Tse Man. / Accompanying booklet titled: Dietary assessment food portion booklet. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 101-122). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Abstract (Chinese version) --- p.iv / Table of contents --- p.vi / List of figures --- p.x / List of tables --- p.xi / List of abbreviations --- p.xiv / Chapter Chapter one: --- Introduction --- p.1 / Breast cancer trends in Hong Kong --- p.1 / Risk factors for breast cancer occurrence --- p.4 / "Body weight, obesity, hormones and breast cancer" --- p.4 / Evidence for postmenopausal women --- p.4 / Evidence for premenopausal women --- p.6 / Hormones and breast cancer --- p.7 / Dietary factors: Foods and nutrients --- p.11 / Animal foods and fats --- p.11 / Dietary fats --- p.13 / Other animal foods --- p.14 / Fruit and vegetable intakes --- p.14 / Positive family history --- p.15 / Alcohol consumption and cigarette smoking --- p.15 / Physical Activity --- p.17 / "Cancer, obesity and immunity" --- p.17 / Aims and scope of the study --- p.19 / Chapter Chapter two: --- Methodology --- p.22 / Questionnaires and their derivation --- p.22 / Literature derivation of the questionnaires --- p.22 / Pretest of the questionnaires --- p.25 / Research ethics --- p.26 / Subject recruitment --- p.26 / Anthropometric measurements --- p.27 / Interviews --- p.28 / First interview --- p.28 / Second and third telephone interviews --- p.29 / Immunoassays --- p.30 / Materials for immunoassays --- p.30 / Immunophenotyping of cells --- p.30 / MultiTEST´ёØ four-color direct immunofluorescence reagent kit --- p.32 / Human tumor neurosis factor-alpha (TNF-α) Quantikine® high sensitivity enzyme-linked immunosorbent assay (ELISA) kit --- p.33 / Methods for immunoassays --- p.33 / Flow cytometric analysis --- p.34 / TNF-α Quantikine® high sensitivity ELISA assay --- p.35 / Data management --- p.35 / Statistical methods --- p.35 / Data analysis --- p.36 / Dietary analysis --- p.36 / Definition of weight status --- p.37 / Measurements of immune cell levels --- p.37 / Chapter Chapter three: --- Results --- p.39 / Participation rate --- p.39 / Characteristics of the patients --- p.40 / Demographics --- p.40 / Pregnancy and breast-feeding experiences --- p.42 / Medical history --- p.43 / Body weight and obesity status --- p.45 / Dietary patterns --- p.46 / Fat and oil removal habit when eating meat and poultry --- p.46 / Perceived fat consumption --- p.46 / Eating out habits --- p.47 / Vegetarian diet adoption and food allergy or intolerance --- p.48 / Cooking methods --- p.48 / Alcohol consumption and supplementation habits --- p.50 / Preferences and perceived amounts of consumption on food groups --- p.51 / Cooking oils used at home --- p.52 / Nutrient intake patterns from dietary recalls --- p.53 / Soy intakes --- p.55 / Meal locations --- p.55 / Energy intakes by weight status --- p.56 / Food group intakes by FFQ --- p.57 / Food items not covered by FFQ --- p.62 / Top ten fat and fiber contributors by FFQ --- p.63 / Daily fruit and vegetable intakes by FFQ and 3 days' dietary recalls --- p.64 / Correlation of FFQ and 3 days' dietary recalls by food group intakes --- p.64 / Correlation of FFQ and 3 days' dietary recalls by fat and fiber intakes --- p.65 / Fat and fiber intakes by weight status --- p.66 / Other lifestyle patterns --- p.68 / Exercise participation and smoking habits --- p.68 / Daily activities' participation by weight status --- p.69 / Immune status / Overview of general immune cell levels --- p.71 / Immune status and BMI weight grouping --- p.72 / Immune status and overweight --- p.74 / Immune status and percent body fat --- p.76 / Immune status and waist-hip ratio --- p.77 / "Weight status, adiposity and immune status: summary" --- p.78 / Immune status and protein intakes --- p.82 / Immune status and fat intakes --- p.83 / Immune status and fiber intake --- p.84 / Immune status