Die beleidsdokument oor inklusiewe onderwys (South Africa. Department of Education, 2001) is in 2001 onderteken en in Suid-Afrika geïmplementeer. Die dokument beveel aan dat alle leerders die mees geskikte onderrig ontvang, maar as gevolg van die gaping wat tussen die ontwikkeling en implementering van die inklusiewe beleid bestaan, word nie alle leerders suksesvol in skole ingesluit nie. Sommige ouers besluit op alternatiewe skoolplasings en onderrig hulle kinders tuis, juis as gevolg van die onsuksesvolle insluiting van sommige leerders. Die doel van die studie is om die invloed van sekere onderrigstrategieë op die skolastiese prestasie van ʼn leerder met Asperger-sindroom te bepaal. Hierdie studie is in die interpretatiewe paradigma ingebed, ʼn enkel gevallestudie is as navorsingsontwerp aangewend en die metodologie is kwalitatief van aard. Inhoudsanalise is gebruik om die data te analiseer. Die leerder in hierdie studie is gediagnoseer met Asperger-sindroom. Hierdie leerder is om verskeie redes nie suksesvol in skole ingesluit nie en daarom is die leerder tuis onderrig. Tydens die tuisonderrigproses het die navorser-opvoeder besef dat hierdie leerder op ʼn spesifieke manier leer en dink. Onderrigstrategieë is geïmplementeer en aangepas volgens die leerder se individuele onderrigbehoeftes. Die navorsingbevindinge dui aan dat die ontwikkeling en aanpassing van onderrigstrategieë wel ʼn positiewe invloed op die leerder in die studie se skolastiese prestasie gehad het. In hierdie studie is dit duidelik dat leerders met Asperger-sindroom wel ʼn spesifieke manier van dink en leer toon en dat opvoeders so ʼn leerder se spesifieke denkpatrone in ag moet neem tydens die aanpassing van onderrigstrategieë. Die onderrigstrategieë wat tydens hierdie studie ontwikkel is, kan moontlik vir ander leerders wat op die outistiese spektrum gediagnoseer is ook voordelig wees.

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

CHAPTER 1 - POSTULATION OF PROBLEM, PURPOSE, METHOD AND PROGRAM OF STUDY: 1. Postulating the problem - The following problematical questions are investigated in this study:- a. Are there specific skills in which the trainable mentally retarded Down's Syndrome child is inferior to and/or more improved than other trainable mentally retarded groups? b. To what extent can the Down's Syndrome children participate in the same training program when grouped together? c. In which skills do Down's Syndrome children show the greatest train= ability? d. Is there a remarkable inferiority or progress in social competence, when compared with trainable Down's Syndrome and other trainable children in the training centre? 2. Aim of study - The following aims have been set for this study: a. to discover in which skills Down's Syndrome children have the great test inferiority and in which skills they show the greatest possibility of improvement. This means the question of the trainability of the Down's Syndrome child; b. to discover the grouping criteria which are used to classify the child with Down's Syndrome and all the other trainable children in the training centre; c. the criteria used by the different centres to promote a trainable child to the following class or group; d. to set a theoretical framework for a training program, which is based on the findings in this study, for trainable Down's Syndrome children; e. to find out what training facilities are available to the trainable Down's Syndrome child and to make some recommendations in this context. 3. Study method - In this study the descriptive method is used. The setting of a theoretical framework about the existing knowledge on the trainable Down's Syndrome child in the training centres is based on the following:- a. Study of literature: The most reliable sources of literature on the topic of this study are found in research results of American and British researchers; b. Empirical research: Questionnaires were sent to all the training centres in the Republic to collect information about the inferiority and/or progress in certain skills in Down's Syndrome children, grouping criteria and training programs for them. The program of study is set out in the last part of chapter 1. CHAPTER 2 - CONCEPTUALIZATION IN GENERAL: The following impediment categories were discussed in the first part of the chapter: motor, sensory, behaviouristic, mental and emotional impediments. The most important points of discussion are the concepts: educability and trainability of mentally retarded children. In the second part of this chapter the concepts: education ("opvoeding"); instruction ("onderwys”); training ("opleiding"); educability (“opvoedbaarheid”); trainability ("opleibaarheid") and untrainability (“onopleibaarheid") are discussed. 1. Educable and trainable mentally retarded - The Mentally Retarded Children's Act (Act No. 63 of 1974) refers to the child in the special class and special school as the educable mentally retarded and the child who is certified as uneducable as the trainable mentally retarded. The child in the institution is referred to as the untrainable mentally retarded. 2. Educability - Educability refers to the child's ability to gain from scholastic activities such as writing, reading and arithmetic and to transfer these skills with insight to practical situations. 3. Trainability - The trainable mentally retarded child's cognitive processes are concrete operational and cannot reach the abstract stage. Trainability therefore implies the possibility of making progress in the following skills: self-help, communication, socialization and occupation. 4. Untrainability - The child's inability to progress from the skills named in par. 3 and to succeed in adaptation to the social environment characterise the untrainable child who receives custodial care in an institution. CHAPTER 3 - DOWN 1S SYNDROME OR MONGOLISM: In comparing a few terms: Mongolism, Unfinished child, Acromicria, G1-Trisomy and Downs’ Syndrome, the latter is preferable, because it prevents a stigma which is sometimes attached to the syndrome and it also gives the syndrome a scientific dignity. 