According to Mechanic (1967), the layman has usually assumed that the psychiatric professional is the unbiased expert on who is, or is not, mentally ill. In addition, the psychiatric professional has also usually assumed that his labeling decisions are based upon an unbiased scientific examination of the available information. However, Mechanic, and other sociological observers of the mental illness labeling process, have recently questioned whether these assumptions are legitimate. In fact, these observers have found that the professional’s labeling decisions are apparently heavily biased in favor of mental illness. Mechanic (1967), recounting his experience at two state institutions, reported that once a person is presented for institutionalization, seldom if ever does the psychiatrist dis- agree, although the psychiatrist’s “reasons” for hospitalization may be based on different premises than the public’s. Scheff (1964a, 1964b) found that when psychiatrists work within a court commitment setting, they tended to presume the existence of mental disorder. In a detailed examination of actual court procedures and psychiatrists’ pre- commitment patient interviews, his evidence indicated that the psychiatrists’ investigations appeared biased and presumed the existence of disorder. The psychiatrists frequently chose arbitrary evidence upon which to base their decisions- -evidence that involved elaborate psychiatric straining and interpretation. Often they decided to commit the person in question even where no evidence could be found. Their offhand remarks suggested pre- judgment of the case, and the interviews were conducted with such marked haste and carelessness that they only lasted on the average about ten minutes. As one of the psychiatrist’s states: The petition cases are pretty automatic. If the patient’s own family wants to get rid of him you know there is something wrong (Scheff, 1964a, p. 410). Coffman (1961) has noted that psychiatrists usually seek only that information that is consistent with their opinions through a process he has called “discrediting”. Within the mental hospital with which he was associated, the patient’s records and history were carefully searched to provide justification for the patient’s label, while any evidence of health was usually ignored. On the other hand, Gove (1970) has disputed the veracity of these observations. He has presented evidence that psychiatric professionals do not routinely label people as mentally ill, and do not commit every person they examine to a mental institution. Gove has also questioned the scientific adequacy of the methods employed by Mechanic and Scheff. Unfortunately, Gove’s rebuttal was based upon a review of the literature, and most, if not all, of the studies in his review were not originally directed toward the question of possible professional bias. In the writer’s opinion, an adequate test of the legitimacy, or illegitimacy, of Mechanic’ (1967), Scheff’s (1964a, 1964b), or Goffman’s (1961) observations has not yet been made. If professional bias does exist in the mental illness labeling process, then two primary factors might account for Mechanic’s, Scheff’s, and Goffman’s observations. First, an individual’s work setting may be associated with various situational expectancies that might influence one’s diagnostic judgment. For example, the situational expectancies of the psychiatric professional, operating within his typical work setting, might be biased in favor of the probable appearance of a mentally ill person. If one expects to interview a mentally ill person, then one’s diagnostic judgment of that person’s mental status might be affected. Second, the psychiatric professional’s training and experience might foster an increased inclination to view people as mentally ill--a greater inclination than the non-professional. If the professional is less inclined to tolerate deviance than the non-professional, then the professional’s diagnostic judgments should be more likely to lead to the mental illness label. The primary goal of this dissertation will be to examine these two factors--situational expectancies and tolerance of deviance--and their role in the mental illness labeling process. Bias in the application of the mental illness label may be traceable to the effects of these two factors. / This thesis was digitized as part of a project begun in 2014 to increase the number of Duke psychology theses available online. The digitization project was spearheaded by Ciara Healy.

Counselor educators and counseling practitioners today reflect the future direction of the counseling profession; therefore, their opinions are important when discussing how professional counselors can reconcile the basic philosophies of humanistic counseling with the practical advantages and ethical and philosophical disadvantages that appear to be coexistent when discussing the diagnosis of clients and the Diagnostic and Statistical Manual of Mental Disorders IV-Text Revision (DSM). This study sought to provide a reflective and concise description of the current perceptions of licensed professional counselors in reference to their training, their practice, and their dispositions about diagnosis and utilization of the DSM despite its theoretical grounding in the medical model and its chronic problems with gender and cultural bias—all in direct opposition to counseling's humanistic, multicultural model of practice. Results of this study suggested that more training in DSM/diagnosis led to participants' higher perception of their ability to diagnose and utilize the DSM; however, participants' perceptions were split on whether or not training should include psychopharmacology. Results also suggested that LPCs most frequently occurring ethical dilemma in relation to diagnosis involved the reimbursement requirements of insurance/managed care companies; however, they strongly disagreed that diagnosing clients conflicted with their counseling professional identity. Participants strongly agreed that they were multiculturally competent; however, those participants who indicated that they diagnose using a multicultural or wellness perspective did not agree that the DSM does not adequately present disorders in such a way as to allow LPCs to diagnose culturally diverse and female clients accurately.

