Submitted by Daniele Santos (danielesantos.htl@gmail.com) on 2017-06-06T18:33:40Z No. of bitstreams: 1 Thesis_Tania Ngo_Revised.pdf: 2343388 bytes, checksum: 712a5c30f8c6b9eddacef1040388043a (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2017-06-06T20:10:30Z (GMT) No. of bitstreams: 1 Thesis_Tania Ngo_Revised.pdf: 2343388 bytes, checksum: 712a5c30f8c6b9eddacef1040388043a (MD5) / Made available in DSpace on 2017-06-21T13:08:33Z (GMT). No. of bitstreams: 1 Thesis_Tania Ngo_Revised.pdf: 2343388 bytes, checksum: 712a5c30f8c6b9eddacef1040388043a (MD5) Previous issue date: 2017-05-02 / Affordability is a key concern of international donors who finance antiretroviral drugs to treat AIDS in Sub-Saharan African countries. The ability of Sub-Saharan Africa to reduce their prices below large-scale manufacturers in India is challenging. Additionally, these medicines must meet The World Health Organization prequalification standards. While the cost of second-line ARVs remains a concern, donors should also focus resources on other factors of ARV access, such as the supply of human resources for health, infrastructure and issues of sustainable financing. This research specifically aims to determine if the domestic production of
antiretroviral drugs can be a successful and viable option to increase access to ARVs in sub-Saharan Africa by using three case studies of Uganda, Kenya and The democratic Republic of Congo. The research is intended to explore a potentially economical way to provide ARVs to populations with HIV/AIDS in order to move away from a dependence on foreign aid, which does not guarantee continued long-term access to the medications. Since ARVs must be taken daily for the duration of the patient's life, it is important to develop ways to increase access to the medications in a manner that facilitates the long-term drug procurement. The success of local manufacturers then relies on the capacity of the firm to achieve two necessary elements of donor-financed requirements: international quality standards and economies of scale to lower price. I recommend that more countries in Africa should produce ARVs locally in order to lower to cost and increase accessibility, especially in small villages. Even though the current operation of local production has not led to a significant increase in access primarily due to market entry restrictions, this endeavor have the ability to amplify long-term access to affordable ARV drugs

The questionnaire text in English, Afrikaans and Native language / The aim of the study was to minimise non-adherence to antiretroviral (ARV) treatment amongst HIV/AIDS adult patients at a hospital in Namibia thereby promoting successful outcomes in patients on ARV treatment. A quantitative cross-sectional descriptive study was conducted on a sample of 112 non-adherent adults. Data collection was through structured interviews and patients’ records review. Data analysis was by descriptive statistics. Rate of non-adherence was 36.7%. Characteristics common in the sample were, being a woman, age of 31-45 years, being unmarried, low educational status, lack of HIV status disclosure, feeling that taking ARVs reminded one of HIV and experience of ARV side effects. Reasons for missed doses included forgetting, alcohol use, access to care, work commitments, lack of food, stress and travelling. Of the respondents, 86.6% had unsupressed viral loads. Recommendations include use of reminders, automated SMS, establishing treatment supporters and collaborative efforts in reducing active substance use to improve adherence. / Health Studies / M.A. (Nursing Science)

The purpose of this study was to assess the impact of virologic monitoring frequencies on treatment failure, adherence to therapy, and the emergence of drug resistance in HIV-1 infected patients. A quantitative, meta-analysis was conducted to investigate the virologic outcomes of infrequent and frequent Viral Load (VL) testing among patient on combination antiretroviral therapy (cART). Data was collected through a self-designed data collection form. Two comparison groups emerged being guided by the VL monitoring frequency. In group I, the health outcomes were compared for (≥3 VLs per year) versus (≤2 VLs per year) and (2 VLs per year) versus (≤1 VLs per year) for group II. Data were analysed using the Cochrane's statistical software, RevMan v5.3. The findings support (2 VLs per year) as the optimal VL monitoring strategy for stable and virologically suppressed patients and there is nothing to be gained by (≥3 VLs per year). / Health Studies / M.P.H.

