Aims: It is argued that one’s sense of self is threatened and eroded by mental illness. According to the narrative perspective, one’s personal life narrative is displaced and maintained by a story of illness. However, dialogical self theorists argue that mental illness limits the number of ‘I’ positions available within an individual, resulting in the positions/voices becoming rigid and being dominated by a singular, monological position. The aims of this qualitative study are to attempt to understand and examine psychiatric inpatients’ personal lived experiences of an art group. The goal of the study is to focus on the impact of the art-making process on these patients with regards to the construction of their sense of self. Design: A qualitative research design was used in the study. Method: Four psychiatric in-patient art group members – three male and one female, between the ages of 27 and 40 – were interviewed. A semi-structured interview schedule consisting of sixteen questions focusing on the interviewees’ experiences of the art group was used. The interviews were analysed using an interpretive phenomenological analysis. Results: Three superordinate themes emerged: What the Participants Gained From the Art Group, Sense of Community and Leaving a Mark, and The Experience of Self in the Art group. All three Superordinate themes fall within the participants’ experience of the art group. Conclusion: All four of the participants expressed positive feelings and enjoyment towards the art group. Participation in the art group provided the participants with a sense of pride, achievement and hope within their lives. As a result of participation on the art group, one of the four participants was able to construct a thin alternative experience and sense of self.

Dissertation / The aim of this study was to determine the knowledge of persons with hypertension in a selected geographical area regarding cardiovascular risk factors in order to make recommendations for patient education. A quantitative, non-experimental, descriptive study was done in the form of a survey using a questionnaire as measuring instrument. The population was hypertensive patients from selected private medical practices in the western part of KwaZulu-Natal and the bordering eastern part of the Free State. Convenience sampling was used and 46 respondents participated in the study. Only 16 (35%) of the respondents achieved a percentage on or above the competency indicator of 50%. Respondents performed worst in questions where definitions, for example hypertension, were assessed. Recommendations for a patient education document, nursing practice and further research were made. / Health Studies / M.A. (Health Studies)

Eating disorders remain a phenomenon that escapes full comprehension, resulting in frustration for those who suffer from the disorders, their families, and their therapists. It is becoming increasingly necessary to describe the mechanism by which eating disorders develop, in order to effectively treat and prevent these disorders. The aim of this study was to illuminate factors that contributed to the development of eating disorders within the individual contexts of the lives of the participants, as well as how those factors interacted in context to culminate in the development of an eating disorder. This qualitative study was conducted from an interpretive perspective. The findings show how individual contextual factors interact to produce a marked fear of gaining weight, which is driven by fear of negative evaluation, and that the eating disorder behaviour serves specific functions that are related to coping with stress within the lives of the participants. / Psychology / M. Sc. (Psychology with specialisation in Research Consultation)

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: There is growing interest in how genetic and environmental risk factors interact to confer risk for dysregulated iron homeostasis, which is considered a possible pathogenic mechanism in multiple sclerosis (MS). While iron deficiency has been associated with greater disability and disease progression, cerebral accumulation and overload of insoluble iron has also been reported in MS patients. Variation in the matriptase-2 (TMPRSS6) gene has recently been described that may lead to reduced iron levels, which raised the question of whether it may be involved in dysfunctional iron regulation as a pathogenic mechanism in MS. The aims of the study were as follows: 1)) comparison of the allele frequencies and genotype distribution for TMPRSS6 A736V (rs855791, c.2207C>T) and HFE