Diante do enigma representado pelos alunos incluídos, sobretudo, aqueles com graves problemas psíquicos, ou com transtornos globais do desenvolvimento, o conhecimento do professor parece ser insuficiente. Na falta de beira do pedagógico, o discurso clínico é chamado a margear os processos de ensino e aprendizagem, sendo recorrente a desligitimação da escola como espaço potente e a indicação de práticas reeducativas. Que razões levam a escola a não reconhecer seu papel constitutivo? A educação, ao se ocupar dos que estão fora do ideal de normalidade, perdeu a referência de sujeito como uma trama enigmática? Trata-se de um estudo teórico, no qual essas questões são problematizadas a partir da experiência profissional da pesquisadora, das fontes primárias da educação especial (Relatórios de Jean Itard – 1901 – e Tratado médico filosófico sobre alienação mental ou mania – 1800 – de Phillip Pinel), do campo da psicopatologia médico-biológica e fundamental e do conto A terceira margem do rio, de Guimarães Rosa. Defendemos a partida de Itard como gesto capaz de partir áreas e instaurar um novo espaço-tempo, uma terceira margem, no que antes era dual. Educação – especial. O traço que une e separa, surge da aposta, do diagnóstico como margem, de Itard na transformação de Victor pela educação. Traço instaurador de uma área e de um sujeito, não guarda um sentido a priori. A fim de sublinhar a função constitutiva da escola e do professor, o traçado precisa deslizar do ideal de normalidade à pergunta pelas condições de possibilidade de uma educação, duvidando, suspendendo, verdades cristalizadas e empobrecedoras do humano. / Given the enigma represented by the students included, especially those with severe psychological problems, or with Global Development Disorders, the knowledge of the teachers seems to be insufficient. In the absence of pedagogical border, clinical discourse is called to do margin in the processes of teaching and learning, often not legitimating the school as potent and powerful space, and indication of re-educational practices. What reasons lead school not to recognize his role constitutive? The education, dealing with the "out of the ideal of normality", lost the individual as an enigmatic plot? It is a theoretical study, in which these issues are raised from the professional experience of the researcher, the primary sources of special education (Reports of Jean Itard- 1901- and A treatise on insanity and others disorders affecting the mind -1800- Philippe Pinel), the field of biological medical and fundamental psychopathology and from the tale called “A terceira margem do rio” (The third margin of the river) written by Guimarães Rosa. We advocate the departure of Itard as capable of break off areas and establish a new space-time, a third margin, in what used to be dual. Special – education. The lineament that unites and separates, arises from the investment, the diagnosis as margin, from Itard believing in Victor transformation through education. Lineament originator of an area and an individual, don't keep a sense a priori. In order to emphasis the constitutive function of the school and the teacher, the stroke need to slide off the ideal of normalcy to question the conditions of possibility of an education, doubting, suspending, petrified and depleting the human truths.