A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine.Johannesburg, 2013 / Chronic Kidney disease (CKD) is emerging as a global threat to health. In sub-Saharan Africa, most patients do not receive renal replacement therapy due to lack of funds. Measures to retard the progression of CKD are important. METHOD: A retrospective review of 122 patients attending a renal clinic, over a two a year period was performed. Patients with CKD from hypertension, diabetes mellitus, tubulo-interstitial disease were inluded. Patients with CKD due to viruses, malignancies and autoimmune RESULTS: Diabetes mellitus and hypertensiion were the leading causes of CKD. BP control improved, though 765 were on ≥3 anti-hypertensives. Serum creatinine doubled in 8.2% of patients. BP, acidosis and anaemia were independent risk factors for progression of CKD. The two year renal survival rate was 82%. CONCLUSION: Renal function progressed in few patients, which would be related to low levels of proteinuria, good BP control and us of RAS blockers

The employment of metaphors in drawing meaning from our experiences is an indispensable ingredient in most patient narratives. More specifically, they are essential to the conceptual system we reference to understand and respond to the disruptions brought upon by chronic illness. Through an analysis of patient narratives penned by a group of contemporary American authors, this study identifies trends in how patients can use metaphor to “bridge” the gap between their lives pre and post diagnosis, a process that in many cases presents vulnerability as a viable remedy for alleviating the alienation and diminished self-image so often impacting the lives of patients with lifelong disorders. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

This study explores the process of psychological adjustment to multiple sclerosis. Fourteen participants who were given a definite diagnosis of multiple sclerosis between five and forty years prior to the study and who experienced the relapse-remitting form of the disease were interviewed face to face using a semi structured interview schedule. Grounded theory was used to analyse the interviews and to build a theoretical account of the process of psychological adjustment to multiple sclerosis. The results suggest a model of adjustment in which some individuals with multiple sclerosis move from a stance of denial to a position of acknowledgement in response to the progress of the disease. Reaching acknowledgement allows individuals to adopt an active coping stance which can protect against negative psychological consequences. This adjustment process takes place against an overall process in which individuals experience multiple sclerosis as a progression through a series of different disease phases. Findings suggest that individuals also have to adjust within the social context. Role adjustment and communication were found to be central issues in the family adjustment process. Communication was also central to adjustment in the wider social context. Participants' service use suggests that they also undertake an adjustment from reliance on medical approaches to seeking out self help and alternative approaches. It is argued that this service use process reflects the individual adjustment process. The findings are critically evaluated and compared to existing models of adaptation to chronic illness. The clinical and service implications are discussed. A critical discussion of the methodology is presented and implications for further research are explored.

Thesis (M.S.)--Boston University

Introduction and aims: In the United Kingdom hepatitis B virus (HBV) and hepatitis C virus (HCV) disproportionately affect migrants and people who inject drugs (PWID). Ascertainment rates of HBV and HCV are 10-40% and screening is recommended in at risk groups. Treatment uptake for HCV in PWID is low at 2-18%, and the most effective way to increase uptake is not known. This research aims to evaluate methods to address the low ascertainment and treatment rates of HBV and HCV in these populations. Methods: A pilot observational cohort study of screening for chronic viral hepatitis in primary care. A retrospective observational cohort study into outcomes of HCV treatment in PWID. A prospective cluster randomised trial of nurse versus doctor initiated treatment for HCV in PWID and a qualitative analysis exploring the engagement with treatment for HCV of PWID. Results: Direct testing results in a greater uptake of screening than opportunistic testing in migrants in primary care (21% versus 1.9%, p = < 0.0001). PWID have SVR rates of 55%, re-infection rates of 2.4 per 100 person years, and crack cocaine use reduces over treatment (90% to 49%, p= < 0.0001). Nurse initiation of treatment does not result in a higher uptake of therapy (9.6 % versus 7.8%, p=0.53). Treatment engagement themes included the normalisation and stigmatisation of HCV and the perception of HCV treatment as a transformative process. Discussion: Direct testing for HBV and HCV appears to result in a greater uptake of testing in migrants in primary care and should be investigated in a randomised controlled trial. HCV treatment in PWID is safe and effective, and illicit drug use may reduce over treatment. Further service development is unlikely to result in a greater uptake of antiviral therapy for HCV in PWID and other options should be explored to improve treatment uptake.

No description available.

Long-term conditions (LTCs) are a leading cause of morbidity and mortality worldwide. Health behaviours are a component of many self-management regimes. However, adoption of health behaviours for people with LTCs is relatively low. The purpose of this thesis was to explore the role of the future as it influenced the decision to invest in health for people with LTCs. Specifically, I examined the association between the time discount rate and economic insecurity to explore how the future influences health behaviours. In the first empirical chapter, I found that the time discount rate was associated with maintained physical activity participation but not healthy eating or low-risk alcohol consumption in older adults who have at least one LTC. In the second empirical chapter, I found economic insecurity, which is the anxiety produced from an unsafe financial future, was associated with smoking in older women and physical activity in older men. In the final empirical chapter, I explored how health itself may influence perceptions of the future by investigating the effect of a lagged health shock on the time discount rate in a sample of Danish adults. I found positive health shocks were associated with becoming more future-oriented in women at the 90% significance level and more present-oriented in men at the 95% significance level. The findings of this thesis may be used in the development of policy and interventions to support commencement and adherence to self-management regimes for people with LTCs.

