South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates between patients enrolled in the mHealth intervention (n = 832) and those in the standard of care comparison group (n = 918). A quantitative, retrospective cohort approach was used to answer the research questions using binary logistic regression analyses. The mHealth intervention was found to be significantly linked to lower likelihood of 6- and/or 12-month LTF among patients. There were 2 other key findings: a positive correlation between pregnancy and LTF, and a positive correlation between viral load increases and LTF. This study added evidence to the existing literature on the effectiveness of using mHealth-based interventions to improve HIV/AIDS care. Based on these findings, professionals should pay special attention to pregnant women and those clients with increasing viral loads to ensure they are not LTF. Positive social change that may result from this study is better health outcomes for patients on ART due to reduced risk of HIV related complications and other illnesses. This awareness would improve the lives of the patients, and positively impact their families, communities, and ultimately the global community, by reducing the overall impact of HIV disease.

En Viticulture de Précision, l’imagerie multi-spectrale est principalement utilisée pour des dispositifs de télédétection. Ce manuscrit s’intéresse à son utilisation en proxidétection, pour la caractérisation du feuillage. Il présente un dispositif expérimental terrestre mobile composé d’un GPS, d’une caméra multi-spectrale acquérant des images visible et proche infrarouge, et d’un Greenseeker RT-100 mesurant l’indice Normalized Difference Vegetation Index (NDVI). Ce système observe le feuillage de la vigne dans le plan de palissage, en lumière naturelle. La parcelle étudiée comporte trois cépages (Pinot Noir, Chardonnay et Meunier) plantés en carré latin. En 2013, six jeux de données ont été acquis à différents stades phénologiques.Pour accéder aux propriétés spectrales de la végétation, il est nécessaire de calibrer les images en réflectance. Cela requiert l’utilisation d’une mire de MacBeth comme référence radiométrique. Lorsque la mire est cachée par les feuilles, les paramètres de calibration sont estimés par une interpolation linéaire en fonction des images les plus proches sur lesquelles la mire est visible. La cohérence de la méthode d’estimation employée est vérifiée par une validation croisée (LOOCV).La comparaison du NDVI fournie par le Greenseeker avec celui déterminé via les images corrigées permet de valider les données générées par le dispositif. La polyvalence du système est évaluée via les images où plusieurs indices de végétation sont déterminés. Ils permettant des suivis de croissance de la végétation originaux offrant des potentialités de phénotypage ou une caractérisation de l’état sanitaire de la végétation illustrant la polyvalence et le gain en précision de cette technique. / Mutispectral imaging systems are widely used in remote sensing for Precision Viticulture. In this work, this technique was applied in the proximal sensing context to characterize vine foliage. A mobile terrestrial experimental system is presented, composed of a GPS receiver, a multi-spectral camera acquiring visible and near infrared images, and a Greenseeker RT-100 which measures the Normalized Difference Vegetative Index (NDVI). This optical system observes vine foliage in the trellis plan, in natural sunlight. The experimental field is planted with Chardonnay, Pinot Noir and Meunier cultivars in a latin squared pattern. In 2013, six datasets were acquired at various phenological stages.Spectral properties of the vegetation are accessible on images when they are calibrated in reflectance. This step requires the use of a MacBeth colorchart as a radiometric reference. When the chart is hidden by leaves, the calibration parameters are estimated by simple linear interpolation using the results from resembling images, which have a visible chart. The performance of this method is verified with a cross-validation technique (LOOCV).To validate the data provided by the experimental system, the NDVI given by the Greenseeker was compared to those computed from the calibrated images. The assessment of the versatility of the system is done with the images where several indices were determined. It allows an innovative follow-up of the vegetative growth, and offering phenotyping applications. Moreover, the characterization of the sanitary state of the foliage prove that this technique is versatile and accurate.

