Seulement une minorité d’adolescents qui consomment des substances psychoactives développe des problèmes significatifs reliés à cette consommation. Il importe donc de connaître et de comprendre les processus par lesquels se développe la consommation problématique afin de pouvoir la prévenir. Cette étude examine le rôle des symptômes dépressifs et des relations sociales dans le développement de la consommation problématique à l’adolescence. Plus précisément, elle vise à déterminer, à l’aide d’un devis longitudinal corrélationnel prospectif, si le soutien des pairs, le soutien des parents et la qualité de la relation maître-élève ont des effets modérateurs protecteurs sur la relation entre les symptômes dépressifs et la consommation problématique. L’échantillon utilisé pour cette étude est tiré de la Stratégie d’Intervention Agir Autrement et comprend 4473 adolescents. Des régressions linéaires multiples ont été effectuées et ont démontré que les symptômes dépressifs et le soutien des parents augmentent le risque d’une consommation problématique, alors que le soutien des pairs le diminue. De plus, les résultats confirment le rôle protecteur du soutien des pairs, mais indiquent que le soutien des parents exacerbe le lien entre les symptômes dépressifs et la consommation problématique. Par ailleurs, la qualité de la relation maître-élève est associée à une consommation moins problématique uniquement chez les jeunes qui n’ont pas beaucoup de symptômes dépressifs. Les implications de ces résultats sont discutées. / Of adolescents who use drugs, only a minority develops significant problems related to this drug use. It is then relevant to know and understand the processes by which this problematic consumption develops itself in order to be able to prevent it. This study examines the roles of depression symptoms and social relationships in the development of problematic drug use at the adolescence. More precisely, it aims at determining, with the help of a prospective correlational longitudinal design, if peers support, parental support and the quality of the teacher-student relationship have moderator effects on the relationship between depressive symptoms and problematic drug use. The sample used for this study is taken from the Stratégie d’Intervention Agir Autrement and is comprised of 4473 teenagers. Multiple linear regressions were completed and showed that depressive symptoms enhance the risk of a problematic drug use to be developed, whereas peers support impairs it. Contrary to what was expected, results show that parental support enhances the risk of developing a problematic drug use and that the teacher-student relationship has no significant impact. Moreover, peers support has a protective role, parental support intensifies the relationship between depressive symptoms and problematic drug use, whereas the quality of the teacher-student relationship attenuates it.

No description available.

PhDPH / Department of Public Health / Substance use/abuse is a persistent public health problem in tertiary institutions around South Africa. Alcohol and illegal drugs are the most commonly-used substances by youths in tertiary institutions, including student nurses at the Limpopo College of Nursing (LCN). This study sought to develop a model to prevent substance use/abuse by student nurses at the LCN, South Africa. A convergent parallel mixed-method was used to collect and interpret the data. A phenomenological research approach was utilized for gathering data from the lecturers, student affairs officers and student nurses in the qualitative design which was explorative and descriptive in nature. The population comprised of student nurses, lecturers and student affairs officials who were purposefully selected. Data were collected through unstructured in-depth interviews and analyzed through Tesch’s open-coding steps for qualitative empirical research to develop themes and categories. Data generated the following themes: The Consequences of Socialization Factors on the Incidence of Substance Use/Abuse by Student Nurses and The Effect of Environmental Factors on the Incidence of Substance Use/Abuse by Student Nurses. Within each theme, sub-themes emerged. Trustworthiness of the collected data were ensured. A quantitative design was employed to collect data from all student nurses in five campuses of LCN. A stratified sampling technique was used to select respondents and structured questionnaires were used to collect data. A total of 445 questionnaires were collected. Quantitative data were analyzed numerically and through descriptive and correlation statistics using the Statistical Package for the Social Sciences (SPSS) version 24. The results showed that substance use/abuse is more prevalent among students of the age group of between 21 and 24 years that represented the majority in LCN. Data were analyzed independently for which a convergent analytic approach was used to merge the data sets. Validity and reliability were ensured. Ethical considerations were adhered to. The overall findings highlighted that substance use/abuse by the student nurses was widespread. Various factors, including behavioural, environmental and student earning stipend, have contributed to the problem. The concept “prevention” was analyzed using Walker & Avant’s (2014) steps. The results of both the empirical study and concept analysis formed the basis for model development. The framework of Dickoff, James and Wiedenbach (1963) was used to develop a model. The developed model was validated by the group using a close-ended checklist, analyzed using simple descriptive statistics. The model was in accordance with the legislative provisions of the LCN lease agreement, Higher Education Act as well as the National Institute on Drug Abuse (NIDA, 2003). / NRF

