The aim of this study was to investigate experiences and perceptions of private · medical practitioners about the implementation of the current death notification form (Bl-1663) in cases of confirmed Aids-related deaths. The study focussed on reporting patterns by private medical practitioners of the deceased's underlying causes of death in BI-1663. The study also focussed on the reasons advanced for the reporting patterns described above. The research method employed in this study was cross-sectional surveys. Self-administered questionnaires were used to gather the data and the target population was all private medical practitioners practising within the Mafikeng / Mmabatho area of the North West Province of South Africa. A response rate of eighty-two and half per cent (82,50%) was achieved. The data were presented in the form of frequency tables and pie charts and descriptive statistics was used to analyse it. The findings of this study revealed that the majority of private medical practitioners either omitted information that HIV / AIDS was an underlying cause of death or reported another condition in BI-1663 during notification of confirmed AIDS related deaths. Reasons advanced for the phenomenon were fears of unauthorised breach of the deceased's confidential information by unintended parties that often led to invalidation of the deceased's insurance and funeral benefits, as well as stigmatisation and social discrimination of relatives the deceased. The study recommends that third parties (informants) should be relieved of the duties of conveying the deceased's confidential medical information to the state during death notification processes. Medical practitioners themselves should submit Part 2 of BI- 1663 that contains the deceased's confidential information directly to Public Health Officials. The study also recommends that the Department of Health should provide formal training to the medical practitioners with respect to death certification in order to enable them to certify causes of deaths in a manner that is useful for epidemiological analysis and public policy. / (MBA) North-West University, Mafikeng Campus, 2005

Parkinson's disease (PD) is one of the most common motor neurodegenerative diseases, affecting 1-2% of the world's population over the age of 65. It is characterised by a loss of dopamine neurons within the substantia nigra, which is an integral part of the basal ganglia (BG) where dopamine is the most important modulating neurotransmitter. As the BG is primarily involved with the execution of movement, the lack of dopamine input results in dysfunctional motor control. The current PD treatment, L-DOPA, improves these motor symptoms, however only provides patients 5 to 10 years of improved quality of life before debilitating side effects, often worse than the original symptoms, begin. The neuropeptide substance P (SP) is found in high concentration in the substantia nigra, and BG in general, where it is involved in dopamine release. In the late stages of PD, SP content within the substantia nigra and BG is decreased, thus implicating SP in the pathophysiology of PD. However, SP production has not been examined in the early stages of PD when dopaminergic degeneration is first initiated. This thesis therefore sought to characterise the role of SP in dopaminergic degeneration in an experimental model of early PD, the 6-hydroxydopamine model in rats. In contrast to the prevailing dogma that a decline in SP is associated with neurodegeneration in PD, this thesis demonstrates that SP is actually increased within the striatum in early PD, particular in perivascular tissue and within surviving dopaminergic neurons during the degenerative process. Increasing exposure of the dopaminergic neurons to SP, either by inhibition of substance P breakdown with Captopril or by direct injection with SP, exacerbated the disease progression as indicated by more profound neurogenic inflammation, functional deficits and increased dopaminergic cell death. However, when SP was inhibited by treatment with a SP NK₁ receptor antagonist, dopaminergic neurons were conserved, the inflammatory response was reduced and motor function was returned to near normal levels. We conclude that SP is increased in early PD, and that increased SP plays an important role in the degenerative process, specifically, in the genesis of BBB breakdown and initiation of neurogenic inflammation. Treatment with an NK1 antagonist may thus represent a novel therapeutic approach to early stage Parkinson’s disease. / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Parkinson's disease (PD) is one of the most common motor neurodegenerative diseases, affecting 1-2% of the world's population over the age of 65. It is characterised by a loss of dopamine neurons within the substantia nigra, which is an integral part of the basal ganglia (BG) where dopamine is the most important modulating neurotransmitter. As the BG is primarily involved with the execution of movement, the lack of dopamine input results in dysfunctional motor control. The current PD