Thesis (doctoral)--Göteborg University, 2003. / Includes bibliographical references.

Thesis (doctoral)--Göteborgs universitet, 1991. / Includes bibliographical references (p. [304]-322).

The teaching profession is widely regarded as being very stressful (Klassen, Usher & Bong, 2010; Otero, Castro, Santiago & Villardefrancosl, 2010). South African teachers, especially Black teachers working in previously disadvantaged areas, have to cope with serious stressors such as overcrowded classrooms and limited resources on a daily basis (Ngidi & Sibaya, 2002; Moloi, 2010). Occupational stress of this nature is known to have significant negative implications for well-being, and chronic stress has been linked to mood and anxiety disorders, and other forms of psychopathology (Bellingrath, Weigl & Kudielka, 2009; Brock & Buckley, 2012; Mundai, 2010). However, psychological buffers could enable individuals to sustain normal development and even experience well-being, despite the presence of long-term stress (Friborg, Hjemdal, Rosenvinge & Martinussen, 2003; Ryff & Singer, 2003). Noted among these so-called protective factors, the process of self-regulation has been found to be predictive of positive outcomes with regard to physiological and psychological well-being (Hofer, Busch & Kärtner, 2011; Peterson & Seligman, 2004). Self-regulation has, however, been found to represent a resource susceptible to depletion with repeated use, and there have been contradictory reports regarding the long-term sustainability of self-regulation capacity (Converse & DeShon, 2009; Ryan & Deci, 2008). No longitudinal studies could be found that explore the natural progression of self-regulation in a highly stressful context, and how changes in self-regulation are associated with changes in stress and well-being levels. This thesis consists of three sub-studies that are reported in three manuscripts. In the first of these sub-studies the levels of occupational stress and mental well-being in a cohort of Black South African teachers were investigated, including how these two variables are related to each other. The second sub-study aimed firstly to investigate the association between self-regulation and Black South African teachers’ self-reported levels of mental well-being. Secondly, it aimed to determine the role of the sub-constructs of the self-regulation process in the teachers’ selfreported levels of mental well-being. The aim of the third article was also two-fold. It first aimed to determine the natural progression of self-regulation within a highly stressful work context over a period of three years. It then aimed to determine how long-term changes in the selfregulation of individuals finding themselves in high-stress working conditions are associated with changes in their self-reported levels of stress and mental well-being. Black South African teachers (N=200, 101 men, 99 women) of ages ranging from 25 to 65 years from the North-West province of South Africa participated in the baseline phase of the SABPA project in 2008. Of the original 200 participants, a total of 173 teachers (88 men, 85 women) took part in data collection for the follow-up study in 2011. Data were collected by making use of quantitative measures (Teacher Stress Inventory (Boyle, Borg, Falzon & Baglion, 1995); General Health Questionnaire-28 (Goldberg & Hillier, 1979); Mental Health Continuum-Short Form (Keyes, 2006); Short Self-Regulation Questionnaire (Carey, Neal & Collins, 2004)) that have been validated for use in the South African context. The findings indicate that this group of teachers experienced high levels of stress, and symptoms indicative of mental illness to an extent that warrants psychiatric intervention. However, participants also reported higher than expected levels of mental health. The findings further indicated that self-regulation contributed positively to the participants’ mental health levels. The longitudinal findings also indicated improvements in this group of teachers’ selfregulation levels over time, and that these long-term changes in self-regulation were positively associated with changes in participants’ mental health. Recommendations for future investigations on the role of self-regulation in well-being that flowed from this research include extending research to other cultural groups and general populations; use of multiple or mixedmethod approaches to provide more insight into the participants’ short- and long-term experience of their working environment, their levels of stress and well-being and their self-regulation levels; investigating the psychological perspective on stress and exploring the concept of optimal self-regulation and the maintenance thereof. The study provided a holistic insight into the importance of self-regulation as protective factor in a highly stressed context, especially with regards to the promotion of mental well-being on a short term and long term basis. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

