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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Integrative medicine (IM) is a unique clinical paradigm that may be applied across numerous healthcare professions and diverse settings. With its focus on whole person health and lifestyle medicine, it advocates utilizing complementary and alternative medicine in addition to traditional treatments in order to achieve an individual’s optimal wellness. Literature supports how significantly this distinctive, promising field of practice can help reduce overall healthcare costs, alleviate the heavy burden of chronic disease, bolster efforts focused on preventive measures, and improve both patient outcomes along with practitioner wellbeing. In order to meet a growing demand for easily accessible, ongoing professional education in IM, the Arizona Center for Integrative Medicine launched an innovative curriculum called the Integrative Medicine in Residency (IMR). This online, two hundred hour, integrative course premiered with eight Family Medicine Residencies across the United States. The purpose behind this study was to aid in developing an appropriate compilation of instruments for a long-term follow‐up questionnaire for IMR graduates, distribute the survey to a trial cohort, and present a summary of the pilot survey results. The instrument was developed in order to: provide feedback on the course, aid in future program modification, determine how graduates implement what they learned through IMR, identify barriers to care, and help distinguish areas where physicians may need additional support to better incorporate IM into practice. The final forty‐four‐question survey, with quantitative and qualitative measures, was distributed in 2015 over three months to residents that graduated between 2011‐2014 via their program directors. All candidates were sent an email with an embedded link to Survey Monkey. Through this series of online, self‐reported responses, the questionnaire was filled out in real time and results were auto‐populated into a secure excel file for further statistical analysis. Our trial cohort attained valuable responses from thirty‐one graduates. Results demonstrated that students were largely satisfied with their education and pleased with the personal and professional impacts following their IMR training; however, barriers to care most notably reported were time, cost, and patient receptivity. This study emphasizes the importance of providing easy access to ongoing IM education for physicians, while also highlighting the equal importance of future research into how to better support healthcare providers seeking to provide the comprehensive IM therapy all patients deserve.

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M.Com. (Industrial Psychology) / Please refer to full text to view abstract

This paper investigates the nature of company investment in training. A survey was undertaken in 2007 of 106 large companies operating in South Africa to examine the size of expenditure on training by these firms, the beneficiaries of the training; and investigate firms’ attitudes towards such programmes. Both the level of firm spending, and the proportion of payroll it amounts to are significant. The study reveals that businesses are acutely aware of the risks of skills shortages and their role in mitigating the risks to themselves. It also finds that investment into training and development is directly and largely driven by a need to increase productivity, profitability, and sustainability as companies try to proactively address a lack of skilled labour.