C282Y (rs1800562, c.845G>A) between patients diagnosed with MS and unaffected controls; 2) determination of the effects of clinical characteristics, relevant lifestyle factors and genotype on serum iron parameters in MS patients compared to population matched controls; and 3) determination of clinical outcome in relation to age of onset and degree of disability in MS patients. The study population included 121 Caucasian MS patients and 286 population-matched controls. Serum iron, transferrin, ferritin and transferrin saturation levels were available from previous studies and lifestyle factors were subsequently documented in a subgroup of 68 MS patients and 143 controls using the study questionnaire. Genotyping of TMPRSS6 A736V and HFE C282Y were performed using allele-specific TaqMan technology. The genotype distribution and allele frequencies of TMPRSS6 A736V and HFE C282Y did not differ between MS patients and controls. MS patients homozygous for the iron-lowering minor T-allele of TMPRSS6 A736V had significantly lower serum iron levels (p=0.03) and transferrin saturation levels (p=0.03) compared to CC homozygotes. In MS patients the iron-loading minor A-allele of HFE C282Y was also associated with a paradoxical decrease in serum ferritin (p<0.01) compared to GG homozygotes. When considering the combined effect of the minor alleles of TMPRSS6 A736V and HFE C282Y with opposite effects on iron levels, we found a significant reduction in serum ferritin levels (p<0.05), independent of age, sex, body mass index (BMI) or dietary red meat intake in MS patients. A similar effect was not observed in the population- and age-matched controls. Higher dietary red meat intake correlated significantly with increased ferritin only in controls (p=0.01 vs. 0.21 for MS patients). In the presence of the minor allele of HFE C282Y, the TMPRSS6 A736V CT and TT genotypes were associated with a significantly earlier age of onset of MS when the post hoc test was applied (p=0.04). All the study aims were successfully accomplished. Our results support the possibility of an epistatic effect between TMPRSS6 A736V and HFE C282Y associated with reduced ferritin levels in MS patients. Pathology-supported genetic testing (PSGT) applied in this study as a new concept for analysis of complex diseases with a genetic component, is well placed to optimise clinical management in patients with MS. / AFRIKAANSE OPSOMMING: Daar heers toenemende belangstelling in hoe die wisselwerking tussen genetiese en omgewingsfaktore die risiko tot wanregulering van yster-homeostase beïnvloed. Laasgenoemde is ‘n moontlike patogeniese meganisme vir meervoudige sklerose (MS). Alhoewel verhoogde gestremdheid en siekteprogressie met ystertekort geassosieer is, is ysterophoping in die serebrum asook ‘n oormaat onoplosbare yster al by MS-pasiënte gevind. Variasie in die matriptase-2 (TMPRSS6) geen wat tot verlaging in ystervlakke kan lei, is onlangs beskryf en laat die vraag ontstaan of dit betrokke is by wanregulering van yster-homeostase as patogeniese meganisme in MS. Die doelwitte van die studie was as volg: 1) vergelyking van alleelfrekwensies en genotipeverspreiding vir TMPRSS6 A736V (rs855791, c.2207C>T) en HFE C282Y (rs1800562, c.845G>A) tussen MS-pasiënte en ongeaffekteerde kontroles; 3) bepaling van die effekte van kliniese indikators, relevante leefstylfaktore en genotipe op serum yster parameters in MS-pasiënte in vergelyking met populasie-ooreenstemmende kontroles; en 4) bepaling van kliniese uitkoms ten opsigte van aanvangsouderdom en graad van MS-aantasting. Die studiepopulasie het uit 121 kaukasiese MS-pasiënte en 286 kontroles van dieselfde populasie, wat nie die siekte het nie, bestaan. Serum yster, transferrin, ferritien en transferrien-versadigingsvlakke was beskikbaar vanaf vorige studies. Leefstylfaktore is in ‘n subgroep van 68 MS-pasiënte en 143 kontroles gedokumenteer met behulp van die studie-vraelys. TMPRSS6 A736V en HFE C282Y genotipering is met alleel-spesifieke TaqMan-tegnologie uitgevoer. Beide pasiënte en kontroles het dieselfde genotipeverspreiding en alleelfrekwensies getoon. Die A-alleel van HFE C282Y is met ‘n paradoksale verlaging in serum ferritien geassosieer (p<0.01) in MS-pasiënte met TMPRSS6 A736V, moontlik weens geen-geen interaksie wat nie deur ouderdom, liggaamsmassa-indeks of inname van rooivleis in die dieet beïnvloed is nie (p<0.05) en nie by kontroles gevind is nie. MS-pasiënte wat homosigoties is vir die T-alleel van TMPRSS6 A736V, het statisties betekenisvolle laer serum ystervlakke (p=0.03) en transferrienversadiging (p=0.03) getoon in vergelyking