Child Sexual Abuse (CSA) is a societal problem whose origins date back to the times of the ancient Greeks and Romans. It is found in all levels of society, from the wealthiest to the poorest; and the short-term and long-term impacts it has on the lives of the victims, can be devastating. There are many reasons for the occurrence of child sexual abuse, but in all cases, the ultimate accountability rests on the shoulders of the sexual offender. The nature of child sexual victimisation varies from verbal suggestions to violent physical force. Irrespective of which type the child is being subjected to, as the weaker partner in the pedagogical relationship with the adult, s/he is never able to defend herself/himself. The global phenomenon, and the increase in CSA, has given rise to the research question, namely: How does child sexual abuse impact on the school life experiences and academic performance of learners at school? The purpose of this research study was to provide insight into the following issues: • The nature and identification of the symptoms of child sexual abuse; • The manner in which sexually abused children manifest their experiences of sexual abuse at school; • How sexually abused children cope with their learning tasks; and • Recommendations for educators. The literature relating to CSA was reviewed, with the aim of establishing a solid theoretical foundation for the study. CSA has been looked at holistically, encompassing the accepted definitions, the related concepts, the nature of sexual abuse, the prevalence and incidence of CSA, the possible causes, the short-term and long-term impacts, and the suggestions by adult survivors for use by educators in their efforts to help abused learners. 11 In an attempt to provide acceptable answers to the research problem, a mixed- method research design was implemented. The research study was conducted in two phases: Stage 1 consisted of an exploration of the research problem by means of the following question put to the participants: In your experience as an adult survivor of child sexual abuse how did the abuse impact on your school life experiences, including your academic performance? A total of nineteen participants from the Eastern Cape Province shared their experiences, by means of writing their life story as a narrative. Purposive and availability sampling of adult survivors was undertaken. In order to ensure the trustworthiness and authenticity of the research methodology, Guba’s model of data verification was used. Accepted ethical measures were taken into consideration and adhered to during the research. The analysed data were taken directly from the narratives that the individual participants saved onto flashdrives. Consensus by the researcher and coder was reached regarding the identification of themes, categories and subcategories. The following four significant themes emerged, based on the results of the data analysis: Theme One: Health, sexuality and the sexual experiences of sexual abused children and adolescents. Theme Two: The social development of sexually abused children and adolescents. Theme Three: School-related experiences and academic performance of sexually abused children and adolescents. Theme Four: Advice and suggestions from adult survivors for young victims of CSA. 12 Stage 2 offered recommendations to the teachers of learners who are, or have been sexually abused, derived from the findings of Phase 1. The conclusion was reached that CSA does have an impact on the academic performance of learners. Therefore, teachers are in need of a greater understanding and awareness of CSA, in order to help these learners.

Recent findings by Public Health Ontario (PHO) state that there were approximately 36, 346 confirmed cases of chlamydia in Ontario as of 2011. This represents an incidence rate that increased by 54% since 2006 rising from 177 to 272 per 100,000 in 2011. National rates only increased by 38% (210 to 290 per 100,000), meaning that Brant County rates surpassed both, increasing by over 100% (150 to 395 per 100,000). The main objective of this series of manuscripts is to develop a clear profile of re-infected individuals in comparison to non-repeaters, while considering co-infections wit gonorrhea. The secondary objective was to determine the sexual network as well as spatial distribution patterns of cases in Brant County. The study period is from January 1st, 2006 until December 31st, 2015, Data were extracted from the integrated public health information system (iPHIS). Basic descriptive statistics will be performed followed by a Cox-regression analysis in order to compare individuals who are repeaters with those who are not repeaters. Within the study period, there were 2,829 cases of chlamydia and 328 were reinfections. We identified twelve hotspots with high chlamydia infection rates of which, 58 per cent occurred within the previously identified core group, in the urban core of Brant County.

