Good health is a fundamental resource for social and economic development. Non-communicable chronic diseases (NCDs) such as cardiovascular diseases (CVD), cancer, chronic respiratory diseases and diabetes mellitus are reaching epidemic proportions worldwide. Over the last decades NCDs remain the main public health problem in Lithuania also. The leading NCD’s in the Lithuania are CVD and cancer. The key targets of the Health 21 policy for WHO European Region as well as of Lithuanian Health Programme are reduction of morbidity and mortality from CVD, cancer and other NCD’s. The leading strategy to tackle NCDs is control and prevention of risk factors. Common, modifiable risk factors underlie the major NCD’s. Seven risk factors are responsible for the majority of NCD in the European region: high blood pressure, tobacco, alcohol, high cholesterol, being overweight, low intake of fruits and vegetables, and physical inactivity. The lifestyle habits start to develop in childhood. Children and adolescents begin to smoke and use alcohol, adopt unhealthy nutrition habits and sedentary lifestyle. Harmful lifestyle choices lead to children’s overweight, increase of their blood pressure (BP), and metabolic disorders. Many epidemiological studies designed to assess the association between health indices in childhood and adulthood were conducted over the last years. However, the number of longitudinal, cohort studies that would follow people from childhood to middle age and would apply the... [to full text]

Objectifs : Analyser l’évolution de l’embonpoint chez les enfants québécois entre 4 et 8 ans et évaluer le rôle des différents facteurs de risque sur l’excès de poids persistant. Les données proviennent de l’étude longitudinale du développement des enfants du Québec (ÉLDEQ, 1998-2010). Cette enquête est réalisée par l’Institut de la statistique du Québec auprès d’une cohorte de 2120 nourrissons québécois nés en 1998, faisant l’objet d’un suivi annuel à partir de l’âge de 5 mois. Méthodes d’analyse : univariées, bivariées, modélisation semi-paramétrique, analyses de régressions logistique et log-linéaire (Poisson). Principaux résultats : i) L’excès de poids persistant chez les enfants âgés de 4 à 8 ans est un phénomène fluctuant, qui ne varie pas de façon significative selon le sexe ; ii) Le fait d’allaiter les enfants ne semble pas avoir un effet protecteur en ce qui concerne l’excès de poids ; iii) En ce qui concerne le poids à la naissance, les données dont on dispose ne nous permettent pas de tirer des conclusions ; iv) Le fait d’avoir une santé moins qu’excellente à la naissance semble augmenter le risque d’avoir un excès de poids persistant ; v)Ce qui influence surtout, c’est de toujours manger trop ou trop vite, ou le fait de vivre dans une famille avec un ou deux parents qui font de l’embonpoint ; vi) Les mères qui ont fume pendant leur grossesse présentent une probabilité plus élevée d’avoir des enfants avec un excès de poids persistant que celles qui n’ont pas fumé. / Objectives: Analysis of trends of overweight among children in Quebec between 4 and 8 years and evaluation of the role of various risk factors of persistent excess weight. Data: based on the Québec Longitudinal Study of Child Development (QLSCD 1998-2010). This survey is being conducted by the Institut de la statistique du Québec with a cohort of 2120 children born in Québec in 1998, being followed annually from the age of 5 months. Methods of analysis: univariate, bivariate, semi-parametric modeling, logistic and loglinear (Poisson) regression analysis. Main results: i) The persistent excess weight in children aged 4 to 8 years is a fluctuating phenomenon, which does not vary significantly by sex; ii) The act of breastfeeding children does not seem to have a protective effect with regard to children being overweight; iii) Regarding the birth weight, the available data do not allow us to draw any conclusion; iv) Having a less than excellent health at birth appears to increase the risk of persistently being overweight; v) Primary influences are always eating too much or too fast, or living in a family with one or two parents who are overweight; vi) Mothers who smoked during pregnancy are more likely to have children who are overweight than those who did not smoke.

Persons with severe hemophilia A exhibit significant variations in clinical phenotype; approximately 10% are milder bleeders. This study explored factors that might contribute to this inter-patient heterogeneity. Using a multi-center prospective study following boys with severe hemophilia A on a tailored primary prophylaxis regimen, age at first joint bleed, body mass index, protocol adherence and family activity level were modeled on the age at escalation from once-weekly to twice-weekly and alternate day infusions. Escalation, based on bleeding frequency, served as a surrogate marker of bleeding severity. We also assessed the roles of clinical and hemostatic parameters in predicting age at first joint bleed using a cross-sectional study. Results suggest that a delayed first joint bleed indicates later escalation (milder bleeding pattern) and that a longer lag time is associated with an earlier onset of joint bleeding. Larger studies are needed to definitively identify predictors of clinical heterogeneity in these patients.

