Background: Prenatal exposure to opioids, cocaine, and methamphetamine is associated with alterations in fetal brain that lead to structural changes in the brain postnatally, contributing to developmental and behavioral effects seen throughout childhood. Opioid exposure is associated with withdrawal in newborns, effects on somatic growth of infants, difficulty with executive functions and a tendency towards externalizing behaviors in older children. Cocaine and methamphetamine exposure are associated with effects on somatic growth, irritability and feeding issues in infants, problems with executive functions, and externalizing behaviors. Many substance-exposed children are placed in foster care and the pre-licensure training for foster parents does not specifically address how to care for substance-exposed children. Purpose: To create and evaluate a video that outlines common effects of prenatal exposure to opioids, cocaine, and methamphetamine, as well as evidenced-based caregiver interventions. Methods: The script for the video “Caring for Children with Prenatal Substance Exposure: Opioids, Cocaine, and Methamphetamine” was written by the author and evaluated by two clinical experts. The video was filmed and was presented to 6 licensed foster parents and 1 unlicensed adoptive parent who evaluated the video’s presentation at Devereux Foster Care Agency in Tucson, AZ using the Patient Educational Materials Assessment Tool for Audio/Visual (PEMAT-AV). Responses were entered into the PEMAT Autoscoring tool and component scores for understadability and actionability were calculated. Results: Both clinical experts evaluated the video’s content as being factual, and consistent with evidence-based research. Mean PEMAT-AV understandability and actionability scores were both 100%. Discussion: The video’s content and presentation are both strong as evidenced by high evaluation scores from clinical experts and foster parents, making it a useful educational tool for educating foster parents on caring for substance-exposed children. Further research is needed to determine if the viewing video increases foster parent knowledge and produces long-term change in parenting practices. Additionally, the video was designed to also be used to educate biological parents of substance-exposed children, but future studies are needed to determine if the video is an effective educational tool for this population.

There is growing evidence investigating the aftermath of homicide on those families bereaved. The literature suggests a potentially devastating emotional and psychological impact on family members and loved ones. Despite this, the research focused on developing and empirically evaluating service provision and clinical interventions for this population is sparse and lends its focus to support groups (Blakley & Mehr, 2008) and family therapy (Hatton, 2003). The aim of the current thesis is to conduct an evaluation of a service that provides therapeutic interventions with those bereaved by homicide. It will present a mixed methods approach, utilising thematic analysis of interviews with staff members and quantitative analysis of service user’s psychological distress outcomes. Finally, based on key findings presented, implications for future research, policy development and practice are included.

Master of Science / Food Science Institute / Randall K. Phebus / Due to the potential of Shiga toxin-producing Escherichia coli (STEC) contamination, beef processors use various antimicrobial interventions throughout the slaughter and fabrication processes to reduce risks of contaminating the food supply. Certain antimicrobials are approved and marketed for spraying onto chilled subprimal cuts; however, administering these treatments through commercial-scale equipment against foodborne pathogens is not fully validated. This study evaluated the efficacy of three common antimicrobial sprays, individually (Study 1) and combined (Study 2), against a rifampicin-resistant STEC cocktail (O26, O45, O103, O111, O121, O145, and O157:H7) using a commercial style subprimal spray cabinet. For Study 1, beef subprimals (n=16) were mist-inoculated with the cocktail (ca. 5 log CFU/cm²), followed by spray-treatment with individual antimicrobials [200 ppm peracetic acid (PAA), 2% Centron™ (sulfuric acid, sodium sulfate anhydrous and water mixture; CEN), 4.5% lactic acid (LA), or water (W)]. Study 1 was designed as randomized generalized block. After each treatment phase, STEC population reductions were quantified. As individual antimicrobial treatments, LA and PAA provided greater (P ≤ 0.05) STEC reductions (0.5 and 0.6 ± 0.08 log CFU/cm², respectively) compared to water (0.2 ± 0.08 log CFU/cm²), but the CEN reduction (0.4 ± 0.10 log CFU/cm²) was statistically similar to W. To test the efficacy of combined treatments on subprimal cuts in Study 2, a split-plot design was used using three replications. The inoculated subprimals (n=4) were first treated with PAA, LA, CEN, or W; vacuum packaged; and stored for 72 hours at 4°C. Each subprimal was then divided (n=16) and treated with each of the four antimicrobials as a second treatment. Cumulative reductions from the two treatments and storage ranged from 0.5 to 1.5 log CFU/cm² (± 0.3 log CFU/cm²); the greatest reduction was observed when subprimals were treated with LA followed by vacuum packaged storage and another LA application. Nevertheless, there was no statistical significance among treatments for a particular combination of treatments in Study 2. These studies indicate that the individual antimicrobial treatments evaluated are marginally effective for reducing STEC populations on chilled beef subprimal cuts during fabrication. Although there does not seem to be a specific combination of treatment that is more effective than another, the overall bacterial reduction may be improved by combining treatments when the beef is stored under vacuum packaged conditions and retreated upon bag opening, as typical of mechanical tenderization operations.