Persistent infection with certain subtypes of Human papillomavirus (HPV) is a necessary cause of cervical cancer, the second most common cancer among women worldwide. Uptake of HPV vaccines in the targeted Canadian female population has been lower than anticipated. This study’s primary objective was to determine undergraduate women’s perceptions about HPV vaccination. A total of 401 female University of Ottawa undergraduate students completed a newly developed cross-sectional web survey. The prevalence of HPV vaccination was 49%. While the overall attitude towards receiving the vaccine was positive, vaccinated respondents had more favorable attitudes toward the vaccine. Lack of vaccine knowledge and cost were the primary barriers that have prevented HPV vaccination among non-vaccinated respondents. Offering HPV vaccination for women aged 18 to 25 presents a strategy for addressing suboptimal vaccination coverage in the targeted female population and may reduce health inequities demonstrated by variations in cervical cancer incidence within jurisdictions.

Although there is an increasing amount of literature on child sexual abuse, there is a dearth of information on the experiences of non-offending fathers of sexually abused children. Uncovering the issues that these fathers encounter after learning about the abuse of their children is essential in designing a therapeutic framework to help these men and their families. This qualitative study explored the experiences of four non-offending fathers of sexually abused children. Each subject was interviewed on video tape for approximately one hour using a general interview guide. The results were categorized into four areas: initial reaction to disclosure, changes in relationships, self issues, the recovery process. Two general themes emerged from these categories: disruption in the father's role as protector and the process of regaining a sense of normalcy. These findings point to the importance of including non-offending fathers in the treatment plans of counselling agencies working with victims of child sexual abuse. / Arts, Faculty of / Social Work, School of / Graduate

Background: Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) is an urgent public health issue in Mexico. Mexico has witnessed a 122% increase in reported prevalence of HIV since 2001 (Holtz et al., 2014). Country estimates suggest there are between 140,000-230,000 individuals living with HIV in Mexico (CENSIDA, 2014). While approximately 50% of individuals living with HIV in Mexico are unaware that they are living with the virus (CENSIDA, 2014). Despite a federal universal HIV program implemented in 2011, HIV in Mexico has not reached a chronic infectious disease status as seen in other regions of the globe (Deeks, 2013). The mortality rate among individuals with HIV/AIDS in Mexico is 4.2 per 100,000 (CENSIDA, 2014). There is a paucity of findings regarding social and epidemiological data focused on populations outside traditional at risk populations of HIV in Mexico (Martin-Onraët et al., 2016). Analyzing aggregate country level data for Mexico provides necessary insights to better understanding previously unconsidered social factors that are informing sexual and reproductive health trends influencing HIV health patterns. Methods: Secondary analyses were performed on Mexico's Encuesta Nacional de Salud y Nutrición 2012 (ENSANUT). Mexico’s ENSANUT is a probabilistic aggregate national dataset with a multistage stratified cluster sampling design (Janssen et al., 2013). ENSANUT is Mexico’s equivalent to the National Health and Nutrition Examination Survey (NHANES) in the United States. Data is collected via self-report interviews conducted at the participant's home. A structured questionnaire was administered to individuals 20 years of age and older (≥ 20) where sexual and reproductive data was collected from participants. The ENSANUT adult study sub-sample (n=46,227) is comprised of 42.75% men and 57.25% women. A general linear model (GLM), principal component analysis (PCA), chi-squares (χ²), and logistic regressions were applied to the study adult subsample to disentangle social factors associated with sexually transmitted infections (STIs) in the population. Quantitative analyses were conducted on SAS 9.4. Findings: Men were more likely to have a STI diagnosis (OR=3.60; 95% CI 3.00, 4.32, p=<0.001). Previous HIV testing was found to be protective for STI diagnosis across both genders (OR=0.82, 95% CI 0.72, 0.94, p=<0.001). Co-infections of HIV/gonorrhea and HIV/syphilis (n=20) were the highest in the study population. The latent variable model indicates mental health and access to health care resources are critical for positive sexual and reproductive health outcomes in Mexico. Mental health was found to be non-protective for STI risk among the study population (OR=1.59, 95% CI 1.41, 1.81, p=<0.0001). Policy recommendations: 1. Increased access and utilization of HIV resources and mental health services would benefit the study population. Further qualitative research is needed to better understand the barriers to health care access and utilization in these two domains; 2. Increase in preventative programs and health initiatives that encourage established strategies for positive sexual and reproductive health outcomes. These strategies include: universal human papillomavirus (HPV) vaccines, wide availability of Pre-Exposure Prophylaxis (PrEP), and routine HIV/STI screenings; 3. Alternative data collection strategies for ENSANUT which are culturally appropriate for sexual and reproductive health constructs.

