published_or_final_version / Dentistry / Master / Master of Orthodontics

published_or_final_version / Behavioral Health / Master / Master of Social Sciences

Early intervention in psychosis emerged in the 1980s and has gradually become a new paradigm in mental health service worldwide. Yet, very few studies on the history of early intervention in mental illness exist even to date. This dissertation explored the situation in 19th century England when Britain was the only superpower in the world and at the same time was plagued by the rising number of insanity cases that she could only cope with by building more and bigger asylums. The idea of early treatment of insanity was found in various publications written by different physicians in the first half of 19th century. A few of them also proposed primary preventive measures as they believed that a good and disciplined life style could help to avoid the illness. They also saw that insanity could be hereditary. Meanwhile, the debate over the nature of insanity whether it is purely biological or goes beyond the physical body was happening in England as in continental Europe. The physicians supporting the idea of early intervention were also those who subscribed to the theory that insanity has a biological origin. The staging concept in the development of mental illness was well conceived by some physicians. There were also attempts to identify the symptoms in incipient insanity which is close to the modern concept of prodromal stage. Some medical professions also put forward detailed theories on the pathology of the illness based on their knowledge on brain physiology and its interaction with other organs of the body. During this period, professionalization of psychiatrists was advancing. In this process, there was clash between two schools of thoughts. One considered that the profession should move along a scientific path while the other considered that more effort should be devoted to pragmatic issues such as those concerning asylum management. This conflict had in some way hindered the advancement of early treatment. Another major obstacle to the provision of early treatment was the distrust of the society towards psychiatrists. After a number of notorious cases involving people being wrongly confined in the asylums had been widely publicized, the law was tightened to limit the authority of psychiatrists in certifying insanity and in treating uncertified cases. This had resulted in a serious blockade on the road to early treatment. Stigmatization of mental illness in the society was also a major factor in deterring people from seeking early assistance. From the experience in 19th century England, it was found that medicalization of mental illness, professionalization of psychiatrists, establishment of mutual trust between psychiatrists and the society, as well as de-stigmatization of mental illness would be conducive to the development of an early intervention paradigm. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Proteinuria has been recognized as a common feature in many forms of chronic kidney disease (CKD). As traditional medications for proteinuric nephropathy, such as blockade of the renin-angiotensin system (RAS), has only achieved limited clinical success, more effective renoprotective strategies need to be explored. Bone marrow-derived mesenchymal stem/stromal cells (BM-MSCs) have recently shown promise as a therapeutic tool in acute kidney injury (AKI) models. The therapeutic potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) in proteinuric nephropathy models is unknown. Using a co-culture model of human proximal tubular epithelial cells (PTECs) and BM-MSCs, I first examined the potential effect of BM-MSCs in albumin-induced pro-inflammatory response and epithelial-to-mesenchymal transition (EMT) in PTECs. The unstimulated BM-MSCs exerted moderate suppressive effect on tubular inflammation as only albumin-induced CCL-2 and CCL-5 expression was attenuated in PTECs. When concomitantly stimulated by albumin excess, however, BM-MSCs remarkably suppressed albumin-induced tubular IL-6, IL-8, TNF-α, CCL-2, and CCL-5 expression, suggesting albumin overloaded milieu to be a prerequisite for them to fully exhibit their anti-inflammatory effects. This effect was mediated via deactivation of tubular NF-κB signaling as BM-MSCs prevented the overexpression of p-IκB and nuclear translocation of NF-κB. In addition, albumin-induced tubular EMT, as shown by the loss of E-cadherin and induction of α-SMA, FN-1 and collagen IV in PTECs, was also prevented by BM-MSC co-culture. To dissect the mechanism of action, I next explored the paracrine factors secreted by BM-MSCs under an albumin-overloaded condition and studied their contribution to the protective effect on tubular inflammation and EMT. Albumin-overloaded BM-MSCs per se overexpressed 34 paracrine factors, of which hepatocyte growth factor (HGF) and TNFα-stimulating gene (TSG)-6 were regulated by P38 and NF-κB signaling. These paracrine factors suppressed both the proinflammatory and profibrotic phenotypes in albumin-induced PTECs. Neutralizing HGF and TSG-6 abolished the anti-inflammatory and anti-EMT effects of BM-MSC co-culture in albumin-induced PTECs, respectively. Finally, in albumin-overloaded mice, a well established murine model reminiscent of human CKD, treatment with mouse BM-MSCs markedly reduced BUN, tubular CCL-2 and CCL-5 expression, interstitial macrophage, α-SMA and collagen IV accumulation independent of changes in proteinuria, together with upregulated renal cortical expression of HGF. Exogenous BM-MSCs were detected in their kidneys by PKH-26 staining. Collectively, these in vitro and in vivo data suggest a modulatory effect of BM-MSCs on albumin-induced tubular inflammation and fibrosis and underscore a therapeutic potential of BM-MSCs for CKD in the future. / published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

No description available.