Over the next thirty years, Alzheimer’s disease rates will increase alongside global aging. To handle the anticipated increase in demand, knowledgeable and skilled dementia caregivers are in need throughout the long-term care spectrum. Online training programs have emerged as a viable and convenient platform to educate both formal and informal caregivers. The first and second study systematically reviewed online dementia training programs and evaluated the CARES® Dementia Basics Training Program among formal and informal caregivers. The first study is a systematic review of online dementia-based training programs for both formal and informal caregivers conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA) method. Methodological quality of the final sample (N=15) was assessed by the Cochrane Collaboration Back Review Group criteria. Results of the systematic review suggests that online interventions improve the condition and preparedness of caregivers, but future evaluations should consider study designs with multiple time points, control groups, and content that is personalized and interactive. In the second study, an evaluation of the online CARES® Dementia Basics Program among formal and informal caregivers was performed. The sample (N=233) included respondents from the states of OR, WA, CA and IL over three time points. Results indicate baseline differences in education, race, and caregiver type and a modest improvement in knowledge among both formal and informal caregivers. Recommendations are provided for future development and evaluation of online interventions.

This work was carried out with the objective of improving dairy farms in Cameroon using an integrated method. Research done in the area on milk production in the country was reviewed. A participatory rural appraisal was conducted in dairy farms of the North West Region of Cameroon. An economic opportunity survey was carried out on 61 dairy farms in the same region. Interventions aimed at solving main constraints were planned. An on-farm study on the effect of feed supplementation before calving on milk production, ovarian activity and calf growth of Holstein, indigenous Red Fulani cows and their crosses was conducted. Corresponding blood samples were analyzed using ELISA Progesterone kits. Animal health studies involved screening for Brucella abortus antibodies in 21 villages by ELISA. Partial budgeting was used to evaluate the financial impact of interventions. Results show that five small scale dairy production systems are found in the region: transhumance, improved extensive, semi intensive, zero grazing and peri-urban. Main constraints to dairy production include in order of importance: poor marketing opportunities and long distances to market, limited grazing land and poor supplementation of cattle, limited health control, inadequate knowledge in processing, conservation and storage of milk, poor 19 reproductive management and prolonged calving interval, lack of water in the dry season, poor housing, poor organization of group, limited number of dairy cows and poor record keeping. Milk production per cow on-one-day and average calf production interval account for the greater part of economic opportunity. A human progesterone ELISA kit was validated for use in cattle. Brucella screening showed a general seroprevalence of 8.4%. It is recommended that infected cattle should be slaughtered. A specific control programme should be organized and an effort should be made to determine the causes of the spread of brucellosis. A regular Brucella testing should be instituted. Farmers adopting interventions had returns of 193 and 232% without and with opportunity costs proving the positive impact of interventions using the integrated method. These interventions need to be spread to more farms in the country. The integrated method was proven to be effective in ensuring improvement of dairy systems in Cameroon. This method needs to be adopted for further dairy production improvement by the creation of multidisciplinary intervention teams and the training of integrated intervention specialists in the dairy sector. Copyright 2009, University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. Please cite as follows: Bayemi Pougue, HD 2009, Improving the management of dairy production systems in Cameroon, PhD thesis, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd-etd-05252009-225140/ > D629/ag / Thesis (PhD)--University of Pretoria, 2009. / Animal and Wildlife Sciences / unrestricted