met CC-homosigote. In MS-pasiënte was die yster-oorlading A-alleel van HFE C282Y ook geassosieer met ‘n paradoksale afname in serum ferritien (p<0.01) in vergelyking met GG-homosigote. Wanneer die gekombineerde effek van die risiko-geassosieerde allele van TMPRSS6 A736V en HFE C282Y met teenoorgestelde effekte op ystervlakke geanaliseer word, is daar ‘n statisties beteknisvolle afname in serum ferritienvlakke (p<0.05), onafhanklik van ouderdom, geslag, liggaamsmassa-indeks of rooivleisinname in MS-pasiënte. ‘n Soortgelyke effek is nie waargeneem in populasie- en geslag-gelyke kontroles nie. Die inname van rooivleis in die dieet was betekenisvol minder by MS-pasiënte teenoor kontroles (p=0.03) en dit het slegs betekenisvol met verhoogde ferritien by kontroles gekorreleer (p=0.01 teenoor 0.21 by MS-pasiënte). In die teenwoordigheid van die risiko-geassosieerde alleel van HFE C282Y, is die TMPRSS6 A736V CT en TT genotipes geassosieer met ‘n statisties-betekenisvolle vroeër aanvangsouderdom van MS soos bepaal met die post hoc-toets (p=0.04). Al die doelwitte van die studie is suksesvol uitgevoer. Die resultate ondersteun die moontlikheid van ‘n epistatiese effek tussen TMPRSS6 A736V en HFE C282Y wat geassosieer is met ‘n verlaging in ferritienvlakke in MS-pasiënte. Patologie-gesteunde genetiese toetsing soos toegepas in hierdie studie as ‘n nuwe konsep vir analise van komplekse siektes met ‘n genetiese komponent, is goed geplaas om kliniese hantering van MS-pasiënte te optimaliseer.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The immune response against M. tuberculosis is multifactorial, involving a network of innate and adaptive immune responses. Characterization of the immune response, a clear understanding of the dynamics and interplay of different arms of the immune response and the identification of infection-stage specific biomarkers are critical to allow the development of better tools for combating tuberculosis. In an attempt to identify such biomarkers, we studied pulmonary tuberculosis patients and their contacts in Addis Ababa, Ethiopia as part of EDCTP and BMGF funded tuberculosis projects by using multiplex techniques. We analysed 45 genes using the Multiplex Ligation Dependent Probe Amplification (MLPA) technique and the expression of IL-4δ2, BLR1, MARCO, CCL-19, IL7R, Bcl2, FcyR1A, MMP9, and LTF genes discriminate TB cases from their healthy contacts. FoxP3, TGFß1 and CCL-19 discriminate latently infected from uninfected contacts. Single genes predict with an area under the Receiver Operating Characteristic (ROC) curve of 0.68 to 0.85 while a combination of genes identified up to 95% of the different groups. Similarly, the multiplex analysis of cytokines and chemokines also showed that single or combinations of plasma cytokines and chemokines discriminate between different clinical groups accurately. The median plasma level of EGF, fractalkine, IFN-y, IL-4, MCP-3 and IP-10 is significantly different (p<0.05) in active tuberculosis and non active tuberculosis infection and the median plasma levels of IFN-y, IL-4, MCP-3, MIP-1ß and IP-10 were significantly different (p<0.05) before and after treatment. We also found a significant difference (p<0.05) in plasma levels of cytokines of patients infected with the different lineages and different families of the modern lineage. The plasma level of IL-4 was significantly higher in patients infected with lineage 3 (p<0.05) as compared to lineage 4 and the CAS familyinfected patients had a higher plasma level of IL-4 (P<0.05) as compared to patients infected with H and T families but there was no difference between H and T families. We identified genes and cytokines which had been reported from other studies in different settings and we believe that these molecules are very promising biomarkers for classifying active tuberculosis, latent infection, absence of infection and treated infection. These markers may be suitable for the development of clinically useful tools but require further validation and qualification in different populations and in larger studies. / AFRIKAANSE OPSOMMING: Die immuunrespons teen M. tuberculosis is multifaktoriaal en betrek ‘n netwerk van niespesifieke and spesifieke immuunresponse. Karakterisering van die immuunrespons, ‘n duidelike insig in die dinamika en tussenspel deur die verskillende arms van die immuunrespons en die identifikasie van spesifieke biomerkers is krities belangrik om die ontwikkeling van nuwe hulpmiddels teen tuberkulose te bevorder. In ‘n poging om sulke biomerkers te identifiseer het ons pulmonale tuberkulose pasiënte en hulle