M.Sc (Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: Bacterial vaginosis (BV) results from a shift in normal vaginal flora and predisposes women to sexually transmitted infections (STI) including HIV. Risk factors for BV are not well understood. This analysis seeks to determine the disease frequency of BV, assess determinants of BV and quantify time to first BV episode in HIV negative women. Methods: Baseline and follow-up data from 1066 women was analysed in STATA10. Logistic regression was used to determine baseline factors associated with BV and Kaplan Meier survival analysis to estimate time to BV episode. Results: BV prevalence and incidence was estimated at 48.42% and 81 cases per 100 women years respectively. Controlling for age and education, women with Trichomonas vaginalis, Chlamydia trachomatis, Herpes Simplex Virus2 and lower socio-economic status were 67%- 380%, 31%-472%, 20%-220% and 4%-91% more likely to present with BV respectively. Consistent condom use and being a housewife or student was significantly (p<0.05) associated with lower prevalent BV, with a significant interaction between age and education (p<0.05). The median time to first BV episode was 9.7 months. Conclusion: The analysis identifies modifiable risk factors like condom use, injectable contraceptives and treatment of STIs which could potentially decrease the high BV disease burden.

The current study examined the efficacy of a 1 month future time perspective modification intervention over a 1 month and 6 months period. Participants (N = 92) with elevated scores on measures of depressive symptoms or suicidal ideation were assigned to either the intervention condition or a no-intervention control condition. A repeated-measures manova revealed that those in the time perspective modification intervention condition showed significant reductions in psychache and hopelessness at 1 month, relative to those in the control condition. Repeated-measures manovas did not reveal significantly greater changes in depressive symptoms, suicidal ideation, or future time perspective. No results at 6 months were found to be significant. These results suggest that a future time perspective modification intervention can reduce important predictors of suicidality, although the sustainability of these gains and their relation to suicide is unclear. / Thesis (Master, Psychology) -- Queen's University, 2011-08-29 13:29:07.463

Thesis (Ph. D.)--University of Wisconsin--Madison, 1972. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Submitted in partial fulfilment of the academic requirements for the degree: Master of Education - Research Methodology in the Department of Educational Psychology of the Faculty of Education at the University of Zululand, 2010. / There is ongoing debate regarding the public health message of introducing a microbicide that is less efficacious than condoms into the HIV prevention field. One key issue is whether the availability of microbicides would undermine women's bargaining power to negotiate condom use. Most microbicide trials report increased condom use among participants. This analysis attempts to separate the influence of increased safer sex counselling from the direct impact of gel use as a facilitator to condom acceptability. In-depth interviews were conducted with a random sample of women participating in the MDP 301 Phase III microbicide trial, and a sub-sample of their male partners. Data from 63 female and 5 male interviews were analysed to assess the impact that participating in a clinical trial and using a vaginal microbicide/placebo gel had on condom usage. Two thirds of women reported not using condoms prior to study participation due to male opposition. Most of the women interviewed were unable to explain their partners' resistance to condoms. Some of the underlying factors were related to men's resistance to using condoms with a main or long term partner (as opposed to casual partners); preference for skin-to-skin contact; or rumours about negative health implications such as condoms containing maggots. A third of women started using condoms, although inconsistently, after joining the trial. Women used participation in the trial as the rationale for discussing the risks of HfV infection and condom use with their partners. Men appeared to be more willing to use condoms in the presence of gel, and this was partially due to the gel counteracting the negative effects of condom use on sexual pleasure. Joining the trial appeared to create an opportunity for women to discuss sex with their partners, and the introduction of gel into the relationship serves as a bargaining tool for condom use with their partners.

This thesis examines the mode of trial concerns in the U.S.A., New York State, California, England and Wales and Canada --specifically the ability of the jury to comprehend complex cases and the perception/reality that bench trials may not be as fair as jury trials. Defining complex cases as those involving serious fraud indictments, capital murder trials, and lawsuits or indictments against corporations and their managers, the thesis examines problems associated with jury trials in such cases. It evaluates the comparative law and customs and practices regarding the use of juries, emphasizing problems with jury selection, deficits in jury deliberation and post trial problems associated with jury verdicts. The thesis also evaluates the judge only trial, attempting to determine whether a state imposed non jury trial in a criminal case as is presently proposed in the England and Wales Parliament creates an unfairness to the defendant because bench trials significantly differ from jury trials in the application of the rules of evidence and in the role of the judge. The thesis reports on the results of a survey of New York State trial judges, a like survey of New York State lawyers, and the opinions of nine England and Wales judges authorized to try serious fraud cases who were interviewed regarding these issues. The surveys and interviews finds that there is a high degree of support for jury verdicts expressed by the judges, examines evidentiary and pretrial practices in both modes of trial and attempts to evaluate whether claims of procedural flaws and prejudice in bench trials by respected academics are accurate. The thesis concludes by affirming the competence of juries to try complex cases, proposing modifications to post jury verdict procedures to evaluate jury misconduct and advocating that the bench trial evidentiary rules and conduct rules become comparable to the jury trial. The thesis recommends that mode of trial choices be given to the defendant, advocates that when a bench trial is selected that peremptory challenges of the trial judge be permitted and postulates that these reforms will make the bench trial a more attractive alternative to the jury trial in complex cases.