Drug abuse is a very common problem these days; and this problem is especially rampant among the young people of South Africa. Early problems in family management, the antisocial behaviour of the child, and peer pressure and rejection ignite the early onset of substance abuse. Treatment programmes and therapeutic methods to treat chemical dependency are available and utilised, but the high relapse rate and lack of support from family members and dysfunctional families, as well as the fears and challenges expressed by in-patient youth about being reintegrated with their families and a lack of supporting literature in this regard remain a cause for concern and need to be considered by the social work profession in order to plan effective intervention strategies. In response to this situation a research project was undertaken with the purpose of exploring and describing the perceptions, expectations, fears and needs of chemically dependent youth in a rehabilitation centre about being integrated into their family systems in an attempt to forward recommendations to assist social workers in rendering effective therapeutic services to service users in rehabilitation centres who have a substance abuse problem. A qualitative approach was utilised following an explorative, descriptive and contextual research design. The study was conducted at an in-patient rehabilitation centre called the Dr Fabian and Florence Ribeiro Treatment Centre in Cullinan, Gauteng Province in South Africa. Data were collected by means of semi-structured interviews. A sample of participants was selected by using purposive sampling from a population of service users in the Dr Fabian and Florence Ribeiro Centre who are chemically dependent. Data were analysed according to the framework provided by Tesch (cited in Creswell, 2003). Guba‘s model (cited in Krefting, 1991) was employed for data verification. The research findings point to the fact that participants had both negative and positive perceptions about going back to their respective families. On the one hand, there were negative perceptions shared. These were founded on a feeling of worry about the fact that their families criticised them a lot or that their families would not accept that they had changed, would still treat them like addicts, and not trust them. Furthermore, they feared relapse, triggers in their environment and family members who were abusing a substance. On the other hand, some participants perceived the reintegration with their families, following treatment, in a positive light as they were looking forward to joining them again after being in v treatment for three months.They were excited about the fact that they had been granted an opportunity where they could show their families that they have changed and have the chance of starting a new life. Moreover, part of the research findings point to the fact that some of the participants‘ families had already organised employment, a place for them to stay and financial assistance. From the research findings it became clear that the participants harboured the following expectations towards the families with whom they were reuniting: They need the family‘s love and support; to trust them again: to mend severed relationships and spend quality time together; to provide practical and material help, and for the family to be educated on addiction and for the family to accompany them to aftercare. In terms of research findings directed at the site (i.e., the rehabilitation centre) where the research was conducted the participants indicated that they needed more activities, they would like their families to be part of their recovery process, and expressed the need for individual sessions apart from group sessions and aftercare services. In terms of recommendations it was apparent that community members, community organisations and the government sector need to develop and launch chemical substance abuse prevention and awareness programmes through various media, (i.e. articles in newspapers, magazines, talks and documentaries on radio and television, community gatherings and meetings in all communities). Moreover, it is recommended that parents should take responsibility for monitoring and countering substance abuse in their children. Families need to be empowered through talks, attending parenting skills training, workshops and group meetings. South Africa needs to develop a policy focusing on families. Furthermore, it is recommended that treatment centres need to provide individual sessions, family therapy, aftercare services and more extramural activities, if these are not included in their treatment regime. / Social Work / M.A. (Social Science)

