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A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 2017. / Background: In spite of the contributions of cardiovascular disease (CVD) to morbidity and mortality in chronic kidney disease (CKD) worldwide, there are no studies that have looked at cardiovascular risk factors (CVRFs) and their association with cardiovascular changes in African children with CKD. Several CVRFs have been implicated in the initiation and progression of cardiovascular changes in children with CKD, and these changes have been reported even in early CKD. This study investigated CVRFs and their association with cardiovascular changes in South African children with CKD. Method: This comparative cross sectional study recruited children (5-18 years) with CKD being followed up at the Division of Paediatric Nephrology of the Charlotte Maxeke Johannesburg Hospital and the Chris Hani Baragwanath Academic Hospital. One hundred and six children with a spectrum of CKD including those on chronic dialysis (34 CKD I, 36 CKD II-IV and 36 CKD V-dialysis) were enrolled over a 12 month study period. All patients had a short history taken along with a physical examination. Blood samples for serum creatinine, urea, albumin, calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase, total cholesterol, haemoglobin and C-reactive protein, Vitamin D, Fibroblast growth factor-23 (FGF-23), Fetuin-A and genomic DNA studies were taken. Where feasible, transthoracic echocardiography and high resolution ultrasonography of the common carotid artery was performed. Results: The overall median age of the patients was 11 years (8-14 years), with a male female ratio of 2.1:1. Several CVRFs detected include hypertension, proteinuria, anaemia, hypercholesterolaemia and dysregulated mineral bone metabolism. The most common CVRF detected was anaemia (39.6%) and its prevalence was highest in the dialysis group when compared with the other CKD groups. The overall median (range) cIMT was 0.505mm (0.380-0.675), and was highest in patients with dialysis dependant CKD (p=0.003). The distribution of left atrial diameter (LAD) and left ventricular mass (LVM) differed significantly (p<0.05) across the different CKD groups. Abnormal LAD was seen in 10% of patients; left ventricular hypertrophy (LVH) in 27%; left ventricular systolic dysfunction in 6% and diastolic dysfunction in one patient. Mean arterial pressure and haemoglobin levels were independently associated with cIMT; hypertension was independently associated with concentric LVH; and age and hypoalbuminaemia were independently associated with eccentric LVH. Overall, the dialysis group had the highest prevalence of vascular changes, cardiac changes and associated risk factors. A skewed pattern of Fetuin-A and FGF-23 levels with medians (range) of 57.7 (0.9-225.2) mg/dL and 28.9 (0-3893.0) pg/ml respectively, were observed. The levels of these two biomarkers varied significantly between the different CKD groups (p<0.05). Fetuin-A was independently associated with abnormal LAD but no similar relationship with other cardiovascular changes and plasma levels of Fetuin-A and FGF-23 was found. Plasma FGF-23 levels correlated better with markers of bone mineralization than Fetuin-A. Eight Fetuin-A SNPs were analysed; rs2248690, rs6787344, rs4831, rs4917, rs4918, rs2070633, rs2070634 and rs2070635. We found an association between log-transformed Fetuin-A levels and the SNP rs4918 G-allele compared to the rs4918 C-allele (p=0.046) and the rs2070633 T-allele when compared to the rs2070633 C-allele (p=0.015). Markers of MBD such as phosphate and PTH levels were associated with Fetuin-A SNPs. The rs6787344 G-allele was significantly associated with phosphate levels (0.042), and the rs4918 G-allele with PTH (p=0.044). Seven deaths were recorded in the dialysis group during the study period and severe hypertension and intracranial bleed were the most common causes of death. Modifiable risk factors such as increased total cholesterol (TC) and decreased albumin levels were more commonly seen among the deceased dialysis patients. Conclusion: A high prevalence of CVRFs and cardiovascular changes were observed in the study groups, even in those with mild to moderate disease. Information obtained from the study highlights the need to address modifiable CVRFs such as hypertension, anaemia and hypoalbuminaemia in children with CKD and also the need to determine new, population specific, paediatric reference values for cIMT in healthy African children. Finally, the study was able to demonstrate differences in the relationship between Fetuin A SNPs and Fetuin-A levels and cardiovascular changes in our study population when compared with previously published data. We postulate that these differences may be due to genetic differences between our population and other population groups previously studied. / LG2018