Magister Public Health - MPH / Antiretroviral regimens have side effects that can threaten adherence by patients resulting in evolution of viral resistance due to suboptimal drug levels. Studies have shown that drug adherence of at least 80% can result in viral load suppression. There is no literature on the association between the level of adherence to antiretroviral therapy and the degree of virological suppression in Namibia. The aim of the present study was to determine the therapeutic and virological outcomes in HIV/AIDS patients at 6 and 12 months after initiation of highly-active antiretroviral therapy (HAART) in an urban population in Namibia. The distribution of viral load results showed a low uptake (35%) of virological monitoring at 6 month time point and even lower (12%) at 12 months. A conservative viral load threshold for virological response is required in the Namibian setting. The current adherence level of >80% encourage increased ARV therapy rollout. Poor virological outcome was associated with self-reported adherence. / South Africa

The main purpose of this study is to investigate how we can understand the correlation between social vulnerability and crime among young men with a foreign background. I intend to highlight the reality of the everyday life of six convicted young men shortly before they committed criminal acts as I aim to understand the influence of socioeconomic risk factors in their lives. The selected research method is a qualitative text analysis based on a true criminal case which occurred in a disadvantaged Stockholm suburb. The selected young men who appear in this study are aged between 17-21 and were among the main suspects. The empirical data consists of verbatim transcripts of interrogation interviews with police investigators and the court verdict. The study’s results have been analyzed based on the theory of dynamics of human behavior and on the basis of risk factors. The results show that all the young men have poor school results, poor communication with their family and that all live in cramped housing conditions that does not offer enough opportunity for private space. Several of the young men lack income and employment and are financially supported by family members. In summary, the results show that the social risk factors that occur in their lives are similar and that their current life situation is a result of the social existence in which they reside.

Magister Curationis - MCur / Depression is defined as a psychiatric condition, wherein a person experiences extreme sadness, social withdrawal, and expresses self-deprecating thoughts. Across the world, millions of people with Human Infectious Virus (HIV) suffer from depression each year. Depression is regarded as the most common disabling medical condition that affects both HIV-positive and HIV-negative individuals, globally. It is further reported that depression is the most common neuropsychiatric disturbance observed in HIV infected individuals. In South Africa, the prevalence of depression symptoms among Antiretroviral Therapy (ART) clients is reported to be 25.4%. However, depression among this group is often underdiagnosed and untreated in Primary Health Care settings. The need for routine screening is encouraged by studies confirming that depression and anxiety disorders accelerate the progression of HIV disease. Methods A quantitative descriptive research design was used. The study population included 1 440 males and females, aged eighteen years and over, who were HIV positive and received ART at the Clinic. A randomly selected sample of 372 respondents were recruited, but 110 had to be excluded because of eligibility issues; therefore, 262 respondents completed the Beck Depression Inventory (BDI) questionnaire. Mann-Whitney U test, Fisher’s exact test and the Spearman Rank test were used to analyse the data, using GraphPad Prism software. Depression symptoms were evaluated, using BDI, and a score of -> 10 indicated depression. Results Of the 262 respondents, 52% had club membership, compared to 48%, who were only on ART. There were significantly more female respondents (44%) involved in Adherence Clubs, as opposed to their male counterparts (8%), a difference of 36% overall (p=0.016). In summary, the number of individuals, who were suffering from some form of depression, enrolled in ART Adherence Clubs was 8.4% of the total sample, compared to 10% of those who were not in ART adherence clubs. The overall prevalence of depression in this current study was 18.4 %, which was in line with other studies conducted in a South African context, and a similar setting. Clinical depression status represents the main outcome of interest in this research project. The model category was 0-10, which indicated that a significant majority, 69.5%, n= 182, of the enrolled respondents were classified as healthy, in terms of clinical depression status. Beck depression scores were consistent across gender. Depression seemed to be more severe in the 35-44 age category. Fisher’s exact test confirmed the absence of any statistical difference between ART club membership and their depression status. Spearman rank correlation coefficient of -0.02 indicates a very low association between length of HIV seropositivity and Beck Depression score. Conclusion This is the first study reporting on the prevalence of depression, in relation to HIV infection, as well as ART treatment, and the associated adherence programme in Cape Town. Further research on a similar topic is recommended, using other instruments in the same geographic area.

