Context: The Women’s Health Initiative (WHI) study, published in July 2002, had a significant impact on the prescribing of hormone replacement therapy (HRT). The controversy surrounding the findings, however, has led to much uncertainty regarding the prescription of HRT. Aims and Objectives: The aim of this study is to determine both the initial and the continued impact of the WHI study on the prescribing of HRT in a defined South African population and to determine whether HRT was appropriately individualised based on recommendations published subsequent to the WHI study. Setting: Claims data from a Managed Healthcare Organisation (MHO) that administers for a number of medical aid schemes in South Africa. Method: A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined populations. The time-frame of the dataset included January 2002, to assess prescribing patterns prior to the publication of the WHI study, January 2003 to determine the initial impact of the WHI study, and January 2005 to assess the continued impact. An extensive, additional dataset of all the HRT users in the defined populations was utilised to conduct a sub-group analysis and determine whether HRT had been appropriately individualised. Key Findings: The percentage of patients in the dataset using HRT decreased from 30.05 percent in January 2002 to 28.30 percent in January 2003 and to 23.24 percent in January 2005, with the latter decrease reaching statistical significance. Although sex hormones and modulators (G03) of the genital system were the most frequently prescribed drug class in all three years of the study period, the prescribing frequency decreased significantly from 10.40 percent in January 2002 to 9.32 percent in January 2003 and 7.44 percent in January 2005. The most noteworthy change in the prescribing of HRT was a 3.95 percent decrease in the prescribing of conjugated equine estrogen (CEE), with a corresponding 2.53 percent increase in the prescribing of estradiol between January 2002 and January 2003. However, less pronounced changes were observed in the prescribing frequencies of other types of HRT, including medroxyprogesterone and estrogen (the HRT type investigated in the estrogen plus progestin phase of the WHI study). Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study) and were at a higher risk for disease states for which HRT use is considered harmful or has an uncertain effect, such as diseases affecting the cardiovascular system. Conclusion: It can be concluded that the WHI study did have an impact on the prescribing of HRT in the defined South African population of this study, but that the impact was considerably less than the impact reported in global studies. It was also determined that HRT was appropriately individualised according to recommendations made subsequent to publication of the WHI study.

No abstract available. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2012.

This thesis explores the potential of video as a research tool for anthropologists in the recording of a single ritual. The study examines interactions between ethnographers, informants and viewers. The thesis reveals the capacity of video to make possible close, detailed readings of performance in terms not originally anticipated by the researcher. Archival storage of the video recording allows for critique and assessment of the research. The case study chosen in which to test the potential of \ dcso as a research tool was a woman's 'initiation' r^L'ial (called inton jane) in Shixini in the Eastern Gape (in what was, until recently, the independent homeland of Transkei). Historically, the ritual was supposedly held at the time of a girl's first menstruation, this being the physical symbol of her transformation into adulthood. Ritual seclusion served to effect an accompanying social transformation in preparation for marriage. Paradoxically, in the late 1980's, it was older women and mothers, already married and well past the age of first menstruation, who were undergoing the ritual seclusion and symbolic marriage. The study explores this paradox with the goal of understanding the purpose of the ritual in contemporary times. By recording large segments of the ritual on video, and subjecting the footage to a close analysis of verbal and non-verbal aspects of performance, both the ritual and the merits of video as a research tool could be examined. Video was utilised, in an interactive research process, as an information elicitation tool. The analysis of the recorded text of the ritual brings to the fore elements which make what is apparently a paradox understandable. The elements which explicate the paradox were not anticipated when the research commenced, and in all likelihood would have eluded a researcher who did not have the benefit of the incidental capture on video. The thesis reveals the enormous Contribution video can make to research and suggests that video has an important contribution to make to the discipline of anthropology.