Since its introduction in 2002, West Nile virus (WNV) persists in Mississippi with dozens of cases and a few deaths each year. Little is known about the epidemiology and ecology of WNV in our state. This is the first study of the dynamics of West Nile virus in Mississippi utilizing both mosquito and human case surveillance. Herein I showed that the primary vector for WNV in MS, Culex pipiens quinquefasciatus, is associated with anthropogenic urban environments as opposed to rural wooded areas. I also found that other potential WNV vectors in MS are likely involved in enzootic transmission among natural bird reservoirs and not related to human transmission. Secondly, I showed that a simple commercial wicking assay (dip-stick test) can be beneficial to vector surveillance and mosquito control programs with limited resources when monitoring local mosquito populations in anticipation of human disease transmission. In my study, the lead time from finding infected mosquitoes to onset of human cases ranged from almost two weeks to two months, an important finding in regard to public health. Lastly, I performed a descriptive analysis on data from a survey I sent out to Mississippi WNV patients who were diagnosed between 2008 and 2013. The survey focused on self-reported personal protective behaviors and descriptions of their home and property at the time of infection. Results highlighted a few key epidemiological and behavioral aspects of WNV patients in Mississippi: 1) television and internet were the primary avenues for patient education; 2) amount of time spent outdoors appeared associated with WNV infection; and 3) use of personal protection measures did not usually change from before WNV infection to after. This study will help public health personnel achieve their goals to promote health and educate the public about personal protective behaviors for WNV and other mosquito-borne diseases, and thus, reduce risk of future infections. It will also lay groundwork for future studies such as widespread sero-surveys of populations to assess WNV infection rates and onsite environmental surveys to validate patient responses. Also, hypothesis-driven studies of specific risk factors associated with WNV infection are in order and currently planned.

<p>  </p> <p>Sexual aggression occurs at alarming rates on college campuses, wherein upwards of one-third of college women report some form of sexual victimization during their college careers. While individuals of any gender may perpetrate or experience sexual aggression, this form of violence is disproportionately perpetrated by men against women. Numerous risk factors for perpetrating sexual aggression have been identified, with prominent etiological, conceptual, and explanatory models of sexual aggression all emphasizing the role of impelling risk factors—which includes dispositional or personality traits that may serve to increase proclivity to sexually aggress, as well as attitudes, beliefs, and assumptions that contribute to sexually aggressive behaviors. Despite the proliferation of research on impelling risk factors for perpetrating sexual aggression, there is little consensus on how these constructs are operationalized and to what extent similarities and dissimilarities exist between existing measures of impellance for sexual aggression. Therefore, first aim of the present study seeks to examine the underlying factor structure of impelling risk factors for sexual aggression perpetration. Importantly, personality traits may represent an important non-specific impellor for sexual aggression; yet few researchers have examined the role of normal and pathological personality traits in predicting perpetration of sexual aggression, despite the robust literature on the role of personality in predicting other forms of aggression and violence. As a result, the present study also examined the role of both normal and pathological personality traits in independently and while controlling for the effect of emergent factors of impellance in predicting sexually-aggressive outcomes. Furthermore, exploratory analyses were conducted to examine the incremental validity of emergent factors of impellance above and beyond the role normal and pathological personality traits in predicting sexually-aggressive outcomes. Participants included <em>N</em> = 275 men between the ages of 18 and 26 from a large public university in the midwestern region of the United States, who completed an online survey assessing impelling risk factors for sexual aggression, normal personality, pathological personality, coercive condom use resistance, sexual-intimate partner violence, sexual assault perpetration, sexual objectification, and post-refusal sexual coercion. Results from the principal component analysis suggested that a three-factor solution best explained the variance in existing measures of impellance. Results from regression analyses indicated that normal personality significantly predicted all five sexually-aggressive outcomes, and that pathological personality significantly predict four of the study’s sexually-aggressive outcomes. After controlling for the effect of impelling risk factors for sexual aggression, both normal and pathological personality traits only accounted for additional variance not explained by measures of impellance for coercive condom use resistance and sexual objectification. Broadly, results identifying the underlying factor structure of impellance align with existing theoretical models of sexual aggression; however, results from the present study also extend these models by presenting a more granular, nuanced, and differentiated view of risk factors that were previously conceptualized to perform similarly. In addition, results from the present study underscore the importance of both normal and pathological personality traits in predicting sexually-aggressive outcomes. Despite this, results from the present study also suggest that after accounting for impelling risk factors of sexual aggression, personality may only help predict minimal additional variance in sexually-aggressive outcomes. Implications for both the screening and assessment of men at risk of perpetration sexually aggression, as well as recommendations for the prevention of sexual violence are discussed.</p>

Background. Sleep disturbances can indicate an increased risk of dementia. This study examines whether machine learning can predict this association and which sleep disturbance factors impact dementia. Methods. To assess the association, we use five machine learning algorithms (gradient boosting, logistic regression, gaussian naive Bayes, random forest and support vector machine) and data on the older population (60+, n=4175) in Sweden from the Swedish National Study on Ageing and Care – Blekinge (SNAC-B). The algorithms use 16 features from SNAC-B, which are on personal and sleep disturbance factors. Further, each algorithm uses 10-fold stratified cross-validation to obtain their results, which consist of the Brier score for checking accuracy and the feature importance for examining the risk factors for dementia.  Results. Logistic regression found an association between dementia and sleep disturbances. However, it is slight for the given features. Gradient boosting was the most accurate algorithm with 92.9% accuracy, 0.926 f1-score, 0.974 ROC AUC and 0.056 Brier score. The significant risk factors were different in each machine-learning algorithm. If the person sleeps more than two hours during the day, their sex, education level, age, waking up during the night and if the person snores are the variables that most consistently have the highest feature importance across algorithms. Conclusions. There is an association between sleep disturbances and dementia, which machine learning algorithms can predict. Furthermore, the risk factors for dementia vary across the algorithms, but sleep disturbances can predict dementia.

