Seven different but integrated experiments were conducted to study the factors affecting the utilisation of dietary energy. The first two experiments involved feeding broiler chickens diets containing either corn oil or corn starch as the supplementary source of energy at two protein levels. Herring meal was used in all diets because of the high biological value of its protein. All diets were calculated to be isocaloric and to contain the same balance of amino acids; minerals and vitamins were added to meet the requirements for these nutrients. Live weight gain and the efficiency of food utilisation within calorie:protein regime were not improved when fat was substituted for starch in isocaloric diets. The superiority of the low-fat high-protein diet in promoting the highest metabolisability of energy, questions the validity of the claim that added dietary fat has an "extra-caloric" effect. Birds fed the high-fat low-protein diet which had a lower calorie:protein ratio, deposited more abdominal adipose tissue, indicating that in evaluating growth performance, the balance between energy and protein is of greater significance than the source of supplementary energy. Formulation of isocaloric diets has necessitated the inclusion of the so-called nutritionally-inert ingredients such as cellulose. Since the diets used to test the main hypothesis of "extra-caloric effects" attributable to dietary fat incorporated cellulose, the effect of the latter on the physiological parameters under study, was tested. At high levels of inclusion cellulose depressed body weight gain. Adverse effects of added dietary cellulose on food conversion efficiency and energy metabolisability were also evident. Another effect of .added dietary cellulose which is particularly interesting is that it decreased abdominal adipose tissue. Results of the above studies have shown significant differences among the different treatment groups in body weight gain, efficiency of food utilisation and metabolisability of energy within the first three weeks posthatching. The possibility that the residual yolk may influence the metabolic parameters in question was considered and tested. Absence of the yolk sac, excised surgically, did not influence the performance of birds on the basis of growth and energy utilisation as measured by body weight gain and metabolisable energy values, respectively. The residual yolk did not influence food conversion efficiency in the first and third weeks of the experimental period. However, depression of food conversion efficiency resulting from the removal of residual yolk was found to occur in the second week. It was noted that birds without residual yolk retained a greater amount of nitrogen compared to birds with residual yolk in the first week posthatching. The residual yolk does not contribute significantly towards the nourishment of the chick in the first week posthatching as evidenced by the fact that abstinence from food resulted in the death of both the groups retaining yolk sacs and those without yolk sacs at approximately the same time. The presence of a large bacterial population in the avian caeca and extrapolation of the features associated with bacteria-host symbiosis in ruminants and other animals to the domestic chicken have led to speculation that the avian caeca perform some cellulolytic and proteolytic functions. The relevance of the concept of caeca-mediated nutrient utilisation to the topic under study prompted an experiment using intact and caecectomized chickens to investigate the effect of the excision of the caeca on the utilisation of dietary energy and protein. Caecectomized and intact control New Hampshire cockerels were fed diets used in the previous studies. Metabolisable energy values and uric acid excretion were used as the criteria for measuring dietary energy and protein utilisation. Caecectomy did not affect the metabolisability of the diets. Metabolisability of the diet incorporating corn starch was more variable and slightly lower with the caecectomized birds. Uric acid excretion was similar for the caecectomized and the intact birds. Macroscopic and histological examination of sections of the caeca revealed that regeneration of the caeca had occurred in four caecectomized birds that survived until autopsy 85 weeks later. Although the onset of the regeneration of the caeca was not observed, it would appear that the degree (or the absence) of regeneration of the caeca in caecectomized birds may be responsible for the discrepancies in the findings reported with such birds. / Land and Food Systems, Faculty of / Graduate

published_or_final_version / Industrial Engineering / Master / Master of Science in Engineering

