Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: Pressure garment therapy (PGT) forms a significant part of burn rehabilitation. It is most commonly used to treat hypertrophic scars but the benefits of this intervention remain questionable. Adherence with this intervention also presents several challenges for the patient and clinician. Aim of the study: The aim of this study was to explore the experiences of adult burn survivors who participated in PGT during 2006 - 2010 at Tygerberg Academic Hospital (TAH). Methods: A phenomenological study design using qualitative research methods was implemented. Semi-structured interviews were conducted with eight burn survivors. The participants were chosen using purposive sampling methods. Thematic analysis was conducted using pre-determined themes from the literature as a starting point. Data was coded and categorised according to themes that emerged during data analysis. Results: The findings of the study revealed that several factors impacted on the participant’s experiences of pressure garment therapy. Factors related to the consequences of the burn injury included the participant’s loss of function, loss of participation, loss of self-confidence, financial dependence, emotional impact and impact on relationships. Factors related to pressure garment usage included physical effects, socio-emotional effects and the wearing schedule (which included maintenance and effort, adherence and time). Factors that contributed to adherence included support, inner strengths, knowledge, seeing a difference, seeing others, enablers to accessing the service and satisfaction with the service. Factors that contributed to non-adherence included lack of support, emotional turmoil and barriers to accessing the service. Participants made recommendations to improve the overall burn service at TAH. Conclusion: The findings of the study show that participants experienced PGT as a beneficial intervention. There were several complex factors that impacted the participants’ experiences of PGT. The most significant benefit as described by the participants was the improvements noted in scar appearance, whilst the main barrier was that the garments were cosmetically displeasing due to their colour.Recommendations: To adopt a person-centred approach to burn management, recommendations made include improvements needed within the occupational therapy service such as changing the colour of the garment material, the standardisation of the PGT treatment protocols and improving staff attitudes. Other recommendations include establishing a network for counselling services as well as an information pack for patients admitted to the burns unit. / AFRIKAANSE OPSOMMING: Drukklereterapie vorm ʼn belangrike deel van die rehabilitasie van brandwonde. Dit is die mees algemene behandeling vir hipertrofiese littekens, maar daar bestaan steeds twyfel aangaande die voordele van hierdie intervensie. Daar bestaan heelwat uitdagings, vir beide die terapeut en die pasiënt, om die behandelingsriglyne na te volg. Doel van die studie: Die doel van hierdie studie was om die ervarings van volwasse brandwond oorlewendes wat vanaf 2006 tot 2010 drukklereterapie by Tygerberg Akademiese Hospitaal ontvang het, te ondersoek. Metode: ʼn Fenomenologiese studie ontwerp is geimplïmenteer deur middel van kwalitatiewe navorsingsmetodes. Semi-gestruktureerde onderhoude is met agt brandwond oorlewendes gevoer. Die deelnemers is gekies deur doelgerigte steekproefneming metodes. Tematiese analise is uitgevoer met behulp van voorafbepaalde temas wat as beginpunt uit die literatuur geneem is. Data is gekodeer en gekategoriseer volgens temas wat na vore gekom het tydens data analise. Resultate: Die bevindings van die studie het aangedui dat verskeie faktore die deelnemers se ervarings van drukklereterapie beïnvloed het. Faktore wat met die gevolge van die brand beserings verband hou het die volgende