This study investigated the health needs of immigrant women from the African Great Lakes living in South Africa in the province of Gauteng, Tshwane Metropolitan city. It described their challenges and related factors compromising their holistic wellness, and identifies their context specific health needs as a gender group. A qualitative approach was utilised concurrently with participatory action research method. Data collection involved triangulation of instruments. A literature study was conducted to select relevant information usable as basis for this study. Data analysis and interpretation revealed factors that make it difficult for immigrant women from the African Great Lakes region to gain access to health care services in South Africa, identifying their specific women’s health needs. Recommendations proposed that policy makers and implementing professionals rendering women’s health care services should consider utilising a holistic and interdisciplinary approach to meet these basic needs. / Health Studies / M.A. (Public health)

Assignment (MPhil)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: The aim of this study was to investigate practical methods of monitoring AIDS related wasting and lipodystrophy in a resource-poor clinical setting with HIV infected women as the population group of interest. Measurement of body composition changes using anthropometry is both cost- and time-efficient. Various different skinfolds were taken and two different equations (the equations of Pollock et al. (1975) and Durnin and Womersley (1974) for calculating body fat were used to determine the most promising method or methods of monitoring body composition changes in a clinical setting. Detailed anthropometric measurements were performed, as well as selected measurements for haematological parameters and quality of life (QoL) for a group of 8 participants on antiretroviral medication (ART group) and 6 participants who were not on treatment (TN group). New variables namely, intra-abdominal indicator (IAI) and a percent of ideal body mass to percent of ideal arm circumference ratio (%IBW:%IAC) were investigated as possible indicators of lipodystrophy. Although measurements were taken at various timepoints, three specific time-points were chosen for data-analysis for the ART group and two time points for the TN group. These three time-points were, baseline (on the day of recruitment for TN participants and within one month before the initiation of treatment for ART participants), short-term (2 to 12 weeks after treatment initiation or the baseline measurement or for the ART and the TN participants) and long-term (within one and a half year of treatment initiation for the ART group). ART and TN participants did not differ for many variables at baseline. The major differences between ART and TN were in measured and derived variables of the arm, especially percent of ideal arm circumference (%IAC) and upper arm fat area (UAFA), which were significantly lower in the ART group. CD4+ and QoL improved significantly for the ART participants from baseline to long-term. This was not associated with changes in muscle mass, but rather some fat mass variables. Participants on antiretroviral medication exhibited changes relating to abdominal obesity. It was concluded that antiretroviral therapy contributed greatly to the QoL of the participants and it probably aided in the recovery from wasting for at least one participant in this study. Measures of the arm can be used in a rural clinical setting to effectively monitor patients with regard to AIDS related wasting. The new variables IAI and %IBW:%IAC could be helpful in the monitoring of lipodystrophy and should be investigated in future research. / AFRIKAANSE OPSOMMING: Die doelwit van hierdie studie is om praktiese metodes te ondersoek om VIGS-verwante uittering en lipodistrofie te meet in ‘n plattelandse kliniese omgewing (waar hulpbronne dikwels beperk is) met MIV ge-infekteerde vroue as populasiegroep. Die gebruik van antropometrie om veranderinge in liggaamssamestelling te meet is beide koste- en tydeffektief. Verskeie velvoumetings is geneem en twee verskillende vergelykings (die vergelykings van Pollock et al. (1975) en Durnin en Womersley (1974)) is gebruik om liggaamsvetinhoud te