and vitamin C intake --- p.85 / Immune status and menopausal status --- p.86 / Chapter Chapter four: --- Discussion / Implications of findings --- p.88 / Interpreting the Immune status of the subjects --- p.88 / Lymphocyte and NK cell levels --- p.89 / Regulatory T cell (Treg) levels --- p.89 / TNF-α levels --- p.90 / Immune status and nutrient intakes --- p.90 / Typical dietary patterns of the subjects --- p.91 / Physical activity patterns --- p.94 / Weight status --- p.95 / "Subjects' fat, fiber intakes and anthropometric measurements compared to previous research" --- p.96 / Limitations of the study --- p.96 / Future directions of research --- p.98 / Chapter Chapter five: --- Conclusion --- p.99 / References --- p.101 / Appendices --- p.123 / Chapter A1 --- Questionnaire (Chinese version) --- p.123 / Chapter A2 --- Questionnaire (English version) --- p.138 / Chapter B1 --- Food frequency questionnaire (Chinese version) --- p.153 / Chapter B2 --- Food frequency questionnaire (English version) --- p.156 / Chapter C --- Dietary assessment food portion booklet --- p.160 / Chapter D1 --- 3 days dietary recall questionnaire (Chinese version) --- p.161 / Chapter D2 --- 3 days dietary recall questionnaire (English version) --- p.174 / Chapter El --- Consent form (Chinese version) --- p.187 / Chapter E2 --- Consent form (English version) --- p.189 / Chapter F --- Results of patient invitation to participate during recruitment period --- p.191

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Communication in nursing is to establish a nurse-patient relationship. Some nurses are quite effective at this whilst others are not so effective. The female patient diagnosed with cancer of the breast can face many dilemmas ranging from a physical, psychological and psychosocial domain. Nursing, being an interactive skill, requires the nurse to be able to communicate with the patient. The inability to communicate can hamper this very crucial relationship. For the purpose of this study it was decided to provide an in-depth account of the management of the nurse-patient communication in the ward. The rationale for choosing this setting (ward) were based on the comprehensive functions of a professional nurse and his/her ability to communicate. The objectives set for the study were to describe the manner in which professional nurses communicated with the patient diagnosed with cancer of the breast and who underwent a mastectomy, barriers that prohibited the communication and the patient’s perception of the communicative processes. A quantitative, exploratory and descriptive approach was applied to investigate and describe factors that influence communication between the patient with breast cancer and the professional nurse within a provincial hospital in the Western Cape. The total population included only female patients diagnosed with cancer of the breast who underwent a mastectomy and who were referred to the breast outpatient clinic. These female patients had to be diagnosed during a twenty month period as of January 2007 to August 2008 and had to be hospitalised within a ward setting after their diagnosis. The population size consisted of 27% of the total population with a 9% refusal rate. A survey was done using a six point Likert scale ranging from strongly disagree, disagree and mildly disagree to mildly agree, agree and strongly agree. The questionnaire consisting of close-ended questions were used for the collection of data and the researcher personally collected data. Ethical approval was obtained from the Committee of Human Science Research at Stellenbosch University and the Department of Health - Cape Town. Consent to conduct the research was obtained from the institution and informed consent from the participants. A pilot study was conducted to test the questionnaire which did form part of the study. A 10% sample of the population, namely 10 participants, was