treatment, L-DOPA, improves these motor symptoms, however only provides patients 5 to 10 years of improved quality of life before debilitating side effects, often worse than the original symptoms, begin. The neuropeptide substance P (SP) is found in high concentration in the substantia nigra, and BG in general, where it is involved in dopamine release. In the late stages of PD, SP content within the substantia nigra and BG is decreased, thus implicating SP in the pathophysiology of PD. However, SP production has not been examined in the early stages of PD when dopaminergic degeneration is first initiated. This thesis therefore sought to characterise the role of SP in dopaminergic degeneration in an experimental model of early PD, the 6-hydroxydopamine model in rats. In contrast to the prevailing dogma that a decline in SP is associated with neurodegeneration in PD, this thesis demonstrates that SP is actually increased within the striatum in early PD, particular in perivascular tissue and within surviving dopaminergic neurons during the degenerative process. Increasing exposure of the dopaminergic neurons to SP, either by inhibition of substance P breakdown with Captopril or by direct injection with SP, exacerbated the disease progression as indicated by more profound neurogenic inflammation, functional deficits and increased dopaminergic cell death. However, when SP was inhibited by treatment with a SP NK₁ receptor antagonist, dopaminergic neurons were conserved, the inflammatory response was reduced and motor function was returned to near normal levels. We conclude that SP is increased in early PD, and that increased SP plays an important role in the degenerative process, specifically, in the genesis of BBB breakdown and initiation of neurogenic inflammation. Treatment with an NK1 antagonist may thus represent a novel therapeutic approach to early stage Parkinson’s disease. / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

O presente estudo aborda a percepção de pais de crianças e adolescentes com câncer sobre a doença e sobre a morte. A pesquisa de campo possibilitou, através das entrevistas, a obtenção das histórias parciais de pais ou mães de crianças e adolescentes com câncer. Foi possível verificar que os pais percebem os sintomas físicos do filho e tomam suas providências; após o diagnóstico sabem que seu filho tem câncer, mas dividem-se em mencionar o nome da doença ou mantê-la sob resguardo; percebem a doença como algo descontrolado, maligno, perigoso. Os médicos são vistos como facilitadores no processo saúde-doença, mas em alguns casos, também como aqueles que certificam a família sobre o prognóstico inevitável. O câncer muda a vida da família, desde a rotina até os valores. Alguns pais acreditam que o câncer existe em todas as pessoas, mas se desenvolve em algumas dependendo de seu estado físico ou emocional. Aqui surgem as concepções genéticas, religiosas, de causa-efeito, noções de culpa e castigo, menção das histórias de vida para explicar a doença. Para a morte, os pais mencionam pensar nela de forma mais próxima depois do advento da doença. Componentes de fé, esperança e elaboração para suas angústias aparecem com frequência nas falas destes pais. O estudo permitiu compreender de que forma os pais percebem e representam a doença de seus filhos com câncer, como vivenciam a possibilidade e o sentido da morte e de que maneira passam a compreender a finitude depois da dura experiência. / The present study focuses on the perception about disease and death of parents of children and adolescents with cancer. The field research was carried out trough interviews with fathers or mothers of children and adolescents with cancer. The interviews showed that when the parents perceive the physical symptoms of their children they usually take some measures; after the cancer has been diagnosed in their children they stay undecided between mentioning the name of the disease or maintaining it under disguise; they perceive the disease as something unbridled, malignant, dangerous. The doctors are seen as facilitators in the health disease process, but in some cases, also as those that will inform the family about the inevitable prognostic. The cancer changes the life of the family, both their daily routines and their values. Some parents believe that the cancer may affect all persons, but will probably develop or manifest itself only in some specific persons, epending on its emotional or physical situation. Here emerge the conceptions of genetics, of religion, of cause and effect, notions of guilt and punishment, mention of life histories to explain the disease. The parents mention that they think more about death after the advent of the disease. Components of faith, hope and elaboration to their anguishes appear many times in their talk. The study makes possible to understand how the parents perceive and represent the disease of their children with cancer, how they experience the possibility and the meaning of death, and how they start to understand the finitude of life after a hard personal and family ordeal.

O presente estudo aborda a percepção de pais de crianças e adolescentes com câncer sobre a doença e sobre a morte. A pesquisa de campo possibilitou, através das entrevistas, a obtenção das histórias parciais de pais ou mães de crianças e adolescentes com câncer. Foi possível verificar que os pais percebem os sintomas físicos do filho e tomam suas providências; após o diagnóstico sabem que seu filho tem câncer, mas dividem-se em mencionar o nome da doença ou mantê-la sob resguardo; percebem a doença como algo descontrolado, maligno, perigoso. Os médicos são vistos como facilitadores no processo saúde-doença, mas em alguns casos, também como aqueles que certificam a família sobre o prognóstico inevitável. O câncer muda a vida da família, desde a rotina até os valores. Alguns pais acreditam que o câncer existe em todas as pessoas, mas se desenvolve em algumas dependendo de seu estado físico ou emocional. Aqui surgem as concepções genéticas, religiosas, de causa-efeito, noções de culpa e castigo, menção das histórias de vida para explicar a doença. Para a morte, os pais mencionam pensar nela de forma mais próxima depois do advento da doença. Componentes de fé, esperança e elaboração para suas angústias aparecem com frequência nas falas destes pais. O estudo permitiu compreender de que forma os pais percebem e representam a doença de seus filhos com câncer, como vivenciam a possibilidade e o sentido da morte e de que maneira passam a compreender a finitude depois da dura experiência. / The present study focuses on the perception about disease and death of parents of children and adolescents with cancer. The field research was carried out trough interviews with fathers or mothers of children and adolescents with cancer. The interviews showed that when the parents perceive the physical symptoms of their children they usually take some measures; after the cancer has been diagnosed in their children they stay undecided between mentioning the name of the disease or maintaining it under disguise; they perceive the disease as something unbridled, malignant, dangerous. The doctors are seen as facilitators in the health disease process, but in some cases, also as those that will inform the family about the inevitable prognostic. The cancer changes the life of the family, both their daily routines and their values. Some parents believe that the cancer may affect all persons, but will probably develop or manifest itself only in some specific persons, epending on its emotional or physical situation. Here emerge the conceptions of genetics, of religion, of cause and effect, notions of guilt and punishment, mention of life histories to explain the disease. The parents mention that they think more about death after the advent of the disease. Components of faith, hope and elaboration to their anguishes appear many times in their talk. The study makes possible to understand how the parents perceive and represent the disease of their children with cancer, how they experience the possibility and the meaning of death, and how they start to understand the finitude of life after a hard personal and family ordeal.

Les répercussions du sida sur la communauté intellectuelle préfiguraient un changement certain dans l’esthétique littéraire contemporaine. Le témoignage de l’expérience individuelle de l’écrivain, à cet instant de désarroi collectif et de répression sociale à l’égard de la communauté homosexuelle, cherchait à provoquer une reconfiguration de l’espace de l’aveu par la projection du sujet privé dans la sphère publique. Cette posture de mise à nu avait déjà vu le jour dans les écrits féministes des années 70, mais elle a subi dans les années 80 et 90 une transformation importante puisque c’est le sujet masculin qui s’est exposé par la médiation du corps dans le récit de la maladie à l’heure du sida. Les discours de l’intime tentaient de rapprocher les espaces social et littéraire tout en affirmant des formes définies par des éthiques et des esthétiques hétérogènes. La période d’écriture de la maladie, qui clôt l’oeuvre de Guibert, est caractérisée par l’ancrage du contexte social de l’épidémie du sida. Par conséquent, les trois récits qui la fondent, soit À l’ami qui ne m’a pas sauvé la vie (1990), Le protocole compassionnel (1991) et Cytomégalovirus (1992), constituent le triptyque sur lequel s’appuiera ma réflexion, auquel s’ajoute le journal tenu par Guibert depuis son adolescence jusqu’à sa mort, Le mausolée des amants (2001), qui a été publié dix ans après la disparition de l’auteur. Cette oeuvre s’inscrit en partie dans cette mouvance du témoignage de la maladie, qui prend place entre 1987 et 1991, période pendant laquelle l’écrivain sent sa vulnérabilité sur le plan de sa santé. Il est proposé d’étudier à travers ces écrits l’écriture de l’aveu et de la dénonciation, telle qu’elle est pensée chez Guibert. Il s’agira de réfléchir sur les stratégies et les fonctions du témoignage littéraire d’une telle expérience à travers la mise en récit du sujet. Une problématique traverse toutefois cette posture de mise en danger individuelle où la nécessité de se révéler est l’objet d’un non-consensus. Or, cette recherche d’intensité par l’aveu, qui repose sur la maladie, la sexualité et la mort, veut dépasser sa dimension apocalyptique en tentant d’inscrire l’oeuvre dans une éthique sociale. De ce fait, le dévoilement, sur le mode de la dénonciation, s’oriente sur la dimension collective en prenant à partie la société et la communauté. / The impact of Aids on the intellectual community anticipates an important change in contemporary literature’s aesthetics. Testimony of the writer’s experience, in an epoch of collective disarray and social repression towards homosexuals, strived to create a new context for self-confession by prospecting the personal subject into public sphere. This mode of self-exposure was already manifest in feminine texts from the 70’s, but it underwent an important transformation in the 80’s and 90’s. In the age of Aids, it is the masculine subject that, by means of the body, unveils itself in narratives about the disease. Discourses about personal intimacy attempted to bring social and literary spaces closer by elaborating forms of heterogeneous ethics and aesthetics. The closing period of Guibert’s work, which focuses on illness is anchored in the social context of the Aids epidemic. Consequently, the three texts, À l’ami qui ne m’a pas sauvé la vie (1990), Le protocole compassionnel (1991) and Cytomégalovirus (1992) constitute the central subject of my reflection, along with the personal diary that Guibert kept from his teenage years until his death, Le mausolée des amants (2001). To a certain extent, this journal bears witness to the encroaching disease, which evolved between the years 1987 and 1991, the period during which the writer felt a growing vulnerability regarding his health. This study will focus on Guibert’s thinking about confession and denunciation. It will be a matter of reflecting on the strategies and functions of literature bearing intensity to the subjective experience of Aids. Moreover, the quest for achieving intensity by self-confession which concerns telling the story of illness, sexuality and death, seeks to go beyond an apocalyptic dimension by inscribing the work in a social and ethical context. In this way, self-exposure holds forth the collective aspect by confronting society and community.

RÉSUMÉ Les répercussions du sida sur la communauté intellectuelle préfiguraient un changement certain dans l’esthétique littéraire contemporaine. Le témoignage de l’expérience individuelle de l’écrivain, à cet instant de désarroi collectif et de répression sociale à l’égard de la communauté homosexuelle, cherchait à provoquer une reconfiguration de l’espace de l’aveu par la projection du sujet privé dans la sphère publique. Cette posture de mise à nu avait déjà vu le jour dans les écrits féministes des années 70, mais elle a subi dans les années 80 et 90 une transformation importante puisque c’est le sujet masculin qui s’est exposé par la médiation du corps dans le récit de la maladie à l’heure du sida. Les discours de l’intime tentaient de rapprocher les espaces social et littéraire tout en affirmant des formes définies par des éthiques et des esthétiques hétérogènes. La période d’écriture de la maladie, qui clôt l’oeuvre de Guibert, est caractérisée par l’ancrage du contexte social de l’épidémie du sida. Par conséquent, les trois récits qui la fondent, soit À l’ami qui ne m’a pas sauvé la vie (1990), Le protocole compassionnel (1991) et Cytomégalovirus (1992), constituent le triptyque sur lequel s’appuiera ma réflexion, auquel s’ajoute le journal tenu par Guibert depuis son adolescence jusqu’à sa mort, Le mausolée des amants (2001), qui a été publié dix ans après la disparition de l’auteur. Cette oeuvre s’inscrit en partie dans cette mouvance du témoignage de la maladie, qui prend place entre 1987 et 1991, période pendant laquelle l’écrivain sent sa vulnérabilité sur le plan de sa santé. Il est proposé d’étudier à travers ces écrits l’écriture de l’aveu et de la dénonciation, telle qu’elle est pensée chez Guibert. Il s’agira de réfléchir sur les stratégies et les fonctions du témoignage littéraire d’une telle expérience à travers la mise en récit du sujet. Une problématique traverse toutefois cette posture de mise en danger individuelle où la nécessité de se révéler est l’objet d’un non-consensus. Or, cette recherche d’intensité par l’aveu, qui repose sur la maladie, la sexualité et la mort, veut dépasser sa dimension apocalyptique en tentant d’inscrire l’oeuvre dans une éthique sociale. De ce fait, le dévoilement, sur le mode de la dénonciation, s’oriente sur la dimension collective en prenant à partie la société et la communauté. / ABSTRACT The impact of Aids on the intellectual community anticipates an important change in contemporary literature’s aesthetics. Testimony of the writer’s experience, in an epoch of collective disarray and social repression towards homosexuals, strived to create a new context for self-confession by prospecting the personal subject into public sphere. This mode of self-exposure was already manifest in feminine texts from the 70’s, but it underwent an important transformation in the 80’s and 90’s. In the age of Aids, it is the masculine subject that, by means of the body, unveils itself in narratives about the disease. Discourses about personal intimacy attempted to bring social and literary spaces closer by elaborating forms of heterogeneous ethics and aesthetics. The closing period of Guibert’s work, which focuses on illness is anchored in the social context of the Aids epidemic. Consequently, the three texts, À l’ami qui ne m’a pas sauvé la vie (1990), Le protocole compassionnel (1991) and Cytomégalovirus (1992) constitute the central subject of my reflection, along with the personal diary that Guibert kept from his teenage years until his death, Le mausolée des amants (2001). To a certain extent, this journal bears witness to the encroaching disease, which evolved between the years 1987 and 1991, the period during which the writer felt a growing vulnerability regarding his health. This study will focus on Guibert’s thinking about confession and denunciation. It will be a matter of reflecting on the strategies and functions of literature bearing intensity to the subjective experience of Aids. Moreover, the quest for achieving intensity by self-confession which concerns telling the story of illness, sexuality and death, seeks to go beyond an apocalyptic dimension by inscribing the work in a social and ethical context. In this way, self-exposure holds forth the collective aspect by confronting society and community.