Background: Ceramide synthesis and metabolism is a promising target in cancer drug development. γ-tocotrienol (GT3), a member of the vitamin E family, orchestrates multiple effects that ensure the induction of apoptosis in both, wild-type and RAS-mutated pancreatic cancer cells. Here, we investigated whether these effects involve changes in ceramide synthesis and transport. Methods: The effects of GT3 on the synthesis of ceramide via the de novo pathway, and the hydrolysis of sphingomyelin were analyzed by the expression levels of the enzymes serine palmitoyl transferase, ceramide synthase-6, and dihydroceramide desaturase, and acid sphingomyelinase in wild-type RAS BxPC3, and RAS-mutated MIA PaCa-2 and Panc 1 pancreatic cancer cells. Quantitative changes in ceramides, dihydroceramides, and sphingomyelin at the cell membrane were detected by LCMS. Modulation of ceramide transport by GT3 was studied by immunochemistry of CERT and ARV-1, and the subsequent effects at the cell membrane was analyzed via immunofluorescence of ceramide, caveolin, and DR5. Results: GT3 favors the upregulation of ceramide by stimulating synthesis at the ER and the plasma membrane. Additionally, the conversion of newly synthesized ceramide to sphingomyelin and glucosylceramide at the Golgi is prevented by the inhibition of CERT. Modulation ARV1 and previously observed inhibition of the HMG-CoA pathway, contribute to changes in membrane structure and signaling functions, allows the clustering of DR5, effectively initiating apoptosis. Conclusions: Our results suggest that GT3 targets ceramide synthesis and transport, and that the upregulation of ceramide and modulation of transporters CERT and ARV1 are important contributors to the apoptotic properties demonstrated by GT3 in pancreatic cancer cells.

The purpose of this study was to identify certain experiences among Swedish scholars towards their use of Wikipedia. The goal was to create a deeper understanding of how audiences with academic professions experience Wikipedia as a place to share knowledge with other individuals. This study was done through the perspectives of the ANT theory (Latour, 2005) and the User-Gratification theory (Katz et al., 1973). The method of choice was a mixed method research where the primary choice of method was qualitative interviews with seven Swedish scholars and one expert interview consisting of an employee at the Swedish Wikimedia foundation. This material was analyzed through a thematic analysis. Some of the findings from the interview was also analyzed through a computational network analysis to provide deeper insight into the concept of Wikipedia.    The research showed that there is a variated view on the scholar’s role on Wikipedia. While some of the participants criticized the structure in which the information was produced, some raised awareness into the importance to provide society with reliable and scientific knowledge in which important decisions can be based on. Different actors within the network of Wikipedia were identified which provided a deeper insight into the variety of individuals and non-human elements that work together to generate content on Wikipedia. A few of these actors and their relationships between one another was also visualized during the study. This provided even further analytical insight to Wikipedia as a platform. The overall view among the participants showed that there is a lack of incitement on how and why scholars should contribute to Wikipedia in Sweden. The results also showed that there are a variety of ways in which the platform of Wikipedia can be viewed depending on personal use the website. The cultural approach to Wikipedia was discussed in the context to how Wikipedia can provide society with information and how this might act as a form of cultural heritage online. / Syftet med denna studie var att identifiera vissa erfarenheter bland svenska forskares användning av Wikipedia. Målet med studien var att skapa en djupare förståelse för hur mediepubliker med akademiska yrken upplever Wikipedia som en plats att dela kunskap med andra individer. Studien genomfördes med hjälp av de olika perspektiven som de teoretiska utgångspunkterna ANT teorin (Latour, 2005) och användare-belönings teorin (Katz et al., 1973) bidrog med. Valet av metod blev en blandad metodforskning där det primära metodvalet var kvalitativa intervjuer med sju olika svenska akademiker och en expertintervju med en anställd på Wikimedia Sverige. Det insamlande materialet blev sedan analyserat genom en tematisk analys. Vissa delar av det insamlade materialet blev senare också analyserat genom en nätverksanalys av data för att bidra med djupare kunskap kring konceptet Wikipedia.    Studien visade att det finns en varierad syn på forskarens roll på Wikipedia. Medan vissa deltagare kritiserade strukturen som informationen produceras i, utryckte sig andra kring vikten av att bidra med trovärdig kunskap till samhället som sedan kan ligga till grund för olika beslut. Olika aktörer inom Wikipedia identifierades vilket också bidrog till en djupare insikt i den variation av individer och icke-mänskliga element som jobbar tillsammans för att skapa material på Wikipedia. Vissa av dessa aktörers relationer med varandra identifierades också genom olika typer av visuella element som framställdes under studien. Detta bidrog således också med en djupare analytisk insikt kring Wikipedia som plattform. Den allmänna synen bidrog också med insikt i den bristen på incitament kring hur och varför forskare bör bidra med sin forskning på Wikipedia i Sverige. Resultaten visade också att det finns en mängd olika sätt individer kan skapa sin bild av Wikipedia genom sitt personliga bruk av plattformen. Den kulturella approachen till Wikipedia diskuterades också genom kontexten hur plattformen kan bidra samhället med information och hur detta kan uppfattas som ett kulturellt arv online.