The teaching profession is widely regarded as being very stressful (Klassen, Usher & Bong, 2010; Otero, Castro, Santiago & Villardefrancosl, 2010). South African teachers, especially Black teachers working in previously disadvantaged areas, have to cope with serious stressors such as overcrowded classrooms and limited resources on a daily basis (Ngidi & Sibaya, 2002; Moloi, 2010). Occupational stress of this nature is known to have significant negative implications for well-being, and chronic stress has been linked to mood and anxiety disorders, and other forms of psychopathology (Bellingrath, Weigl & Kudielka, 2009; Brock & Buckley, 2012; Mundai, 2010). However, psychological buffers could enable individuals to sustain normal development and even experience well-being, despite the presence of long-term stress (Friborg, Hjemdal, Rosenvinge & Martinussen, 2003; Ryff & Singer, 2003). Noted among these so-called protective factors, the process of self-regulation has been found to be predictive of positive outcomes with regard to physiological and psychological well-being (Hofer, Busch & Kärtner, 2011; Peterson & Seligman, 2004). Self-regulation has, however, been found to represent a resource susceptible to depletion with repeated use, and there have been contradictory reports regarding the long-term sustainability of self-regulation capacity (Converse & DeShon, 2009; Ryan & Deci, 2008). No longitudinal studies could be found that explore the natural progression of self-regulation in a highly stressful context, and how changes in self-regulation are associated with changes in stress and well-being levels. This thesis consists of three sub-studies that are reported in three manuscripts. In the first of these sub-studies the levels of occupational stress and mental well-being in a cohort of Black South African teachers were investigated, including how these two variables are related to each other. The second sub-study aimed firstly to investigate the association between self-regulation and Black South African teachers’ self-reported levels of mental well-being. Secondly, it aimed to determine the role of the sub-constructs of the self-regulation process in the teachers’ selfreported levels of mental well-being. The aim of the third article was also two-fold. It first aimed to determine the natural progression of self-regulation within a highly stressful work context over a period of three years. It then aimed to determine how long-term changes in the selfregulation of individuals finding themselves in high-stress working conditions are associated with changes in their self-reported levels of stress and mental well-being. Black South African teachers (N=200, 101 men, 99 women) of ages ranging from 25 to 65 years from the North-West province of South Africa participated in the baseline phase of the SABPA project in 2008. Of the original 200 participants, a total of 173 teachers (88 men, 85 women) took part in data collection for the follow-up study in 2011. Data were collected by making use of quantitative measures (Teacher Stress Inventory (Boyle, Borg, Falzon & Baglion, 1995); General Health Questionnaire-28 (Goldberg & Hillier, 1979); Mental Health Continuum-Short Form (Keyes, 2006); Short Self-Regulation Questionnaire (Carey, Neal & Collins, 2004)) that have been validated for use in the South African context. The findings indicate that this group of teachers experienced high levels of stress, and symptoms indicative of mental illness to an extent that warrants psychiatric intervention. However, participants also reported higher than expected levels of mental health. The findings further indicated that self-regulation contributed positively to the participants’ mental health levels. The longitudinal findings also indicated improvements in this group of teachers’ selfregulation levels over time, and that these long-term changes in self-regulation were positively associated with changes in participants’ mental health. Recommendations for future investigations on the role of self-regulation in well-being that flowed from this research include extending research to other cultural groups and general populations; use of multiple or mixedmethod approaches to provide more insight into the participants’ short- and long-term experience of their working environment, their levels of stress and well-being and their self-regulation levels; investigating the psychological perspective on stress and exploring the concept of optimal self-regulation and the maintenance thereof. The study provided a holistic insight into the importance of self-regulation as protective factor in a highly stressed context, especially with regards to the promotion of mental well-being on a short term and long term basis. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

During the growth spurt (GS) which forms part of the mid-adolescence period of boys (13-17 years), considerable changes take place in the body composition of boys. It is therefore an unstable period where imbalances in body proportions (muscle mass, fat mass, neurological development) occur, that might have an effect on sport performance. It is also accompanied by changes in physical and motor fitness. The study firstly aimed to determine anthropometric growth changes in stature, arm span, mass, sitting height and sitting height ratio during mid-adolescence over a period of three years. The study secondly aimed to investigate the developmental changes in physical fitness (muscle strength, aerobic endurance) and motor fitness abilities (speed, agility, hand- eye coordination, explosive power) during the mid-adolescence phase of boys and finally to investigate possible relationships between anthropometric and physical and motor fitness abilities over the course of three years. A convenience sample consisting of all the grade 8 learners (n=182) of a quintile 5 high school in Potchefstroom in the North-West province of South Africa was selected to participate in a longitudinal growth research project over a three year period. Only the boys, with a mean age of 13.58 years in grade 8, of whom 95.4 % were white, 2.3% black and 2.3% colored boys, were part of the study. In 2010, 87 boys had complete measurements, while the final group in 2012 with completed follow-up measurements, were 73 boys. The physical and motor fitness components were measured according to the Australian Sport Search Program consisting of 10 tests (4 anthropometrical tests, 5 motor fitness tests, 1 physical fitness test). The cricket ball throwing test was added as an additional test. The anthropometrical measurements were made using the protocol of ISAK, while sitting height was measured according to the Canadian Sports for Life protocol. Sitting height ratio was calculated according to the formula (sitting height/stature x 100). The data was processed by “Statistica for Windows” Statsoft-computer program package. Descriptive statistics that included means (M), standard deviations (SD) and minimum and maximum values were used. A repeated measures over time analysis of variance (ANOVA) with a Bonferonni adjustment was done to analyze the differences over a period of 3 years within the group for all variables, where p<0.05 indicates a statistically significant difference. A partial correlation analysis was used to determine correlations between variables. Practical significance of correlations was determined according to Cohen’s d-value (0.1=small, 0.3=medium, 0.5=large). The results showed that during mid-adolescence in the period 13.58-14.58 years, boys grow considerably in stature, body mass, arm span and sitting height with accompanying improvement in motor and physical fitness abilities while sitting height ratio showed the greatest increase from 14.58-15.57 years. Stature, mass and arm span showed a parallel development up to 15 years after which further development leveled off, while mass increase showed no leveling off. Speed, agility, coordination and isometric-dynamic shoulder strength (basketball throw) also showed the biggest and significant improvement from 13.58-15.57 years, while explosive leg power and upper body arm and shoulder strength (vertical jump, cricket ball throw) showed the biggest and significant improvements during the period from 14.58 to 15.57 years. Significant correlations up to r=0.74; p<0.05, were found between changes in physical and motor fitness abilities and anthropometric variables, although the correlations become smaller over the 3-year period. Hand-eye coordination showed no correlation with any anthropometrical changes, while upper body strength correlated with all the anthropometrical measurements except sitting height ratio throughout the three years. It was concluded that the most accelerated growth and development took place from 13.58- 15.57 years in boys when they are in their first high school year and which falls within the mid-adolescent period (13-15 years). Furthermore, clear relationships were found between anthropometric, motor- and physical fitness variables. This knowledge of the rate of growth and motor fitness development and the relationships between these variables during the midadolescence period can provide a better understanding of changes that boys underwent during the mid-adolescent period, and can help monitoring the level of physical maturity in adolescents in order to develop training, competition and rehabilitation programs according to their developmental and not their chronological age. This cannot only prevent injuries, but also prevent early burnout in sport. / MA (Sport Science), North-West University, Potchefstroom Campus, 2014

