Submitted in fulfillment of the requirements of the degree of Doctor of Technology: Health Sciences, Durban University of Technology, Durban, South Africa, 2015. / Background: In a vulnerable low-income group with a confirmed high risk of cardiovascular disease, like the elderly in the Sharpeville care centre, an acute intervention is needed in order to improve their health profile. Previous studies suggested homocysteine lowering by vitamin B12, B6 and folate supplementation. The effect of vitamin B12, B6 and folate supplementation on the inflammatory response, thrombotic risk, lipid profile, hypertension, risk of metabolic syndrome and homocysteine metabolism in an elderly, black South African population has never been reported. Objectives: The main aim of this interventional study was to assess the effect of vitamins B12, B6 and folate supplementation at 200% RDA for six months on cardiovascular risk markers of an elderly semi-urbanised black South African community. Design: This study was an experimental intervention non-equivalent control group study design in 104 purposively selected samples of all the elderly attending the day-care centre. Setting and participants: A homogeneous group of respondents was included in the study. All subjects were equivalent in age (>60 years), race (black), unemployed/pensioners (socio-demographic) and 60 years and older attending a day care centre in Sharpeville, situated in the Vaal region, Gauteng, SA. Measurements: The distinctiveness of this study lies in the broad panel of parameters evaluating the CVR in correlation with the increased nutritional intake of vitamin B6, B12 and folate. These included: weight, height, waist, serum cholesterol, high density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, blood pressure, fibrinogen, high-sensitivity C-reactive protein (HS–CRP), homocysteine, vitamin B12, folate, glucose, insulin, adiponectin and fibronectin. Results: A very high incidence (66.36%) of hyperhomocysteinaemia is present in the sample. The mean serum homocysteine level in hyperhomocysteinaemic individuals decreased statistically significantly from 25.00±8.00 umol/l to 18.80±12.00 umol/l after the intervention. The number of respondents with an increased homocysteine level decreased from 100% (baseline) to 67% (follow-up). The supplementation was beneficial (statistically significant changes) to the glucose levels, fibrinolytic status, vitamin B6 serum levels, fibronectin levels and haemopoeiesis (decreased macrocytosis) of all the individuals (regardless of their homocysteine status). Conclusion: It is concluded that supplementation of vitamins B6, B12 and folate at 200% RDA for six months is an effective homocysteine-lowering approach as a strategy to reduce hyperhomocysteinaemia in an elderly population and thereby reduce cardiovascular risk (CVR). The supplementation intervention mentioned is not an effective multifactorial strategy to decrease CVR although beneficial effects were found with other CVR markers independent of homocysteine status.

Thesis (MA (Psychology))--University of Stellenbosch, 2007. / The main objective of this study was to investigate interpreting practices within the psychiatric hospital San Marco1, in the Western Cape. More specifically, the aim was to determine what factors might lead to the obstruction of accuracy by asking employees that act as official and unofficial interpreters to report on certain issues relating to interpreting practices. The second objective of the study was to gain some understanding of what interpreters experience when doing interpreting especially since unofficial interpreters (nurses, cleaners and administrative staff) are often used to act as interpreters within South Africa’s public health services and this may not only have implications for accuracy but also for interpreters’ own mental health. A cross-sectional qualitative interview design was used. The research participants consisted of eight employees of San Marco, (including two administrative clerks/ interpreters, two bilingual security guards, and four bilingual nurses), and two bilingual psychiatrists, who, though not being employees of San Marco, yet have experience in interpreting while working as psychiatrists within psychiatric institutions in South Africa. Participants were asked to respond to semi-structured questions. In addition, participants took part in a structured task in which they were asked to translate and back-translate commonly-used diagnostic questions. Content analysis was used to analyse data collected from semi-structured interviews and participants’ translations and back-translations were checked for inaccuracies. The analysis of interviews revealed the following