In this study, the use of hypnosis in the treatment of chronic low back pain is described in terms of Ecosystemic thinking, as opposed to traditional conceptualisations of hypnosis. Six case studies were used. Each is described in detail, as well as the therapeutic rationale behind each case, in order to present the reader with an understanding of the thinking behind using Ecosystemic hypnotherapy. / Psychology / M.A. (Psychology)

Submitted in partial fulfillment of the requirements for the degree of Masters in Technology: Clinical Technology, Durban University of Technology, 2009. / Exercise assessment, counseling and training are not widely offered to patients with chronic kidney disease. Haemodialysis patient’s participation in exercise and an adequate assessment of exercise effects on haemodialysis outcome are needed so that more interventions can be developed to improve the well being of those patients with chronic kidney disease. Exercise is not routinely advocated in patients with end-stage renal disease receiving maintenance haemodialysis. Lack of widespread awareness of exercise in haemodialysis literature may be contributing to these shortcomings in clinical practice. Purpose of the study This study was aimed to establish the effect of exercise during haemodialysis on pedal oedema and solute removal. This is the first time that such a study was undertaken in dialysis units in South Africa. Methodolgy In a quasi-experimental design, thirty-four end-stage renal failure patients on three times weekly haemodialysis program from Bloemfontein and Newcastle MediClinic Renal Units participation in the study. Ethical approval for the study was obtained from Durban University of Technology Ethics Committee. Seventeen patients were in the intervention group (aged between 25 and 60) and seventeen in the control group (aged between 18 and 60). The intervention group did not exercise for the first three months of the study in order to establish a baseline period. Thereafter, exercising took place from the fourth to the ninth month. Patients pedaled on an exercise cushion for fifteen minutes every hour to achieve a total of sixty minutes of exercise over a four-hour dialysis session. Patients in the control group did not pedal on the exercise cushion during the nine-month study period. Pre and post haemodialysis measurements of creatinine, urea and potassium using the Alkaline Picrate, Urease and Ion Selective Electrode methods respectively were done for each patient monthly over the nine month period. Oedema of the lower limb was evaluated by measuring the right and left ankle circumference, in centimeters before and after dialysis. Urea Kt/V was also measured before and after haemodialysis for each patient over the study period. Results Statistical analysis of results showed a significant 30% reduction in urea levels and a 46% reduction in creatinine levels in the intervention group at the end of the nine month period, a 12% reduction in the potassium levels in the intervention group which was 4% more than the control group. The urea Kt/V in the intervention group showed a 9% greater reduction than the control group. There was a significant improvement in oedema of 45% of the right ankle for the first three months of exercise and thereafter there was a an increase in ankle size in the last three months which was a 13% reduction in oedema compared to baseline. There was a significant improvement in oedema of 60% of the left ankle for the first five months of exercise and thereafter there was an increase in ankle size in the last month which showed a 25% reduction compared to baseline. The reason for the increase in ankle size in both ankles in the last three months in inconclusive and future investigation is recommended. Conclusion The results of this study demonstrated benefits of exercise during haemodialysis on solute removal and oedema perhaps due to the acute increases in blood flow and therefore increasing perfusion of skeletal muscles.

Background. Help-seeking is a concept of growing interest in the context of psychosis and the move towards early intervention and community-based service models. Despite a preponderance of first episode studies in this field, help-seeking is also of clinical relevance to adults with more chronic psychosis in the face of spiralling patterns of relapse and diminished recovery. Recent research into attachment theory opens up new avenues for exploring aspects of relating in psychosis, including help-seeking in mental health service contexts. Methods. A systematic review of attachment and psychosis was carried out to critically assess the strength and nature of empirical support for this theory within a clinical context. A social-constructivist based grounded theory study of help-seeking and chronic psychosis was conducted amongst nine individuals in a long term rehabilitation service. This aimed to develop an experiential account and grounded theory of the processes shaping help-seeking for this clinical group. Study findings were reviewed against existing constructs of attachment style, service attachment, recovery style and beliefs about psychosis. Results. A grounded theory emerged from the study emphasising the importance of three domains; ‘beliefs about the self’, ‘beliefs about others’ and ‘service experience’, in dynamically shaping views to help-seeking and receiving, for those with chronic psychosis. Attachment theory and recovery coping style were seen as compatible with this model. Conclusions. Individuals with chronic psychosis may continue to experience difficulties with help-seeking and service engagement, even within supported service settings. An appreciation of the interpersonal significance of service interactions, and improved understanding in this area, may help services better anticipate, respond to and adjust their models of engaging for this important clinical group.

Context: Albuminuria, a clinical indicator of chronic kidney disease, has a high prevalence among the US population where approximately half of the people with this condition are women. In the US, most participants in food based government assistance programs are women who have food insecurity. Research indicates that obesity and diabetes, known risk factors for chronic kidney disease, are consequences of food insecurity. Aim: The aim of this study is to examine racial-ethnic differences in the relationship between food insecurity and albuminuria in women who participated in the 2011-2012 NHANES. Methods: Odds ratios from racial-ethnic specific multivariate logistic regression were used to determine the associations between food insecurity and albuminuria. Results: Among all participants, black women had the highest rate of food insecurity at 36%. From multivariate analysis, it was determined that among non-Hispanic blacks that having albuminuria was associated (OR= 3.73 95% CI 1.47-9.44) with food insecurity. However, there was no statistically significant association between food insecurity and albuminuria (OR= 1.46 95% CI .501-4.261) for non-Hispanic whites. Discussion: Significant racial-ethnic differences in the association between food insecurity and albuminuria were identified in Non-Hispanic black women. It is recommended that further studies be done to evaluate the biological basis of the relationship between albuminuria and food insecurity in black women. A public health intervention to improve food insecurity may help reduce the risk of albuminuria in black women.

published_or_final_version / Pathology / Master / Master of Philosophy

The grief experienced by mothers and fathers when their child is diagnosed with a life threatening chronic-illness was investigated in order to validate the presence of grief in these parents and look at the factors that influence it. More specifically, I was interested in whether the grief experience differed for mothers and fathers and the impact that perceptions and coping have on both these gender differences in grief and on grief in general. The particular population investigated in this study were parents of children with Cystic Fibrosis. Participants were recruited through questionnaires randomly sent out by the National Cystic Fibrosis Association. In all, 37 mothers and 15 fathers took part. Results not only confirmed presence of grief in these parents but also indicated that this grief differs for mothers and fathers, with mothers reporting significantly higher levels of physical distress. In line with the literature no gender differences were found in regards to perception of impact parents felt their child's chronic-illness had had on their lives. Contrary to what was expected, however, no differences were found amongst the coping strategies used by mothers and fathers. In regards to the question of which factors have the greatest impact on the grief experienced by mothers and fathers combined, the coping strategy of self-blame was found to be the most important, followed closely by negative perceptions. The significance of these findings and their implications for parents and the people who work with them was discussed.

Recently there has been increased interest in chronic fatigue syndrome (CFS), a syndrome of nonspecific symptoms and unknown etiology. The relationship between cardiovascular reflex function, fatigue, and depression in CFS was examined. Findings were as follows: First, there was no evidence of abnormal cardiovascular reflex function in the CFS group. Second, the CFS group had significantly higher systolic and diastolic blood pressure than the control group. Third, the CFS group scored higher on psychological measures of depression, fatigue, and confusion than the control group; the control group scored higher on a measure of vigor than the CFS group. Finally, the CFS group reported more CFS-related symptoms, but some members of the control group did endorse symptoms on a CFS symptom checklist. The possibility that increased peripheral resistance accounts for the elevated blood pressure in the CFS group, and the merits of exploring the role of interleukin-1 and other hormones or "hormone-like" substances in the etiology or maintenance of CFS symptomatology are discussed.

No description available.

No description available.

No description available.