Representations of people with a developmental disability are virtually not covered in the media. Although there is little coverage of people with developmental disabilities in the media, there are a few entertainment television characters who have Down syndrome and are represented in the media. This study will take a look at the history of how people with disabilities were represented in the media and examine how two television characters with Down syndrome were portrayed on the shows by examining their self-esteem. This study seeks to focus on portrayal of people with Down Syndrome because the physical features that people with Down Syndrome possess are easy to identify. Specifically, the study examines the portrayal of self-esteem in two television characters, Corky Thatcher (Life Goes On) and Becky Faye Jackson (Glee). The researcher will also examine how the portrayal of self-esteem in the two characters is similar or different in people who have Down Syndrome. In the study the researcher found that the representation of the character Corky was different from the character Becky. But both characters tackled issues that affected the Down Syndrome community and it affected their self-esteem. Corky and Becky were different from the interviewees in the way they realized their competencies. Although the interviewees who have Down Syndrome and the television characters used self-evaluation differently to evaluate one's own self-esteem, they all seem to exhibit a positive level of self-esteem.

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Cette étude examine, tout d'abord, les qualités psychométriques du Syndrome Douloureux Chronique Questionnaire (SDC-Q) évaluant l'impact des facteurs psychologiques et psychosociaux dans la vie des patients. La solution à cinq facteurs s'avère la plus adéquate ; elle explique 52% de la variance totale. Les intercorrélations montrent une indépendance des facteurs (entre 0,35 et 0,64 ; p<0,05). Les alphas de Cronbach montrent une bonne cohérence interne entre les items (entre 0,75 et 0,84). Ensuite, un programme de prise en charge psychologique de groupe qui contient des informations, des propositions éducatives, une restructuration cognitive des pensées dysfonctionnelles, la thérapie de l'acceptation et de l'engagement (ACT), et la pleine conscience est proposée. Il est comparé à un groupe témoin à 6 semaines et à 3 mois. A 6 semaines, la limitation fonctionnelle perçue dans la vie quotidienne afférant aux loisirs, aux tâches ménagères et aux sentiments de peur liés à la sexualité semble améliorée. Les sentiments d'incompréhension, d'abandon et de solitude ont diminué. La contrariété, l'irritabilité, la tristesse et la colère sont améliorées. A 3 mois, l'évitement expérientiel, mesuré par l'AAQ-II a diminué. Les améliorations de la limitation fonctionnelle perçue, la contrariété, l'irritabilité, la tristesse et la colère sont maintenues. Les résultats des mesures ne semblent pas attribuables à une rémission des symptômes, c'est-à-dire à la diminution à l'intensité de la douleur. Tenter de réduire la douleur est un objectif louable, générer moins de détresse psychologique et donc améliorer la qualité de vie pourraient l'être tout autant. / This study examines, first, the psychometric qualities of Chronic pain Syndrome Questionnaire (SDC-Q) assessing the impact of psychological and psychosocial factors in the lives of patients. The five-factor solution is the most appropriate, explains 52% of the total variance. Intercorrelations show independence of factors (between 0.35 and 0.64, p <0.05). Cronbach's alphas showed good internal consistency between the items (between 0.75 and 0.84). Then, a program of psychological support group that provides information, educational proposals, cognitive restructuring of dysfunctional thoughts, therapy acceptance and commitment (ACT) and mindfulness is proposed. It is compared to a control group at 6 weeks and 3 months. At 6 weeks, the perceived functional limitation in daily life attaching leisure, housework and feelings of fear related to sexuality seem improved. Feelings of incomprehension, abandonment and loneliness decreased. Annoyance, irritability, sadness and anger are improved. At 3 months, experiential avoidance as measured by the AAQ-II decreased. Improvements in perceived functional limitation, annoyance, irritability, sadness and anger are maintened. The measurement results do not seem attributable to a remission of sympptoms, that is to say the reduction in pain intensity. Attempt to reduce the pain is a laudable goal, generate less psychological distress and thus improve the quality of life could be as well.

