Women's social position and their health : a case study of the social determinants of the health of women in Khayelitsha, Cape Town, South Africa

Includes bibliographical references.This thesis examines the social determinants of women's health status, health knowledge and knowledge and use of health services in a peri-urban area, using Kbayelitsha in Cape Town, South Africa as a case study. It argues for the importance of women's health as a specific focus, looks at some trends in women's health internationally over the past two decades and reviews the main factors affecting women's health. Some key issues in women's health of special relevance to developing countries such as South Africa are discussed. There is a special focus on newly urbanised women in peri-urban areas. Against this background the results of a community-based survey, preceded by indepth interviews, and conducted amongst 659 women in Kbayelitsha in 1989 and 1990 are presented. Data collected were statistically analysed using unIvariate,, bivariate and multivariate analysis. A number of priority social and health problems are identified: poverty; poor environmental conditions; lack of education, partlcularly skills training appropriate for finding work and the subordinate social status of women. Major health concerns included reproductive tract infections, especially sexually transmitted diseases, infertility, contraceptive use and ante-natal care during pregnancy. There were inadequacies in cervical screening conducted by health services and deficiencies in respondents' knowledge of AIDS. cervical smears and where to obtain various health services . Young, newly urbanised women, living in the poorly serviced and unserviced informal housing areas were partlcularly vulnerable in their socio-economic and health status within a peri-urban African community such as Khayelitsha. They also had poorest health knowledge and least knowledge of where to acquire health services. Some recommended interventions focussing on certain of these areas are suggested. It is argued that changes in the provision of women's health services within a primary health care setting can only be part of the process of improving women's health. Improvements in women's economic status and their social status are fundamental to any initiatives to improve their health status

Computer Anxiety and Computer Self-Efficacy of Older Adults

Many older adults (aged 55 and older) need training to acquire computer knowledge and skills. Using computers and the Internet could provide access to vital resources for improving older adults\u27 health and maintaining their connections with family and society. This study examined 2 psychological constructs--computer anxiety and computer self-efficacy--that have been shown to impact a person\u27s successful use of computers and related technology. Guided by Bandura\u27s self-efficacy theory, which emphasizes the importance of adult learners being motivated and taking charge of their learning, this study examined the impact of a computer knowledge and skills workshop on older adults\u27 computer anxiety and computer self-efficacy. A concurrent, mixed-methods design was used to collect and analyze survey data and interview transcripts from a convenience sample of African American older adults (N = 11). Mobile technology (i.e., tablet PCs and portable hotspots) was used to access the Internet and e-mail. Data analyses included thematic coding of the interview notes and descriptive statistics to present the survey results. The themes that emerged from the interview data were learning opportunities, positive attitudes, and user-friendly tools and equipment for reducing computer anxiety and constructive attitude changes and learning environments for improving computer self-efficacy. The descriptive statistics indicated favorable changes for computer anxiety with scores averaging a decrease of -26.5% and computer self-efficacy with scores averaging an increase of 62.1%. This study illustrated the feasibility of a low-cost approach for establishing a mobile computer laboratory to help older persons become proficient in their use of computers, the Internet, and related technology

A scoping review to establish the relationship of community to the lives of looked after children and young people

Friendship networks and relationships with communities are important parts of the lives of looked after children and young people (LACYP). Much of legislation, policy, practice and research focuses on „the care experience‟ itself, as distinct from young people‟s everyday lives and their connectivity with wider environments. Considerable lack of understanding remains about what being „in care‟ means. This often results in prejudice and stigma. Groups set up specifically for LACYP offer opportunities to develop networks and relationships with adults and young people, and to raise awarenesses. Transitions may happen early and be experienced frequently by LACYP, however, they can offer new opportunities and positive relationships with different people. Meaningful participation in communities such as schools is an important factor in developing stability in relationships. Concepts of participation and empowerment form part of an ecological framework which locates the community context as central to building resilience for LACYP. What constitutes community cohesion and connectedness for LACYP requires a fine balance between the interests of protection and participation. Successful interconnectedness is a matter of shared concern for all. The key challenge remains that of identifying how stable community relationships for LACYP may be strengthened and supported to dynamic mutual benefit. These documents are outputs from the same project: 1) an end of project discussion paper; 2) an extended version of the discussion paper; and 3) four short guides for practice and polic

Sexual and reproductive health perceptions and practices as revealed in the sexual history narratives of South African men living in a time of HIV/AIDS.