involved in this study. The validity and reliability was assured through the pilot study and the use of a statistician, experts in oncology nursing, an oncology doctor and the research methodologist. Data was tabulated and presented in histograms and frequencies. Statistical significant associations were drawn between variables, using the Chi square test. The Spearman rank (rho) order correlation was used to show the strength of the relationship between two continuous variables. Findings included statistical significance between the level of schooling and the nurse, who took the respondents at face value and communicated what she deemed necessary (rho=0.29, p=0.00). The respondents also showed concern and disagreed that the ward nurses provide their family with relevant information (p=0.00). R ecommendations include:  Nursing education should include a module in communication on a graduate and post graduate level  In-service training programmes should focus on the interpersonal relationship between the nurse and the patient and the importance thereof.  Continuous Quality Improvement should include patient satisfaction surveys.  Awareness campaigns about the importance of communication between the patient and the health professional should be conducted  Developing protocols and policy guidelines that can assist the nursing staff with the communication process. Since communication is an interactive process it requires skillful conduct. Nurses need to realize the importance communication plays in the health sector and the impact it has on patients, irrespective of whether it is from a verbal or non-verbal content. Effective communication or not can have an everlasting impact. / AFRIKAANSE OPSOMMING: Kommunikasie in verpleging behels die vestiging van ’n verpleegster-pasiënt verhouding. Sommige verpleegsters is taamlik effektief hierin, terwyl andere nie so effektief is nie. Die vroulike pasiënt wat met borskanker gediagnoseer is, kan baie dilemmas in die gesig staar wat wissel van ’n fisiese, psigologiese tot ’n psigo-sosiale domein. Verpleging, wat ’n interaktiewe vaardigheid is, vereis dat die verpleegster met die pasiënt moet kan kommunikeer. Die onvermoë om te kan kommunikeer, kan hierdie beslissende verhouding belemmer. Vir die doel van die studie is besluit om ’n indringende verslag van die bestuur van die verpleegster-pasiënt kommunikasie in die saal te doen. Die rasionaal vir die keuse van die omgewing (saal) is gebaseer op die komprehensiewe funksies van ’n professionele verpleegster en sy/haar vermoë om te kan kommunikeer. Die doelstellings wat uiteengesit is vir hierdie studie is om die manier te beskryf waarop professionele verpleegsters met die pasiënt wat met borskanker gediagnoseer is, en wat ’n mastektomie ondergaan het, omgaan, asook die hindernisse wat kommunikasie en die pasiënt se persepsie van die kommunikatiewe prosesse belemmer het. ’n Kwantitatiewe, verkennende en beskrywende benadering is toegepas om faktore te ondersoek en te beskryf wat kommunikasie tussen die pasiënt met borskanker en die professionele verpleegster in ’n provinsiale hospitaal in die Wes-Kaap beïnvloed. Die totale bevolking het slegs vroulike pasiënte wat met kanker gediagnoseer is en ’n mastektomie ondergaan het en na die bors buite-pasiënt kliniek verwys is, ingesluit. Hierdie vroulike pasiënte moes gedurende ’n periode van twintig maande vanaf Januarie 2007 tot Augustus 2008 gediagnoseer en gehospitaliseer gewees het in ’n saalomgewing na hul diagnose. Die bevolking grootte het bestaan uit 27% van die totale bevolking met ’n 9% verwerpingskoers. ’n Opname was gedoen wat die ses punt Likert skaal gebruik wat wissel vanaf sterk verskil van mening, verskil en effense verskil van mening tot effens saamstem, saamstem en sterk saamstem. Die vraelys wat uit geslote vrae bestaan, was gebruik vir die insameling van data en die navorser het die data persoonlik gekollekteer. Etiese