MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, 2009 / South Africa is ranked fourth on the list of 22 high-burden TB countries in the world. Intensifying the prevalence of TB in South Africa is the high TB/HIV co-infection rate, with 44% of new TB patients testing positive for HIV. This burden is intense for rural communities due to poverty and return of people with TB/HIV co-infection who previously migrated for employment. In rural South Africa, TB is the leading cause of mortality in HIV-infected persons, but limited information is available about predictors of death. This study measures TB treatment outcomes in Rixile clinic and assesses predictors of TB mortality. Rixile HIV clinic is based in Tintswalo hospital, Acornhoek, Bushbuckridge, Mpumalanga province. This current study uses secondary data collected through a prospective cohort study conducted by PHRU and RADAR from March 2003 to March 2008 on 3 to 6 monthly intervals. Chi-square and logistic regression statistical tests were used to assess predictors of TB Mortality. TB mortality among study participants was 62.5% during the pre-ARV rollout period (March 2003- October 2005), and treatment completion was 31.7%. Some 5.8% participants interrupted treatment during the pre-ARV rollout period as compared to 4.5% during the ARV rollout period (November 2005- March 2008). TB mortality among study participants was 7.5% during ARV rollout and treatment completion increased to 84.4%. Factors associated with TB mortality were age (p=0.006), sex (p=0.017), BMI (p< 0.001), marital status (p=0.004), education (p=0.03), alcoholic beverages consumption (p=0.04), and ARV treatment (p<0.001). However, only age, sex, and ARV treatment were found to predict TB mortality. The proportion of TB treatment completion was higher and TB mortality was lower during ARV roll-out compared to pre-ARV roll-out. Being at the age of 40 to 75 years, not being on ARV treatment and male sex predicts TB mortality in this population. There is a need to expand ARV treatment and intensify TB care services for older people, particularly males living with HIV in this rural community.

The present study used a discounting task to evaluate how hypothetical treatment outcomes were discounter across successively greater probability values. Two discounting questionnaires were administered to thirty parents, half of which had a child with a disability. Delayed discounting of monetary rewards was assessed in relationship with probability discounting of hypothetical treatment outcomes. The questions on the probability discounting questionnaire consisted of asking participants to choose between a guaranteed percentage of symptom elimination or descending probability to eliminate all of their child’s symptoms. For example, “Which treatment outcome would you prefer for your child? (a) guaranteed elimination of 50% of symptoms or 30% chance to eliminate all symptoms.” Results showed a difference in the levels of discounting across the two groups of participants. Parents of children with disabilities discounted hypothetical monetary rewards more steeply while discounting hypothetical treatment outcomes less steeply compared to parents of children without disabilities. Exponential delay functions provided a strong fit for the monetary delayed function.

Magister Public Health - MPH / Viewing the provision of TB-HIV integrated services from the perspectives of TB/HIV clients can help to identify ways to enhance the provision of these services. The aim of this study was to assess the provision of TB/HIV services including PMTCT from clients perspectives in order to make recommendations on ways to enhance the provision of TB/HIV/PMTCT services at facility and community level. Method: Secondary data analysis was undertaken on a survey that was part of a cross-sectional study conducted in 2008 in Sisonke district, a rural district of KwaZulu Natal province, South Africa. Exit interviews were completed by 274 clients accessing TB, HIV and PMTCT services in 10 selected facilities in Sisonke district. A questionnaire that had both closed and open-ended questions was used for exit interviews. Ethical clearance of the study was originally obtained from the Ethics Committee of the University of the Western Cape. The researcher sought permission from the custodian/owner (primary researcher) of the data. The researcher also adhered to maintaining data integrity including the confidentiality procedures as defined in the primary study. In analysing the data it was checked completeness and internal consistency. The quantitative part of the data was stratified, cleaned and coded. The qualitative part of the data was reviewed repeatedly and clustered. The measures of central tendency like frequency, means, median and standard deviation were used for continuous data while categorical data were analysed with frequency and proportions. The Chi-square test was used to assess the association between depend and independent variables. Results: The results of this study show that the respondents preferred accessing integrated TB-HIV/PMTCT services. Most of the respondents, especially a majority of younger respondents comprising of PMTCT (66.7%), HIV (29.8%) and TB (30.8%) categories reported that they were educated on HIV matters. Also, most of the younger respondents (18 – 30 years) among the PMTCT category (74.3%) and most of the older respondents (older than 30 years) of the pre ART & ART category (71.2%)reported that they were educated about TB matters.In general, the majority ( 90 %) of the respondents preferred TB/HIV/PMTCT services to be provided at the same place but a small majority (42%) of the respondents preferred to be seen the same clinicians. Most (68%) of the PMTCT younger (18-30 years) respondents preferred to receive TB-HIV integrated care at their homes while 70% and 68% of HIV and TB older respondents (>30 years) preferred to receive TB and HIV services at their homes. Viewing the advantages,disadvantages and barriers for accessing TB/HIV/PMTCT integrated services, there is a proportionate distribution in the responses amid the categories though the female respondents comparatively take the lead in reporting about their experiences in accessing TB/HIV/PMTCT integrated services. In this study, majority of the respondents demonstrated that they access good integrated TB-HIV/PMTCT services both at the facilities level and at home. Providing integrated TB-HIV/PMTCT services is widely accepted. Majority of the respondents especially the younger females preferred to continue receiving TB-HIV integrated care at their homes in comparison with older respondents. Conclusion: Most of the respondents comprised of females aged less than 30 years. These respondents like the services provided by the TB-HIV integrated services and want it sustained. They prefer the facilities to be in the same location. However, they prefer to consult different clinicians for the two different health conditions. The respondents also preferred to have HIV test at the same facility and to be visited at home by community health workers in support of the provision of TB/HIV/PMTCT care.