During the growth spurt (GS) which forms part of the mid-adolescence period of boys (13-17 years), considerable changes take place in the body composition of boys. It is therefore an unstable period where imbalances in body proportions (muscle mass, fat mass, neurological development) occur, that might have an effect on sport performance. It is also accompanied by changes in physical and motor fitness. The study firstly aimed to determine anthropometric growth changes in stature, arm span, mass, sitting height and sitting height ratio during mid-adolescence over a period of three years. The study secondly aimed to investigate the developmental changes in physical fitness (muscle strength, aerobic endurance) and motor fitness abilities (speed, agility, hand- eye coordination, explosive power) during the mid-adolescence phase of boys and finally to investigate possible relationships between anthropometric and physical and motor fitness abilities over the course of three years. A convenience sample consisting of all the grade 8 learners (n=182) of a quintile 5 high school in Potchefstroom in the North-West province of South Africa was selected to participate in a longitudinal growth research project over a three year period. Only the boys, with a mean age of 13.58 years in grade 8, of whom 95.4 % were white, 2.3% black and 2.3% colored boys, were part of the study. In 2010, 87 boys had complete measurements, while the final group in 2012 with completed follow-up measurements, were 73 boys. The physical and motor fitness components were measured according to the Australian Sport Search Program consisting of 10 tests (4 anthropometrical tests, 5 motor fitness tests, 1 physical fitness test). The cricket ball throwing test was added as an additional test. The anthropometrical measurements were made using the protocol of ISAK, while sitting height was measured according to the Canadian Sports for Life protocol. Sitting height ratio was calculated according to the formula (sitting height/stature x 100). The data was processed by “Statistica for Windows” Statsoft-computer program package. Descriptive statistics that included means (M), standard deviations (SD) and minimum and maximum values were used. A repeated measures over time analysis of variance (ANOVA) with a Bonferonni adjustment was done to analyze the differences over a period of 3 years within the group for all variables, where p<0.05 indicates a statistically significant difference. A partial correlation analysis was used to determine correlations between variables. Practical significance of correlations was determined according to Cohen’s d-value (0.1=small, 0.3=medium, 0.5=large). The results showed that during mid-adolescence in the period 13.58-14.58 years, boys grow considerably in stature, body mass, arm span and sitting height with accompanying improvement in motor and physical fitness abilities while sitting height ratio showed the greatest increase from 14.58-15.57 years. Stature, mass and arm span showed a parallel development up to 15 years after which further development leveled off, while mass increase showed no leveling off. Speed, agility, coordination and isometric-dynamic shoulder strength (basketball throw) also showed the biggest and significant improvement from 13.58-15.57 years, while explosive leg power and upper body arm and shoulder strength (vertical jump, cricket ball throw) showed the biggest and significant improvements during the period from 14.58 to 15.57 years. Significant correlations up to r=0.74; p<0.05, were found between changes in physical and motor fitness abilities and anthropometric variables, although the correlations become smaller over the 3-year period. Hand-eye coordination showed no correlation with any anthropometrical changes, while upper body strength correlated with all the anthropometrical measurements except sitting height ratio throughout the three years. It was concluded that the most accelerated growth and development took place from 13.58- 15.57 years in boys when they are in their first high school year and which falls within the mid-adolescent period (13-15 years). Furthermore, clear relationships were found between anthropometric, motor- and physical fitness variables. This knowledge of the rate of growth and motor fitness development and the relationships between these variables during the midadolescence period can provide a better understanding of changes that boys underwent during the mid-adolescent period, and can help monitoring the level of physical maturity in adolescents in order to develop training, competition and rehabilitation programs according to their developmental and not their chronological age. This cannot only prevent injuries, but also prevent early burnout in sport. / MA (Sport Science), North-West University, Potchefstroom Campus, 2014

The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study. A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season. A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin. In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study. A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season. A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin. In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015