ingesluit: verlies aan funksie, verlies aan deelname, verlies aan selfvertroue, finansiële afhanklikheid, emosionele impak en die impak op verhoudings. Die volgende faktore het verband gehou met die gebruik van drukklere: fisiese faktore, sosio-emosionele faktore en die dra skedule (dit sluit in onderhoud van die drukklere, moeite, volg van die dra skedule en tyd). Faktore wat bygedra het tot die navolging van die skedule het die volgende ingesluit: ondersteuning, innerlike krag, kennis, die sien van ʼn verskil, sien van ander, toegang tot die diens en tevredenheid met die diens. Die volgende faktore het bygedra tot nie-navolging: gebrek aan ondersteunning, emosionele verwarring en hindernisse tot toegang tot die diens. Deelnemers het aanbevelings gemaak om die brandwonde diens te verbeter. Slot: Die bevindings van die studie dui daarop dat die deelnemers drukklereterapie as ʼn voordelige intervensie ervaar het. Daar was verskeie komplekse faktore wat ʼn impak op drukklereterapie gehad het. Die grootste voordeel, soos beskryf deur deelnemers, was die verbetering in litteken voorkoms; terwyl die hoof hindernis was dat die drukklere kosmeties onaanvaarbaar was as gevolg van die kleur. Aanbevelings: Die volgende aanbevelings is gemaak om ʼn persoon-gesentreerde benadering tot brandwond behandeling te verseker: verbeterings benodig binne die arbeidsterapie diens, soos die verandering van die kleur van drukkleremateriaal, die standaardisering van drukklereterapie protokolle en die verbetering van personeel houdings. Ander aanbevelings sluit in ʼn netwerk vir beradingsdienste, sowel as ʼn inligtingspakket vir pasiente wat tot die brandwondeenheid toegelaat word.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Community Medicine / Master / Master of Philosophy

This study aimed to determine health promotion needs of physically disabled youth with spinal cord injury. The study specifically explored health-related behaviours with reference to participation in physical activity and substance usage, factors that influenced these behaviours and major issues that needed to be targeted in health promotion.

The purpose of this study was to describe the factors contributing to high default of DOTS implementation in the Kwaebibrim district of Ghana. A quantitative, descriptive study was conducted to determine personal, health service, community and treatment factors contributing to high default of DOTS implementation in the district. Data collection was done using a structured questionnaire. Purposive sampling was done. The sample comprised of one hundred and thirty TB patients who were on DOTS implementation at the district chest clinic. The study highlighted TB patients’ knowledge about TB, socio-economic characteristics, organisation of care as well as community perceptions about the disease. The findings revealed that default to treatment is a complex behavioural issue involving multiple factors, an interaction of personal, social and health care factors as well as side effects of medication and duration of treatment. It is therefore recommended that interventions to prevent default of DOTS implementation should be designed with these factors in mind.

Autism Spectrum Disorder (ASD) affects one out of every 68 children in the United States. The disorder is characterized by persistent deficits in social communication, social interaction, and restricted, repetitive patterns of behavior, interest, or activities that together limit and impair everyday functioning. Research has shown that the use of visual resources, such as video modeling procedures, can support individuals with ASD to acquire and maintain a variety of daily living skills leading to enhanced levels of independence. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

研究目的：脊髓損傷是中樞神經系統的嚴重創傷，致殘率高。脊髓損傷後的再生修復一直是當前醫學的難題。迄今為止，脊髓損傷依然缺乏一種有效地治療方法。既往研究證明，胰島素樣生長因子-1對鼠和兔脊髓損傷有保護作用，為了進一步把這些發現應用到臨床方面，我們採用與人類生理更相近的豬只作為實驗動物，構建與臨床相似的脊髓損傷動物模型，并以此為基礎，系統性研究胰島素樣生長因子-1的脊髓保護作用，評估該治療的功效。 / 研究方法：以運動誘發電位為指導，通過直接壓迫和牽拉造成脊髓損傷。18頭猪只隨機分為3組：胰島素樣生長因子-1治療組、生長激素治療組及生理鹽水對照組。脊髓損傷后1小時、24小時及48小時經鞘內注射給藥。于術後第1天、第3天及第21天收集腦脊液檢測胰島素樣生長因子-1和生長激素濃度。連續21天使用修正的 Tarlov 評分標準對動物的運動功能進行評估。第21天處死動物並取材，檢測脊髓中NeuN, GFAP, caspase-3 的活性，并通過TUNEL染色觀察細胞凋亡情況，比較各組之間有無差別。 / 研究結果：通過這種方法建立的脊髓損傷動物模型穩定可靠，各組之間無明顯差異。鞘內給藥24小時及48小時后，腦脊液中胰島素樣生長因子-1和生長激素濃度明顯升高，術後21天檢測，其濃度恢復至基礎值。胰島素樣生長因子-1治療組的運動功能的恢復優於其它各組。與生理鹽水對照組比較，胰島素樣生長因子-1治療組可以明顯提高脊髓損傷后神經元的存活數量，抑制星形膠質細胞增生，減少細胞凋亡。而生長激素治療組僅抑制星形膠質細胞增生，其它方面與生理鹽水對照組無明顯差別。 / 結論：胰島素樣生長因子-1通過提高神經元存活數量，抑制星形膠質細胞增生，以及減少細胞凋亡促進脊髓損傷的恢復。 / Objective: Spinal cord injury is a devastating condition that leads to long-term disabilities. Currently, there is no effective treatment that minimizes spinal cord damage or enhances neurological recovery. Recent studies in rats or rabbits suggested that neurologic recovery after spinal cord injury could be improved with the administration of neurotropic hormones, such as insulin-like growth factor-1 (IGF-1). In order to apply such bench-side discovery to clinical practice, we conducted a study in a higher animal model, akin to human physiology, to evaluate the effectiveness of intrathecal injections of IGF-1to improve neurological recovery in a porcine model of acute traumatic spinal cord injury. / Methods: Traumatic spinal cord injury model was produced by controlled compression and distraction of the exposed T12 segment of the spinal cord. Eighteen pigs were randomly assigned to receive intrathecal injections of either IGF-1, growth hormone or saline at 1, 24 and 48 hours after spinal cord injury. Locomotor function was assessed daily using the validated modified Tarlov’s scale for 21 days. Spinal cord segments were then harvested and the survival of neurons, reactive astrogliosis and apoptosis were determined using neuronal-specific nuclear protein (NeuN), glial fibrillary acidic protein (GFAP), cleaved caspase-3 and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assays. / Results: Intrathecal injections of IGF-1 and growth hormone significantly increase the concentrations of the neurotropic hormones in the cerebrospinal fluid after injury (p < 0.01). These concentrations returned to baseline by 21 days after drug delivery. Motor deficits on the first day after injury were comparable between animals in the treatment and control groups. By the end of the third week, neurologic recovery was better in animals receiving IGF-1 treatment (p < 0.05). Immunohistological and western blot studies of the injured segments of spinal cord showed that treatment with both IGF-1 and growth hormone prevented reactive astrogliosis (p < 0.05) while only IGF-1 improved the survival of mature neurons (p < 0.05). IGF-1 also inhibited apoptosis after spinal cord injury (p < 0.05). / Conclusions: In our clinically relevant model of traumatic spinal cord injury in pigs, intrathecal injection of IGF-1 demonstrated beneficial effects on neurological and histological recovery. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wang, Qinzhou. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 105-122). / Abstract also in Chinese. / Declaration of origination --- p.I / Abstract --- p.II / Acknowledgements --- p.VI / Table of Contents --- p.VIII / List of Tables --- p.XII / List of Figures --- p.XIII / Abbreviations --- p.XVIII / Chapter Part 1 --- Spinal Cord Injury: A Review --- p.1 / Chapter Chapter 1-1 --- Acute Spinal Cord Injury: Epidemiology, Socioeconomic Impact --- p.2 / Chapter 1.1.1 --- Epidemiology of Spinal Cord Injury --- p.2 / Chapter 1.1.2 --- Socioeconomic Impact of Acute Spinal Cord Injury --- p.5 / Chapter Chapter 1-2 --- Mechanisms of Spinal Cord Injury --- p.6 / Chapter Chapter 1-3 --- Putative Treatments for Spinal Cord Injury --- p.8 / Chapter 1.3.1 --- Methylprednisolone --- p.8 / Chapter 1.3.2 --- Stem Cell Therapy --- p.11 / Chapter 1.3.3 --- Riluzole --- p.11 / Chapter 1.3.4 --- Other Pharmacological Therapies for Spinal Cord Injury --- p.12 / Chapter Chapter 1-4 --- Insulin-like Growth Factor-1 for the Treatment of Spinal Cord Injury --- p.13 / Chapter Chapter 1-5 --- Summary --- p.17 / Chapter Part 2 --- Insulin-like Growth Factor-1 and Growth Hormone for Spinal Cord Injury --- p.18 / Chapter Chapter 2-1 --- Hypothesis and Objectives --- p.19 / Chapter Chapter 2-2 --- Establishment of Animal Models for Acute Spinal Cord Injury --- p.22 / Chapter 2.2.1 --- Introduction --- p.22 / Chapter 2.2.2 --- Experimental Animals --- p.22 / Chapter 2.2.3 --- Anesthesia --- p.23 / Chapter 2.2.4 --- Transcranial Electrical Motor Evoked Potential --- p.26 / Chapter 2.2.5 --- Surgery --- p.28 / Chapter 2.2.6 --- Statistics --- p.34 / Chapter 2.2.7 --- Results --- p.34 / Chapter 2.2.8 --- Discussion --- p.38 / Chapter Chapter 2-3 --- Optimal Stimulation Protocols for Transcranial Electrical Motor Evoked Potential. --- p.42 / Chapter 2.3.1 --- Introduction --- p.42 / Chapter 2.3.2 --- Methods --- p.42 / Chapter 2.3.2.1 --- Experimental Animals and Anesthesia --- p.42 / Chapter 2.3.2.2 --- Transcranial Electrical Motor Evoked Potential Recording --- p.44 / Chapter 2.3.2.3 --- Stimulation Protocol --- p.44 / Chapter 2.3.3 --- Analyses --- p.44 / Chapter 2.3.4 --- Results --- p.45 / Chapter 2.3.5 --- Discussion --- p.52 / Chapter Chapter 2-4 --- Evaluation of the Efficacy of Insulin-like Growth Factor-1 and Growth Hormone in a Porcine Model --- p.54 / Chapter 2.4.1 --- Introduction --- p.54 / Chapter 2.4.2 --- Materials and Methods --- p.54 / Chapter 2.4.2.1 --- Study Design --- p.54 / Chapter 2.4.2.2 --- Intrathecal Injection and Collection of Cerebrospinal Fluid --- p.58 / Chapter 2.4.2.3 --- Measurements --- p.58 / Chapter 2.4.2.3.1 --- Clinical Evaluation --- p.58 / Chapter 2.4.2.3.2 --- Biochemical Assessments --- p.58 / Chapter 2.4.2.3.3 --- Spinal Cord Section, Histological and Immunochemical Staining --- p.63 / Chapter 2.4.2.3.4 --- Western Blot --- p.69 / Chapter 2.4.3 --- Statistical Analysis and Sample Size Calculation --- p.72 / Chapter 2.4.3.1 --- General Analysis --- p.72 / Chapter 2.4.3.2 --- Sample Size --- p.72 / Chapter 2.4.4 --- Results --- p.73 / Chapter 2.4.4.1 --- Changes of TceMEP --- p.73 / Chapter 2.4.4.2 --- Motor Deficit after Spinal Cord Injury at Baseline --- p.75 / Chapter 2.4.4.3 --- Insulin-like Growth Factor-1 and Growth Hormone in Cerebrospinal Fluid --- p.77 / Chapter 2.4.4.4 --- Clinical Assessment --- p.80 / Chapter 2.4.4.5 --- Demyelination, Neuron Survival and Astrocyte Reaction --- p.85 / Chapter 2.4.4.6 --- Apoptosis --- p.89 / Chapter 2.4.5 --- Discussion --- p.93 / Chapter 2.4.5.1 --- Principal Findings --- p.93 / Chapter 2.4.5.2 --- Insulin-like Growth Factor-1 and Neuroprotection after Spinal Cord Injury --- p.93 / Chapter 2.4.5.3 --- Growth Hormone and Neuroprotection after Spinal Cord Injury --- p.95 / Chapter 2.4.5.4 --- Strengths and Limitations of Our Study --- p.96 / Chapter 2.4.5.5 --- Summary --- p.97 / Chapter Part 3 --- Summary and Future Directions --- p.99 / Chapter Chapter 3-1 --- Summary --- p.100 / Chapter Chapter 3-2 --- Future Directions --- p.103 / Chapter Part 4 --- References and appendixes --- p.104 / References --- p.105 / Appendixes --- p.123

The purpose of this study was to develop a medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe. The study used the grounded theory approach utilising a mixed sequential dominant status design. Purposive sampling of key stakeholders was the primary method and theoretical sampling became necessary as the study evolved in the qualitative phase. A confirmatory retrospective document review of 119 files of patients was done in the quantitative phase. Pierre Bourdieu’s conceptual canon of field, habitus and capital was utilised as the theoretical point of departure for the study. Findings and results showed dislocation and dissonance between and within