M.Ed. (Educational Management) / Please refer to full text to view abstract

No description available.

The developmental impact of the family system on a child varies according to the functional status of the family. Harter, Pamela, and Neimeyer (1988) found that sexually abused children reported perceptions of significantly less cohesion and adaptability than nonabused children within their families of origin.

Thesis (M.Pharm.(Pharmacology)) --University of Limpopo, 2014. / Management of Sexually Transmitted Infections (STIs) in Private Pharmacies in Limpopo Province: Practice and Knowledge of Pharmacists Background: In 2001, the South African Pharmacy Council (SAPC) developed a strategic plan, which recognised the crucial role that pharmacists could play in controlling sexually transmitted infections (STIs) and the spread of HIV infection. In South Africa, patients seek and receive treatment for STIs from pharmacies despite a legal restriction (Ward, Pharm, Butler, Mugao, Klausner, Mcfarland, Chen & Schwarcz, 2003). Current legislation bars people to seek treatment from the pharmacists for certain acute illnesses, thus significantly influencing the spread of some infections with the view that the longer infections remain untreated, the more opportunities for transmissions to occur. The perceived lack of treatment options in private pharmacies may even prevent patients from accessing advice or preventative measures at the pharmacy level (Gupta, Sane, Gurbani, Bollinger, Mehendale & Godbole, 2010). It is against this background that the study was carried out with the aim of assessing the knowledge and practice of private pharmacists in management of sexually transmitted infections (STIs) in the Limpopo Province and ultimately assist in the reduction of the spread of HIV infections. Objectives: The objectives of the study were; to identify areas of weakness in services provided by pharmacists in management of STIs in private pharmacies; to identify possible pharmaceutical care of HIV; to determine the level of use of Department of Health Standard Treatment Guidelines of sexually transmitted infections by private pharmacy; to determine the availability of sexually transmitted infection drugs for treatment of STIs; and to identify the type of information given to clients with STI. Method: A cross-sectional design was used in this study. The study was carried out in the Limpopo Province, South Africa. Out of the population of 130 pharmacies registered with the SAPC in Limpopo, a sample of 23 was selected. The pharmacies were stratified according to where they were located. This study used a questionnaire designed as an instrument of data collection. The data was collected through a face-to-face interview with the responsible pharmacist in each pharmacy outlet. This study used Simulated Client Method to evaluate the practice. In this method, simulated male and female clients visited randomly selected Pharmacies. Two scenarios were developed for a male patient with urethral discharge and a female patient with vaginal discharge. The simulated clients on a standardised reporting form, outside the pharmacy, carefully recorded all observations made during the simulated scenario. Data analysis: The data were analysed using cross-tabulation techniques and chi-square test was used to check existence of association. Compliance with Standard Treatment Guidelines in terms of treating STI syndrome was used as dependent variable. Location (Rural and urban) of private pharmacies, the gender of the client in the simulated client method, treating genital ulcer syndrome (GUS), treating male urethritis syndrome (MUS) and treating female vaginal discharge syndrome were used as independent variables. The existence of association between the dependent and variable was tested using the Chi-square test of independence. Result: The results showed that 27% of private pharmacies in Limpopo treated and managed STIs clients in accordance with Standard Treatment Guidelines. The structured interviews results showed that 78% of private pharmacists in Limpopo knew the linkage between HIV and STIs. Only 39% of the private pharmacists knew about the existence of Standard Treatment Guidelines and used them in daily client consultations. Cross tabulation of data on compliance with Standard Treatment Guidelines in terms of treating STI syndrome (the dependent variable) and the location of private pharmacies (the independent variable) produced a Chi-square value of 1.31. This showed that the dependent variable had no association with location of independent private pharmacies. The study found that the treatment and management of GUS, MUS and female discharge varied according to location of the private pharmacies. The medicines stocked were in line with the Standard Treatment Guidelines in both rural and urban pharmacies in the Limpopo Province. There was very high demand for STI medication without a prescription averaging of 150 clients per week. Private pharmacies in both areas gave the necessary information to their clients focused on use condom with 54%, partner notification with 38% and only 27% of pharmacists advised client to consult the physician. The simulated client visits showed the discrepancy between knowledge and actual practice of the private pharmacists. Conclusion: The majority of private pharmacies operating in the Limpopo Province do not comply with the Standard Treatment Guidelines for treatment and management of STIs due to inadequate knowledge. While there is a need to train some pharmacists in the provision of primary health care for syndromic STI treatment in order to reduce STIs and HIV transmission, the lifting of current legal restriction in South Africa that prevents pharmacists from prescribing STI medication may be necessary. The knowledge and practice of incidence of specific infections in communities served by the specific pharmacy should be part of the pharmaceutical care provision.