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-06-21T22:15:21Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Marcelo_Felix_Alonso.pdf: 3066911 bytes, checksum: c05f60df7aea1fe1e26c060cd18eb54c (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-06-21T22:44:57Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Marcelo_Felix_Alonso.pdf: 3066911 bytes, checksum: c05f60df7aea1fe1e26c060cd18eb54c (MD5) / Made available in DSpace on 2018-06-21T22:44:57Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Marcelo_Felix_Alonso.pdf: 3066911 bytes, checksum: c05f60df7aea1fe1e26c060cd18eb54c (MD5) Previous issue date: 2006-02-15 / Sem bolsa / O objetivo geral dessa dissertação de mestrado foi estudar a influência das Parametrizações de Convecção na simulação de eventos severos no Brasil, a fim de avaliar o seu desempenho na previsão regional de tempestades potencialmente destruidoras. Com esse raciocínio, comparou-se a precipitação observada e simulada, estudaram-se as reservas de energia envolvidas no processo da convecção, analisou-se como o ambiente termodinâmico e dinâmico em grande escala foi modificado e estudaram-se maneiras de melhorar a parametrização convectiva de Grell a fim de propiciar ainda mais confiabilidade à previsão numérica do tempo, utilizando o modelo regional de mesoescala BRAMS 2.0. Para isso, analisaram-se dois casos de sistemas precipitantes, influenciados por regimes distintos (extratropical e tropical). Não obstante, ainda fez-se uma análise da confiabilidade da Parametrização Convectiva de Grell na simulação da precipitação para o mês de maio de 2005, no Rio Grande do Sul. Evidencia-se a superioridade da Parametrização Convectiva de Grell na simulação da magnitude da precipitação, em relação à Parametrização Convectiva de Kuo. Porém, conclui-se que a Parametrização Convectiva de Grell tende a superestimar o dado observado de precipitação acumulada. Nos dois casos de convecção, pôde-se obter uma boa eficiência da Parametrização convectiva de Grell, em relação à magnitude da precipitação diária acumulada, diminuindo-se o raio da nuvem, aumentando o entranhamento de massa no sistema. Os experimentos cuja peculiaridade é o uso da Parametrização Convectiva de Grell, simularam com melhor precisão as características termodinâmicas do ambiente e representaram com boa exatidão os aspectos dinâmicos favoráveis à gênese e manutenção de tempestades mais severas, fornecendo subsídio no que se refere ao uso da modelagem regional como estratégia adicional na prevenção de fenômenos potencialmente destruidores. Percebe-se, analisando o caso II, que os dados de inicialização do modelo tiveram um profundo impacto na simulação da Linha de Instabilidade. Os experimentos iniciados com os dados de Re-análise, do NCEP, cuja resolução é de 250 km, organizaram as bandas convectivas numa configuração mais parecida com o que foi observado. Todavia, os experimentos iniciados com o modelo T126L28, do CPTEC, cuja resolução é de 100 km, geraram núcleos convectivos em áreas onde não foi observada atividade convectiva. / The general objective of this purpose of was to study the Convection Parameterization influence in the Brazilian severe events simulation, in order to evaluate its performance in the regional severe storm forecast. It was compared observed and simulated precipitation, the energy budghets envolved in the convection process had been studied, were analyzed the large-scale thermodynamic and dynamic modification and had studied ways to improve the Grell convective parameterization for a better weather numerical forecast, using BRAMS 2.0 model. For this, two cases of convective systems had been analyzed, influenced by regimes distinct (extratropical and tropical). Still, we made an analysis of the Grell Convective Parameterization behavior in the precipitation simulation for May 2005, in the Rio Grande Do Sul state. The accumulated precipitation, simulated from experiments that use the Grell scheme, better represented the rain intensity, but overestimated the observed data. The simulations with Kuo scheme underestimated the observed data. The inicialization data has a full influence in the squall line simulation. The LIGRELLA/LIKUOA experiments better simulated the spatial coverage of squall line, with relation the GPCP satellite data. However, the LIGRELLB/LIKUOB experiments simulated maximum precipitation in regions with any observed rain, including, LIKUOB simulated a squall line with propagation opposing the observed.