Some persons with aphasia exhibit a selective verb deficit, which results in a reduced ability to produce verbs in most contexts. A functional level (Bock & Levelt, 1994) impairment may result in impaired sentence production because the verb serves as the semantic-syntactic interface of a sentence. This interface is related to a verb’s relationship with its arguments/thematics. Arguments fill the syntactic slots of subject and object, and those same words serve as thematic roles by referring to who does what to whom. The current study investigates the effect of Verb Network Strengthening Treatment (VNeST) on sentence production using a single subject experimental design across subjects in 4 participants, 2 with nonfluent aphasia and 2 with fluent aphasia. Participants received semantic treatment aimed at re-strengthening the connections between a verb (e.g., measure) and related thematic pairs that refer to the doer and receiver of the action (e.g., carpenter/lumber, chef/sugar). The ability to produce thematic role pairs for trained verbs was tested during treatment while generalization to the ability to produce sentences containing a subject, verb, and object in a picture description task with trained verbs (e.g., The carpenter is measuring the stairs.) and semantically related untrained verbs (e.g., The nurse is weighing the baby.) was monitored. In addition, pre- and post-treatment single word retrieval of verbs (The Northwestern Verb Production Battery (NVPB) (Thompson, 2002)) and nouns (The Boston Naming Test (Goodglass & Kaplan, 1983)) was examined as well as sentence production abilities in unrelated picture description (NVPB) and constrained connected speech tasks. All participants met treatment criteria and exhibited generalization to sentence production with sentences containing trained and semantically related untrained verbs. Participants 1, 2, and 3 exhibited improvements on all pre- and post-treatment measures, including connected speech. Participant 4 exhibited gains on multiple measures but did not show improvement in connected speech. These findings indicate that treatment aimed at strengthening the verb network results in improved word retrieval in naming and sentence production across multiple tasks. Theoretical and clinical implications regarding the impact of using VNeST on rehabilitation of sentence production deficits in aphasia are discussed. / text

published_or_final_version / Orthopaedic Surgery / Master / Master of Philosophy

No description available.

Substance abuse has a severe impact on the South African population. Various organizations, governmental and non-governmental, take on the challenge to assist in the treatment of substance abuse. Several gaps have been identified in dealing with substance abuse in South Africa. One of these gaps includes regular audits of treatment services and prevention programmes. One of the major concerns is that most primary prevention programmes appear to be implemented in the absence of evidence on their effectiveness and are mostly implemented on an ad hoc basis. The respondent organizations appear to display a poor understanding of evaluation. It was evident that there is a need for a systematic review of what works in the context of substance abuse prevention among the South African population as well as the development of an effective regulatory regime regarding primary prevention activities. Evaluation can be an important tool to provide monitoring, as well as a tool to identify strengths and weaknesses in treatment programmes. In light of the above, the South Coast Recovery Centre, a substance abuse treatment centre that operates in the private sector, was approached to evaluate the effectiveness of its treatment programme. The research focused on gaining insight into and exploring the strengths and weakness of the programme based on how patients experienced the programme and how satisfied they were with it. The use of multimethod approach which included positivist and interpretative approaches to evaluation was viewed as an appropriate method to use for the study in facilitating an understanding of the patient’s experience of the programme and how satisfied they were with the intervention they received. The study is both qualitative and quantitative in nature and used questionnaires and focus group interviews as data sources. All participants in the study were inpatients at the South Coast Recovery Centre. Frequency distributions, chi square analysis, as well as a thematic analysis were used to analyze the data of the study. The study concluded that patients were in general satisfied with the treatment programme. The programme provided opportunity for behavior changes and introspective learning. They were satisfied with professionals’ skills and behaviours, 6 types of interventions provided, efficacy and accessibility. Areas that patients were not satisfied with included: the facilitated involvement of relatives, the provision of information, and the large amount of residents in the programme. Recommendations were made with regards to programme improvement. The recommendations included the following: a. A coherent programme with clear links between outcome objectives and programme activities should be created. b. The number of counsellors in the programme should be reconsidered. c. The number of patients that should be allowed in the programme should be reconsidered. d. A platform for counsellors to deal with their personal emotions and counter transference should be created. e. Counsellors’ emotional involvement with patients should be addressed and exposed. f. More structured leisure activities that use interactive learning styles could be implemented in order to facilitate the learning of social skills. g. An awareness of possible comorbid mental disorders should be developed. h. Patients can be more involved with the cost aspect of the programme in order to facilitate more ownership of their treatment process. i. Provision should be made in the programme to allow for more involvement of relatives. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

This study aims to explore parents and treatment personnels experiences of the Marte meo methodat a family treatment home. Three retrospective interviews were made with parents whoexperienced Marte meo treatment, as well as four interviews with treatment personnel. The purposeof the Marte meo method is to develop the interaction between parent and child. Previous resultsfrom studies show that treatment with the Marte meo method could provide positive effects to theparent child relationship. The results in this study have been analyzed by using parts of attachmenttheory, the salutogenic perspective and the term intersubjectivity. The parents in this study all statethat Marte meo treatment strengthened them in their role as a parent. The treatment personnel statethat they have seen positive changes in families living at the family treatment home whoparticipated in Marte meo treatment.