Introduction: An increased incidence of schizophrenia among migrant and ethnic minority groups has been established. Ethnic minorities have poorer access to and outcomes from evidence based psychosocial interventions compared to the majority population. The overall aims of this thesis was to explore culturally adapted psychosocial interventions for migrant and ethnic minority schizophrenia sufferers, and use the results of these investigations to develop culturally adapted cognitive remediation (CR) to meet the needs of South Asian first episode sufferers. Methods: A systematic review and meta-analysis of previous randomised controlled trials (RCTs) investigated the quality, methods and effectiveness of culturally adapted psychosocial interventions for schizophrenia. Interviews, analysed using framework analysis, explored the acceptability, and perceived accessibility, of CR to the target population. CR for first episode psychosis was then adapted to target South Asian sufferers' needs and participants' satisfaction and engagement measured in a feasibility study. Results: The systematic review identified 17 RCTs of culturally adapted psychosocial interventions for schizophrenia. Meta-analysis of culturally adapted Family Intervention (caFI) compared to Treatment As Usual (TAU) showed no reduction in relapse risk. There were non-significant reductions in risk and number of hospitalisations during the intervention and significant shortening of total time in hospital. Meta-analysis of culturally adapted Social Skills Training (caSST), compared to TAU showed improvements in medication and symptom management but no effects when compared to a time-matched psychosocial intervention. Results must be interpreted with caution due to the small number of trials included and limitations in their analyses. Cultural adaptations made to the interventions were similar across trials. This allowed for the development of a measure systematically recording the methods used in culturally adapting interventions. Scale items included: language, therapeutic alliance, teaching style, manual content, family, treatment goals, explanatory models of illness, help seeking behaviour, delivery, stigma, societal context and cultural tenets. Emergent themes from qualitative interviews with ten South Asian first episode schizophrenia sufferers included: help seeking for psychosis, sociocultural influences on help seeking, experience of cognitive deficits, and recommended cultural adaptations to CR. CR was well received by all respondents. Level of acculturation and the influence of family and illness beliefs were associated with distinct pathways to care. A feasibility study of culturally adapted cognitive remediation (caCR) for first episode South Asian psychosis patients resulted in high levels of service user satisfaction, therapeutic alliance and participant retention rates. The majority (87.5%) reported cognitive benefits and a boost in self-esteem. Conclusions: The scale of cultural adaptations for psychosocial interventions for schizophrenia will provide a framework for those developing culturally adapted interventions for migrant or ethnic minority communities and a means to record the degree and type of adaptation. CaCR was acceptable to first episode South Asian psychosis sufferers. A larger trial is required to investigate this intervention's efficacy in terms of cognitive and global functioning.

This study is a systematic literature review over 12 peer reviewed articles regarding the topiccyberbullying. The purpose of this study is to summarise and critically discuss different interventions and preventions used to tackle cyberbullying in school environments.Interventions and preventions will be analysed from a relational perspective. The articles are sorted and discussed in four relevant categories. These are: Netiquette, building relationships, Learning through role models, antibullying programs. The study found that the foundation of most successful interventions against cyberbullying is healthy relationships between students and school staff. The result showed that based on meaningful relationships, successful interventions and preventions can be formed and used in school. It is important to acknowledge that not a single intervention can solve a complex problem like cyberbullying, but instead there is a need for a combination of different interventions and more knowledge about the phenomena cyberbullying.

A challenge for both researchers and practising teachers is to develop, disseminate and implement methods to help all students acquire good reading skills. One way to do this is to conduct intervention studies. Within the framework of this dissertation two such studies are carried out with the purpose of promoting the reading development of children whose reading ability has not yet reached the adequate age level. The empirical material consists of two studies containing different interventions. These studies form the basis of the four articles included in the dissertation. The overall aim was to analyse the effects of the interventions with regard to both quantitative aspects of pupils’ reading abilities as well as the qualitative aspects of interpreting intervention as a method for promoting reading development. The interventions contain training programmes aiming at promoting pupils’ reading development. The participants of the first study attended grades 1-4, while in the other study only pupils from grade 2 participated. The first study comprises two different training programmes, one of which was computer-based. In the other study both training programmes were computer-based. One programme focused on phonology, whereas the other was more oriented towards reading comprehension. Results showed that pupils who received a combination of phonological and comprehension training made greater progress on tests measuring word decoding, phonological ability and reading comprehension than the comparison groups. These results are valid in the short term, i.e. immediately after the end of the intervention, but also in the long term, one year after the intervention was concluded. The results also demonstrate that computer-based intervention in reading training with a strict framework, combined with individually adapted contents may be both effective and motivating and also have a substantial effect on the success of the interventions. The results from one of the studies also showed that it is possible to achieve positive results on pupils’ reading skills with interventions that do not contain any homework. The main contribution of this thesis is important for further research and measures for children with reading disabilities.