information: • not all of the participants who act as interpreters are in fact functionally bilingual in the context with which they work • none of the interpreters are trained in interpreting; and • a clear distinction could be drawn between interpreters who have training in mental health compared to those who lack training in mental health or psychiatry. Furthermore participants’ translations of the nine questions were approximately right. Participants’ translations conveyed more or less the same messages as what was intended with the original English questions. In fact the translations were fairly accurate for untrained interpreters. However, participants were not always specific as to what they were asking about. Interpreters need to translate questions in such a way that it is diagnostically specific in order for the clinician to make an accurate diagnosis. It is crucial that patients have a clear understanding about what the interpreter are asking them and this was not always evident in participants’ translations. The abovementioned results may for obvious reasons lead to the obstruction of accurate interpretation however it should not be attributed to a lack of competence on the interpreters part but should rather be attributed to challenges in a health system which has inherited a history of discrimination and continues to discriminate against certain patients, even when clinicians and interpreters alike may be doing their best not to discriminate. The problem is structural rather than individual, and needs to be addressed as such, and in the context of competing demands in public health care. Although the interviews did reveal valuable information regarding the obstruction of accuracy it should be kept in mind that an analysis of actual recorded interpreting sessions between the clinician, patient and interpreter is necessary for a more in depth understanding of the obstruction of accuracy as investigated in this study and such a study is currently in the planning phase.

No description available.

Submitted in fulfillment of the requirements of the degree of Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Aim The study evaluated the culture of patient safety and the factors that contribute and influence patient safety as a critical element, to healthcare in a public hospital in Kwa-Zulu Natal, through a predesigned questionnaire with the objectives of establishing the current status of the culture of patient safety in the said hospital, evaluating responses from nurses and doctors and other healthcare professionals, exploring the effectiveness of communication and teamwork within units and hospital. Methods The study evaluated the culture of patient safety and the factors that contribute and influence patient safety as a critical element, to healthcare in a public hospital in Kwa-Zulu Natal, through a predesigned questionnaire with the objectives of establishing the current status of the culture of patient safety in the said hospital, evaluating responses from nurses and doctors and other healthcare professionals, exploring the effectiveness of communication and teamwork within units and hospital. Results The resultant data from the predesigned questionnaire was divided into components of teamwork within and between units, hospital and supervisor management support for patient safety, communication openness and feedback regarding errors, non-punitive response to errors, hospital handover of information staffing and overall patient safety grade. The study was compared to the studies in the US and three other countries across the European continent, Netherland, Taiwan, and US [Wagner et al. 2013]. The findings as possible strengths of the study were teamwork within units, learning in the organization, feedback and communication, and manager and supervisor support for patient safety. The areas that needed attention were teamwork across units, communication openness, staffing, non-punitive response to errors and overall patient safety grade, handover of information between units. Conclusions The findings, reflective of a developing country, compared to the findings from similar studies in developed countries such as the USA and countries in transition such as Netherlands and Taiwan. In reference to the precincts that face a developing country such as South Africa, certain highlights emerged from the comparison, as areas of strength, areas requiring attention, and a preliminary insight into current practices within the South African context which can be viewed as an opportunity to sustain current good practices and inform future research. / M