bereken, met die doel om ‘n belowende metode te vind om veranderinge in liggaamssamestelling te meet in ‘n kliniese omgewing. Verskeie antropometriese metings is geneem, sowel as uitgesoekte hematologiese en lewenskwaliteitmetings (QoL) vir ‘n groep van agt deelnemers wat antiretrovirale medikasie ontvang het (ART groep) en ses deelnemers wat nie hierdie behandeling ontvang het nie (TN groep). Nuwe veranderlikes (binnebuikindikator (IAI) en die verhouding van persentasie van ideale liggaamsmassa tot persentasie van ideale armomtrek (%IBW:%IAC)) is ondersoek as moontlike aanwysers van lipodistrofie. Drie spesifieke tydpunte vir die ART groep en twee tydpunte vir die TN groep is gekies uit die verskeie tydpunte waarby metings geneem is, nl. basislyn (gedefinieer as die dag wat TN deelnemers in die studie opgeneem is en 0 tot 4 weke voor die begin van behandeling vir die ART deelnemers), korttermyn (2 tot 12 weke nadat behandeling begin is of na die basislyn meting) en lang-termyn (binne een en ‘n half jaar nadat behandeling begin is vir die ART groep). By die basislyn tydpunt het min van die ART en TN deelnemers se gemete veranderlikes verskil. Die ART en TN groepe het hoofsaaklik verskil ten opsigte van veranderlikes wat betrekking het op die arm, veral persentasie van ideale armomtrek (%IAC) en bo-arm vetarea (UAFA). Hierdie twee veranderlikes was beduidend laer in die ART groep as in die TN groep. CD4+ seltelling en lewenskwaliteit tellings het beduidend verbeter vir die ART deelnemers van die basislyn tot die lang-termyn tydpunt. Hierdie veranderinge is nie samehangend met veranderinge in spiermassa nie, maar eerder met sommige vetmassa veranderlikes. Deelnemers wat antiretrovirale medikasie ontvang het, het veranderinge getoon wat gedui het op ‘n verhoogde neerlegging van vet in die buikarea. Ten slotte is bevind dat antiretrovirale medikasie bygedra het tot die verbeterde lewenskwaliteit van die deelnemers en dat dit waarskynlik ook die omkeer van uittering van ten minste een deelnemer aangehelp het. Daar is ook bevind dat armverwante metinge gebruik kan word in die plattelandse kliniese omgewing om pasiënte suksesvol te monitor ten opsigte van VIGSverwante uittering. Die nuwe veranderlikes, IAI en %IBW:%IAC kan moontlik gebruik word om lipodistrofie-verwante veranderings te meet en die gebruik van hierdie veranderlikes behoort ondersoek te word in verdere navorsing.

Thesis (MSc Nutrition Science)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: First-year female students (FYFS), studying at the University of Stellenbosch were previously identified as a high-risk group for gaining weight. A four-year follow-up of these female students indicated that a large percentage experience weight fluctuations throughout their university careers. The unique weight management needs of the FYFS were also identified in the longitudinal study. The integration of these results with an extensive search and assessment of the weight management literature led to the development of a multidimensional weight-management paradigm for application in the development of weight-management interventions for female students. Subsequently, a self-help weight-management manual, which follows the multidimensional approach proposed in the mentioned paradigm, was developed to address the unique weight-management needs of female students. The aim of the current study was to evaluate the impact of the multidimensional self-help weightmanagement manual (the Manual) on the weight status and associated factors of FYFS at the University of Stellenbosch over an eight-month period. For this purpose a non-randomized quasi-experimental design was used, including purposively selected experimental and control groups. Data were obtained during February (Baseline), May (three months after baseline = Follow-up I) and October 2002 (eight months after baseline = Follow-up 2). All students in the experimental group received the Manual at Baseline for use during the eight-month study period. Because this was a low-intensity intervention programme, no further contact was made with either group during the study period, except when Followup I data were obtained. Measures that were taken and instruments that were completed include the following: weight, height, triceps