<p dir="ltr">This study aims to develop Long Short-Term Memory (LSTM), Gated Recurrent Units (GRU), and Transformer-based Informer models and evaluate the performance of these models using data from one, two, three, and four weeks in advance to predict the progression of rice leaf blast disease; and assess the generalizability of these models across various climatic regions in Taiwan. This research utilized multi-location rice leaf blast diseased leaf percentage data collected between 2015 and 2021 in Taiwan, along with weather data from the Taiwanese meteorological observation network to predict rice blast disease one week in advance, serving as a benchmark for comparing with predictions made two, three, and four weeks in advance.</p>

The study sought to identify reasons for non-compliance among a particular medical aid scheme's members and their dependants registered for the asthma disease risk management (DRM) programme. A quantitative descriptive study was undertaken, using postal questionnaires. The research results indicated that most asthma patients were not compliant with the DRM programme because they lacked knowledge about the programme. Asthma patients' compliance with the DRM programme can be enhanced by health providers' and case managers' positive attitudes, better promotion of the programme, and by involving the patients in managing their illnesses. Asthma patients require education about healthy lifestyles, empowering them to successfully manage their condition, preventing asthma attacks and/or hospital admissions. When asthma is well-managed the patients' quality of life and general wellbeing will improve and the medical aid scheme's costs will be contained. / HEALTH STUDIES / MA (HEALTH STUDIES)

HIV/AIDS is already the leading cause of death worldwide (Unicef et al., 2004:10) with more than 5 million people out of a total of 46 million South Africans that were HIV positive in 2004, giving a total population prevalence rate of 11 per cent (Dorrington et al., 2004:1). Many people infected do not have access to even the basic drugs needed to treat HIV-related infections and other conditions (Wikipedia, 2004:3). The relative high price of many of the antiretroviral (ARV) drugs and diagnostics on the other hand are one of the main barriers to their availability in developing countries (Unicef et al., 2004:77). ARV drugs registered in South Africa include the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and Protease Inhibitors (PIs) (MCC, 2004:1). The objective of this study was to review, analyse and interpret the prescribing patterns of antiviral drugs, with special reference to antiretroviral drugs, in the private health care sector in South Africa by using a medicine claims database. A quantitative, retrospective drug utilisation review was performed. The data ranging from 1 January 2001 to 31 December 2001, 1 January 2002 to 31 December 2002, and 1 January 2004 to 31 December 2004 were used, dividing each year into three four-month periods, namely January to April, May to August, and September to December. It was found that 0.38 per cent (n=1 475 380) for 2001, 0.72 per cent (n=2 076 236) for 2002, and 1.68 per cent (n=2 595 254) for 2004 of all studied prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 0.33 per cent (n=2 951 326) for 2001, 0.87 per cent (n=4 042 145) for 2002, and 1.92 per cent (n=5 305 882) for 2004 of the total number of medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV drugs amounted to R4 990 784.29, thus constituting 1.31 per cent of the total cost (R379 708 489) of all medicine items on the database for 2001, increased to R18 235 075.75, thus constituting 3.03 per cent of the total cost (R601 350 325) of all medicine items on the database for 2002, and increased to R34 714 483.64, thus constituting 5.25 per cent of the total cost (R661 223 146) of all medicine items on the database for 2004. It was found that 35.31 per cent (n=5 599) for 2001, 52.68 per cent (n=15 004) for 2002, and 74.27 per cent (n=43 482) for 2004 of all studied antiviral prescriptions for the research periods 2001, 2002, and 2004 respectively, contained ARV drugs. ARV drugs constituted 46.25 per cent (n=21 183) for 2001, 70.20 per cent (n=50 246) for 2002, and 85.87 per cent (n=118 718) for 2004 of the total number of antiviral medicine items prescribed for the study years 2001, 2002 and 2004 respectively. The total cost of