Environmental intolerance (EI) is a condition characterized by low tolerance to environmental stimuli at levels that would not affect most people. EI is an ill-defined condition from which sufferers experience highly individual multisystem symptoms following exposure from specific environmental sources. Subgroups of EI are typically distinguished by the source that cause negative effects. In this study, intolerance attributed to noise and odors was investigated. Most research on EI is conducted using cross sectional approaches and among the instruments used to quantify EI is the Noise Sensitivity Scale (NSS-11) and the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). To fully understand EI, more longitudinal research is needed. The aim of this study was to establish how a recently developed smartphone app, intended for longitudinal research, compares to the NSS-11 and CSS-SHR with regards to its ability to detect EI. 12 participants (mean age 29 years, SD=10.7 years) filled out the NSS-11/CSS-SHR following a period of two weeks using the app. It was hypothesized that individuals scoring high/low on the NSS-11/CSS-SHR would also express high/low levels of EI as measured by reports in the app on the variables discomfort rating, number of unique symptoms reported and number of reports. Although analyses revealed effects in the direction of the hypothesis for all variables, Independent samples t-test analyses yielded no significant associations. Either there are in fact no differences, but speculatively, the lack of significant associations can also be attributed any the following: (1) the groups were to similar (2) the sample was too small (3) the participants used avoidance as coping strategies.

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Within the United States (U.S.), one-third of those who use cannabis (the most commonly used illicit drug in the U.S.), exhibit cannabis use problems significant enough to warrant a diagnosis of cannabis use disorder (CUD; Compton, Grant, Colliver, Glantz, & Stinson, 2004). Data suggests that quitting cannabis is highly difficult (Copersino et al., 2006), yet, there is little empirical knowledge about the nature of factors that relate to quit processes (e.g., self-efficacy). One potentially promising variable of relevance to CUD is distress intolerance (Leyro, Zvolensky, & Bernstein, 2010). Distress intolerance is referred to as (a) the perceived capacity to withstand negative emotional and/or aversive states, and (b) the behavioral act of withstanding distressing internal states elicited by some type of stressor. Although theoretically nested within a broader network of risk and protective processes, distress intolerance is posited to be related to, though conceptually distinct from, other variables (e.g., anxiety sensitivity; emotion regulation; Leyro et al., 2010). Individuals with higher levels of distress intolerance may be prone to maladaptively respond to distress (e.g., life stressors), and attempt to avoid negative emotions and/or aversive states (e.g., use cannabis to alter the perception or impact of negative mood, or to enhance positive mood). In contrast, persons with lower levels of distress intolerance may be more able to adaptively respond to distress (e.g., seek out alternative, more adaptive coping strategies instead of using cannabis). There is limited knowledge of the explanatory role of the inability to tolerate negative affect and other aversive internal sensations (e.g., withdrawal) in terms of CUD and the nature of the quit experience (e.g., beliefs about barriers to quitting). The aim of the present study was to examine the main and interactive effects of perceived and behavioral indices of distress intolerance in terms of cannabis quit-related variables, including (a) failed quit attempts, and duration of average time to relapse for past quit attempts; (b) greater severity of withdrawal symptoms experienced while quitting in the past, lower self-efficacy for abstaining, and greater perceived barriers for quitting cannabis; and (c) greater CUD problems. The sample recruited was characterized by racially and ethnically diverse (65.2% minority) adult cannabis users, many of whom had not completed college (46.5%). The sample had high rates of co-occuring psychiatric and medical illness (e.g., 36.1% had a current anxiety disorder, 26.4% had a current mood disorder, and half endorsed a medical condition), and over 25% fell below the 2013 Federal Poverty Level. There was no empirical support for an interactive or main effect of perceived or behavioral distress intolerance for any of the dependent variables. Although previous studies did not employ most of the cannabis dependent measures utilized in the current report, the lack of significant effects in the regression models was surprising given previous work on the topic (focused largely on coping motives for cannabis use). At the bi-variate level, there was some modest evidence of a 'signal' for perceived distress intolerance for certain cannabis dependent variables; these effects ranged from small to moderate. These data suggest, at least among the present largely minority sample, neither perceived or behavioral distress intolerance are robustly related to the cannabis dependent measures. One conservative interpretation of these findings is that distress intolerance may not perform the same across all CUD samples. Post hoc analyses focused on perceived distress intolerance subfactors relations to the dependent variables; indirect explanatory role of negative affect in perceived distress intolerance-cannabis relations; and bi-variate relations between perceived and behavioral distress intolerance with other transdiagnostic distress processes. Results suggested (a) no incremental explanatory effect for specific perceived distress intolerance subfactors; (b) a significant indirect effect of negative affect in the relation between perceived distress intolerance and certain cannabis dependent variables; and (c) consistent evidence of convergent validity for perceived distress intolerance with other transdiagnostic affective vulnerability factors. I contextualize the findings in relation to past work, and the methodology employed in the current study. I discuss how future theory-driven work that seeks to uncover the time course and patterning between distress intolerance, negative mood, and cannabis use behavior are needed. I also suggest that this work will likely have the greatest impact when the social contexts of CUD populations (e.g., social determinants of health) are more directly integrated into the theoretical models.