A sepse é uma síndrome clínica que promove alterações características na microcirculação, dificultando a avaliação da perfusão tecidual. No homem, estudos demonstram a importância de estabelecer a terapia baseando-se nas avaliações clínicas rotineiras, bem como nas variáveis de oxigenação e de perfusão tecidual como saturação venosa central de oxigênio, o lactato e a diferença de base. Assim, o objetivo deste estudo foi avaliar a evolução desses parâmetros durante as seis primeiras horas de reposição volêmica, buscando identificar o valor destas variáveis como marcadores de prognóstico. Foram incluídas 30 cadelas com sepse grave e choque séptico submetidas à reposição volêmica com 40 ml/kg/hora de solução cristalóide durante as seis primeiras horas de tratamento intensivo. Durante este período, a pressão arterial sistólica, o débito urinário, a pressão venosa central, o lactato, o déficit de base e a saturação venosa central de oxigênio foram monitorados a cada 90 minutos. A prevalência de algumas características clínicas dos animais, analisando a relação destas características com o desfecho (alta ou óbito) foi realizada através do teste de qui-quadrado ou teste exato de Fisher. A saturação venosa central de oxigênio, o déficit de base e o lactato foram comparados entre os sobreviventes e não- sobreviventes utilizando análise de variância com dois fatores. Foi considerada estatística significativa com p< 0,05. A taxa de mortalidade foi de 36,7%. Os sobreviventes apresentaram valores de saturação venosa central acima de 70% quando comparados aos não sobreviventes (p<0,001). Níveis séricos de lactato mais elevados também foram observados no grupo de não sobreviventes (p<0,001), bem como os valores de déficit de base também foram mais elevados no grupo de sobreviventes quando comparado aos animais que vieram a óbito (p<0,001). O suporte intensivo aos animais com sepse grave é fundamental na redução da mortalidade desses animais. Os valores de lactato, saturação venosa central de oxigênio e de déficit de base podem ser considerados bons marcadores de prognóstico. A utilização destes parâmetros como metas da reposição volêmica durante as seis horas iniciais do atendimento parece reduzir a mortalidade, no entanto, estudos multicêntricos são necessários para definir esta relação. / Sepsis is a clinical syndrome that causes changes in the microcirculation characteristics, making the assessment of tissue perfusion. In humans, studies have shown the importance of establishing a therapy based on routine clinical assessments and the variables of oxygenation and tissue perfusion and central venous saturation of oxygen, lactate and base deficit. The aim of this study was to evaluate the evolution of these parameters during the first six hours of resuscitation in order to identify the value of these variables as prognostic markers. We included 30 dogs with severe sepsis and septic shock underwent replacement with 40 ml / kg / hour of crystalloid solution during the first six hours of intensive care. During this period, the systolic blood pressure, urine output, central venous pressure, lactate, base deficit, and central venous saturation of oxygen were monitored every 90 minutes. The prevalence of some clinical characteristics of the animal, analyzing the relationship of these characteristics with the outcome (discharge or death) was performed using chi-square or Fisher\'s test. The central venous saturation of oxygen, base deficit and lactate were compared between survivors and nonsurvivors using analysis of variance with two factors. It was considered statistically significant with p <0.05. The mortality rate was 36.7%. The survivors had values of central venous oxygen saturation above 70% when compared to non-survivors (p <0.001). Serum lactate higher were also observed in the non survivors (p <0.001), and the values of base deficit were also higher in the group of survivors compared to animals that eventually died (p <0.001). The intensive support to animals with severe sepsis is essential to reduce the mortality of these animals. The values of lactate, central venous saturation of oxygen and base deficit can be considered good markers of prognosis. Using these criteria as goals of resuscitation during the initial six hours of care appears to reduce mortality; however, multicenter studies are needed to define this relationship.