No description available.

Tuberculosis remains a communicable disease of major public health importance in South Africa. The purpose of this study is to search for trends in management of tuberculosis at Hillbrow Health Centre from 2000 to 2002. Furthermore, to assess completeness of routine records, compare performance of tuberculosis control in this clinic with others in region 8 during 2002 and identify residential areas with high volumes of tuberculosis patients. Data was obtained from tuberculosis documents at the facility. Information provided by the district office was compared with research findings and used to evaluate performance of Hillbrow Health Centre against the other four clinics in the region. The main findings from the study conducted at Hillbrow Health Centre were the large number of patients diagnosed with tuberculosis annually and cure rates below 40% during the study period. In 2002, the clinic reported the highest proportion of TB patients and the lowest cure rate compared to the other four clinics reporting tuberculosis in region 8. “Hot spots” for the disease were identified in Hillbrow and Joubert Park suburbs and this is where Esselen, Hillbrow and Urban Health Clinics are situated. There is room for improvement of tuberculosis control. More research needs to be done to determine factors contributing to the high incidence of TB in Hillbrow and Joubert Park Suburbs.

<p>The purpose of this literature study was to describe how patients experience their quality of life while undergoing a pacemaker implantation. Searches were carried out in the databases Academic Search Elite, Ebsco Host, Pub Med, Pub Med Central, Science Direct and manually. Keywords used were quality of life, treatment outcomes, emotions, pacing and life. This resulted in nineteen peer rewieved articles that were selected for the study results. The results showed that patients undergoing a pacemaker implantation experienced an improvement in their physical health with increased functional status, more energy and strength. From a psychological perspective, some patients experienced an improvement in quality of life while others felt worried and depressed. A common factor among the patients was anxiety and insecurity concerning daily routine activities. The amount of time passed after the pacemaker implantation was also a common factor that had impact on how patients experienced their physical and psychological health. To get a deeper knowledge and understanding when meeting patients undergoing a pacemaker implantation it is important that more research, especially qualitative, is carried out.</p>

The purpose of this literature study was to describe how patients experience their quality of life while undergoing a pacemaker implantation. Searches were carried out in the databases Academic Search Elite, Ebsco Host, Pub Med, Pub Med Central, Science Direct and manually. Keywords used were quality of life, treatment outcomes, emotions, pacing and life. This resulted in nineteen peer rewieved articles that were selected for the study results. The results showed that patients undergoing a pacemaker implantation experienced an improvement in their physical health with increased functional status, more energy and strength. From a psychological perspective, some patients experienced an improvement in quality of life while others felt worried and depressed. A common factor among the patients was anxiety and insecurity concerning daily routine activities. The amount of time passed after the pacemaker implantation was also a common factor that had impact on how patients experienced their physical and psychological health. To get a deeper knowledge and understanding when meeting patients undergoing a pacemaker implantation it is important that more research, especially qualitative, is carried out.

Therapeutic alliance has been consistently demonstrated as a robust predictor of treatment outcomes, though the time in psychotherapy at which therapeutic alliance best predicts outcomes is unclear. Unfortunately, evidence suggests that racial and ethnic minority clients typically form weaker therapeutic alliances in treatment. The weaker development in therapeutic alliance among racial and ethnic minority clients may mediate discrepancies in treatment outcomes, including higher dropout rates. The purpose of this study was to explore this possibility by (1) investigating the temporal relationship between therapeutic alliance and treatment outcomes and (2) examining differences in therapeutic alliance ratings and treatment outcome, including unilateral termination, among racial and ethnic minority clients. The findings of this study may be integral to identifying and addressing psychotherapy treatment disparities that are tied to racial or ethnic minority status.

Outcomes for ten adult males who used the SpeechEasy fluency device for one year were investigated. Outcomes were determined from qualitative analysis of responses to open-end questions developed from a content analysis of the Perceptions of Stuttering Inventory (PSI) and the Locus of Control of Behavior (LCB) and portions of the Stuttering Severity Instrument-Third Edition (SSI-3). These survey instruments are commonly administered to adults who stutter to determine their levels of struggle, avoidance, anticipation of stuttering and personal locus of control of behavior. The results of the survey instruments were triangulated with interview responses to establish reliability of responses. Changes in stuttering severity following treatment with the SpeechEasy fluency device were compared to changes in perceptions of struggle, avoidance, anticipation of stuttering and personal locus of control of behavior. Data from the interviews and survey instruments revealed patterns of responses that may assist clinicians who treat individuals who stutter in determining those clients who might benefit from treatment using the SpeechEasy fluency device.

Traumatic brain injury (TBI) is a major health problem affecting the adult and pediatric population. Scientists and clinicians are working diligently to discover possible therapeutics for the treatment of TBI. Two possible treatments to deal with TBI include sleep and the administration of progesterone. Yet, there are conflicting results from studies regarding the efficacy of either treatment. Sleep appears to reduce neuroinflammation and reduce axonal damage in the brain following TBI. Sleep deprivation, however, may have neuroprotective effects after TBI. Progesterone has also been shown to have neuroprotective effects following TBI. But, there are no sufficient data from animal studies to determine if progesterone is an effective therapeutic. More research studies will have to be conducted to further understand the role of sleep and progesterone in alleviating TBI.