Bakgrund: Endometrios är en sjukdom som drabbar var tionde kvinna i fertil ålder. Fysioterapi rekommenderas som alternativ behandling eftersom det kan ha en smärtlindrande effekt och höja kvinnornas livskvalité. I litteraturen framkommer inte hur kvinnor med endometrios upplever den fysioterapeutiska behandlingen som helhet. Det finns därför behov av att undersöka hur den fysioterapeutiska behandlingen upplevs av kvinnor med endometrios. Syfte: Utforska kvinnors erfarenheter och upplevelser av endometrios och fysioterapeutisk behandling vid endometrios. Metod: Studien var av kvalitativ design. Semistrukturerade intervjuer genomfördes med fem kvinnor i åldrarna 24–40 år som diagnostiserats med endometrios. Deltagarna rekryterades via en Facebookgrupp och ett Instagramkonto för kvinnor med endometrios. Bekvämlighetsurval tillämpades. Databearbetning av materialet gjordes genom kvalitativ innehållsanalys. Resultat: I analysprocessen formulerades fyra huvudkategorier: Att leva med endometrios, Betydelse av fysioterapeutens förkunskap, Att skapa en trygg miljö med patienten och Individuella upplevelsen av de fysioterapeutiska behandlingarna. Kategorierna lyfter upplevelser och erfarenheter av sjukdomens påverkan i vardagen, fysioterapeutens kunskap och bemötande samt effekten av behandlingsmetoderna. Slutsats: Endometrios beskrevs ständigt påverka informanternas vardag där fysioterapin bidragit till lindring av symtom genom att de fått ny kunskap om smärtan samt individuellt anpassade behandlingar. Det ansågs värdefullt för informanterna att vara delaktiga i val av behandling. Att bli hörd och bekräftad upplevdes som viktigt i mötet med fysioterapeuten. Det framkom olika upplevelser av effekten av TENS, akupunktur, fysisk aktivitet och behandling av bäckenbotten. För att tydliggöra vad som gör behandlingen effektiv behövs fler studier. / Background: Endometriosis is a disease that affects every tenth woman of reproductive age. Physiotherapy is recommended as part of a treatment because it can have a pain-relieving effect and increase quality of life. The literature does not present how women with endometriosis experience the physiotherapeutic treatment. Therefore, there is a need to investigate how physiotherapeutic treatment is experienced by women with endometriosis. Objectives: Examine women's experiences of endometriosis and physiotherapeutic treatment in endometriosis.  Method: The study was of qualitative design. Five semi-structured interviews were conducted with women aged 24–40 diagnosed with endometriosis. They were recruited through a Facebook group and an Instagram account. Convenience sampling was applied. Data processing was done with qualitative content analysis. Results: Four main categories were formulated: Living with endometriosis, Importance of physiotherapist's knowledge, Creating a safe environment with the patient and Individual experience of the physiotherapeutic treatments. The categories highlight experiences of the impact of the disease, the physiotherapist's knowledge and the effect of treatment methods. Conclusion: Endometriosis was described as constantly influencing the everyday lives of informants where physiotherapy has contributed to relief of symptoms by obtaining new knowledge and by individually tailored treatments. It was considered valuable for informants to be involved in the choice of treatment. Being heard and validated was perceived as important. Various experiences of the effect of TENS, acupuncture, physical activity and treatment of the pelvic floor emerged. To clarify what makes the treatment effective, more studies are needed.

Magister Artium (Social Work) - MA(SW) / Foster care is a major area of interest within the field of social work studies. The South African welfare system has not done enough to assist the youth exiting the system. This study aimed to explore and describe the experiences and support systems for youth exiting the foster care system. A qualitative exploratory-descriptive research approach was utilized with of focus group discussions, which were thematically analysed. The Humanities Social Science Research Ethics Committee ethically approved this study. Four themes were identified: insight into foster care system, challenges experienced by the youth exiting care, support needed by youth exiting care and challenges experienced by the social workers to manage foster care placements.

Adverse childhood experiences (ACEs) are stressful or traumatic events that occur during childhood that impact health and wellbeing, thus having long-lasting effects. In the context of parenting, a history of ACEs can impact a caregiver’s ability to manage stress and interfere with their ability to provide sensitive and regulated caregiving. Thankfully, there are many ways that one can foster resilience in the face of past ACEs. This study aims to help mothers combat ACEs and parenting stress by experimentally investigating the benefits of two resilience-building programs. The first is an emotion-based program that focuses on emotion regulation, self-care, and attachment theory. The second is a behavior-based program that focuses on developmental milestones and general behaviorally based parenting practices (e.g. positive reinforcement, punishment). The present project uses a pre/post/follow-up design to assess parenting stress before and after engagement in the resilience-building programs. Mothers of 3-year-old children will complete the ACEs Questionnaire, which assesses how many and what specific ACEs participants have (pre-assessment), and the Parental Stress Scale (PSS), which assesses their parenting stress (pre, post, follow up). Although statistical analyses will be conducted to examine differences in PSS scores, the ACEs Questionnaire will only be used to ensure that the sample examined is mothers with ACEs, as participants who report no ACEs will be excluded from data analysis. In addition to self-report questionnaires, participants visit the Affect, Regulation, Coping, and Health (ARCH) lab to complete moderately stressful tasks while physiological data is obtained; data from lab visits will not be analyzed in this project but will be collected since this research is a part of a larger study called the 2Gen: Feeling Better Project (2Gen) that aims to examine emotion coregulation and physiological synchrony between mothers and their three-year-old children. After the pre-assessment, participants will be randomly assigned to one of the two 8-week programs (Emotion Curriculum, Behavior Curriculum) which will be provided through electronic links to brief videos. Participants also receive binders with the video scripts, handouts, resources, and reflection questions for each week’s content. Due to being at early stages in data collection, the present project will summarize the 2Gen protocol and will simulate data using mean parenting stress values from comparable studies. That simulated data will then be analyzed using JASP, an open-source statistics software. A 2x2 factorial ANOVA will be run to compare pre and post PSS scores for the emotion and behavior-based resilience-building programs. We hypothesize that parenting stress scores will decrease for all participants; however, we anticipate this change to be greater for those who receive the emotion-based program.

Globally, great strides have been made in developing essential strategies and knowledge necessary to prevent vertical transmission of HIV. Retention in the Prevention of Mother to Child Transmission (PMTCT) programme is essential for the achievement of this aspiration. The study applied Mixed Method Sequential Explanatory Design to explore the factors that underscored the retention decisions of newly diagnosed HIV positive pregnant women. The study was set in the PMTCT programme in the Takoradi Government Hospital, Ghana, a lower middle income country. PMTCT records were retrospectively reviewed. Subsequently, the Appreciative Inquiry process using the 4Is terminology was applied to unearth the experiences and aspirations of mothers (n=12), midwives and Community health nurses (CHNs) (n=12) engaged in the programme. Ethical approval was granted by University of Cape Town Faculty of Health Sciences Human Ethics Research Committee and Ghana Health Service Ethics Review Committee. Retention rate at six weeks postpartum was 67.4%. Retention stories of women enrolled in the PMTCT programme reflected a life-enhancing experience in the face of a life-threatening diagnosis. Four themes were generated: Transitioning to the ‘new’ woman, Journeying with committed companions, Glimpses of triumph and Tying up the loose ends: A daring new path. The study highlighted development of hope in a seemingly hopeless situation, supportive network of family, healthcare professionals and religious leaders, and the commitment and companionship of the midwives and CHNs that culminated in the successes of the programme. ‘Healthy’ HIV-infected mothers and ‘exposed’ infants who tested negative to HIV at the end of the mother-infant pair’s journey in the PMTCT programme was evidence of the diligence of mothers, midwives and CHNs. A collaborative discussion resulted in the development of action plans to improve service delivery, enhance clients’ experiences and improve retention. The study recommends that PMTCT services should be structured to promote hope and empowerment for the clients through shared clients and healthcare professionals’ designed improvement programmes, instituting programmes that promote the emotional health of the health practitioners to sustain the programme, and promptly addressing health system challenges that contribute to disengagement.

In the South African context, a geographical region prone to the occurrence of frequent and intense periods of drought, the emergence of climate conditions reaching new extremes raises concerns of adaptability to sustain living and work well-being in such circumstances. The realisation of economic, social, environmental and psychological impacts resultant from drought conditions is particularly relevant to farmers, an occupation group who are often characterised by socio-economic vulnerability in South Africa. Consequently, this research seeks to explore the yet undocumented experiences of farmers living and working in the current drought conditions, located in the Karoo region of South Africa. A further aim of this research is to explore how these experiences have affected farmers' psychological well-being, as well as understanding the coping mechanisms they have used to deal with this long-standing crisis situation. The present study adopted an exploratory case study design using an interpretivist paradigmatic stance. Based on research conducted and reviewed within the climate change domain, it was understood that farmers' experiences of working in drought conditions were complex, context specific and differed amongst individuals. Therefore, knowledge was viewed as subjective as there was no particular, correct path to knowledge as it emerged through various contexts. The case under study was Karoo farmers in the Western Cape province. Their living and working experiences, and coping mechanisms were specific to their surrounding landscapes and chosen type of farming. Furthermore, this case study was particularly concerned with farmers who retained close living, working and cultural relationships to their natural environments. Consequently, the unit of analysis in this study was the individual. A purposive sampling strategy was adopted and a total of eight participants were interviewed. An inductive approach to analysing the data was undertaken, using Braun and Clarke's (2006) Thematic Analysis. Three major themes emerged during the analysis with a number of associated sub-themes. The results describe the sample's shared ecological grief experiences due to both implicit and explicit impacts resultant from sustained drought conditions. The negative psychological outcomes the sample endured as a result of these experiences, demonstrates the implication of living and working in such conditions for work and psychological well-being. The common coping mechanisms employed over this time are also extracted from the themes. The discussion presents the findings of this study through the lens of the Sustainable Livelihoods Approach framework, to understand how drought conditions presents barriers to these farmers sustaining their well-being.

To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p<.0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.

In Namibia, mental health is considered as a low priority health concern hence resources are instead diverted to life threatening illnesses. Furthermore, it is estimated that about 15% of the Namibian population suffers from mental health, with schizophrenia being the most common mental disorder. Despite the limited resources, The Ministry of Health and Social Services seeks to promote the extension of health for the care of people living with mental disorders to the family and community at large; however, such services are not yet in existence. Consequently, the responsibility of caring for the mental health users is shifted to the family caregivers who tend to be negatively affected. Additionally, only a few mental health users receive adequate mental health services and this places even more burden on the caregivers (MoHSS, 2005:5; MoHSS, 2010:13). It is against this background that the present study was conducted. The goal of the study was to explore the experiences among the caregivers of mental health users with schizophrenia in the Nankudu District, Namibia. The study was explorative in nature hence the qualitative research approach was used. Furthermore, the study adopted the case study design to explore the lives of caregivers in a modern restricted system through interviews to gain in-depth data and to understand of their lives. One on one, semi structured interviews were used to collect data from ten caregivers of mental health users with schizophrenia in Nankudu district. The purposive sampling method was used to select the participants for the study. The findings revealed that the caregivers experience physical, psychological, emotional, social and financial burden as a result of their caregiving roles and responsibilities towards the mental health users. The psychotic episodes for instance were negative experiences for all the caregivers. The caregivers adopted various roles and responsibilities towards the care of persons with schizophrenia such as overall involvement in their treatment plan, seeking for alternative traditional medicine and daily functional support of the mental health users. Moreover, they also experienced stigma from the community members and it constituted to more social and psychological effects. The study further revealed the lack of community based mental health care services and social work services for the mental health users and caregivers. Subsequently, the caregivers rely on other family members, friends and neighbours and interestingly, police officers for support. The study also highlighted some positive experiences encountered by caregivers such as acceptance of their caregiving role, good support system and the mental health user’s adherence to medication and recovery. Due to the highlighted findings, it is recommended that the Ministry of Health and Social Services should establish and implement family psychoeducational programmes for the caregivers and mental health users with schizophrenia to ensure their active involvement in the treatment plan, improve the quality of care and their well-being. Moreover, the Ministry of Health and Social Services should expedite the implementation of community based mental health services to offer support to the mental health users and caregivers as highlighted in the National Mental Health policy. Lastly, health professionals such as Social Workers should provide continuous psychosocial support to the caregivers in order to help them to address their negative experiences. / Dissertation (MSW (Health care))--University of Pretoria, 2019. / Social Work and Criminology / MSW (Health care) / Unrestricted

OBJECTIVE: To examine association between Adverse Childhood Experiences (ACE) and teeth extracted due to dental caries or periodontitis among young and middle-aged US adults. METHODS: Study sample included 15,474 and 17,430 respondents aged 18-64 completing 2010 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey respectively. Outcome was any self-reported tooth extraction due to caries or periodontitis. Primary predictor were self-reported 11 ACE answers (categorized into none, 1, 2, and 3+) before 18 years of age. Covariates included smoking, heavy alcohol consumption, diabetes, health coverage and access to dental care. Odds ratios were computed from unadjusted and adjusted logistic regression models. RESULTS: Overall ACE prevalence was 66.5% and 64.9% in BRFSS 2010 and 2012 study sample respectively. In unadjusted models we observed a graded association wherein adults reporting experienced 2 and 3+ ACE were more likely to experience tooth extractions compared to those reporting no ACE exposure. (BRFSS 2010 OR = 1.47,1.48; BRFSS 2012 OR = 1.33, 1.54 respectively; p<0.05). We found similar results in multivariate models after adjusting for covariates (BRFSS 2010 OR = 1.56,1.34; BRFSS 2012 OR = 1.36, 1.42 respectively; p<0.05). CONCLUSIONS: This study suggests potential long lasting impact of early adverse life events on oral health in young and middle adulthood. Young and middle-aged adults experiencing multiple ACE had significantly more extractions compared to adults who reported not experiencing any ACE. Multidisciplinary efforts between dentists, physicians and social therapists are needed to raise awareness about ACE as means of identifying and reducing dental health inequities. / 2020-06-13T00:00:00Z

Experiencing a patient death can directly affect the well-being of health care professionals; however, this phenomenon and the effects of patients' deaths are not well understood in the transport setting. Transport nurses work in unique settings with complex patients and significant autonomy in determining the plan of care; therefore, the experiences of other health care professionals may not be applicable in this environment. The purpose of this qualitative study was to explore the lived experiences of transport nurses who have experienced patient death using Husserl's life-world and phenomenological philosophies as a theoretical framework. Semistructured interviews were completed with 8 transport nurses who had experienced a patient death in their care using video-conferencing and verbatim transcription of the interviews. Data analysis was manually coded and categorized into themes based on Moustaka's modification of the Van Kaam methods of analysis of phenomenological data. Key findings included 5 themes. Findings from this study indicate that patient death, particularly unexpected death, takes an emotional toll on transport nurses. Most transport nurses indicated that they did not have formal debriefing or support from the transport program following patient death. Transport nurses relied on their partners for feedback and support following patient death. Recommendations based on this research include promoting education regarding the psychosocial effects of death in the transport environment and formal debriefing following an unexpected death. Results from this study can be used to promote positive social change by improving the experiences of transport providers following a patient death, which may lead to improved retention and nurse satisfaction.

Becoming a new parent can cause both immense joy and immense stress that leads to increases and decreases in a new parent’s feeling of life satisfaction. In addition, working as a mental health clinician is a frequently challenging career. Given that many clinicians also become parents while working during the course of their careers, it is surprising that there is not more research on the experience of clinicians who become new parents. More research is needed to find out how people balance the stresses of new parenthood and their emotionally challenging jobs. There is some research on “stress-related growth” that suggests that people can experience stressful or traumatic events and emerge on the other side feeling like they have achieved positive personal growth. This study attempted to find out if this occurs when clinicians become parents. This was a narrative study aimed to add to the research literature on parent clinician’s (clinicians who were also parents) lives by presenting their stories of becoming new parents. Five parent clinicians were interviewed on two separate occasions and those interviews were transcribed; the transcriptions were edited into five individual stories that detail the parent clinician’s unique challenges, how they navigated their challenges, and how they reflected on their experiences and their personal growth. The five parent clinicians recounted many positive and negative experiences that new parenthood had on both their clinical work and personal lives. In addition, they described how their families and identities helped them to make meaning out of the challenges they faced. The parent clinicians all talked about how either the presence or absence of social support, or their personal and professional relationships, impacted their lives when they became new parents. Social support included institutional support such as their employers or graduate departments and personal support such as their co-parents, families, and friends. This support either helped or hindered the parent clinician’s ability to balance the demands of parenthood and work. Furthermore, the findings supported previous research on stress-related growth that suggest that cognitive processing (thinking about an event after it occurred) and social support predict the perception of positive personal growth. This was the first known narrative study on the impacts of new parenthood on mental health clinicians and the study adds to the research literature on clinician’s lived experiences. In addition, the findings from the study can help training directors, clinical supervisors, and agency directors to develop new policies that increase new parents’ social support which may help them weather the storms of becoming a new parent while working as a clinician.