined and described in rich detail, according to themes from the text, as proposed by Braun and Clarke (2006). This study aimed to contribute to the development of effective interventions and to add to the knowledge base of studies focusing on risk and protective factors associated with exposure to community violence among adolescents

Magister Public Health - MPH / Namibia is currently coping with a dual burden of human immunodeficiency (HIV) and HIV-associated tuberculosis (TB). In 2010, HIV prevalence was 18.8%, the TB case notification rate was 634 per 100,000 population, while TB/HIV co-infection was 58% in 2009. There were 372 reported cases of drug-resistant TB (DR-TB) in 2009. This study assessed the prevalence, profile and outcome of adverse events (AEs) associated with the treatment of DR-TB, and risk factors for the adverse events. The researcher used a cross-sectional design. Data was collected from the treatment records of all patients treated for DR-TB (N = 59) at the study facility between January 2008 and February 2010. Descriptive statistics were used to describe the frequency of the adverse events and logistic regression to analyse the association between possible risk factors and (specific) adverse events, with stratification (sub-group analysis) and multivariate analysis to adjust for measured confounders. Results of logistic regression analysis are reported as odds ratio (OR), 95% confidence interval (CI) and p-value, where p<0.05 was considered to be statistically significant. A total of 141 adverse events were experienced by 90% (53/59) of patients in the sample. HIV-associated TB occurred in 31 (53%) of the sample. The prevalence of gastrointestinal tract (GIT) adverse events was 64%, tinnitus 45%, joint pain 28% and decreased hearing 25%. Abdominal pain, rash, nausea, decreased hearing and joint pain were found to be more common in people living with HIV than in HIV-negative patients. Moderate-to-severe adverse events were mostly experienced after four weeks of DR-TB treatment (OR 6.4; 95% CI 1.6 – 25.6, p= 0.01). Drug-resistant TB patients who were coinfected with HIV were more prone to experiencing three or more adverse events (OR 3.9; 95% CI 1.2 – 13.6, p= 0.03). Patients treated with zidovudine-based ART were at an increased risk of experiencing nausea (OR 7.5; 95% CI 1.1 -51.5, p=0.04). Females were associated with an increased risk of skin rash (OR 15.7; 95% CI 1.7 – 143.7, p=0.01). The use of cycloserine-based DR-TB regimens was associated with joint pain (OR 6.5; 95% CI 1.6 – 25.8, p=0.01), while the risk of ototoxicity was associated with the use of amikacin-containing regimens (OR 12.0; 95% CI 1.3 – 111.3, p=0.03). Adverse events were found to be more common among patients treated for DR-TB (90% prevalence), particularly during the intensive phase of TB therapy. Most of these adverse events were mild and tolerable. Some adverse events were more common among DR-TB patients who were co-infected with HIV than in HIV-negative patients. The characteristics and risk factors of the serious adverse events need further research. The use of cycloserine-based DR-TB regimens was associated with joint pain. Findings of the risk factor analysis are inconclusive because of the small sample size, which severely limited the power of the study. Clinicians should invest more time in the prevention and management of adverse events, and should pay greater attention to the needs of HIV co-infected DR-TB patients who are using second-line anti-TB medications, especially those who are concomitantly undergoing treatment using antiretroviral medicines.

Magister Public Health - MPH / HIV/AIDS is a major health problem in Namibia with HIV prevalence estimated at 18.2% among pregnant women. Antiretroviral therapy (ART) was introduced in the public sector in 2003 and ART roll out was expanded throughout the country in the subsequent years. There are 221 ART sites in Namibia which include 34 district hospitals and 187 outreach service points. Currently there are 127,486 patients registered on ART in Namibia. However, there have been cases of patients experiencing treatment failure. The treatment failure can give rise to the emergence of HIV drug resistance. Genotyping information from patients with treatment failure can be valuable for tracking the dominant mutations conferring HIV drug resistance. However, HIV genotyping is not routinely available in Namibia due to cost. It is essential to determine the risk factors associated with development of HIV drug resistance so that these factors can be addressed. The aim of the current study was to describe HIV drug resistance mutations and the risk factors associated with HIV drug resistance among patients failing first- line ART regimen in Oshikoto and Oshana regions in Namibia. The case-control study design was used to collect data from cases who were being suspected of treatment failure to the first–line regimen in Oshikoto and Oshana regions in Namibia. The demographic, clinical and genotype information was collected from patient records. Out of 168 cases, 97 cases were eligible for this study and were matched with 105 controls. The mean age was 44.8 (±13.2) years for controls and 43.3 (±13.3) years for cases. Cases from Oshana and Oshikoto regions harboured 63% and 71% respectively for nucleoside reverse transcriptase inhibitors mutations with the dominant mutation being M184V/I. Sixty-eight percent (68%) and 76% respectively harboured mutations for non-nucleoside reverse transcriptase inhibitors with dominant mutation being K103N. Missed appointments, initiating inappropriate first-line regimen and adverse events or side effects were identified as risk factors for virological failure with odd ratios (OR) of 21.58 (95% CI 6.50 -71.59); 11.70 (95% CI 1.69 - 80.99) and 7.17 (95% CI 1.89 -27.22) respectively. Patients failing the first-line regimen need to be genotyped to assess the development of HIV drug resistance. The patients initiating ART should be educated on impacts of missing clinical appointments and adverse events of the drugs in order to prevent the emergence of drug resistance.

No description available.