goedkeuring was verkry van die Raad vir Geesteswetenskaplike navorsing aan die Universiteit van Stellenbosch en die Departement van Gesondheid – Kaapstad. Toestemming om die navorsing uit te voer is verkry van die inrigting en ingeligte toestemming van die deelnemers. ’n Loodsprojek is uitgevoer om die vraelys te toets wat deel van die navorsing uitgemaak het. ’n 10% Steekproef van die bevolking, naamlik 10 deelnemers, was betrokke by die studie. Die geldigheid en betroubaarheid was verseker deur die loodsprojek en die gebruik van ’n statistikus, kenners in onkologie verpleging, ’n onkologiese dokter en die navorsingsmetodoloog. Data is getabulleer en aangebied in histogramme en frekwensies. Statistiese beduidende assosiasies is gemaak tussen veranderlikes, deur gebruik te maak van die Chi-kwadraat toets. Die Spearman rang (rho) orde korrelasie is gebruik om die sterkte van die verhouding tussen die aaneenlopende veranderlikes te wys. Bevindings het statistiese beduidendheid ingesluit tussen die vlak van geleerdheid en die verpleegster wat die respondente op sigwaarde geneem het en die kommunikasie wat sy noodsaaklik gevind het (rho=0.29, p=0.00). Die respondente het ook besorgdheid getoon en het nie saamgestem dat die saalverpleegsters hul gesinne van die relevante inligting voorsien het nie (p=0.00). A anbevelings sluit in:  Verpleegopleiding behoort ’n module in kommunikasie op graad en nagraadse vlak in te sluit.  Indiensopleidingsprogramme behoort te fokus op die interpersoonlike verhouding tussen die verpleegster en die pasiënt en die belangrikheid daarvan.  Deurlopende kwaliteitsverbetering behoort pasiënt tevredenheidsopnames in te sluit.  Bewusmakingsveldtogte oor die belangrikheid van kommunikasie tussen die pasiënt en die gesondheidsprofesioneel behoort geloods te word.  Protokolle en beleidsriglyne wat die verpleegpersoneel kan help met die kommunikasie proses behoort ontwikkel te word. Sienende dat kommunikasie ’n interaktiewe proses is, word vaardige gedrag geverg. Verpleegsters behoort die belangrikheid wat kommunikasie speel in die gesondheidssektor te besef en die impak wat dit op die pasiënte het, ongeag of dit verbaal of nie-verbaal is. Effektiewe kommunikasie aldan nie, kan ’n ewigdurende impak hê.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Health Locus of Control (HLOC) and other predictors of Quality of Life (QL) were examined for women with an initial versus recurrent breast cancer diagnosis. Twenty-eight women with an initial breast cancer (IBC) diagnoses and twenty-eight women with recurrent breast cancer (RBC) diagnoses were recruited from doctors' offices and cancer support groups. Correlational analyses were used to assess the relationships between variables. No significant differences were found between women with IBC and RBC on Psychological QL. Doctor HLOC and Psychological QL were related for women with RBC (r = .481, p = .01) and marginally so for women with IBC (r = .329, p = .09). A positive correlation was also found between Doctor HLOC and Functional QL for both women with IBC (r = .464, p = .01) and women with RBC (r = .390, p = .04). After controlling for stage of cancer, women with RBC reported higher Functional QL than did women with IBC. Advanced (stages III or IV) versus early (stages I or II) cancer stage related to lower Functional QL, controlling for initial versus recurrent diagnosis (r = -.283, p = .01). A marginally significant relationship was also found for cancer stage, regardless of initial versus recurrent diagnosis, with higher Overall QL for women with early stages of breast cancer (r = -.157, p = .09). No significant differences in Optimism or Overall QL were found between women with IBC versus RBC. No differences were found between married and single women. This research begins to explore differences in Quality of Life for women with a new versus a recurrent breast cancer diagnosis.