1. Etiology of Down’s Syndrome: 1.1 Endogenic factors - The possibility of studying chromosomal behaviour through the developments of new cytologic techniques leads to the study of the cell nucleus in the metaphase of mitosis during which period an exact counting of the chromosomes and observations on their structural patterns is possible. Through two methods: tissue and peripheral blood culture studies three subtypes of Down’s Syndrome are distinguishable:- a. Trisomy 21: This condition is the result of a faulty division of the 21-chromosome pair. The child with trisomy Down’s Syndrome has three, rather than the normal two chromosomes in pair 21. b. Translocation: Children with translocation Down’s Syndrome have an extra number 21- chromosome which has broken and become attached to the same or another chromosome pair. A parent can carry a translocation without showing any symptoms of disease because the parent still carries the correct amount of genetic material, although some of it is out of place (translocated). c. Mosaicism: A child with mosaic Down's Syndrome has 46 chromosomes in some cells and 47 in other cells of his body. 1.2 Exogenetic factors - Disfunctioning of the Pituitary and Thyroid glands causes a hormonal maladjustment in the mother during pregnancy, which can result in the birth of a Down's Syndrome child. Research has shown that a high percentage of Down's Syndrome children have been born from mothers between 30 and 45 years of age. Bad health and a shortage of vitamine A during pregnancy can also cause Down's Syndrome. 2. Clinical diagnosis at birth: Although Down's Syndrome cannot be diagnosed only by a few clinical features without a cytogenetic investigation, these features are especially visible in the first years of life of the Down's Syndrome child. The following physical stigmata are very prominent: hypotonia, disorders in the growth of the skull, a short nose with a flat bridge, anomalies of the palate, a small oral cavity with a protruding fissured tongue, abnormally small teeth, slanting eyes, speckling of the iris, anomalies of the external ears, one rather straight line crosses the palm of the hand instead of the two curved lines of the normal hand, an abnormal space between the first and second fingers and toes, a congenital heart defect and malformed sexual organs. In the last part of this chapter the typical developmental traits of the Down's Syndrome child from birth to approximately 6 years of age are discussed. CHAPTER 4 - CHARACTERISTICS OF THE DOWN'S SYNDROME CHILD'S PERSONALITY: Firstly in this chapter the mental development of the Down's Syndrome child is discussed. The conclusion is reached that the intellectual development is as characteristic as the slow motory development and that the quality of his intelligence is different in comparison with other trainable mentally retarded children. A significant connection between physical, stigmata and intelligence could not be found, The next discussion is devoted to the connection between subtype of Down's Syndrome and intelligence. Although several researchers found that the mosaic Down's Syndrome child has a higher intelligence than the other two subtypes, insufficient research has been done in this field. It has been found that 95% of all Down's Syndrome children are cheerful, but about 5% are stubborn. Social competence and mimicry lend themselves par excellence in training this child. Language development is discussed to show the Down's Syndrome child's inferiority in this characteristic. In the last part of this chapter it is pain= ted out that the Down’s Syndrome child is also backward in motory and sensory development. CHAPTER 5 - DIMENSIONS OF MENTAL RETARDATION IN DOWN'S SYNDROME: The differentiation between educable and trainable mentally retarded children is discussed in chapter 2. I.Q.-groups between 0 and 80 are discussed here to put the Down's Syndrome child in the mental hierarchy:- 1. Educable mentally retarded (I.Q. 50 - 80) - The educable mentally retarded child can't keep up the pace with the normal school program and has thus been placed in a special class or special school. Although there are Down's Syndrome children who are educable they still have great problems in mastering scholastic, motory and speech skills and non-visual tasks. 2. Trainable mentally retarded (I.Q. 30 - 50) - Although the child in the training centre is uneducable in scholastic skills, progress has been seen in the following skills: self-help, communication, socialization and occupation. 3. Untrainable mentally retarded (I.Q. 0 - 30) - The child who is retarded to such a degree that he can't see to his own needs and safety, must receive custodial care in an institution. CHAPTER 6 - THERAPY AND DOWN'S SYNDROME: This chapter deals with the following therapeutic programs:- 1. Medicinal therapy: a. Thyroid treatment has a positive effect in improving the dry skin, thick rippled tongue, coarse voice and sluggishness. b. Vitamine B12 must be administered with other medicaments to stimulate growth in the Down's Syndrome child. c. Pituitary-hormone treatment stimulate this gland to release growth hormones. 2. Music therapy: An outstanding characteristic of the trainable mentally retarded Down's Syndrome child is his receptivity for rhythm and music. This therapeutic medium must be used by parents and teachers to stimulate the gross motor co-ordination and auditory acuity of the Down's Syndrome child. 3. Speech therapy: language development is the trainable mentally retarded Down's Syndrome child's greatest inferiority. His ability for mimicry is the starting point for acquiring speech skills. The daily therapy sessions must include blowing•, sucking• and chewing exercises to better tongue and lip activities. A few practical implications for the training of the Down's Syndrome child are discussed in par. 6.7. CHAPTER 7 - EMPIRICAL RESEARCH: QUESTIONNAIRE: Different aspects, as well as the course of the empirical research, are discussed in this chapter. The descriptive method is selected as the scientific method for this research project. A questionnaire was composed to gather information on the set classification methods and training programs for the child with Down's Syndrome in training centres in the Republic. Firstly in this chapter the questionnaire is motivated as the most suitable scientific research method to deal with the topic of this study. The composition and application, respondents and returns are discussed afterwards. A prerequisite for significant diversions was set at a minimum return of 70% completed questionnaires. A follow-up letter was sent when the return was 63%. Telephone calls to the remaining respondents lifted the return percentage to 71%, so that the set criterium was reached. CHAPTER 8 - TRAINING FACILITIES FOR THE TRAINABLE MENTALLY RETARDED DOWN'S SYNDROME CHILDREN: In this chapter attention is especially devoted to responses in connection with the total number of trainable mentally retarded Down's Syndrome children in the training centres, different school departments and the average number of children in groups in the centres. 1. Occurrence of trainable mentally retarded Down's Sindrome children: Questionnaires were sent to 31 training centres in the Republic. Areturn of 71% (22) questionnaires was obtained. A number of 264 (20,3%) Down's Syndrome children and 1 037 (79,7%) other trainable mentally retarded children are enrolled in 21 (68% respondents} training centres, so that the total number is 1 301 trainable mentally retarded children. 