Doctor Educationis / Background: South Africa has the largest burden of HIV in the world with 7.9 million people living with HIV and 4.4 million registered on antiretroviral therapy (ART) in 2017. KwaZuluNatal is hardest hit by the HIV epidemic with a prevalence of 27% among adults aged 15 to 49 years old. With the widespread ART uptake, the spectrum of HIV related admissions in hospitals has changed over the last decade. Hypertension, diabetes, cardiovascular disease, and renal failure have become significant reasons for inpatient care. Increased life expectancy, rising non-communicable diseases (NCDs) and easier access to ART have played a significant change in the landscape of inpatients as compared to the pre-ART era. To provide integrated healthcare to the patient, it is necessary to understand the prevalence and patterns of HIV comorbidities for efficient and effective service delivery to HIV patients at facility-level. Aim: The current study aimed to describe the prevalence and patterns of HIV-related comorbidities in adult hospital admissions in iLembe, KwaZulu-Natal. Methodology: A retrospective, cross-sectional survey was conducted of all adult HIV-related admissions between 1st October and 31st December 2019. Clinical and demographic characteristics were extracted from admission and discharge records, and laboratory data was collected via the National Health Laboratory Services using Labtrack. Summative and inferential analyses were done using SPSS v 23.

No description available.

The nutritional needs of the renal patient vary as the renal function decreases. Little information exists concerning energy requirements for patients on hemodialysis. Renal failure has been called a wasting disease as evidenced by decreased body weight, body fat, arm circumference and serum proteins. This research was designed to help precisely define energy requirements for the hemodialysis subject. Resting energy expenditure (REE) was measured by indirect calorimetry in 17 male hemodialysis subjects whose mean age was 55 years at the Veterans Administration Medical Center in Hampton, Va. The Beckman MMC Horizon System, a portable device which permits the determination of heat production from gas exchange, oxygen consumption and carbon dioxide production was used. By regression analysis, the measured REE was compared to the basal energy expenditure (BEE): the ideal weight based on the Metropolitan Life Insurance tables, the current weight taken on day of indirect calorimetry, a non-dialysis day, and the post dialysis weight taken immediately after dialysis. A correlation analysis of the dependent variable, IEE, with the current, ideal and post dialysis BBE variable resulted in correlation coefficients of .3783, .0003, and .3946 respectively. None of these correlation coefficients were significantly correlated with the REE. The post dialysis variable had the highest correlation coefficient, and thus the strongest relationship to the REE. While any of the weights studied could be used to determine energy needs for the hemodialysis subject, post dialysis weight may be the most desirable choice. / M.S.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2008. / BACKGROUND: Although hypoglycaemia is a known complication of haemodialysis, there is little information about its prevalence among patients on maintenance haemodialysis. OBJECTIVE: To determine the prevalence of hypoglycaemia in patients on maintenance haemodialysis in Kenyatta National Hospital (Nairobi, Kenya) and to identify potential nutritionrelated causes of hypoglycaemia. METHODS: A cross-sectional, descriptive and observational study design was followed. Patients who had been on chronic maintenance haemodialysis for 3 months or longer were included in the study which was carried out from May 8 through to June 30, 2006. Random blood glucose levels were determined at baseline, 15 minutes, 30 minutes and 45 minutes, and at hourly intervals thereafter until the end of the dialysis session. The prevalence of hypoglycaemia (a blood glucose level less than 3.9 mmol/L) was then determined for the duration of haemodialysis. The relationship between minimum blood glucose levels and dietary intake, anthropometric status, primary diagnosis, co-morbid and socio-demographic factors, prescribed medication and dialysis related factors was determined. RESULTS: Among the 51 haemodialysis patients who participated in the study, the prevalence of hypoglycaemia was 16% (n=8). Eight percent (n=4) of these patients were however already hypoglycaemic on initiation of dialysis. Dietary intake of niacin ((r=0.31; p=0.02), riboflavin (r=0.30; p=0.03) and vitamin B6 (r=0.30; p=0.03) showed a significant relationship with blood glucose levels. The relationships between hypoglycaemic episodes and insulin administration (p=0.06), and between blood glucose levels and BMI (r=0.25; p=0.08 and protein intake (r=0.26; p=0.07) approached significance. There was no significant relationship between blood glucose levels and the duration of haemodialysis (p=0.942), hours of haemodialysis (p=0.27) and the dialysate solution used (p=0.12). CONCLUSIONS: Hypoglycaemia was present in 16% of patients on maintenance haemodialysis. Potential nutritional parameters which may have contributed to lower blood glucose levels in this study include a lower dietary intake of niacin, riboflavin, and vitamin B6. Lower protein intake and lower BMI was marginally associated with low blood glucose levels.

