Orientador: Marcos Ferreira Minicucci / Coorientador: Sandro José Conte / Banca: Marina Politi Okoshi / Banca: Daniela de Rezende Duarte Maksymczuk / Resumo: Introdução: Alguns estudos mostraram que o processo inflamatório está relacionado à gravidade da queimadura. Nesse contexto, a utilização de estratégias para modular essa hiper-resposta inflamatória é bastante atrativa. Nos últimos anos, a vitamina D tem se destacado por sua ação anti-inflamatória e pela modulação da resposta imunológica. Parte das ações da vitamina D é mediada pelo receptor nuclear da vitamina D (VDR). Estudos recentes mostram que polimorfismos do gene do receptor VDR pode influenciar a resposta à vitamina D. Objetivos: O objetivo deste estudo é avaliar a associação dos polimorfismos Taql e Bsml do gene VDR com o tempo de internação, o surgimento de infecção e a mortalidade em pacientes queimados. Casuística e métodos: Foram incluídos prospectivamente os pacientes queimados, com idade ≥ 18 anos, que internaram na enfermaria e na Unidade de Terapia Intensiva do Setor de Tratamento de Queimados do Hospital Estadual Bauru. Os pacientes foram incluídos no período de janeiro de 2013 a janeiro de 2014. Na admissão dos pacientes foram registrados dados demográficos e clínicos foram registrados. Amostras sanguíneas foram coletadas na admissão dos pacientes para dosagem bioquímica, de 25 (OH) vitamina D e determinação dos polimorfismos Taql e Bsml do gene VDR. Os pacientes foram acompanhados durante toda a internação e o surgimento de infecção, o tempo de internação e a mortalidade foram registrados. Para avaliar a associação dos polimorfismos com o tempo de internação utilizamos a análise de regressão linear simples e múltipla. Para avaliar a associação dos polimorfismos com o surgimento de infecção e mortalidade utilizamos a análise de regressão logística. O nível de significância adotado foi de 5%. Resultados: Foram avaliados 87 pacientes, mas em 7 deles, devido problemas técnicos, não foram avaliados os polimorfismos do receptor da vitamina D, Taql e Bsml, por isso... / Abstract: Introduction: Some studies showed that the inflammatory process was related with severe burn injury. Thus, strategies for modulation of inflammatory response are of great interest. In the last years, vitamin D received attention due to its anti-inflammatory and immunomodulatory actions. Most of the actions of vitamin D are through its nuclear receptor (VDR). Recent studies showed that VDR gene polymorphisms could influence vitamin D response. Objective: The objective of this study is to evaluate the association of Taql and Bsml polymorphisms of VDR gene with length of hospital stay, infection development and mortality in burn patients. Methods: We prospectively evaluated burn patients, over the age of 18 years, admitted to the Burn Unit of Hospital Estadual Bauru. The patients were included from January 2013 to January 2014, after signing the written informed consent. Upon admission demographical and clinical data were recorded. Blood sample was collected for biochemical analysis, measure of serum 25(OH) vitamin D3 concentration, and Taql and Bsml polymorphisms determination. The patients were followed during hospital admission, and length of hospital stay, infection development and mortality were recorded. For association between length of hospital stay and VDR polymorphisms we used uni and multivariate linear regressions. For association between polymorphisms and infection development and mortality, uni and multiple logistic regressions were performed. Significance level was 5%. Results: We evaluated 87 patients, however 7 were excluded due to technical problems with VDR polymorphism evaluation. Thus, 80 patients were studied. Considering these patients 60% were male, and average age was 42.5 ± 16.1 years. Regarding the cause of burn 47.5% were caused by fire, 33,7% due to hot liquids, 15% caused by electricity and 3.8% due to other causes. The median of burn surface area was 8.0 (3.0-18.8)% and 47.5% were treated in intensive care ... / Mestre