Purpose: The current U.S. population exceeds three hundred million with approximately 20% living in non-urban rural areas. A higher percentage of rural residents have diagnosed heart disease and report poorer health compared to non-rural residents; however, it is not known whether risk factor modification for heart disease and health status differ based on degree of rurality. The purposes of this study were: 1) to compare differences in health status and cardiac risk factors between cardiac patients living in large and small/isolated rural areas, and 2) to compare the health status of rural cardiac patients with a national sample. Method: A secondary analysis using data from three separate studies was completed using a comparative descriptive design. The Cardiac Rehabilitation participant sample (n-191) included individuals 3 to 12 months post-cardiac event. The Arizona Heart Institute and Foundation Heart Test measured risk factors and the eight subscales of the Short-Form, Medical Outcomes study measured health status. Findings: No significant differences in health status were found; all participants rated their health moderately high. However, individuals in large rural areas reported significantly better general health than those in the normative sample. No differences in smoking, blood pressure, diabetes, or overweight/obese BMI were found between the two rural groups. Differences in exercise, and anger were present between the two groups. Significant differences were identified in waist circumference between the genders placing women at higher risk for heart disease. Conclusions: Identifying health status and cardiovascular risk factors of rural individuals informs interventions to be tested for rural residents.

The objectives of the study were to identify which risk factors for heart disease were most prevalent in a poor, underserved, rural Appalachian county. A random sample of medical records was selected (n = 292) of adult men and women who participated in a countywide health care project. Data were obtained from a health risk appraisal questionnaire and other physical and demographic information and were analyzed using univariate and bivariate statistical procedures. The findings indicated that these rural Appalachian subjects had a significant number of heart disease risk factors: excessive smoking, lack of exercise, high fat diets, and abnormal serum lipid levels.

No description available.

The purpose of this integrated review of the literature was to explore the postsurgical infection complications commonly occurring in individuals undergoing total knee replacement surgery, and the relationship of co-morbidities, lifestyle choices, and genetics on the risk for complication. A comprehensive search of the literature focusing on the patient surgical site infection and total knee replacement surgery using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medical Literature On-line (MEDLINE). Initial searches revealed 80 results. Upon closer scrutiny, duplicates were removed, as well as those not relevant to infection in total knee arthroplasty. This resulted in a review of 6 articles that fit the inclusion criteria. Inclusion criteria were articles written in the English language and published in scholarly, peer-reviewed, journals from 2009 to present. In addition to published articles, pertinent material from current nursing textbooks was evaluated and chosen to further substantiate the literature results. In cases of knee arthroplasty, diagnoses of obesity and diabetes were discovered to be risk factors for postsurgical infection. The findings of this thesis offer interpretation for nursing practice, research, education, and policy. Implications for nursing research, policy, education and practice are highlighted along with limitations of this integrative review.

Utbrändhet orsakar mänskligt lidande, kostar mycket tid, pengar och arbetskraft. Syftet med denna kvantitativlitteraturstudie var att identifiera arbetsfaktorer som bidrar till att sjuksköterskan blir utbränd. Vetenskapliga artiklar granskades och 10 stycken redovisas i resultatet. Resultatet visar fyra tema som är faktorer av betydelse för utbrändhet hos sjuksköterskor; brister i den psykosociala arbetsmiljön, obalans mellan krav och resurser, organisation och ledarskap samt kunskap och utbildning. De sjuksköterskor som arbetar i en organisation utan ett stöttande ledarskap, är inte tillfredställda med sitt arbete. Sjuksköterskor som inte har balans mellan psykiska krav och påverkningsmöjligheter, blir utbrända. De sjuksköterskor som får utbildning i ökad kunskap inom sitt arbetsområde är de sjuksköterskor som blir minst utbrä / The burnout cause human suffering, cost time and money and labour. The aim of this quantitative study was to identify the factors in nurse’s work, which can contribute to cause a state of exhaustion called burnout. Scientific research reports were examined and 10 are presented in the study. The results show four themes that are factors of importance for burnout among nurses; deficiencies in the psychosocial work environment, imbalance between demands and resources, organisation and leadership, and knowledge and education. The nurse who works in an organization without supporting from leadership, are not satisfied with their work. The nurse who have not balance between demands and influence in their work, get burnout. The nurses who get good social support at work and outside work and increased knowledge about what the unit they work in are specialized in, are the nurses who least get burnout.