La littératie en santé (LS) désigne les connaissances, la motivation et les compétences permettant d’accéder, comprendre, évaluer et appliquer l’information dans le domaine de la santé. C’est un déterminant majeur de santé qui est fréquemment considéré comme un mécanisme des inégalités sociales de santé. Ce travail de thèse a comme objectif fondamental d’évaluer l’association entre la LS, les inégalités d’information et l’état de santé des personnes atteintes de cancers. Toutefois, devant le manque d’instruments de mesure de la LS, nos premiers travaux ont consisté en la validation d’outils de mesure en France. Nos travaux empiriques se sont appuyés sur les analyses de trois enquêtes.Ces analyses ont permis d’obtenir des éléments de validation de plusieurs échelles subjectives en version française évaluant la LS, la numératie et la décision partagée.Un niveau limité de LS a été montré associé à une moindre participation au processus de décision partagée, des comportements de recherche d’information et un état de santé mentale et physique altéré. De plus, les patients avec un niveau limité de LS sollicitent davantage le médecin généraliste et les services sociaux.La prise en compte du niveau de LS des patients pendant tout le parcours de soins nous parait indispensable. Cela pourrait permettre d’adapter l’information au niveau de LS afin de réduire les inégalités d’information et augmenter la participation des patients à la prise de décision. En outre, cela pourrait également permettre aux professionnels de santé de proposer un accompagnement particulier pour les personnes à faible niveau de LS afin d’améliorer leur état de santé et leur qualité de vie. / Health Literacy (HL) refers to the knowledge, motivation, and skills to access, understand, evaluate, and apply information in the health field. It is a major determinant of health that is frequently considered as a mechanism of the social inequities of health. The main objective of this thesis is to evaluate the association between HL, information inequities and the health status of people with cancer. However, given the lack of HL measuring instruments in France, we started with the psychometric validation of measurement tools.Our empirical work is based on analyzes of three surveys.These analyses allowed having valid French version of subjective scales measuring HL, numeracy and shared decision-making process. Our analyzes have shown that a limited level of HL is associated with less involvement in the shared decision process, more information seeking and impaired mental and physical health status. In addition, patients with limited level of HL consulted more often the general practitioner and the social worker. Considering the patients’ HL level during all the course of their care seems mandatory. This would allow information to be tailored to patients’ HL level, to reduce information inequities and increase patient participation in decision-making. In addition, this would also allow health professionals to propose special care for people with low levels of HL to improve their health and quality of life.

The aim of the study is to determine the nature and utilisation of an Employee Assistance Programme (EAP) in a white-collar work environment, and, more specifically, in a South African context. Information about the research topic was obtained from accumulate records of the Standard Bank's Employee Well-being Programme (EWP), structured interviews which were conducted with eleven EWP practitioners and a union representative, and from self-administered questionnaires which were completed by a sample of 153 of the bank's employees. The study includes an in-depth literature review on EAPs in general and issues such as the nature and scope of the bank's EWP, the extent to which the EWP addresses employees' needs, the nature and extent of the marketing of the EWP, and the extent to which the workforce is utilising the programme, were explored and described. The main findings are that the EWP shows evidence of acceptance by employees as well as a degree of utilisation that compares favourably with local and international trends. It also shows an incongruence between marketing and employee orientation and training initiatives and reveals that programme evaluation efforts are insufficient and could be significantly improved. Accordingly, recommendations have been made pertaining to the needs of employees, employee and union involvement, a multi-disciplinary approach to case management, marketing, training and evaluation with regard to the EWP, an EWP database, and a post-treatment follow-up. / Social Work / M.A. (Social Work)

身為供應商，服務一個開始國際化的客戶是其企業成長的重要契機，為了因應客戶海外設廠，廠商面臨不得不跨出母國市場的壓力。臺灣過去是全球許多資訊產品的生產重鎮，但近年來許多廠商開始進行海外直接投資，將生產線移至亞洲(如中國大陸、越南等)、北美(墨西哥)或歐洲(捷克)等國家，臺灣的供應商開始感受到客戶外移的壓力，中心廠將生產基地外移，連帶促使其上游產業也陸續跟隨其客戶至一起至海外進行投資，在考量組織資源與客戶服務的天平上，供應商在此議題必須做出重要的抉擇。是該在當地設立完整價值活動的子公司，還是以出口方式來服務？是否存在其它折衷的策略選項？不跟隨客戶進行國際化，可能因無法維繫買賣關係而喪失該客戶，跟隨客戶國際化，又面臨到環境的不確定性及跨國營運的挑戰，企業需要尋求可以兼顧客戶關係與維持原有優勢的營運方式，同樣面臨客戶在海外設廠的情境，為何供應商在價值活動的國際化上會有不同的決策？對於製造業的供應商而言，營運活動之佈局尚未獲得完整解答，因此，本論文探討之研究問題包括：(一)當母國客戶在海外設立製造據點時，供應商的國際化跟隨策略為何？(二)當母國客戶在海外設立製造據點時，供應商價值活動的跟隨決策受到哪些因素的影響？ 本研究以供應商為研究對象，與客戶接觸之價值活動為分析單位，針對研究問題一，透過個案研究，本研究探究國際化跟隨策略之內涵，發現「價值活動之地理位置」與「價值活動之決策權」為跟隨策略之兩個重要構面。針對研究問題二，透過問卷調查，本研究證實跟隨決策之影響因素：供應商對客戶的依賴關係會增加供應商決策權外移程度；供應商內部作業鑲嵌程度愈高時會促使廠商採取價值活動留在母國；客戶集權程度愈高時，供應商之價值活動與決策權均傾向留在母國；價值活動與客戶海外據點之知識與決策鑲嵌程度，會促使供應商將價值活動與決策權均移往地主國。 本研究從個案資料及組織間關係的依賴、同形及鑲嵌觀點等理論觀點，以供應商之主要客戶海外設廠為主要研究情境，探討供應商之國際化跟隨策略內涵與影響因素，並進行理論意義與實務意涵之討論。 / As a supplier, serving an international customer is a key opportunity of growth. Taiwan was a major manufacturing country of many electronic products in the world in the past. But in recent years, many firms, for cost or service concern, start to move their production lines to China, Vietnam, Mexico, Czech Republic, etc. The suppliers of these firms face pressures from customer migrations. By exporting to serve the customer in the host country, the buyer-seller relationship can not be well-kept. By Setting up a completed value activities subsidiary, the suppler face the uncertainties and challenges of cross-border operations. To or not to go, it’s an important decision the supplier must make. Furthermore, facing the same situation, customer’s FDI, why firms chose different strategies？ This paper considers both inter and intro organizational interactions to discuss this issue. Two research questions are investigated. First, to quickly respond to the key customer’s demand in the host country, what is supplier’s customer-driven internationalization strategy? Second, what factors would affect supplier’s customer-driven internationalization strategy. In other words, this research aims to explore the influential factors abut a supplier’s internationalization strategies to service home customer’s demand in the host country. This study takes the view of a supplier, who faces the key customer set up manufacture unit in host country. In order to explore the issues, this study adopted two study researches. At first, this study took 7 case studies form 6 companies to confirm the decision dimensions of internationalization strategies. We found that the locations of activities and the degree of decision power are two important dimensions of supplier’s internationalization strategies. Secondly, according to survey results from 103 suppliers in Taiwan, the findings include below. (1) Positive relationship between suppliers’ dependency and decision power in the host country. (2) The higher internal-embeddedness of the activities, the higher possibilities the location of the activities would located in the home country. (3) Negative relationship between customer’s decision centrality and decision power in the host country. Also negative relationship between customer’s decision centrality and the possibility the location of the activity would located in the home country. (4) The higher external-embeddedness of the activity, the higher possibilities the location of the activity would located in the host country. Also positive relationship between external-embeddedness and decision power in the host country.

Polycystic ovary syndrome (PCOS) is a complex clinical condition characterized by hyperandrogenism and chronic oligo/anovulation. Infrequent ovulation and metabolic alterations in women with PCOS are associated with subfertility and probably increased miscarriage rates compared with normal fertile women. The overall risk of developing type 2 diabetes and impaired glucose tolerance (IGT) is three- to sevenfold higher in PCOS women, and the onset of glucose intolerance seems to occur at an earlier age than in healthy controls. Women with PCOS also have several risk factors for cardiovascular disease, although it is unclear whether they actually experience more cardiovascular events than other women. Very few studies assessing the long-term reproductive and metabolic consequences in older women with previously confirmed PCOS have been conducted. In this long-term follow-up of women with PCOS, 84 women with a diagnosis of PCOS between 1987 and 1995 and age at the follow-up > 35 years and an age-matched population-based group of control women participated. Data on reproductive outcome, ovarian reserve, endothelial function, insulin sensitivity and beta-cell function were collected. According to our results most women with PCOS had given birth and the rate of spontaneous pregnancies was relatively high. The rate of miscarriages was not increased in PCOS patients and the ultrasound findings together with increased levels of anti-müllerian hormone suggested that their ovarian reserve is superior to women of similar age. PCOS women displayed signs of endothelial dysfunction, but this was largely due to the increased prevalence of independent risk factors for cardiovascular disease such as increased BMI, triglycerides and blood pressures. IGT and type 2 diabetes occurred more often in PCOS women. Free androgen levels and beta-cell function decreased over time whereas insulin sensitivity remained unchanged. Obesity at young age and progressive weight-gain rendered them more prone to be insulin resistant at the follow-up. Beta-cell function was increased in PCOS women in comparison with control subjects but declined over time. Independent of PCOS phenotype at the index assessment and persistence of PCOS symptoms at the follow-up investigation, premenopausal women with PCOS had lower insulin sensitivity and increased beta cell function in comparison with control subjects. Conclusion: The long-term reproductive outcomes of PCOS are similar compared to women with normal ovaries. Although symptoms and androgen levels are normalized over time, women with PCOS continue to display reduced insulin sensitivity and increased beta-cell function and they also have an increased risk of IGT and type 2 diabetes.

Amalgam has been used as a dental restorative material for centuries, but its potential health effects and biopersistance has lead to a decreased use especially in the Nordic countries. New materials have been introduced, partly to replace the mercury containing amalgam and partly because of esthetical reasons. The possible health effects of amalgam have been studied extensively and the material has been replaced with other less well-examined materials during the last few decades. The prevalence of side effects of dental materials is considered to be low in relation to the vast number of dental treatments undertaken. With the introduction of new and more complex materials, side effects related to dental treatment may increase. Epidemiological data suggest that the side effects of dental resins that have almost completely replaced amalgam fillings in Scandinavia, possess a risk for adverse reactions; however, the causal relation has not been fully established. Therefore, the type and extent of side effects caused by resin-based materials are of great interest. The aims of the study were: - to describe the change in health over time for patients with problems related to their dental materials. The hypothesis was that the patients could be divided into subgroups based on their symptoms and that the ability to recover differs between these groups [Paper I]. Furthermore, to determine whether factors such as the replacement of dental restorative materials and follow-up time had any impact on the perceived health. - to assess the long-term development of symptoms and their social consequences among patients referred for diagnosis and treatment of symptoms related to dental materials [Paper II] - to investigate the possible risks with dental restorative materials other than amalgam [Paper III]. - to describe side effects assessed to be caused by resin-based materials that occurred in a group of patients as well as treatment and long-term consequences of the reactions [Paper IV]. A questionnaire was sent to 614 patients [Paper I and II] that had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental materials. The questionnaire contained questions on, among others; civil status, present health, medical and dental treatment and other measures and precautions taken because of psychosocial problems related to current employment situation, feelings, self-image and coping behavior. Moreover, information was collected [Paper III] from the Swedish Dental Materials Register 2003 (DentMr), a compilation of MSDS for 487 materials, and information from the user guide of the materials. The Material Safety Data Sheets (MSDS) included in the DentMR were examined regarding the given composition of the products, the occurrence of CAS-numbers and the risk- and safety phrases of the substances. Information was collected [Paper IV] on 36 patients with reactions to resin-based restorative materials from the Swedish National Register of Side-Effects of Dental Materials. Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with local symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. However, the reason for this improvement was unclear. Replacement of dental restorative materials had no significant impact on the ability to recover completely. Our results also indicate a relationship between patients’ self-related health and social consequences in daily life. Those with remaining complex symptoms had more often stopped working or had decreased their work hours because of their symptoms The information about hazards with dental materials seems insufficiently described in MSDS and there might be materials with side effects unknown to both patients and dental professionals. A literature search indicated that some of the listed substances had possible hazards, e.g. substances with embryotoxic and neurotoxic potential. The patients were very heterogeneous; a few with only local symptom free reactions while other had more complex symptoms. The latter group would gain from a multidisciplinary approach, i.e. dental, medical, as well as social and psychological factors have to be considered when developing care management programs for this group of patients. Furthermore, there is a need for stronger regulations of dental materials, such as those applied to pharmaceutical drugs. Finally, it was found that the majority of symptoms suspected to be caused by resin-based materials were local or a combination of local and extra-oral symptoms that appeared within the first 24 hours after treatment. The most frequent adverse effect reported was skin problems/dermatitis. It appears as though immediate reactions to resin based materials are not uncommon and more prevalent than allergic reactions. Still, we have had, difficulties in verifying associations between the dental restorative materials and adverse reactions and also to identify the offending component.

Oral and pharyngeal cancer is commonly treated with a combination of radiotherapy and surgery. It is a clinical knowledge that patients often experience severe swallowing disorders following treatment. Since surgical sequelae are instantaneous and obvious, little attention has been paid to other concurrent effects of the treatment. To shed light on this subject, the aim of this thesis was twofold (i) to make a retrospective inventory of the sequelae following treatment and (ii) to perform a prospective, inceptive examination at diagnosis, and to follow-up after radiotherapy, six months and 12 months after surgery. The files of ninety-nine patients revealed that following treatment one-third had to use gastric fistulas and more than nine of ten patients had restricted swallowing capacity. Every second patient could only swallow puréed or liquid food. Adequate intra-oral sensation and discrimination ability is essential for bolus preparation and bolus control, for appropriate elicitation of the swallowing reflex and, hence, for the oral phase of swallowing. At the inceptive examination, the prospective part of the study demonstrated intra-oral discrimination ability in patients was equal to that in healthy controls but was impaired six months after treatment and there was no significant improvement after 12 months. It had been expected that the patient’s healthy, non-tumor side would compensate but it did not. An explanation was found when it was revealed that radiotherapy induced a delayed decline in intra-oral sensation. Sensory decline was not demonstrated within a month after radiotherapy but was manifest six months later. Since the radiotherapy field includes the neck, because of the risk for metastasis, it is highly plausible that pharyngeal sensation declines in a manner corresponding to that found intra-orally when the healthy side is irradiated. In accord with this presumption, pharyngeal swallowing function deteriorated in patents with oral tumors. Cineradiographic evaluation of oral and pharyngeal swallowing function disclosed a significant association between the degree of swallowing dysfunction and the degree of sensory decline and with the degree of impairment of shape recognition. Conclusions: Delayed intra-oral sensory decline, found to be induced by radiotherapy, can be expected to appear in the entire radiation field, including the oral cavity and the pharynx, with adverse effect on swallowing. Testing intra-oral sensation close to the last radiotherapy session is not advisable, because sensory decline does not develop immediately after radiotherapy but manifests after six months. Spontaneous sensory rehabilitation cannot be expected after six months. The significant association between degree of swallowing dysfunction and degree of intra-oral sensory decline and impaired discrimination ability must be considered in the quest for functional rehabilitation of patients treated for oral or pharyngeal cancer.

Attendance at Neonatal Follow-up (NFU) programs is crucial for parents to gain access to timely diagnostic expertise, psychosocial support, and referral to needed services for their infants. Although NFU programs are considered beneficial, up to 50% of parents do not attend these programs with their infants. Non-attending infants have poorer outcomes (e.g., higher rates of disabilities and less access to required services) as compared to attenders. The purpose was to determine factors that predicted attendance at NFU. Naturally occurring attendance was monitored and maternal-infant factors including predisposing, enabling, and needs factors were investigated, guided by the Socio-Behavioral Model of Health Services Use. A prospective two-phase multi-site descriptive cohort study was conducted in 3 Canadian Neonatal Intensive Care Units that refer to 2 NFU programs. In Phase 1, standardized questionnaires were completed by 357 mothers (66% response rate) prior to their infant’s (N= 400 infants) NICU discharge. In Phase 2, attendance patterns at NFU were followed for 12 months. Higher maternal stress at the time of the infant’s NICU hospitalization was predictive of attendance at NFU. Parenting alone, more worry about maternal alcohol or drug use, and greater distance to NFU were predictive of non-attendance at NFU. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months. Two distinct attendance patterns emerged: no or minimal attendance (18.5%) and attendance at all or the majority of scheduled appointments (81.5%). The most frequent point of withdrawal from NFU occurred between NICU discharge and the first scheduled appointment; followed by drop-out following the first NFU appointment. These results provide new insight into patterns of attendance and the maternal-infant factors that characterize attenders/non-attenders at NFU and serve as the critical first step in developing interventions targeted at improving attendance, infant outcomes, and reporting of developmental sequelae.

Attendance at Neonatal Follow-up (NFU) programs is crucial for parents to gain access to timely diagnostic expertise, psychosocial support, and referral to needed services for their infants. Although NFU programs are considered beneficial, up to 50% of parents do not attend these programs with their infants. Non-attending infants have poorer outcomes (e.g., higher rates of disabilities and less access to required services) as compared to attenders. The purpose was to determine factors that predicted attendance at NFU. Naturally occurring attendance was monitored and maternal-infant factors including predisposing, enabling, and needs factors were investigated, guided by the Socio-Behavioral Model of Health Services Use. A prospective two-phase multi-site descriptive cohort study was conducted in 3 Canadian Neonatal Intensive Care Units that refer to 2 NFU programs. In Phase 1, standardized questionnaires were completed by 357 mothers (66% response rate) prior to their infant’s (N= 400 infants) NICU discharge. In Phase 2, attendance patterns at NFU were followed for 12 months. Higher maternal stress at the time of the infant’s NICU hospitalization was predictive of attendance at NFU. Parenting alone, more worry about maternal alcohol or drug use, and greater distance to NFU were predictive of non-attendance at NFU. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months. Two distinct attendance patterns emerged: no or minimal attendance (18.5%) and attendance at all or the majority of scheduled appointments (81.5%). The most frequent point of withdrawal from NFU occurred between NICU discharge and the first scheduled appointment; followed by drop-out following the first NFU appointment. These results provide new insight into patterns of attendance and the maternal-infant factors that characterize attenders/non-attenders at NFU and serve as the critical first step in developing interventions targeted at improving attendance, infant outcomes, and reporting of developmental sequelae.