Salivary IgA is the primary antibody of mucosal immunity. It has been suggested that chronic stress may lower levels of IgA and lead to an increased susceptibility to respiratory illness. It is also suggested that acute stress increases IgA during active coping (that involves mental effort or controllability, such as time-based mathematics or memory tests) and decreases it during passive coping tasks (with no mental effort required or uncontrollable, such as the passive viewing of disgust images). However, tasks often classed as stressors have produced consistent IgA effects in areas of passive coping and chronic stress. These inconsistencies might be a consequence of methodological issues, such as sampling procedures, or may reflect individual differences, for example how a task is appraised. This thesis examined appraisal effects with focus on control over a stressful event and a potential relationship with salivary IgA. Three different study designs were used to examine stress, appraised control and salivary IgA. To alter appraisal during passive coping, disgust images were presented as either real pictures or as fake effects from fictional films to change the participant's perception of control during the image presentations. The role of appraised control during a chronic stress situation was explored in caregivers, and finally, appraised control and subjective stress were investigated in relation to IgA daily for a week in undergraduates, alongside perceived stress and hassles from the prior month. Viewing disgusting images increased perceived stress, irrespective of whether the images were presented as real or fake. Crucially, control was lower and salivary IgA increased only in the group that were told the images were real. Appraised control over a chronic stressor of caregiving did not affect IgA, but neither did perceived stress. Finally, in undergraduates, stress measured at the same time as sampling showed a lower level of IgA on days rated the highest compared to lowest on stress, and appraised control had a negative correlation with IgA when averages were used over the week, but only in a sub-group of participants. Perceived stress or hassles from the prior month did not relate to IgA. The main conclusions are that a participant's appraisal of passive coping tasks can be altered and that this may lead to a change in their IgA response. The overall results challenge the view that IgA is a stress marker, as the only consistent effect of stress on IgA was its consistency. Yet inconsistent IgA responses are likely to be a recurring issue in research due to the sensitivity of IgA to a number of different methodological practices that may cause a direct effect, or may alter appraisals.

Education is a key component of empowerment and has a significant impact on the economic and social development in any country. People who have intellectual disabilities are usually marginalized because they are considered limited in their abilities to contribute to the enhancement of the social and economic development in a country. The purpose of the research study was explore the perceptions of teachers and primary care-givers regarding strategies for empowering children with intellectual disabilities. The research design was qualitative in nature and a phenomenological methodology was adopted. Purposive sampling was used to recruit research participants from two primary schools for children with special needs in Katlehong on the East Rand. The sample size was twenty research participants; ten teachers and ten primary care-givers. The data gathered was analysed using Thematic Content Analysis. Results indicated that both teachers and primary care-givers are experiencing challenges empowering these children. Teachers require support, equipment and training to develop skills needed to address the educational needs. Primary care-givers need to be educated regarding how to support the educational programmes presented to their children, and encouraged to become personally involved in the educational lives of their children. The conclusion reached is that teachers’ efforts to empower children with intellectual disabilities are being obstructed due to many factors. Their voices need to be heard by the Department of Education on what strategies they perceive as being effective to empower children with intellectual disabilities. The primary care-givers need to gain a better understanding of concept ‘intellectual disability’ so that they can stimulate and support efforts made by the school to empower them.