Made available in DSpace on 2015-12-10T14:23:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-27. Added 1 bitstream(s) on 2015-12-10T14:29:23Z : No. of bitstreams: 1 000848635.pdf: 388929 bytes, checksum: fb8a734b65143535639956be215b3641 (MD5) / Introdução: Alguns estudos mostraram que o processo inflamatório está relacionado à gravidade da queimadura. Nesse contexto, a utilização de estratégias para modular essa hiper-resposta inflamatória é bastante atrativa. Nos últimos anos, a vitamina D tem se destacado por sua ação anti-inflamatória e pela modulação da resposta imunológica. Parte das ações da vitamina D é mediada pelo receptor nuclear da vitamina D (VDR). Estudos recentes mostram que polimorfismos do gene do receptor VDR pode influenciar a resposta à vitamina D. Objetivos: O objetivo deste estudo é avaliar a associação dos polimorfismos Taql e Bsml do gene VDR com o tempo de internação, o surgimento de infecção e a mortalidade em pacientes queimados. Casuística e métodos: Foram incluídos prospectivamente os pacientes queimados, com idade ≥ 18 anos, que internaram na enfermaria e na Unidade de Terapia Intensiva do Setor de Tratamento de Queimados do Hospital Estadual Bauru. Os pacientes foram incluídos no período de janeiro de 2013 a janeiro de 2014. Na admissão dos pacientes foram registrados dados demográficos e clínicos foram registrados. Amostras sanguíneas foram coletadas na admissão dos pacientes para dosagem bioquímica, de 25 (OH) vitamina D e determinação dos polimorfismos Taql e Bsml do gene VDR. Os pacientes foram acompanhados durante toda a internação e o surgimento de infecção, o tempo de internação e a mortalidade foram registrados. Para avaliar a associação dos polimorfismos com o tempo de internação utilizamos a análise de regressão linear simples e múltipla. Para avaliar a associação dos polimorfismos com o surgimento de infecção e mortalidade utilizamos a análise de regressão logística. O nível de significância adotado foi de 5%. Resultados: Foram avaliados 87 pacientes, mas em 7 deles, devido problemas técnicos, não foram avaliados os polimorfismos do receptor da vitamina D, Taql e Bsml, por isso... / Introduction: Some studies showed that the inflammatory process was related with severe burn injury. Thus, strategies for modulation of inflammatory response are of great interest. In the last years, vitamin D received attention due to its anti-inflammatory and immunomodulatory actions. Most of the actions of vitamin D are through its nuclear receptor (VDR). Recent studies showed that VDR gene polymorphisms could influence vitamin D response. Objective: The objective of this study is to evaluate the association of Taql and Bsml polymorphisms of VDR gene with length of hospital stay, infection development and mortality in burn patients. Methods: We prospectively evaluated burn patients, over the age of 18 years, admitted to the Burn Unit of Hospital Estadual Bauru. The patients were included from January 2013 to January 2014, after signing the written informed consent. Upon admission demographical and clinical data were recorded. Blood sample was collected for biochemical analysis, measure of serum 25(OH) vitamin D3 concentration, and Taql and Bsml polymorphisms determination. The patients were followed during hospital admission, and length of hospital stay, infection development and mortality were recorded. For association between length of hospital stay and VDR polymorphisms we used uni and multivariate linear regressions. For association between polymorphisms and infection development and mortality, uni and multiple logistic regressions were performed. Significance level was 5%. Results: We evaluated 87 patients, however 7 were excluded due to technical problems with VDR polymorphism evaluation. Thus, 80 patients were studied. Considering these patients 60% were male, and average age was 42.5 ± 16.1 years. Regarding the cause of burn 47.5% were caused by fire, 33,7% due to hot liquids, 15% caused by electricity and 3.8% due to other causes. The median of burn surface area was 8.0 (3.0-18.8)% and 47.5% were treated in intensive care ...