Three essays form this thesis which addresses the effectiveness of interventions aimed at attaining two health Millennium Development Goals (MDG) set by the United Nations: a 2/3rds reduction by 2015 of 1990 child mortality rates (MDG4) and 3/4th reduction of 1990 maternal mortality rates by the same date (MDG5). The first chapter assesses the relative efficiency of 85 countries at using these interventions for the reduction of child and maternal mortality. It teases out the extent to which mortality reduction is a result of the interventions themselves as opposed to the context in which they are implemented. A three step procedure which includes Data Envelopment Analysis indicates that efficiency is mainly driven by context. Chapter 2 addresses the association between the 2000-2008 rates of change of interventions and the rate of change of mortality. It uses finite mixture modeling to take account of the possibility that there may be underlying heterogeneity in the mortality reduction functions of the 32 sub-Saharan African countries studied. Results support this hypothesis and show that an intervention may exhibit increasing returns to scale in some countries and decreasing returns to scale in others. Chapter 3 assesses the link between interventions and mortality rates and examines cost minimizing scenarios for attaining MDG4 and MDG5 in 27 sub-Saharan African countries. Lagged data on interventions predicts mortality rates (by OLS) to take into account the potential reverse causality between the two. Results indicate that achieving MDG mortality targets at the least possible cost invariably requires very substantive increases in medical human resources, yet training physicians has not been the main objective of public health organizations. Furthermore, improving the context in which interventions are implemented - increasing female literacy or effectiveness of political stability- allows countries to reach mortality targets with substantially lower levels of interventions (including, much lower levels of physician density).

Type 2 diabetes mellitus (T2DM) continues to be a national challenge for Canadians. African and Caribbean Immigrants are among the most affected groups and those at risk of developing comorbidities and related complications. It continues to prove challenging to treat T2DM for the affected individuals. Effectively treating the disease can help mitigate risk factors for related comorbidities and complications while improving the quality of life for those affected. There is increasing research, outside of Canada, showing the evidence for the effectiveness of culturally sensitive and adapted interventions to immigrant patients affected with T2DM. In light of the effectiveness of such interventions in many industrialized nations, a systematic review (SR) can offer the best evidence for the scope and consideration of such treatment approaches in Canada. This SR aimed to determine whether community-based diabetic interventions in Canada, are culturally sensitive to African and Caribbean minorities living with type II diabetes. A narrative synthesis was employed to report the effect of interventions seeking to affect outcomes of T2DM patients in Canada. Of the 63 articles included for full review, 60 were excluded for not meeting the criteria of having the target population explicitly identified and also not having any mention of cultural sensitivity. Three articles were included for the final review because the target population was explicitly identified. The final results showed that all interventions were found not to be culturally sensitive to African and Caribbean T2DM patients in Canada. Our results suggest a lack in Canadian literature. To the best of our knowledge, this is the very first systematic review on this subject matter in Canada. This review provides dependable information and recommendations to researchers, educators, clinicians, and policy makers for future research with T2DM African and Caribbean patients in Canada. RÉSUMÉ Le diabète de type 2 demeure un défi national pour les Canadiens. Les immigrants d’origine d’Afrique et des Caraïbes sont parmi les groupes les plus frappés et l'un des plus à risque de développer des troubles comorbides et de complications liées au diabète. Traiter le diabète continue à poser un défi chez les personnes affectées. Traiter efficacement cette maladie peut contribuer à réduire des principaux facteurs de risque quant aux troubles comorbides et complications, tout en améliorant la qualité de vie chez les personnes affectées. Un nombre grandissant de recherche, hors du Canada, démontrent avec des preuves concluantes que les interventions sensibles et culturellement adaptées aux immigrants affectés par le diabète sont efficaces. Étant donné l'efficacité de ces interventions dans nombreux pays industrialisés, une revue systématique peut nous offrir la meilleure preuve pour l'envergure relative à ce genre de traitement au Canada. La présente étude méthodique vise à déterminer si les interventions contre le diabète, en milieu communautaires au Canada, sont culturellement adaptées aux minorités ethniques d’origines d’Afrique et des Caraïbes souffrant de diabète de type II. Une synthèse narrative a été utilisée afin de signaler les effets des interventions par rapport aux résultats des patients souffrant du diabète de type 2. Parmi les 63 articles considérés pour une évaluation complète, 60 ont été exclus car ni la population cible ou la mention de la sensibilité culturelle n’a été explicitement identifiée. Trois articles ont été inclus pour l’évaluation finale car la population cible fut explicitement identifiée. Aucune des interventions n’est culturellement sensible aux patients Africains et Caribéen affecté par le diabète de type 2. Nos résultats démontrent un écart dans la littérature Canadienne. A ce que nous sachons, cette revue systématique est la première qui touche à cette question au Canada. Cette revue fournie des données fiables et recommandations qui permettront aux chercheurs, enseignants, cliniciens, et aux décideurs en matière de politiques de santé pour des recherches futures auprès des patients Africains et Caribéen souffrants du diabète de type 2 au Canada.