The aim of this study was to uncover and understand the reality of living with chronic, intractable nonmalignant back pain, as it is understood by sufferers themselves. A narrative autoethnographic research design was chosen, enabling me to interact with participants during the interview process, as well as have the opportunity to further explore my own experiences, as a long time sufferer of chronic, intractable nonmalignant back pain. Thematic analysis of participant interviews, and a deep, introspective scrutiny of my own journey, resulted in four stories being written. These stories illustrate the startlingly similar experiences we share. Although each story is written around one central character, they are in fact composite characters, representing the participants’ experiences as well as my own. The stories are: ‘The merry-go-round: Searching for a cure’, describing the endless visits to various specialists, in search of the elusive ‘cure’. ‘Mourning the loss’, illustrating the grief-like process we must go through when it becomes apparent that a cure is not possible and pain will be with us for the rest of our lives. ‘Walk a mile in my shoes’, giving a snapshot of issues facing us in our daily lives, and ‘Here we go again’, a description of a ‘typical’ pain management hospital stay. A fifth story, ‘We’re not in Kansas anymore’, was added following a bizarre emergency admission I was forced to endure during the course of my research. It is therefore a story where I am the central character. These stories illustrate the impact chronic back pain has on a sufferer’s life, ranging from loss of mobility to an altered body image. They also illustrate the struggle to maintain normality, including masking the pain and facing labelling and stigma. These stories identify and demonstrate the often hidden aspects of chronic intractable back pain, and have the power to inform practicing nurses, students, teachers and the community of the ‘lived experience’.

The long-term success of lung transplantation has been challenged by chronic graft dysfunction, which is manifested as obliterative bronchiolitis (OB). We demonstrated that allograft airway fibrosis is a dynamic process of tissue remodelling, in which cellular and matrix components dynamically change before or after complete obliteration of the airway lumen. This dynamic process was associated with changes in expression and activity of matrix metalloproteinases (MMPs). The early inflammatory phase was associated with MMP-dependent migration of blood-borne fibrocytes, which highly express MMP-9 and MMP-12. ‘Established’ fibrosis was associated with MMP-2 and MMP-14 expressed by myofibroblasts in both human OB lesions and their animal models. In established allograft airway fibrosis, general MMP inhibition resulted in apoptosis of myofibroblasts in vivo and in vitro, while low-doses of MMP-inhibitor treatment induced upregulation of MMP-2, increased collagenolytic activity, and significantly decreased myofibroblasts and collagen. The dynamic process of tissue remodelling in established allograft airway fibrosis was supported by underlying continuous alloimmune responses, in particular, direct T-cell-myofibroblast contact. iii Modulation of tissue remodelling using a low-dose MMP inhibitor in combination with cyclosporine induced partial regression of fibrosis after its establishment. We further demonstrated the mechanism of alloimmune responses unique to the lung. Human and animal studies demonstrated that bronchioles develop de novo lymphoid tissue characterized by formation of high endothelial venules and homing of effector memory T-cells. A following study demonstrated the important role of local immunological memory maintained by the intrapulmonary lymphoid tissue in exerting effector function in allograft rejection. Collectively, the present studies support the hypothesis that tissue remodelling is an important mechanism of allograft airway fibrosis. Regulation of tissue remodelling and underlying tissue injury is important not only to arrest aberrant remodelling of allograft airways but likely to reverse aberrant remodelling and to regenerate normal tissue architecture in airways after lung transplantation.

The repetitive ballistic movements in highland dancing, which occur at more than 100 beats/min while the dancers try to reach a maximal vertical height with each jump, could possibly develop chronic injuries similar to ballet and aerobic dance. This study aimed to determine the following: number of injuries/dancer, number of injuries/100 hours of training, the number of chronic injuries compared to acute, anatomical location of the injuries and possible predictors for sustaining an injury in highland dancers. The 76 participants, aged 7 through 22, were from two Saskatoon Dance Schools. The information was collected by retrospective and prospective questionnaires and data analyzed using a Chi-square, analysis of variance and a binary logistic regression. The six-month retrospective survey found a total of 6 dance-related injuries compared to the 42 dance-related injuries in the four-month prospective questionnaire. When analyzing only the injured dancers the CHD (competitive) had 1.62 injuries/dancer, RHD (recreational) had 1.86 injuries/dancer and the Control group (non-highland dancers) had 2.0 injuries/dancer. Significant differences were not found for the number of injuries sustained in these three dance groups (X2 = 0.72, p<0.70). The injury rate per 100 hours of training for only the injured dancers in each group was as follows; CHD 2.59 injuries/100 hours, RHD 4.51 injuries/100 hours and the Control group 4.97 injuries/100 hours. The majority of the chronic versus acute injuries were sustained by the CHD (9 chronic, 8 acute), however they were not statistically different from the RHD (4 chronic, 7 acute) (X2 = 0.738, p<0.05). Most of the injuries occurred to the lower leg, with the knee, shins/calf, ankles and the feet as the major sites. Significant differences were found for these four lower leg sites versus the rest of the body (X2 = 11.20, p<0.05). There were also no differences for the number of lower leg injuries between the CHD and RHD (X2 = 4.605, p<0.05). The three variables associated with an increased risk for sustaining an injury were age, having a previous injury and the onset of menarche.