A research report submitted to the Faculty of Medicine university of tho Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of science in Medicine. / Breast cancer is a major health problem, afflicting up to 1 in 9 women in developed countries with Western diet and life style. While screening programs have led to earlier diagnosis, including diagnosis at a pre-invasive stage in a number of women, the majority of patients with breast cancer still present with clinically detectable, invasive breast cancer, which even if clinically localised still carries the risk of systemic micrometastases, Such patients have been shown to benefit both in terms of disease free as well as of overall survival from the addition of adjuvant systemic treatment. The identification of progostic factors which can be used to tailor specific forms of adjuvant treatment to the patient's disease has been an important goal of breast cancer research during the last 20 years. A particularly important goal is the early identification of poor risk patients, who may benefit from aggressive intervention with intensive chemotherapy, While many prognostic markers, including nodal status, hormone-receptor-status, ploidy and growth fraction and the expression of various oncogenes and proto-oncogenes by the tumor cells have been proposed as prognostic factors, the results, to date, have been equivocal for a number of these. Recently there has been much. interest in the prognostic importance of cerbB- 2 protein in breast cancer. Most of these studies have concentrated on immunohistochemically stainable e-erb-2 in tumor tissue. This dissertation focusses on the prognostic impact of the soluble c-erbB-2 protein in the serum of breast cancer patients treated at the Breast Clinic of tne Johannesburg Hospital and University of the Witwatersrand. The results of this investigation have been reported under the title "Soluble c-erhB-2 fragment in Serum Correlates With Disease Stage and Predicts for Shortened Survival in Patients with Early Stage and Advanced Breast Cancer" by H. Kandt, L. Seymour & W.R. Bezwoda, Published in British Journal of Cancer, Vo170 p739-742" 1994. / Andrew Chakane 2018

The morbidity and mortality from tuberculosis may be influenced by the delay from the onset of symptoms until diagnosis. This study was performed to investigate patient and health services delays in the diagnosis o f pulmonary tuberculosis, and the patients’ explanations for these delays.

MMed, Haematology, Faculty of Health Sciences, University of the Witwatersrand / Background: Mycobacterium tuberculosis (MTB) infection remains a serious public health challenge in sub-Saharan Africa. Rapid and early diagnosis is critical in the successful control of this eminently treatable infection. This study compared the diagnostic usefulness of culture, bone marrow trephine biopsy granulomata, bone marrow trephine biopsy Ziehl-Neelsen (ZN) stain and bone marrow mycobacterial polymerase chain reaction (PCR) in establishing the diagnosis of mycobacterial infection in HIV infected patients. Materials and methods: The trephine biopsies of HIV positive patients done for the investigation of suspected tuberculosis were reviewed for granulomata and stained with ZN stain. The corresponding bone marrow aspirates were subjected to DNA real-time PCR analyses using LightCyler TB Kit® (Roche Diagnostic). Culture results were used as diagnostic gold standard. Results: Of the 60 patients studied, 24 were culture negative. Of the 34 culture positive, 62% were Mycobacterium tuberculosis and 38% were Mycobacterium avium intracellulare. Using the culture method as a gold standard, the sensitivities and specificities were 97% and 23% for bone marrow trephine biopsy granulomata, 65% and 58% for bone marrow trephine biopsy ZN staining and 50% and 73% for bone marrow aspirate PCR analysis respectively. Ninety-seven percent of all trephine biopsies with positive ZN stain had granulomata. Conclusion: The presence of granulomata in bone marrow trephine biopsies of HIV infected patients appear to have a high diagnostic yield whilst mycobacterial PCR has the lowest yield but highest specificity. These results should be confirmed in a prospective case controlled study because the sample size in this study was small, and the study was a retrospective one.