skinfoid, mid-upper ann circumference, hip circumference, waist circumference, Adolescent Self-Concept Scale (self-concept), Body Shape Questionnaire (body shape concerns), Eating Attitudes Test (eating attitudes and behaviours), General Health Questionnaire (general psychological well-being), 90-item Semi-quantified Food Frequency Questionnaire (dietary intake from nine food groups), and the Baecke Questionnaire of Habitual Physical Activity (physical activity). Additional questions on weight related perceptions and practices, dissatisfaction with body parts, reasons for eating and socio-demographic factors were also included. The Baseline characteristics of the FYFS involved in this study, which did not differ between the experimental and control groups for all key variables, identified them as a typical group of young female adults who are healthy but are not realistic about their weight status and who experience numerous problems related to their weight status. The implementation of the Manual was found to be significantly effective in limiting weight gain among the FYFS in the experimental group. The control group experienced almost a full unit increase in BMI (0.93 kg/m²), while the increase found for experimental group was 0.53 kg/m² (p=0.004). Although the weight of both groups increased initially the experimental group went on to lose weight, while the control group continued to gain weight during the last five months of the intervention. The impact of the Manual is further illustrated by the fact that the FYFS in the experimental group who indicated that they did Lise the Manual extensively experienced a significantly lower rise in their weight (change in BMI over study period = 0.37 kg/m²) than those in the experimental group who indicated that they did not use the Manual (change in BMI over study period = 0.89 kg/m²). Factors that are possibly linked to the success attained with the Manual were identified and include more reasonable weight goals; the use of sound weightreduction methods such as a balanced diet and physical activity; improvements in self-concept; maintenance of physical activity levels, especially during the first three months at university; improvement in general psychological well-being; decreased intake of foods from the "other" (includes mainly high fat, sugar based foods such as doughnuts, cookies, cake, tart), beverage and grains food groups; and possibly less concerns with body shape from the start. Factors for which no link with weight management success could be established include changes in body composition; perceptions of own weight; weight loss attempts; foods from the vegetables, fruit, milk and cheese, meat, fish and chicken, fats and fast foods food groups; physical activity over the total eight-month period; reasons for eating; eating attitudes and behaviour; dissatisfaction with body parts; and body shape concerns. It is recommended that the implementation of the Manual on the campus of the University of Stellenbosch to prevent weight gain of FYFS should be considered, bearing in mind some of the recommendations formulated by the FYFS in the experimental group. / AFRIKAANSE OPSOMMING: Eerstejaar damestudente wat aan die Universiteit van Stellenbosch studeer is voorheen geïdentifiseer as 'n hoë risiko groep vir gewigstoename. 'n Vier-jaar opvolg van hierdie damestudente het aangedui dat 'n groot persentasie vir die duur van hul universiteitsloopbane gewigsfluktuasies ondervind. Die unieke gewigshanteringsbehoeftes van die eerstejaar damestudente is ook tydens die longitudinale studie geïdentifiseer. Die integrasie van hierdie resultate met 'n uitgebreide soektog en ontleding van die literatuur wat betrekking het op gewigshantering het aanleiding gegee tot die ontwikkeling van 'n multidimensionele gewigshanteringsparadigma wat gebruik kan word tydens die ontwikkeling van gewigshanteringsintervensies vir damestudente. As 'n volgende stap is 'n self-help gewigshanterings handleiding, wat die multidimensionele benadering voorgestel in die genoemde paradigma volg, ontwikkelom die unieke gewigshanteringsbehoeftes van damestudente aan te spreek. Die doel van die huidige studie was om die impak van die multidimensionele self-help gewigshanteringshandleiding (die Handleiding) op die gewigstatus