Person-oriented and variable-oriented analyses were conducted to investigate sociodemographic differences in biological, psychosocial and disease care factors in youth with type 1 diabetes. Additionally, diabetes knowledge was evaluated as a potential mediator of SES effects on HbA1c and disease care. The sample included 349 youth, age 9-17 years (79.9% Caucasian, 71.3% lived with two biological parents, M SES = 46.24). Person-oriented t-tests confirmed commonly reported ethnic differences in HbA1c and disease care behaviors. However, variable-oriented analyses controlling for confounding sociodemographic influences showed most disease care effects attributed to ethnicity were better explained by SES. While diabetes knowledge was not a significant mediator of meal composition, it appeared to suppress the effect of social class on carbohydrate and fat consumption, such that more diabetes knowledge minimized the negative effect of lower SES on optimal carbohydrate and fat consumption. Results may inform future interventions for youth at risk of poor metabolic control.

Using Ontario health administrative data, we identified 12,143 adults with chronic kidney disease (CKD) who received outpatient nephrology care prior to start of renal replacement therapy (RRT) in order to study the effect of care-related factors in predicting late start of predialysis care (PDC, defined as first outpatient nephrology visit <6 months prior to RRT start) and to explore covariates which further quantify the PDC received. Lack of an usual provider of primary care (OR 0.76; 95%CI 0.66, 0.87) predicted late start of PDC. In addition to late start of PDC, number of nephrology visits (OR 0.97 per visit; 95% CI 0.96, 0.98), and having seen a nephrologist in only 1 or 2 of the 6 months prior to RRT start (OR 1.33; 95%CI 1.18, 1.51), were also independent predictors of one-year mortality, suggesting that other measures of PDC are needed to better characterize the care received.

Using Ontario health administrative data, we identified 12,143 adults with chronic kidney disease (CKD) who received outpatient nephrology care prior to start of renal replacement therapy (RRT) in order to study the effect of care-related factors in predicting late start of predialysis care (PDC, defined as first outpatient nephrology visit <6 months prior to RRT start) and to explore covariates which further quantify the PDC received. Lack of an usual provider of primary care (OR 0.76; 95%CI 0.66, 0.87) predicted late start of PDC. In addition to late start of PDC, number of nephrology visits (OR 0.97 per visit; 95% CI 0.96, 0.98), and having seen a nephrologist in only 1 or 2 of the 6 months prior to RRT start (OR 1.33; 95%CI 1.18, 1.51), were also independent predictors of one-year mortality, suggesting that other measures of PDC are needed to better characterize the care received.

Magister Artium (Psychology) - MA(Psych) / The Human Immuno-deficiency Virus (HIV) that leads to Acquired Immuno-Deficiency Syndrome (AIDS) is considered to be spreading at a high rate in South Africa. Research indicates that this disease is highly prevalent among people 15 and 49. It is estimated that one in five adults in South Africa is HIV positive. Community or home-based care nurses manage the treatment of sufferers at their homes while under the care of their family members, friends, spouses and significant others. The present study explored the experiences and coping strategies of HIV/AIDS primary caregivers. / South Africa

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Aim: The aim of this qualitative study was to explore the experiences of individuals with Huntington’s disease (HD) in a South African context. The focus of the current study was not only on the challenges faced by individuals with HD, but also the resources/supports that help them cope with their neurological condition. Method: I conducted twelve semi-structured interviews with the participants and they transcribed verbatim. I then performed a thematic analysis. Results: Using Bronfenbrenner’s Ecological System’s Theory as the theoretical framework, several themes were identified that related to the participants’ experiences of living with HD. Challenges included: triad of symptoms, sleep problems, testing process, relationships, children, it’s a monster, employment, social support, partners and family members with HD, medical aid, life insurance, financial problems, lack of HD facilities, lack of understanding of HD, symptoms watching and the progression of HD. Several supports/resources were also identified and included: knowledge about HD, counselling, medication, coping, employment, social support, testing process, partners and family members with HD, medical aid, life insurance, cure, possible HD facilities, religion, grant and adaptation over time. Conclusion: This was the first study of this kind in a South African context, which set out to explore the experiences of individuals with HD in the Western Cape, South Africa. The findings from this study demonstrate that although these individuals with HD experience several challenges due to their debilitating condition, they also employ several resources to help them cope with HD. Lastly, the findings that emerged from this study contribute to raising awareness about the experiences of these individuals living with HD and could serve as a valuable foundation for tailor-made interventions for these unique individuals. / AFRIKAANSE OPSOMMING: Doel: Die doel van hierdie kwalitatiewe studie was om die ervaringe van individue met Huntington se siekte (HS) in 'n Suid-Afrikaanse konteks te verken. Die fokus van die huidige studie het verband gehou nie net met die uitdagings wat deur individue met HS ervaar word, maar ook die hulpbronne / ondersteuning wat hulp verleen met hulle neurologiese toestand om dit te beter te hanteer. Metode: Ek het twaalf semi- gestruktureerde onderhoude met die deelnemers gevoer en woordeliks getranskribeer , waarna tematiese analise uitgevoer is. Resultate: Met behulp van Bronfenbrenner se Ekologiese Sisteem Teorie as die teoretiese raamwerk , is verskeie temas wat verband hou met die deelnemers se ervarings van die lewe met HD geïdentifiseer. Uitdagings sluit in: drietal van die simptome, slaap probleme, toets-proses, verhoudings, kinders, dit is 'n monster, indiensneming, sosiale ondersteuning, metgeselle en familie-lede met HD, mediese fonds , lewensversekering, finansiële probleme, die gebrek aan HD fasiliteite, 'n gebrek aan begrip van HD, dophou van simptome en die vordering van HD. Verskeie ondersteuning / hulpbronne is ook geïdentifiseer en sluit in: kennis oor HD, berading, medisyne, hantering, werk, sosiale ondersteuning, toetsproses, vennote en familie -lede met HD, mediese fonds, lewensversekering, genesing, moontlike HD fasiliteite , godsdiens, staats-toelaag en aanpassing oor tyd. Gevolgtrekking: Dit was die eerste studie van hierdie aard in 'n Suid-Afrikaanse konteks wat die ervarings van individue met HD in die Wes-Kaap , Suid-Afrika uiteensit. Die bevindinge van hierdie studie toon dat, alhoewel hierdie individue met HD verskeie uitdagings as gevolg van hul aftakenlende toestand ondervind, is daar ook 'n paar hulpbronne in plek om hulle met die hantering van hierdie neurologiese toestand te help. Laastens , die bevindinge uit hierdie studie dra by tot die verhoging van bewustheid oor die ervarings van hierdie individue wat met HD lewe en kan as 'n waardevolle fondament vir pasgemaakte intervensies vir hierdie unieke individue dien.