Article / PURPOSE: To determine the prevalence of disability in Peru, explore dependency on caregiver's assistance and assess access to rehabilitation care. METHOD: Data from Disability National Survey (ENEDIS), including urban and rural areas, were analyzed. Disability was defined as a permanent limitation on movement, vision, communication, hearing, learning/remembering or social relationships. Dependency was defined as the self-reported need for a caregiver to help with daily activities; and access to rehabilitation care was defined as the self-report of any therapy for disabilities. Estimates and projections were calculated using sample strata, primary sampling units and population weights, and prevalence ratios (PRs) and 95%CI were reported. RESULTS: From 798 308 people screened, 37 524 (5.1%; 95%CI 4.9--5.2%) had at least one disability. A total of 37 117 were included in further analysis, mean age 57.8 (SD ± 24.1) years, 52.1% women. Dependency was self-reported by 14 980 (40.5%; 95%CI: 39.2-41.9%) individuals with disabilities. A family member, usually female, was identified as a caregiver in 94.3% (95%CI: 93.3-95.3%) of dependent participants. Only 2881 (10.7%; 95%CI: 9.7-11.9%) of people with disabilities reported access to rehabilitation care. Major inequality patterns of disability burden versus access to rehabilitation care were observed by age and education level. Older age groups had higher disability burden yet lower chances of access to rehabilitation care. Conversely, the higher the education level, the lesser the overall disability burden but also the higher chances of reporting receiving care. Private healthcare insurance doubled the probability of having access to rehabilitation compared with those without insurance. CONCLUSIONS: Approximately 1.6 million Peruvians have at least one disability, and 40% of them require assistance with daily activities. Informal caregiving, likely female and relative-provided, is highly common. Rehabilitation care access is low and inequitable. Our results signal a major need to implement strategies to guarantee the highest standard of health care for people with disabilities. Implications for Rehabilitation Major inequality patterns in terms of burden of disability versus access to rehabilitation care were observed: those groups who concentrate more disability reported receiving less rehabilitation care. Caregiving is mostly informal and provided by a direct relative, mainly a woman, who resigned to their usual activities in order to help care for the person with disability. As a result, there is a need to develop appropriate support and training for caregivers. Access to care services in Peru is low and inequitable, but especially for people with disabilities: they experience greater barriers when accessing healthcare services even in the case of having health insurance. / Revisión por pares

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Student Number : 8910202A - MPH research report - School of Public Health - Faculty of Health Sciences / An increasing number of people are migrating to South African urban centers (GJMC, 2000). There are various reasons that can be attributed to this migration; including the hope of finding employment and better living conditions. Recent urban migrants find themselves faced with the basic problem of lack of shelter and, depending on the migrant’s situation, they may choose to live in indoor shacks within the city center, backyard shacks in the black townships or join the growing number of informal settlement dwellers (GJMC, 2000). The number of informal settlements continues to grow at an alarming rate in Johannesburg (CEROI, 2000). This poses unique health care challenges as well as presenting the health care system with unusual disease conditions associated with general lack of infrastructure and services (CEROI, 2000). It has been established that the proportion of HIV infected patients is higher in people living in informal settlements when compared to people living in private houses (SAHR, 2000). Thus, it is expected that more people will be presenting with HIV and AIDS related illnesses in an informal settlement health center as compared to well-developed residential areas. This study aimed at exploring the prescribing patterns of health care givers for patients attending a health center in an informal settlement as well as to determine the major disease patterns prevalent in the area. The study was carried out in Davidsonville and OR Tambo clinics as well as Bophelong and Hikhensile clinics in Ivory Park. The study covered regions five, one and two respectively according to Gauteng metropolitan services area classification (GJMC, 2000). The findings of the study will help the appropriate policy makers improve the Essential Drug List and inform public health officials in formulating strategies that may lead to health status improvement for people living in informal settlements.

In South Africa today only one in every three children lives with both of their biological parents. Most children not living with biological parents live with a grandparent. Vulnerable children are those whose basic needs for food, shelter, safety, protection, and education are not met or are insufficiently met. Many children who are orphaned are vulnerable, but vulnerability is not limited to orphans only. Children who live with their grandparents can be called vulnerable children as they suffer the loss of parental contact through death, illness, abandonment or migrant labour. Care-givers of vulnerable children face numerous challenges in their daily lives. Although the care of grandchildren by grandmothers is not unusual or new, the traditional network of financial and emotional support for this care-giving task has gradually fallen away over the years as parents are deceased, or too ill to work or have abandoned their children. This has left care-givers, many of whom are elderly and themselves vulnerable, with less resources and more financial and care-giving responsibility. Care-givers and the children for whom they care live in a wider context of poverty, unemployment, the HIV pandemic and crime in South Africa. Care-givers are at risk of burn-out due to the intensity of the challenges they face. Increasing resilience of care-givers serves to increase the positive outcomes for the vulnerable children in their care. The goal of this study was to explore whether participation in awareness-based Gestalt group work sessions would enhance the resilience of care-givers of vulnerable children. In the context of applied research, a mixed methods approach was used, specifically an embedded mixed methods approach. The study measured respondents‟ resilience before and after the implementation of a series of eight Gestalt group work sessions. A quasi-experimental research design, the comparison group pre-test-post-test design, was used for the quantitative part of the study and a case study design for the qualitative part. Quantitative data were collected through a structured interview using a pre-determined interview schedule based on theoretical constructs of resilience. Qualitative data were collected through semi-structured interviews, observations and field notes. The respondents were 19 care-givers of vulnerable children from a semi-rural area in KwaZulu-Natal. They were selected through snowball sampling and were assigned into comparison and experimental groups through a simple random sampling method. The experimental group participated in the Gestalt group work sessions whilst the comparison group did not. Although the quantitative results showed no significant difference in the pre- and post-test results, the qualitative results confirmed that experimental group members experienced a positive effect upon their resilience through participating in the Gestalt group work. Conclusions drawn from the qualitative findings indicated that respondents had a high level of resilience present in their lives before the research began. The awareness-based Gestalt group work sessions had a positive impact upon aspects related to the resilience of care-givers of vulnerable children. / Dissertation (MSW)--University of Pretoria, 2013. / gm2014 / Social Work and Criminology / unrestricted

Master of Public Health - MPH / Tuberculosis (TB) continues to be a major cause of ill health and the leading cause of death from a single infectious agent worldwide. Furthermore, young children, especially those under five years old and infants, are at risk of developing more severe forms of TB. TB cases continue to cluster among disadvantaged groups such as the poor whose lives are characterised by adverse living conditions. Defaulting from treatment poses a severe threat to children’s health because untreated TB or breaks in treatment could lead to a child developing more severe forms of TB, or worse, could result in mortality. Currently, long-term hospitalisation has the most successful TB treatment outcomes. Therefore, to ensure compliance, children are taken out of their social environment and admitted to hospital. However, being separated from one’s family, especially at a crucial stage of development, could have long-terms effects on the child’s development. The study explored, factors influencing access to care that caregivers of children; who are five years and younger, who received prolonged treatment at a specialised TB hospital in the Western Cape, South Africa experienced. A qualitative approach allowed the researcher to use personal interactions as a focus for studies and was suitable when aiming to understand health behaviour in its everyday context as experienced by the participant. The study results indicated the factors that enable caregiver visitation, is largely dependent on availability of finances. Furthermore, the hospital itself was identified as being accommodating with regards to visiting hours, telephonic calls and served as important mediator between health service provider, the children, their caregivers and the rest of the staff. Visitation depended on availability of finances, and this was the main barrier that was identified by caregivers. The challenges that hampered visitation were unemployment, lack of access to private and public transport and challenges related to farm-workers. A large number of caregivers work on farms in the Cape Winelands and many of them are dependent on seasonal work which results in inconsistent income. This limited availability of finances for visitation. Furthermore, the working conditions, long shifts and lack of employment benefits which were associated with farming, prevented caregivers from visiting. This study revealed that there are a series of factors which influence access to care of caregivers; this is especially the case in children hospitalised for TB. These factors need to be considered by policy makers as well as the Specialised Tuberculosis facility when dealing with children under five as the best way to ensure that treatment is completed through hospitalisation. Therefore, the strategies to assist families of children with TB need to be explored to assist in the continuity of care as well as the child’s development.

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Bakgrund: Kvinnor som utsatts för våld i nära relationer är ett globalt folkhälsoproblem och strider mot de mänskliga rättigheterna. Konsekvenserna av våldet innebär ett liv i rädsla, skam och lidande. Detta leder ofta till att kvinnorna söker vård först vid akut skada. Vanligare är dock att söka vård för indirekta skador och följdsjukdomar vilket ofta leder till att vårdgivare missar att identifiera våldet. Syfte: Att beskriva kvinnor som utsatts för våld i nära relationer och deras upplevelse av mötet med vårdpersonal. Metod: Litteraturstudie baserad på 14 kvalitativa artiklar vilka granskades och fyra teman identifierades: Bemötande, Att bli sedd och hörd, Tillit och Skam. Resultat: Kvinnor som utsatts för relationsvåld upplevde vårdpersonal som stressad och oförstående. Vidare var avskild kommunikation en viktig del i mötet och kvinnorna önskade få frågan om våld i hemmet ställd. Mötet med vårdpersonal kunde även bidra till att förstärka upplevelsen av skam och skuld. Slutsats: Vårdpersonal bör uppmärksamma bemötandet av kvinnor och se bakom yttre symtom för att kunna identifiera relationsvåld. Frågan om våld måste ställas regelbundet och på ett respektfullt sätt. Det är nödvändigt att samtal sker avskilt från kvinnans man och omgivning. Information bör finnas tillgänglig i miljö där patienter vistas. Klinisk betydelse: Resultatet i denna studie visar att vårdpersonal med små medel kan förbättra mötet med kvinnor som utsatts för våld i nära relation. Ytterligare kunskap är nödvändig och specialiserad vårdpersonal bör finnas för att kunna tillgodose denna patientgrupps specifika omvårdnadsbehov. Nationella riktlinjer borde framarbetas och vårdprogram följas. / Background: Women subjected to intimate partner violence is both a global health issue and a violation of basic human rights. The result of the violence is a life of fear, shame, and suffering. Consequently, these women do not seek healthcare until acute injuries occur. More common is to seek care for indirect injuries or associated illnesses, which frequently leads to a misdiagnosis of the violence. Aim: The aim of this study was to describe how women who have been subjected to domestic violence experience the interactions with their caregivers. Method: A literature review based on fourteen qualitative articles that have been closely studied and four main themes were identified: Interaction, To be seen and heard, Trust and Shame. Result: Women who have been subjected to domestic violence experienced care givers as stressed and lacking in understanding. Private conversation was an important part of the interaction and the women wished to be asked about domestic violence. However, the interaction with care givers could potentially enhance the feeling of shame and guilt. Conclusion: Care givers need to be perceptive in their interactions with the women in order to see beyond superficial symptoms and identify domestic violence. Questions about violence should be asked respectfully and on a regular basis. It is also essential that these questions are asked separately, not in the presence of the spouse or in public. Information should be available in patient environment. Clinical implication: The result of this study shows that care givers can improve their interaction with women subjected to domestic violence by small means. Further knowledge is necessary and specialized staff are required to provide for this group's specific care needs. National guidelines should be created and care programs should be followed.

The goal of this study was to explore the nature and extent of palliative care in the Nairobi Hospice, in Kenya. Owing to the limited information available on this subject, the study is based on a research question that seeks to deepen understanding of the experiences of palliative care services by patients facing life-threatening illnesses. In answering the research question, the study employed a variety of methods. First, it used qualitative research approach in order to unearth personal experiences of the value of services received. Second, it employed applied research with the aim of using results to influence the formulation and improvement of palliative care programs in Nairobi. Further, the study employed the case study method as the research strategy. Focus group interviews were utilised as the data collection technique. The researcher used an interview schedule and administered semi-structured questions on a group basis. Availability sampling method was used to draw a sample of 20 patients receiving palliative care at the Nairobi Hospice. Confirmation from the study indicated that patients receive medical care, counselling, and spiritual care as well as day care services, usually provided by the hospice staff. The study further confirmed the value of palliative care. Services provided offered a number of benefits for the patients for instance, enhanced hope, mobility, as well as improved state of health for these patients. At the same time the study underscored the value of spiritual guidance. However this was provided as an additional service, being offered outside the hospice. Measures to integrate this service would improve the value of palliative care services in general. Further, it was noted that there was no particular time frame for receiving palliative care at the hospice since patients receive care at different intervals. The study also disclosed that patients’ illnesses impacted on their families negatively for example, a number of these patients were either abandoned or separated from their families, their families suffered financial strains while others were in denial and felt very desperate about the whole situation. The study conclusively indicated that social workers can play a vital role in palliative care provision by either conducting regular home visits, educating and creating awareness as well as offering counselling services to both the patients and their families. / Dissertation (MSW)--University of Pretoria, 2008. / Social Work and Criminology / MSW (Health Care) / Unrestricted