Includes bibliographical references (leaves 273-287). / Over the last decade, sexual abuse committed by young sexual offenders has increasingly been reported in South Africa. Such offenders are often inappropriately managed by both mental health and related professionals and the justice system. This dissertation describes the process involved in the development and implementation of a diversion programme for young sexual offenders in the local setting by the use of action research. This is preceded by an overview of the concepts of diversion and the characteristics, assessment and management of young sexual offenders. The development and implementation process is presented in stepwise action cycles, highlighting the various action steps that were taken. These are evaluated in the 'observation' and 'reflection' sections of each cycle. Twelve action cycles, spanning a period of 6 years, are described, beginning with the identification that young sexual offenders and their management posed a problem, the development of a diversion programme and the initial pilot studies, through to the formation of SAYSTOP, a multidisciplinary umbrella organisation. Further steps describe the wider implementation of the programme, facilitator training and follow-up studies conducted on young sexual offenders. The multi-disciplinary role played by SAYSTOP in the management of young sexual offenders is discussed and the SAYSTOP diversion programme is compared to guidelines suggested in the literature. The strengths, weaknesses and limitations of both the process and the SAYSTOP diversion programme are discussed in the conclusion, followed by recommendations for future guidelines and policy decisions regarding young sexual offenders. Results indicate that sexual offences committed by youths in South Africa are common and that no intervention programmes exist that aim to rehabilitate these offenders. Professionals from various fields were able to combine their experience and develop a group intervention programme targeting these youths. Following successful administration of this programme to young sexual offenders a manual documenting both the content and objectives of group sessions was developed. Structured workshops with the aim of training future facilitators (probation officers) ensured that the diversion programme was implemented on a regional level in the Western and Eastern Cape. Follow-up studies on young sexual offenders and feedback from facilitators indicated that the core concepts of the programme were understood by participants although several areas were identified that needed to be addressed in more detail. The follow-up studies showed that none of the youths re-offended, although disappointingly only ± 30% of youths could be interviewed. A system whereby young sexual offenders could be managed and followed-up over a longer period within a continuum of care model could not be implemented. Insufficient resources and high staff turnover are identified as key factors that hampered both the development and implementation of the SAYSTOP diversion programme. Although the SAYSTOP diversion programme proved to be successful as a first line of intervention, further refinement of the programme content, development of a continuum of care model and a central management structure involving all role players is necessary for this form of diversion programme to be successful in the future.

Includes abstract. / Includes bibliographical references. / The Highly Active Antiretroviral Therapy (HAART) era in the mid-nineties signalled a dramatic change in the long-term outcome of Human Immunodeficiency Virus (HIV). Many children have shown significant neurologic benefit, and in particular, a decline in the incidence of HIV encephalopathy. As increasing numbers of children have survived into adolescence and early adulthood new challenges have arisen, such as the detection and characterization of milder forms of HIV-associated neurocognitive deficits in children previously thought to be asymptomatic...

Includes bibliographical references. / BCG is the only vaccine against tuberculosis and has been used for over 90 years. BCG efficacy is variable, especially in countries with high TB prevalence, where over a million deaths due to tuberculosis, are still reported annually. New TB vaccines are under development to either replace or boost the BCG vaccine. However, our understanding of the immune response required for protection against TB disease, remains inadequate. Identification of a protective immune response is only possible in a clinical trial of an efficacious vaccine, allowing comparison of vaccine-induced immune responses in protected and unprotected individuals. In the absence of such a vaccine, as is the case with TB, we can only explore biomarkers of risk of disease. The most commonly measured outcomes of anti-mycobacterial immunity in clinical trials, specific Th1 cells, are typically thought to be protective in TB. However, to date, human mycobacteria-specific Th1 responses have not correlated with risk of TB disease. New approaches are urgently required to identify other factors at play in conferring protection against TB. In this thesis, we explored BCG-specific cytotoxic T cells as candidate correlates of risk of TB disease in BCG-vaccinated infants. We hypothesized that reduced production of cytotoxic molecules by T cells in response to BCG are associated with risk of developing TB disease. We designed a case/control study nested within a large trial of newborn BCG-vaccination.Blood was collected at 10 weeks and infants, were followed up for two years.We compared outcomes in infants ultimately diagnosed with TB (at risk of TB disease) and two groups of healthy infants (not at risk of TB disease), the first group had household contact with TB cases, the second group were randomly selected from the community, which is endemic for TB. Amongst these groups, we designated a training and a test cohort to allow validation of candidate correlates of risk of TB.

The diagnosis of Schizophrenia in children has historically been the source of much psychiatric controversy, especially with regard to classification, treatment and prognosis. This was further complicated by the broad category for the diagnosis of psychotic disorders in childhood in the Diagnostic and Statistical Manual of Mental Disorders (DSM 11).This included Schizophrenia in childhood, autism, and other psychotic conditions. The work of Kolvin (1971 a-f) and Rutter (1972), have been instrumental in separating autism and Schizophrenia into distinct categories. This review is not aimed at being an exhaustive coverage of all the literature on Schizophrenia in childhood, but is focused on classification, phenomenology, epidemiology, differential diagnosis, etiology, course, cross-cultural factors, and treatment. The adult literature has been referred to, when there is no appropriate reference in the literature on children with Schizophrenia, in certain focused areas. Specific research questions will be discussed in depth in the appropriate sections. These are: 1) Is Schizophrenia with childhood onset a discretely homogenous entity or is the condition on a continuum with adult Schizophrenia? 2) Are the current classification systems diagnostically valid in children with Schizophrenia? 3) Do phenomenological descriptions of the condition assist the clinician diagnostically, given the financial constraints limiting the extent of special investigations, in the South African context? 4) The evidence concerning the etiology of Schizophrenia in childhood will be critically evaluated. 5) Do current treatment models have any relevance to clinical practice in South Africa, especially with regard to the need for cost-effective solutions? 6) Two cases obtained from the in-patient Unit of the Red Cross Hospital's Child and Family Unit will also be examined, in the light of the literature. As much of the literature prior to DSM III generally did not clearly differentiate between childhood Schizophrenia, autism and other heterogeneous conditions (Rutter, 1972), they have not been included, except for seminal papers. In addition the age groups in the papers do not always mention the pubertal status of the children, thus for the purpose of the review, primarily studies focusing on samples with onset prior to 13 years are included. These have lately been characterized in the literature as 'VEOS' (Very Early Onset Schizophrenia). In one of the few longitudinal studies of children with Schizophrenia, Werry, McClellan and Chard (1991), reported that more than half the sample (55%) which had been diagnosed as schizophrenic at first presentation, was found to have Bipolar Disorder at follow-up. It is possible that the papers reviewed may also reflect this once longitudinal follow-up has been completed. The results of longitudinal studies are awaited.

Globally and in South Africa, university students’ knowledge of sexual and reproductive health (SRH) is low. This study was conducted in response to the dearth of information about the sexual and reproductive health knowledge of postgraduate students. Research conducted to explore the SRH knowledge of undergraduate students suggests that the level of SRH knowledge among undergraduate students is low. The aim of this study was to determine the SRH knowledge of postgraduate students at University of Cape Town (UCT), in South Africa. A cross sectional survey design was utilized, using an adapted and pretested online questionnaire. All postgraduate students enrolled in the first semester of 2017 (9444) were invited to anonymously complete the online survey. Four hundred and six (406) students completed the online survey, of whom 293 were female and 107 males. The age range of respondents was between 18 years and 57 years, with the median age for both male and female respondents being 24 years. Six survey responses were excluded from the statistical analysis because of incomplete data. Post graduate students from the African continent comprised 90.75% of the respondents. Most respondents were white (51.50%) from both Africa and abroad. The results indicated that respondents knew about sexually transmitted infections, and human immunodeficiency virus (HIV) & acquired immune deficiency syndrome (AIDS). Female respondents were more aware of breast examination, and the role of Papanicolaou smear (Pap smear) in SRH. Almost half of the respondents in this study (49%) stated that they had no need for more information about contraceptives. Lecturers were identified as one of the top five sources of information across faculties, which could suggest that the university environment provides students with important SRH-related information. Most postgraduate students had knowledge of sexual and reproductive health with regards to contraception, Pap smear, clinical breast examination, STIs, HIV and AIDS. Further research should focus on the relationship between SRH knowledge and usage among this population. As university lecturers were identified as an important source of information across faculties, the University should consider the incorporation of SRH education in the broader curriculum and as an integral component of student health services.

Includes bibliographical references (leaves 106-112). / Measures of the severity of metabolic acidosis (base excess) and of the severity of the underlying acid-base derangements (levels of lactate, chloride, albumin, and strong ion gap) have been used to differentiate survivors from nonsurvivors in various types of adult critical illness, including states of severe hamodynamic compromise following cardiac surgery on cardiopulmonary bypass (CPB) and in septic shock. prognostic studies of acid-base data for critically ill children in the settings of post-operative cardiogenci shock and septic shock are relatively scarce. It has been suggested that hyperchloraemia migh be a benign phenomenon that should not prompt escalation of therapy. Although it is recognised that hypoalbuminaemia is associated with adverse outcome, and obscrues the extent of underlying metabolic acidosis, the significance of 'unmeasured' anions estimated from the strong ion gap remains controversial. It has been suggested that the admission lactate level is strongly predictive of paediatric intensive care unit (PICU) outcome in both shock states, but it is not known whether calculation of the lactate: pyruvate ratio would add prognostic value in children with either post-operative cardiogenic, or septic shock.

Includes abstract. / Includes bibliographical references. / This study primarily aims at determining the correlates of Attention Deficit Hyperactivity Disorder (ADHD) among children and adolescents in Northern Nigeria. The secondary aims of the study include a comparison of the identified correlates with results from other developing countries and the developed nations. The results would also provide a rational basis for advocating preventive measures for targeted problems associated with ADHD in the study.

<p>Psykologiska bedömningar av föräldrar beskrivs sällan som en mer uttalad och tydlig del av arbetet inom barn- och ungdomspsykiatri, utan det är i hög grad ett underförstått arbetsområde. Syftet med den här undersökningen var att beskriva hur arbetet med psykologiska bedömningar av föräldrar konceptualiseras och praktiseras under det inledande skedet av behandlingskontakter inom BUP. Nio psykologer vid sju öppenvårdsmottagningar intervjuades och intervjuerna analyserades tematiskt. En viktig aspekt som framkommer i resultatet är hur det gemensamma arbetet mellan psykolog och förälder för att etablera en arbetsallians erbjuder goda möjligheter till psykologiska bedömningar av föräldern. Under arbetet med alliansen, och med alliansen som bas, kan olika former av systematik och modeller för psykologiska bedömningar tillämpas. Resultatet indikerar också att arbetsalliansens centrala betydelse för bedömningsarbetet är tydligt relaterad till organisationens påverkan på det arbetet, liksom till betydelsen av psykologisk kompetens vid arbete med psykologiska bedömningar av föräldrar.</p>

<p>Syfte</p><p>Syftet med denna studie har varit att med hjälp av intervjuer undersöka hur skolpersonal och föräldrar uppfattar betydelsen av motorisk träning för barn med ADHD/DAMP. I detta ligger att undersöka på vilket sätt barnens motorik, koncentrationsförmåga samt sociala förmåga påverkas av fysisk aktivitet, och på vilket sätt diagnosen ADHD/DAMP ställer krav på pedagogiska förhållningssätt.</p><p>Metod</p><p>Vi har gjort en litteraturgenomgång och en kvalitativ intervjustudiestudie. Urvalsgruppen från St: Örjans skolor har bestått av två pedagoger, en idrottslärare, en assistent och en förälder. Samtliga inom skolpersonalsgruppen hade många års erfarenhet inom området. Vi har använt oss av halvstrukturerande intervjuer som lagts upp utifrån följande temaområden: skolpersonal och förälders syn på fysisk aktivitet/motorisk träning för barn med ADHD/DAMP, den fysiska aktivitetens påverkan på barnen, förhållningssätt och bemötande samt barnet/barnens anpassningsförmåga till aktivitet.</p><p>Resultat och slutsats</p><p>Vad man kan urskönja av resultatet är att samtliga intervjupersoner i denna studie är ense om att fysisk aktivitet och motorisk träning är av stor betydelse för barn med ADHD/DAMP.</p><p>Något som de intervjuade tryckte på var den fysiska aktivitetens betydelse för barnens sociala utveckling, här sågs idrotten som en viktig arena. Genom idrott och fysisk aktivitet får barnen lära sig att umgås med andra, visa hänsyn, respekt, empati och förstå att andra människor har känslor. Den sistnämnda förmågan saknas ofta hos dessa barn.</p><p>Vad det gäller motoriken behöver dessa barn mycket träning och enligt litteraturen kan denna träning på sikt ge goda resultat. Noterbart i studien är dock att det råder delade meningar om att koncentrationsförmågan kan påverkas av fysisk aktivitet. Även intervjupersonerna menar att det inte med säkerhet går att säga att koncentrationen förbättras av fysisk aktivitet. Trots att vi har kommit i kontakt med erfarna personer inom detta område, anser vi inte riktigt att vi fått ut det vi förväntat oss. Detta kan bero på att våra och de intervjuades praktiskt pedagogiska kunskaper skiljer sig åt. I resultatet framträder det att de intervjuade har svårt att i mer preciserad form tala om motorisk träning, vilket gör att den röda tråden i deras beskrivningar är svår att läsa av. Slutsatsen är att de intervjuade anser att fysisk aktivitet och motorisk träning har en påtaglig betydelse för barn med ADHD/DAMP i relation till barnens sociala, emotionella och motoriska utveckling samt till viss del deras koncentrationsförmåga.</p>

While the functional and anatomical aspects of reconstructive surgery in children with leg length inequality (LLI), prominent ears (PE) and cleft lip and palate (CLP) have been studied in detail, the psychological aspects of surgery have been less explored. The benefit of a changed appearance and function on self-esteem and ability to social interaction are other areas where information is lacking. The aim of this thesis is to examine, during the process of reconstructive surgery, the mental health, self-esteem and social interaction of children with defects in appearance and function. Children, aged 6-16 years, with LLI (n=27) and PE (n=31) were invited to participate in interviews and psychological assessments by filling in a battery of questionnaires and tests (depression; anxiety; self-esteem; cognitive ability; and behaviour) before Ilizarov and otoplasty surgery and one year after. Parents filled in a child symptom check list and a state and trait anxiety questionnaire. Another six adolescents with CLP and their parents participated in interactive interviews with the aim of identifying relevant psychological issues for individuals with this condition. These issues were subsequently used to create new questionnaires. Being different, the development of self-esteem and social interaction were the central themes of the questionnaires designed after the interview study. The new questionnaires were explored in a retrospective study on other adolescents (n=26) with CL/P and their parents. Beck’s Youth Inventories (BYI) was used as comparative data. The LLI group had significantly lower mental health and self-esteem scores than the control group before surgery. The leisure activity level in both patient groups was low according to parents’ report before surgery. The mental health scores of both patient groups (LLI and PE) were improved after reconstructive surgery, but self-esteem was not affected. The questionnaires for CL/P patients proved to be useful in the exploration of self-esteem from a developmental perspective and in the search for strengthening factors of social interaction. Self-esteem was average or high on group level for adolescents with CL/P compared to BYI measure. Parents rated their adolescents to have higher self-esteem than the adolescents themselves. Females had a less positive development of self-esteem, there was an interaction effect between the female and male patients’ evaluation of self-esteem by higher age. Even a minor appearance defect like PE may affect mental health negatively. There were no adverse psychological effects one year after surgery in LLI and PE patients, rather, there were signs of improved mental health. Adolescents with CL/P have an anticipated risk of more mental health problems and especially those individuals who have been bullied. Cleft teams and Child and Adolescent Psychiatric Clinics should be attentive and offer psychological support to those individuals most affected by their conditions.