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Psychology uses theory supported by empirical evidence to accumulate generalisable knowledge and learn from various contexts. Two commonly used theories are the Theory of Planned Behaviour (TPB) and Common-Sense Self Regulation Model (CS-SRM). Possible limitations in previous studies using these theories have been identified: (1) TPB studies focus upon one specified behaviour and ignore behavioural alternatives; (2) the CS-SRM is routinely not fully operationalised. This research aimed to develop an ‘extended TPB’ assessing ‘intention choice’ (where participants report their intended course of action regarding one or more specified behavioural alternatives) and to operationalise the CS-SRM more fully than is usually reported. The context was people with urological cancer. Methods: Three studies were conducted: (1) CS-SRM-based longitudinal study of people with urological cancer (n=172) to predict anxiety and depression; (2) Extended-TPB-based prospective study of men with localised prostate cancer (n=35) using both between- and within-person approaches to explore intention choice with respect to treatment; (3) Extended-TPB-based before-after study of medical students (n=93) to evaluate the effects of teaching on simulated communication behaviour. Results: (1) Anxiety and depression at Time 2 were predicted by number of information sources reported at Time 1 after controlling for baseline anxiety and depression; (2) TPB constructs were consistent with intention choice and intention choice was consistent with actual treatment. Within-persons, the model could not identify men who later reported poor outcomes; (3) All TPB-related cognitions changed between Time 1 and Time 2 but simulated behaviour scores did not change. Discussion: Relationships between the TPB constructs both between- and within-persons were consistent with actual treatment. The extended TPB measures were sensitive to change when behavioural alternatives were assessed. The CS-SRM was operationalised beyond illness representations. Conclusions: It was feasible to apply both the extended TPB (between- and within-persons) and CS-SRM in this context.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Masters of Science in Medicine in Emergency Medicine. Johannesburg, 2013 / To determine the types of uropathogens encountered in patients presenting to a busy private emergency department in Johannesburg and compare sensitivity patterns of the bacteria identified with current antimicrobial prescribing patterns.

The urothelium is a stratified epithelium that serves as a barrier between the urinary tract and blood. It consists of terminally differentiated umbrella cells, which are specialized for synthesizing and assembling uroplakins into a tough apical plaque and responsible for the barrier function; intermediate cells which are few in number but serve as umbrella cell progenitors; and unipotent basal cells, which populate the majority of the urothelium. The urothelium is one of the most quiescent epithelia in the body but can rapidly regenerate in response to damage. The urothelium is also a source of cells that give rise to bladder cancer. Patients with chronic inflammation caused by indwelling catheters or repeated urinary tract infections have a higher risk of developing bladder cancer. Bladder cancers with squamous histological features are considered to be more aggressive with poor prognosis and the majority are categorized as basal subtype. The expression of Peroxisome Proliferator-Activated Receptor-gamma (PPARG) is strongly down regulated in the basal subtype of bladder cancer, suggesting that its removal might be essential in tumorigenesis. PPARG is a nuclear hormone receptor that was originally described as a master regulator of adipogenesis but could also promote cellular differentiation in a number of epithelium. PPARG also serves as an important regulator in anti-inflammatory activity after a variety of injuries, acting in part by antagonizing the NF-B pathway. In urothelial cells, it has been shown that PPARG promotes urothelial differentiation in vitro, but its function in vivo remains unexplored. To determine the role of PPARG in vivo, we used Cre-Lox recombination to conditionally delete the Pparg gene in the mouse urothelium using the ShhCre driver, which drives recombination in basal and intermediate cells, and their respective daughters. Interestingly, ShhCre;Ppargfl/fl mutants lack umbrella and intermediate cells which normally populate the luminal and sub-luminal layers, and are instead populated with an abnormal cell population negative for classical urothelial markers. The basal compartment, which in wild type mice is largely populated by P63+ KRT5+ basal cells with a small sub-population expressing KRT14; has an increased number of KRT14-expressing cells in the mutants and exhibits squamous features that are not present in the normal urothelium. In wild type animals, urinary tract infection (UTI) with uropathogenic E.coli results in a transient innate immune response, followed by proliferation and repair, which is largely complete within 2 weeks. When ShhCre;Ppargfl/fl mutants were challenged with urinary tract infection, the innate immune response was not resolved even after several weeks, as characterized by persistent NF-B activity, excessive influx of neutrophils and macrophages, and massive granulation tissue in the stroma. In addition, the Pparg-knockout urothelium exhibited squamous metaplasia. The Krt14+ basal cell population, which is considered to be the cells of origin of bladder cancer, greatly expanded in the Pparg-deleted urothelium after infection, and some lesions progressed to acquire invasive features. Together these findings suggest that PPARG is essential for the normal differentiation of the urothelium and is a potent regulator of the inflammatory response after UTI. Understanding the link between the loss of PPARG, chronic inflammation and tumorigenesis in the urothelium could shed light on the urothelial differentiation network and pave the way for the development of therapeutic approaches to various urinary diseases.

