Syftet var att undersöka högkänslighet och stress hos studenter. Metoden var en kvantitativ jämförande studie mellan grupper (kvinnor och män). Undersökningen genomfördes genom en elektronisk enkät. Urvalet var ett tillfällighetsurval av kvinnor och män i åldrarna 19 – 56 som studerade vid ett universitet, totalt 122 stycken deltagare, 31 män och 91 kvinnor. Deltagarna besvarade en enkät som bestod av bakgrundsfrågor och mätinstrument som mätte stress och högkänslighet. Resultatet visade på att högkänslighet och stress var skattad högst bland kvinnorna. Slutsatsen är att kvinnor och män skiljer sig i högkänslighet och stress samt att stress och högkänslighet korrelerar med varandra. / The aim was to investigate high sensitivity and stress among students. The method was a quantitative comparative study between groups (women and men). The survey was conducted through an electronic questionnaire. The selection was an opportunity sample of women and men who studied at a university and was between the ages of 19-56, a total of 122 participants 31 men and 91 women. The participants answered a questionnaire that consisted of background questions and instruments to measure stress and high sensitivity. The results showed that high sensitivity and stress was underestimated highest among women. The conclusion is that women and men differ in high sensitivity and stress, and that stress and high sensitivity correlate.

I analyze the causes of highly skilled emigration, otherwise known as Brain Drain, in the three countries of the Southern Cone: Argentina, Chile, and Uruguay. These three upper-middle income countries have similarities in culture and level of economic development, which serve as the grounds for an effective comparison. I find that Chile has been especially successful in combatting Brain Drain while Argentina has been especially unsuccessful. Uruguay has been neither successful nor unsuccessful, but still faces a significant Brain Drain problem due to uncontrollable factors (for example, its small population). I recommend that the Argentine and Uruguayan governments broaden their current anti-Brain Drain policies, with the aims of (a) reducing the emigration rate of highly skilled workers, (b) promoting return migration among highly skilled workers in all sectors, and (c) maintaining connections with members of their respective diasporas. I find that the policies that directly address the issue of highly skilled migration are not necessarily the most effective. Thus, I emphasize potential policies to reduce Brain Drain that address economic issues that indirectly cause Brain Drain, in addition to addressing migration directly.

Generally, immigrants face different challenges adapting to their new environment while starting a new life in the new environment. One of these problems is related to employment as they find it difficult finding jobs in their host countries. A number of them are often jobless or having jobs that do not correspond with their educational qualification. This is one of the factors that influence the earnings of immigrants in the Swedish labour market. This study focused on the factors influencing the underutilization of immigrant’s foreign educational credentials in the Swedish labour market. The study is based on human capital theory, cultural shock theory and discrimination theory. Through qualitative research design, rich detailed data about the phenomenon was collected from participants that participated in the study. Findings of the study revealed that the two major factors that influence the underutilization of immigrant’s foreign educational credential in the Swedish labour market are structural factors and individual factors (lack of social network with Swedish natives, inability to fluently communicate in Swedish, and loss of professional knowledge due to lack of practice).

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree in Master of Science in the School of Molecular and Cell Biology August 2017 / Antiretroviral therapy (ART) drugs such as stavudine (d4T) are known to have off-target side-effects, including the inhibition of DNA polymerase gamma which replicates mitochondrial DNA (mtDNA). ART-induced depletion of mtDNA copy number may cause mitochondrial toxicities such as sensory neuropathy (SN). Genetic variation in DNA polymerase gamma or in other nuclear genes influencing mtDNA replication and mtDNA copy number may therefore contribute to susceptibility to d4T-induced SN. DNA samples from 263 HIV-positive South African adults exposed to d4T were classified as cases with SN (n = 143) and controls without SN (n = 120). A total of 28 single nucleotide polymorphism (SNPs) were chosen in nuclear genes from the mtDNA replication pathway and from a GWAS paper examining SNP association with ART-induced SN (Leger et al. 2014). Genotyping was performed using Sequenom Mass Spectrometry. MtDNA copy number was determined using a qPCR assay. Associations between SN and genetic variants, between genetic variants and mtDNA copy number, and between mtDNA copy number and SN were evaluated in univariate and multivariate models using Plink v1.07 and GraphPad v7. Age and height were significantly different in the cases with SN vs controls without SN. In univariate analyses, three SNPs and two haplotypes were significantly associated with SN, three SNPs were associated with pain intensity and three haplotypes were significantly associated with mtDNA copy number. However, there were no significant associations with SN, pain intensity or mtDNA copy number after correction for multiple SNP testing. No significant difference in mtDNA copy number in cases vs. controls was observed. In conclusion variation in nuclear-encoded mitochondrial genes examined in the current study do not play a role in ART-related mitochondrial complications such as changes in mtDNA copy number, or occurrence of SN. / MT2018