INTRODUÇÃO: A obesidade grave dificulta fisicamente a avaliação da composição corporal. OBJETIVO: Desenvolver equações para estimativa de gordura corporal (GC) em obesos grau III. MÉTODOS: Adultos obesos graves tiveram a GC estimada por bioimpedância elétrica (BIA impedância de 5, 50, 100 e 200kHz) e por método de referência (pletismografia de deslocamento aéreo - PDA). Avaliaram-se os limites de concordância e seu coeficiente de correlação (CCC). Novas equações preditivas foram desenvolvidas por análise de regressão multivariada. RESULTADOS: A GC estimada por BIA e PDA foi similar para a população estudada (64,8 ± 15kg vs 65,6 ± 16kg, p>0,05). Ambas tiveram boa acurácia, precisão e CCC, porém a sua comparação teve amplos limites de concordância que variaram de -10,4 a 8,8kg. A equação residente de BIA aplicada em mulheres superestimou a GC (-1,3 kg; p<0,05) e em homens subestimou a GC (5,6 kg; p<0,05). Novas equações preditivas de GC foram criadas, para BIA de freqüência de 50kHz, Horie-Waitzberg & Barbosa-Silva1: GC1 (kg) = 23,25 + (0,13 × idade) + (1,00 × peso atual) + (0,09 × Resistência 50kHz) (0,80 × altura) e para BIA de frequência de 100kHz, Horie-Waitzberg & Barbosa-Silva2: GC2 (kg) = 23,97 + (0,10 × Impedância 100kHz) + (0,11 × idade) + (0,99 × peso atual) - (0,80 × altura). CONCLUSÕES: A equação residente no aparelho de BIA foi inadequada para estimar a GC em pacientes obesos grau III. As equações desenvolvidas especialmente para esta população forneceram estimativas de GC mais precisas (melhores limites de concordância, precisão, acurácia e CCC). / RATIONALE: Severe obesity limits physically the body composition assessment. AIM: To develop equations of body fat (BF) estimative in severe obesity. METHODS: Severely obese adults had BF estimated by bioelectrical impedance (BIA impedance of 5, 50, 100 and 200kHz) and reference method (air displacement plethysmography - ADP). The limits of agreement and of concordance correlation coefficient (CCC) of the data were evaluated. New predictive equations were developed by multivariate regression analysis. RESULTS: The BF estimations from BIA and ADP were similar for the studied population (64.8 ± 15kg vs 65.6 ± 16.4kg, p>0.05). Both had good accuracy, precision, and CCC, but their comparison had wide limit of agreement with range from -10.4 to 8.8kg. The home BIA equation overestimated BF in women (-1.3 kg, p<0,05) and underestimated BF in men (5.6 kg; p <0.05). BF new predictive equations were generated, for BIA with 50kHz frequency, Horie- Waitzberg & Barbosa-Silva1: BF1 (kg) = 23.25 + (0.13 × age) + (1.00 × current weight) + (0.09 × Resistance 50kHz) (0.80 × height) and for BIA with 100kHz frequency, Horie-Waitzberg & Barbosa-Silva2: BF2 (kg) = 23.97 + (0.10 × Impedance 100kHz) + (0.11 × age) + (0.99 × current weight) - (0.80 × height). CONCLUSIONS: The home equation on BIA was inadequate for estimating BF in severely obese patients. Equations developed especially for this population provides more accurate BF estimative (better limits of agreement accuracy, precision and CCC).

Orientadores: Jose Guilherme Cecatti, Maria Laura Costa do Nascimento / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T00:58:50Z (GMT). No. of bitstreams: 1 Ferreira_EltonCarlos_M.pdf: 3220735 bytes, checksum: adb82ed562a5753986a41b8a54b80cb0 (MD5) Previous issue date: 2014 / Resumo: Objetivo: avaliar a distribuição dos partos segundo o Sistema de Classificação em Dez Grupos de Robson (RTGCS) explorando os dados da Rede Brasileira de Vigilância da Morbidade Materna Grave (RBVMMG) e do Hospital da Mulher (CAISM) da Universidade Estadual de Campinas (UNICAMP), Brasil; e comparação de ambos com os dados do estudo Global Survey da Organização Mundial de Saúde (WHO). Método: Foram realizadas duas abordagens. A primeira foi uma análise secundária de um estudo de corte transversal multicêntrico que ocorreu em 27 maternidades brasileiras de referência, localizadas nas cinco regiões do país e participantes da RBVMMG. Foi realizada a codificação dos dados para alocação de todas as mulheres segundo o RTGCS e as mulheres foram classificadas de acordo com o espectro clínico de gravidade e a condição subjacente de morbidade materna grave. Para a segunda abordagem, foi realizado um estudo de corte transversal, com avaliação das mulheres admitidas para parto no CAISM no período de janeiro 2009 a julho de 2013. As mulheres foram agrupadas segundo a RTGCS e, adicionalmente, a distribuição das mulheres entre os diferentes grupos foi comparada entre os casos que tiveram morbidade materna grave, operacionalmente definida pela necessidade de internação em unidade de terapia intensiva (UTI), com os demais casos sem complicações graves. Para as duas abordagens (RBVMMG e CAISM), realizou-se também uma comparação com resultados publicados de outro grande estudo, realizado em diferentes contextos e países, fundamentalmente com os dados para o Brasil, disponíveis no estudo Global Survey da WHO. Resultados: Para a RBVMMG, das 7247 mulheres que compuseram o estudo, 73.2% foram submetidas à cesariana (CS). O grupo 10, grupo com provável indicação de cesárea por complicação materna e/ou fetal, foi o mais prevalente com 33.9% e também aquele com maior contribuição para a taxa geral de cesárea, 28%. Os grupos que tiveram maior gravidade (¨near miss¨ e óbito