This thesis uses observational study design methods to explore the relationship between depression and various outcomes following acute myocardial infarction (AMI). There are three main studies. First, the relationship between depression and mortality following AMI was measured. The main finding was that the factor determining the increased mortality rate in depressed patients is reduced cardiac functional status. The main implication was that efforts to address increased mortality in depressed patients with cardiovascular illnesses should focus on processes that impact cardiac functional status. Second, the impact of depression on service consumption following AMI was examined. Depressive symptoms were associated with a 24% (Adjusted RR:1.24; 95% CI:1.19-1.30, P<0.001), 9% (Adjusted RR:1.09; 95% CI:1.02-1.16, P=0.007) and 43% (Adjusted RR: 1.43; 95% CI:1.34-1.52, P<0.001) increase in total, cardiac, and non-cardiac hospitalization days post-AMI respectively, after adjusting for baseline patient and hospital characteristics. Depressive-associated increases in cardiac health service consumption were significantly more pronounced among patients of lower than higher cardiac risk severity. The disproportionately higher cardiac health service consumption among lower-risk AMI depressive patients may suggest that health seeking behaviors are mediated by psychosocial factors more so than by objective measures of cardiovascular risk or necessity. Third, methodological issues related to missing data were explored. A systematic review of three psychiatric journals revealed that a small minority of studies (5.8%) addressed the impact of missing data in a meaningful way. An example using real data demonstrated the potential bias introduced by missing data and different ways to address this bias. The paper concludes with recommendations for both reporting and analyzing studies with substantial amounts of missing data. Overall, the studies add to the literature exploring the relationship between depression and outcomes following acute myocardial infarction. Future studies measuring the relationship between depression and mortality will need to factor the mediating relationship between depression and cardiac functional status. The increased health service utilization associated with depression will need to be replicated in other illness models. Together, the studies add to the existing conceptual framework for measuring relationships between depression and outcomes in patients with cardiovascular illnesses.

For several years scientific research has provided ample evidence to support the fact that the health of an individual is dependent on more than merely the absence of the symptoms of disease. This is the view that has been accepted by the World Health Organisation and therefor it was included in its definition of health. In the field of practiced psychology, a lot of attention was drawn to the relation between the psyche and physical health, of which various researchers have found that psychological well-being has an influence, and is influenced by, the health of the individual. From the pharmaceutical dimension of health management, it is clear that disease symptoms correlate with the drug utilisation of patients, although only completely in those cases in which the economic considerations do not play a role. As mentioned earlier there is existing evidence indicating the relationship between psychological well-being and health. This relation might influence, in another dimension, the drug utilisation of the individual. Drug utilisation studies may be the ideal tool to reveal evidence that will enable someone to improve the health of SAPS members, as well as members of the economically disadvantaged South African public. The general objective of this study was to determine the drug utilisation and psychological well-being of South African Police Service members. This empirical study can be classified as a one-shot cross sectional design, and consisted of two phases. In the first phase, a random sample of 170 SAPS participants from a specified rural area was requested to complete questionnaires including a Demographic questionnaire, Sense of Coherence Scale (Antonovsky, 1987), Affectometer II (Kammann & Flett, 1983) and Satisfaction With Life Scale (Diener et al., 1985). The data from the questionnaires were processed and statistically analysed. In the second phase, the study population consisted of all polmed® patients stationed in the specified area. The medical data of the participants, extracted from the polmed® database, was processed and statistically analysed. It was concluded that the level of psychological well-being, in particular the affect balance, of the SAPS members is distressfully low, and that this is mainly due to their working environment. Further it was found that the doctor visits of the SAPS members occur very frequently and are accompanied with high costs. In the inquiry to the medication usage of polmed® members, 8 medication groups were implicated as high frequency and cost groups (in particular medication that work in on the central nervous system), regardless of gender or age. The specified groups represented the most of the products used by the study population. It was found that the majority of products used, are patent or brand name products. Finally, results have indicated that the hospitalisation of SAPS members is very frequent and therefore very costly. Recommendations for further research, as well as the practice, were formulated. / Thesis (M.Pharm.)--Potchefstroom University for Christian Higher Education, 2002.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management Johannesburg, 2011 / Introduction: South Africa is currently facing a quadruple burden of diseases: poverty related conditions, emerging chronic diseases, injuries and HIV/AIDS. Increasing burden of these diseases is having a detrimental impact on service delivery particularly in rural areas, where the majority of the population are dependent on public health system. Although numerous epidemiological studies had been done in the past to determine the prevalence of these conditions, only a few studies have attempted to quantify the effect of these diseases on health facilities such as admission rate, bed occupancy rate and resource utilisation. More data is required to develop a better understanding of their impact and to guide development of appropriate response strategies. Aim of the study: To `analyse trends of admissions and resource utilisation in adult medical wards of a rural district hospital in South Africa. Methodology: This was a descriptive cross-sectional, retrospective study involving an analysis of data from adult medical wards in the George Masebe Hospital (a district hospital in Limpopo Province) for six months in 2009. Results: The study found average number of admissions per month was 148, their length of stay varied from one day to more than a year. Their median age was 44 years. They were black, had no medical aid and unemployed and the majority of them were dependent on social welfare grant. The most common health problems diagnosed amongst the medical admissions were HIV related conditions such as gastro-enteritis, pneumonia, AIDS and tuberculosis as well as other chronic diseases such as diabetes mellitus. A striking discovery was the high incidence of mental illness amongst the admissions. The majority of them were discharged home. The crude death rate was 190 per 1000 admissions and the main cause of death was HIV related conditions. The average direct expenditure per month was R 1,040,579. The expenditure for salaries was the main expenditure (54%) followed by Allied health services (29%). The average expenditure per patient was R 7,039 (R 7,548 for female patients and R 6454 for male patients). v Conclusion: This was the first study on admission trends resource utilisation in this Hospital and in the Limpopo Province. The evidence from this study would hopefully steer the re-organisation of some of the Hospital services, more especially the establishment of a step-down ward facility within the Hospital. This study has recognised that the increased number of admissions in rural district hospitals often result from double burden of infectious and chronic diseases. More studies on the subject are needed to identify their impact on resource utilisation at these hospitals.