Abstract The frequent positioning of men's sexual risk-taking as driving the HIV/AIDS epidemic in South Africa has triggered interest in men's sexual and reproductive health (SRH) perceptions, attitudes, and practices. Much research, however, presents men as a homogenous group, and focuses on the quantifiable aspects of male sexual behaviors, providing an inadequate basis for understanding men's SRH needs and addressing the gendered aspects of HIV prevention. This study used sexual history narratives to yield more nuanced and contextualized understandings of male sexuality as it relates to SRH. Fifty sexual life history individual interviews and 10 focus-group discussions (FGDs) with men, as well as 25 sexual life history interviews with women, were conducted with participants purposively sampled from three age categories: (18-24, 25-55, and 55+ years), a wide range of cultural and racial backgrounds, and in urban and rural sites across 5 provinces in South Africa. Interviews and FGDs elicited stories of participant's early knowledge of sex and sexual experimentation and then explored sexual relationships and experiences in adulthood-including engagement with HIV risks and SRH management. The data were analyzed using a thematic approach. Many male participants conformed to dominant norms of masculinity associated with a high risk of sexually transmitted infections including HIV, such as having regular unprotected sex, reluctance to test for HIV, and poor SRH-seeking behaviors. Yet, the narrative accounts reveal instances of men taking steps to protect their own SRH and that of their partners, and the complex ways in which hegemonic gender norms influence men and women's SRH. Ultimately, the study points to the value of sexual biographies for gaining a deeper understanding of male sexuality, and the social structures, meanings, and experiences that underlie it. Such insights are critical to more effectively engaging men in HIV prevention efforts

Associating object names with descriptions of shape that distinguish possible from impossible objects.

Five experiments examine the proposal that object names are closely linked torepresentations of global, 3D shape by comparing memory for simple line drawings of structurally possible and impossible novel objects.Objects were rendered impossible through local edge violations to global coherence (cf. Schacter, Cooper, & Delaney, 1990) and supplementary observations confirmed that the sets of possible and impossible objects were matched for their distinctiveness. Employing a test of explicit recognition memory, Experiment 1 confirmed that the possible and impossible objects were equally memorable. Experiments 2–4 demonstrated that adults learn names (single-syllable non-words presented as count nouns, e.g., “This is a dax”) for possible objectsmore easily than for impossible objects, and an item-based analysis showed that this effect was unrelated to either the memorability or the distinctiveness of the individual objects. Experiment 3 indicated that the effects of object possibility on name learning were long term (spanning at least 2months), implying that the cognitive processes being revealed can support the learning of object names in everyday life. Experiment 5 demonstrated that hearing someone else name an object at presentation improves recognition memory for possible objects, but not for impossible objects. Taken together, the results indicate that object names are closely linked to the descriptions of global, 3D shape that can be derived for structurally possible objects but not for structurally impossible objects. In addition, the results challenge the view that object decision and explicit recognition necessarily draw on separate memory systems,with only the former being supported by these descriptions of global object shape. It seems that recognition also can be supported by these descriptions, provided the original encoding conditions encourage their derivation. Hearing an object named at encoding appears to be just such a condition. These observations are discussed in relation to the effects of naming in other visual tasks, and to the role of visual attention in object identification

The effectiveness of different lifestyle interventions on body composition, insulin sensitivity, and novel biomarkers of insulin resistance in obese individuals

Obesity is a serious global health problem (WHO, 2009) and an independent risk factor for a number of chronic diseases (Quilliot, Petit et al. 2002). Obesity is caused by a mismatch between energy intake and energy expenditure leading to storage of surplus energy and expansion of fat stores which causes metabolic disturbances (Speakman, 2004). Diet and exercise interventions remain the cornerstone of treatment for obesity but they have been largely ineffective (Franz et al. 2007). The purpose of this thesis was to identify components of a lifestyle intervention that are most likely to improve body composition, insulin sensitivity, and novel biomarkers of insulin resistance in obese individuals. This was achieved by investigating 4 different short term interventions. In study 1, isocaloric diet and exercise interventions were compared, while in study 2 concurrent training (regular resistance training combined with aerobic exercise) and concurrent training incorporating an eccentric component were compared. Briefly, the key findings of this PhD thesis were that isocaloric diet and exercise interventions lead to similar reductions in body weight, but exercise training may lead to greater improvements in body composition and metabolic health. Importantly, aerobic fitness was the single best predictor of improvements in metabolic health in this population. Resistance training is important for improving lean tissue mass, fat oxidation and resting metabolic rate. The novel biomarkers of insulin resistance are differentially regulated by diet, exercise and different modes of exercise training. Improvements in body composition and fitness drive improvements in insulin sensitivity and the circulating concentration of the biomarkers, and there is a cyclical relationship between the biomarkers and metabolic health. It is important to study the biomarkers for better understanding of metabolic processes but larger scale studies may be required to determine their role. A combination of calorie restriction, aerobic exercise and resistance training will optimise improvements in insulin resistance and body composition in obese individuals