Resumo: A triagem de crianças para bacteriúria assintomática objetivando prevenir pielonefrite e danos renais é amplamente recomendada. Amostras de urina, colhidas sem contaminação, de 500 pré-escolares com idade entre 2 a 7 anos foram submetidas ao teste com cloridrato de trifeniltetrazólio (TTC) e a urocultura. Culturas quantitativas foram realizadas usando dois diferentes meios de cultura: ágar CLED e ágar MacConkey. As colônias foram contadas, após 18-24 horas de incubação à 35-37ºC. O achado de 105 ou mais UFC/mL do mesmo microrganismo foi considerado como positivo. Para realizar o teste com TTC, 4 mL da urina foram misturados com 1 mL da solução aquosa de TTC estéril à 1% e incubados à 35-37ºC por 4 horas. Uma segunda urocultura foi realizada para as crianças que apresentaram resultado positivo. A sensibilidade aos antimicrobianos foi determinada. Uma comparação entre a urocultura e o teste com TTC foi feita, para avaliação do teste. Um questionário foi aplicado para avaliar fatores predisponentes comportamentais e funcionais. A triagem para bacteriúria assintomática, em pré-escolares em Araraquara-SP-Brasil mostrou uma prevalência de 1,4%. Escherichia coli foi o microrganismo mais isolado e a resistência a tetraciclina foi significante. Os resultados mostram que o teste com TTC possui 91,3% de sensibilidade; 64,3% de especificidade; 15,5% de valor preditivo positivo e 99,0% de valor preditivo negativo. Esses valores mostram que este teste pode ser usado como metodologia de triagem. O fato de já ter desenvolvido ITU anteriormente; usar o papel de trás para frente na higienização anal; beber menos de 1L de água por dia; e usar roupa íntima apertada foram considerados possíveis fatores de risco para o desenvolvimento de bacteriúria assintomática. / Abstract: Urinary tract infection (UTI) is the most commom of bacterial infections. Screening children for asymptomatic bacteriuria to prevent pyelonephritis and renal scarring is widely recommended. Urine samples, revealed without contamination, from 500 pre-school children aged 2 to 7 years were submited to the tryphenyl tetrazolium chloride (TTC) test and urine culture. Quantitative urine cultures was performed using two different agar types: CLED and MacConkey. Colonies were count after 18-24 hours of incubation at 35-37ºC. The finding of 105 or more CFU/mL of the same microorganism constituted a positive culture. To perform the TTC test, 4 mL of the urine were mixed with 1 mL of the TTC 1% aqueous sterile solution and incubated at 35-37ºC for 4 hours. We performed a second urine culture for all children with a positive result. Antimicrobial susceptibility was determined. A comparison between the quantitative culture and the TTC test were made, for the evaluation of the test. A questionnaire were used to assess predisposing behavioral and functional abnormalities. The screening survey for asymptomatic bacteriuria in pre-school children in Araraquara-SP-Brazil showed a prevalence of 1.4%. Escherichia coli was the commonest organism isolated and resistence to tetracycline was significant. The results show that the TTC test has sensitivity 91.3%, specificity 64.3%, positive predictive value 15.5% and negative predictive value 99.0%. This test can be use as a screening test. History of the urinary tract infection, inadequate hygiene, poor fluid intake and use of tigh-fitting underwear appear to be risk factors for asymptomatic bacteriuria. / Orientador: Maria Stella Gonçalves Raddi / Coorientador: Antonio Carlos Pizzolitto / Coorientador: Elisabeth Loshchagin Pizzolitto / Banca: Maria Jacira Silva Simões / Banca: Isabel Cristina Affonso Scaletsky / Mestre

Catheter-associated urinary tract infections (CAUTIs) contribute to increased patient length of stay and health care costs. The literature has shown that one plausible cause of CAUTIs is improper Foley catheter insertion techniques among nurses. The purpose of this project was to answer the project-focused question that asked if there was a difference in nurses' practice skills following an educational intervention involving aseptic Foley insertion. Benner's novice-to-expert theory was the conceptual model for the study. Nurses from a college nursing program were asked to demonstrate Foley catheter insertion on a simulation model, and their technique was evaluated using a standardized checklist. Following the simulation demonstration, an educational intervention was conducted with ample opportunity for the nurses (n = 16) to practice catheter insertion. Following the practice opportunity, the nurses completed a 2nd return demonstration. Percentages of correct skills from the preintervention observation were compared with percentages of correct skills from the postintervention observation to determine the effectiveness of the education intervention in enhancing Foley catheter skills in an acute care setting. Results of a paired t test revealed a significant increase (p < .01) in performance scores on the demonstrations after the intervention and catheter insertion techniques were taught. Hospitals and nursing education programs could implement simulation interventions to improve nurses' Foley catheter insertion skills. This study has the potential to contribute to social change by providing evidence that simulation training can lead to improved competence and confidence with nursing skills.