Food insecurity exists when access to safe, nutritionally adequate foods is limited or uncertain, or when acquisition of these foods occurs in socially unacceptable ways (Anderson, 1990). Considerable research has focused on identifying the risk factors for and potential consequences of household food insecurity; however, few studies have investigated whether and how place of residence might influence household food insecurity. To address this gap in the literature, a mixed methods approach was used to explore the connections between risk factors, household food insecurity, and health in urban and rural settings. This dissertation comprised three studies. In the first study, secondary data were used to identify the household factors that increased the risk for household food insecurity and to examine whether place of residence moderated these relationships. Significant associations were found between household sociodemographics and household food insecurity. In addition, rural households were more likely to report household food insecurity. Although most moderation models were non-significant, a moderation effect was found for educational attainment: secondary school graduation increased the risk for household food insecurity in urban households, yet it was protective in rural households. In the second study, secondary data were used to examine the relationship between household food insecurity and poor general, physical, and mental health, and to test for a moderation effect of place of residence. In the main effects models, household food insecurity was associated with an increased likelihood of poor health on all measures. There was no evidence of urban-rural differences in these relationships. In the third study, qualitative data were used to explore household food insecurity from the perspective of urban and rural residents in Eastern Ontario. Findings revealed that urban and rural residents described similar conditions, processes, and consequences of household food insecurity; however, the unique features of the urban and rural settings influenced how people managed these experiences. In particular, certain aspects of the rural settings added to the complexity of managing household food insecurity. Overall, the results of this dissertation suggest that the urban-rural context, although important, is secondary to the primary contribution of low economic and social resources in household food insecurity.

This qualitative study was designed to explore the experience of risk factor modification from the perspective of patients who had sustained an acute myocardial infarction. Research has shown that modification of coronary risk factors including stopping smoking, reducing hypercholesterolemia and obesity, reducing hypertension, developing a habit of regular exercise, and developing methods to modify the coronary-prone behavior pattern reduces morbidity and mortality due to coronary heart disease. The literature reviewed indicated that cardiac rehabilitation programs are generally structured to provide the patient with information on coronary artery disease. However, it has been shown that information alone may not be enough to ensure that changes in behavior occur. Since there was a scarcity of information on measures to assist patients to modify their coronary risk factors, and as the literature indicated that the experience of risk factor modification had not been explored from patients' perspectives, a phenomenological design was therefore selected as the methodology for this study. Data were collected through twelve in-depth interviews with six participants. A guide of semi-structured questions was used for the initial interview and additional questions were generated from the data themselves. The constant comparative method of data analysis enabled the researcher to construct an analytic framework which represented patients' perceptions of their experiences in risk factor modification. In this framework, the central theme of patients' experiences was gaining mastery over their risk behavior(s). Gaining mastery occurred in three phases: searching for attribution, acknowledging risk, and attaining control. In attaining control, various cognitive and behavioral strategies were identified which led to a delineation of measures that could be provided to assist other patients in modifying their coronary risk factors. The findings demonstrated that a unique perspective of risk factor modification has been provided by patients based on their own experiences. It was also shown that intervention, consisting of teaching, counseling, and support, is essential to each phase of this process. The implications of this study focus on the importance of intervention in both in-hospital and out-patient cardiac rehabilitation programs. Intervention to assist patients to develop and use those skills that will enable them to gain a sense of mastery over their risk behaviors is essential if an initial or recurrent myocardial infarction is to be prevented. Implications for nursing practice, education, and research are outlined in light of the research findings. / Applied Science, Faculty of / Nursing, School of / Graduate

Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea in the United States. Although C. difficile is widely-recognized as a pathogen among hospitalized populations, CDI has emerged in the community setting but is under-diagnosed. This study sought to increase knowledge about the incidence of, risk factors for, and outcomes associated with community-associated CDI (CA-CDI). A retrospective nested case-control study was conducted using insurance claims data from the Wellmark Data Repository for the time period between January 1, 2003 and December 31, 2007. Persons with CDI were identified and were classified as community-associated CDI and hospital-acquired CDI. During this time, 304 cases of CA-CDI and 338 cases of HA-CDI were identified. Within this population, the incidence rate for CA-CDI was 11.16 cases per 100,000 person-years, whereas the incidence rate for HA-CDI was 12.41 cases per 100,000 person-years. Conditional logistic regression was utilized to determine the risk for CA-CDI related to pharmacologic exposures, comorbidity, demographic characteristics, and healthcare utilization. Prior to controlling for other risk factors and covariates; being over the age of 50 years, gender, history of hospitalization, number of outpatient physician visits, antimicrobial use, gastric acid suppressant use, underlying comorbidity, and diagnosis of gastrointestinal disease (including IBD, diverticular disease, GERD) were associated with the development of CA-CDI. However, after adjustment for all covariates, increased risk for CA-CDI within this population was consistently associated with antimicrobial use, being between the age of 19 and 74 years, and diagnosis of inflammatory bowel disease. Gastric acid suppressant use was a risk factor in a number of models, although this association was not consistent. Furthermore, persons who last received antimicrobials in the previous 150 days and persons who received a greater number of different antimicrobial agents were at increased risk for CA-CDI. Antimicrobial use was the primary risk factor for CA-CDI, although 27% of cases did not have prior exposure to antimicrobials. In fact, 17% of CA-CDI cases did not have any of the traditional risk factors for CDI (i.e., no antimicrobial or gastric acid suppressant exposure, no underlying illness, and no history of hospitalization). Furthermore, none of the CA-CDI cases underwent surgical procedures attributable to CA-CDI, although approximately 25% of CA-CDI cases were hospitalized with a diagnosis of CDI. This research demonstrates that CDI is occurring in the community setting and in populations that were previously not considered to be at risk. In this study, the risk factors for CA-CDI were similar to those identified in hospitalized populations, although it was not uncommon for persons to develop CA-CDI without any of these risk factors. Furthermore, the characteristics of persons with CA-CDI and the outcomes in this group were different than those previously reported among hospital-acquired CDI cases. Collectively, this study provides valuable knowledge about the epidemiology of CA-CDI and serves as a foundation for future research.