the habitus of social fields the judiciary, health (medical) and the prison systems with an ensuing hysteretic effect that negatively affected the outcome of forensic psychiatric rehabilitation in special institutions in Zimbabwe. Forensic psychiatric patients were caught up in a double bind situation of aligning to both of the contradictory functions of the medical and the prison systems. The result of this hysteretic scenario seemed to breed some kind of rehabilitative schizophrenia. The developed medico-judicial framework is projected to transform the libido dominandi of the present into a widened scope of therapeutic jurisprudence. The medico-judicial framework is forwarding the forensic psychiatric practitioner to a new address since it has changed its residence from the special institution to the forensic psychiatric hospital. It is inviting the person involved with forensic psychiatric rehabilitation to begin again, inciting him or her to be open to the possibilities of mapping a path through the tangled growth of current realities into an increased width and depth of comprehensive forensic psychiatric practice that follows an empowering legislative prescript / Health Studies / D. Litt. et Phil. (Health Studies)

Background: The relationship between informational support and use of health care services among individuals newly diagnosed with cancer remains little documented despite its importance for optimal care delivery. Aim: To document the role of informational support in light of patterns of health services used by women and men newly diagnosed with cancer. Method: A sequential mixed methods approach (i.e., quantitative-qualitative) was conducted among women and men newly diagnosed with either breast or prostate cancer. First, an existing quantitative database was used to determine whether an intervention relying on multimedia tool as a complement to the provision of usual cancer informational support to patients (N = 250) would modify subsequent health care service use. A follow-up qualitative inquiry with distinct individuals also newly diagnosed (N = 20) was conducted to explore this relationship further. Next, the resulting quantitative and qualitative findings were merged and reanalyzed using a quantitative-hierarchical approach to enhance our understanding of the phenomenon. Findings: Several personal and contextual factors were found to qualify the relationship between cancer informational support and health service use. Although quantitative analyses showed no significant differences in terms of overall reliance on health care services among participants who received more intense cancer informational support as opposed to those who received care as usual, several sex differences were noted in terms of number of visits to health care professionals, time spent with nurses and satisfaction with cancer information received. Qualitative findings revealed that participants reported a variety of experiences pertaining to cancer information received (e.g., positive, unsupportive or mixed) as well as several processes at play (e.g., cancer information seen as enabling, confirming, or conflicting). These differences in informational support, in turn, influenced their subsequent service utilization (e.g., more phone calls made to health professionals, reduction in face-to-face visits, reluctance to use cancer-related services). The mixed data analysis clarified further the findings allowing a broader perspective to emerge. Conclusion: Findings underscore that the relationship between cancer information and use of services is not as straightforward as initially anticipated. These findings provide initial insights that may inform future research on the topic and assist health care providers in optimizing their cancer informational interventions to guide patients in their reliance on health care services.

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