Digitized by Kansas Correctional Industries

Digitized by Kansas Correctional Industries

Thesis (M.Pharm.)--Potchefstroom University for Christian Higher Education, 2002.

This dissertation had three specific aims: to estimate the prevalence of adherence among drug users, to determine whether drug use was directly associated with adherence, and to assess whether factors drawn from the Behavioral Model of Health Care Utilization (BMHCU) are associated with adherence. The self-reported prevalence of adherence to prescribed health care recommendations in the past 12 months among the community sample of drug users and non-drug users from similar low-income areas in the study sample ranged from 53%-74%. Non-drug users consistently had higher rates of adherence than drug users, except for adherence to female health care recommendations, yet this difference was insignificant at the bivariate level. In the multivariate analysis, when controlling for all other variables within the BMHCU, only non-injection drug use was significantly associated with adherence to mental health care recommendations. In exploring its predictive utility, the BMHCU accounted for a range of 17% to 54% of the variance for the adherence measures. Although percentages accounted for by the BMHCU were substantial the fact that very few predictor variables were significant may indicate multicollinearity and other severe limitations with the data, such as small sample size, and the conceptualization of the adherence measure. The conceptualization of adherence remains an issue in need of further delineation. Further studies are needed in order to develop appropriate measures of adherence. Qualitative studies may be needed to further understand adherence among drug users.

The primary goal of this dissertation is to gain a better understanding, in thecontext of a dynamic stochastic general equilibrium framework, of the role of inventories and capacity utilization (of both capital and labor) and, in particular, therelationship among them. These are variables which have long been recognized asplaying an important role in the business cycle. An analysis of the association between inventories and capital utilization seems natural, for physical capital could beseen as a stock ultimately destined to be transformed into an inventory of finishedgoods. In the same way, inventories could be seen as a stock of physical capital already transformed into finished goods. Introducing variable rates of utilization ofcapacity, then both can be seen as providing a short-run adjustment "buffer stock"mechanism.The analysis of the relationship between those variables is centered on the effectsof two possible shocks: preference (demand) shocks and technology shocks. Impulse-response experiments show that inventories and the rate of capital utilization aremostly complements, while inventories and the rate of labor utilization are mostlysubstitutes. Moreover, low-persistence shocks emphasize the role of inventories asbeing a "shock absorber", whereas high-persistence shocks emphasize the role of inventories as being a complement to consumption. Consistent with the stylized facts inthe literature, simulation results show that inventory holdings are pro-cyclical, while the inventory-to-sales ratio is counter-cyclical.Two additional "themes" are explored. The first has to do with the treatmentof uncertainty and the consequences of using, as it is done in most of the literature, afirst-order approximation. By approximating the decision rules to a second order, weobserve that higher exogenous uncertainty enhances the importance of the precautionary motive to holding inventories. The second additional theme is a more generalframework for the analysis of capital utilization. We find that the two most commonways of modeling capital utilization can t in a more general specification that incorporates spending on capital maintenance. Though the aforementioned results do notvary qualitatively after that concept is introduced, quantitative answers do.