Thesis (MSc)--Stellenbosch University, 2015 / Stellenbosch : Stellenbosch University / ENGLISH ABSTRACT : Substance abuse is a major problem globally with immeasurable consequences to the health of users. Rehabilitation is one of the strategies that can help to fight against substance abuse. It is divided into two forms: in-patient and out-patient rehabilitation. In this study, we consider a compartmental model of substance users in rehabilitation, where a periodic function is included to illustrate seasonal oscillations of drug users entering rehabilitation. In this thesis, we derive two basic reproduction numbers R0 and [R0], where R0 is the model with periodicity and [R0] the model without periodicity. We show that the model has a drug-free equilibrium when the basic reproduction number R0 is less than one and drug persistent equilibrium when R0 is greater than one. We fit the model to data and obtained sneak preview of the future of these forms of rehabilitation. Our results indicate that when R0 is less than one, the in- and out-patient populations decrease quickly and when R0 is greater than one drugs persists and after a long period of time, individuals in rehabilitation approaches w-periodic solution. Sensitivity analysis is performed and the results show that control measures should focus on the effective contact rate between susceptibles and drug users so as to control the epidemic. These results have significant implications on the management and planning of rehabilitation programs in South Africa. / AFRIKAANSE OPSOMMING : Dwelm misbruik is wêreldwyd ‘n ernstige problem met onmeetbare gevolge vir die gesondheid van gebruikers. Rehabilitasie is een van die strategieë wat dwelm misbruik kan help beveg. Dit word in twee vorms verdeel: binnepasiënt- en buitepasiëntrehabilitasie. In hierdie studie ondersoek ons ‘n kompartementele model van dwelmgebruikers in rehabilitasie, waar ‘n periodieke funksie ingesluit word om seisoenale skommelings aan te toon met betrekking tot dwelmgebruikers wat rehabilitasie aanpak. In hierdie tesis lei ons twee basiese reproduksienommers af, R0 en [R0], waar R0 die model met periodisiteit en [R0] die model sonder periodisiteit is. Ons toon aan dat die model ‘n dwelmvrye ekwilibrium het wanneer die basiese reproduksienommer R0 minder as een is en ‘n dwelm-voortsettingsekwilibrium het wanneer R0 meer as een is. Ons pas die model op die data toe en verkry ‘n vooruitskouende blik op die toekoms van hierdie vorms van rehabilitasie. Ons resultate dui aan dat wanneer R0 minder as een is, die binne- en buitepasiënt-bevolkings vinnig verminder en wanneer R0 meer as een is, die gebruik van dwelms voortduur en dat nà ‘n lang tydperk individue in rehabilitasie nader aan w-periodieke oplossing beweeg. Sensitiwiteitsontleding word uitgevoer en die resultate toon aan dat daar ‘n bewustheid moet bestaan dat die graad van effektiewe kontak tussen vatbare individue en dwelmgebruikers beperk moet word ten einde die epidemie onder beheer te bring. Hierdie resultate het betekenisvolle implikasies vir die bestuur en beplanning van rehabilitasieprogramme in Suid-Afrika. / rs201601

Thesis (MScMedSc)--University of Stellenbosch, 2011. / ENGLISH SUMMARY: Background: Primary immunodeficiency disorders (PID) disrupt the proper functioning of the immune system. The prototypic PID is X-linked Agammaglobulinemia (XLA). This disorder is caused by mutations in the Bruton tyrosine kinase (Btk) gene and results in an arrest in B cell development which leads to a profound reduction of all classes of serum immunoglobulins (i.e antibodies). Patients with a lack of antibodies experience recurring bacterial infections during early childhood that can be fatal if not treated. Intravenous gammaglobulin replacement therapy (IVIg) is the standard treatment for XLA. It provides passive immunity thereby reducing the number and severity of infections as well as limiting many of the infectious complications. Early detection and treatment of XLA allows affected individuals to live a relatively normal life. Objective: The purpose of this study was to determine the molecular basis of XLA in South Africa using a direct sequence-based method to detect abnormalities in the Btk gene to aid clinical diagnosis of the disease. Methods : Male patients with a clinical diagnosis of XLA were included in this study. Genetic analysis was used to explore the exonic region of the Btk gene of 5 unrelated male patients and compared to 10 healthy controls. Family members were followed up to determine carrier status, where possible. Results: Mutational analysis revealed Btk abnormalities in 4 of the 5 patients leading to a definitive diagnosis of XLA. Two of the three mutations found in this study have been previously described while one mutation appears to be novel. The novel mutation is a one base pair deletion in exon 16 which leads to the truncation of the Btk protein. Despite the clinical findings suggestive of XLA, no mutation was identified in the exonic region of the Btk gene of the remaining patient, indicating that this patient might have a different form of PID. Maternal follow-up confirmed the maternal inheritance pattern as all mothers screened were carriers of the Btk mutation present in the affected individual. Discussion : Using a direct sequence-based method abnormalities were identified in the Btk gene of three patients. Molecular diagnosis coupled to clinical history of the patient provides a definitive XLA diagnosis. This study supports the use of molecular techniques in the diagnosis of PID and underlines the synergy that could be possible in a clinical setting. / AFRIKAANSE OPSOMMING: Agtergrond: Primêre immuungebrek siektes (PIGS) word gekenmerk aan ‘n gebrek aan teenliggame in die immuunsisteem wat lei tot herhaalde infeksies in jong kinders wat fataal kan wees indien dit nie vroegtydig behandel word nie. Die prototype van die bekende PIGS is X-gekoppelde Agammaglobulinemia (XGA). Die siekte word veroorsaak deur mutasies in die Bruton Tirosien kinase (Btk) geen en lei tot ʼn stilstand in B sel ontwikkeling en gevolglik ʼn vermindering van alle klasse van serum immuunoglobulins (teenliggaam). Intraveneuse gammaglobulien vervangingsterapie(IVIg) is die standaard behandeling vir XGA. Dit voorsien passiewe immunitiet en gevolglik verminder dit die getal en erns van infeksies en beperk baie van die aansteeklike komplikasies. Vroeë diagnose en behandeling van XGA laat toe dat geaffekteerde individue ʼn relatiewe normale lewe ly. Doel: Die doel van hierdie studie is om die molekulêre basis van XGA in Suid Afrika te ondersoek, deur gebruik te maak van direkte volgorde bepaling van die Btk geen in die hoop om die kliniese diagnose van die siekte aan te help. Metode : Manlike pasiente met ‘n kliniese diagnose wan XGA was by die studie ingesluit. Genetiese analise was gebruik om die “exonic” omgewing van die Btk geen te ondersoek van 5 onverwante manlike pasiente en vergelyk teenoor 10 gesonde kontrole. Waar moontlik was familie lede ogevolg om draers te bepaal. Resultaat: Mutasies in die Btk geen is geidentifiseer in 3 van die 4 pasiente, klinies gediagnoseer meet XGA. Die mutasies sluit 2 reeds beskryfde variante in en een nuwe mutasie, ‘n een basis paar delesie in ekson 16 van die Btk geen, Ten spyte van die kliniese profiel suggestief van XGA in die 5de pasient, was geen mutasies geidentifiseer in die “exconic” omgewing van die Btk geen nie, dit kan moontlik toegeskryf word aan die teenwoordigheid van ‘n ander vorm van PIGS in hierdie pasient. Opvolg analise op die DNA van die moeders van die pasiente het die moederlike oorerwings patroon van die siekte bevestig aangesien al die moeders draers van die geidentifiseerde mutasie in die Btk geen van die gaffekteerde individu was. Gevolgtrekking: Genetiese analise van die Btk geen blyk ʼn sensitiewe en spesefieke metode te wees om individue met XGA te diagnoseer. Hierdie studie ondersteun die gebruik van molekulêre metodes in die diagnose van PIGS en beklemtoon die moontlike sinergie wat kan bestaan tussen hierdie tipe benadering in die kliniese omgewing. / National Research Foundation / National Health Laboratory Services : Pathology Research Development Grant of NHLS Research Trust Grants

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Thoracic spine pain (TSP) is a very common condition and can be just as disabling as cervical and lumbar pain. The causes of thoracic spine pain are numerous, ranging from less serious non-specific mechanical causes to serious specific underlying pathology. Chiropractors used to request routine radiographs as part of their diagnostic work-up, however limited correlation currently exists between radiographical findings and clinical symptoms in non-specific mechanical thoracic spine pain. The overutilization of plain film radiographs worldwide emphasises the need to investigate which clinical conditions in patients with TSP are sent for radiographs and if they were ethically indicated. Literature is currently limited on the role of thoracic spine x-rays and their influence on the management of patients with TSP. Objectives: The objectives of this retrospective study were: 1) to record the consultation at which thoracic spine radiographs were requested by the student or clinician and the reasons therefore, 2) to determine the number of incidental radiographic findings in the selected patients‟ radiographs, 3) to determine the suspected clinical diagnosis and management of the selected patients prior to referral for thoracic spine radiographs, 4) to determine any change in the clinical diagnoses and management following radiographic reporting of the selected patient‟s radiographs, 5) to determine the correlation between the suspected clinical diagnosis and the radiographic diagnosis of patients with thoracic spine pain. Method: The archives of the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) were searched for all available thoracic spine radiographs and corresponding patient files of patients who presented to the clinic with thoracic spine pain from 1 January 1997 to 31 December 2014. The ABCS (Alignment, Bone, Cartilage, Soft tissue) System was utilised to record data of the radiographs without any knowledge of the patient‟s main compliant. The corresponding patient files were then evaluated with selected clinical variables being recorded. Statistical analysis and interpretation included frequency counts, percentages, mean, standard deviation and ranges for the descriptive objectives. The radiographic and clinical diagnoses were then compared in a two-by-two table to determine any possible relationships in diagnoses of patients with thoracic spine pain. Results: Thirty clinical files and their corresponding thoracic spine radiographs were analysed in this study. The mean age of the patients was 43.6 (± 19.1) years with a gender distribution of 40% males and 60% females. Statistical testing using paired t-tests in order to assess the correlation between the clinical and radiological diagnoses was not possible, as the categories were too different. The most frequent primary radiological diagnosis was both old trauma and scoliosis at 33.3%, followed by thoracic spondylosis at 20%. The majority of thoracic spine radiographs were requested at the initial consultation. The most common reasons for radiographic referral were severe, progressive TSP at 58.6%, trauma at 48.3% and persistent, localised TSP for more than four weeks at 37.9%. The diagnosis remained unchanged in 70% of the patients following radiographic examination. However, in 30% of the cases the clinical diagnosis was changed following radiographic examination. Most patients were diagnosed with non-specific mechanical causes of thoracic spine pain. A wide variety of treatment modalities were utilised before and after radiographic examination, including soft tissue therapy, electro modalities, spinal manipulative therapy and dry needling. A total of 66.6% of the patients in the study had changes made to their management protocol following radiographic evaluation. There was a greater use of spinal manipulative therapy, following radiographic evaluation at 56.7% versus only 26.7% of cases prior to radiographic imaging. Conclusion: Thoracic spine radiographs have little impact on the diagnosis and management of patients with thoracic spine pain as the majority of clinical diagnoses were non- specific mechanical causes of thoracic spine pain. Thoracic spine radiographs were influential in the diagnosis and management of 30% of the cases. Thoracic spine radiographs may therefore be over-utilised at the DUT CDC. However, the use of spinal manipulative therapy more than doubled following radiographic evaluation of the thoracic spine in patients with thoracic spine pain. / M

The purpose of this research was to highlight the benefits of a Memory Box Programme on the social and emotional developmental functioning of orphaned children. The study focused on the memory box approach used by Sinomlando Centre with orphaned children. The Sinomlando Memory Box Programme has been in existence since 2000. The overall objective of this Memory Box Programme is to enhance resilience in vulnerable children and orphans affected by HIV and AIDS through the methodology of memory boxes In contributing to the discourse on memory work, an interpretive method of data collection and analysis in the form of a focus group discussion and thematic analysis was utilized in this study. Three focus groups were conducted with 26 orphaned children between the ages of 12 years to 15 years. Sampling of the children was based on a purposive sample, targeting children orphaned by AIDS who attended a 5-day camp conducted through a local NGO. The results of the study indicate that children who attended the Sinomlando Memory Box Programme had benefited from their involvement in the programme in diverse ways. They felt that being involved in a Memory Box Programme equipped them with better coping mechanisms and skills. These included the appropriate expression of feelings, the ability to talk about their parent’s death, and overcoming their sense of alienation so they could better cope with their difficult circumstances. / Thesis (M.A.) - University of KwaZulu-Natal, Pietermaritzburg, 2009.

South Africa is one of the countries most affected by HIV/AIDS, and the impact on children living in affected households and communit ies is significant. The loss of a parent or caregiver due to an AIDS. related illness has le ft many children orphaned. Understandings of bereavement. particularly amongst African adolescents. and adults’ responses to orphans’ psychological and emotional d ifficulties, remains under.developed. This paper explored adolescents’ experiences of par ental AIDS.related illness and bereavement. Ten adolescents participated in this s tudy. Qualitative methods such as observation, individual interviews and a focus grou p were the means of data collection. Key findings of the study were that: adolescents we re profoundly affected by the death of their parents with some showing signs of great anxi ety in relation to their future; were in need of emotional and material support; and were af fected by the intense stigma associated with HIV/AIDS which resulted in secrecy and shame. This study suggests that if we listen to the voices of children, we will learn about thei r emotional, psychological, developmental, and behavioural needs, which in turn will inform interventions working with vulnerable and orphaned children. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

BACKGROUND: Cystic fibrosis (CF) patients grow poorly and tend to be malnourished. They frequently suffer from lung infections necessitating the repeated use of antibiotics. AIM: This study was conducted to determine whether supplementation with a probiotic Lactobacillus reuteri (L. reuteri) could reduce the incidence and duration of lung infections, and whether this would impact on their anthropometric data. The secondary purpose was to compare the nutritional status of the CF patients attending CF clinics in Kwazulu-Natal (KZN) with CF patients attending CF clinics in Cape Town (CT). METHODS: Twenty three CF patients 6-31 years of age from 2 CF clinics in Kwazulu-Natal started the study although only 16 patients completed it. The study was a randomized, double blind, placebo controlled crossover trial with six months on placebo and six months on probiotic. Weight, height, mid arm circumference (MAC), triceps skin fold thickness (TSF), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured, sputum collected and a symptom diary completed over the 12 month period. Anthropometric data of CF patients attending CF clinics in CT was obtained from the publication by Westwood & Saitowitz (1999). RESULTS: Compliance with taking the L. reuteri was poor. Most took only 50% of the required daily dose. Probiotic supplementation showed a slight (non significant) trend to improve FEV1 and FVC, while no significant difference could be seen in the number and duration of the lung infections. Sputum analysis showed a non significant trend towards the probiotic reducing the number of bacteria in the sputum. There was a significant reduction of symptoms for fever, running nose, sore throat and ear ache while on placebo. There was a significant increase in weight gained off probiotic compared to the probiotic period. The changes in height, weight for age (WFA) percentiles, height for age (HFA) percentiles, WFA and HFA Z-scores, percentage expected weight for age and percentage expected height for age all showed no difference whether on or off probiotic. Over half the CF children in the KZN clinics were underweight for their actual height compared to one third in the CT clinics with a higher number of subjects below the 5th percentile for MAC and TSF readings compared to CT. CONCLUSION: Due to a small sample size and poor compliance no firm conclusions could be drawn. However a slight (non significant) improvement could be seen in favour of the probiotic for FEV1, FVC, and sputum analysis. Although all other findings were not significantly different it would be of benefit to carry out further investigation with improved compliance with the probiotic to see if the parameters set out above could be improved. The KZN and CT CF groups were comparable and the nutritional status of CF patients on KZN was well below that of the CT CF clinics and further monitoring would need to be carried out.