materno) foram, em ordem decrescente, os grupos 7 e 9, o grupo 8 e o grupo 10. O grupo 3 teve um caso de resultado materno grave (¨near miss¨ + óbito materno) para cada 29 casos de condição potencialmente ameaçadora da vida. Nas mulheres desse grupo submetidas a CS, essa relação atingiu valores de 1:10. Em todos os grupos avaliados, a hipertensão foi o fator de gravidade mais frequente. Na segunda abordagem, foram admitidas 12.771 parturientes durante o período do estudo. A taxa de cesariana encontrada foi de 46.6%. O grupo 1 foi o mais prevalente com 28.1%, sendo o grupo 5 aquele que mais contribui para a taxa geral de cesárea (12.7%). Apresentaram, proporcionalmente, mais internação em UTI os grupos 10 (46.8%), 5 (13.3%) e 2 com 9.8%. Conclusões: O estudo evidenciou uma alta taxa de cesárea nas duas populações avaliadas e o uso do RTGCS mostrou-se útil, evidenciando grupos clinicamente relevantes com alta taxa de parto por cesárea. Estudos futuros serão necessários para melhor avaliar a associação entre cesárea e morbidade materna grave, assim como definir possíveis intervenções e a taxa de cesárea esperada para esse grupo específico de mulheres / Abstract: Objective: To evaluate the distribution of delivering women according to the Robson¿s Ten Group Classification System (RTGCS) exploring the data from the Brazilian Network for the Surveillance of Severe Maternal Morbidity (RBVMMG) and from a tertiary hospital (CAISM), University of Campinas, Brazil; comparing both data with that from the WHO Global survey. Method: Two approaches were proposed. The first, a secondary analysis of a database obtained from a multicenter cross-sectional study taking place in 27 referral obstetric units located in the five geographical regions of Brazil, members of the Brazilian Network for the Surveillance of Severe Maternal Morbidity (RBVMMG), was carried out. For this analysis, data was organized following information necessary to classify all women into one of the RTGCS and cases from each of the 10 groups were classified according to case severity and underlying cause of severe morbidity. Subsequently, certain Robson groups were subdivided for further analysis. For the second approach, a cross-sectional study of data from women delivering at CAISM from January 2009 to July 2013 was carried out. Women were grouped according to RTGCS and, additionally, the distribution of women among the different groups was compared between cases who had severe maternal morbidity (SMM), operationally defined by intensive care unit (ICU) admission, with the other cases without severe complications. For both approaches (RBVMMG and CAISM), patients distributed among groups were compared to another Brazilian study population, available on the WHO Global Survey study. Results: For RBVMMG, among the 7247 women considered, 73.2% underwent cesarean section (CS). Group 10 had the highest prevalence rate (33.9%), also contributing most significantly (28%) to the overall CS rate. Groups associated with a severe maternal outcome (maternal ¨near miss¨ or maternal death), in decreasing order were: groups 7 and 9, 8 and 10. Group 3 had one case of severe maternal outcome (maternal ¨near miss¨ + maternal death) for every 29 cases of potentially life-threatening conditions. When evaluating only women undergoing CS in this group, ratios of 1:10 were achieved, indicating a worse outcome. Among all groups evaluated, hypertension was the most common condition of severity. For CAISM, of the 12771 women, 46.6% underwent CS. Group 1 had the highest prevalence rate (28%) and Group 5 contributed most significantly to overall CS rates. ICU admission was proportionally higher in groups 10 (46.8%), 5 (13.3%) and 2 with 9.8%.Conclusions: The study demonstrated a high cesarean section rate in the two populations studied and the use of RTGCS proved to be extremely useful, showing clinically relevant groups with high rates of cesarean section. Future studies are needed to better evaluate the association between cesarean section and severe maternal morbidity, as well as to define possible interventions and the expected cesarean section rate for this particular group of women / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

Sepsis remains a severe issue in critically ill patients. Adjunctive therapies might play important role to decrease morbidity and mortality. The aim of this thesis is to investigate new adjunctive therapies role in the treatment of sepsis and septic shock. / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Magister Public Health - MPH / Despite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006. / South Africa