A research report submitted to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science. Johannesburg, 2017 / Background: The early childhood years, is an important period in a person’s formative life. These are the foundational years for development. There are many intrinsic and extrinsic factors that can negatively affect childhood development. Assessing the development of children is important. If a problem is detected, prompt intervention may prevent further impairments. The Platfontein community is a San bushmen community consisting of the !Xun and Khwe tribes. This is a very poor community that faces many challenges. Of these challenges, many have the potential to hinder healthy childhood development. The current level of development of healthy children in the Platfontein community is not known. This was a descriptive cross sectional study. A sample of convenience was used as all children that attended the crèches in the Platfontein community were invited to participate in the study. The objectives of the study were as follows 1) to determine whether the children that attend the crèches in the Platfontein community present with motor developmental delay 2) to determine the demographics (including morbidities) and anthropometric data of the study participants, 3) to determine the level of motor development in children between the ages of three and six years who attended the local crèches in the Platfontein community, 4) to establish the nature of the relationship between the existing morbidities and the motor development of the children attending the crèches in Platfontein and 5) to establish if there was a difference in motor development of children assessed between the two crèches, the two tribes, 6) to compare the motor development of the children attending the crèches in the Platfontein community to that of children in other national or international studies. Methods: The Movement Assessment Battery for Children-2 (M-ABC2®) was administered to determine the motor development of the children attending the !Xun and the Khwe crèches. Demographic and anthropometric data were also collected. Microsoft Office Excel 2007 and the SAS system statistical programme were used to analyse the data. The Fishers exact test was used to compare the morbidities between the two crèches as well as the association between the morbidities and the M-ABC2® percentile rank. The final M-ABC 2® categories were compared using the Chi-square test. A p-value of≤ 0.05 was deemed statistically significant. Results: Demographic information was obtained for 64 participants, anthropometric data for 63 participants and 54 M-ABC-2® were successfully completed. In total 54% (n=29) participants did not have a risk for motor developmental delay, 24% (n=13) were at risk for motor developmental delay and 22% (n= 12) had a definite motor developmental delay. The test result of the manual dexterity subcategory was the task of most concern as 68.5% of the sample scored at or below the 5th percentile of the M-ABC2® manual dexterity components. Statistical analysis revealed no relationship between the following morbidities: malnutrition [p=0.19], stunting [p= 1.00] and a history of Tuberculosis (TB) [p=0.49] and motor development. There was no statistical significant difference between the M-ABC-2® scores of the children attending the Khwe and the !Xun crèches. Comparing these results too other South African studies, this sample scored much lower. Buys (2014) reported that 85% did not have a risk for developmental delay and that 15% were at risk for, or had a developmental delay. Gritzman (2012) reported that 80% did not have a risk for motor developmental delay and that 20% were at risk or impaired. The socio economic statuses of the samples in both studies were of a higher status than those of the Platfontein sample. Comparing the results to Brazilian studies, this sample also scored lower. Valentini et al (2012) reported that 64.2% of children in the study population did not have a risk for developmental delay and that 35, 8% were at risk for or had a developmental delay. Valentini, Clark and Whitall (2014) reported that 63.3% of children in the study population did not have a risk for developmental delay and that 36.7% were at risk for or had a developmental delay Conclusion: There is a motor developmental delay of the children attending the crèches in the Platfontein community as measured by the M-ABC-2® and when compared to national and international studies. An intervention programme is advised. / MT2017

South Africa (SA) needs a suitable tool to evaluate child development as no such tool exists at present. Well known standardised tests are designed in First World Countries but pose problems when used on different populations. The Bayley Scales of Infant Development, a tool designed and normed in the United States of America (USA) is considered to be the gold standard in infant assessment. The revised and updated, 3rd edition was published in 2006. No studies have been done on its use on populations other than the USA. The USA and SA populations are very different and therefore may perform differently on developmental tests since previous research has shown that African infants perform better than USA infants. The main aim of this study was to use the Bayley Scales of Infant and Toddler Development III (Bayley-III) to evaluate the performance of a cohort of black urban African infants in South Africa, in an effort to determine whether it is a suitable tool for use on this population. The Hypothesis was that SA and USA children perform similarly on the test. Other objectives included assessing whether gender or anthropometric indicators influence performance. The revised 3rd edition of the Bayley Scales of Infant Development (Bayley-III) was used to assess the performance of 122 black African infants at several urban clinics in Gauteng, South Africa. The sample consisted of infants falling into four age categories; 3, 6, 9 and 12 months. SA scores were compared to USA norms. Scores were compared across age groups, subtests and sex. Height, weight and head circumference was also measured, converted into z-scores and correlated with test scores. Overall the SA mean score was 103.4, which is statistically significantly higher (p=0.0007) than the USA mean of 100.For subtests, the mean score was 99.7 for the cognitive, 106.8 for the language and 103.5 for the motor subtests as opposed to 100 for the USA. Therefore the results of this study showed that SA scores were statistically significantly higher than the USA norms. Gender differences in scores for specific subtests were found, indicating that girls and boys perform differently developmentally at different ages. However this analysis was at subgroup level with individually small numbers and further research is required to investigate this. Anthropometric indicators such as height, weight and head circumference were found to have no significant association with scores on the test, indicating that growth had no effect on development in this population Although the overall SA mean (103. 4) was statistically significantly higher than the USA mean (100), clinically the difference is small when one considers the variability of development. Developmental milestones can be reached within a range of months and can vary considerably. The Bayley-III is therefore a suitable tool to use on this population. More research is recommended to assess a larger more diverse group, including all age groups for which the Bayley-III caters, as well as on all population groups in SA.

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