The scope of this project is an examination of medical compliance for the Hispanic patient with End State Renal Disease.

published_or_final_version / Social Work / Master / Master of Social Work

End-stage renal disease (ESRD) introduces physical, psychological, social, emotional and spiritual challenges into patients’ lives. Spirituality has been found to contribute to improved health outcomes, mainly in the areas of quality of life (QOL) and well-being. No studies exist to explore the influences of spirituality on the health outcomes and general well-being in patients with end-stage renal disease receiving haemodialysis (HD) treatment in Scotland. This study was therefore carried out to examine and explore spirituality in the day-to-day lives of patients with ESRD receiving HD treatment and how it may influence their health outcomes and, in particular, QOL and general well-being. The study described in this thesis employed a sequential mixed method approach over two stages: quantitative and qualitative. Following ethical approval, a cross-sectional survey was conducted with 72 patients from 11 dialysis units recruited from four Health Boards in Scotland. The participants in the study were regular patients attending the dialysis units three times per week. Data on patients’ quality of life, general well-being, and spirituality were collected using self-administered questionnaires including demographic information: the Short Form Medical Outcome Study Questionnaire (SF-36v2), the General Health Questionnaire, and the Spiritual Well-Being Questionnaire. The data were analysed using the Predictive Analytics Software for Windows. The findings highlighted that patients’ quality of life was markedly lower than the United Kingdom general population average norms of 50. Increasing age was associated with better mental health but worse physical health. The survey also found that there were no significant associations between spirituality and patients’ quality of life and general well-being. However, it was considered important to complement and enrich the survey findings by gaining a deeper understanding of the influences of spirituality on patients’ health outcomes and general well-being by carrying out the qualitative component of the study. Qualitative data were collected using semi-structured interviews with a subsample of 21 patients from those who participated in the survey. A thematic approach using Framework Analysis informed the qualitative data analysis. Four main themes emerged from the qualitative interviews: ‘Emotional and Psychological Turmoil’, ‘Life is Restricted’, ‘Spirituality’ and ‘Other Coping Strategies’. The findings from the interviews confirmed that patients’ quality of life might be affected because of the physical challenges such as unremitting fatigue, disease unpredictability, or being tied down to a dialysis machine, or the emotional and psychological challenges imposed by the disease into their lives such as wholesale changes, dialysis as a forced choice and having a sense of indebtedness. The findings also revealed that spirituality was an important coping strategy for the majority of participants who took part in the qualitative component (n=16). Different meanings of spirituality were identified including connection with God or Supernatural Being, connection with the self, others and nature/environment. Spirituality encouraged participants to accept their disease and offered them a sense of protection, instilled hope in them and helped them to maintain a positive attitude to carry on with their daily lives, which may have had a positive influence on their health outcomes and general well-being. The findings also revealed that humour was another coping strategy that helped to diffuse stress and anxiety for some participants and encouraged them to carry on with their lives. The findings from this study contribute knowledge to increase our understanding of the influence of spirituality on the health outcomes and general well-being of patients with end-stage renal disease currently receiving haemodialysis treatment. Based on the findings from this thesis, recommendations are made for clinical practice, patient and nurse education and for future research.

Made available in DSpace on 2016-04-29T14:17:35Z (GMT). No. of bitstreams: 1 Lucirley Mazera.pdf: 737252 bytes, checksum: eda4ba22395bf86bca4d5ab4433b5246 (MD5) Previous issue date: 2008-10-14 / Chronic renal disease and hemodialysis treatment imposes a big strain and series of limitations to the patient, with regard of the biological, sociological, and psychological perspectives. In this context, practical intervention of the social work is of great need and relevance. The research objective was the understanding of the social modifications in the lifestyle of chronic renal disease patients submitted to hemodialysis treatment from the patient's most significative experiences and introspective reflections about the illness and it's treatment. From our experience and the results obtained from the present investigation, some remarkable aspects are: the public health policies contribution aimed to patients with chronic renal disease, such as rights assurance, based on ANVISA's RDC-154 (2004); the knowledge correlated to the social stigma and to the discriminatory process imposed by the illness-related segregation; the importance of the actuation of the Social Services with the chronic renal patients submitted to hemodialysis, through the Professional Mediation. The methodology used was video recorded Focus Groups. The objective was to understand how the chronic renal patients submitted to hemodialysis experience the treatment and the most significative difficulties during the sickening process. Some empirical categories emerged from the process, such as Disease, Family, Kidney Transplant, Health Teams, Multidisciplinary Team. Willing to discuss the profession essence, we evolved a reflexion based on the emerged categories / A doença renal crônica e o tratamento de hemodiálise impõem ao paciente renal crônico, um grande desgaste e uma série de limitações que envolvem o biológico, o social e o psicológico. Neste contexto, a intervenção prática do assistente social se faz presente e necessária. Neste sentido esta pesquisa objetivou compreender as modificações sociais no modo de vida dos pacientes renais crônicos em hemodiálise, a partir da vivência e das inflexões mais significativas que o paciente atribui à doença e seu tratamento. Através da experiência que reunimos nesta área e dos estudos obtidos através da presente investigação, alguns aspectos merecem destaque: a contribuição das políticas públicas de saúde destinadas aos pacientes renais crônicos como garantia de direitos, a partir da RDC-154 de 2004 da ANVISA; os necessários conhecimentos correlatos ao estigma social e ao processo discriminatório da segregação imposta pela doença; a importância da ação do Serviço Social com os pacientes renais crônicos em hemodiálise, através da mediação profissional. A metodologia utilizada foi norteada pela técnica de grupo focal em vídeo, com o objetivo de compreender como os pacientes renais vivenciam a experiência do tratamento e as dificuldades mais significativas no processo do adoecimento. Como resultado deste processo algumas categorias empíricas emergiram, tais como, doença, família, transplante renal, equipes de saúde, equipe multiprofissional. Em torno delas desenvolvemos uma reflexão, procurando remeter ao debate a essência da profissão

The purpose of this study was to examine health literacy and treatment adherence among Latinos with end stage renal disease. Health literacy has been overlooked as one of the factors that affects one's ability to comply with the physician's prescribed medical treatment.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1628. Advisers: Belinda M. Reininger; Henry S. Brown. Includes bibliographical references.