en geassosieerde faktore van eerstejaar damestudente aan die Universiteit van Stellenbosch oor 'n tydperk van agt maande, te evalueer. Vir hierdie doeleinde is 'n nie-gerandomiseerde kwasi-eksperimentele ontwerp gebruik, wat doelbewus geselekteerde eksperimentele en kontrole groepe ingesluit het. Data is gedurende Februarie (Basislyn), Mei (drie maande na basislyn = Opvolg-I) en Oktober (agt maande na basislyn = Opvolg-2) 2002 versamel. Alle studente in die eksperimentele group het die Handleiding tydens Basislyn ontvang vir gebruik tydens die agt maande studieperiode. Omdat dit 'n lae-intensiteit intervensie program was, is geen verdere kontak gedurende die studieperiode met beide die groepe gemaak nie, behalwe tydens die versameling van Opvolg-I data. Metings wat geneem is en instrumente wat voltooi is, sluit die volgende in: gewig, lengte, triseps velvou, mid-bo-armomtrek, heupomtrek, middelomtrek, "Adolescent Self- Concept Scale" (self-konsep), "Body Shape Questionnaire" (besorgdheid oor liggaamsvorm), "Eating Attitudes Test" (eetgedrag en -houding), "General Health Questionnaire" (algemene sielkundige welstand), 90-item semi-gekwantifiseerde voedselfrekwensievraelys (dieetinname van nege voedselgroepe), en die "Baecke Questionnaire of Habitual Physical Activity" (fisieke aktiwiteit). Addisionele vrae aangaande gewigsverwante persepsies en praktyke, ontevredenheid met liggaamsdele, redes vir eet en sosio-demografiese faktore is ook ingesluit. Die Basislyn eienskappe van die eerstejaar damesstudente wat aan hierdie studie deelgeneem het, het nie tussen die eksperimentele en kontrole groepe vir alle sleutelveranderlikes verskil nie. Hierdie inligting het ook daarop gedui dat die studente 'n tipiese groep jong vroulike volwassenes is wat gesond is maar, onrealisties is oor hul gewigstatus en baie gewigstatusverwante probleme ondervind. Die resultate toon dat die implementering van die Handleiding beduidend effektief was om die gewigstoename by eerstejaar damestudente in die eksperimentele groep te beperk. Die gewig van die kontrole groep het byna 'n volle LMI eenheid (0.93 kg/m²) toegeneem terwyl die toename vir die eksperimentele groep 0.53 kg/m² was. Alhoewel die gewig van beide groepe aanvanklik toegeneem het, het die eksperimentele groep daarna gewig verloor terwyl die kontrole groep se gewig gedurende die laaste vyf maande van die intervensie verder toegeneem het. Die impak van die Handleiding word verder geïllustreer deur die feit dat die eerstejaar damesstudente in die eksperimentele groep wat aangedui het dat hul wel die Handleiding ekstensief gebruik het, 'n beduidend laer toename in gewig (LMI verandering gedurende studieperiode = 0.37 kg/m²) ondervind het as die studente in die eksperimentele groep wat aangedui het dat hul nie die Handleiding gebruik het nie (LMI verandering gedurende studieperiode = 0.89 kg/m²). Faktore wat moontlik gekoppel kan word aan die sukses verkry met die Handleiding is geïdentifiseer en sluit die volgende in: meer redelike gewigsdoelwitte; die gebruik van veilige gewigsverlies metodes soos 'n gebalanseerde dieet and fisieke aktiwiteit; verbetering van self-konsep; handhawing van fisieke aktiwiteitsvlakke, veral gedurende die eerste drie maande op universiteit; verbetering van algemene sielkundige welstand; verlaagde inname van voedsel van die "ander-" (sluit hoofsaaklik hoë vet, suiker gebasseerde voedsels soos oliebolle, koekies en tert in), drankies- en graanvoedselgroepe; en moontlik minder besorgdheid oor liggaamsvorm van die begin af. Faktore waarvoor geen verband met sukses met gewigshantering gevind is nie sluit die volgende in: liggaamsamestelling; persepsies van gewig; gewigsverliespogings; voedselinname uit die groente-, vrugte-, melk en kaas-, vleis, vis en hoender-, vette- en kitskosse-voedselgroepe; fisieke aktiwiteit gedurende die totale agtmaande periode; redes vir eet; eetgedrag en -houding; ontevredenheid met liggaamsdele; en besorgdheid oor liggaamsvorm. Dit word aanbeveel dat die implementasie van die Handleiding op die kampus van die Univérsiteit van Stellenbosch oorweeg word om gewigstoename van eerstejaar damesstudente te voorkom. Dit word ook aanbeveel dat die aanbevelings van die studente in die eksperimentele groep in hierdie verband, in ag geneem moet word.