Le syndrome métabolique (SM) augmente le risque de diabète et de maladies cardiovasculaires. Les composantes de cet état sont l’obésité, l’hypertension, le profil lipidique, la résistance à l’insuline, l’inflammation et l’atteinte hépatique. L’accumulation excessive de la masse grasse, surtout abdominale, entraîne une inflammation systémique de faible niveau. En effet, le tissu adipeux secrète des adipokines (leptine, visfatine, IL-6 et TNF-a) qui sont impliquées dans l’inflammation. Notre but a été d’étudier : 1) les associations de l’évolution de 5 ans de l’indice de masse corporelle (IMC) et de la leptine circulante avec les facteurs du SM et 2) l’expression de certaines adipokines dans les lymphocytes. Pour ces études, la cohorte STANISLAS a été un outil parfait (recueil des données sur les facteurs du SM, bio-banques : lymphocytes, sérum, plasma, ADN). L’étude longitudinale a démontré que certains de facteurs du SM évoluent ensemble au fil du temps et que ces groupes de facteurs sont liés à l’IMC en fonction du sexe. Ensuite, nous avons constaté des associations de la leptine avec des facteurs de risque du SM, différentes en fonction du sexe, indépendamment de la masse grasse. Enfin, nous avons détecté l’ARNm de nos adipokines et sa quantification a démontré des associations de la visfatine avec l’IMC et l’expression du TNF-a, et de la leptine avec la pression artérielle. L’ensemble de nos résultats souligne le rôle-médiateur de la leptine et l’impact du sexe sur les actions de cette hormone et ouvre de nouvelles perspectives pour étudier les adipokines dans le contexte de l’inflammation, en proposant un modèle d’étude : les lymphocytes. / The metabolic syndrome (MS) raises the risk for developing diabetes and cardiovascular disease. The components of this state are obesity, hypertension, disturbed lipid profile, insulin resistance, inflammation and hepatic steatosis. The excessive accumulation of fat mass, particularly in the abdomen, leads to low-grade systemic inflammation. Indeed, the adipose tissue produces adipokines such as leptin, visfatin, IL-6 and TNF-a that are implicated in the inflammatory processes. Our goal was to study: 1) the associations between 5 year-changes of the body mass index (BMI) and circulating leptin concentrations with the factors of the MS and 2) the expression of some adipokines in the lymphocytes. The STANISLAS cohort has enabled us to fulfil our research work (collection of a great number of data concerning MS factors, bio-banks: lymphocytes, serum, plasma, DNA). The longitudinal study on BMI changes and the factors associated with MS has shown that some of these factors evolve together (clusters) and that these groups of factors are associated with BMI changes in a sex dependent manner. We described also, associations of circulating leptin with MS factors, dependent to sex and independently of fat mass. Finally, we were able to detect and quantify mRNA of adipokines in lymphocytes. The quantification of the mRNA has shown associations of visfatin with BMI and gene expression of TNF-a and of leptin with blood pressure. The results obtained by this research work underline the mediating role of leptin and the impact of sex on the actions of this hormone and offers new perspectives for studying adipokines in the context of inflammation, by proposing a new model: PBMCs.

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M.Tech.

Thesis submitted for the degree: Doctor of Philosophy, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg June 2017. / The epidemics of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa are closely related and particularly persistent, proving a considerable burden for healthcare provision, and complicating utilization of care. Concern has been expressed about patients’ experience at healthcare facilities as this may impact on drug adherence, treatment success and willingness to return for regular monitoring and drug pick-up. This is particularly relevant for HIV programmes, with HIV now a chronic disease, with daily treatment necessary for life; TB treatment is limited in duration, to six months although can be as long as two years in case of multiple drug resistant TB. Utilization of healthcare services is an important determinant of health outcomes generally, with public health relevance, particularly for HIV and TB services in areas of high prevalence. The main aim of universal health coverage is to make healthcare accessible without barriers based on affordability, availability or acceptability of services. Various factors have been shown to hinder or enable patient utilization of healthcare services, such as organization of services, costs of transport to and from clinics, time loss at clinics receiving care, staff attitudes, waiting times and cleanliness of facilities. Objectives This study aimed to determine and quantify factors associated with healthcare utilization in patients utilizing HIV care (including those not yet initiated on antiretroviral treatment (ART) - pre-ART) or TB treatments in a rural sub-district of Hlabisa in KwaZulu-Natal and to understand healthcare providers’ perspectives regarding patient care and provision of quality care. The study used data from patient exit interviews, and additionally findings from interviews with healthcare providers in the local HIV treatment and care programme, structured around the responses from the patient-exit interviews. The study had three specific objectives: 1) to establish and quantify factors associated with healthcare utilization, with utilization decomposed to availability, affordability and acceptability of healthcare services, for patients in HIV or TB treatment and care; 2) to quantify ability-to-pay for healthcare and identify associated factors for patients in pre-ART care, or on ART or TB treatment; 3) to understand the healthcare providers’ perspectives regarding patient care and provision of quality HIV care. Methods In 2009 patient-exit interviews were conducted in six primary healthcare (phc) clinics in rural South Africa with 300 patients receiving ART and 300 patients receiving TB treatment; patients were randomly selected using a two-stage cluster random sampling approach with primary sampling units (phc) selected with probability-proportional-to-size. In 2010 an additional 200 HIV-infected patients in pre-ART care from the same clinics were interviewed. Patient-exit interviews were conducted in a private room outside the facility and all data were analysed using STATA 11. In 2012, a qualitative study was carried out with healthcare providers in eight (of 17) randomly selected phc clinics; 25 ART healthcare providers were engaged in discussion structured around patient-exit interviews feedback to assess possible challenges/facilitators ART healthcare providers face when providing care. Discussions took place in the consultation rooms when no clinical sessions were ongoing and these were recorded and transcribed; and data were managed using Nvivo 10. Thematic content analysis was conducted using both inductive and deductive approaches and clinic or healthcare provider identifiers were removed and replaced with pseudonyms. Summary statistics describe patient characteristics by patient group and key availability, acceptability and affordability factors associated with utilization of healthcare services; separate univariate and multivariable regression models were run to assess associations between patient characteristics and these key availability, acceptability and affordability factors. Patient socio-demographic characteristics (sex, age, education, employment and marital status) were controlled for and adjusted for clustering at facility-level. Factor analysis was performed to investigate underlying patient satisfaction factors. Results Socio-demographic characteristics of the patients More women than men were seen in the primary care clinic, especially among pre-ART patients (79%), followed by 62% HIV and 53% utilized TB care, with an age-sex profile comparable to previous studies in the area. Pre-ART patients were significantly younger than ART and TB patients, with a median age of 32 years for pre-ART patients, 39 years for ART patients and 37 years for TB patients. Unemployment at household level was high, up to 86% of ART patients’ head of households were unemployed and only 9% of TB patients were employed. / MT2017

Thesis advisor: Sara Moorman / Improved survival for medical conditions that were previously fatal in infancy has led to more individuals living longer with chronic illnesses. These individuals, some of whom have largely unapparent, unpredictable, and yet severe symptoms from birth, may experience a unique set of physical, social, and emotional impacts associated with their condition as compared to youth with less severe, treatable pediatric conditions or individuals with adult-onset conditions. This dissertation explores these challenges using the case of youth with Barth Syndrome (BTHS), a rare, severe, genetic condition in males associated with life-limiting and life-threatening symptoms. Research questions explored: (1) how symptom severity, visibility, and controllability informed individuals’ social management and legitimization of BTHS; (2) how awareness regarding their limited, uncertain prognosis impacted life planning for youth with BTHS; and (3) which coping strategies individuals with BTHS used to manage the physical, social, and emotional impacts associated with their incurable, life-limiting condition. Thirty-three sixty-minute interviews were conducted in two groups: individuals with BTHS ≤15 years of age (n=18) and/or their caregivers, and individuals with BTHS ≥16 years of age (n=15). Interview transcripts were analyzed using Atlas.ti. Results demonstrated that (1) the severity, visibility, and lack of control over BTHS symptoms was associated with individuals needing to seek social support for their condition, rather than attempting to pass as healthy as other males with chronic conditions have been found to do; (2) individuals opted to forgo socially “on-time” goals (i.e., long-term, knowledge-based goals) based on their perceptions of their limited, uncertain time horizons and struggled to identify alternative goals; and (3) individuals used secondary coping strategies (i.e., regulating their emotional responses to their external stressor rather than controlling the stressor itself) to cope with the impacts associated with having an incurable, severe, and chronic health condition. These results can be used to inform practices for providing increased social and institutional support to chronically ill youth, including promoting positive coping strategies and facilitating meaningful, attainable, goal selection. These interventions may alleviate some of the challenges faced by the growing number of youth living with chronic illnesses seeking to safely and meaningfully engage in the realms of work, family, education, and social life. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

A dissertation presented in fulfillment of part of the requirements for the degree of Master of Medicine (Pathology) in the Faculty of Medicine, University of the Witwatersrand, Johannesburg, November, 1966. / WHSLYP2017

M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2011