Children detained in juvenile detention centers in the United States are a unique population. They are neither incarcerated, nor are they free to live in society. Although some popular literature does exist on juvenile detention, such literature is minimal. Further, there are few research studies on this population in any field of inquiry. Indeed the entire subject of juvenile detention has been largely overlooked by research scientists, as well as theologians. The focus of this empirical study is the theology and spirituality of children in a single juvenile detention center in New Jersey, US. Currently, there are no studies on this topic. This study begins to address that void and represents the first theological research of its kind on this population. The methodological approach of the thesis is multi-disciplinary. While the study addresses theology and spirituality as separate categories, it also integrates theology with research in psychology and clinical mental health. The project itself consists of 200 individual, face-to-face interviews with male juvenile residents detained in the Ocean County Juvenile Detention Center, Toms River, New Jersey, US. An original questionnaire has been developed by the author as a research tool. This empirical research adds to the academic literature on children in juvenile detention centers in the United States and recommends ways that staff may communicate with children to begin a theological dialogue. Further, this thesis offers a specific methodology and research tool to be duplicated for use in other juvenile detention centers toward working with children in a concrete, evidence-based, spiritual context. v This study also includes a chapter on the evolution of the author’s spirituality and theology in the course of the project and attempts to locate the self of the researcher within the study. Finally, this thesis presents an outline for a new hermeneutic in working with children in a juvenile detention setting. This new approach represents a practical step toward bridging an existing gap between a stated need for a new hermeneutic for working with children in theological literature and its inception. / Philosophy, Practical and Systematic Theology / D. Th. (Practical Theology)

This thesis examined body dissatisfaction and body change behaviors among adolescent girls and boys from a biopsychosocial framework. The contribution of biological, psychological and sociocultural factors were examined in relation to body dissatisfaction, weight loss, weight gain and increased muscle tone behaviors among early adolescent girls and boys. In particular, pubertal maturation, body mass index (BMI), perception of body shape and size and psychological factors, such as depression, anxiety, ineffectiveness, self-esteem and perfectionism, were examined as possible factors that may precipitate or maintain body dissatisfaction and engagement in body change strategies. The sociocultural factors evaluated were the quality of family and peer relationships, as well as the influence of family and peers in predicting the adoption of specific body change strategies. The specific mechanisms by which these influences were transmitted were also examined. These included perceived discussion, encouragement and modelling of various body change strategies, as well as perceived teasing about body shape and size. A number of separate cross-sectional and longitudinal studies were conducted to examine the above relationships and identify the factors that contribute to weight loss, weight gain and increased muscle tone behaviors in adolescents. Study 1 examined the psychometric properties and principal components structure of the Bulimia Test Revised (BULIT-R; Thelen, Farmer, Wonderlich, & Smith, 1991) to assess its applicability to adolescent samples. Study 2 investigated the nature of body dissatisfaction and weight loss behaviors among 603 adolescents (306 girls and 297 boys) using a standardised questionnaire. This preliminary study was conducted to ascertain whether variables previously found to be relevant to adolescent girls, could also be related to the development of body dissatisfaction and weight loss behaviors among adolescent boys. Studies 3 and 4 described the development and validation of a body modification scale that measured weight loss, weight gain and increased muscle tone behaviors. Studies 5 and 6 were designed to modify an Excessive Exercise Scale developed by Long, Smith, Midgley, and Cassidy (1993) into a shorter form, and validate this scale with an adolescent sample. Study 7 investigated the factors that contribute to weight loss, weight gain and increased muscle among adolescent girls and boys both cross-sectionally and longitudinally (over one year). Structural equation modelling was used to examine associations among self-reported body dissatisfaction, body change strategies and a range of biological, psychological and sociocultural variables both cross-sectionally and longitudinally. Overall, the results suggested that both girls and boys experience body dissatisfaction and engage in a number of different body change strategies in order to achieve an ideal size. A number of gender similarities and differences were identified in the expression of body dissatisfaction and the adoption of body change strategies for both girls and boys. Girls were more likely than boys to report body dissatisfaction and engage in weight loss behaviors, while boys were more likely than girls to engage in weight gain and increased muscle tone behaviors. Generally, the same factors were found to contribute to weight loss, and more specifically, bulimic symptomatology, ad weight gain in both adolescent girls and boys. While a combination of biological, psychological and sociocultural factors contributed to bulimic symptomatology, only biological and psychological factors were found to contribute to weight gain in adolescents. The most notable gender differences were found in the model of increased muscle tone. Sociocultural and biological factors contributed to increased muscle tone behaviors in girls, while sociocultural and psychological factors were implicated in these behaviors in adolescent boys. With the exception of the model of increased muscle tone for boys, body dissatisfaction was a consistent factor in the adoption of body change behaviors. Consistent with previous investigations, the present thesis provides empirical support for the need to examine the etiology and maintenance of such concerns and behaviors from a multifaceted perspective.

