The health status of a substantial number of South African children can be classified as “children at risk” (Luiz, 1999) as the majority of children are influenced by factors such as poverty, poor living conditions and the HIV/AIDS epidemic. These are only some of the influences that contribute significantly to the health status of South African children and consequently their development. It can thus be argued that developmental assessment is imperative in the South African context. One of the most important reasons are that children with special needs in South Africa can be identified and given the opportunity to catch up developmentally and cope successfully as opposed to those who are identified much later (Foxcroft & Roodt, 2006). Furthermore, children in South Africa must begin Grade one in the year in which they turn seven. They may only enter grade one if the school has an opening and if the necessary evidence is provided to the Department of Education that the child will be able to cope with the demands of formal schooling (Department of Education, 2002). Developmental assessment measures therefore needs to be appropriate, accurate and informative in the modern South African context. The need for a measuring instrument to assess children’s overall development and thus their developmental readiness to cope with the demands of formal schooling could be satisfied by the Griffiths Mental Development Scales – Extended Revised (GMDS-ER). This recently revised measure has not been normed on a representative, contemporary South African sample. The purpose of the study was therefore to generate information on the applicability of British norms for the contemporary South African population. This study compared and explored the performance of South African and British children aged 5-years and 6-years on the Griffiths Mental Development Scales - Extended Revised (GMDS-ER). A contemporary South African sample was obtained by testing children between the ages of 5-years and 6-years on the GMDS-ER, whilst the British sample was drawn from the United Kingdom and Eire standardization sample. The British sample was screened for normality and a similar process was followed to establish normality for the South African sample. A matched simple frequency distribution technique (taking into account age, socioeconomic status and gender as variables) was employed to approximate the equivalence between the samples. The profiles were compared by conducting an independent sample t-test with subsequent post hoc analyses to explore potential differences in the performance of the two samples. The major findings of the present study were as follows: 1. There is a significant difference between the South African and British children’s overall developmental profiles (as measured by the GMDS-ER). 2. Generally, South African children performed better on the Locomotor subscale and the Personal Social Subscale (although not statistically significant), whilst British children performed statistically better on the Language, Eye and Hand Co-ordination, and Practical Reasoning Subscales. 3. No significant differences were found for the Performance Subscale which could indicate that South African and British children’s performances on this scale are similar. Further investigations into the applicability of the GMDS-ER for the contemporary South African context are recommended and the establishment of South African norms for clinical utilization is essential. Caution with regard to the utilization of the British–based norms in the South African context is final recommendations.

Background: Negative outcomes from fetal exposure to maternal dug use include Neonatal Abstinence Syndrome (NAS) and altered development, the unpredictability of which suggests a biological element as yet not accounted for. The manner in which the human placenta protects the fetus from xenobiotics such as drugs of misuse is not completely characterised. However, Adenosine Triphosphate Binding Cassette (ABC) transporters in placentae have demonstrated their ability to efflux xenobiotics away from the fetal vascular compartment leading to lower concentrations than in the maternal compartment and some commonly used drugs have been shown to be substrates for these proteins, e.g. methadone. It is suggested that polymorphisms in the genes that encode these transporter proteins may alter their expression and/or function. Hypothesis- Polymorphisms (SNPs) in the ABC transporters ABCB1, ABCG2, ABCC1 and ABCC2 change protein expression and/or function leading to increased fetal exposure demonstrated by increased signs of NAS and/or altered development. Objectives: To determine if genotype alters protein expression and whether there is a relationship between the level of placental multidrug resistance protein P-glycoprotein (P-gp), Breast Cancer Resistance Protein (BCRP), Multidrug Resistance Associated Proteins (MRP1 and MRP2) expression and neonatal and/or developmental outcomes. Methods: Drug using women were recruited. In the immediate postnatal period placental tissue, cord blood and maternal hair samples were taken. Hair was analysed to determine drug use in the preceding 3 months, immunoblotting determined the level of P-gp, BCRP, MRP1 and MRP2 protein expression. Sequenom MassExtend Array produced genotypes from DNA obtained from cord blood. Infants were assessed for NAS at birth, 3 days and 3 weeks. At 8 months and 1 year development was assessed using the Griffiths Mental Development Scales. Plink was used to determine statistically significant associations between genotype and outcome phenotypes. Results- The level of fetal drug exposure did not predict the need for pharmacological treatment for NAS. 32 polymorphisms with significant associations to outcome measures were identified: 4 SNPs significantly altered protein expression, (3 for P-gp and 1 for MRP1). 41 SNPs were associated with changes across 4 of the 5 GMDS subscales. Discussion: No clear relationship between MDRP protein expression and neonatal outcome was noted. However, fetal genotype did influence the expression of P-gp and MRP1 and genotype across all four proteins was associated with significant changes in the measures of infant development. This was a small study and as such generation of susceptible haplotypes was not possible. However the data generated do support the concept. Further larger and longer term prospective studies, building on the experience reported in this thesis, are necessary to generate more data in order to identify haplotypes leading to increased fetal susceptibility to drug exposure.