Det finns många olika sorters barn. De är olika på grund av sina medfödda dispositioner, men framförallt på grund av vilka dispositioner deras olika uppväxtmiljöer ger dem möjlighet att utveckla. Det finns även gemensamma faktorer som gäller alla människor att ta i beaktande. Allt detta ger en mycket komplicerad bakgrundsbild till fenomen som kamratskap, vänskap, social rangordning och utanförskap. Det som står klarast lysande är dock den stora betydelse gemenskap med andra barn i samma ålder har för barns sociala utveckling och att en slutsats blir att det är denna resurs som måste säkerställas innan intentionerna om att ge alla barn samma chanser till god psykosocial hälsa och möjlighet att ta sin plats i samhället kan förverkligas. / Children are not all alike. The diversities among children are due to both to individual genetics and different environmental upbringing.Biological factors that apply to the human race as a social animal are not to be overseen. Together these factors gives a very intricate back-ground to phenomena such as being peers, being friends, social hierarchies and isolation. What stands out in the study of these phenomena is however the great importance of intellectual fellowship and feeling of solidarity with other children of the same age. A conclusion must therefore be that it is of utmost importance that resources such as intellectual fellowship and feeling of solidarity with other children of the same age are guaranteed for all children before the intentions of giving all children the same chances of good psychosocial health and means to take their legitimate place in society can be realized.

With regards to Swedish succession rights, and the distribution of the inheritance as such, there is an underlying conflict of a fundamental nature betweenthe deceased´s former interest in how the estate should be distributed on theone hand, and the interest of the primary heirs in the preservation of theinheritance on the other. The deceased´s interest can be derived from the rightto private ownership, while the interest of the primary heirs rests upon thestatutory minimum portion of the inheritance (laglott) which they are entitled to by law. The statutory minimum portion of the inheritance is half of the sharethat is due by law (arvslott) to the primary heirs if there is no will, i.e. if theintestate succession (legala arvsordningen) is followed. Furthermore, this conflictof interest can provoke an individual to plan their estate with the intention ofminimizing the inheritance of one or more of their primary heirs. This pertainsespecially to children who are not the offspring of the surviving spouse,considering that they are entitled to receive their statutory minimum portion ofthe inheritance immediately upon the deceased’s – their parent's – death. Thedispositions at hand for someone who wants to plan their estate (dödsrättshandlingar) according to Swedish law are of two particular types. Wills (testamenten)and beneficiary designations (förmånstagarförordnanden). Gifts made in contemplation of the donor’s impending death (gåvor för dödsfalls skull), ties into thiscategory as well. Namely, gifts of this nature are in this respect equated to wills.Another rationale for sorting these three different dispositions together can befound in their common purpose, i.e. to benefit someone else with all or someof the estate. In the most abstract terms, these three categories could be called,gratuitous legal dispositions made ad mortis causa, (benefika dispositioner fördödsfalls skull). In light of this the thesis explores and examines whether a primaryheir´s legal protection – especially if the statutory minimum portion of theinheritance – has an equal efficiency in relation to this broad category –constituted of the three aforementioned subsets – accessible to someone whowants to plan their estate. The result of the thesis is primarily that such adifference in fact does exist and secondarily that this inconsistency to some extent is unjustifiable considering (1) the similar nature and purpose of these dispositions, and (2) the presence and function of the legal institute of forcedheirship in Swedish law.