Traditional medicine has a long history of being used for treating various ailments ranging in severity. Although traditional medicine has typically been the health care for the poorest levels of society, there is a worldwide growth in popularity. The growing popularity of traditional medicine, termed the green boom, may be ascribed to people taking a more holistic approach to maintain their health. Traditional medicine is widely used on a regular basis by 70% of South Africans. Various indigenous medicinal plants are used for the preparation of traditional herbal medicine. These plants are mostly indigenous to the regions were it is used. In this study four medicinal plants (Bulbine frutescens, Leonotis leounurus, Melianthus major & Zantedecshia aethiopica) that are traditionally used in the Eastern Cape region for treating burn wound infections, were collected for investigation. The in vitro antibacterial activity of these plants was tested against different bacterial strains of eight different bacteria. The bacteria used in this investigation included bacterial strains of four Gram-positive bacteria, S. aureus, methicillin-resistant S. aureus (MRSA), E. feacalis, S. pyogenes and four Gramnegative bacteria, P. aeruginosa, A. baumanii, K. pneumoniae and P. mirabilis. Traditional preparations as well as three different extracts (methanol, aqueous & acetone) of the plants were used for in vitro antibacterial activity testing. The microtitre plate assay and agar dilution assay were used for determining the antibacterial activity of the traditional preparations and plant extracts against the different bacterial strains. In the microtitre plate assay the antibacterial activity was tested using the bacterial growth indicator, INT and a microtitre plate spectrophotometer to determine the minimal inhibitory concentrations of the plant extracts and traditional preparations. The microtitre plate assay was used for testing the antibacterial activity of the plants against the bacterial strains of five bacteria, S. aureus, MRSA, P. aeruginosa, A. baumanii and K. pneumoniae. The bacterial strains of the three bacteria, S. pyogenes, E. feacalis and P. mirabilis were not compatible with the microtitre plate assay using INT and spectrophotometric readings to determine bacterial inhibition. Therefore the agar dilution assay were used as an alternative method for determining the MIC’s of the plant extracts against the bacterial strains of these bacteria. The initial plant extract concentration in the microtitre plate assay differed with the different plant extracts in the microtitre plate assay. Acetone followed by methanol extracted the highest plant extract concentrations with the different medicinal plants. M. major followed by L. leonurus produced the highest plant extract concentrations following extraction with the different extraction solvents. Consequently the acetone extract of M. major had the highest plant extract concentration before serial dilution in the microtitre plate assay. Uniform plant extract concentrations were tested in the agar dilution assay. The methanol extract followed by the acetone extract of the plants gave the highest antibacterial activity against the different bacterial strains. The extracts of M. major followed by L. leonurus inhibited the highest number of bacterial strains in the microtitre plate assay and the extracts of B. frutescens inhibited the lowest number of bacterial strains. The acetone and methanol extracts of M. major were the only extracts that displayed antibacterial activity in the agar dilution assay. The bacterial strains of P. mirabilis were the only bacteria that were inhibited using this method. The bacterial strains of S. pyogenes and E. feacalis were not inhibited at any of the plant extract concentrations in the agar dilution assay.

Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and enables structural, functional, and metabolic imaging of the human body. One primary clinical application of MRI is the neuroimaging of tumors, which demands both multi-parametric qualitative and quantitative information from MR scans. Although the role of the quantitative MRI (qMRI) is well accepted, it suffers from long acquisition times leading to patient discomfort, especially in geriatric and pediatric patients. Quantitative imaging is also critical to estimating temperature during MR scans of patients with implants and leads. The radiofrequency stimulus pulses of an MRI exam can couple to conductive implants, resulting in eddy current propagation and consequential heating. The heating can lead to third-degree burn lesions along the surfaces of titanium joints, deep brain stimulation (DBS), and pacemaker leads. Such challenges raise safety concerns in MRI, requiring fast and accurate temperature estimations to ensure patients’ safety. This thesis aims to tackle the abovementioned challenges in MRI, specifically focusing on developing novel quantitative imaging approaches using magnetic resonance fingerprinting (MRF) methods and applications. MRF is a framework that allows measuring multiple tissue properties in a single acquisition. In the first chapter, we extend the current implementation of MRF and introduce tailored MRF (TMRF), an imaging method offering qualitative and quantitative information simultaneously, with promising results in differentiating healthy and pathological tissues. This method increases scanner efficiency and decreases acquisition time for neuroimaging while simultaneously providing qualitative and quantitative imaging measures. We demonstrate these advances in in vitro phantoms healthy volunteers- and pediatric patient- populations. In the second chapter, we address the issue of MRI safety for patients with conductive implants like deep brain stimulation (DBS) leads by using MRF-based thermometry (MRFT) to accurately predict and monitor temperature near these implants during MRI scans, enhancing safety and efficacy for image-guided procedures and imaging patients with such implants. Successful approaches will be incorporated into an imaging protocol to increase safety and effectiveness for image-guided lead placement and imaging patients with implanted leads. To validate MRFT in vivo in patients, we conducted a patient study using MRFT to evaluate the accuracy of MRFT in vivo near DBS lead. In the third section, we implement an open-source MRF package (OMEGA) for a multi-site, multi-field strength MRF repeatability study, demonstrating its accuracy and repeatability of MRF across various conditions.

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: Pressure garment therapy (PGT) forms a significant part of burn rehabilitation. It is most commonly used to treat hypertrophic scars but the benefits of this intervention remain questionable. Adherence with this intervention also presents several challenges for the patient and clinician. Aim of the study: The aim of this study was to explore the experiences of adult burn survivors who participated in PGT during 2006 - 2010 at Tygerberg Academic Hospital (TAH). Methods: A phenomenological study design using qualitative research methods was implemented. Semi-structured interviews were conducted with eight burn survivors. The participants were chosen using purposive sampling methods. Thematic analysis was conducted using pre-determined themes from the literature as a starting point. Data was coded and categorised according to themes that emerged during data analysis. Results: The findings of the study revealed that several factors impacted on the participant’s experiences of pressure garment therapy. Factors related to the consequences of the burn injury included the participant’s loss of function, loss of participation, loss of self-confidence, financial dependence, emotional impact and impact on relationships. Factors related to pressure garment usage included physical effects, socio-emotional effects and the wearing schedule (which included maintenance and effort, adherence and time). Factors that contributed to adherence included support, inner strengths, knowledge, seeing a difference, seeing others, enablers to accessing the service and satisfaction with the service. Factors that contributed to non-adherence included lack of support, emotional turmoil and barriers to accessing the service. Participants made recommendations to improve the overall burn service at TAH. Conclusion: The findings of the study show that participants experienced PGT as a beneficial intervention. There were several complex factors that impacted the participants’ experiences of PGT. The most significant benefit as described by the participants was the improvements noted in scar appearance, whilst the main barrier was that the garments were cosmetically displeasing due to their colour.Recommendations: To adopt a person-centred approach to burn management, recommendations made include improvements needed within the occupational therapy service such as changing the colour of the garment material, the standardisation of the PGT treatment protocols and improving staff attitudes. Other recommendations include establishing a network for counselling services as well as an information pack for patients admitted to the burns unit. / AFRIKAANSE OPSOMMING: Drukklereterapie vorm ʼn belangrike deel van die rehabilitasie van brandwonde. Dit is die mees algemene behandeling vir hipertrofiese littekens, maar daar bestaan steeds twyfel aangaande die voordele van hierdie intervensie. Daar bestaan heelwat uitdagings, vir beide die terapeut en die pasiënt, om die behandelingsriglyne na te volg. Doel van die studie: Die doel van hierdie studie was om die ervarings van volwasse brandwond oorlewendes wat vanaf 2006 tot 2010 drukklereterapie by Tygerberg Akademiese Hospitaal ontvang het, te ondersoek. Metode: ʼn Fenomenologiese studie ontwerp is geimplïmenteer deur middel van kwalitatiewe navorsingsmetodes. Semi-gestruktureerde onderhoude is met agt brandwond oorlewendes gevoer. Die deelnemers is gekies deur doelgerigte steekproefneming metodes. Tematiese analise is uitgevoer met behulp van voorafbepaalde temas wat as beginpunt uit die literatuur geneem is. Data is gekodeer en gekategoriseer volgens temas wat na vore gekom het tydens data analise. Resultate: Die bevindings van die studie het aangedui dat verskeie faktore die deelnemers se ervarings van drukklereterapie beïnvloed het. Faktore wat met die gevolge van die brand beserings verband hou het die volgende ingesluit: verlies aan funksie, verlies aan deelname, verlies aan selfvertroue, finansiële afhanklikheid, emosionele impak en die impak op verhoudings. Die volgende faktore het verband gehou met die gebruik van drukklere: fisiese faktore, sosio-emosionele faktore en die dra skedule (dit sluit in onderhoud van die drukklere, moeite, volg van die dra skedule en tyd). Faktore wat bygedra het tot die navolging van die skedule het die volgende ingesluit: ondersteuning, innerlike krag, kennis, die sien van ʼn verskil, sien van ander, toegang tot die diens en tevredenheid met die diens. Die volgende faktore het bygedra tot nie-navolging: gebrek aan ondersteunning, emosionele verwarring en hindernisse tot toegang tot die diens. Deelnemers het aanbevelings gemaak om die brandwonde diens te verbeter. Slot: Die bevindings van die studie dui daarop dat die deelnemers drukklereterapie as ʼn voordelige intervensie ervaar het. Daar was verskeie komplekse faktore wat ʼn impak op drukklereterapie gehad het. Die grootste voordeel, soos beskryf deur deelnemers, was die verbetering in litteken voorkoms; terwyl die hoof hindernis was dat die drukklere kosmeties onaanvaarbaar was as gevolg van die kleur. Aanbevelings: Die volgende aanbevelings is gemaak om ʼn persoon-gesentreerde benadering tot brandwond behandeling te verseker: verbeterings benodig binne die arbeidsterapie diens, soos die verandering van die kleur van drukkleremateriaal, die standaardisering van drukklereterapie protokolle en die verbetering van personeel houdings. Ander aanbevelings sluit in ʼn netwerk vir beradingsdienste, sowel as ʼn inligtingspakket vir pasiente wat tot die brandwondeenheid toegelaat word.

Summaries in Afrikaans and English / A primary school child finds him or herself in the middle childhood years and it is considered to be a rich phase of life, since children have already reached important milestones. These children have the ability not only to act with empathy but also to maintain independent behaviour. As a result of the development in the cognitive and moral stage of development, these children can also distinguish between right and wrong and they show insight that social rules can be changed. As a result of this development, it is believed that this child will accept learners with different skills more confidently when the required awareness is provided. One group of learners with special skills, which I focused on during this research, are those who have been deformed by burn wounds. Statistics show that a growing number of children in South Africa are deformed by burn wounds. As a result of the changing policy on inclusive education, these children cannot be denied into the mainstream education system because of deformity or disability anymore. It is therefore believed that an increasing number of deformed or disabled children will be entering the mainstream education system. Information is gathered through various methods by using triangulation. The literature study, semi-structured interviews with children as well as teachers for experimental subjects, who completed an incomplete sentence test and open questions, added valuable information. Research indicated that children in this phase of life are indeed equipped with certain life skills, which place them in a privileged position to handle interaction with the deformed child, if they receive the required awareness. The information also indicated that the gestalt approach could be used as theoretical perspective for the compilation of the guideline. This approach recognises that play is the child's natural communication medium but also recognises that awareness is created through means of experimentation. To my knowledge, there is no program or guideline from the gestalt approach that enables education staff to address children's awareness in respect of their inherent skills in the middle childhood years. The researcher made a breakthrough in the integration of the gestalt approach with the education environment by constructing a practical guideline from the gestalt approach for education staff. Education staff should, however, receive training with regards to the gestalt approach in order to use this guideline effectively. / Laerskoolkind bevind hom- of haarself in die middelkinderjare en dit word as ryk lewensfase beskou, aangesien kinders reeds belangrike mylpale bereik het. Hierdie kinders beskik oor die vermoe om nie slegs empaties op te tree nie, maar om ook selfstandige gedrag te handhaaf. As gevolg van die ontwikkeling in die kognitiewe en morele ontwikkelingsterrein, kan hulle ook tussen reg en verkeerd onderskei en toon hulle insig dat sosiale reels verander kan word. As gevolg van hierdie ontwikkeling word daar verwag dat hierdie kind met die nodige bewusmaking, leerders wat oor verskillende bekwaamhede beskik, met meer selfvertroue sal kan aanvaar. Een groep leerders, waarop daar tydens hierdie navorsing gefokus sal word, wat oor spesiale bekwaamheid beskik, is diegene wat deur brandwonde geskend is. Statistieke toon dat toenemende aantal kinders jaarliks in Suid-Afrika, weens brandwonde geskend word. As gevolg van die veranderende beleid op insluitende onderwys, kan kinders weens geskend- of gestremdheid nie meer tot die hoofstroomonderwysstelsel geweier word nie. Die verwagting is dus dat toenemende aantal geskende of gestremde kinders die hoofstroomonderwysstelsel sal betree. Inligting is deur verskeie metodes ingesamel deur die benutting van triangulering. Die literatuurstudie, semi-gestruktureerde onderhoude met kinders asook onderwysers as proefpersone wat 'n onvoltooide sinnetoets en oop vrae voltooi het, het bruikbare inligting tot gevolg gehad. Daar is gevind dat kinders in hierdie lewensfase wei oor bepaalde lewensvaardighede beskik, wat hulle in 'n bevoorregte posisie plaas om, indien hulle die nodige bewusmaking ontvang, interaksie met die geskende kind sal kan behartig. Die inligting het verder ook daarop gedui dat die gestaltspelbenadering as teoretiese perspektief vir die samestelling van die riglyn benut kan word. Hierdie benadering erken dat spel die kind se natuurlike kommunikasiemedium is, maar ook dat bewuswording geskied deur middel van eksperimentasie. Sover bekend is daar geen program of riglyn vanuit die gestaltbenadering, wat opvoedkundige personeel in staat stel om kinders in die middelkinderjare se bewustheid ten opsigte van hulle inherente vaardighede aan te spreek nie. Die navorser het 'n deurbraak in die integrering van die gestaltbenadering met die opvoedkundige omgewing gemaak deurdat 'n praktiese riglyn vanuit die gestaltspelbenadering vir opvoedkundige personeel saamgestel is. Opvoedkundige personeel behoort egter opleiding met betrekking tot die gestaltspelbenadering te ontvang ten einde hierdie riglyn effektief te kan benut. / Social Work / M. Diac. (Play Therapy)

Summaries in Afrikaans and English / A primary school child finds him or herself in the middle childhood years and it is considered to be a rich phase of life, since children have already reached important milestones. These children have the ability not only to act with empathy but also to maintain independent behaviour. As a result of the development in the cognitive and moral stage of development, these children can also distinguish between right and wrong and they show insight that social rules can be changed. As a result of this development, it is believed that this child will accept learners with different skills more confidently when the required awareness is provided. One group of learners with special skills, which I focused on during this research, are those who have been deformed by burn wounds. Statistics show that a growing number of children in South Africa are deformed by burn wounds. As a result of the changing policy on inclusive education, these children cannot be denied into the mainstream education system because of deformity or disability anymore. It is therefore believed that an increasing number of deformed or disabled children will be entering the mainstream education system. Information is gathered through various methods by using triangulation. The literature study, semi-structured interviews with children as well as teachers for experimental subjects, who completed an incomplete sentence test and open questions, added valuable information. Research indicated that children in this phase of life are indeed equipped with certain life skills, which place them in a privileged position to handle interaction with the deformed child, if they receive the required awareness. The information also indicated that the gestalt approach could be used as theoretical perspective for the compilation of the guideline. This approach recognises that play is the child's natural communication medium but also recognises that awareness is created through means of experimentation. To my knowledge, there is no program or guideline from the gestalt approach that enables education staff to address children's awareness in respect of their inherent skills in the middle childhood years. The researcher made a breakthrough in the integration of the gestalt approach with the education environment by constructing a practical guideline from the gestalt approach for education staff. Education staff should, however, receive training with regards to the gestalt approach in order to use this guideline effectively. / Laerskoolkind bevind hom- of haarself in die middelkinderjare en dit word as ryk lewensfase beskou, aangesien kinders reeds belangrike mylpale bereik het. Hierdie kinders beskik oor die vermoe om nie slegs empaties op te tree nie, maar om ook selfstandige gedrag te handhaaf. As gevolg van die ontwikkeling in die kognitiewe en morele ontwikkelingsterrein, kan hulle ook tussen reg en verkeerd onderskei en toon hulle insig dat sosiale reels verander kan word. As gevolg van hierdie ontwikkeling word daar verwag dat hierdie kind met die nodige bewusmaking, leerders wat oor verskillende bekwaamhede beskik, met meer selfvertroue sal kan aanvaar. Een groep leerders, waarop daar tydens hierdie navorsing gefokus sal word, wat oor spesiale bekwaamheid beskik, is diegene wat deur brandwonde geskend is. Statistieke toon dat toenemende aantal kinders jaarliks in Suid-Afrika, weens brandwonde geskend word. As gevolg van die veranderende beleid op insluitende onderwys, kan kinders weens geskend- of gestremdheid nie meer tot die hoofstroomonderwysstelsel geweier word nie. Die verwagting is dus dat toenemende aantal geskende of gestremde kinders die hoofstroomonderwysstelsel sal betree. Inligting is deur verskeie metodes ingesamel deur die benutting van triangulering. Die literatuurstudie, semi-gestruktureerde onderhoude met kinders asook onderwysers as proefpersone wat 'n onvoltooide sinnetoets en oop vrae voltooi het, het bruikbare inligting tot gevolg gehad. Daar is gevind dat kinders in hierdie lewensfase wei oor bepaalde lewensvaardighede beskik, wat hulle in 'n bevoorregte posisie plaas om, indien hulle die nodige bewusmaking ontvang, interaksie met die geskende kind sal kan behartig. Die inligting het verder ook daarop gedui dat die gestaltspelbenadering as teoretiese perspektief vir die samestelling van die riglyn benut kan word. Hierdie benadering erken dat spel die kind se natuurlike kommunikasiemedium is, maar ook dat bewuswording geskied deur middel van eksperimentasie. Sover bekend is daar geen program of riglyn vanuit die gestaltbenadering, wat opvoedkundige personeel in staat stel om kinders in die middelkinderjare se bewustheid ten opsigte van hulle inherente vaardighede aan te spreek nie. Die navorser het 'n deurbraak in die integrering van die gestaltbenadering met die opvoedkundige omgewing gemaak deurdat 'n praktiese riglyn vanuit die gestaltspelbenadering vir opvoedkundige personeel saamgestel is. Opvoedkundige personeel behoort egter opleiding met betrekking tot die gestaltspelbenadering te ontvang ten einde hierdie riglyn effektief te kan benut. / Social Work / M. Diac. (Play Therapy)

The present investigation sought to explore the efficacy of stress inoculation in the management of pain with severely burned adults. Subjects were 16 adult burn patients randomly assigned to either the stress-inoculation or no-treatment comparison group. The focus of the analysis was the amount of change or improvement from pretreatment to posttreatment periods. The stress-inoculation group showed significant improvement on all nine dependent measures, while the no-treatment group improved significantly on only two (physical and emotional self-ratings). The overall comparison of the amount of change between groups revealed that the stress-inoculation group showed significantly greater improvement in pain management than the no-treatment group during this time. It was concluded that stress inoculation, as a flexible treatment package, was efficacious in the management of pain experience of burn patients.

With the decrease in burn mortality following improved burn care facilities and methods, burn survivors are often left with residual physical and psychosocial consequences that they have to cope with requiring adaptation and modification of lifestyle. Burn survivors habitually receive excellent treatment for their wounds while in hospital but may experience challenges due to disruption of care and rehabilitation after discharge. This aim of the study was to explore and describe the lived experiences of burn survivors’ adaptation post hospital discharge. A qualitative, hermeneutic, phenomenological design using an interpretive framework was used. A purposeful sampling was used in the selection of nine participants who were above 18 years and had been admitted to the Limpopo Burn Unit while still undergoing reviews at the Plastic and Reconstructive Surgery Clinic. Data were collected through face-to-face interviews using unstructured open-ended questions. Data were analysed using the Colaizzi’s strategy. Three main themes emerged from the data, along with sub-themes. (a)The burn survival experience involved the person in totality with reference to their internal and external environment. (b)The process of recovery was lengthy and started in hospital and continued post discharge at home. (c) Reclaiming their life and finding new meaning was a process of adaptation. The core of the participants’ needs included the need for the care and rehabilitation of the whole person in terms of their physical and psychosocial aspects, the importance of the survivor’s involvement in his/her care, and the rehabilitation. Health care personnel and family support during this difficult time should be available in order to enable the survivors to cope and adapt effectively and reclaim their lives. / Health Studies / M.A. (Nursing Science)

Burn injuries are associated with significant mortality and morbidity. Intentional burn injuries are not well understood, and warrant study to improve adjustment and outcomes. The present study examined group differences between intentional and unintentional burn injuries, comparing individuals with self-inflicted (SIB; n=109) and other-inflicted (OIB; n=109) burns to an unintentional burn (UB) group. Compared to UB, those with intentional (SIB, OIB) burn injuries were more likely to be young, female, unmarried, unemployed, abuse substances, and have positive alcohol/drug screens at hospital admission. Individuals with intentional burns report more psychological distress, lower quality of life in some areas, and lower life satisfaction. When SIB and OIB were examined individually, OIB were more likely to be African American compared to SIB and UB. OIB also had more anxiety and paranoia than UB. SIB was more likely than OIB and UB to have had medical problems or psychiatric disorders and treatment prior to the burn injury. Those with SIB were 3 times more likely than UB to die in the hospital even after controlling for age, severity of burn, and inhalation injuries. Moreover, the SIB group had high rates of suicidal ideation at discharge and follow-up. Treatment implications for burn treatment providers were discussed.