kontakte in Addis Ababa, Etiopië, as deel van die EDCTP en BMGF befondste tuberkulose projekte bestudeer met multipleks tegnieke. Ons het 45 gene analiseer met ‘Multiplex Ligation Dependent Probe Amplification (MLPA)’ en gevind dat die geenuitdrukking van IL-4•2, BLR1, MARCO, CCL-19, IL7R, Bcl2, Fc•R1A, MMP9, en LTF TB pasiënte van hulle kontakte onderskei. FoxP3, TGF•1 en CCL-19 onderskei tussen latent infekteerde en ongeïnfekteerde kontakte. Enkele gene voorspel met ‘n area onder die ‘Receiver Operating Characteristic (ROC)’ kurwe van 0.68 tot 0.85 terwyl die kombinasie van gene 95% van die verskillende groepe identifiseer. Soortgelyk het multipleks analise van sitokiene en chemokiene verskillende kliniese groepe akkuraat van mekaar onderskei. Die mediane plasmavlakke van EGF, fractalkine, IFN-•, IL-4, MCP-3 en IP-10 is beduidend verskillend (p<0.05) in aktiewe tuberkulose en nie-aktiewe tuberkulose infeksie en die mediane plasmavlak van IFN-•, IL-4, MCP-3, MIP-1• en IP-10 was beduidend verskillend voor en na behandeling. Ons het ook beduidende verskille (p<0.05) in plasmavlakke van sitokiene in pasiënte gevind wat infekteer is met verskillende stamme and verskillende families van die moderne stamme. Die plasmavlak van IL-4 was beduidend hoër in pasiënte wat infekteer is met stam 3 (p<0.05) teenoor stam 4 en die CAS familie-infekteerde pasiënte het ‘n hoër plasmavlak van IL-4 (p<0.05) teenoor pasiënte met H en T familie infeksie hoewel daar geen versikke was tussen die H en T families nie. Ons het gene en sitokiene identifiseer wat deur ander werkers onder verskillende omstandighede ook beskryf is en ons glo dat hierdie molekules baie belowende biomerkers is om aktiewe tuberkulose, latent tuberkulose, die afwesigheid van infeksie en behandelde infeksie van mekaar te onderskei. Hierdie merkers mag toepaslik wees vir die ontwikkeling van bruikbare kliniese hulpmiddele maar benodig verdere validasie en kwalifikasie in verskillende populasiegroepe en in groter studies. / Bill and Melinda Gates Foundation (BMGF) / European and Developing Countries Clinical Trials Partnership (EDCTP) / African European Tuberculosis Consortium (AE TBC).

Thesis (MScMedSc)--Stellenbosch University, 2012. / Bibliography / ENGLISH ABSTRACT: Background: In the era of antiretroviral therapy (ART), the risk of acquired immune deficiency syndrome (AIDS) related deaths has decreased and people living with Human Immunodeficiency Virus (HIV) now have prolonged life spans. However, an increasing trend of non-AIDS associated deaths has been reported despite adequate control of viral loads. HIV infection is established as a chronic inflammatory condition which is associated with an increased risk for thrombosis. Thus HIV infected patients are at a higher risk of developing cardiovascular disease (CVD) and other inflammatory-associated complications. Inflammation is linked with thrombosis and promotes the formation of thrombin, which plays an important role in platelet activation. Furthermore, activated platelets have been shown to play a key role during infection and the inflammatory process, particularly by mediating interactions between cells of innate immunity. Soluble markers of platelet activation have been shown to be increased in HIV-infection. However, these have not been well documented by flow cytometry. P-selectin CD62P is stored in the alpha granules of platelets and is expressed on the surface only upon platelet activation. This facilitates interaction with other blood cells and the endothelium. Activated platelets may play a role in HIV-induced atherosclerosis through the expression and release of mediators that induce endothelial activation and support the adhesion of leukocytes to the inflamed vessel wall. Fibrinogen is a precursor of the blood coagulatory protein fibrin and the degradation of fibrin to D-dimer is a measure of the formation and the subsequent dissolution of blood clots. In HIV infected patients, chronic inflammation induces the up-regulated expression of tissue factor (TF) on monocytes which triggers the activation of the clotting cascade and increases the level of D-dimers. Methods: This pilot study consisted of ART naïve patients and all platelet flow analyses were carried out on whole blood. In this study, a total of 57 adult South Africans were recruited from a clinic in the Western Cape. These included 32 HIV positive patients and 25 HIV negative individuals. The levels of platelet activation and platelet function were investigated using a novel platelet cytometry assay. The method was optimized to ensure minimal platelet activation: no centrifugation or red blood cell (RBC) lysis steps were performed. The platelet-specific markers CD41a and CD42b were used to ensure gating on platelets only. CD62P expression was used to evaluate platelet activation and these levels were correlated with Fibrinogen, hsCRP, Ddimer, CD4 counts and viral load. Furthermore, platelet function was evaluated by investigating the response of platelets to endogenous agonists which included adenosine diphosphate(ADP) and arachidonic acid (AA) at varying concentrations. Results:This study demonstrated higher baseline levels of CD62P expression in treatment naïve HIV positive patients as compared to uninfected controls (mean %CD62P 71.74 ± 2.18 vs control 54.52 ± 2.42; p=<0.0001). In addition it was shown that %CD62P expression correlated directly with platelet counts (r=0.374, p=0.042). Platelet counts showed an inverse correlation with viral loads (give values) Fibrinogen levels correlated with the absolute WCC (r=0.659, p=0.0021); absolute neutrophil count (r=0.619, p=0.0105); absolute monocyte count (0.562, p=0.0235) and hsCRP (r=0.688 p=0.0011). In addition, fibrinogen showed a strong negative correlation with CD4 counts (r=-0.594, p=0.0014) and therefore, may be a valuable marker of both disease progression and risk of thrombosis in treatment naïve HIV positive patients. HsCRP levels correlated with the absolute neutrophil counts (r=0.392, p=0.0005). The HIV Group showed an overall hyper-response to ADP at a concentration 0.025 μM as compared to uninfected controls (62.34 ± 9.7 vs control 36.90 ± 5.7, p=0.0433). Conclusions: In this study we describe a novel Flow Cytometry technique that may be used to evaluate the levels of platelet activation and platelet function in HIV infected patients. In addition we report a cost-effective panel in the form of fibrinogen, WCC and platelets that may be valuable in predicting the progression of HIV infection to AIDS or other inflammatory- associated complications in treatment naïve HIV infected patients. Platelet counts showed an inverse correlation with viral loads and a direct correlation with the level of activated platelets. These findings taken together suggest the potential prognostic value of platelet activation and platelet counts in the context of asymptomatic HIV infected patients. Our findings suggest WCC and Fibrinogen may be used to evaluate the inflammatory profile of individual HIV infected patients. This may have a direct impact on HIV patient management prior to initiation of antiretroviral therapy and valuable in monitoring responses to treatment. Further, we present a novel flow cytometry based platelet functional assay and suggest the use of ADP at a concentration of 0.025 μM to evaluate platelet function optimally in HIV infected patients. The utilization of the novel Flow Cytometry technique as described in this study would add significant value in the assessment of thrombotic risk and disease progression in HIV infected patients and may additionally prove to be of value in other chronic inflammatory conditions. / AFRIKAANSE OPSOMMING: Voorkennis: In die era van antiretrovirale terapie (ART), het die risiko van vigs-verwante sterftes verminder en mense wat nou met volle naam (MIV) leef, het ‘n verlengde lewensduur. Nogtans, word 'n toenemende neiging van nie-vigs geassosieer sterftes berig wat hoofsaaklik toegeskryf word aan trombotiese toestande. MIV-infeksie word as 'n chroniese inflammatoriese toestand beskou met ʼn verhoogde trombose risiko geassosieer word. Dus, MIV-besmette pasiënte het 'n hoër risiko om kardiovaskulêre siekte (CVD) te ontwikkel ongeag of hulle ARV naïef is of op behandeling is nie. Inflammasie word geassosieer met trombose en bevorder die vorming van trombien, wat 'n belangrike rol in plaatjie aktivering speel. Verder, word daar bewys dat geaktiveerde bloedplaatjies 'n belangrike rol speel tydens infeksie en die inflammatoriese proses.Hulle bemiddel interaksies tussen die selle van ingebore immuniteit. Daar word bewys dat oplosbare merkers van plaatjie aktivering verhoog is in MIV-infeksie, maar die bewyse is nie so goed gedokumenteer deur vloeisitometrie nie. P-selectin (CD62P) word gestoor in die alfa korrels van plaatjies en word uitgedruk op die oppervlak slegs wanneer plaatjies geaktivering word; daardeur fasilitering dit die interaksie met ander bloedselle en die endoteel. Geaktiveerde plaatjies kan ook 'n rol in MIV-geïnduseerde aterosklerose speel deur middel van die uitdrukking en vrylating van bemiddelaars wat endoteel aktivering induseer asook die adhesie van leukosiete aan die ontsteekte vat wand ondersteun.. Fibrinogeen, 'n voorloper van die bloed koagulatories proteïen fibrin en die degradasie van fibrin na D-dimeer is' n maatstaf van die vorming en die daaropvolgende ontbinding van bloedklonte. Kroniese inflammasie in MIVbesmette pasiënte, induseer die op-gereguleerde uitdrukking van weefsel faktor (TF) op monosiete wat die aktivering van die stolling kaskade inisieer en die D-dimere vlakke verhoog. Metodes: Hierdie loodsstudie bestaan uit ART naïewe pasiënte en al die plaatjie vloei ontleding was op vol bloed uitgevoer. In hierdie studie, 'n totaal van 57 volwasse Suid-Afrikaners was van' n kliniek in die Wes-Kaap gewerf. Dit sluit 32 MIV-positiewe pasiënte en 25 MIV negatiewe individue in. Die vlakke van plaatjie aktivering en plaatjie funksie was ge ondersoek deur middel van 'n nuwe plaatjie sitometrie toets. Die metode was geoptimaliseer om minimale plaatjie aktivering te verseker: dus geen sentrifugering of volle naam (RBS) liseer stappe was gebruik nie. Die plaatjie-spesifieke merkers, CD41a en CD42b was gebruik om te verseker dat slegs bloedplaatjes gekies word. Die uitdrukking van CD62P was gebruik vir die evaluering van plaatjie aktivering en hierdie vlakke was gekorreleer met fibrinogeen, hsCRP, D-dimeer, CD4- tellings en virale lading. Verder, was plaatjie funksie geëvalueer deur die reaksie van plaatjies aan endogene agoniste wat ADP en AA by wisselende konsentrasies insluit te ondersoek. Results: Hierdie studie het getoon hoër basislyn vlakke van CD62P uitdrukking in behandeling naïewe MIV-positiewe pasiënte in vergelyking met onbesmette beheermaatreëls (beteken% CD62P 71,74 ± 2,18 vs beheer 54,52 ± 2,42, p <0.0001). Daar is ook getoon dat% CD62P uitdrukking direk gekorreleer met plaatjie tellings (r = 0,374, p = 0,042). Plaatjie tellings het 'n omgekeerde korrelasie met virale ladings (gee waardes) fibrinogeen vlakke korreleer met die absolute WCC (r = 0,659, p = 0,0021), absolute neutrofiel telling (r = 0,619, p = 0,0105); absolute monosiet telling (0,562, p = 0,0235) en hsCRP (r = 0,688 p = 0,0011). Daarbenewens, fibrinogeen het 'n sterk negatiewe korrelasie met 'n CD4-tellings (r = -0,594, p = 0,0014) en daarom kan 'n waardevolle merker van beide die siekte en die risiko van trombose in behandeling naïewe MIV-positiewe pasiënte. HsCRP vlakke gekorreleer met die absolute neutrofiel tellings (r = 0,392, p = 0,0005). Die MIV-groep het 'n algehele hiper-reaksie op die ADP by 'n konsentrasie 0,025 μM in vergelyking met onbesmette beheermaatreëls (62,34 ± 9,7 vs beheer 36,90 ± 5.7, p = 0,0433). Gevolgtrekkings: In hierdie studie beskryf ons 'n roman vloeisitometrie tegniek wat gebruik kan word om die vlakke van Plaatjie aktivering en plaatjie funksie in die MIV-besmette pasiënte te evalueer. Verder het ons 'n verslag van 'n koste-effektiewe paneel in die vorm van fibrinogeen, WCC en plaatjies wat waardevol kan wees in die voorspelling van die vordering van MIVinfeksie tot VIGS of ander inflammatoriese-verwante komplikasies in die behandeling naïewe MIV-besmette pasiënte. Plaatjie tellings het 'n omgekeerde korrelasie met die virale laste en 'n direkte verband met die vlak van geaktiveerde bloedplaatjies. Hierdie bevindinge saam, dui op die moontlike prognostiese waarde van Plaatjie aktivering en die plaatjie tel in die konteks van die asimptomatiese MIV-geïnfekteerde pasiënte. Ons bevindinge dui daarop WCC en fibrinogeen kan gebruik word om die inflammatoriese profiel van individuele MIV-geïnfekteerde pasiënte te evalueer. Dit kan 'n direkte impak op MIV pasiënt vooraf aan die inisiasie van antiretrovirale terapie en waardevolle in die monitering van die reaksie op behandeling. Verder bied ons 'n roman vloeisitometrie gebaseer plaatjie funksionele toets en dui op die gebruik van die ADP teen 'n konsentrasie van 0,025 μM plaatjie funksie optimaal te evalueer in MIVgeïnfekteerde pasiënte. Die benutting van die roman vloeisitometrie tegniek soos beskryf in hierdie studie sal 'n beduidende waarde toevoeg in die beoordeling van die die trombotiese risiko en die siekte in MIV-geïnfekteerde pasiënte en kan addisioneel bewys van waarde te wees in 'n ander chroniese inflammatoriese toestande. / National Reserach Foundation

Dissertation / The aim of this study was to determine the knowledge of persons with hypertension in a selected geographical area regarding cardiovascular risk factors in order to make recommendations for patient education. A quantitative, non-experimental, descriptive study was done in the form of a survey using a questionnaire as measuring instrument. The population was hypertensive patients from selected private medical practices in the western part of KwaZulu-Natal and the bordering eastern part of the Free State. Convenience sampling was used and 46 respondents participated in the study. Only 16 (35%) of the respondents achieved a percentage on or above the competency indicator of 50%. Respondents performed worst in questions where definitions, for example hypertension, were assessed. Recommendations for a patient education document, nursing practice and further research were made. / Health Studies / M.A. (Health Studies)

D.Litt. et Phil. / This research focuses on the development of a short-term cognitive behavioural intervention treatment programme for adult victims of hijackings who developed Post-Traumatic Stress Disorder (PTSD) as a result. A programme was developed incorporating previously tested cognitive behavioural techniques and was tailored to the South African context. The need for the study arose out of the serious crime problem facing the South African population.Crime is rampant and has spread to all avenues of people's lives. There is no place that can be presumed to be safe. Being a victim of a car hijacking is a traumatic experience, and the effects thereof are often far-reaching in a person's life. It has been found that many people develop PTSD as a result of an experience, which is out of the range of 'normal' human experience (a trauma).

Eating disorders remain a phenomenon that escapes full comprehension, resulting in frustration for those who suffer from the disorders, their families, and their therapists. It is becoming increasingly necessary to describe the mechanism by which eating disorders develop, in order to effectively treat and prevent these disorders. The aim of this study was to illuminate factors that contributed to the development of eating disorders within the individual contexts of the lives of the participants, as well as how those factors interacted in context to culminate in the development of an eating disorder. This qualitative study was conducted from an interpretive perspective. The findings show how individual contextual factors interact to produce a marked fear of gaining weight, which is driven by fear of negative evaluation, and that the eating disorder behaviour serves specific functions that are related to coping with stress within the lives of the participants. / Psychology / M. Sc. (Psychology with specialisation in Research Consultation)

Stellenbosch University. Faculty of Medicine and Health Sciences. Interdisciplinary Health Sciences. Family Medicine and Primary Care. / Thesis (MFamMed) -- Stellenbosch University, 2010. / Bibliography / ENGLISH ABSTRACT: Introduction: This thesis summarises the findings of a medical audit on the management of Cryptococcal Meningitis (CM). The study population of HIV positive adults (N = twenty five) were admitted during November 2009 – June 2010 to five hospitals of the Cape Winelands (East) District, Western Cape, South Africa. In the context of the HIV pandemic, CM has become the most common cause of community-acquired meningitis, and has poor outcomes if left untreated. The South African HIV Clinician Society has published treatment guidelines in 2007. These guidelines have been used by the audit team to compile a list of measurable criteria (with set targets) to evaluate the structure, process and outcome of CM management. A pilot audit (2008) at the regional hospital has demonstrated that certain target standards were not met. Aims and Objectives: The aim was to improve the quality of the clinical care of HIV-patients diagnosed with CM in the Cape Winelands (East) district. The objectives included the review of the audit criteria and target standards, demonstrating improvement in quality of CM care at the Level 1 and 2 hospitals, identifying new interventions based on the findings and providing recommendations to the health facilities. Methods In 2009, the researcher formed a new audit team, reviewed the audit criteria and held teaching interventions based on the national treatment guidelines. An intervention, based on the findings of the pilot audit, aimed at improving the clinical team’s adherence to the treatment guidelines. Results The audit identified the following areas that did not meet the target standards: the availability of Amphotericin B (Ampho B) and spinal manometers; the use of manometry in all initial lumbar punctures (LPs); completing fourteen days of the required Ampho B treatment; renal monitoring in patients on Ampho B; commencement of antiretroviral treatment (ART) by week four; and, the two-month survival