Hypertension is a major cause of morbidity and mortality in communities of African ancestry. The most appropriate method of predicting the risk for blood pressure (BP)-related cardiovascular events is through 24-hour ambulatory BP (ABP) monitoring. Although the cost of monitors precludes the use of 24-hour BP measurement in groups of African descent in Africa, the extent to which BP-related cardiovascular risk may be underestimated by nurse-derived clinic BP measurements, and the current method of BP-related risk assessment in these communities, is uncertain. In this regard, nursederived BP measurement is thought to be superior to other forms of in-office BP measurement. Ambulatory 24-hour, day and night BP (SpaceLabs, model 90207) and nursederived clinic BP (CBP) (mean of 5 values) control rates were determined in 689 randomly selected participants (>16 years) of African ancestry in South Africa. Of the participants 45.7% were hypertensive and 22.6% were receiving antihypertensive medication. More participants had uncontrolled BP at night (34.0%) than during the day (22.6%, p<0.0001). However, uncontrolled CBP was noted in 37.2% of participants, while a much lower proportion had uncontrolled ABP (24.1%)(p<0.0001). These differences were accounted for by a high prevalence of isolated increases in CBP (whitecoat effects)(39.4%). Thus, in communities of African descent, despite a worse BP control at night than during the day, a high prevalence of white-coat effects translates into a striking underestimation of BP control when employing CBP rather than ABP measurements. Nurse-derived BP measurements are often as closely associated with organ damage as ABP. However, the extent to which relationships between nurse-derived BP measurements and organ damage reflect a white-coat effect (isolated increase in inoffice BP) as opposed to the adverse effects of BP per se are unknown. In 750 participants from a community sample, target organ changes were determined from carotid-femoral pulse wave velocity (PWV) (applanation tonometry and SphygmoCor software) (n=662) and left ventricular mass indexed to height2.7 (LVMI) (echocardiography)(n=463). Nurse-derived CBP was associated with organ changes independent of 24-hour BP (LVMI; partial r=0.15, p<0.005, PWV; partial r=0.21, p<0.0001) and day BP. However, in both unadjusted (p<0.0001 for both) and multivariate adjusted models (including adjustments for 24-hour BP)(LVMI; partial r=0.14, p<0.01, PWV; partial r=0.21, p<0.0001) nurse office-day SBP (an index of isolated increases in in-office BP) was associated with target organ changes independent of ambulatory BP and additional confounders. Thus, nurse-elicited whitecoat effects account for a significant proportion of the relationship between nursederived CBP and target organ changes independent of ambulatory BP. Therefore, high quality nurse-derived BP measurements do not approximate the impact of BP effects per se on cardiovascular damage. In 750 participants from a community sample I evaluated whether nurse officeday BP is inversely related to day-night BP (BP dipping) and whether this relationship may in-part explain the independent association between office-day BP and organ damage. Nurse office-day systolic BP (SBP) was correlated with % night/day SBP (r=0.22, p<0.0001) and night SBP (r=0.14, p=0.0001). Although unadjusted and multivariate adjusted (including for day SBP) nurse office-day SBP was associated with LVMI (partial r=0.15, p<0.01) and PWV (partial r=0.22, p<0.0001), neither day-night SBP (LVMI; partial r=-0.01, p=0.88, PWV: partial r=-0.04, p=0.30) nor % night/day SBP (LVMI; partial r=0.01, p=0.91, PWV: partial r=0.04, p=0.37) were independently related to target organ changes. Moreover, the relationships between nurse office-day SBP and target organ changes persisted with adjustments for either day-night SBP (p<0.05- p<0.0001) or night SBP (p<0.01-p=0.0001). Thus, although nurse office-day SBP, an index of an alerting response, is independently associated with an atttenuation of nocturnal decreases in SBP, neither a decreased BP dipping, nor nocturnal BP explain the independent relationship between nurse office-day SBP and target organ changes. Whether nurse office-day BP is affected by antihypertensive therapy, is uncertain. In the present study the effect of antihypertensive therapy on nurse office-day BP was assessed in 173 patients whom, off treatment, had a daytime diastolic BP ranging from 90 to 114 mm Hg. Over the treatment period marked decreases in BP occurred (p<0.0001). However, neither nurse office-day systolic (baseline=16.5±15.8 mm Hg, 4 months=15.3±18.9 mm Hg, p=0.49), nor diastolic (baseline=0.9±9.3 mm Hg, 4 months=4.3±10.7 mm Hg, p<0.005) BP decreased significantly from baseline. Thus, despite producing marked decreases in nurse-derived in-office and out-of-office ambulatory BP, antihypertensive therapy produces no change in nurse-elicited isolated increases in in-office BP (white coat-effects) in a group of African descent. In conclusion, the results of the present thesis indicate that in an urban, developing community of African descent, as compared to 24-hour BP measurements, nurse-derived BP measurements elicit a significant in-office increase in BP which translates into a marked underestimation of BP control at a community level; is strongly associated with organ damage through effects that cannot be attributed to 24-hour BP or to relationships with an attenuated decline in nocturnal BP; and which cannot be treated with antihypertensive therapy. Further work is required to assess the most cost-effective approach to excluding nurse-elicited isolated increases in in-office BP before initiating antihypertensive therapy to groups of African descent.