2. School departments: The training centres are organized in the following departments (the number of centres which have a certain department are given in brackets): nursery class (10}, adaptation class (10), junior class (12), senior class (11). 3. Average number of children in different groups The 68% centres that completed this item in the questionnaire reported an average of 14 children in a group. The conclusion is also reached that the trainable mentally retarded Down's Syndrome child shows the best progress when he receives sufficient stimulation in the early years at home. Ways of maintenance of the centres up to 1/4/75 is discussed in the last part of the chapter. CHAPTER 9 - GROUPING CRITERIA FOR THE TRAINABLE MENTALLY RETARDED DOWN'S SYNDROME CHILDREN: Grouping criteria for the trainable mentally retarded children, general differences in skills between Down's Syndrome and other trainable children and promoting criteria for trainable mentally retarded children are discussed in this chapter. 1. Grouping criteria for the trainable mentally retarded children: Responses show that 27% of the respondent's grade I.Q. as an important grouping criterium. The I.Q.'s of only 36% of the children in the centres are known by members of staff. Chronological age is graded as an important criterium by 73% respondents, mental age by 32%, visual-motor skills by 45% and social competence by 50% of the respondents. 2. Differences in skills between Down's Syndrome and non-Down's Syndrome trainable mentally retarded groups of children: No difference is noticed in visual-motor skills by 40% respondents. Down's Syndrome children are graded weaker in these skills by 18% respondents. As seen by 5% respondents, Down’s Syndrome children are much better in self-help skills, 10% as better, 40%•as the same and 5% respondents as weaker than other trainable children in the centres. In connection with scholastic work the Down's Syndrome child is seen as the same by 40% respondents, weaker by 10% and much weaker by 5% respondents. Social competence is graded as much better by 18% respondents, better by 23%, the same by 14% and weaker by 5% respondents. 3. Promoting criteria for trainable mentally retarded children: Visual-motor skills are the most important promoting criterium, as graded by training centres. Chronological age is placed second. CHAPTER 10 - A TRAINING PROGRAM FOR THE TRAINABLE MENTALLY RETARDED DOWN'S SYNDROME CHILDREN IN THE TRAINING CENTRE: In this chapter the necessity for a special adapted training program for the trainable mentally retarded Down's Syndrome children, differences in skills between Down's Syndrome children of the same chronological age, psychometric media to determine the functioning of different skills are discussed. Based on this knowledge a training program for the trainable mentally retarded Down’s Syndrome child is set out. 1. The necessity for a special adapted training program for the trainable mentally retarded Down's Syndrome child: A special or adapted training program for the trainable Down’s Syndrome children is suggested by 40% respondents. Another 40% respondents believe that Down’s Syndrome children can take part in the same program (without adaptation) with other trainable children, while 20% respondents did not respond to this item. Information collected from literature and the rest of the empirical research, however, shows without any doubt that the trainable mentally retarded Down's Syndrome child is inferior in certain skills (see par. 10. 2.2) and shows possibilities for improvement in other skills, when compared with other trainable children. The conclusion is therefore reached that a specially adapted program must be set for the Down's Syndrome child to give more opportunity for stimulation in skills in which he is inferior, 2. Differences in skills amongst Down's syndrome children of the same chronological age: Responses show that 45% respondents notice great individual differences amongst Down's Syndrome children of the same chronological age; 32% respondents see no markable differences in skills and 23% respondents did not respond to this item. Individual differences amongst trainable Down's Syndrome children are not denied, but specific inferiorities in motory, auditory, language and tactual skills are present in all the trainable mentally retarded Down's Syndrome children. 3. Psychometric media to determine the functioning level of certain skills: It is concluded that the Stanford-Binet Intelligence Scale, the Merrill Palmer Scale and the Goodenough-Harris Drawing Test (elaborated from the Goodenough-Draw-a-Man Test) can, after adaptation to South African circumstances, be used as intelligence scales to differentiate between educable, trainable and untrainable children. The Vineland Social Maturity Scale and the Gunzburg Progress Assessment Charts must be used to determine the improvement in connection with the following skills: self-help, knowledge of his own body and perception, communication, socialization and occupation. 4. Trainability: Responses demonstrated that the mental age of the trainable Down's Syndrome children is increasable with implementing of a training program which takes the specific inferiorities and improvement possibilities of certain skills into consideration. The Down's Syndrome child is therefore trainable to quite a large extent. CHAPTER 11 - SUMMARY, CONCLUSIONS AND RECOMMENDATIONS: In this chapter recommendations in connection with training facilities, grouping criteria, a training program and other possible research subjects are discussed. / Thesis (MEd)--PU for CHE

CHAPTER 1 - POSTULATION OF PROBLEM, PURPOSE, METHOD AND PROGRAM OF STUDY: 1. Postulating the problem - The following problematical questions are investigated in this study:- a. Are there specific skills in which the trainable mentally retarded Down's Syndrome child is inferior to and/or more improved than other trainable mentally retarded groups? b. To what extent can the Down's Syndrome children participate in the same training program when grouped together? c. In which skills do Down's Syndrome children show the greatest train= ability? d. Is there a remarkable inferiority or progress in social competence, when compared with trainable Down's Syndrome and other trainable children in the training centre? 2. Aim of study - The following aims have been set for this study: a. to discover in which skills Down's Syndrome children have the great test inferiority and in which skills they show the greatest possibility of improvement. This means the question of the trainability of the Down's Syndrome child; b. to discover the grouping criteria which are used to classify the child with Down's Syndrome and all the other trainable children in the training centre; c. the criteria used by the different centres to promote a trainable child to the following class or group; d. to set a theoretical framework for a training program, which is based on the findings in this study, for trainable Down's Syndrome children; e. to find out what training facilities are available to the trainable Down's Syndrome child and to make some recommendations in this context. 