Division of Nephrology Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of Witwatersrand 7th June, 2017 / Objective Renal transplantation is the ideal therapeutic option for patients that reach end-stage renal failure. However, patients require long term immunosuppression following surgical transplantation to prevent graft rejection [1,2,4]. Mycophenolate mofetil (MMF) had proven to be an effective immunosuppressant in transplant patients[8,9,10], although it is associated with an increase in gastrointestinal adverse effects, which may result in dose adjustment or termination of use [22]. There is a paucity of data regarding gastrointestinal side effects of MMF in South Africa. This study attempts to describe the incidence of gastrointestinal complications, incidence of dose adjustment and discontinuation of MMF due to side effects, to compare the incidence of GI complications between those that had prior gastrointestinal ailments and those that had no prior gastrointestinal ailments and finally to determine possible risk factors (age, gender, ethnicity, donor type, pre-transplant GI diagnosis, pre-transplant diabetes and combination of MMF with tacrolimus) of gastrointestinal adverse effects. Method Data was collected retrospectively from the file records of the renal transplant unit at CMJAH (Charlotte Maxeke Johannesburg Academic Hospital) on adult patients who had received kidney transplants between 1998 and 2010 and who had received MMF as part of the immunosuppressive regimen for at least the one year post-transplant. Relevant data was captured in an anonymous fashion on a collection sheet. Descriptive analysis of the data was carried out. Time-to-event data were analysed by Kaplan-Meier survival analysis. The assessment of the effect of prior gastrointestinal ailments, as well as risk factors, was carried out by Cox Proportional Hazards regression to estimate the Hazard Ratios. Results A total of 188 patients were included in the study group, which comprised 65.4% males and 32.4% females (2.1% missing data). The mean age at transplant was 38.1 years. The patients were predominantly black (69.1%). Donors were predominantly deceased donors. Of the 24.5% of donors who were living donors, 76.1% were related living donors, while the rest were non-related living donors. The majority of patients (82%) were induced with MMF dose of 2 grams per day. After 5 years, 13.8% of patients discontinued MMF while 86.2% of the patients were still on MMF. 48.1% had a dose adjustment due to gastrointestinal side effects. 61% of patients had had a diarrhoeal adverse event by 5 years. 21.8% of the patients had gastrointestinal side effects other than diarrhoea by 5 years. The combination of tacrolimus and MMF was found to be a significant risk factor for diarrhoeal adverse events (Hazard Ratio 1.82; 95% CI 1.21-2.73). Having a living donor graft reduced the chance of non-diarrhoeal gastrointestinal adverse event (Hazard Ratio 0.33; 95% CI 0.13-0.84, p<0.02). A trend towards significance was seen in living donors having less diarrhoeal events although it did not reach statistical significance (Hazard Ratio 1.32; 95% CI 0.87-2.00, p=0.20). Conclusion As far as the authors are aware, this is the first local study on MMF and GIT adverse effect. We found the combination of MMF and tacrolimus is associated with increased risk of having diarrhoeal adverse events, which is consistent with international data[34,35]. Living donor graft is associated with a lower risk of developing non-diarrhoeal gastrointestinal events. Although non-significant, data suggest the same trend favoring living donor graft with regards to diarrhoeal events. / MT2017

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master or Medicine in the branch of Paediatrics Johannesburg, 2015 / Malnutrition and diarrhoea are major causes of childhood morbidity and mortality in the developing world. Lactose malabsorption has been associated with diarrhoea in malnourished children, but they are often managed with lactose containing feeds. This study quantified the prevalence of lactose malabsorption in children with severe acute malnutrition (SAM) and diarrhoea admitted to an urban South African hospital. Sixty-three Children with SAM and diarrhoea were included in the study and had their stool tested for reducing substances using the Benedict’s test. Fifty-nine percent had stool positive for reducing substances (≥0.5g%). After multivariate analysis, age of <12 months was the only factor found to significantly predict positive reducing substances (LR 4, p=0.046). Death was 4 times more likely in children with positive reducing substances (p=0.035). The role of lactose free feeds in children with SAM and diarrhoea has not been adequately explored.

Lactose intolerance is a common and inconvenient medical condition and can cause severe discomfort. People who experience lactose intolerance often take lactase enzyme supplements when they wish to consume dairy products. As a consequence, they normally consume dairy products that are rendered lactose free or else a lactase enzyme supplement is taken concurrently. Normally, these are pills or tablets that dissolve and release the enzyme in the stomach. However, the enzyme may be denatured in the low pH conditions of stomach. Hence, a higher dose is required to ensure that an effective concentration can survive and pass into the small intestine - the site of the enzyme ' s physiological action. This problem is being addressed by microencapsulation methods : surrounding the enzyme with protective materials in the form of small particles. These protect the enzyme in the stomach and allow release in the small intestine. The goal of this research was to investigate an appropriate microencapsulation method for this purpose. An oil - in - oil solvent evaporation method was used to produce microparticles containing BSA protein with a EUDRAGIT S 100 - methacrylic acid and methyl methacrylate copolymer. BSA was used as a cost - effective surrogate for lactase during the research. Sonification was employed during the emulsification step. The microparticles produced at different sonication amplitudes or power outputs were uniform with similar morphologies, typically spheres. Microparticle size decreased with sonicator energy output from 120 µ m to 12 µ m as the amplitude changed from 40 % to 70 %. The encapsulation efficiency at amplitude levels of 50 %, 60 % and 70 % was between 70 % and 80 %. However, the encapsulation efficiency recorded at the 40 % setting was much lower, around 40 %. The release profiles of those microparticles were studied at different pH. There was a slight leakage from the microparticles at low pH. Above pH 7, total release was achieved within 2 hours. The results of this research confirm that the microparticles could encapsulate lactase as part of a treatment of lactose intolerance. / Thesis (M.App.Sc.)--School of Chemical Engineering, 2005.

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Thesis (M.App.Sc.)--University of Adelaide, School of Chemical Engineering, 2006. / "November 2005". Bibliography: leaves 64-69. Also available in print form.

Thesis (Ed. D.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains vi, 70 p. Includes abstract. Includes bibliographical references (p. 65-70).