This study is an exploration, through ethnographic and auto-ethnographic inquiry, of the personal world, gambling experiences and underlying biopsychosocial vulnerabilities of three individual case studies - one male and two females - each representing a different sub-type of pathological gambler. It comprises the integration and implementation of a psycho-structural stage matching model to explore comorbidity and identify certain biopsychosocial manifestations in the respective stages of pathological gambling. Long term treatment strategies were identified and patient treatment matching was explored. Further, it comprises my personal relationship and therapeutic treatment of these sub-types of gamblers over a period of one year and longer. In this study it is hypothesized that formulating appropriate matching long term treatment strategies should be based on the stage of change, the phase in the psycho-structural model, as well as the gambler's underlying vulnerability. From this a comprehensive gambling disposition profile can be completed with proper intervention matching approaches. A number of other hypotheses emerged from this study that could provide valuable information and serve as a guideline to those working with pathological gamblers. / Psychology / D.Phil.

The objectives of this study were to provide a detailed biopsychosocial description of the characteristics of a sample of 100 individuals screened and referred by the National Responsible Gaming Programme helpline for their outpatient treatment programme over an eighteen month period, and, importantly, to measure the success of this specific treatment programme at set intervals, up to a one year follow-up period. While 80% of the sample did not relapse during the six-week treatment programme, the number of treatment seekers without any gambling relapses during each follow-up period declined, and those falling back into gambling increased as time went on. After one year 47% of treatment seekers managed not to revert back to gambling – total abstinence. A further 28% reported having relapsed once or twice or that their gambling was controlled. 25% of treatment seekers reported that they reverted back to gambling fulltime which leaves the success rate of the treatment at 75%. Treatment seekers reported an overall reduction in gambling participation, debt and expenditure and an overall improvement in social and vocational functioning. There is evidence in this study to support the perspective that pathological gambling is a multidimensional disorder and that certain sub-groups of gamblers have distinct gambling behaviour. / Psychology / M.Soc.Sc.

Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care. To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV). Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.

Bipolêre versteuring is ‘n kroniese, herhalende en ernstige siekte met ‘n voorkoms van 1 % wêreldwyd. Pasiënte kan psigoties word, selfmoordideasie hê en ook soms aggressief raak. Dikwels moet hulle gehospitaliseer word - ook teen hulle wil, want hulle mag soms geen insig toon nie. Pasiënte mag presenteer met ‘n ko-morbiede toestand, byvoorbeeld substansmisbruik of ‘n persoonlikheidsversteuring. Dit gebeur dikwels dat hulle nie hulle toegewysde rolle, byvoorbeeld dié van gade, broodwinner, ouer of volwasse kind, kan vervul nie. Versorgers van pasiënte gediagnoseer met bipolêre versteuring, word eweneens beïnvloed deur die siekte en die gepaardgaande stigma daarvan. Dit kan vir hulle baie moeilik wees wanneer hulle die verantwoordelikhede en rolle van die pasiënt moet oorneem. Beskou vanuit die oogpunt van ‘n ekologiese sisteemperspektief is die aard van hierdie impak op die maatskaplike funksionering van die versorgers relevant vir maatskaplike werk in die geestesgesondheidsveld. Die verkenning van hierdie impak en die ontwikkeling van ‘n intervensie om die impak aan te spreek het dus die rasionaal van hierdie studie gevorm. Die geïntegreerde biopsigososiale model, binne ‘n ekologiese sisteem perspektief, word aangewend by die psigiatriese instelling waar die navorser werk. Hierdie benadering het dus ook gedien as die vertrekpunt vir die betrokke studie. Die gemengde-metode navorsingsbenadering is tydens hierdie studie benut ten einde ‘n uitgebreide analise van die navorsingsprobleem te verskaf. Die voorgenome studie het binne die kategorie van toegepaste navorsing geval, want die doel daarvan was om ‘n program te ontwikkel om hulp te verleen aan versorgers van individue gediagnoseer met bipolêre versteuring. Die navorser het haar navorsing gerig aan die hand van Rothman en Thomas (1994) se intervensie ontwerp en ontwikkelingsmodel (D&D) deur gebruik te maak van kwalitatiewe en kwantitatiewe metodes. Na afloop van die analise van die kwalitatiewe data, is ‘n unieke psigo-maatskaplike opvoedkundige program, die SEE-SAW program, ontwikkel en toe geïmplementeer. Die konsep van balans versus wanbalans binne die sisteem is essensieel; die navorser se program het ten doel gehad om beter balans binne die sisteem van die pasiënt en versorger te bewerkstellig. Die gevolgtrekkings het duidelik getoon dat die versorger van die bipolêre pasiënt blootgestel is aan ‘n wye spectrum van behoeftes en uitdagings, maar dat intervensies soos die SEE-SAW program van groot waarde mag wees. / Bipolar disorder (BD) is a chronic, recurrent, serious illness that occurs in 1 % of people globally. Patients might become psychotic, suicidal and sometimes violent. They often need to be hospitalised, even against their will because they may have no insight. Patients may have a comorbid condition such as substance abuse or a personality disorder. They are frequently unable to fulfil their assigned roles of spouse, breadwinner, parent or adult child. Caregivers of patients diagnosed with BD are also affected by the illness and the associated stigma. It becomes very difficult for them when they have to take over the responsibilities and roles of the patient. The nature of this impact on the social functioning of the caregivers, understood from an ecological systems perspective, is relevant for social work in the mental health care field. Discovering more about this impact and developing an intervention to curb it therefore formed the rationale for this study. The integrated biopsychosocial model, within an ecological systems perspective, is being used at the psychiatric institution where the researcher works. This approach therefore also served as the point of departure from which this research was conducted. A mixed methods research approach was utilised to provide a comprehensive analysis of the research problem. The proposed study fell into the category of applied research, due to its aim of designing a programme to assist caregivers of people diagnosed with BD. The researcher directed the study according to Rothman and Thomas’s (1994) intervention design and development model (D&D), using qualitative and quantitative methods. After the analysis of the qualitative data a unique psychosocial educational programme, the SEE-SAW programme, was developed and then implemented. The concept of equilibrium versus disequilibrium in the system is central; the researcher’s programme therefore strove towards better equilibrium within the system of patient and caregiver. From the conclusions it is apparent that the caregiver of the BD patient is exposed to a wide spectrum of needs and challenges, but that interventions such as the SEE-SAW programme may be very helpful. / Thesis (PhD)--University of Pretoria, 2014. / Social Work and Criminology / PhD (Social Work) / Unrestricted

Introduction. L’ostéoarthrose trapézo-métacarpienne (OTM) est l’une des ostéoarthroses (OA) de la main la plus prévalente, la plus douloureuse et la plus handicapante. Bien qu’une approche biopsychosociale soit préconisée dans la gestion de douleur chronique, la majorité des études sur l’OTM ne documentent que ses composantes physiques. La gestion de cette pathologie est souvent jugée sous-optimale, probablement due à une méconnaissance de la maladie et à l’absence de guide de pratique clinique. Ce travail doctoral a visé à (1) documenter l’efficacité des interventions non-chirurgicales et chirurgicales et (2) investiguer les impacts de l’OTM dans diverses sphères de la vie, (3) examiner les facteurs biopsychosociaux qui influencent la sévérité de la douleur et des incapacités fonctionnelles, et (4) documenter l’utilisation des ressources en santé que font les personnes atteintes d’OTM. Méthodologie. Le premier objectif a eu recours à deux revues systématiques en suivant la méthodologie de la Cochrane Collaboration. Pour les deuxième, troisième et quatrième objectifs, une étude descriptive a été menée auprès de 228 participants atteints d’OTM. Ils ont répondu à un questionnaire comprenant diverses échelles dûment validées. Des régressions linéaires multiples ont été utilisées afin d’identifier les facteurs de la sévérité de la douleur et des incapacités fonctionnelles. Résultats. Les résultats des revues systématiques ont montré des preuves scientifiques de qualité faible à modérée qui appuient l’efficacité des interventions suivantes en termes de douleur, d’incapacités fonctionnelles, de satisfaction et/ou d’événements indésirables: (1) injections de solution saline (intra-/extra-articulaire); (2) orthèse thermoplastique du pouce; (3) mobilisation nerveuse; (4) combinaison des exercices/mobilisation nerveuse et articulaire; (5) trapézectomie par voie antérieure ou postérieure; (6) trapézectomie et reconstruction ligamentaire avec ½ flexor carpi