Persons with severe hemophilia A exhibit significant variations in clinical phenotype; approximately 10% are milder bleeders. This study explored factors that might contribute to this inter-patient heterogeneity. Using a multi-center prospective study following boys with severe hemophilia A on a tailored primary prophylaxis regimen, age at first joint bleed, body mass index, protocol adherence and family activity level were modeled on the age at escalation from once-weekly to twice-weekly and alternate day infusions. Escalation, based on bleeding frequency, served as a surrogate marker of bleeding severity. We also assessed the roles of clinical and hemostatic parameters in predicting age at first joint bleed using a cross-sectional study. Results suggest that a delayed first joint bleed indicates later escalation (milder bleeding pattern) and that a longer lag time is associated with an earlier onset of joint bleeding. Larger studies are needed to definitively identify predictors of clinical heterogeneity in these patients.

We assessed potential mechanisms that may jeopardize skeletal muscle perfusion during surgery leading to adverse outcomes including muscle injury and flap hypoxia. In craniotomy patients, we observed an increase in serum lactate and creatine kinase and urine myoglobin; indicative of muscle damage. The early rise in lactate correlated with elevated BMI, suggesting that obesity caused tissue compression and muscle ischemia. In our rodent model, we investigated the effects of flap preparation and phenylephrine on muscle perfusion by assessing microvascular blood flow and tissue PO2. Phenylephrine reduced muscle blood flow by ~20%, yet increased PO2 by ~10% suggestive of decreased O2 metabolism. At baseline, muscle flap blood flow was reduced by ~50% while PO2 was severely reduced ~80% (~5 torr) suggesting that flap perfusion was attenuated and O2 metabolism was increased. Phenylephrine infusion further reduced muscle flap perfusion. These data demonstrate multiple mechanisms by which muscle perfusion is jeopardized during surgery.

We assessed potential mechanisms that may jeopardize skeletal muscle perfusion during surgery leading to adverse outcomes including muscle injury and flap hypoxia. In craniotomy patients, we observed an increase in serum lactate and creatine kinase and urine myoglobin; indicative of muscle damage. The early rise in lactate correlated with elevated BMI, suggesting that obesity caused tissue compression and muscle ischemia. In our rodent model, we investigated the effects of flap preparation and phenylephrine on muscle perfusion by assessing microvascular blood flow and tissue PO2. Phenylephrine reduced muscle blood flow by ~20%, yet increased PO2 by ~10% suggestive of decreased O2 metabolism. At baseline, muscle flap blood flow was reduced by ~50% while PO2 was severely reduced ~80% (~5 torr) suggesting that flap perfusion was attenuated and O2 metabolism was increased. Phenylephrine infusion further reduced muscle flap perfusion. These data demonstrate multiple mechanisms by which muscle perfusion is jeopardized during surgery.

There is no abstract available for this thesis. / Department of Family and Consumer Sciences