This study was designed to understand the meaning of the lived experiences of incarcerated male juveniles who had committed drug-related crimes and to suggest guidelines for their rehabilitation with specific reference to their health care needs. In order to achieve these objectives, the researcher used Parse’s (1998) Theory of Human Becoming as a theoretical framework for the study and Parse’s (1998, 2005) phenomenological-hermeneutic research method. This study was restricted to three juvenile correctional centres in the Gauteng province, Republic of South Africa (RSA). A sample of 15 male juveniles (5 at each of the three juvenile correctional centres) was used for the purpose of individual dialogical engagements with the participants. Focus group interview sessions were held with two groups (5 members per group) at two identified juvenile correctional centres. A qualitative content analysis according to methods recommended by Graneheim and Lundman (2004) was performed on the data that was collected from the individual dialogical-engagements and the focus group interviews. The researcher attempted to elucidate the meanings that the participants attached to their experiences of incarceration as narrated by them and analysed the data according to Parse’s (1998; 2005) phenomenological-hermeneutic method comprising of extraction-synthesis and heuristic interpretation. The findings of this research confirm that problems of drug abuse and criminal activity represent a multifaceted, complex and often intractable phenomenon. The research also confirmed that the participants suffer from a variety of emotional and psychological problems such as depression, anxiety, fear, guilt, remorse, regret and a craving for the drugs that they had abused before their incarceration. It appears that the participants find it extremely difficult to deal effectively with these disorders on their own and that they are generally averse to asking for professional help and assistance. Interventions to alleviate these problems are crucial for the success of the current rehabilitation programmes being pursued in the correctional centres where the participants are accommodated. / Health Studies / D. Litt. et Phil. (Health Studies)

The proposed research aims to explore and describe the experiences, challenges and coping strategies of fathers, parenting children, abusing illegal substances. The use and abuse of illegal substances became national and global dilemmas. The impact and damage caused when drugs are widely used over time is irreversible, as it influences the lives of users and those of their families, their communities, and the country. This research provides an opportunity for fathers, parenting children, abusing illegal substances to share their experiences and challenges. Data are collected by conducting in-depth and face-toface interviews with the participants. The collected data are analysed by following the eight steps of Tesch in Creswell (2009:186). Data are analysed using Lincoln and Guba’s model of trustworthiness of qualitative research for validation. The study endeavours to obtain an understanding of the experiences and challenges encountered by fathers, parenting children, abusing illegal substances and how social workers could assist in addressing this dilemma. / Social Work / M.A. (Social Work)

This study examines changes over time in 40 different Sherlock Holmes films and 39 television series and movies spanning from 1900 to 2017. Quantitative observations were mixed with a qualitative examination. Perceptions of law enforcement became more positive over time, the types of crime did not vary, and representation of race and gender improved over time with incrementally positive changes in the representation of queer, mentally ill, and physically handicapped individuals. The exact nature of these trends is discussed. Additionally, the trends of different decades are explored and compared. Sherlock Holmes is mostly used as a vehicle for storytelling rather than for the salacious crimes that he solves, making the identification of perceptions of crime in different decades difficult. The reasons for why different Sherlock Holmes projects were created in different eras and for different purposes are discussed.

MA.CRM / Department of Criminal Justice / See the attached abstract below

Whoonga is a relatively new addition into the drug market. The need for this study was prompted by the devastating effects this new arrival has had in the lives of young people addicted to it. The purpose of this study was to investigate the effects of whoonga on the learning of affected youth in Kwa-Dabeka Township. This study adopted a qualitative method and employed a phenomenological approach to explore the experiences of participants with regard to whoonga use and their learning. Data was collected through purposive sampling. Interviews were conducted, using semi-structured and unstructured questions with the help of an interview guide. Observations were also conducted to collect more data. This was done in the classroom during teaching and learning, as well as outside the classroom during recess. The study employed a social learning theoretical framework on the experiences of participants with regard to the use of whoonga. Four participants from one high school in Kwa-Dabeka Township were involved in the study. Themes that emerged from the study were that all the participants were totally ignorant of what they were getting themselves into before they started using whoonga. Peer pressure, coupled with curiosity made their decision to use whoonga easy. Challenges that participants face now on daily basis are far beyond their young age. The findings have indicated that learning is a situation of near impossibility for the participants. The findings have also depicted a picture of young people who are trapped in a vicious cycle of one of life‟s harshest living conditions in terms of their encounters with parents, school and the communities they come from. Despite their hopes for a brighter future one day, participants see no end in sight for their suffering at the hands of this unforgiving, destructive drug at this point in time. / Educational Studies / M. Ed. (Socio-Education)

Introduction. L’ostéoporose est une maladie chronique silencieuse jusqu’à la survenue de fractures de fragilisation, qui sont des prédicteurs importants de récurrence de fractures. La prise en charge des fractures de fragilisation au moyen de traitements de prévention secondaire des fractures est sous-optimale dans la population. Dans le but de pallier à cet écart dans les soins, de multiples initiatives de prévention secondaire des fractures ont été étudiées. Ces services ont souvent un niveau d’intervention de faible intensité et/ou un accès à des soins à court terme. Objectifs. Cette thèse comprend quatre volets liés à l’implantation d’un Service de Liaison pour Fractures (FLS) de haute intensité d’intervention ayant un suivi systématique à long terme. Le premier objectif vise à rapporter la performance de l’intervention au moyen d’indicateurs clés. Le second objectif consiste à mesurer l’usage des traitements pour l’ostéoporose dans le FLS. Le troisième objectif est d’identifier les trajectoires de soins par la présence aux visites de suivi systématique dans le FLS. L’objectif final consiste à évaluer le rapport coût-utilité en utilisant des groupes de trajectoires de soins en comparaison à la pratique clinique usuelle. Méthodologie. Un FLS appelé le programme Lucky BoneTM a été approuvé avec un devis d’étude de cohorte prospective et implanté dans deux cliniques externes d’orthopédie en milieu hospitalier. L’intervention était multifacette ; 1) identifier les femmes et les hommes de 40 ans et plus avec une fracture ostéoporotique, 2) investiguer pour la fragilité osseuse, 3) initier un traitement préventif, et 4) intégrer les sujets à un suivi systématique de deux ans. Des données cliniques et administratives ont été collectées pour mesurer l’impact du programme. Le premier volet de cette thèse rapporte la performance du FLS. Un devis de cohorte permettait de mesurer les indicateurs clés de performance (ICPs) ; les taux d’investigation pour la densité minérale osseuse (DMO), d’initiation de traitement, de participation au suivi, et le taux d’incidence de fractures subséquentes. Les changements des valeurs sériques de biomarqueurs osseux et des scores de questionnaires sur la qualité de vie/capacité fonctionnelle/douleur étaient également mesurés au moyen de modèles à effets mixtes. Le second volet de cette thèse mesure les taux de persistance et les niveaux d’adhésion (proportion de jours couverts (PDC) > 80% = bonne adhésion) au traitement sur un et deux ans de suivi. Le troisième volet de cette thèse consiste à identifier les groupes de trajectoires de soins basées sur les fréquences des visites de suivi systématique au moyen de modélisation pour les trajectoires par group-based. Le dernier volet vise à mesurer l’impact économique de ces ii groupes de trajectoires de soins par rapport à un groupe simulé de pratique clinique usuelle, qui était modélisé au moyen d’une analyse coût-utilité et des modèles analytiques de Markov. Résultats. Des 532 participants, 85.7% étaient des femmes et l’âge moyen était de 63±11 ans. Premier volet : Les résultats de la mesure des ICPs étaient les suivants : taux d’investigation de la DMO de près de 86%, taux d’initiation de traitement de > 86%, présence à au moins une visite de suivi pour 83.6% des sujets (22.2% de présence à toutes les visites) sur deux ans, et un taux d’incidence de fractures subséquentes de 2.6 par 100 personnes-années. Les biomarqueurs osseux ont grandement diminué en seulement six mois, suggérant une inhibition de la résorption osseuse par le traitement. Une amélioration significative de la capacité fonctionnelle a été observée dans le temps (14%-64%). Second volet : Les taux de persistance au traitement sur un et deux ans étaient de 66.4% et 55.6%, respectivement. Les proportions de patients avec un PDC > 0.8 sur un et deux ans étaient de 64.2% et 62.5%, respectivement. Troisième volet : Trois groupes de trajectoires de soins ont été prédits et interprétés comme une utilisation élevée (UE, 48.4%), une utilisation intermédiaire (UI, 28.1%) et une utilisation faible (UF, 23.5%). Quatrième volet : Les ratios coût-utilités incrémentaux des groupes UE, UI et UF par rapport à la pratique clinique usuelle étaient de 3,600$, 22,000$ et 74,000$ par année de vie pondérée par la qualité gagnée, respectivement. Conclusions. Un FLS ayant une haute intensité d’intervention et un suivi systématique des patients avec une fracture de fragilisation a entrainé des taux d’investigation et de traitement élevés, un faible taux de récurrence de fractures, mais une participation au suivi qui pourrait être améliorée sur deux ans. Plus de la moitié des participants étaient toujours traités et avaient un usage optimal de ces traitements après deux ans. Près de la moitié des sujets appartenaient à un groupe de trajectoire de soins élevée, ce comportement s’avérant coût-efficace. La principale limite de ce programme de recherche est le manque d’un groupe de contrôle. Un essai pragmatique randomisé contrôlé est à envisager pour supporter ces résultats. Les pistes de recherches futures incluent l’investigation des comportements reliés à l’utilisation des soins chez les patients à haut risque de refracture, et