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Cette recherche vise à étudier l’impact d’interventions réalisées par les parents dans l’unité néonatale de soins intensifs. Plus spécifiquement, le premier objectif est de documenter les effets différentiels de la Méthode Mère Kangourou « MMK » accompagnée ou non du Massage en incubateur «MI » ou du Massage en Position Kangourou « MPK » et des Soins Traditionnels «ST » accompagnés ou non du massage dans l’incubateur sur la croissance physique mesurée par le poids, la taille et le périmètre crânien pendant une période de 5 et 15 jours dans l’unité néonatale et l’impact à 40 semaines d’âge gestationnel. Le second objectif est de comparer, chez des enfants qui bénéficient de la « MMK » la valeur ajoutée du « MPK » ou du «MI » sur le neuro-développement à 6 et 12 mois d’âge corrigé de l’enfant. Un échantillon total de 198 enfants et leur famille a été recruté de la façon suivante dans trois hôpitaux de Bogota. Dans chaque hôpital, 66 sujets ont été répartis aléatoirement à deux conditions. Ces hôpitaux ont été choisis afin de tester les effets de diverses conditions expérimentales et de diminuer les bais de sélection. Dans chaque hôpital, deux techniques ont été assignées aléatoirement. Il s’agit, dans le premier, de la « MMK & MPK » vs « MMK & MI ». Dans le second, « MMK sans massage » vs « MMK & MI ». Dans le troisième, « MI » a été comparé aux « ST » ce qui implique une absence de contact physique continu des bébés avec leurs parents. Les résultats rapportés dans le premier article sont à l’effet que, dans le premier hôpital, il y a un effet compensatoire de l’intervention « MMK & MPK » sur la perte physiologique du poids de l’enfant prématuré dans les 15 premiers jours de vie avec un impact sur le poids à 40 semaines d’âge gestationnel, sur la durée du portage kangourou et sur la durée d’hospitalisation totale. Aucun effet sur le périmètre crânien ou la taille n’est apparu. Dans le deuxième hôpital, aucune différence significative n’est rapportée pour le poids sauf quand l’intervention est commencée après le 10ième jours de vie alors que l’enfant « MPK» semble grossir mieux que le «MMK avec MI». Finalement, dans le troisième hôpital il n’y a aucun effet du massage sur les variables anthropométriques, le groupe avec MI grossissant moins vite avec un léger impact sur le poids à 40 semaines. Cela pourrait être dû à la perte de chaleur due à l’ouverture de l’incubateur quand l’enfant est très immature. Dans le second article, les 66 enfants de l’hôpital sont répartis aléatoirement dans le groupe « MMK & MPK» vs le groupe « MMK & MI», ont complété, à 6 et 12 mois d’âge corrigé, un test de neuro-développement, le Griffiths. Les résultats à 6 mois ne montrent aucune différence entre les 2 interventions, mais a 12 mois le IQ semble dépendant du nombre de jours d’hospitalisation de l’enfant, cette durée d’hospitalisation correspond au temps que met l’enfant à se stabiliser physiquement et correspond également au temps que mettent la mère et l’enfant à s’adapter à la méthode kangourou. Une fois, l’adaptation kangourou réussie, la dyade mère enfant sort avec l’enfant toujours en position kangourou. Le temps d’hospitalisation correspond au temps que met l’enfant à être éligible à l’apprentissage de la MMK par la mère. À 12 mois les deux groupes montrent des résultats équivalents, mais des différences positives sont apparues pour le groupe « MMK & MPK» dans les sous échelle Coordination Oculo Manuelle et Audition et Langage du test Grffiths. Dans l’ensemble, les résultats suggèrent que la pratique des deux interventions non traditionnelles peut contribuer à une meilleure croissance physique dans nos cohortes. Le gain de poids du bébé, notamment, est affecté par l’intervention MPK (Hôpital 1) ou sans l’ajout du Massage (Hôpital 2). Par