Observational analysis study on the influence of the physical hospital environment on aggressive behaviour and the management thereof in an adult acute psychiatric admission unitVan den Berg, Marietta January 2008 (has links)
Includes bibliographical references (leaves 81-96). / Aggression is a complex phenomenon that is influenced by a range of factors including individual patient factors, social-interactive factors and envirnmental factors. Many studies have tried and failed to demonstrate that changes such as physical environmental change, intensive case management, increased staff training or skills reduce the levele of violence, as captures by number of incidents accuring in in-patient units.
Kaliski, Sean Z
Bibliography leaves 309-337. / Aims: to determine which static and dynamic risk factors contributed to the commission of violent offences, and to habitual violence in offenders that had been referred for pre-trial psychiatric assessment. b. to assess, by logistic regression modelling, the relative importance of the significant risk factors. All defendants admitted to the Forensic Psychiatry Unit at Valkenberg Hospital for 30 day pre-trial assessments over a 6 month period were entered. All subjects were assessed by 2 psychiatrists and a clinical psychologist, who used semi-structured interviews A forensic social worker interviewed family members. Court documentation provided information about the events of the offence and conviction record. A psychometrist administered Barrat's Impulsivity Scale (BIS), Zuckerman's Sensation Seeking Scale (ZSS), and Annett's Handedness Test (Zuckerman et al. 1964). Nursing staff and occupational therapists compiled daily reports on the subjects' behaviour in the ward.
The relationship between impulsivity, affect and a history of psychological adversity: a cognitive-affective neuroscience approachIpser, Jonathan January 2011 (has links)
There is increasing evidence that trauma exposure is associated with impulsive behaviour and difficulties regulating affect. The findings of recent studies implicate the disruption of neurobiological mechanisms, particularly those involving the neurotransmitter serotonin, in both impulsivity and affect regulation.
Psychological trauma - including exposure to intimate partner violence (IPV) - is highly prevalent in South Africa, and may result in posttraumatic stress disorder (PTSD) in a subset of individuals. Pregnant women and new mothers are particularly vulnerable; and trauma exposure and PTSD in this sub-group may be associated with a number of adverse maternal-child sequelae including poor birth outcomes and impaired infant neurodevelopment. Risk factors for psychological trauma exposure, and for subsequent PTSD, are likely to include environmental and genetic influences. Given the high burden of trauma and related disorders, the unique genetic ancestry, and the relative paucity of empirical data, further work in South African populations is warranted. This thesis aimed to investigate a number of questions about trauma and PTSD in the Drakenstein Child Health Study (an ongoing South African birth cohort study), including their risk factors, their impact on infant birth anthropometry and development, and their genetic correlations. This thesis includes five publications, all presenting data from the Drakenstein Child Health Study. Pregnant women were recruited from two clinics in the Drakenstein sub-district - a peri-urban community outside Cape Town, Western Cape. Sociodemographic characteristics; psychosocial risk factors (including depression, stressful life events, psychological distress and alcohol and substance misuse); trauma exposure (childhood trauma, IPV and lifetime trauma); and PTSD were assessed using validated and reliable self-reported questionnaires, as well as diagnostic psychiatric interviews.
Includes bibliographical references. / The HIV/AIDS epidemic in South Africa is characterised mainly by heterosexual transmission and an extremely rapid spread among adolescents and young adults in their early twenties, indicating the need for an increased focus on preventive efforts aimed at this age group. Apart from the development of a cure or vaccine to prevent HIV transmission, preventive programmes clearly offer the best chance of halting the spread of HIV, and these need to be based on behavioural change to modify or prevent risk behaviours. The challenge is to develop suitable theory-based programmes that address and promote safer sex behaviour, taking into account the local social and cultural environment. This cross-sectional study focused on a key HIV preventive behaviour, namely condom usage, and used as its research target adolescents, a key risk group for HIV infection in South Africa. It aimed to investigate the key variables that influence condom usage among adolescents in the Cape Town metropolitan area. The study was based on an integrated theoretical model using constructs from 5 of the most common social cognitive behavioural theories, namely, the Health Belief Model, Bandura’s Social Cognitive Theory, the Theory of Reasoned Action, the Theory of Planned Behaviour and the Theory of Subjective Culture and Interpersonal Relations. In addition, variables from Basch’s construct availability model were included. The sample comprised a representative three-stage sample of grade 11 adolescents from 36 schools in the Cape Town Metropolitan area (n = 1931). Formative research, in the form of an elicitation study using to focus group interviews with a purposive sample of adolescents, was used to develop the theory-based self-completion questionnaire used in this study. Twelve constructs were included in the questionnaire as potential correlates of condom use, namely: intention, self-standards, self-efficacy, affect, attitude, beliefs, norms, condom availability, health concern, worry about AIDS, construct availability and condom availability. The dependent variable was condom use on the last coital episode.
Neurocognitive disorders in young adults commencing highly active anti-retroviral treatment in the Western CapeJoska, John Anton January 2010 (has links)
Includes abstract. / Includes bibliographical references. / HIV-associated neurocognitive disorders (HAND) remain prevalent in the era of highly active anti-retroviral therapy (HAART). The aim of the study was to investigate whether HAND are as prevalent in South Africa as in other regions, and whether individuals with HAND in South Africa will respond to HAART. The literature was reviewed to elucidate potential mechanisms of the development of HIV-associated dementia (HAD), the most severe form of HAND, and to establish the effect that HAART has exerted on HAND across diverse studies. A prospective clinical cohort study was initiated in Cape Town, comprising 170 participants. The reviewed literature suggests that HAD is likely mediated by a range of HIV-related factors (including possible difference in HIV sub-type) and host-related factors.
Includes bibliographical references. / Intimate relationships in adolescence play an important role in psychosocial development and can impact on relationships during adulthood. There is a need for evidence-based interventions to prevent intimate partner violence (IPV), promote sexual and reproductive health, and equitable, enjoyable relationships during adolescence. A nuanced understanding of contemporary adolescents' intimate relationships is needed to inform intervention development. A series of studies was undertaken to explore (a) contemporary adolescents' ideas about and experiences of relationships; (b) young adolescents' sexual behaviour and dating; (c) adolescents' conceptions of a good relationship; and (d) published-evidence guidelines for developing school-based violence prevention interventions. For study (a), qualitative data were collected during focus group discussions and in-depth interviews with 14-18 year olds. Survey data from 13-16 year olds (for study b) and 15-18 year olds (for study c) were analysed using regression analyses. Adolescentsâ€™ intimate relationships are fluid and unstructured, highly gendered, and greatly influenced by peer relationships; however, experience with relationships and sex are varied. For girls, good relationships were associated with having a mutual main partnership with an older, educated boyfriend in which there was good, open communication particularly about sexual and reproductive health. For boys, a mutual main partnership and very little quarrelling were associated with good relationships. Young adolescents' reported engaging in a variety of sexual behaviours ranging from kissing to sexual intercourse with the former more common than the latter. These findings indicate a need for early interventions that are carefully adapted and acceptable to adolescents who have varying levels of experience with relationships, sex, and violence. Adolescents would benefit from developing gender equitable attitudes; critically reflecting on their ideas and practices related to good and poor relationships; building sexual decision-making skills to better prepare them to develop and maintain good, healthy relationships and end poor or abusive ones. Interventions should incorporate adolescents' perspectives and balance evidence-based best practice and resource availability.