ce, au moyen d’issues qualitatives centrées sur le patient. / Introduction. Osteoporosis is an asymptomatic chronic disease until the development of osteoporosis-related fractures. Furthermore, the occurrence of a previous fragility fracture strongly increases the risk of subsequent fractures. Given the current suboptimal management of fragility fractures in usual clinical practice, several secondary fracture prevention strategies have been studied. However, continuous access to care is typically not central to these interventions as they mostly involve only one visit to a specialized healthcare professional. Objectives. This thesis had four main objectives derived from research questions focusing on the implementation of a high-intensity Fracture Liaison Service (FLS) with a systematic follow-up of two years. The first objective was to measure the performance of the intervention using key indicators. The second objective was to report on the utilization patterns of osteoporosis drugs. The third objective was to identify trajectories of compliance to follow-up care. The last objective was to evaluate the economic impact of trajectory groups of compliance to follow-up care with respect to usual care. Methodology. An FLS intervention called the Lucky BoneTM Program was approved as a prospective cohort study and implemented in two hospital-based outpatient orthopedic clinics. The intervention encompassed four components: 1) the identification of fragility fractures in women and men aged 40 years or older, 2) the investigation for bone fragility, 3) the initiation of treatment, 4) the integration of patients to a two-year systematic follow-up. Both clinical and administrative data were collected prospectively and retrospectively to measure the impact of the intervention. The first component of this thesis reported on the performance of the FLS. A cohort study design allowed for the measuring of key performance indicators (KPIs) such as the rates of bone mineral density (BMD) investigation, treatment initiation, and follow-up participation over two years, as well as the incidence rate of subsequent fragility fractures. A secondary outcome was to longitudinally measure the change in bone biomarker levels and questionnaire scores using mixed-effect models. The second component of this work aimed to measure patterns of osteoporosis drug use with a cohort study design by reporting 1 and 2-year persistence rates and compliance levels (compliance being defined as a proportion of days covered (PDC) > 0.8). The third component of this thesis consisted in the identification of trajectory groups of compliance to follow-up care using group-based trajectory modelling (GBTM). The fourth and final component iv of this thesis was a cost-utility analysis using Markov decision analytic models to evaluate the economic impact of trajectory groups of compliance to follow-up care with respect to a usual care in a simulated cohort. Results. Of the 532 fragility fracture patients that provided informed consent, 85.7% were female and the mean age was 63±11 years. First component: The FLS intervention yielded the following KPIs: BMD results were collected in almost 86% upon ordinance in the FLS, a prescription for anti-osteoporosis therapy was handed to > 86% of participants, 83.6% of subjects attended at least one follow-up visit (22.2% attended all visits) over two years, and the subsequent fracture incidence rate was of 2.6 per 100 person-years. Biomarker levels significantly decreased after six months in the FLS, supporting the inhibition of bone resorption induced by therapy. Questionnaire scores showed significant improvement of functional capacity over time (14%-64%). Second component: The one and two-year persistence rates were 66.4% and 55.6%, respectively. The proportions of patients with a one and two-year PDC > 0.8 were 64.2% and 62.5%, respectively. Third component: Through GBTM, three follow-up compliance trajectory groups were identified and consisted of high followers (HF, 48.4%), intermediate followers (IF, 28.1%) and low followers (LF, 23.5%). Fourth component: The incremental cost-utility ratios of the HF, IF and LF trajectory groups relative to usual care were $3,600, $22,000 and $74,000 per quality-adjusted life year gained, respectively. Conclusions. A high-intensity FLS intervention with a systematic follow-up of fragility fracture patients allowed ongoing access to care over a two-year period. This resulted in high rates of investigation and treatment initiation, a low subsequent fracture rate, but follow-up participation could be improved over two years. More than half of the patients were persistent and compliant to therapy after two years. Almost half the cohort had a high compliance to follow-up care trajectory and this behaviour was found to be very cost-effective compared to usual care. The main limitation of this research program was the lack of a control group to assess effectiveness. A large pragmatic randomized controlled trial is needed to support these results. Further research should focus on understanding behaviours related to compliance to care using patient-centered outcomes, especially considering the high risk of fractures over time.