ailleurs, le massage en incubateur n’a pas de différence significative en comparaison aux soins traditionnels, ces interventions ont toutefois un impact mineur (tendances) sur le neuro développement à 6 et 12 mois d’âge corrigé dans cette étude. / This research aims to study the impact of interventions by parents in the neonatal intensive care unit. More specifically, the first objective is to document the differential effects of the Kangaroo Mother Care «KMC» with or without the Massage Incubator «MI» or Massage Kangaroo Position «MKP» and Traditional Care «TC» with or without Massage in the Incubator «MI» on physical growth as measured by the weight, height and head circumference during a period of 5 to 15 days in the neonatal unit and impact at 40 weeks gestational age. The second objective is to compare, in children who benefit from the «KMC» value added « MKP» or «MI» on neurodevelopment at 6 and 12 months corrected age of the child. A total sample of 198 children and their families was recruited as follows in three hospitals in Bogota. In each hospital, 66 subjects were randomly assigned to two conditions. These hospitals were selected to test the effects of various experimental conditions and reduce bais selection. In each hospital, two techniques were randomly assigned. In the first hospital, « KMC & MKP» vs. «KMC & MI». In the second, «KMC without massage» vs. « KMC & MI»." In the third, «MI» was compared to «TC» which implies a lack of continuous physical contact babies with their parents. The results reported in the first article are the effect that in the first hospital, there is a compensatory effect of the intervention «KMC & MKP» on the physiological loss of the child's weight early in the first 15 days of life with an impact on weight at 40 weeks of gestational age, the duration of the kangaroo carry and the total hospital stay. No effect on head circumference or size is not appeared. In the second hospital, no significant difference was reported for the weight except when the intervention is started after the 10th day of life while «MMK» child seems to grow better than the «MMK with MI». Finally, in the third hospital there is no effect of massage on anthropometric variables, the group with «MI» slower magnifying a slight impact on weight at 40 weeks. This could be due to the heat loss due to the opening of the incubator when the child is very immature. In the second article, the 66 children from the hospital were randomly assigned to the group « KMC & MKP» vs. the group «KMC & MI », completed at 6 and 12 months corrected age, a neuro-development test, Griffiths. The 6-month results show no difference between the 2 interventions, but 12 months on IQ seems dependent on the number of days of hospitalization of the child, the hospital stay is the time it takes for the child to stabilize physically and also corresponds to the time taken by the mother and child to adapt to the kangaroo method. Once the successful adaptation kangaroo, the mother child dyad out with the child still in the kangaroo position. The hospitalization time is the time it takes for the child to learning the MMK by the mother. At 12 months both groups showed equivalent results, but positive differences emerged for the group «KMC & MKP'' in the subscale Coordination Oculo Manual and Hearing and Language Test Grffiths. Overall, the results suggest that the practice of two non-traditional interventions may help improve physical growth in our cohort. The baby's weight gain in particular is affected by the intervention MKP (Hospital 1) or without the addition of massage (2 Hospital). Moreover, the incubator massage has no significant difference compared to «TC», these interventions, however, have a minor impact (trends) on the neuro development at 6 and 12 months corrected age in this study.