A research report submitted to the Faculty of Health Sciences, the University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Child Health Neurodevelopment Johannesburg, 2013 / Human Immunodeficiency Virus (HIV) infection in infancy may influence the developing brain and lead to adverse neurodevelopmental consequences. We aim to describe the neurodevelopmental characteristics of a cohort of young children infected with HIV prior to antiretroviral therapy (ART) initiation and after achieving viral suppression. A retrospective analysis of data collected as part of a randomised equivalence trial between April 2005 and May 2009, at a hospital in Johannesburg, South Africa. 195 HIV-infected children under 2 years of age were assessed. A simple, inexpensive screening questionnaire (Ages and Stages Questionnaire - ASQ) was used to identify neurodevelopmental delays. The ASQ was administered prior to ART initiation, and again after viral suppression on a protease inhibitor-based regimen had been achieved. Median age pre-ART was 8.8 months (range 2.2 - 24.9), 53.9% were male. Mean time to viral suppression was 9.4 months (range 5.9 - 14.5) and the ASQ was administered to 108 caregivers at this time. Compared to pre-ART, at viral suppression, there was significant reduction in the proportion of children failing the gross motor (31.5% vs. 13%, p<0.01), fine motor (21.3% vs. 10.2%, p=0.02), problem solving (26.9% vs. 9.3%, p<0.001) and personal social (17.6% vs. 7.4%, p=0.02) domains. The proportion of children failing the communication domain was similar at each time point (14.8% vs. 12%, p=0.61). At time of viral suppression 10.2% failed at least one of the five domains. Achieving viral suppression on ART resulted in significant improvements in the neurodevelopmental function of young HIV-infected children, however, neurodevelopmental problems still persisted in a large proportion. Appropriate screening for neurodevelopmental delay and timely referral could help improve outcomes.

HIV-associated peripheral neuropathy (PN), and related functional limitations that affect the quality of life (QoL), may now be one of the most formidable challenges in the health care of people living with HIV (PLHIV). The most common PN is distal sensory polyneuropathy (DSP). It is likely that there is a high prevalence of PN among PLHIV in Rwanda. The available data on the prevalence of PN are poor and there are none on how PN is associated with functional abilities and the QoL of PLHIV, which can guide management. In addition, current management of PN is mostly related to symptomatic management and is mainly pharmacological which may not rehabilitate the neuromuscular function that has been affected by PN. This thesis planned to re-validate and adapt the lower extremity functional scale (LEFS) and the brief peripheral neuropathy screen (BPNS), establish the prevalence of PN, and determine the effects of physiotherapeutic exercises on PN, lower extremity functional limitations and QoL, among Rwandan PLHIV receiving antiretroviral therapy (ART). Methods Study 1 translated LEFS from English to Kinyarwanda, modified it accordingly, and tested its reliability among 50 adult PLHIV on ART. The study also piloted

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine (Pharmacotherapy) / Background: The decision of when to start treatment in an HIV-infected individual has always been problematic as far as CD4 count is concerned. Aims: To determine the clinical outcome of patients who commence HAART at different CD4 cell count levels. Method: Retrospective analysis of records of a cohort of patients who are received ART at workplace wellness clinics in three mines in Limpopo province from January 2003 to December 2009. Patients were divided into three groups based on their baseline, group A (CD4 <100), group B (CD4 101-200) and group C (CD4 201-250) Each patient’s data was analyzed one year after his/her commencement. Results: The percentage of patients who died in group A (16%) differs significantly from the percentage of patients who died in group B (4%) (Fisher exact test p= 0.038) and also differ significantly from the percentage of patients who died in group C (0%) (Fisher exact test p= 0.011). The percentages of patients who developed TB in the three groups are 8%, 8% and 2.9% respectively. When compared statistically, these percentages do not differ significantly (Fisher exact test p=0.059).The percentages of patients with severe bacterial pneumonia in the three groups (2%, 2% and 0% respectively) do not differ significantly (Fisher exact test p=0,276).The percentage of hospital admissions for patients in group A (18%) differ significantly from the percentage in group B (6%) and the percentage in group C (6%) (Fisher exact test p= 0.05). The percentage of patients with weight loss of more than 10% of baseline value in group A (24%) differ significantly from the percentage in group B (4%) (Fisher exact test p= 0.003) and also differ significantly to from the percentage in group C (0%) (Fisher exact test p= 0.001). The percentage of patients with undetectable viral load in group B (89%) is significantly different from the percentage in group A (69%) (Fisher exact test p= 0.03) and is also significantly different from the percentage in group C (61%) (Fisher exact test p= 0.008).The change in mean CD4 cell count was found to be statistically significant within each group (paired t test, p<0.0001), but the mean changes between the three groups (132,141 and 172) respectively, do not differ significantly (ANOVA test). Conclusion: Patients with baseline CD4 cell count of less than 100 have a poor clinical outcome when compared to patients with baseline CD4 cell count of more than 100. Efforts must be made to identify patients early before CD4 cell count fall to below 100 and preferably initiate HAART when CD4 cell count is above 200.

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Genetics. Johannesburg, South Africa 2017 / Background: Stavudine (d4T) use is associated with the development of sensory neuropathy (SN), several mechanisms may underlie d4T-induced toxicity, including: (1) Inter-patient genetic variability in the genes modulating the deoxynucleotide triphosphate (dNTP) pool sizes. (2) Variation in intracellular ARV drug concentrations due to genetic variation in drug transporters. In our study we examined the genetic variation in four stavudine transporter genes and seven genes regulating the deoxythymidine triphosphate (dTTP) synthesis and their associations with d4T-induced SN or CD4+ T cell count or mtDNA copy number. Methods: We examined a cohort of HIV-positive South African (SA) adults exposed to d4T, including 143 cases with SN and 120 controls without SN. 26 single nucleotide polymorphisms (SNPs) from the literature were chosen, prioritised on being tagSNPs with minor allele frequency >5% in Kenyan Luhya (a proxy population for the SA Black population); SNP functional effects and suitability for multiplex analysis on the genotyping platform. Genotyping was performed using Sequenom mass spectrometry. A qPCR assay was used to measure the mtDNA copy number. Association of sensory neuropathy, CD4+ T cell count and mtDNA copy number with genetic variants was evaluated using PLINK. Results: All 26 SNPs were in Hardy-Weinberg equilibrium (HWE) in both the cases and controls. SNP rs8187758 of the SLC28A1 transporter gene and a 3-SNP haplotype ABCG2 were significantly associated with CD4+ T cell count after correction for multiple testing (p = 0.043 and p=0.042 respectively), but were not significant in multivariate testing. No SNP remained significantly associated with SN or mtDNA copy number, after correction for multiple testing. Conclusion: Variation in genes encoding molecular transporters of d4T may influence CD4+ T cell counts after ART. This study presents a positive step towards achieving personalized medicine in SA. / MT 2018

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Diagnostic Radiology Johannesburg, 2013 / INTRODUCTION: There is limited information on the radiographic presentation of children eligible to start HAART in resource-limited settings. OBJECTIVES: Determine radiographic patterns on pre-HAART chest X-rays (CXRs) in children, compare findings in immune-suppressed vs. non immune-suppressed children, compare the percentage of children with radiographic features of pulmonary TB to the percentage of children on TB treatment and assess inter-observer agreement between 3 radiologists. METHODS: Children (0-8 years) participating in a cohort study of TB and BCG-IRIS who had an acceptable routine pre-HAART CXR were included. CXRs were independently assessed by 3 radiologists, blinded from clinical data, using a standardised assessment form. All 3 readings were used to create a majority consensus finding during the data analysis phase. RESULTS: Amongst 161 children, the median age at enrolment was 2.3 years (25% (41/161) were <1year), 54% (87/161) were on TB treatment and 65% (100/154) were immune-suppressed. The majority (71%) had an abnormal CXR finding, predominantly air space disease (42%) and parenchymal interstitial disease (21%). Of the sub-group of 112 (70%) CXRs that could be assessed for lymphadenopathy, 75(67%) had one or more features suggestive of TB (74 lymphadenopathy, 2 cavities, 18 miliary infiltration) and 65% (70/107) were immune-suppressed. Statistically significant differences between immune-suppressed and non-immune-suppressed children were noted for features of lymphadenopathy and radiographic pulmonary TB. Amongst the sub-group of 112 CXRs a high percentage 49/75 (65%) were on TB treatment, with 26/75 (35%) not on TB treatment. Inter-observer agreement between all 3 readers was fair for overall abnormal CXR findings (K=0.23), airspace disease (K=0.22), moderate for parenchymal interstitial disease (K=0.54) and slight for lymphadenopathy (K=0.05). CONCLUSION: Among children eligible to start HAART, most (71%) presented with abnormal CXR findings and the majority (67%) had one or more CXR signs suggestive of TB. Of concern was the high proportion of CXRs (30%) that were of insufficient quality to be assessed for lymphadenopathy and the poor inter-observer agreement for lymphadenopathy.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Pharmacotherapy, Johannesburg, 2011 / Long term antiretroviral therapy (ART) use is known to cause various toxic adverse effects in patients. Hepato-toxicity is one of the most significant adverse effects which have been associated with all antiretroviral therapy drugs in South Africa and worldwide.