This study investigated the health needs of immigrant women from the African Great Lakes living in South Africa in the province of Gauteng, Tshwane Metropolitan city. It described their challenges and related factors compromising their holistic wellness, and identifies their context specific health needs as a gender group. A qualitative approach was utilised concurrently with participatory action research method. Data collection involved triangulation of instruments. A literature study was conducted to select relevant information usable as basis for this study. Data analysis and interpretation revealed factors that make it difficult for immigrant women from the African Great Lakes region to gain access to health care services in South Africa, identifying their specific women’s health needs. Recommendations proposed that policy makers and implementing professionals rendering women’s health care services should consider utilising a holistic and interdisciplinary approach to meet these basic needs. / Health Studies / M.A. (Public health)

Young women working in SMEs are increasingly being affected by HIV and AIDS, and SMEs are expected to respond to HIV and AIDS through workplace policies and programmes. This requires commitment from SMEs to help young women who face various gendered vulnerabilities to HIV and AIDs. The study, whose purpose was to investigate young women workers’ experiences of the HIV and AIDS response of small and medium enterprises in a semi urban area in KwaZulu-Natal, used a qualitative approach and collected data from three SMEs in Pietermaritzburg during the period of the study. Findings of the study indicate that the majority of respondents from all three SMEs agree on experiencing limited or no HIV and AIDS policies and programmes in SMEs. With reference to incomplete or limited responses, two SMEs provide financial assistance for funerals. However, some aspects such as education and awareness, monitoring, management commitment, provision of medical aid, facilitation of peer education, appointment of an HIV officer and more were not evident. Thus recommendations were made on how SMEs should respond, and future research ideas were outlined. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

Young women working in SMEs are increasingly being affected by HIV and AIDS, and SMEs are expected to respond to HIV and AIDS through workplace policies and programmes. This requires commitment from SMEs to help young women who face various gendered vulnerabilities to HIV and AIDs. The study, whose purpose was to investigate young women workers’ experiences of the HIV and AIDS response of small and medium enterprises in a semi urban area in KwaZulu-Natal, used a qualitative approach and collected data from three SMEs in Pietermaritzburg during the period of the study. Findings of the study indicate that the majority of respondents from all three SMEs agree on experiencing limited or no HIV and AIDS policies and programmes in SMEs. With reference to incomplete or limited responses, two SMEs provide financial assistance for funerals. However, some aspects such as education and awareness, monitoring, management commitment, provision of medical aid, facilitation of peer education, appointment of an HIV officer and more were not evident. Thus recommendations were made on how SMEs should respond, and future research ideas were outlined. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

The purpose of the study was to investigate the cardiovascular disease (CVD) risk profile of black African females in the Makana region, Eastern Cape, South Africa. Baseline measures from 40 participants, who met the criteria, were compared against the 2003 South African Demographic and Health Survey (SADHS) and the 2013 South African National Health and Nutritional Examination Survey (SANHANES-1). The risk factors measured were anthropometric (stature, body mass and body mass index (BMI)), morphological (waist circumference (WC), fat mass and lean mass), cardiovascular (heart rate and blood pressure (BP)), physical activity (step count and energy expenditure), biochemical (glycated haemoglobin and full blood lipid profile) and behavioural (alcohol and tobacco use). Results showed significantly higher (p≤0.05) values for overweight/obesity (BMI 37.60 kg.m⁻²; WC 1130.58 mm; fat mass 45.23%) and high BP (130/88 mmHg) compared to the previous national surveys, highlighting these CVD risk factors as problematic. The subsequent sub-study aimed to assess the efficacy of a pedometer-based walking intervention on high BP. The walking programme (n=25) was based on individual step goals to be completed at a moderate-intensity on five days.week⁻¹ for 12 weeks. The same measurements were taken at monthly intervals, Week 0, Week 4, Week 8 and Week 12, with the addition of dietary intake and fitness level, and the exclusion of the behavioural variables. There were no significant differences (p≤0.05) in systolic and diastolic BP with the exercise intervention, although there was a strong, negative relationship with time for diastolic BP (r²=0.9857). This trend suggests that the lack of significance may be a result of poor compliance and/or the small sample size. Individual results, however, showed no compliance-result relationship for the two risk factors of interest: overweight/obesity and high BP. Future recommendations include supervised or group-based exercise interventions to improve compliance, and the addition of resistance training to the aerobic programme.