Magister Public Health - MPH / Background: Malnutrition accounted high level of childhood morbidity and mortality in Ethiopia including Durame area. Durame area is one of the food insecure districts in Southern region. As a result of high prevlanece of acute malnutrtion, which is 8.3%, Ministry of Health partnering with World Vision Ethiopia started outpatient therapeutic program (OTP) in seven OTP sites to rehablitate severely malnourished children. Reports indicate that number of factors affect the rehabilitation outcome of children with severe acute malnutrtion in OTP programs. However, there are no studies conducted to assess their contribution in the rehablitaiton outcome. Hence, this study will attempt to investigate these factors and assess their public health significance in Durame area. Aim: To assess the factors affecting the rehabilitation outcome of an OTP for children with severe acute malnutrition in Durame area, Southern Ethiopia Method: the study used a descriptive study with an analytical component. Three-hundred and sixty (360) medical records were calculated during sampling and proportional numbers of medical records were sampled from the seven OTP sites. The medical records were reviewed using semi-structured questionnaires from September 1 to September 10, 2008. The data was entered and analyzed using EPI info version 3.3.2 software. Results: three hundred fifty five (98.6%) of the total sample records were reviewed. Three hundred twenty nine (92.7%) children were cured, 11(3.8%) died, 7 (2%) defaulted and 8 (2.3%) were non-cure. Average weight gain on discharge was 3.4gm/kg/day and the mean length of stay was 55.6 days (SD+14 days). More than 60% of children were admitted in three of the seven OTP sites where Demboya OTP sites taking the larger share. Nearly half of the total children (49.8%) were between 6 to 12 months of age and the median age of admission was 13 months. The male to female ratio in the study population was almost equal. Average family size was 6.3 and 58.3% of children came from households with 6 or more family members. Forty two (11.8%) children in the study had twin. The average walking distance to the OTP sites was 62.9 minutes and two hundred fifty six mothers travelled less than an hour. Most of the children (92.1%) were referred from the community and most of the children were admitted with MUAC followed by pitting edema. One hundred seventy four (49%) of the total children were beneficiaries of GFR. On admission two hundred twenty six (63.7%) children were breastfeeding, 257 (72.4%) had no symptoms of sickness and 327 (92.1%) did not have abnormal physical examination findings. More than half (51.5%) of them did not receive any home visit and the larger share of the home visits (37.3%) were made when children got illnesses. One hundred sixteen (32.7%) children in the study had chronic medical conditions during follow up. Fever or hypothermia (0.6%), dehydration (0.8%), anemia (0.6%), skin infection (1.6%) and Plumpy nut refusal (2.0%) were the main abnormal medical findings during follow up. Assessment of the influence of the socio-demographic and biological characteristics on the rehabilitation outcome indicated that the sites, family size, chronic medical conditions, absenteeism, weight loss, presence of fever or hypothermia, dehydration and anemia had significant association with the treatment outcome (p<0.05). Further analysis for significant variables using regression analysis indicated that absenteeism, chronic medical illness, fever or hypothermia and anemia are predictor variables contributing significant information for the prediction of the treatment outcome (p<0.05). Conclusion: The program has high success rate in terms of increasing cure and decreasing death, default and non-cure rates but it did not meet the minimum international recommendations for average length of stay and average weight gain. The study identified the main socio-demographic and biological characteristics of children with SAM and factors that affect the rehabilitation outcome. Children under the age of 24 months were most affected with SAM and no gender variation. Larger proportions of malnourished children were living in families above the average family size, which had significant association with the outcome. OTP sites were accessible for majority children in the program but higher level of absenteeism which significantly associated with the outcome. The study identified socio-demographic and biological factors that influenced the rehabilitation outcome as well as the predictor variables contributing significant information for the prediction of the treatment outcome. It could assist the program implementers to design appropriate public health measures. The achievement in Durame OTP program indicates effectiveness of community based management of SAM and existing potential to integrate in routine health system in resource scarce setting like Durame. Recommendations: to sustain the achievements and improve the growth areas necessary public health measures are prime importance.

Master of Public Health - MPH / Background: Severe acute malnutrition contributes disproportionately to child mortality rates despite availability of the WHO protocol, “Ten Steps”, to guide hospital management. Auditing morbidity and mortality rates of malnourished children at hospitals is useful to measure the effectiveness of hospital-based management compared to standards advocated by the WHO protocol. The study aimed to assess the adequacy of clinical management practices for severely malnourished children admitted to three district hospitals in the Western Cape as compared to the WHO guidelines. Objectives: To describe prognostic indicators on admission such as clinical severity of malnutrition and co-morbidities such as HIV, TB, diarrhoea and pneumonia. To assess the management practices of severe malnutrition against the key principles of management during the stabilisation phase as outlined by the WHO guidelines. To describe the number of severely malnourished children who were treated for or died due to preventable complications (hypothermia, hypoglycaemia, dehydration, over-hydration, infection, electrolyte imbalance). Methodology: A retrospective, descriptive study based on a folder review of medical records of 83 severely malnourished children admitted to the Stellenbosch, Helderberg and Eersteriver hospitals from September 2009 to June 2011 was done. viii Structured data collection was undertaken to capture data to allow assessment of the clinician’s management practices, and the adequacy thereof in implementing the first six steps of the WHO protocol guidelines. Results The predominant co-morbidities in the sample were diarrhoea in 51% ofcases and pneumonia in 33%. Thirteen percent were HIV infected, 28% of the sample had TB. Clinical signs were poorly documented by clinicians. The highest percentage of adequate management practices was for treatment of infections with 90% of patients receiving antibiotics. The second best management practice was for treatment of electrolyte and micronutrient deficiency. Hypoglycaemia and hypothermia were poorly managed as children developed these complications in the hospitals and yet these complications were still left untreated. Nineteen percent of the sample needed transfer to a specialist hospital. Conclusion The study concludes that overall management practices for children admitted with severe acute malnutrition to three district hospitals in the Western Cape was poor and often did not adhere to the WHO guidelines. Doctors showed poor understanding of the need for accurate assessment and monitoring in order to reduce the mortality risk of these patients.

Magister Curationis - MCur / The study explores the experiences of nurses who care for severe/profound intellectual disabled patients at Level 3 Psychiatric Hospital in Cape Town. People with severe intellectual disabilities require constant care and supervision which can only be provided in specialised units. In the Western Cape, one such facility is a special section for the intellectually disabled at a level three hospital. Intellectual disability is a serious lifelong disability that places a heavy burden on affected individuals. Caring for these patients may affect the individuals who work within the intellectual disability services. This study explores the experiences of nurses who care for these patients. A Phenomenological research design was chosen as the researcher identified it as the most appropriate method to describe the lived experiences of the nurses. Purposive sampling was used to select 10 participants. However, data saturation was reached after interviewing eight participants. Data was collected through in-depth unstructured interviews. The audio-taped responses were transcribed verbatim and phenomenological data analysis done. Ethical clearance was obtained from the Higher Degrees Committee of the University of the Western Cape. Permission to do the research at the level three hospitals was sought from the Associated Psychiatric Hospital Committee. Consent to participate in the study was obtained from the participants, and ethical principles were adhered to. Participants were informed of the right to withdraw at any stage of the study and intervention offered when required. Trustworthiness of the research process was ensured. Findings: from this study the nurses who care for severe/profound intellectual disabled patients reported that they were not adequately prepared to care for these patients. It has also been reported that caring for the severely/profound disabled comes with some consequences, where emotional (negative and positive), physical and professional consequences were mentioned. The shortage of resources was found to be one of the challenges the nurses experienced. The nurses felt unappreciated for the work they did and less supported by their employer.