This dissertation presents an ethnographic account of a socially diverse, public breast cancer clinic in Johannesburg. The findings of this qualitative research radically challenge the unproblematised and overdetermined use of the categories of race and gender in existing literature concerning this disease. The growing breast cancer epidemic in South Africa affects all demographic categories of women including young women. Yet, previous research frames this as a racialised and gendered crisis. Black women have been depicted as ignorant “problem patients” who resist biomedical treatment, and all women are described as having a particular relationship to their breasted bodies and a deep fear of mastectomy. Departing from these stereotypes, this ethnography reveals unanticipated data showing, firstly, that race, class, age and level of education did not determine women’s relationship to breast cancer and biomedicine. Secondly, socially diverse women commonly experienced breast cancer as a life-threatening disease that evoked confrontation with existential concerns regarding suffering, death, family, and faith. Due to these commonalities, an intimate and powerful sociality existed amongst women at this clinic. Thirdly, within this sociality, women accepted mastectomy as a necessity in creating a healthy body. Breastlessness was normalised and women generally were reluctant of breast reconstruction, thus destabilising the conceptual relationship between breasts and gender. This dissertation’s deconstruction of the use of hegemonic social categories is a significant intervention in a context where these categories are often viewed as absolute determinants of social and health phenomena, and therefore prompts more nuanced approaches to understanding experiences of illness in post-apartheid South Africa.

Lifestyle behaviors, including diet and exercise, may mediate the risk of breast cancer recurrence. Large national and international organizations, including the American Cancer Society, the American Institute for Cancer Research, and the World Research Fund, recommend consuming a diet high in plant-based foods, specifically fruits, vegetables, and whole grains, and low in dietary fat and added sugar for cancer recurrence prevention. In addition, these organizations recommend regular physical activity, typically 30 minutes of moderate to vigorous activity per day. However, many cancer survivors unfortunately fall short of meeting these recommendations. In addition, low-income, and racial/ ethnic minority populations, especially Latinas, are at increased risk of breast cancer recurrence due to a myriad of factors such as limited access to health care. Theory-based, behaviorally-focused, and culturally-tailored nutrition and physical activity education has been shown repeatedly to improve these lifestyle behaviors in other populations. Previous intervention studies by our research group have significantly improved dietary behaviors among Hispanic/ Latina breast cancer survivors. This dissertation consists of a review of the educational literature on diet and physical activity studies among breast cancer survivors, and three studies: (1) a methodological description on the development of a theory-based, behaviorally focused intervention with classroom and online education curricula, (2) an empirical validation study of a survey instrument, and (3) a cross sectional study of women’s diet and physical activity behaviors and theory-based determinants. Taken together, these studies can inform future educational interventions with this population by using our culturally-tailored, theory-based, behaviorally-focused model as a framework and by using our validated assessment tools. These studies can also inform future educational interventions by understanding diet and physical activity behaviors and related potential mediators. These dissertation activities were conducted within the context of a larger, on-going, two-by-two factorial designed National Cancer Institute (NCI) funded educational intervention study, Mi Vida Saludable (My Healthy Life), which aims to change diet and physical activity behaviors of Hispanic/ Latina breast cancer survivors. The main study will examine the separate and synergistic effects of a) online education and b) in-class education. The intervention is based upon nutrition education curricula developed by the non-profit organization Cook for Your Life, which develops recipes and cooking education for cancer patients and survivors in New York City and a previous intervention conducted by this research group, that targeted fruit, vegetable, and dietary fat intake only. The on-going larger study, Mi Vida Saludable, involves cohorts of 30-40 Hispanic/ Latina breast cancer survivors who go through the intervention arms, at intervals of every 4-8 months, depending on recruitment. As of April 2018, two of the five planned cohorts have completed the study, and four of the five cohorts have been randomized. The purpose of the initial comprehensive review of the literature was to inform the development of this Mi Vida Saludable educational intervention. Three areas relevant to the intervention were reviewed. The first area was the varying dietary and physical activity guidelines, both for cancer survivors, and also for common simultaneously occurring lifestyle-related diseases such as heart disease and diabetes. Similarities and differences were examined, and