figures post-diagnosis. The re-audit at the Level 2 hospital highlighted the need for improved medical record keeping to aid the audit process. Arrangement of inpatient ART counselling happened more consistently at the Level 1 hospitals. Adherence to the ART target and measures to prevent Ampho B related morbidity is comparable to that of the Level 2 hospital. The audit has also provided insight to the researcher and audit team on the practical challenges of conducting a prospective data collection technique across different care settings. Recommendations Level 1 hospitals should continue to manage CM patients. The availability of spinal manometers and closer adherence to renal monitoring require attention. Formal feedback to the audit team and clinical teams is planned. A multimodal interdisciplinary Quality Improvement approach (such as an integrated care pathway) is recommended and a future re-audit is encouraged to assess improved adherence to the CM management guidelines. The buy-in of stakeholders (management, health care workers and patients), the ongoing support of an audit team and a committed Quality Improvement environment will allow the medical audit process to become ingrained in the South African public healthcare setting. / AFRIKAANSE OPSOMMING: Inleiding Hierdie tesis bied ‘n opsomming van die sleutelbevindinge van ‘n mediese oudit van Cryptokokkale Menigitis (CM) sorg. Die studie groep van MIV-positiewe volwassenes (N = vyf-en-twintig) het binne-pasiënt behandeling ontvang gedurende November 2009 tot Junie 2010 in vyf hospitale van die Kaapse Wynland (Oos) distrik. In die konteks van die MIV pandemie het CM die mees algemene oorsaak van gemeenskapsverworwe meningitis geword, en het swak uitkomste indien onbehandeld. Die Suid-Afrikaanse HIV Clinici Vereniging het in 2007 behandelingsriglyne gepubliseer. Hierdie riglyne het die oudit span gebruik om ‘n lys van meetbare kriteria (met teiken standaarde) saam te stel om die struktuur, proses en uitkoms fasette van CM sorg te evalueer. ‘n Proef oudit (2008) by die streekshospitaal het getoon dat sekere teiken standaarde nie behaal was nie. Doelstelling Die doelstelling was om die kwaliteit van kliniese sorg van MIV-pasiënte met CM (in die Kaapse Wynland (Oos) distrik) te verbeter. Die doelstelling sluit in die hersiening van die oudit kriteria, die bevesting van verbetering in kwaliteit CM sorg by vlak 1 en 2 hospitale, identifisering van nuwe ingreep-moontlikhede gebaseer op die bevindinge en die verskaffing van toepaslike aanbevelings aan die gesondheidsorg fasiliteite. Metodes Die navorser het in 2009 ‘n nuwe oudit span gevorm, die oudit kriteria hersien en opleidingsingrepe geskoei op die nasionale riglyne gefasiliteer. Opleidingsingrepe, gebaseer op bevindinge van die proef oudit, het ten doel gehad dat die kliniese span die nasionale riglyne nakom. Resultate Die oudit het die volgende areas uitgelig waar daar nie aan die teikenstandaarde voldoen was nie: the beskikbaarheid van Amphotericin B (Ampho B) en spinale manometers; die gebruik van manometrie in alle aanvanklike lumbaal punksies (LPs); voltooi van die veertien dae Ampho B behandelingsteiken; nierfunksie monitoring van pasiënte op Ampho B; aanvang van anti-retovirale behandeling teen week vier; en, die twee maande oorlewing post-diagnose syfers. Die opvolg oudit by die vlak 2 hospitaal bevestig die belang van verbeterde kliniese notas om die oudit proses te vergemaklik. Die reël van binne-pasiënt ART berading gebeur meer bestendig in Vlak 1 hospitale. Bereiking van die ART teiken en maatreëls om Ampho B verwante morbiditeit te voorkom, is vergelykbaar met die bevindinge by die vlak 2 hospitaal. Die oudit het die navorser en die oudit span ingelig rakende die praktiese uitdagings om ‘n prospektiewe data insamelingsmetode te poog in verskillende kliniese kontekste. Aanbevelings Vlak 1 hospitale kan steeds CM pasiënte versorg. Die beskikbaarheid van spinale manometers en deeglike nierfunksie monitering sal die behaling van teiken standaarde vergemaklik. Formele terugvoer aan die oudit span en kliniese span word beoog. ‘n Multimodale interdissiplinêre Kwaliteitsverbeterings benadering (soos ‘n geïntegreerde sorgplan) word aanbeveel en ‘n toekomstige oudit word aangemoedig om verbetering in toepassing van die CM riglyne te evalueer. Dit is belangrik om die sleutelspelers (bestuur, gesondheidswerkers en pasiënte) te betrek. Verder word voortgesette ondersteuning van die oudit span en ‘n toegewyde omgewing van kwaliteitsverbetering aanbeveel. Sodoende sal die oudit proses in Suid-Afrikaanse publieke sorg geintegreer word.