Evidence-based screening, brief intervention and referral to treatment for substance-using adolescents with delinquent-type behavioursCarney, Tara January 2014 (has links)
Includes bibliographical references. / Background: Both substance use and delinquent-type behaviours are prevalent among adolescents in Cape Town, South Africa. However, early interventions in developed countries for adolescents with similar problems are not available in many low and middle income countries, including South Africa. This is a concern as providing evidence-based interventions that address these dual behavioural problems may prevent their progression. There is thus a need for identifying and understanding the kinds of interventions that would be able to address both of these problems Aim: The aim of this thesis is to identify an evidence-based intervention for reducing adolescent substance use and delinquent-type behaviours and adapt it for use among adolescents in Cape Town, South Africa. Method: This study comprised six parts. Study I utilised a longitudinal data set to examine the association between substance use and delinquent-type behaviours, as well as the trajectory of these behaviours among school-going adolescents in Cape Town. As one needs to know how to identify adolescents who would benefit from such an intervention, Study II identified suitable screening tools for identifying these adolescents. While screening tools are generally brief instruments to identify problems with substance use, assessment instruments for those adolescents who screen positive would more comprehensively assist in the further evaluation of their problem behaviours, as well as measure other risk factors for substance use and delinquent-type behaviour. Study III therefore tested and adapted assessment tools for those adolescents who screen positive for substance use and delinquent-type behaviour. The next step was to identify a suitable evidence-based brief intervention that addressed substance use and delinquent-type behaviours in an integrated manner. Study IV consisted of a systematic review and meta-analysis to identify such an intervention. As only studies from developed countries were included in the review, the final two studies concentrated on adapting the intervention identified in Study IV with service providers and adolescents in focus groups 6. Study V consisted of a cultural adaptation which tested the ecological validity of the identified brief intervention in Cape Town communities. Study VI was a content adaptation that modified the brief intervention for adolescents in this context, and to include a focus on delinquent-type behaviours. Results: The final result is a screening, brief intervention and referral to treatment (SBIRT) package that is ready to be tested for efficacy on substance use and delinquent type behavioural outcomes. Each study contributes to the different components that make up this package. The results from the longitudinal study indicated that while substance use is not predictive of delinquent-type behaviours, these two behaviours co-occur at different stages of adolescence. In addition, adolescents that smoked and were delinquent were at significantly higher risk of engaging in later delinquent-type behaviour. This suggests that it would be efficient to address the two risk behaviours simultaneously using an integrated intervention. The GAIN-SS was identified as an easy-to-use and psychometrically sound short screener for identifying adolescents with both problems who may benefit from a brief intervention. The comprehensive assessment tool developed for use if an adolescent screens positive and may therefore be eligible for such a brief intervention, measured the following core domains: substance use, delinquency, parenting practices, peer substance use and readiness to change. These were modified based on both adolescent participants’ and experts’ recommendations. Following assessment, Teen Intervene was identified as the brief intervention which was the most effective in reducing early adolescent substance use and consequences related to substance use. While this promising intervention addresses substance use and behavioural outcomes broadly, it did not do so in an integrated and comprehensive manner. Teen Intervene was also only tested in one population, and the results of the qualitative studies (V and VI) were therefore helpful in the adaptation of the intervention. Qualitative work found that the context that adolescents in the study have been exposed to within their home setting, school and community, as well as their relationships with people within these settings, influence their engagement in risk behaviours. Therefore ensuring ecological validity is important when modifying the identified intervention for use in Cape Town. The intervention was expanded to include a focus on delinquent-type behaviours and a handbook was developed for adolescents that contained information from the, skills-building exercises, as well as goal setting from the original intervention for the individual adolescent. Recommendations for the implementation of this intervention showed that the types of recruitment strategies in place may affect the uptake of services, and organisational factors (organisational readiness, staff issues, available resources) may affect the delivery of intervention services. Such issues should be taken into account before implementation takes place. Conclusion: This thesis is one of the first to investigate the relationship between substance use and delinquent-type behaviours in a developing country setting. It describes the identification of an SBIRT package for substance use and delinquent type behaviours among adolescents, and how these were adapted to develop an integrated intervention that addresses both of these problems. This adapted intervention may provide an option of tailor-made services for adolescents in disadvantaged communities in Cape Town, where adolescents are often affected by a host of social problems but where a lack of resources are available to address these problems. The contextual and content-based adaptation processes highlighted the importance of working with adolescents directly to ensure that the intervention adequately addressed the local context as well as the specific issues that they face, at their level of understanding. The engagement of service providers, who may be trained to deliver this integrated intervention package, was also important to address possible challenges that could occur while delivering the intervention. The next steps in the process would be to implement the adapted version of the intervention to iron out some of the potential implementation issues that were alluded to above, and ultimately to assess its efficacy in addressing the very real social conditions described in Chapter 1.