the resulting recommendations were used in the intervention development. The second area of review consisted of dietary and physical activity interventions that specifically targeted breast cancer survivors. Commonalities of successful interventions included the use of Social Cognitive Theory and the Stages of Change construct of the Transtheoretical Model. Finally, the text message literature was reviewed as it pertains to weight management, dietary, and physical activity behaviors, specifically among Hispanic/ Latina populations. Findings indicated that text message interventions were more successful if they decreased in frequency over time, included specific educational advice, and had the ability for two-way communication. The findings from these literature reviews were used to develop the Mi Vida Saludable intervention. (1). The methodological study involved the development of the content of the Mi Vida Saludable group education and electronic (“e-“)-communication programs. These programs were developed using a systematic stepwise theory-based, behaviorally-focused process, the Nutrition Education DESIGN Procedure. Briefly, DESIGN stands for: 1. Decide behaviors; 2. Explore determinants or potential mediators of change; 3. Select theory; 4. Indicate objectives; 5. Generate plans; and 6. Nail down evaluation. DESIGN was applied to help assure the curricula a) enhance motivation and b) facilitate action to change the following behaviors: 1) increase fruit and vegetable intake, specifically focused on non-starchy varieties, 2) decrease dietary fat intake operationalized as less fatty meats, decreased fat added during cooking, and smaller portions of cheese, 3) decrease added sugar intake operationalized as fewer sugar sweetened beverages and less added sugar in processed food and cooking, and 4) increase daily moderate-to-vigorous physical activity. The behavior-change theory applied was the Social Cognitive Theory. The resulting group education program consisted of 4 lessons, 4 hours each in length. Each lesson included a hands-on cooking component and facilitator-led nutrition education and discussion. Two of the four lessons included field trips to the local grocery store and farmers’ market. The resulting e-communication program included 11-months of weekly text messages, biweekly emailed newsletters, and ongoing website access. The content of the online curriculum was developed after the classroom curriculum and mirrored the classroom curriculum so that mode of education would be the key variable tested. (2). A survey instrument was developed to assess two key psychosocial potential mediators of behavior change from Social Cognitive Theory, preferences and self-efficacy, separately for each targeted behavior. This survey was tested for validity and reliability. Expert panel review assessed scale validity by Content and Face Validity. Participants from the target population assessed scale validity and reliability by 1) cognitive interviewing, 2) convergent validity, 3) internal consistency reliability, and 4) test-retest reliability. Content and face validity, and cognitive interviews successfully improved the questionnaire before quantitative analysis. Modifications from content and face validity included the addition of pictures of fruits and vegetables and the addition of examples of different food types high in fat and added sugar. Results from the cognitive interviews indicated primarily that changes should be made in the questionnaire to examples of foods with and without dietary fat and added sugar. Study findings revealed that Cronbach alpha values were sufficient for all Preferences and Self-efficacy scales except for Preferences for Added Sugar Intake. Study findings also revealed that item-total correlations were sufficient for all reduced Preferences and Self-efficacy scales, and that ICC values were sufficient for all Preferences and Self-efficacy reduced scales except for Preferences for Dietary Fat Intake. (3). Psychosocial potential mediators and measures of quality of life were examined in a cross sectional study of Mi Vida Saludable participants as they relate to women’s diet and physical activity behaviors at study entry. Outcome variables included diet, specifically servings of fruits and vegetables (both total and varieties specifically targeted by the intervention), percent dietary fat and added sugar, as well and average minutes of physical activity per week. Our study found that, among Hispanic/ Latina breast cancer survivors, decreased self-efficacy to choose lower sugar foods, increased locus of control of powerful others, and increased stress are related to increased added sugar intake. We also found that increased preferences for foods low in fat are related to decreased fat intake. Finally, we found higher mental health-related quality of life scores are related to increased fruit and vegetable intake, decreased fat intake, and increased physical activity. The results from these three studies will be used to understand behavioral outcomes of the Mi Vida Saludable study, as well as develop future interventions with this and other populations. Advancing our understanding of potential mediators and psychological variables can improve the development and success of interventions, especially among understudied populations such as Hispanic/ Latina breast cancer survivors.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences