Motivation In South Africa, various transitional changes parallel detrimental modifications in lifestyle behaviour of especially the lower socio-economic communities. We are currently double-burdened by a high prevalence of communicable and noncommunicable diseases such as diabetes, chronic respiratory and cardiovascular diseases, which is accompanied by a high cardiovascular mortality rate. Healthcare and treatment resources are limited and low-cost intervention strategies to lower this burden are urgently needed. Unhealthy lifestyle behaviours, such as excessive alcohol consumption and tobacco use, are known to augment inflammation as reflected by inflammatory markers such as C-reactive protein and interleukin-6, which are well-known risk factors for cardiovascular disease and mortality. Several studies showed the prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in advanced disease states and that suPAR associates with different types of cancers, infectious diseases, diabetes, coronary artery disease and all-cause mortality. Since the discovery of suPAR in 1991, the role of this less known inflammatory marker in various diseases has been under debate. It was further reported that black individuals have higher suPAR levels than whites. However, whether an unhealthy lifestyle and cardiometabolic risk factors are related to suPAR, whether suPAR plays a role in the development of cardiovascular disease such as hypertension, and whether suPAR could predict all-cause and cardiovascular mortality, especially among the understudied black South African population, remain to be established. Aim The central aim of this thesis was to determine if suPAR associates with cardiovascular disease development in a black South African population. We therefore explored whether suPAR relates to lifestyle and cardiometabolic risk factors, associates with the development of hypertension and has prognostic value for cardiovascular and all-cause mortality over five years. Methodology This five-year prospective sub-study, which is embedded in the international Prospective Urban and Rural Epidemiology study, included black South African volunteers of ages older than 35 years from the North West province, South Africa. Baseline data collection took place in 2005 during which 2 010 men and women from urban and rural areas were examined. A total of 1 292 participants returned for examination and were followed-up for the first time in 2010. Of these participants, 214 were newly identified as being infected with the human immunodeficiency virus (HIV), while 233 died during the five year period. Standardised methods were used to capture all data and included health questionnaires (lifestyle factors, medication use, disease status and history, mortality outcome), cardiovascular and anthropometric measurements, as well as biochemical analyses of inflammatory markers (suPAR, C-reactive protein, interleukin-6), HIV status and relevant metabolic markers. In preparation for statistical analyses, non-Gaussian variables were logarithmically transformed. We compared means and proportions with independent t-tests, analysis of variance, analysis of covariance (for adjustments) and Chi-square tests, while dependent t-tests and McNemar tests were used for analysis of longitudinal data within individual groups. We determined relationships between variables with Pearson’s correlation coefficients. Independent relationships were determined with logistic regression, forward stepwise multiple regression and proportional Cox-regression analyses. Mortality rates were calculated using Kaplan-Meier survival function estimates and log-rank tests. In all cases, p≤0.05 were used to indicate statistical significance. Results and conclusions of each manuscript Three manuscripts were written in order to achieve the aim of this thesis. In the first manuscript we explored the cross-sectional relationships of suPAR with lifestyle and cardiometabolic risk factors in a black South African population. We showed that suPAR was independently associated with lifestyle behaviours, including alcohol consumption, as indicated by gamma-glutamyltransferase levels (β=0.24; p<0.001), tobacco use (β=0.13; p<0.001) and unemployment (β=0.07; p=0.039), despite no direct links with cardiometabolic factors such as blood pressure, dyslipidaemia, glycaemia or adiposity. These findings emphasise the important need to address lifestyle behaviours in order to limit the detrimental effect of modifiable risk factors on the health and mortality rate of this population. Secondly, we determined whether suPAR was associated with the development of hypertension over five years. We found that suPAR was higher and increased more prominently (14.2% vs. 6.94%; p=0.007) in participants that developed hypertensio than in those that remained normotensive. Change in systolic blood pressure was independently associated with baseline suPAR (β=0.14; p=0.043), while becoming hypertensive was associated with an increase in suPAR (odds ratio=1.41; p=0.015). Whether inflammation leads to the development of hypertension or vice versa, remains unclear. Our findings emphasise the need to acknowledge the role of inflammation in hypertension and may permit further investigation of the use of suPAR as a potential marker for early risk identification and intervention. The third manuscript investigated the prognostic value of suPAR, compared to other inflammatory markers C-reactive protein and interleukin-6, in all-cause and cardiovascular mortality. We showed for the first time in a black population that suPAR predicted both all-cause (hazard ratio=1.27; p=0.003) and cardiovascular mortality (hazard ratio=1.40; p=0.026), independent of interleukin-6. Future research is needed to clarify the mechanisms behind the association of suPAR with cardiovascular mortality and to explore the possibility of a suPAR cut-off value for early identification of those with increased risk for cardiovascular morbidity and mortality in this population. General conclusion In this thesis we showed for the first time that suPAR has potential as a marker of cardiovascular disease development in black South Africans. SuPAR associated with hypertension and independently predicted all-cause and cardiovascular mortality over five years. Our findings, that suPAR is independently associated with adverse health behaviours such as alcohol and tobacco use, lend support for the use of suPAR as a novel approach for early risk identification and intervention strategies, which may be effective in combatting the high cardiovascular disease burden among the black South African community. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Diabetes typ 2 är en endokrin sjukdom där insulinfrisättningen från pankreas betaceller är nedsatt, vilket leder till insulinresistens. Det är en tyst och smygande sjukdom som främst upptäcks när patienter har utvecklat komplikationer. De vanligaste komplikationerna är ögon, njure, fot och hjärt- och kärlsjukdomar. Ärftlighet, hög ålder, fysisk inaktivitet och fetma är vanliga orsaker till diabetes typ 2, vilket gör att livsstilsförändringar exempelvis ökad fysisk aktivitet, viktminskning och sunda matvanor är betydelsefullt vid behandlingen av sjukdomen. Aktuellt examensarbete syftar till att beskriva vuxna patienters upplevelser av livsstilsförändringar vid diabetes typ 2. Det bygger på en litteraturstudie bestående av åtta kvalitativa artiklar. Resultatet består av följande huvudteman, en förändrad tillvaro, känna sig åsidosatt och känna sig hälsosam. Dessa huvudteman är uppbyggda av fem subteman så som ”kroppen spelar roll”, ”en inre kamp för livsstilsförändringar”, ”behov av information”, patientens möte med sjukvården”, ”bryta gamla vanor” och ”upplevelser av livsstilsförändringar”. Resultatet visar att drabbas av diabetes typ 2 innebär förändringar i patientens vardag, vilket ger känslan av en förändrad tillvaro. Det framkommer i resultatet att patienterna får ett otillfredsställande möte med hälso- och sjukvårdspersonal, vilket leder till att de känner sig åsidosatta. Därtill får patienterna en bristfällig information om diabetes typ 2, vilket innebär att de erhåller en ofullständig upplysning om livsstilsförändringar och komplikationer. Slutligen upplevde patienterna livsstilsförändringar som nödvändiga men svåra och energikrävande. Slutsatsen tydliggör patienternas behov av stöd, undervisning och vägledning, vilket är bra att sjuksköterskan blir medvetet om.

Recent years have witnessed an increased interest in small independently operated businesses with researchers expressing an interest in the manner in which the independent owner-operator is motivated to enter the market and their subsequent approach to business. Research into these small firms has shown that the owner/operators may create their businesses for a variety of reasons. However an emerging perspective is that not all individuals will actively pursue traditional objectives such as growth and profit maximisation, rather they are increasingly choosing their occupation to suit their ‘style of life’. Lifestyle motivations have thus been recognised in the literature as important stimuli to small business formation. Various research has been undertaken into the lifestyle construct and the impact on the motivations and behaviours of the individual towards the creation and development of smallscale enterprises. This study aims to build on recent work in this area to provide an enhanced understanding of lifestyle theory. This study adopts an interpretivist approach to understand the fundamental meanings attached to lifestyle entrepreneurship in the context of the small business. Bed and Breakfast (B&B) accommodation operations are used as a frame through which to understand the motivations of the individual towards venture creation. This study develops the ideal typifications of Business Orientated Lifestylers, Lifestyle Focused Business Performers and Self Expressive Homemakers to help explain the complex and dynamic range of lifestyle motivations and objectives present, and proposes the model of a continuum to portray these lifestyle business owners as being between low intensity and high intensity lifestyle goals and objectives. It is suggested that the typologies and subsequent lifestyle continuum presented in this study can be used by researchers, policy makers and practitioners to better understand the lifestyle entrepreneur and the environment within which they operate, and further, to support these lifestyle entrepreneurs in the operation of their business.

This thesis will focus on understanding how middle managers on five different car dealership companies in three different cities in the south of Sweden perceive the position and situation within the company, and the result of this position. It will also focus on how he or she perceive his or hers relationship with the employees and superiors in the company to be. This paper will also aim to understand by which means the middle manager chooses to deal with the perceived situation regarding the company and relationships within it. The study will be based on the experiences and opinions of the middle manager. This thesis is different from other studies made on middle managers due to the fact that even if stress will be a factor taken into consideration, it will not be the main focus of the paper. This BA thesis will be conducted with a qualitative method with semi structural interviews conducted at the interviewees respective workplaces. The result of these interviews are that the middle managers consider their relationships with the sales people at the company and with their superiors to be a good one, but not without complications. These complications are the result of the lines between professional and private life being blurred. These complications cause some stress and pressure for the middle managers, and the way for them to deal with this is to make their profession their lifestyle, they choose to live their professions. By doing this they limit the effect these complications have on their professional as well as private life

Background: Previous studies on anthroposophic lifestyle and allergy show that the children have less risk of developing allergies. All studies so far have been retrospective and have included children in school age. In view of the facts that this lifestyle seems to protect children from allergies and that different symptoms of atopy have increased dramatically during the last decades it is of general interest to study this group of children more in detail. The earlier findings have now been followed up in a prospective research program ALADDIN (Assessment of Life style and Allergic Disease During Infancy), applying different approaches. One of these is to focus on stress (as measured by cortisol) as a factor that may underlie the decreased risk of allergy in children from anthroposophic families.   Aim: This thesis is based on data from the ALADDIN study focusing on influence of family lifestyle on allergy sensitization early in children’s life in relation to psychosocial factors and salivary cortisol as an indicator of stress. Methods: A total of 552 families were recruited during pregnancy or during the first month of the child´s life in two recruitment waves, 330 families between September 2004 and November 2007 and another 222 families between March 2008 and January 2011. They were recruited at anthroposophic maternal and child health care centers (MCHC) and from conventional MCHCs.  Data on demographics and exposures were obtained by questionnaires and interviews. Parental capacity to adapt to stressors was evaluated by means of the questionnaire “Sense of Coherence” (SOC; Antonovsky). Salivary samples were collected at home from the infants and both parents for analyzes of cortisol. Blood samples were obtained from the parents and from the children for analyzes of IgE. Results: Many family related characteristics differed markedly between the groups before and during pregnancy, during delivery and the first 12 months of age. Children from anthroposophic families had lower levels of salivary cortisol compared to peers from families with a more conventional lifestyle on all sampling occasions at 6 months of age and on some of the occasions at 12 and 24 months of age. There were no differences concerning cortisol between parents with different lifestyle and no significant differences concerning SOC-scores between the three lifestyle groups. An anthroposophic lifestyle was associated with a lower risk of allergic sensitization up to five years of age. This risk was partially explained by lower cortisol levels during infancy. Children in families with a partly anthroposophic lifestyle also had substantially lower risk of sensitization. Conclusion: An anthroposophic lifestyle protects from development of allergy during childhood, at least up to five years of age. This protective capacity is partly mediated by low cortisol levels during infancy but is also dependent on unknown characteristics of this lifestyle.  These results call for further studies on health related effects of an anthroposophic lifestyle.

No description available.

No description available.

Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50-79 years recruited to the Women's Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers across the United States. Baseline (B) and change in each of the following were evaluated at year 3 (Y3) and year 6 (Y6; baseline n= 93,676; Y3 n= 76,598; Y6 n= 75,428): recreational physical activity (MET-h/wk), sitting, sleeping (min/day), and lean body mass by dual energy X-ray absorptiometry (subset N= 6475). Falls per year (0, 1, 2, >= 3) were assessed annually by self-report questionnaire and then dichotomized as = 1 and = 2 falls/year. Logistic regression models were adjusted for demographics, body mass index, fall history, tobacco and alcohol use, medical conditions, and medications. Higher baseline activity was associated with greater risk of falling at Y6 (18%; p for trend <0.0001). Increasing sedentary time minimally decreased falling (1% Y3; 2% Y6; p < 0.05). Increasing activity up to >= 9 MET-h/wk. (OR: 1.12, 95% CI: 1.03-1.22) or maintaining >= 9 MET-h/wk. (OR: 1.20, 95% CI: 1.13-1.29) increased falling at Y3 and Y6 (p for trend <0.001). Adding lean body mass to the models attenuated these relationships. Physically active lifestyles increased falling among post-menopausal women. Additional fall prevention strategies, such as balance and resistance training, should be evaluated to assist post-menopausal women in reaching or maintaining levels of aerobic activity known to prevent and manage several chronic diseases.

A adoção de hábitos saudáveis como a prática de atividades físicas, alimentação equilibrada, sono saudável e a cessação do tabagismo tem sido apontada como importante medida para melhorar a saúde, a qualidade de vida e facilitar a prevenção e controle de algumas doenças crônicas na população. Assim, intervenções em saúde que visam orientar e facilitar a adoção de tais hábitos são componentes importantes e necessários no planejamento de programas de promoção da saúde. Mesmo que desconsiderássemos qualquer outro benefício além do financeiro, este já seria suficiente para justificar ações voltadas para a promoção da saúde por possibilitarem otimização dos recursos materiais e humanos nas intervenções em saúde . Visando ampliar ainda mais este benefício, novas tecnologias capazes de reduzir custos e manter qualidade de atendimento têm sido pesquisadas. É neste contexto que a abordagem telefônica para promover saúde surge como uma opção. Este estudo tem a finalidade de avaliar a efetividade da abordagem telefônica na promoção da saúde. O estudo foi realizado no Centro de Promoção da Saúde da Faculdade de Medicina da Universidade de São Paulo, com 46 indivíduos. Foram feitos de 3 a 5 contatos por pessoa, por meio dos quais foram feitas orientações e intervenções baseadas nos preceitos da Terapia Cognitivo-Comportamental e do Modelo Transteórico. Os resultados mostraram que, após a intervenção, os clientes que receberam cinco contatos telefônicos, mudaram o comportamento, passando a praticar alguma atividade física com regularidade e melhorando a qualidade do sono, esta mudança foi estatisticamente significativa. Os outros comportamentos estudados não apresentaram mudança estatisticamente significativas após 3 ou 5 contatos, apesar de alguns clientes apresentarem mudanças favoráveis em seu comportamento, principalmente no grupo que recebeu 5 contatos. Concluindo, a abordagem telefônica favoreceu a adoção de hábitos saudáveis, mostrando-se, portanto, como uma estratégia de apoio favorável à promoção da saúde. / The adoption of healthy habits such as physical activities, balanced diet, healthy sleep, and the cessation of smoking have been pointed out as important measures to improve health, quality of life and further the prevention and control of some chronic diseases in our population. As such, healthy interventions aiming to guide and further the adoption of these habits are important and necessary compounds in the planning of programs dedicated to promoting healthy lifestyles. Even if we do not consider any other benefit, aside from the financial benefit, this would already be enough to justify actions taken for promoting a healthy lifestyle since this could optimize material and human resources in the areas dedicated to health. Aiming to extend even more this benefit, research is being done to find new technologies capable of reducing costs and maintaining the quality of attendance. It is in this context that the telephonic approach for healthy lifestyle promotion appears as an option. This study intended to evaluate the effectiveness of the telephonic approach for healthy lifestyle promotion. This study was performed at the Healthy Lifestyle Promotion Center of the University of São Paulo Medical School, with 46 individuals. Each individual received 3 to 5 telephone calls through which guidance and interventions were made based on Cognitive-Behavioral Therapy and Transtheoretical Model norms. The results pointed out, that after this intervention the clients, who had received 5 telephone calls, changed their behavior, They started to practice some form of regular physical activity and changed their quality of sleep, this change was statistically significant. The remaining behaviors studied showed no statistically significant changes after the 3 to 5 telephone calls, although some clients presented favorable behavior changes, principally in the group that had received the 5 telephone calls. In conclusion, the telephonic approach indeed has furthered the adoption of healthy lifestyle habits, and thus has shown to be an favourable strategy in the promotion of healthy lifestyles.

"Sedentary lifestyles are ubiquitous in modern societies. Sitting, watching television and using the computer are examples of sedentary behaviors that are currently common worldwide. Many research results show that the length of time that a person is sedentary is linked with an increased risk of obesity, diabetes, cardiovascular disease, and all-cause mortality. Determining how best to motivate people to become more active is not only necessary but also imperative. The electronic pedometer, as a proven device to increase physical activity, has been widely accepted by consumers for decades. As smartphones are functionally able to run accurate pedometer apps, we explore the potential of leveraging context-aware (e.g. location, identity, activity and time) smartphone application—more advanced pedometer—to help people mitigate sedentary lifestyle. The smartphone application we developed, “On11”, intelligently tracks people’s physical activities and identifies sedentary behaviors. With the knowledge it learns from the users, On11 provides recommendations based on users’ geographic patterns. Our study consists of four steps: (1) a pre-survey that helps us comprehend people’s views on physical activity, how people use their smartphones, and how smartphone applications may help them to be more active, (2) a large scale Twitter study (over 3 months, analyzed 929,825 running-related tweets) that determines how difficult it is for people to keep performing the most popular exercise—running, (3) a 2-week trial of our smartphone app which promotes an easier exercise—walking, and (4) a post-survey for subjects who participated in the app trial to validate if the app works as expected."