This thesis is devoted to general practice (GP) networks in Belgium, their development and their activities within the Belgian health system context. These networks are specific research tools for the repeated or continuous collection and analysis of data related to diseases and other health events observed in general practice, including interventions of general practitioners. The thesis focuses on three not-for-profit general practice research networks which are operational today: (1) the national Network of Sentinel General Practices (SGP), coordinated by the Federal research institute Sciensano; (2) the Flemish Intego network, coordinated by the Academic Center for General Practice of Catholic University Leuven; (3) the network of the Fédération des maisons médicales et des collectifs de santé francophones (FMM) with its Monitoring Chart (Tableau de bord), which collects data from Wallonia and the Brussels-Capital Region. The thesis is divided into a general introduction, three main parts and a final discussion with concluding remarks. The general introduction outlines the importance of data from general practice and the contribution of GP networks to research. Furthermore, it points out the importance of general practice for the control of sexually transmitted infections (STIs), a specific field of action. The first main part of the thesis investigates the research question of how the three GP research networks developed within the specific context of the Belgian health system. It is based on the interpretation of written sources such as project reports, annual network reports, research publications, parliamentary documents, relevant websites and the existing research literature. The context analysis included a comparison with the Netherlands since the latter have strong traditions with regard to the position of the general practitioner in the health system (gatekeeper to secondary care, whereas in Belgium the patient generally chooses his/her health provider, and a Global Medical File administered by the general practitioner is not mandatory in Belgium), to general practice research networks and computerisation. It could be shown (1) that Belgium has held a middle position in the European Union regarding GP computerisation; (2) that, contrary to the Netherlands, an operational national GP network based on data from electronic health records (EHRs) could not be established; and (3) that Belgian health system computerisation, which advanced substantially in the last decade, put the issue of health data collection and storage by a new digital service on the agenda. Subsequently, three sub-chapters focus on the development of the three GP networks from their foundation until today. They demonstrate that the SGP and Intego were founded as innovative tools originating from Flemish general practice research, whereas the Monitoring Chart originated from the dynamism of Integrated Primary Health Care Centres (IPHCCs, Maisons médicales) in French-speaking Belgium. Acting as health observatories was both part of the mission of the IPHCCs and the demand of the Regional governments. With time, the research designs of the three GP networks became more sophisticated. Furthermore, European cooperation of the SGP with other GP networks since the late 1980s stands out, since the vision to establish a European sentinel general practice network led to joint influenza surveillance as one of its lasting achievements. In continuation of the developments described above, the second main part of the thesis addresses the missions and the organisation of the three GP networks today as well as their respective strengths and limitations in comparative perspective. It is based on network publications and reports, relevant websites and informal information from the networks themselves. The comparison shows that there is little overlap between the activities of the three GP networks, given the different areas of investigation and the complementarity of supplementary information collected by the SGP versus routine data extraction from EHRs in the other two networks. Furthermore, Intego and the Monitoring Chart essentially cover different parts of the country. The prospective research design of the SGP allows formulating hypotheses and designing research questionnaires with precise definitions of diagnoses before the start of a new research topic in order to minimise inter-observer variability, whereas the diagnosis in the other two networks is the result of the general practitioner's clinical judgement. The Intego network disposes of