Physical activity has several advantages for health. The first objective of this research was to determine the relationship between physical activity and selected physical and psychological health components. The physical components include: diabetes risk, obesity, cholesterol and cardiovascular disease. The psychological health components include stress and depression. Secondly, this research aimed to determine the relationship between physical activity and medical costs. Medical costs were divided into pharmaceutical, general practitioners and hospital claims. A total of 9 860 employees of the same financial institution in South Africa, between the ages 18 and 64 (x̄ = 35.3 ± 18.6 years), participated in the study and participation was voluntary. No differentiation was made between race groups. The assessment of selected health risk factors and physical activity was done by using the Health Risk Assessment (HRA) methodology developed by the company, Monitored Health Risk (MHM). Assessment included a physical activity, diabetes risk and cardiovascular risk questionnaire, BMI and random blood glucose measurements, as well as stress and depression scores. The amount of days absent from work in the past six months was also determined by the questionnaire. Participants was categorised in three groups – low, moderate and high physical activity participation. Medical expenditure data was obtained from Monitored Health Risk Management Pty (Ltd). Hospital, pharmaceutical and general practitioners (GP) claims included all costs occurring during a six month period. The majority of the study group showed low physical activity participation (78.27%). The results also showed that both men and women showed an increased risk for diabetes, and high physical activity levels have a practically and statistically significant effect on the reduction of diabetes risk. In this study all the physical activity groups of both males and females showed an increased average body mass index (BMI) and therefore are considered to be an increased risk according to the classification as stipulated by the study perimeters. The average means for cholesterol in all groups are categorised as low risk. No significant differences are seen between the female groups as well as between the different male groups. The men in the study group showed higher cardiovascular risk than women. There are no statistically significant differences between the women’s groups. However, regarding the male groups, the low physically active male group showed significant differences to the high physical active male group. Thus, in this study it appears that the men participating in high levels of physical activity show the lowest risk for cardiovascular disease and therefore appear to be influenced by physical activity. The majority of the study group is shown to be in the high stress category (55.48%). It seems that work issues (82%), financial problems (74%) and family problems (69%) contribute most to the population’s high stress levels and depression experience. The Physical activity index (PAI) in relation to stress only shows practical significance in moderate and high physical women. The PAI and stress-related index reports statistically (p≤0.05; 0.001) significant and practice significant difference within the population. There was also a statistically significant (p≤0.05) relation between stress and physical activity in relation to days absent. Although high levels of stress and low levels of physical activity are present in the population, the relation become statistically significant in relation with depression. The study group was divided into two groups when the medical cost was examined. One group consisted of those individuals who do not use chronic medication and the other group, those individuals that use chronic medication. The majority of the study group (chronic and nonchronic medication use), show low physical activity participation (average of 78.80%). The results show statistically and practically significant differences between the groups that do not use chronic medication and the groups that use chronic medication. The women that use chronic medication show an increase in pharmaceutical costs with an increase in physical activity. However, when investigating the GP cost of women who use chronic medication, there is only a small difference in GP cost in the different physical activity participation categories. The data shows that men have higher pharmaceutical costs than women in all the physical activity categories. The results also indicate that men who use chronic medication, participating in low levels of physical activity do show higher pharmacy and GP costs. Medical cost associated with hospitalisation of those men whose chronic medications show an average higher medical cost (R231.72 versus R672.71). The women who are on chronic medication show about two and a half times higher hospitalisation cost (R253.97 versus R650.82) and the men an almost four times higher cost (R189.34 versus R721.71). No practically significant difference was found between the groups. The women show an increased incidence of low physical activity participation (82.38%), whereas 68.80% of the men show low physical activity participation. Women who use chronic medication and participate in moderate physical activity show lower hospital costs. The women in this study group that use chronic medication and participate in high levels of physical activity show the highest hospital cost. The men’s profile indicates that medical cost due to hospital claims rise with the higher levels of physical activity. / Thesis (PhD (Human Movement Sciences))--North-West University, Potchefstroom Campus, 2013.