ARV medicine items, represented 67.33 per cent (n=R4 990 784.29) during 2001, 84.72 per cent (n=R18 235 075.75) during 2002, and 91.20 per cent (n=R34 714 483.64) during 2004 of the total cost of all antiviral medicine items claimed through the database (n=R7412577.73 for 2001, n=R21523365.56 for 2002, and n=R38 064 347.38 for 2004). The average cost per ARV medicine items for 2004 increased from R317.93i190.80 for the period January to April to R369.2W219.50 for the period May to August, and decreased to R324.79±212.48 for the period September to December and resulted in a cost saving of R41 044.35 for the period May to August versus September to December for the ARV medicine items. The implementation of the pricing regulations could thus be a possible reason for this cost saving, due to fact that the single exit price only came into effect from May 2004. The weighted average number of ARV medicine items per prescription was 1.75*0.31 for 2001, increased to 2.35±0.03 to 2002 and remained stable on 2.35±0.02 for 2004. It was found that majority of prescriptions contained more combination ARV medicine items than single ARV medicine items, ranging from 6 834 (69.76 per cent; n=9 796) prescriptions containing combination ARV medicine items in 2001 and 32 941 (93.39 per cent; n=35 271) prescriptions containing combination ARV medicine items in 2002 to 98 805 (96.93 per cent; n=101 938) prescriptions containing combination ARV medicine items in 2004. Lastly, it was perceived that didanosine was the active ingredient with the largest prevalence for all three four-month periods of 2001 and also for the periods January to April and May to August of 2002, whilst efavirenz represented the active ingredient with the largest prevalence for the period September to December of 2002, and also for all three four-month periods of 2004. Didanosine represented the active ingredient with the highest total cost for the period January to April of 2001, whilst the combination of lamivudine/zidovudine represented the active ingredient with the highest total cost for the periods May to August and September to December of 2001, and also for all three-four month periods of 2002 and 2004. Nelfinavir has the highest average cost for period January to April of 2001, ritonavir for period May to August of 2001, and saquinavir mesylate for period September to December of 2001. Nelfinavir has the highest average cost for all three-four month periods of 2002, while didanosine has the highest average cost for all three four-month periods of 2004. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006

Made available in DSpace on 2017-07-21T14:35:53Z (GMT). No. of bitstreams: 1 KATHIANE CRISTINA DA SILVA RECHE.pdf: 1442031 bytes, checksum: 73be2f3a6bf6010a6bdd91352e31db6e (MD5) Previous issue date: 2016-03-18 / The heart rate variability (HRV), defined as temporal variation between consecutive heart beats, provides information about cardiac autonomic regulation. It is known that the physiological parameter can be influenced by chronic obstructive pulmonary disease (COPD), however more information to assist in elucidating this context are necessary, especially focused on the reality of the Brazilian population. This study aimed to investigate whether the airflow limitation compromises cardiac autonomic function and if autonomic function limits the COPD patients functional capacity. Therefore, participants underwent spirometry, anthropometry, assessment of HRV and six-minute walk test (6MWT). For HRV, the GOLD CD group and GOLD AB group were compared with each other and between control group (normal spirometry); addittionaly, it was evaluated whether treatment situation (ET- in treatment and NT - untreated) is associated with HRV. The statistical analyses of the data were performed using STATA 7.0 program. The Kolmogorov-Smirnov, Spearman rank correlation, simple and multiple linear regression and analysis of variance were applied. The logarithmic transformation was applied to the non-normal distribution variables. About sample population of COPD patients (60 individuals), 53% of participants are men; age 63.7 ± 9.45 years; GOLD (A 15%, B 13%, C - 20%, D - 52%); FEV1 (% predicted): 46.6 ± 19.8; BMI: 25.5 ± 5.0 kg/m²; 6MWT: 391.5 ± 107.0 m; A correlation between FEV1 and HRV (RR, r = 0.33; p <0.001 and LF, r = 0.30; p <0.02), BMI (r = 0.33; p <0.01) CC (r = 0.30; p <0.02) 6MWD (r = 0.57; p <0.001); Regression analysis indicated that sex (β = 0.02 p <0.1) and age (β = 0.02 p <0.5) are not associated with HRV, indicated an association between severity disease and RR index (β = 101.1;. p <0.01), an association between the HRV (RR β = 132.9; p <0.01;.TP β = 0,8 p <0.04;. LF β = 13.1; p <0.03; HF β = 1.3; p <0.001;. HFun β = 13.1; p < 0.03; LF/HF β = 0.7; p <0.02) and the treatment situation, association between sex (β = 96.5; p < 0.03), and HRV (RR β = 0.5; p <0.01; SDNN β = 256.1;. RMSSD β = -49454.3; p < 0.01;. LF β = -49.5; p <0.05; SD1 β = 49248.8 p <0,01) with functional capacity. The variance analysis of HRV indexes showed differences only RR index (p <0.05) GOLD GOLD AB and CD, but between ET and NT groups showed differences (p <0.05) of the indexes LF, HF, HFun, and LF/HF. Thus, the results of this study indicated that lung function is related to the functional capacity and this may be limited by sympathetic predominance in the cardiac function modulation. Sex and age were not significantly associated with HRV, but the disease severity was associated with RR index. The treatment situation was variable with more strength of association with HRV, suggesting that sympathetic predominance in the heart rate modulation is higher in the ET group. / A variabilidade da frequência cardíaca (VFC) definida como a variação entre os batimentos cardíacos consecutivos ao longo do tempo fornece informações sobre a regulação autonômica do coração. Sabe-se que este parâmetro fisiológico pode ser influenciado pela doença pulmonar obstrutiva crônica (DPOC), todavia mais informações que auxiliem na elucidação deste contexto se fazem necessárias, em especial voltados à realidade da população brasileira. Este estudo teve por objetivo investigar se a limitação do fluxo aéreo compromete a função autonômica cardíaca e se a função autonômica limita a capacidade funcional dos pacientes com DPOC. Para tanto, os participantes foram submetidos à espirometria, antropometria, avaliação da VFC e teste de caminhada de seis minutos (TC6M). Quanto à VFC, o grupo de sujeitos mais graves (GOLD C e D) e o grupo menos grave (GOLD A e B) foram comparados entre si e com sujeitos de espirometria normal (controle); considerou-se também a situação de tratamento (ET- em tratamento e NT - não tratado) para comparar a VFC. O tratamento estatístico dos dados foi realizado através do programa STATA 7.0 e aplicou-se testes de Kolmogorov-Smirnov, correlação de postos de Spearman, regressão linear simples e múltipla e análise de variância. A transformação logarítmica foi aplicada para as variáveis que não teve distribuição normal. Da população amostral de pacientes com DPOC (60 indivíduos), 53% dos participantes são homens; idade 63,7 ± 9,45 anos; GOLD (A -15%, B -13%, C - 20%, D - 52%); Volume exiratório forçado no 1° segundo -VEF1 (%predito): 46,6 ± (19,8); Índice de massa coporal - IMC: 25,5 ± 5,0 kg/m²; TC6M: 391,5 ± 107,0 m; observou-se correlação entre o VEF1 e a VFC (RR, r = 0,33 p < 0,001 e LF, r = 0,30 p < 0,02), IMC (r = 0,33; p <0,01), CC (r = 0,30 p < 0,02), TC6M (r = 0,57 p <0,001). A análise de regressão indicou que sexo (β = 0,02; p < 0,1) e idade (β = 0,02; p <0,5) não estão associados à VFC, indicou associação entre a severidade da doença e o índice RR (β = 101,1; p < 0,01), associação entre a VFC (RR β = 132,9 p < 0,9; TP β = 0,8 p < 0,04; LF β = 13,1 p < 0,03; HF β = 1,3 p < 0,001; HFun β = 13,1 p < 0,03; LF/HF β = 0,7 p < 0,02) e a situação de tratamento, associação entre sexo (β = 96,5 p < 0,03) e VFC (RR β = 0,5 p < 0,01; SDNN β = 256,1; RMSSD β = -49454,3 p < 0,01; LF β = -49,5 p < 0,05; SD1 β = 49248,8 p < 0,01) com a capacidade funcional (R² = 51%). A análise de variância dos índices da VFC apontou diferença apenas do índice RR (p < 0,05) entre GOLD AB e GOLD CD, mas entre os grupos ET e NT apontou diferença (p < 0,05) dos índices LF, HF, HFun, e LF/HF. Assim, os resultados deste trabalho indicam que, a função pulmonar relaciona-se com a capacidade funcional e esta pode ser limitada pelo predomínio simpático na modulação da função cardíaca. As variáveis sexo e idade não foram significativamente associadas à VFC, mas a severidade da doença teve associação com o índice RR. A situação de tratamento foi a variável com mais força de associação com a VFC, sugerindo que o predomínio simpático na modulação da frequência cardíaca é maior no grupo tratado.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-09-24T18:58:13Z No. of bitstreams: 1 Emerson Butzen_.pdf: 7216894 bytes, checksum: 2d8c31ef74b3d53d626a08f772032736 (MD5) / Made available in DSpace on 2018-09-24T18:58:13Z (GMT). No. of bitstreams: 1 Emerson Butzen_.pdf: 7216894 bytes, checksum: 2d8c31ef74b3d53d626a08f772032736 (MD5) Previous issue date: 2018-04-26 / UNISINOS - Universidade do Vale do Rio dos Sinos / O cenário contemporâneo relativo às doenças crônicas não transmissíveis (DCNTs) é desafiador. De acordo com dados do último relatório da Organização Mundial da Saúde (OMS), no contexto mundial, 38 milhões das mortes são consequência de tais doenças. Até 2030 a previsão é que esse número aumente para 52 milhões. Nesse sentido, o acesso à internet e a proliferação de dispositivos móveis, como é o caso dos smartphones, são ferramentas que facilitam o controle e o acompanhamento autônomo de pacientes. Além disso, os sistemas sensíveis ao contexto se referem a soluções transparentes para coleta de dados de usuários. Eles permitem a identificação de hábitos cotidianos dos indivíduos, o que pode ser decisivo no tratamento de doenças. Já o perfil dinâmico é a criação e a manutenção automática com base em informações e atividades do usuário conforme o tempo (VALMORBIDA; BARBOSA, 2014). Assim partir dos contextos detectados, definem-se perfis, e a conversão entre os dois fornece recomendações de recursos personalizados ao paciente. Considerando este conjunto de informações, define-se a questão de pesquisa que orienta a construção deste estudo: como seria um modelo baseado na Computação Ubíqua que permitisse o gerenciamento de perfis dinâmicos orientados ao acompanhamento de pacientes de DCNTs? Além do auxílio no controle das doenças, defende-se que tais perfis possibilitam a autogestão e a organização do paciente quanto à alimentação adequada, práticas de atividades físicas, indicadores biológicos, índices glicêmicos e riscos comportamentais. A composição dos perfis decorre de informações sobre as condições crônicas do paciente, tais como: pressão, glicemia, cintura (ICQ), peso, entre outros, além de aspectos comportamentais, como a ingestão de medicamentos, atividades físicas, etc. O estudo visa criar um módulo para gerenciamento de perfis dinâmicos, voltado para cuidados com as DCNTs. Salienta-se que para a elaboração desta dissertação, elencam-se dois casos de pacientes portadores de doença aguda coronariana (DAC), que a principal causa de óbitos nas sociedades modernas. A revisão de literatura compreende investigações acerca do u-Health (CACERES et al., 2006), de perfis e de fatores de risco de doenças crônicas não transmissíveis. A realização do estudo contou com a parceria do PPG em Saúde Coletiva, da Unisinos, para a coleta de dados junto à pacientes em acompanhamento, por meio da aplicação criada no andamento desta pesquisa. A pesquisa é aplicada e centrada na proposição do módulo ChronicProfile, integrado ao modelo U’Ductor (VIANNA; BARBOSA, 2014). A implementação do protótipo envolve os seguintes componentes: 1) aplicação web ‘MeuCuidador Plano de Cuidado’, utilizada pelos médicos para cadastro do plano de cuidados; 2) aplicativo Android ‘MeuCuidador’, destinado aos pacientes para cadastro de informações acerca de suas atividades diárias. Os módulos do aplicativo compreendem a seleção e o processamento de históricos de contextos, a inferência e a geração de perfis, além das bases de dados específicas. Para avaliar a viabilidade do módulo proposto, dois tipos de experimentos foram desenvolvidos. O primeiro, vale-se de contextos reais de pacientes portadores de alguma DAC e trata da verificação de diferenças entre os perfis e da melhora das condições crônicas do paciente. Já no segundo experimento, avalia-se a capacidade do protótipo para geração de um perfil dinâmico para um mesmo paciente, mediante a inserção de um novo fator de risco a ser monitorado. Entre os resultados, destaca-se que a avaliação dos dados históricos de contextos e dos planos de cuidados de especialistas, realizada a partir do ChronicProfile, permite o monitoramento e a aferição do estado atual do paciente, a evolução ou involução dos fatores de risco relacionados a sua DCNT. / The contemporary scenario of noncommunicable chronic diseases (NCDs) is challenging. According to the latest report of the World Health Organization (WHO), in the global context, 38 million of deaths are a consequence of such diseases. For 2030, the number is expected to increase 52 million. Besides, the internet access and the proliferation of mobile devices, such as smartphones, are tools that facilitate the control and autonomous follow-up of patients. Furthermore, context-aware systems refer to transparent solutions for collecting users data that allow the identification of daily habits of individuals, which can be decisive in the treatment of diseases. The dynamic profile is a creation and automatic maintenance based on information and user Activities conforms the time cite Valmorbida2014. Therefore from detected contexts, profiles are defined, and the conversion between the two provides recommendations of personalized features to the patient. Considering this set of information, the research question is defined : how a model based on of Ubiquitous Computing could be designed to manage dynamic profiles in the monitoring of patients with NCDs? The study argue that those profiles supports the diseases control, allow the self-management and the organization of the patient specially about his proper nutrition, physical activities, biological indicators, glycaemic indices and behavioral risks. The profiles composition derives from information about the patient’s chronic conditions, such as: pressure, blood glucose, waist (WHR), weight, among others, besides the behavioral aspects, as medication intake, physical activities, etc. The study aims to create a module for dynamic profile management, focused on the attention to NCDs. The conduction of this research considers two cases from bearers patients of acute coronary disease (ACD), the main cause of death in modern societies. The literature review covers investigations about u-Health solutions (CACERES et al., 2006), of profiles and risk factors for noncommunicable chronic diseases. This applied research is centered in the proposition of a model called ChronicProfile, integrated to U’Ductor model (VIANNA; BARBOSA, 2014). The study was carried out with the partnership of PPG in Collective Health, from Unisinos, to collect data from the patients in follow-up, through the application created in the course of this research. The prototype implementation involves the follow components : 1) the web application « Meu Cuidador Plano de Cuidado », dedicated to medical utilization to register the care plan ; 2) the Android application « MeuCuidador », designed to patients to register informations about their daily activities. The application modules implies historic contexts selection and processing, the inference and generation of profiles, besides the specific data bases. The modules viability evaluation derives from two experimentals. First, real contexts from patients with some ACD were analysed to verify differences between profiles and the improvement of their chronic conditions. Secondly, the prototype capacity was evaluated to the generation of a dynamic profile to a same patient by inserting a new risk factor to be monitored. Among the results, the main one implies ChronicProfile’s data evaluation from historical contexts and care plans from specialists that permits monitoring and measurement of patient curent conditions, and also the NCDs risk factos of evolution or involution.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-07-20T14:00:58Z No. of bitstreams: 1 Cassius Ariovaldo Paim_.pdf: 4051434 bytes, checksum: dc710d4c2c1f5860ca9842506743254f (MD5) / Made available in DSpace on 2015-07-20T14:00:58Z (GMT). No. of bitstreams: 1 Cassius Ariovaldo Paim_.pdf: 4051434 bytes, checksum: dc710d4c2c1f5860ca9842506743254f (MD5) Previous issue date: 2015-03-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Segundo a Organização Mundial da Saúde (OMS) em 2008 morreram em torno de 36 milhões de pessoas devido a doenças crônicas não transmissíveis (DCNTs) em todo o mundo. Para estes tipos de doenças é necessário o tratamento seja permanente e contínuo, ao encontro disto existem modelos para cuidado ubíquo de doenças crônicas não transmissíveis que suprem estas necessidades. Entretanto não se encontrou nenhum modelo genérico quanto ao tratamento de diferentes DCNTs, que vise incentivar o uso de recursos sensíveis ao contexto através da promoção de alteração no comportamento do usuário. Frente a isto, existem ferramentas como gamification, que se caracteriza pelo uso de elementos de jogos em contextos que não são jogos, esta ferramenta promove a alteração no comportamento incentivando o usuário através do uso recompensas. Considerando este conceito foi desenvolvido o modelo Octopus, um modelo de gamification para auxílio no cuidado ubíquo de DCNTs, que explora o uso dos recursos sensíveis ao contexto que auxiliem no cuidado ubíquo de DCNTs. Diferentemente de outros trabalhos, este modelo é genérico quanto ao tratamento de DCNTs, atende qualquer público, utiliza sensibilidade ao contexto e trilhas de recursos. Um protótipo do modelo foi avaliado através do uso de cenários. Através dessa avaliação foi possível verificar a viabilidade do modelo e o suporte a diversas DCNTs comprovando o aspecto genérico do modelo. / According to the World Health Organization (WHO) in 2008 died around 36 million people due to chronic non-communicable diseases (NCDs) worldwide. For these type of diseases is needed a permanent and continuous treatment, to against this there are models for ubiquitous care of noncommunicable diseases that meet these needs. However it was not found any generic model regarding the treatment of different NCDs, aimed at encouraging the use of context sensitive resources to promote the change of user behavior. Facing this, there are tools like gamification, which is characterized by the use of game elements in contexts that are not games, this tool promotes the change in behavior by encouraging the user through the use rewards. Considering this concept was developed Octopus model, a gamification model to aid in the ubiquitous care of NCDs, which explores the use of context sensitive resources that help the ubiquitous care of NCDs. Unlike other studies, this model is generic as to the treatment of NCDs, supports any public, uses context awareness and resources trails. A prototype of the model was evaluated through the use of scenarios, based on this evaluation was possible to verify the model’s viability and the support for several NCDs proving the generic aspect of the model.

Le patient acteur dans la prise en charge du cancer: attentes normatives et travail du malade. Dans un contexte d’humanisation des soins valorisant la figure de l’individu acteur de sa santé, la présente thèse interroge les positionnements des malades touchés par le cancer et des accompagnants dans la prise en charge et le vécu de cette pathologie (professionnels soignants et proches) sur ce « devenir acteur » de la maladie. Elle met en évidence le travail de gestion de la maladie réalisé par les individus touchés, en analysant notamment comment ils composent avec les dimensions incertaines de l’expérience du cancer. Elle montre également que les considérations éthiques de « droit à l’information », de patient « associé aux décisions » ou encore « au cœur de la prise en charge » et la politique de lutte contre le cancer axée sur une « éducation sanitaire » contribuent à faire émerger des attentes normatives qui pèsent sur les malades. Au travers de quatre temps de la maladie – la découverte et l’annonce du cancer, la période des traitements, le vécu de la rémission et les trajectoires de fin de vie -, elle interroge plus spécifiquement les écarts entre les rôles attendus ou prescrits et les rôles effectivement endossés, les stratégies de coopération, de négociation ou de résistance entre les acteurs et les éléments qui fondent les prises de décision des malades et leur engagement dans les actions qu’ils mènent pour faire face au cancer au quotidien. Le questionnement sous-jacent porte ainsi sur les actions et stratégies entreprises par les acteurs touchés pour tenter de maitriser une trajectoire de maladie marquée par l’incertitude et sur la manière dont ces dernières s’intègrent – ou non – dans les attentes portées sur « l’individu acteur de sa santé et de sa maladie ». / The patient actor in the management of cancer : normative expectations and patient workIn the context of a humanisation of care that enhances the figure of the individual as an actor in his or her health, this thesis questions the positioning of patients affected by cancer and their caregivers and close relatives in the care and experience of this pathology from the point of view of their "becoming actor". It highlights the disease management work done by the affected individuals, notably by analyzing how they deal with the uncertain dimensions of the experience of cancer. It also shows how the ethical considerations of the "right to information", the patient "associated with decisions" or even "at the heart of care" and the fight against cancer policy centered on "health education" contribute to bring to the foreground normative expectations that weigh on the sick. Through four stages of the disease - the discovery and announcement of cancer, the treatment period, the experience of remission and end-of-life trajectories - it more specifically examines the differences between the expected and prescribed roles and the roles effectively endorsed, the strategies of cooperation, negotiation or resistance between the actors and the elements that underpin the decision-making of the patients and their commitment to the actions they take to face cancer on a daily basis. The underlying questioning thus focuses on the actions and strategies undertaken by the actors affected in an attempt to control a trajectory of illness marked by uncertainty and how the latter integrate - or not the expectations of " the individual actor of his health and his disease ".

<p>The aim of this thesis was to examine different approaches to support the self-care of persons with Type 2 diabetes, with special reference to practical, social, and sexual aspects of women's self-management. The methods to elucidate this comprised: evaluating a new model for diabetes patient education; designing a model to analyse the role of social networks in women's diabetes; conducting individual and focus group interviews for deeper understanding of the social and sexual aspects of diabetes; and collecting questionnaire data as a complement to the above.</p><p>The experience-based educational program led by pharmacists was found to improve participants' subjective control over diabetes and to provide important emotional support and encouragement to continue self-care. Metabolic control as measured by HbA_1c temporarily improved. The social network model elucidated potential mechanism leading to conflict of disease and social demands in women's diabetes. Qualitative analysis of the focus group interviews pointed to the role of guilt, shame, and social taboo in connection with the women's diabetes and sexuality.</p><p>Borderland is the metaphor I have chosen to describe the space between the traditional health care system and the everyday self-care of people with chronic disease. Using Borderland as a framework, a future model for diabetes management, anchored in our own and other's findings, is outlined and the concept of "Disease Manager Role" is introduced. The vision of a self-care support center in Borderland addresses such issues as accessibility, continuity, equitable provider-user relations, shared care plans, and strengthening social support.</p>

Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006.

The aim of this thesis was to examine different approaches to support the self-care of persons with Type 2 diabetes, with special reference to practical, social, and sexual aspects of women's self-management. The methods to elucidate this comprised: evaluating a new model for diabetes patient education; designing a model to analyse the role of social networks in women's diabetes; conducting individual and focus group interviews for deeper understanding of the social and sexual aspects of diabetes; and collecting questionnaire data as a complement to the above. The experience-based educational program led by pharmacists was found to improve participants' subjective control over diabetes and to provide important emotional support and encouragement to continue self-care. Metabolic control as measured by HbA1c temporarily improved. The social network model elucidated potential mechanism leading to conflict of disease and social demands in women's diabetes. Qualitative analysis of the focus group interviews pointed to the role of guilt, shame, and social taboo in connection with the women's diabetes and sexuality. Borderland is the metaphor I have chosen to describe the space between the traditional health care system and the everyday self-care of people with chronic disease. Using Borderland as a framework, a future model for diabetes management, anchored in our own and other's findings, is outlined and the concept of "Disease Manager Role" is introduced. The vision of a self-care support center in Borderland addresses such issues as accessibility, continuity, equitable provider-user relations, shared care plans, and strengthening social support.