radialis (FCR) et tunnel métacarpien; (7) trapézectomie et reconstruction ligamentaire et interposition tendineuse en utilisant ½FCR et tunnel métacarpien; et (8) arthroplastie par distraction d’hématome. Pour ce qui est des résultats de l’étude descriptive, les participants étaient âgés de 63 ans en moyenne et plus de 80% d’entre eux rapportaient de la douleur d’intensité modérée à sévère (≥ 4/10). Leur score moyen au QuickDASH (incapacités fonctionnelles) était modéré (46,1/100). Leur score moyen de qualité de vie physique (SF-12v2) était inférieur à la moyenne de la population générale (41,0 vs 50,0). Près de 30% des participants présentaient des signes cliniquement significatifs d’anxiété et/ou de dépression. La fréquence de la douleur et le niveau d’incapacités fonctionnelles expliquaient 59,0 % de la variance dans la sévérité de la douleur tandis que le sexe, l'intensité de la douleur, la dépression et l'éducation expliquaient 60,1 % de la variance dans les scores d’incapacités fonctionnelles. Acétaminophène, anti-inflammatoires non stéroïdiens oraux, injections intra-articulaires de cortisone, orthèses, massage/exercices et application de chaleur/froid étaient fréquemment employées, tandis que les principes ergonomiques, des aides techniques, de la mobilisation nerveuse et des interventions psychosociales l’étaient beaucoup moins. Conclusions. L’OTM peut engendrer une douleur sévère, affectant divers aspects de la vie quotidienne. Les connaissances générées par cette thèse permettront de bonifier les recommandations des guides de pratique pour l’OTM, ainsi que de faciliter la gestion personnalisée de cette pathologie dans une perspective biopsychosociale. / Introduction. Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent, painful, and handicapping hand osteoarthritis (OA). Although a biopsychosocial approach is advocated in the management of chronic pain, the majority of studies on TMO document only its physical components. The non-surgical management of this pathology is often considered suboptimal, probably due to the poor understanding of the TMO and the absence of a clinical practice guide. This doctoral work thus aimed to (1) document the efficacy of non-surgical and surgical interventions and (2) investigate the impacts of TMO in various spheres of daily life, (3) examine the biopsychosocial factors that influence the severity of pain and functional disability, and (4) document the healthcare resources used by TMO patients. Methods. To answer the first objective, two systematic reviews were conducted using the methodology of the Cochrane Collaboration. For the second, third and forth objectives, a descriptive study was carried out among 228 participants with TMO. They answered a questionnaire comprising various scales duly validated. Multiple linear regression analyses were used to identify factors of pain severity and functional disability. Results. The results of the systematic reviews showed low to moderate quality evidence supporting the efficacy of the following interventions in terms of pain, physical function, satisfaction and/or adverse events: (1) saline injections (intra-/extra-articular); (2) custom-made thermoplastic thumb orthosis; (3) nerve mobilization; (4) combination of exercises/nerve and joint mobilization; (5) trapeziectomy by anterior or posterior approach; (6) trapeziectomy and ligament reconstruction with ½ flexor carpi radialis (FCR) and metacarpal tunnel; (7) trapeziectomy and ligament reconstruction and tendon interposition using ½FCR and metacarpal tunnel; and (8) distraction hematoma arthroplasty. The descriptive study revealed that the participants were on average 63 years old and over 80% of them reported moderate to severe pain (≥ 4/10). Their mean QuickDASH score was moderate (46.1/100) for functional disability. Their mean physical quality of life score (SF-12v2) was lower than the average in the general population (41.0 vs 50.0). Nearly 30% of the participants had clinically significant signs of anxiety and/or depression. Pain frequency and magnitude of disability explained 59.0% of the variance in pain severity while sex, pain intensity, depression and education explained 60.1% of the variance in functional disability scores. Acetaminophen, oral nonsteroidal anti-inflammatory drugs, cortisone injections, orthotics, hand exercise, hand massage and heat/cold application were frequently employed, while ergonomic principles, assistive devices, nerve mobilization and psychosocial intervention were much less used. Conclusions. TMO can cause severe pain and affect various aspects of daily life. The new knowledge generated by this thesis will allow to improve the recommendations for TMO, thus facilitating a tailored management of this pathology from a biopsychosocial perspective.