Physical activity has several advantages for health. The first objective of this research was to determine the relationship between physical activity and selected physical and psychological health components. The physical components include: diabetes risk, obesity, cholesterol and cardiovascular disease. The psychological health components include stress and depression. Secondly, this research aimed to determine the relationship between physical activity and medical costs. Medical costs were divided into pharmaceutical, general practitioners and hospital claims. A total of 9 860 employees of the same financial institution in South Africa, between the ages 18 and 64 (x̄ = 35.3 ± 18.6 years), participated in the study and participation was voluntary. No differentiation was made between race groups. The assessment of selected health risk factors and physical activity was done by using the Health Risk Assessment (HRA) methodology developed by the company, Monitored Health Risk (MHM). Assessment included a physical activity, diabetes risk and cardiovascular risk questionnaire, BMI and random blood glucose measurements, as well as stress and depression scores. The amount of days absent from work in the past six months was also determined by the questionnaire. Participants was categorised in three groups – low, moderate and high physical activity participation. Medical expenditure data was obtained from Monitored Health Risk Management Pty (Ltd). Hospital, pharmaceutical and general practitioners (GP) claims included all costs occurring during a six month period. The majority of the study group showed low physical activity participation (78.27%). The results also showed that both men and women showed an increased risk for diabetes, and high physical activity levels have a practically and statistically significant effect on the reduction of diabetes risk. In this study all the physical activity groups of both males and females showed an increased average body mass index (BMI) and therefore are considered to be an increased risk according to the classification as stipulated by the study perimeters. The average means for cholesterol in all groups are categorised as low risk. No significant differences are seen between the female groups as well as between the different male groups. The men in the study group showed higher cardiovascular risk than women. There are no statistically significant differences between the women’s groups. However, regarding the male groups, the low physically active male group showed significant differences to the high physical active male group. Thus, in this study it appears that the men participating in high levels of physical activity show the lowest risk for cardiovascular disease and therefore appear to be influenced by physical activity. The majority of the study group is shown to be in the high stress category (55.48%). It seems that work issues (82%), financial problems (74%) and family problems (69%) contribute most to the population’s high stress levels and depression experience. The Physical activity index (PAI) in relation to stress only shows practical significance in moderate and high physical women. The PAI and stress-related index reports statistically (p≤0.05; 0.001) significant and practice significant difference within the population. There was also a statistically significant (p≤0.05) relation between stress and physical activity in relation to days absent. Although high levels of stress and low levels of physical activity are present in the population, the relation become statistically significant in relation with depression. The study group was divided into two groups when the medical cost was examined. One group consisted of those individuals who do not use chronic medication and the other group, those individuals that use chronic medication. The majority of the study group (chronic and nonchronic medication use), show low physical activity participation (average of 78.80%). The results show statistically and practically significant differences between the groups that do not use chronic medication and the groups that use chronic medication. The women that use chronic medication show an increase in pharmaceutical costs with an increase in physical activity. However, when investigating the GP cost of women who use chronic medication, there is only a small difference in GP cost in the different physical activity participation categories. The data shows that men have higher pharmaceutical costs than women in all the physical activity categories. The results also indicate that men who use chronic medication, participating in low levels of physical activity do show higher pharmacy and GP costs. Medical cost associated with hospitalisation of those men whose chronic medications show an average higher medical cost (R231.72 versus R672.71). The women who are on chronic medication show about two and a half times higher hospitalisation cost (R253.97 versus R650.82) and the men an almost four times higher cost (R189.34 versus R721.71). No practically significant difference was found between the groups. The women show an increased incidence of low physical activity participation (82.38%), whereas 68.80% of the men show low physical activity participation. Women who use chronic medication and participate in moderate physical activity show lower hospital costs. The women in this study group that use chronic medication and participate in high levels of physical activity show the highest hospital cost. The men’s profile indicates that medical cost due to hospital claims rise with the higher levels of physical activity. / Thesis (PhD (Human Movement Sciences))--North-West University, Potchefstroom Campus, 2013.

The increased prevalence of obesity amongst adolescents is considered a worldwide epidemic. Within the black population of South Africa, obesity is significantly more prevalent amongst black girls than black boys. The high prevalence of obesity amongst children can be attributed to a combination of various lifestyle factors, namely a decrease in physical activity, an increase in television viewing, Westernization and increased food supply. The decrease in physical activity amongst adolescents over the last few decades has led to an increase in the number adolescents diagnosed with type 2 diabetes mellitus. Research has indicated that insulin sensitivity improves with regular physical endurance activity, irrespective of change in bodyweight. Regular physical exercise also lowers the risk of type 2 diabetes mellitus, and prevents the development of coronary heart diseases, hypertension and obesity. The primary goals of this study were two-fold: Firstly, to determine the relationship between BMI, percentage body fat and insulin sensitivity amongst black adolescents, and, secondly, to determine whether there exists a positive correlation between current cardiovascular fitness (V02-maximum),together with everyday physical activity status, and insulin sensitivity amongst black adolescents. One hundred and twenty-four (124) black boys and 148 black girls between the ages of 14 and 17 participated in the study. The BOD-POD was used to calculate percentage body fat, and blood analysis for fasting glucose and insulin were completed. Insulin sensitivity (QUIKI-index) and resistance (HOMA) were also calculated, and habitual physical activity was measured using the "Previous Day Physical Activity Recall" (pDPAR) questionnaire. Physical development was determined with the Tanner questionnaire, cardiovascular fitness (VO2-maximum) was determined using the "Bleep" test and anthropometry (mass, length, skin folds, waist and hip circumference) was measured to determine body composition. The results of this study found a statistically significant negative correlation between skin fold thickness, percentage body fat, BMI and insulin sensitivity in girls. A significant negative correlation between percentage body fat and V02-maximum was found in boys, while their self-reported activity (PDPAR) did not correlate with percentage body fat. Current cardiovascular fitness and habitual physical activity status (PDPAR) showed no significant relationship with insulin sensitivity. Amongst the girls there was however a tendency towards a positive correlation between insulin sensitivity and V02-maximum. / Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.