a substantial number of routine parameters collected over more than two decades by now. With these data, the researchers can design retrospective cohort studies without recording or recall bias by the GP who does not know during his/her daily routine for which research questions his/her data may be used later. The Monitoring Chart stands out by its comparatively strong presence in the Brussels-Capital Region and its data from the less well-to-do part of the population. The third main part of the thesis focuses on STIs which provided a research opportunity, given that Belgian public health efforts to control them have increased in recent years and that the three GP networks engaged in research activities in this regard. The first sub-chapter addresses challenges for the surveillance and monitoring of STIs due to the nature of the pathogens, followed by a sub-chapter about characteristics of STI surveillance and monitoring in Belgium. Afterwards, a sub-chapter describes health policy efforts in order to establish the Belgian HIV Plan 2014-2019. The development of the HIV Plan was analysed by applying the policy streams model of John Kingdon. The analysis was based on published government statements, parliamentary documents, and websites of stakeholders, and showed that the Federal Ministry of Health initiative to achieve the HIV Plan was characterised by a coordinating role with a participatory approach towards the other Belgian governments and stakeholders. The 2013 protocol agreement of the Belgian governments committed them to principles, actions, and cooperation regarding HIV prevention, testing, treatment of persons living with HIV and care for their quality of life, but not to budgets, priorities or target figures. The implementation of the plan, highlighting aspects relating to general practice, is addressed in the subsequent sub-chapter. Two further sub-chapters are based on the analysis of retrospective cohort studies with Intego data from 2009 to 2013, based on EHR routine registration by over 90 general practitioners in Flanders. In the first sub-chapter, the frequencies of gonorrhoea and syphilis diagnoses were investigated. Case definitions were applied. Due to small case numbers obtained, cases were pooled and averaged over the observation period. Frequencies were compared with those calculated from mandatory notification. A total of 91 gonorrhoea and 23 syphilis cases were registered. The average Intego annual frequency of gonorrhoea cases obtained was 11.9 (95% Poisson confidence interval (CI) 9.6; 14.7) per 100,000 population, and for syphilis 3.0 (CI 1.9; 4.5), respectively, while mandatory notification was calculated at 14.0 (CI: 13.6, 14.4) and 7.0 (CI: 6.7, 7.3), respectively. In spite of limitations such as small numbers and different case definitions, the data suggests that the general practitioner was involved in the large majority of gonorrhoea cases, while the majority of new syphilis cases did not come to the knowledge of the general practitioner. The second sub-chapter deals with the prescription of antibiotics to treat gonorrhoea in general practice in Flanders 2009-2013. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. The study investigated to which extent contemporary gonorrhoea treatment guidelines were followed. Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013. Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013. Future opportunities, recommended in the final discussion, include (1) extending provider-led STI testing in Belgium, with a prominent role for general practitioners; (2) investigating barriers and facilitators for the achievement of the Global Medical File, notably if sensitive and potentially stigmatising issues such as STIs or mental health are involved; (3) making task delegation by the general practitioner towards other primary health care providers more attractive; (4) facilitating general practitioners' tasks by the introduction of support features into the EHR in order to improve registration and quality of care in general; (5) eliciting Regional government support in order to investigate the diagnostic profiles of the patient population of IPHCCs; and (6) establishing an extended network for the collection and analysis of "production data" (such as the number of contacts, interventions, referrals, prescriptions and diagnostic requests) from general practitioners and other primary health care providers, proceeding from the know-how and the experience of the three investigated GP networks. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished