Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2009. / Härtill 4 uppsatser.

The aims and objects of this work, as outlined in the introduction, were to a s s e s s the necropsy incidence of deaths due to heart failure in the African in Durban, to a s s e s s the necropsy incidence of the various aetiological types of heart failure with particular reference to right ventricular hypertrophy and failure, and to compare and contrast the incidence, complications, morbidity and mortality of heart disease in the Natal African with the same in other African and racial groups, both in South African and elsewhere. Many of the points emerging from this work merely confirm what has long been known, but others refute previous concepts. The all-age average necropsy incidence of deaths from heart failure in the African in Durban is of the order of 8%. This percentage does not, unfortunately, lend itself to straight comparison with most other series because of the high infant mortality shown in the present study. However, in considering deaths due to heart failure in the 10-plus age groups, the African still shows a lower mortality from heart disease in comparison with figures obtained for Indians or those reported for the Coloured and White races in South Africa. There are six major causes of heart disease in the African, which in order of frequency are, rheumatic heart disease, hypertensive heart disease, cardiomyopathy, cor pulmonale, pericarditis, and syphilitic heart disease. While little difference is apparent in the incidence of rheumatic and hypertensive heart disease, and possibly cor pulmonale, among the various races, cardiomyopathy, pericarditis and syphilitic heart disease are far more important causes of heart failure in the African by contrast with the other racial groups in South Africa. Although coronary a r t e r y disease is by comparison very uncommon in the African, cardiomyopathy, pericarditis, and syphilitic heart disease together claim as many deaths from heart failure in these people as does coronary heart disease among the Indian and White races in the Republic. Except for minor variations in the incidence of certain aetiological types, and the geographical distribution of endomyocardial fibrosis and cardiomyopathy/. . cardiomyopathy, the g e n e r a l p a t t e r n of h e a r t d i s e a s e among the Africans in Natal a p p e a r s to be s i m i l a r to that r e p o r t e d from other P r o v i n c e s in South Africa and most other c o u n t r i e s on the continent. Rheumatic h e a r t d i s e a s e is r e s p o n s i b l e for 21. 5% of all deaths from congestive h e a r t failure in the African in Durban. The immediate and the l a t e c a r d i a c complications of r h e u m a t i c fever in the Durban African a r e , on the whole, found to be no different from those r e p o r t e d in W e s t e r n communities. The findings in t h i s study t h e r e f o r e refute the view that r h e u m a t i c h e a r t d i s e a se i s infrequent in the African after the age of 40 y e a r s , and failed to support the suggestion that the d i s e a s e affects them m o r e s e v e r e l y or that death from r h e u m a t i c heart d i s e a s e o c c u r s at an e a r l i e r age in t h i s r a c e . While it is a g r e e d that s e v e r e valvular deformity in young African subjects (under 15 y e a rs of age) o c c u r s c o m p a r a t i v e l y m o r e frequently, it must be stated that this is in no way p e c u l i a r to the African, similar lesions being o b s e r v e d in Indian s u b j e c t s of c o r r e s p o n d i n g age. Hypertensive h e a r t d i s e a s e is common among the African in Durban, accounting among t h em for 18. 9% of all deaths from congestive h e a r t f a i l u r e. While both e s s e n t i a l and secondary forms of h y p e r t e n s i o n occur in the local indigenous population, the former appears to be m o r e common, with a peak incidence in the seventh decade of life. Secondary hypertension, mostly r e n a l in origin, is an i m p o r t a n t cause of h y p e r t e n s i v e congestive c a r d i ac f a i l u r e in the fourth decade. The wide v a r i a t i o n s in the type of h y p e r t e n s i on r e p o r t e d from the different regions in Africa, and the doubt e x i s t i n g as r e g a r ds the significance of focal lesions in the kidneys, point towards the need for g e n e r a l l y accepted c r i t e r i a in the diagnosis of r e n a l hypertension, p a r t i c u l a r ly with r e g a r d to chronic phylonephritis. Cardiomyopathy c l a i m s 15. 8% of all deaths from congestive heart f a i l u r e in the local African population. While many of the pathological changes o c c u r r i n g in the h e a r t in t h i s d i s e a s e were found to be s i m i l a r to those of other i n v e s t i g a t o r s , c e r t a i n f e a t u r e s , relating to c a r d i a c hypertrophy and s t r u c t u r a l a l t e r a t i o n s in the pulmonary v e s s e l s , have been e s p e c i a l ly i n v e s t i g a t e d / . . . investigated and results obtained in this series of cases show that whereas pure right ventricular hypertrophy is uncommon in cardiomyopathy biventricular hypertrophy with predominance of the right ventricle is the most frequent form of cardiac enlargement in such cases. Equal hypertrophy of the ventricles is the next common form of enlargement; left ventricular predominance is by far the least frequent, and no case of exclusive left ventricular hypertrophy was encountered. Although structural alterations in the pulmonary a r t e r i e s , indicating pulmonary a r t e r i a l hypertension, were observed in a large number of cases investigated, such changes were in no way specific to cardiomyopathy, since similar changes were observed in cor pulmonale due to emphysema and also in some cases of hypertensive congestive heart failure. Structural alterations in the small muscular pulmonary a r t e r i e s and arterioles were also identical with those found in emphysema. Whereas fresh pulmonary emboli and infarcts were frequently encountered and were often of such degree as to be the immediate cause of death, chronic pulmonary thrombo-embolism of an extent sufficient to have been the cause of right ventricular predominance was seldom found. It is suggested that the cause of the pulmonary hypertension and certain pathological changes in the heart in cardiomyopathy may lie in some form of exogenous toxin, possibly related to the practice of herbal medication among the African people, which acts as an a r t e r i a l vasoconstrictor in both the pulmonary and systemic circulations. This would suggest that the a r t e r i a l changes observed in the lungs are probably the result and not the cause of pulmonary hypertension. The incidence of cor pulmonale as a cause of congestive heart failure among the African in Durban is of the order of 12%. It has been shown that almost one quarter of all cases of right ventricular failure remains undiagnosed, as regards aetiology, at routine necropsy. The latter finding pointed towards the need for an investigation of the causes of right ventricular failure in the African. Such a study was undertaken and special methods of investigation w e r e / . . . were used as aids towards a more conclusive diagnosis. This study showed fibrosing lung disease, due particularly to the late complications of pulmonary tuberculosis, to be the most important cause in the production of chronic cor pulmonale in the African in Durban. The development of cor pulmonale in such cases depends not only on the presence of pulmonary parenchymal damage by fibrosis, but also on the associated pleural thickening, adhesions between chest cage and diaphragm, emphysema, and the curtailment of the pulmonary a r t e r i a l bed. In this series, all cases of fibrosing lung disease with cor pulmonale investigated for cardiac hypertrophy by means of separate weighing of the ventricles, showed evidence of pure right ventricular enlargement, indicating no significant chronic burden on the left ventricle of a diastolic overload through bronchial shunting. Thrombo-embolic cor pulmonale, hitherto believed to be r a r e in the African, emerges as the most important cause of acute cor pulmonale and the second most common cause of the more chronic varieties of the disease. The usual pathological type of pulmonary thrombo-embolic disease observed in this study is one in which fairly large pulmonary a r t e r i e s , as opposed to those of microscopic size, were involved and in consequence infarction was frequent. The lack of completely organised lesions, and the relatively small increase in total heart weights (majority below 400 Gms) suggest a rapid course in these cases, measured in months rather than in years. The usual source for pulmonary emboli was found to be the veins draining the lower limbs, particularly the deep calf veins. Whereas a predisposing factor for the development of venous thrombosis was found in just over half the number of cases investigated, in 44% of all cases of thrombo-embolic cor pulmonale in this study no cause was found at necropsy for the peripheral venous thrombosis. Of the predisposing causes encountered a posteriorly placed amoebic liver abscess emerges as an interesting aetiologic factor in the development of thrombo-embolic cor pulmonale because of its ability to produce hepatic vein and inferior vena caval thrombosis. Emphysema, usually in association with chronic bronchitis, was found to be the third most common cause of chronic cor pulmonale among Africans/ . . . Africans in Durban, and was encountered mainly in its mixed form (centrilobular and panlobular). Although structural alterations in the pulmonary a r t e r i es were noted in a significant number these were sometimes of insufficient degree to be the cause of pulmonary hypertension, thereby suggesting some other factor in the production of a raised pulmonary a r t e r i a l p r e s s u r e . Results of separate ventricular weighing in these cases show exclusive right ventricular hypertrophy, again indicating strain solely on the right ventricle. Bilharzial cor pulmonale, although one of the r a r e r causes of cor pulmonale in the African in this series, is suspected to be probably more frequent than hitherto believed. The lack of obvious macroscopic changes in the lungs of such cases is stressed, and while this may account for omissions in diagnosis, a sudden recent increase in the incidence of bilharzial cor pulmonale might also suggest that the disease is becoming more severe. Primary pulmonary hypertension as a cause of cor pulmonale in the African is r a r e , being suspected in only one case in this series. In keeping with the generally high incidence of infective diseases in the African, pericarditis as a complication of tuberculosis and hepatic amoebiasis, and the cardiac complications of syphilitic aortitis still occupy major positions among the causes of congestive heart failure in this population; together accounting for 12.4% of all deaths from congestive heart failure. Tuberculosis and amoebiasis are important not only in the production of p e r i c a r d i t i s , but, as mentioned, also play an important part in the development of cor pulmonale. Syphilitic heart disease, besides being a significant factor in the production of congestive heart failure, is the most important cause of a sudden cardiac death in the African. In conclusion it may be said that while little can be achieved with regard to the control of diseases for which no cause has as yet been found, the elimination of infective conditions such as tuberculosis, amoebiasis and syphilis will result in a significant drop in the incidence of death and disability from heart failure in the African in Natal. / Thesis (M.D.)-University of Natal, Durban, 1967.

UK health and safety legislation aims to protect employees from injury at work; professional footballers as employees are therefore covered by this legislation. A risk assessment approach to health and safety issues, as required by the Management of Health and Safety at Work Regulations 1992, has been undertaken to establish the epidemiological and aetiological factors related to injuries in professional football and to identify management and training procedures to reduce the incidence and severity of injuries. Issues of injury frequency and causation during the period 1994 to 1997 were addressed through two routes. First, during the 1994 World Cup Finals, 1996 European Championships, and 1994 to 1997 English league seasons via match analysis. Second, player injuries at four professional football league clubs were recorded by the club physiotherapist. These results provided complementary evidence showing an overall injury rate of 8.5/1000 playing hours, injury rates during training and matches being 3.5/1000 and 27.7/1000 playing hours, respectively. Two thirds of the injuries occurred during competitive match play, the remainder during training, the highest incidences of match and training injuries taking place during the first month of the playing season (P<O.05) and the pre-season period (P<0.05), respectively. The lower extremity was the site of 87% of the reported injuries, 41% and 22% of all injuries being muscular strains and re-injuries, respectively. Injury profiles differed between youth and senior players (P<0.01). Additional information was recorded through an assessment of club training routines and a survey of professional footballers' knowledge and application of injury prevention strategies. Issues relating to current injury prevention practices, player's perception of injury risk and advice received relating to these issues were addressed. These results provided supportive evidence showing poor understanding of and adherence to accepted athlete training procedures and the implementation of injury prevention practices. The studies suggest that a substantial number of injuries could be prevented in English professional football through identification of the hazards presented to players, an assessment of the existing risk levels and implementation of more rigorous control measures. Deficiencies in injury prevention practices indicate a need for wider education of players and coaches regarding the hazards and risks associated with professional football and the availability of medical and sports science knowledge to reduce these levels of risk.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2002. / Härtill 5 uppsatser.

Abstract The purpose of this study was to explore the development and course of social phobia by analysing qualitatively all the textual material obtained about the persons with treatment-resistant social phobia who, during the years 1995-2000, underwent a surgical procedure called endoscopic sympathetic block (ESB) to alleviate their phobic symptoms. In the other part of this study, the effect of this surgical procedure on social phobia was assessed quantitatively. The qualitative part of the study was based on the phenomenologic-existential philosophy and the principles of grounded theory. The qualitative analysis revealed four kinds of parenthood in the families of socially phobic persons: a violent, alcoholic type, a dominant type with high demands, a negligent type and a good enough type. A "vicious circle of social phobia" was formulated as a substantial category. The quantitative part of the study was an open, prospective follow-up study, where 169 patients operated on for social phobia during the years 1995–2000 were followed up for 5 years, and the changes in their symptoms were estimated using a modified version of Davidson's brief social phobia scale and the Liebowitz quality of life scale. The quantitative and qualitative parts of the study were linked together by investigating each person's family background with a semi-structured interview. According to variation analysis of the results, all symptoms of social phobia seemed to be alleviated highly significantly by ESB, and the results remained similar throughout the follow-up. Reflex sweating of the trunk was the only significant side effect. Overall satisfaction with the operation was estimated to be 3.5 on a five-point scale, representing the description "some help of the operation". Thus, ESB can be regarded as an additional treatment method for social phobia if traditional treatment with medication and psychotherapy has not provided any help for the patient.

Magister Artium - MA / This research investigates, within the framework of classical Sunni Islamic scholarship,what we might expect an Islamic opinion about evolution to be,bringing together an accurate and detailed understanding of evolutionary biology as the field stands today with a systematic consideration of the traditional Islamic sciences.The scope of the study encompasses the scholarly traditions recognized, at least by their respective adherents, to be part of Muslim orthodoxy – referred to in Islamic discourse as Ahl al-Sunnah wa al-Jamāʿah or more colloquially as “Sunni”. It covers the works of the scholars of the Ashʿarī, Māturīdī, and Salafī theological schools as well as the sources which they all draw upon – the Qur’ān, the Sunnah, and the opinions of the Salaf.The reason for this choice is that these traditions represent for most Muslims the “mainstream” of Islamic thinking, and therefore have a greater relevance for determining what a general Islamic perspective on evolution could be.The study first identifies and defines the methodological approaches of classical Sunni scholarship that have relevance to the question of an Islamic position on biological evolution. It also identifies and defines the issues within the field of Evolutionary Biology that need to be brought under scrutiny. The methods of classical Islamic Theology are then applied to the claims of Evolutionary Biology, drawing on traditional Islamic sources. The result of the study is an extrapolation of what an orthodox Islamic position towards biological evolution could be. Is Islam neutral towards the idea of biological evolution? Does it support it or categorically reject it? Can it accept certain aspects of Evolutionary Biology while rejecting others?Finally, the extrapolated “classical” Islamic position on evolution is compared with the writings of some contemporary Muslim scholars whose views run contrary to that extrapolation. Possible reasons for the discrepancy are explored.Such an interdisciplinary work should provide a valuable frame of reference for a more accurate analysis of the creation-evolution debate unfolding in the Muslim world today.

Fifteen adult women (mean age 34.5 years) participated in this exploratory study. The study aimed to identify commonalities in trichotillomania patients’ personality structure and psychological functioning. Relevant historical data were obtained, the Massachusetts General Hospital Hairpulling Scale was completed, and a Rorschach test in terms of the Comprehensive System was administered. The results point to an innate vulnerability in the sample’s personality structure that impedes their capacity for efficient problem-solving, decision-making, and coping behaviour. Other key findings include a distorted perception of themselves, a limited capacity for control and stress tolerance, difficulty in modulating and expressing emotions, the interference of primary process thinking in ideational activity, and the effects of these factors on their interpersonal relationships. Theoretical inferences are made about the probable aetiological roots of these findings. As the subjects’ level of functioning was unexpectedly high in the light of their deep-rooted pathology, the dynamic role and function of self-induced hair pulling as a symptom were considered. Suggestions are made to improve the treatment prognosis of the disorder. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2006. / Psychology / unrestricted

The purpose of this study was to investigate whether there is an association between developmental milestones of babies and the prevalence of spinal deformities in adolescents in Middelburg, Mpumalanga. The relationship between spinal deformities in a cross-sectional group of adolescents and parental recall was the focus of the study. One hundred and four adolescents were evaluated to determine if a spinal deformity was present. The subjects were then allocated to either the case (those with spinal deformities) or the control (subjects without spinal deformities) groups. The mothers of the subjects were then interviewed with regard to some of the developmental milestones of their offspring, and other factors which may have had an influence on the development of adolescent spinal deformities. The results showed that a perfectly "normal spine" was seldom found and that even in the control group some minor deviations, within normal limits, were present. Most of the mothers of subjects from the case group did not realise that their offspring had a deformity. There was a non¬significant trend for more crawlers to be present in the control group. Subjects who did not crawl, and who were also late walkers appeared to have an increased tendency to develop adolescent spinal deformities. Despite the fact that the schools approached were multi-racial, only white parents responded to the request for participation in this trial. The possible reasons for this should be investigated and a trial comparing the prevalence of spinal deformities amongst adolescents from all ethnic groups in South Africa should be conducted. Due to the possible recall bias of this study, it is recommended that a longitudinal study, commencing with the babies attending baby clinics in South Africa (representative of the South Africa population), be conducted to determine the influence of developmental milestones on the prevalence of spinal deformities in adolescence. / Dissertation (MPhysiotherapy)--University of Pretoria, 2010. / Physiotherapy / unrestricted

Background: This thesis explores, in-depth, the experience and sense-making of transactional analyst psychotherapists working with clients who present with Internet addiction (IA). It engages with the therapist’s broad experience and understanding of Internet addiction presentation, therapeutic assessment, ‘diagnosis’ and ‘treatment’ rather than the singular experience, expression, and meaning-making of the individual client. Method: As a counselling psychologist trainee, I was particularly interested in sampling highly experienced therapists, with an extensive range of skills developed through a robust clinical training. Four therapist participants, all professional members of the European Association of Transactional Analysis (EATA), were interviewed using semi-structured, one-to-one interviews and the material was analysed using interpretive phenomenological analysis (IPA). Findings and Discussion: Four higher-order concepts emerged within this study. They concerned: the complexity of IA; aetiological and predisposing factors; functions and features of IA; and treatment factors. Practical and theoretical implications for future research, clinical supervision, treatment, psycho-educational and political programmes are presented. Of the key emergent findings the Internet was understood by participants as a conduit or medium for addiction given a high prevalence of an underlying ‘disorders’. All of the participants believed in the existence of childhood aetiological roots which underpinned comorbidity with IA. Attachment difficulties in childhood would often predispose individuals to develop issues around loneliness, low self-esteem, control, loss and instability, and cognitive dissonance later in life. Participants believed a relationship existed between depression, low self-esteem and escapism as contributing factors. Conclusion: A systematic review of the extant research is proposed, along with quantitative studies to specifically evaluate the strength of this relationship. Further empirical research is particularly recommended to explore how these factors can predispose individuals to developing sub-types of IA, and especially in the context of historic childhood abuse and / or neglect. The complex nature and aetiology of IA can demand a high level of clinical expertise from professionals who would benefit from specific trainings concerning childhood attachment difficulties. Integrating a psychodynamic approach, or being aware of transference processes, could possibly enhance treatment effectiveness, and help safeguard both clients and therapists from counter-therapeutic interventions.

Magister Chirurgiae Dentium - MChD / This is a retrospective study of malignant tumours of the maxillofacial and oral region in children that presented over a 20 year period (1973 to 1993) at the Red Cross War Memorial Children's Hospital and Groote Schuur Hospital, Cape Town. Of the 352 children that were treated for a malignant tumour arising from various anatomic sites in the head and neck region, 30 were found to have had maxillofacial and oral involvement. This represented an incidence of 8,5%. Histologically, the majority of the tumours were non-odontogenic and mesenchymal in origin. The rhabdomyosarcoma was found to be the most common neoplasm, followed by the Burkitt's lymphoma. The age range was 6 months to 13.8 years (mean age 5.7 years). Males were more commonly affected than females, with a ratio of 1.3:1. There were 26 (86,7%) black patients and 4 (13,3%) white patients, representing a ratio of 6.5:1. Fifty percent of the cases were from the Eastern Cape. The mandible and the maxilla were the most common sites to be involved, followed by the soft tissues of the face. The most common presenting symptom was a painless swelling (73,3%) of the face. Twenty percent of the patients had "floating" or loose teeth. Radiographic features in the jaws were poorly circumscribed destructive lytic lesions with displacement of teeth. Histologic type was found to be the most significant variable affecting the outcome, with the Burkitt's lymphomas having the best prognosis and the rhabdomysarcomas the worst. The most common cause of death was metastases to the lungs. It is concluded that although malignant tumours of the maxillofacial and oral region in children are rare, their prognosis is poor. Therefore, any child presenting with a facial swelling should be viewed with suspicion.