A Research Submitted to the Faculty of Health Sciences (School of Public Health), University of the Witwatersrand, in Partial Fulfilment of the Requirements for the Degree of Masters in Public Health in the field of Social Behaviour Change and Communication 27 May 2014 / Introduction: HIV/AIDS services are now given freely at public health facility level. They have been decentralized to the formal primary health facilities in the rural areas. Despite the efforts by the South African government, the utilization of those services remains a challenge. There are gender disparities in utilisation of HIV/AIDS services as females utilize the services in greater numbers compared to their male counterparts. The newly diagnosed seropositive men tend to disappear soon after HIV testing, only to appear in a formal health system when their immune system is seriously suppressed and at a more advanced WHO stage of disease. Therefore, the overall aim of this study was to explore the underlying perceptions and beliefs that influence utilization of HIV/AIDS services by newly diagnosed HIV positive men in Mbashe Sub-District of the Eastern Cape between January 2010 and March 2011 Methods: The study was conducted in the rural Mbashe Sub-District of the Eastern Cape Province and utilized a qualitative methodology. This qualitative approach relied on semi-structured in-depth interviews with newly diagnosed HIV positive men of 18-49 years of age who were either accessing or not accessing the HIV/AIDS services during January 2010 and March 2011.The participants were recruited through purposive sampling and 18 interviews were conducted in 6 different facilities at three different service levels. Interviews were audio-recorded and transcripts were subjected to thematic content analysis based on the Health Belief Model. Results: The results show that both groups of men reacted negatively to HIV positive status. The experiences during HIV Counselling and Testing were not linked to whether men could access services. The barriers to utilizing the available HIV/AIDS services included fear of stigma and discrimination, need for an alternative quick cure which delayed utilization of the services, the clinic as gendered space, compromised Provider-Initiated Counselling and Testing (PICT) model implementation, shortage of food, physical fitness and alcoholism. The facilitators for access included the need for survival, disclosure and social support, and cues to action like witnessing a relative dying due to HIV/AIDS related illness. However, the HBM model could not squarely explain the trends in accessing HIV service since few constructs were found to be relevant and also some issues that are outside the HBM model emerged. Conclusions: The study demonstrates that newly diagnosed men‟s utilization of the subsequent free HIV/AIDS services at the primary health care level is influenced by many factors . There are those factors that trigger men to utilize the services and those that deter them from accessing necessary HIV/AIDS services. The factors that influence their access to services are mainly within the multilevel framework which ranges from individual, family, community and societal factors. Therefore, the targeted interventions to address the issue should focus on addressing stigma and discrimination, policy change on training, recruitment and deployment of male nurses, integration of traditional/spiritual interventions within the mainstream of health services, correct implementation of the PICT model and encouraging couple counselling and testing. The Health Belief Model constructs, especially perceived severity, were not strongly linked to whether men accessed services or not.

Thesis (M.Ph.)--Chinese University of Hong Kong. / Bibliography: leaves 66-78.

No description available.

Lei Ieng Kit Kenny. / "April 2002." / Thesis (M.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 89-118). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.