Direct health costs of inflammatory polyarthritis 10 years after disease onset:Results from the Norfolk Arthritis Register

Objectives: To explore the change in direct medical costs associated with inflammatory polyarthritis (IP) 10 to 15 years after its onset. Methods: Patients from the Norfolk Arthritis Register who had previously participated in a health economic study in 1999 were traced 10 years later and invited to participate in a further prospective questionnaire-based study. The study was designed to identify direct medical costs and changes in health status over a 6-month period using previously validated questionnaires as the primary source of data. Results: A representative sample of 101 patients with IP from the 1999 cohort provided complete data over the 6-month period. The mean disease duration was 14 years (SD 2.1, median 13.6, interquartile range 12.6–15.4). The mean direct medical cost per patient over the 6-month period was £1496 for IP (inflated for 2013 prices). This compared with £582 (95% CI £355–£964) inflated to 2013 prices per patient with IP 10 years earlier in their disease. The increased cost was largely associated with the use of biologics in the rheumatoid arthritis subgroup of patients (51% of total costs incurred). Other direct cost components included primary care costs (11%), hospital outpatient (19%), day care (12%), and inpatient stay (4%). Conclusion: The direct healthcare costs associated with IP have more than doubled with increasing disease duration, largely as a result of the use of biologics. The results showed a shift in the direct health costs from inpatient to outpatient service use

Determinants of Sexual Activity and Its Relation to Cervical Cancer Risk among South African Women

BACKGROUND. Invasive cervical cancer is the commonest cause of cancer morbidity and mortality in South African women. This study provides information on adult women's sexual activity and cervical cancer risk in South Africa. METHODS. The data were derived from a case-control study of hormonal contraceptives and cervical cancer risk. Information on age of sexual debut and number of lifetime sexual partners was collected from 524 incident cases and 1541 hospital controls. Prevalence ratios and adjusted prevalence ratios were utilised to estimate risk in exposures considered common. Crude and adjusted relative risks were estimated where the outcome was uncommon, using multiple logistic regression analysis. RESULTS. The median age of sexual debut and number of sexual partners was 17 years and 2 respectively. Early sexual debut was associated with lower education, increased number of life time partners and alcohol use. Having a greater number of sexual partners was associated with younger sexual debut, being black, single, higher educational levels and alcohol use. The adjusted odds ratio for sexual debut < 16 years and ≥ 4 life-time sexual partners and cervical cancer risk were 1.6 (95% CI 1.2 – 2.2) and 1.7 (95% CI 1.2 – 2.2), respectively. CONCLUSION. Lower socio-economic status, alcohol intake, and being single or black, appear to be determinants of increased sexual activity in South African women. Education had an ambiguous effect. As expected, cervical cancer risk is associated with increased sexual activity. Initiatives to encourage later commencement of sex, and limiting the number of sexual partners would have a favourable impact on risk of cancer of the cervix and other sexually transmitted infections.National Cancer Institute (R01 CA 73985

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Evaluation of Bleeding Disorders in Patients With Noonan Syndrome: A Systematic Review

Background: Noonan syndrome (NS) is an autosomal dominant genetic condition that has a number of clinical features, including bleeding diathesis and a number of hematological abnormalities including clotting factor deficiencies, von Willebrand disease and abnormal platelet count/function. Methods: We evaluated the frequency/types of bleeding disorders, and associated hematological laboratory findings, in patients with NS, using published data from 1965 to 2014. Results: Of 45 studies identified, 31 included data for 428 patients with NS. Of these patients, 43% had reported bleeding, 26% had no reported bleeding and no bleed data was reported for 31%. Most patients (90%) had bleeding-related laboratory test abnormalities, but only 194 (45%) had a confirmed diagnosis of a specific bleeding disorder. Abnormal laboratory tests included: prolonged prothrombin time, activated partial thromboplastin time, and other platelet-related disorders. Of the 194 patients with a confirmed diagnosis of a specific bleeding disorder, 153 (79%) had single clotting factor deficiencies, von Willebrand disease or platelet-related disorders, and 41 (21%) had multiple deficiencies including platelet-related disorders. Conclusion: As patients with NS can experience multiple bleeding disorders, including abnormal platelet function, clinical evaluations should be performed at diagnosis, after diagnosis, before any surgery is undertaken, and if patients become symptomatic