Van der Westhuizen, Claire
Includes bibliographical references. / Mental disorders and violence-related injuries make significant contributions to the global disease burden, mostly affecting young people. In emergency centres, mental disorders and violence-related injuries are commonly seen and, according to international data, violently injured patients are at-risk for mental disorders. Despite the scale of this problem, little evidence exists, especially from low- and middle-income-countries, regarding predictors of mental disorder and violence-related injuries, and data concerning interventions have not been synthesised.
Using Theory of Change to design and evaluate complex mental health interventions in low and middle income countries: the case of PRIMEBreuer Erica 13 February 2019 (has links)
Background: Many health interventions are complex and consist of several interacting components (Medical Research Council 2008). These components include multiple causal strands, outcomes and levels of governance and may result in unexpected outcomes and non-linear change (Glouberman and Zimmerman 2002). As such they present challenges to the design and evaluation of complex health interventions. Although broad theoretical guidance has been developed by the UK Medical Research Council (MRC) (Craig, Dieppe et al. 2008), it contains little practical guidance and has been criticised for not including theory driven approaches to evaluation such as Theory of Change (ToC) (Anderson 2008). De Silva, Breuer et al. (2014) have proposed that ToC may complement the MRC guidance on complex health interventions. Methods: This study explores how ToC can strengthen the design and evaluation of complex health interventions using the example of The Programme for Improving Mental Health Care (PRIME). PRIME is a research programme which aimed to develop, implement and evaluate the integration of mental health into primary health in districts or sub-districts in Ethiopia, India, Nepal, South Africa and Uganda. A ToC approach was used in addition to other approaches to design and evaluate these complex mental health interventions. Firstly, I conducted a systematic review to determine the extent to which ToC has been used to design and evaluate public health interventions. Secondly, I compared the process of developing the ToC between all five PRIME countries and reflected on the value of ToC workshops using a framework analysis of workshop documentation and interviews with facilitators. Thirdly, I explored the development of the ToCs within the programme as a whole and the implications for the development of the intervention and the choice of evaluation methods. Fourthly, I presented a ToC for the integration of mental health care in low and middle income countries. Fifthly, I demonstrated how ToC can be used as a framework for a qualitative comparative analysis of process and outcome data using longitudinal data from 10 PRIME implementation facilities in Nepal. Lastly, I provide a set of 10 key lessons learned from PRIME in the application of ToC to complex mental health interventions. Results I found that the ToC approach has been used for the design and evaluation of public health interventions since the 1990s. However, there is a lack of clear description of the use of ToC in the literature on public health interventions and inconsistency in how it is used. In applying the ToC approach to PRIME, I found that facilitators reported that ToC workshops were a valuable way to develop ToCs and that different stakeholders at the workshop contribute different types of information to the ToC process. Hierarchies within the health system are an important consideration for ToC workshops as power dynamics are likely to influence the functioning of the group. In addition, I found that the development of a cross country ToC can result in a programme theory which is relevant for complex multilevel intervention in different contexts. This ToC can provide a framework to map contextually relevant interventions and can be used to complement other intervention development approaches. The ToC can also be used to ensure indicators for all the short-, medium- and long-term outcomes are identified. However, combining process and outcome data analysis using the ToC is not straightforward. Qualitative Comparative Analysis (QCA) can be used to analyse process and outcome data in a single analysis in health services research. Conclusion: ToC can be used to strengthen the design and evaluation of complex health interventions and can be used to complement the MRC guidance in the design and evaluation of complex health interventions.
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