Transition metal and related compounds have been extensively studied over the past several decades. These investigations revealed a wide range of behavior, encompassing colossal magnetoresistance (CMR), high-TC superconductivity, and magnetic semiconductivity, all of which continue to present fundamental challenges to the understanding of such phenomena. There is, however, a close correlation between such characteristics and the appearance of magnetic order. This correlation underlies the present study, which focuses on the magnetic and transport behavior of various Manganese (Mn), Iron (Fe) and Cobalt (Co) containing materials, with particular emphasis on the nature of the magnetic order they display and the critical exponents that characterize the accompanying phase transition. The magnetic and transport properties of two specific systems will be covered: first various doped manganites from the series (La,Pr)1-x(Ca,Ba)xMnO3, and second the magnetic semiconductors Fe0.8Co0.2Si and Ga0.98Mn0.02As. In the manganites, the influence of doping on; (i) the evolution of the metal-insulator transition (MIT) with composition; (ii) the universality class of the magnetic critical behavior associated with the paramagnetic to ferromagnetic transition, which occurs in the vicinity of a MIT with which CMR is associated; (iii) the mechanisms underlying ferromagnetism across the MIT; (iv) the correlation between the appearance of a Griffiths-like phase and CMR, and (v) the origin of Griffiths-like phase have been investigated. Four different systems have been studied: La1-xCaxMnO3 (0.18 ≤ x ≤ 0.27), La1-xBaxMnO3 (x ≤ 0.33), (La1-yPry)0.7Ca0.3Mn16/18O3 (y ≤ 0.85), and Pr1-xCaxMnO3 (x = 0.27, 0.29). In Fe0.8Co0.2Si and Ga0.98Mn0.02As, the scaling between magnetization and conductivity has been the subject of ongoing debate. In bulk Fe0.8Co0.2Si, a novel scaling between the anomalous Hall effect (AHE) and the magnetization enables the anomalous Hall coefficient to be accurately determined. In turn, this enables the universality class for the transition to ferromagnetism to be established independently from the anomalous Hall conductivity. In an epitaxial (metallic) Ga0.98Mn0.02As microstructure, the magnetization has been indirectly determined from the AHE. Subsequent analysis yields magnetic critical exponents consistent with the Mean-Field model, direct support for which had previously been lacking.

Transition metal and related compounds have been extensively studied over the past several decades. These investigations revealed a wide range of behavior, encompassing colossal magnetoresistance (CMR), high-TC superconductivity, and magnetic semiconductivity, all of which continue to present fundamental challenges to the understanding of such phenomena. There is, however, a close correlation between such characteristics and the appearance of magnetic order. This correlation underlies the present study, which focuses on the magnetic and transport behavior of various Manganese (Mn), Iron (Fe) and Cobalt (Co) containing materials, with particular emphasis on the nature of the magnetic order they display and the critical exponents that characterize the accompanying phase transition. The magnetic and transport properties of two specific systems will be covered: first various doped manganites from the series (La,Pr)1-x(Ca,Ba)xMnO3, and second the magnetic semiconductors Fe0.8Co0.2Si and Ga0.98Mn0.02As. In the manganites, the influence of doping on; (i) the evolution of the metal-insulator transition (MIT) with composition; (ii) the universality class of the magnetic critical behavior associated with the paramagnetic to ferromagnetic transition, which occurs in the vicinity of a MIT with which CMR is associated; (iii) the mechanisms underlying ferromagnetism across the MIT; (iv) the correlation between the appearance of a Griffiths-like phase and CMR, and (v) the origin of Griffiths-like phase have been investigated. Four different systems have been studied: La1-xCaxMnO3 (0.18 ≤ x ≤ 0.27), La1-xBaxMnO3 (x ≤ 0.33), (La1-yPry)0.7Ca0.3Mn16/18O3 (y ≤ 0.85), and Pr1-xCaxMnO3 (x = 0.27, 0.29). In Fe0.8Co0.2Si and Ga0.98Mn0.02As, the scaling between magnetization and conductivity has been the subject of ongoing debate. In bulk Fe0.8Co0.2Si, a novel scaling between the anomalous Hall effect (AHE) and the magnetization enables the anomalous Hall coefficient to be accurately determined. In turn, this enables the universality class for the transition to ferromagnetism to be established independently from the anomalous Hall conductivity. In an epitaxial (metallic) Ga0.98Mn0.02As microstructure, the magnetization has been indirectly determined from the AHE. Subsequent analysis yields magnetic critical exponents consistent with the Mean-Field model, direct support for which had previously been lacking.