3. Study method - In this study the descriptive method is used. The setting of a theoretical framework about the existing knowledge on the trainable Down's Syndrome child in the training centres is based on the following:- a. Study of literature: The most reliable sources of literature on the topic of this study are found in research results of American and British researchers; b. Empirical research: Questionnaires were sent to all the training centres in the Republic to collect information about the inferiority and/or progress in certain skills in Down's Syndrome children, grouping criteria and training programs for them. The program of study is set out in the last part of chapter 1. CHAPTER 2 - CONCEPTUALIZATION IN GENERAL: The following impediment categories were discussed in the first part of the chapter: motor, sensory, behaviouristic, mental and emotional impediments. The most important points of discussion are the concepts: educability and trainability of mentally retarded children. In the second part of this chapter the concepts: education ("opvoeding"); instruction ("onderwys”); training ("opleiding"); educability (“opvoedbaarheid”); trainability ("opleibaarheid") and untrainability (“onopleibaarheid") are discussed. 1. Educable and trainable mentally retarded - The Mentally Retarded Children's Act (Act No. 63 of 1974) refers to the child in the special class and special school as the educable mentally retarded and the child who is certified as uneducable as the trainable mentally retarded. The child in the institution is referred to as the untrainable mentally retarded. 2. Educability - Educability refers to the child's ability to gain from scholastic activities such as writing, reading and arithmetic and to transfer these skills with insight to practical situations. 3. Trainability - The trainable mentally retarded child's cognitive processes are concrete operational and cannot reach the abstract stage. Trainability therefore implies the possibility of making progress in the following skills: self-help, communication, socialization and occupation. 4. Untrainability - The child's inability to progress from the skills named in par. 3 and to succeed in adaptation to the social environment characterise the untrainable child who receives custodial care in an institution. CHAPTER 3 - DOWN 1S SYNDROME OR MONGOLISM: In comparing a few terms: Mongolism, Unfinished child, Acromicria, G1-Trisomy and Downs’ Syndrome, the latter is preferable, because it prevents a stigma which is sometimes attached to the syndrome and it also gives the syndrome a scientific dignity. 1. Etiology of Down’s Syndrome: 1.1 Endogenic factors - The possibility of studying chromosomal behaviour through the developments of new cytologic techniques leads to the study of the cell nucleus in the metaphase of mitosis during which period an exact counting of the chromosomes and observations on their structural patterns is possible. Through two methods: tissue and peripheral blood culture studies three subtypes of Down’s Syndrome are distinguishable:- a. Trisomy 21: This condition is the result of a faulty division of the 21-chromosome pair. The child with trisomy Down’s Syndrome has three, rather than the normal two chromosomes in pair 21. b. Translocation: Children with translocation Down’s Syndrome have an extra number 21- chromosome which has broken and become attached to the same or another chromosome pair. A parent can carry a translocation without showing any symptoms of disease because the parent still carries the correct amount of genetic material, although some of it is out of place (translocated). c. Mosaicism: A child with mosaic Down's Syndrome has 46 chromosomes in some cells and 47 in other cells of his body. 1.2 Exogenetic factors - Disfunctioning of the Pituitary and Thyroid glands causes a hormonal maladjustment in the mother during pregnancy, which can result in the birth of a Down's Syndrome child. Research has shown that a high percentage of Down's Syndrome children have been born from mothers between 30 and 45 years of age. Bad health and a shortage of vitamine A during pregnancy can also cause Down's Syndrome. 2. Clinical diagnosis at birth: Although Down's Syndrome cannot be diagnosed only by a few clinical features without a cytogenetic investigation, these features are especially visible in the first years of life of the Down's Syndrome child. The following physical stigmata are very prominent: hypotonia, disorders in the growth of the skull, a short nose with a flat bridge, anomalies of the palate, a small oral cavity with a protruding fissured tongue, abnormally small teeth, slanting eyes, speckling of the iris, anomalies of the external ears, one rather straight line crosses the palm of the hand instead of the two curved lines of the normal hand, an abnormal space between the first and second fingers and toes, a congenital heart defect and malformed sexual organs. In the last part of this chapter the typical developmental traits of the Down's Syndrome child from birth to approximately 6 years of age are discussed. CHAPTER 4 - CHARACTERISTICS OF THE DOWN'S SYNDROME CHILD'S PERSONALITY: Firstly in this chapter the mental development of the Down's Syndrome child is discussed. The conclusion is reached that the intellectual development is as characteristic as the slow motory development and that the quality of his intelligence is different in comparison with other trainable mentally retarded children. A significant connection between physical, stigmata and intelligence could not be found, The next discussion is devoted to the connection between subtype of Down's Syndrome and intelligence. Although several researchers found that the mosaic Down's Syndrome child has a higher intelligence than the other two subtypes, insufficient research has been done in this field. It has been found that 95% of all Down's Syndrome children are cheerful, but about 5% are stubborn. Social competence and mimicry lend themselves par excellence in training this child. Language development is discussed to show the Down's Syndrome child's inferiority in this characteristic. In the last part of this chapter it is pain= ted out that the Down’s Syndrome child is also backward in motory and sensory development. CHAPTER 5 - DIMENSIONS OF MENTAL RETARDATION IN DOWN'S SYNDROME: The differentiation between educable and trainable mentally retarded children is discussed in chapter 2. I.Q.