<p>The Human Immuno-deficiency Virus (HIV) that leads to Acquired Immuno-Deficiency Syndrome (AIDS) is considered to be spreading at a high rate in South Africa. Research indicates that this disease is highly prevalent among people 15 and 49. It is estimated that one in five adults in South Africa is HIV positive. Community or home-based care nurses manage the treatment of sufferers at their homes while under the care of their family members, friends, spouses and significant others. The present study explored the experiences and coping strategies of HIV/AIDS primary caregivers.</p>

This is a foundational study that applies Receiver Operating Characteristic (ROC) analysis to the evaluation of a chronic disease model that utilizes Remote Monitoring (RM) devices to identify clinical deterioration in a Chronic Obstructive Pulmonary Disease (COPD) population. Background: RM programmes in Disease Management (DM) are proliferating as one strategy to address management of chronic disease. The need to validate and quantify evidence-based value is acute. There is a need to apply new methods to better evaluate automated RM systems. ROC analysis is an engineering approach that has been widely applied to medical programmes but has not been applied to RM systems. Evaluation of classifiers, determination of thresholds and predictive accuracy for RM systems have not been evaluated using ROC analysis. Objectives: (1) apply ROC analysis to evaluation of a RM system; (2) analyse the performance of the model when applied to patient outcomes for a COPD population; (3) identify predictive classifier(s); (4) identify optimal threshold(s) and the predictive capacity of the classifiers. Methods: Parametric and non-parametric methods are utilized to determine accuracy, sensitivity, specificity and predictive capacity of classifiers Saturated Peripheral Oxygen (SpO2), Blood Pressure (BP), Pulse Rate (PR) based on event-based patient outcomes that include hospitalisation (IP), accident & emergency (A&E) and home visits (HH). Population: Patients identified with a primary diagnosis of COPD, monitored for a minimum of 183 days with at least one episode of in-patient (IP) hospitalisation for COPD in the 12 months preceding the monitoring period. Data Source: A subset of retrospective de-identified patient data from an NHS Direct evaluation of a COPD RM programme. Subsets utilized include classifiers, biometric readings, alerts generated by the system and resource utilisation. Contribution: Validates ROC methodology, identifies classifier performance and optimal threshold settings for the classifier, while making design recommendations and putting forth the next steps for research. The question answered by this research is that ROC analysis can provide additional information on the predictive capacity of RM systems. Justification of benefit: The results can be applied when evaluating health services and planning decisions on the costs and benefits. Methods can be applied to system design, protocol development, work flows and commissioning decisions based on value and benefit. Conclusion: Results validate the use of ROC analysis as a robust methodology for DM programmes that use RM devices to evaluate classifiers, thresholds and identification of the predictive capacity as well as identify areas where additional design may improve the predictive capacity of the model.

<p>The Human Immuno-deficiency Virus (HIV) that leads to Acquired Immuno-Deficiency Syndrome (AIDS) is considered to be spreading at a high rate in South Africa. Research indicates that this disease is highly prevalent among people 15 and 49. It is estimated that one in five adults in South Africa is HIV positive. Community or home-based care nurses manage the treatment of sufferers at their homes while under the care of their family members, friends, spouses and significant others. The present study explored the experiences and coping strategies of HIV/AIDS primary caregivers.</p>

This study focuses on the impact of HIV/AIDS on women in Namibia. Namibia, with a population of only 1.7 million people, is ranked as the seventh highest country in the world in terms of HIV/AIDS infections. The percentage of women living with HIV/AIDS in Namibia accounts for 54% of the total of 68 196 people in the country living with the virus. Women are also diagnosed with the disease at a younger age (30) in comparison to their male counterparts (35 years). Desoite their needs, women living with HIV/AIDS bear a triple burden of caring for those living with HIV/AIDS, caring for themselves and coping with the responses to their infection. There are few focused intervention strategies to support and care for women living with HIV/AIDS in Namibia.

This study focuses on the impact of HIV/AIDS on women in Namibia. Namibia, with a population of only 1.7 million people, is ranked as the seventh highest country in the world in terms of HIV/AIDS infections. The percentage of women living with HIV/AIDS in Namibia accounts for 54% of the total of 68 196 people in the country living with the virus. Women are also diagnosed with the disease at a younger age (30) in comparison to their male counterparts (35 years). Desoite their needs, women living with HIV/AIDS bear a triple burden of caring for those living with HIV/AIDS, caring for themselves and coping with the responses to their infection. There are few focused intervention strategies to support and care for women living with HIV/AIDS in Namibia.