The main aim of this study was to explore and describe the development and cognitive ability of a sample of children aged six to eight enrolled in specialised education, in the category of specific learning disability (SLD). This was achieved through the utilization of the Griffiths-Mental Development Scales – Extended Revised, the Wechsler Intelligence Scales for Children – Fourth Edition and input from the trans-disciplinary team. A non-probability, purposive sampling method was employed and the sample consisted of eight participants. The multiple case study method was used in order to achieve the aim of the study. Both qualitative and quantitative data were incorporated to provide a holistic description of the participants. Quantitative data was obtained from the Griffiths-Mental Development Scales – Extended Revised, the Wechsler Intelligence Scales for Children – Fourth Edition while qualitative data was obtained from the Biographical Questionnaire, input from members of the trans-disciplinary team, data from the participants‟ archives as well as clinical observations made during the assessment process. The data was analysed according to the domains of childhood development.The results obtained revealed that the general development of the sample as measured by the Griffiths-Mental Development Scales – Extended Revised was average. The Eye and Hand Co-ordination Subscale was the most problematic for the participants. The majority of the sample obtained below average scores on the Wechsler Intelligence Scales for Children – Fourth Edition‟s full scale IQ (FSIQ). The Verbal Reasoning Index and the Working Memory Index yielded the lowest scores amongst the sample. The results indicated that the majority of the participants are stronger with non-verbal as opposed to verbal reasoning. The study revealed that the two measures, the Griffiths-Mental Development Scales – Extended Revised, the Wechsler Intelligence Scales for Children – Fourth Edition complement one another. The developmental and intellectual nature of the measures allow for gaps left by the one measure to be filled by the other. The study highlighted the importance of gaining information from the trans-disciplinary team and not relying purely on psychometric measures. It was made clear through the study that deficits often exist that are not picked up by assessment measures alone. In order to gain a comprehensive, holistic picture of a child, one needs to consult a variety of sources. Questions regarding the classification system of high needs learners as well as the current system of specialised education were raised.

This thesis contributes to the historiography of women in medicine by exploring, in-depth, one small specialty, public health, which, from 1974, offered women doctors working within it equality of opportunity with men for career development. At that time, most women doctors working in the English health service were relegated to junior or support roles, their particular needs for family-friendly working environments being largely ignored. This research examines the reasons behind the development of these equal opportunities and the subsequent rapid trajectory of women doctors in public health, comparing it with the much slower progress made by female colleagues in hospital medicine and general practice. In considering the factors helping or hindering women’s advance in medicine from 1974, it proposes that these changes occurred in public health because the specialty was not tied to the pyramidal model of medicine, developed in the 1930s by senior male doctors for male doctors, which dominated other specialties and which stifled progress. An innovative feature of this research, following women’s entry to consultant and training posts in proportions equal to men in public health, is to highlight their subsequent move into major strategic roles within the health service management structure from the late 1980s. Interviews with senior public health men and women doctors help shed light on how this move was achieved and how women in strategic positions were able to combine high profile careers with domestic responsibilities. Also includes five transcipts of interviews : The five interviewees, whose career stories are presented here - Professor Sian Griffiths, Professor Sheila Adam, Professor Mala Rao, Dr Sue Atkinson and Professor Fiona Sim - were selected, with the help of the Faculty of Public Health, for their considerable achievement in strategic leadership roles in public health practice, whether in leading complex organisation, chairing national policy committees, leading international work, promoting education and development.

Despite the concept of twins and twinning being a highly explored area of research for many years, limited research has been conducted on the comparison of first and second born twin development. The nature of twins leads people to believe that twins will present with similar characteristics, however, this study explores the possibility that due to their ordinal position they could in fact present with differing characteristics and could differ developmentally. The early holistic development of a child influences the rest of their lives. Concerning twins, the development of individuality and self-knowledge is especially important. Theorists, such as Piaget (1950), propose that child development takes place in stages and that although the order in which children proceed through these stages is the same, the pace at which this takes place can vary. The necessity of monitoring the child’s journey through these stages highlights the value of child developmental assessment. This form of assessment needs to be holistic, needs to involve a multidisciplinary team of professionals and needs to utilize assessment measures that are valid, reliable, culture-fair and standardized. The Griffiths Mental Development Scales-Extended Revised (GMDS-ER) is one such measure. This study, focusing on twin development, aimed to contribute and provide valuable information to a larger research project that is currently under way aiming to increase the applicability of the Griffiths Mental Development Scales-Extended Revised (GMDS-ER) in the South African context. The primary aim of the study, however, was to explore and compare the performance of normal first born and second born twins, aged between 2 and 8 years 4 months old, on the GMDS-ER. The purpose of the study was to generate information on the relationship between first born twins’ general development and second born twins’ general development. An exploratory, descriptive quantitative design was used. Participants were selected through a combination of non-probability purposive, convenience and snowball sampling. Data was analysed using descriptive statistics and dependent sample t-tests were employed to compare the General Quotients (GQ’s) of the first and second born twins in the sample. Results showed that no significant differences were found between the first and second born twins’ general development. Information generated from this study contributed to 1) child development research; 2) twin developmental research within a South African context; and 3) a greater group of studies on the GMDS-ER, currently underway in the United Kingdom and South Africa, aiming to contribute to the international credibility of this measure