-groups between 0 and 80 are discussed here to put the Down's Syndrome child in the mental hierarchy:- 1. Educable mentally retarded (I.Q. 50 - 80) - The educable mentally retarded child can't keep up the pace with the normal school program and has thus been placed in a special class or special school. Although there are Down's Syndrome children who are educable they still have great problems in mastering scholastic, motory and speech skills and non-visual tasks. 2. Trainable mentally retarded (I.Q. 30 - 50) - Although the child in the training centre is uneducable in scholastic skills, progress has been seen in the following skills: self-help, communication, socialization and occupation. 3. Untrainable mentally retarded (I.Q. 0 - 30) - The child who is retarded to such a degree that he can't see to his own needs and safety, must receive custodial care in an institution. CHAPTER 6 - THERAPY AND DOWN'S SYNDROME: This chapter deals with the following therapeutic programs:- 1. Medicinal therapy: a. Thyroid treatment has a positive effect in improving the dry skin, thick rippled tongue, coarse voice and sluggishness. b. Vitamine B12 must be administered with other medicaments to stimulate growth in the Down's Syndrome child. c. Pituitary-hormone treatment stimulate this gland to release growth hormones. 2. Music therapy: An outstanding characteristic of the trainable mentally retarded Down's Syndrome child is his receptivity for rhythm and music. This therapeutic medium must be used by parents and teachers to stimulate the gross motor co-ordination and auditory acuity of the Down's Syndrome child. 3. Speech therapy: language development is the trainable mentally retarded Down's Syndrome child's greatest inferiority. His ability for mimicry is the starting point for acquiring speech skills. The daily therapy sessions must include blowing•, sucking• and chewing exercises to better tongue and lip activities. A few practical implications for the training of the Down's Syndrome child are discussed in par. 6.7. CHAPTER 7 - EMPIRICAL RESEARCH: QUESTIONNAIRE: Different aspects, as well as the course of the empirical research, are discussed in this chapter. The descriptive method is selected as the scientific method for this research project. A questionnaire was composed to gather information on the set classification methods and training programs for the child with Down's Syndrome in training centres in the Republic. Firstly in this chapter the questionnaire is motivated as the most suitable scientific research method to deal with the topic of this study. The composition and application, respondents and returns are discussed afterwards. A prerequisite for significant diversions was set at a minimum return of 70% completed questionnaires. A follow-up letter was sent when the return was 63%. Telephone calls to the remaining respondents lifted the return percentage to 71%, so that the set criterium was reached. CHAPTER 8 - TRAINING FACILITIES FOR THE TRAINABLE MENTALLY RETARDED DOWN'S SYNDROME CHILDREN: In this chapter attention is especially devoted to responses in connection with the total number of trainable mentally retarded Down's Syndrome children in the training centres, different school departments and the average number of children in groups in the centres. 1. Occurrence of trainable mentally retarded Down's Sindrome children: Questionnaires were sent to 31 training centres in the Republic. Areturn of 71% (22) questionnaires was obtained. A number of 264 (20,3%) Down's Syndrome children and 1 037 (79,7%) other trainable mentally retarded children are enrolled in 21 (68% respondents} training centres, so that the total number is 1 301 trainable mentally retarded children. 2. School departments: The training centres are organized in the following departments (the number of centres which have a certain department are given in brackets): nursery class (10}, adaptation class (10), junior class (12), senior class (11). 3. Average number of children in different groups The 68% centres that completed this item in the questionnaire reported an average of 14 children in a group. The conclusion is also reached that the trainable mentally retarded Down's Syndrome child shows the best progress when he receives sufficient stimulation in the early years at home. Ways of maintenance of the centres up to 1/4/75 is discussed in the last part of the chapter. CHAPTER 9 - GROUPING CRITERIA FOR THE TRAINABLE MENTALLY RETARDED DOWN'S SYNDROME CHILDREN: Grouping criteria for the trainable mentally retarded children, general differences in skills between Down's Syndrome and other trainable children and promoting criteria for trainable mentally retarded children are discussed in this chapter. 1. Grouping criteria for the trainable mentally retarded children: Responses show that 27% of the respondent's grade I.Q. as an important grouping criterium. The I.Q.'s of only 36% of the children in the centres are known by members of staff. Chronological age is graded as an important criterium by 73% respondents, mental age by 32%, visual-motor skills by 45% and social competence by 50% of the respondents. 2. Differences in skills between Down's Syndrome and non-Down's Syndrome trainable mentally retarded groups of children: No difference is noticed in visual-motor skills by 40% respondents. Down's Syndrome children are graded weaker in these skills by 18% respondents. As seen by 5% respondents, Down’s Syndrome children are much better in self-help skills, 10% as better, 40%•as the same and 5% respondents as weaker than other trainable children in the centres. In connection with scholastic work the Down's Syndrome child is seen as the same by 40% respondents, weaker by 10% and much weaker by 5% respondents. Social competence is graded as much better by 18% respondents, better by 23%, the same by 14% and weaker by 5% respondents. 3. Promoting criteria for trainable mentally retarded children: Visual-motor skills are the most important promoting criterium, as graded by training centres. Chronological age is placed second. CHAPTER 10 - A TRAINING PROGRAM FOR THE TRAINABLE MENTALLY RETARDED DOWN'S SYNDROME CHILDREN IN THE TRAINING CENTRE: In this chapter the necessity for a special adapted training program for the trainable mentally retarded Down's Syndrome children, differences in skills between Down's Syndrome children of the same chronological age, psychometric media to determine the functioning of different skills are discussed. Based on this knowledge a training program for the trainable mentally retarded Down’s Syndrome child is set out. 1. The necessity for a special adapted training program for the trainable mentally retarded Down's Syndrome child: A special or adapted training program for the trainable Down’s Syndrome children is suggested by 40% respondents. Another 40% respondents believe that Down’s Syndrome children can take part in the same program (without adaptation) with other trainable children, while 20% respondents did not respond to this item. Information collected from literature and the rest of the empirical research, however, shows without any doubt that the trainable mentally retarded Down's Syndrome child is inferior in certain skills (see par. 10. 