Children detained in juvenile detention centers in the United States are a unique population. They are neither incarcerated, nor are they free to live in society. Although some popular literature does exist on juvenile detention, such literature is minimal. Further, there are few research studies on this population in any field of inquiry. Indeed the entire subject of juvenile detention has been largely overlooked by research scientists, as well as theologians. The focus of this empirical study is the theology and spirituality of children in a single juvenile detention center in New Jersey, US. Currently, there are no studies on this topic. This study begins to address that void and represents the first theological research of its kind on this population. The methodological approach of the thesis is multi-disciplinary. While the study addresses theology and spirituality as separate categories, it also integrates theology with research in psychology and clinical mental health. The project itself consists of 200 individual, face-to-face interviews with male juvenile residents detained in the Ocean County Juvenile Detention Center, Toms River, New Jersey, US. An original questionnaire has been developed by the author as a research tool. This empirical research adds to the academic literature on children in juvenile detention centers in the United States and recommends ways that staff may communicate with children to begin a theological dialogue. Further, this thesis offers a specific methodology and research tool to be duplicated for use in other juvenile detention centers toward working with children in a concrete, evidence-based, spiritual context. v This study also includes a chapter on the evolution of the author’s spirituality and theology in the course of the project and attempts to locate the self of the researcher within the study. Finally, this thesis presents an outline for a new hermeneutic in working with children in a juvenile detention setting. This new approach represents a practical step toward bridging an existing gap between a stated need for a new hermeneutic for working with children in theological literature and its inception. / Philosophy, Practical and Systematic Theology / D. Th. (Practical Theology)

Text in English / Interactive health communication between the health-care professional (HCP) and patient relationship for diabetes health-care positively contributes to patient-centred care. Hence individual patient concerns are addressed and catered for in the medical system. The purpose of this study was to analyse in-depth how HCP-patient relationships and HCP-HCP teamwork dynamics positively contribute to effective diabetes patient care and treatment adherence. Different health communication models and theories were reviewed and a conceptual framework was developed from the literature. A qualitative case study approach was used to collect data at Stanger Hospital’s diabetes clinic. Data was collected using three different methods, namely in-depth interviews with HCPs and patients individually, observations conducted at the clinic analysing both the HCPs and patients, and finally, documentation that emerged as a third data collection method where patient files and diabetes educational material were analysed at the clinic. Triangulation by means of the three methods ensured that reliable, valid and credible data was collected in the field. Diabetes health-care and treatment management are affected by the social context/social system which includes family and culture. These social factors are acknowledged as core in the literature. However, a single comprehensive health communication model did not exist solely in this regard. The data indicated that at the Stanger Hospital’s diabetes clinic, patient-centred (individual tailor-made treatment plans) care was only implemented after patients had defaulted treatment for reasons linked to their social circumstances. The findings of the study indicate that teamwork was favoured in the HCP-HCP relationship at the diabetes clinic, and that this made a positive contribution to effective diabetes patient care. HCPs were overburdened at the clinic since patient numbers were high and there were staff shortages. The patients’ empirical data indicated that interactive communication positively contributed to their medical concerns being catered for at the diabetes clinic, but this tended to occur only after non-adherence. Patients required care and support from HCPs in order to learn to accept diabetes and manage their illness. / Sociology / D. Litt. et Phil. (Sociology)