Two studies were devised to determine why the difference in manual aiming performance, between full vision and no vision, is decreased for a randomized visual feedback schedule. In study one, aiming accuracy and precision was assessed for up to four trials in the same vision condition, following a switch in visual feedback availability. In experiment one, visual feedback availability was uncertain; while in experiment two, certainty was provided. Results of both experiments revealed that the precision of the first trial immediately following the switch in visual condition was reminiscent of the trial that preceded it, even when performed under different visual conditions. For study two, the inter-trial interval was evaluated by extending the interval to five seconds. Results indicated no reminiscence effect. Overall, we suggest that when the inter-trial trial is brief, individuals rely on offline visual information from the preceding trial to plan the subsequent movement, regardless of certainty.

Two studies were devised to determine why the difference in manual aiming performance, between full vision and no vision, is decreased for a randomized visual feedback schedule. In study one, aiming accuracy and precision was assessed for up to four trials in the same vision condition, following a switch in visual feedback availability. In experiment one, visual feedback availability was uncertain; while in experiment two, certainty was provided. Results of both experiments revealed that the precision of the first trial immediately following the switch in visual condition was reminiscent of the trial that preceded it, even when performed under different visual conditions. For study two, the inter-trial interval was evaluated by extending the interval to five seconds. Results indicated no reminiscence effect. Overall, we suggest that when the inter-trial trial is brief, individuals rely on offline visual information from the preceding trial to plan the subsequent movement, regardless of certainty.

The aim of this thesis was to develop and evaluate a complex intervention for major depression in patients with lung cancer. Major depression is a leading cause of disease burden worldwide and is particularly important in patients with lung cancer, not only because it is common in this poor prognosis cancer group but also because it substantially reduces the quality of the often short period of time that patients have left to live. The thesis describes a systematic review of the relevant research literature, the development of a complex intervention and a multi-centre randomised controlled trial. I found no trials, in my systematic review, that had evaluated the effectiveness of treatments for depression in patients with lung cancer. I did, however, find six trials of interventions intended to improve symptoms or quality of life in this patient group, the findings of which suggested that enhanced care approaches were more effective in reducing depressive symptoms than standard medical care. I developed the complex intervention ‘Depression Care for People with Lung Cancer’ (DCPLC) with 12 patients who had major depression and lung cancer. DCPLC was delivered by a team of cancer nurses and psychiatrists in collaboration with the patient’s GP. It included education about depression, antidepressant medication, psychological treatments (behavioural activation and problem solving therapy) and systematic progress monitoring. The trial comparing DCPLC with usual care included 142 patients. Patients who received DCPLC reported significantly lower average depression severity during their time in the trial, and better self-rated depression improvement, anxiety, quality of life, role functioning and perceived quality of depression care. The methodological limitations, relevant literature and implications of these findings for future research and for clinical practice are discussed.

Circulating concentrations of vitamin D metabolites are associated with risk for a variety of diseases, including colorectal cancer. It is not known what level of circulating 25(OH)D is optimal for health; however, over-the-counter (OTC) vitamin D supplements are commonly used to improve status, though their effectiveness is unknown. It is also not known if polymorphic variation in genes associated with the vitamin D endocrine system is associated with differences in vitamin D metabolite levels or colorectal neoplasia.METHODS: A double-blind, randomized, placebo-controlled trial examined the effect of 400 IU OTC cholecalciferol on circulating concentrations of 25(OH)D. Associations between polymorphic variation in VDR, RXRA, GC, and CASR and circulating vitamin D metabolites or colorectal neoplasia were examined through analysis of the Ursodeoxycholic Acid (UDCA) and Wheat Bran Fiber (WBF) clinical trial data. A single nucleotide polymorphism (SNP) tagging approach was employed and a total of 42 VDR, 32 RXRA, 35 CASR and 25 GC tagSNPs were analyzed.RESULTS: The net change in serum 25(OH)D in the supplement versus placebo group was 2.3 ng/ml (8.5% change, P = 0.06). Principal components analyses revealed gene-level associations between RXRA and serum 1,25(OH)2D concentrations (p = 0.01) as well as GC and 25(OH)D concentrations (p < 0.01). Seven individual GC polymorphisms were significantly associated with circulating measures of 25(OH)D in addition to CASR polymorphism rs1042636 and proximal colorectal neoplasia (p-value =0.02), following a multiple comparisons adjustment. The CART analysis identified rs17467825 as predictive of continuous measures of 25(OH)D. GC polymorphisms rs1555563, rs7041, and rs222029 were identified as significantly predictive of the 25 ng/ml threshold for insufficiency.CONCLUSION: The results demonstrate that daily 400 IU OTC cholecalciferol is sufficient to maintain baseline concentrations of 25(OH)D in healthy adults, but not to significantly increase levels in all individuals. The results also identified polymorphisms in RXRA, GC, and CASR associated with or that predict vitamin D metabolite levels or colorectal neoplasia risk. The results justify further investigation on the optimal vitamin D supplementation dose for the general population and genetic variation that may be related to circulating concentrations of vitamin D metabolites or colorectal neoplasia.

No description available.