2.2) and shows possibilities for improvement in other skills, when compared with other trainable children. The conclusion is therefore reached that a specially adapted program must be set for the Down's Syndrome child to give more opportunity for stimulation in skills in which he is inferior, 2. Differences in skills amongst Down's syndrome children of the same chronological age: Responses show that 45% respondents notice great individual differences amongst Down's Syndrome children of the same chronological age; 32% respondents see no markable differences in skills and 23% respondents did not respond to this item. Individual differences amongst trainable Down's Syndrome children are not denied, but specific inferiorities in motory, auditory, language and tactual skills are present in all the trainable mentally retarded Down's Syndrome children. 3. Psychometric media to determine the functioning level of certain skills: It is concluded that the Stanford-Binet Intelligence Scale, the Merrill Palmer Scale and the Goodenough-Harris Drawing Test (elaborated from the Goodenough-Draw-a-Man Test) can, after adaptation to South African circumstances, be used as intelligence scales to differentiate between educable, trainable and untrainable children. The Vineland Social Maturity Scale and the Gunzburg Progress Assessment Charts must be used to determine the improvement in connection with the following skills: self-help, knowledge of his own body and perception, communication, socialization and occupation. 4. Trainability: Responses demonstrated that the mental age of the trainable Down's Syndrome children is increasable with implementing of a training program which takes the specific inferiorities and improvement possibilities of certain skills into consideration. The Down's Syndrome child is therefore trainable to quite a large extent. CHAPTER 11 - SUMMARY, CONCLUSIONS AND RECOMMENDATIONS: In this chapter recommendations in connection with training facilities, grouping criteria, a training program and other possible research subjects are discussed. / Thesis (MEd)--PU for CHE

MOTIVATION: The increasing prevalence of metabolic syndrome (MetS) is creating immense concern worldwide. In 2009, the International Diabetes Federation (IDF) announced the new MetS definition. MetS is diagnosed by any 3 of the following 5 indicators being present: increased waist circumference (WC), blood pressure (BP), triglycerides, and fasting glucose values, and decreased high–density lipoprotein cholesterol (HDL–C) concentrations. Psychosocial stress relating to an urban environment or acculturation greatly influences the prevalence of both MetS and target organ damage (TOD). Furthermore, in urban Africans, active coping (AC) responses have been associated more with MetS and the related cardiovascular pathology than avoidance. A further synergistic effect of MetS and AC responses was also revealed in African men, in strong association with both subclinical atherosclerosis and renal impairment. Microalbuminuria was four times higher in Africans with MetS, than in those without any MetS indicators. Furthermore, Africans, especially those utilising AC responses, present with greater carotid intima–media thickness (CIMT) than their Caucasian counterparts, although they exhibit a lipid profile that is anti–atherogenic. OBJECTIVES: The objectives were firstly to indicate and compare differences regarding AC responses in the African and Caucasian men, in accord with the prevalence of MetS indicators. Secondly, the extent to which AC responses and MetS indicators predict endothelial dysfunction was investigated. METHODOLOGY: This comparative target population study is nested in the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study, which was conducted from February until the end of May in both 2008 (Africans) and 2009 (Caucasians), avoiding seasonal changes. The Ethics Committee of the North–West University approved the study, and all volunteers gave written informed consent prior to participation. Procedures were conducted according to the institutional guidelines of the Declaration of Helsinki. The participants included 202 male teachers of which 101 were African and 101 Caucasian. Ambulatory blood pressure (BP) measurements were recorded with the Cardiotens CE120 at 30 minute intervals during the day and 60 minutes at night. Actical accelerometers determined physical activity (PA). Registered clinical psychologists supervised completion of the psychosocial questionnaires, including the Coping Strategy Indicator. Participants fasted overnight; after the last BP recording, disconnection of the Cardiotens CE120 and Actical followed. A fasting 8 hour overnight collected urine sample was obtained from each participant. Anthropometric measurements followed, after which a registered nurse commenced blood sampling. The SonoSite Micromaxx was used for the scanning of CIMT. MetS indicators (glucose, triglyceride, and HDL–C), together with gamma glutamyl transferase, cotinine, and ultrahigh–sensitivity C–reactive protein (hs–CRP), were analyzed with Konelab 20i. The albumin–to–creatinine ratio and CIMT determined TOD. Participants were stratified according to ethnicity and median splits of AC response scores (high AC and low AC). Diabetic medication users (n= 8), and participants with renal impairment (n= 2) or HIV positive (n= 13), were excluded from analyses. 2×2 ANCOVA’s determined significant interactions for ethnicity and AC. Partial correlations between MetS indicators and TOD were performed within each ethnic and AC group, independent of age, alcohol consumption and PA. Regression analyses were performed for four models, firstly with microalbuminuria and secondly with CIMT as dependent variables. Significant values were noted as p 0.05, r 0.35, and adjusted R2 0.25. RESULTS: Caucasian men were physically more active than African men, whilst BP, alcohol consumption and hs–CRP levels were significantly higher in African men. Psychological variables revealed higher avoidance scores in Caucasian men and higher social support scores in African men. More MetS indicators exceeded the IDF cut–off points in high AC African men (14.71%) than in their Caucasian counterparts (3.33%). Furthermore, more MetS indicators predicted endothelial dysfunction in African men, especially the high AC responders. CONCLUSION: The following hypotheses were accepted: high AC responses in urban African men were associated with a higher prevalence of MetS indicators than in their Caucasian counterparts, while MetS indicators were associated with a marker of TOD in urban high AC African men, but not in their Caucasian counterparts. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2011.

MOTIVATION: The increasing prevalence of metabolic syndrome (MetS) is creating immense concern worldwide. In 2009, the International Diabetes Federation (IDF) announced the new MetS definition. MetS is diagnosed by any 3 of the following 5 indicators being present: increased waist circumference (WC), blood pressure (BP), triglycerides, and fasting glucose values, and decreased high–density lipoprotein cholesterol (HDL–C) concentrations. Psychosocial stress relating to an urban environment or acculturation greatly influences the prevalence of both MetS and target organ damage (TOD). Furthermore, in urban Africans, active coping (AC) responses have been associated more with MetS and the related cardiovascular pathology than avoidance. A further synergistic effect of MetS and AC responses was also revealed in African men, in strong association with both subclinical atherosclerosis and renal impairment. Microalbuminuria was four times higher in Africans with MetS, than in those without any MetS indicators. Furthermore, Africans, especially those utilising AC responses, present with greater carotid intima–media thickness (CIMT) than their Caucasian counterparts, although they exhibit a lipid profile that is anti–atherogenic. OBJECTIVES: The objectives were firstly to indicate and compare differences regarding AC responses in the African and Caucasian men, in accord with the prevalence of MetS indicators. Secondly, the extent to which AC responses and MetS indicators predict endothelial dysfunction was investigated. METHODOLOGY: This comparative target population study is nested in the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study, which was conducted from February until the end of May in both 2008 (Africans) and 2009 (Caucasians), avoiding seasonal changes. The Ethics Committee of the North–West University approved the study, and all volunteers gave written informed consent prior to participation. Procedures were conducted according to the institutional guidelines of the Declaration of Helsinki. The participants included 202 male teachers of which 101 were African and 101 Caucasian. Ambulatory blood pressure (BP) measurements were recorded with the Cardiotens CE120 at 30 minute intervals during the day and 60 minutes at night. Actical accelerometers determined physical activity (PA). Registered clinical psychologists supervised completion of the psychosocial questionnaires, including the Coping Strategy Indicator. Participants fasted overnight; after the last BP recording, disconnection of the Cardiotens CE120 and Actical followed. A fasting 8 hour overnight collected urine sample was obtained from each participant. Anthropometric measurements followed, after which a registered nurse commenced blood sampling. The SonoSite Micromaxx was used for the scanning of CIMT. MetS indicators (glucose, triglyceride, and HDL–C), together with gamma glutamyl transferase, cotinine, and ultrahigh–sensitivity C–reactive protein (hs–CRP), were analyzed with Konelab 20i. The albumin–to–creatinine ratio and CIMT determined TOD. Participants were stratified according to ethnicity and median splits of AC response scores (high AC and low AC). Diabetic medication users (n= 8), and participants with renal impairment (n= 2) or HIV positive (n= 13), were excluded from analyses. 2×2 ANCOVA’s determined significant interactions for ethnicity and AC. Partial correlations between MetS indicators and TOD were performed within each ethnic and AC group, independent of age, alcohol consumption and PA. Regression analyses were performed for four models, firstly with microalbuminuria and secondly with CIMT as dependent variables. Significant values were noted as p 0.05, r 0.35, and adjusted R2 0.25. RESULTS: Caucasian men were physically more active than African men, whilst BP, alcohol consumption and hs–CRP levels were significantly higher in African men. Psychological variables revealed higher avoidance scores in Caucasian men and higher social support scores in African men. More MetS indicators exceeded the IDF cut–off points in high AC African men (14.71%) than in their Caucasian counterparts (3.33%). Furthermore, more MetS indicators predicted endothelial dysfunction in African men, especially the high AC responders. CONCLUSION: The following hypotheses were accepted: high AC responses in urban African men were associated with a higher prevalence of MetS indicators than in their Caucasian counterparts, while MetS indicators were associated with a marker of TOD in urban high AC African men, but not in their Caucasian counterparts. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2011.

Abstract: The aim of the study was to evaluate the indoor air quality (IAQ) of a semi-airtight (the building only utilises mechanical means to ventilate the occupied spaces however an airtight seal is not established as a result of infiltration due to building design) office building that is situated in central Johannesburg that exclusively uses a heating, ventilation and air-conditioning (HVAC) system for ventilation. This implies a system that only utilises mechanical ventilation to heat, cool, humidify and clean the air for comfort, safety and health of employees. This includes the control of odour levels, and also the maintenance of carbon dioxide (CO2) below stipulated levels. Methods: The building is divided into two sections; west and east. Each section has its own ventilation supply. A randomisation process was used to ascertain which offices needed to be sampled, in which section as well as on which floor. For this study, five offices per section were measured. Thus, ten offices per floor were measured and measurements were taken on every second floor. All measurements were done in accordance with the specific requirements of the manufacturer of any specific instrument used and measurements were taken over an eight hour period (full work shift). Results were compared to the available standard, as well as compared to the ambient concentrations. Results: None of the monitored contaminants’ concentration were above the provided standards (ASHRAE or ACGIH). Where standards were unavailable, the HVAC system maintained an indoor contaminant concentration that is substantially lower when compared to the outdoor air concentrations. Conclusion: The buildings’ HVAC system maintains indoor air quality at a healthy level it is unlikely that any one of these contaminants may lead to SBS amongst the employees. / MSc (Occupational Hygiene), North-West University, Potchefstroom Campus, 2014

Abstract: The aim of the study was to evaluate the indoor air quality (IAQ) of a semi-airtight (the building only utilises mechanical means to ventilate the occupied spaces however an airtight seal is not established as a result of infiltration due to building design) office building that is situated in central Johannesburg that exclusively uses a heating, ventilation and air-conditioning (HVAC) system for ventilation. This implies a system that only utilises mechanical ventilation to heat, cool, humidify and clean the air for comfort, safety and health of employees. This includes the control of odour levels, and also the maintenance of carbon dioxide (CO2) below stipulated levels. Methods: The building is divided into two sections; west and east. Each section has its own ventilation supply. A randomisation process was used to ascertain which offices needed to be sampled, in which section as well as on which floor. For this study, five offices per section were measured. Thus, ten offices per floor were measured and measurements were taken on every second floor. All measurements were done in accordance with the specific requirements of the manufacturer of any specific instrument used and measurements were taken over an eight hour period (full work shift). Results were compared to the available standard, as well as compared to the ambient concentrations. Results: None of the monitored contaminants’ concentration were above the provided standards (ASHRAE or ACGIH). Where standards were unavailable, the HVAC system maintained an indoor contaminant concentration that is substantially lower when compared to the outdoor air concentrations. Conclusion: The buildings’ HVAC system maintains indoor air quality at a healthy level it is unlikely that any one of these contaminants may lead to SBS amongst the employees. / MSc (Occupational Hygiene), North-West University, Potchefstroom Campus, 2014

Major depression is a highly prevalent mood disorder with chronic debilitating effects. Additional to a rising rate in incidence, depression is highly co–morbid with other psychiatric disorders, but also chronic cardiometabolic illnesses that present with an inflammatory component. The exact aetiology of depression is still unknown, being multifactorial in its possible aetiology. Various hypotheses have attempted to shed light on both endogenous and exogenous risk factors as well as the underlying pathology that may lead to the development of the disease. This has led to a wide range of mediators being implicated, including biogenic amines, the HPA–axis, neurotrophic factors, inflammatory agents, the cholinergic system and circadian rhythm, to name a few. The mechanisms of action of current treatment strategies, except for a few atypical and novel treatment approaches, are limited to interactions with monoamines and are at best only 65% effective. Many of these are also plagued by troubling side–effects, relapse and recurrence. It has therefore become imperative to explore novel targets for the treatment of depression that may produce more rapid, robust and lasting antidepressant effects with a less daunting side–effect profile. The strong co–morbidity between depression and various cardiometabolic disorders, including cardiovascular disease, atherosclerosis, type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) has led to the proposal that a metabolic disturbance may be a vital component that drives inflammatory and immunological dysfunction in depression. Supporting of this is evidence for a role of inflammatory cytokines and neurotrophic factors in the pathogenesis of depression. It has also been demonstrated that a link exists between insulin– and nitric oxide (NO)– mediated pathways in the brain, which further highlights the role of oxidative stress and cell damage. Furthermore, evidence supports a role for oxidative stress and NO in T2DM and/or insulin resistance. Insulin has also been implicated in various physiological processes in the central nervous system (CNS) and may also influence the release and reuptake of neurotransmitters. Preclinical and clinical evidence has provided support for the antidepressant–like effects of insulin–sensitizing peroxisome proliferator activated receptor (PPAR)– agonists, such as rosiglitazone and pioglitazone. In preclinical studies, however, these effects are limited to acute treatment with pioglitazone or sub–chronic (5 days) treatment with rosiglitazone. It is well–recognized that such findings need to be confirmed by chronic treatment paradigms. The aim of the current study was therefore to further investigate the proposed antidepressant–like effects of pioglitazone in a genetic animal model of depression, the Flinders sensitive line (FSL) rat, using a chronic treatment protocol. The FSL rat model was reaffirmed as presenting with inherent depressive–like behaviour compared to its more resilient counterpart, the Flinders resistant line (FRL) rat. Moreover, imipramine demonstrated a robust and reliable antidepressant–like effect in these animals using the forced swim test (FST), thus confirming the face and predictive validity of the FSL rat model for depression. In contrast to previous preclinical studies, acute dose–ranging studies with pioglitazone in Sprague Dawley rats delivered no significant anti–immobility effects in the FST, whereas results similar to that seen in the dose–ranging studies were observed following chronic treatment using FSL rats. Since altered pharmacokinetics could possibly influence the drug’s performance, another route of administration, viz. the subcutaneous route, was utilized as an additional measure to exclude this possibility. The results of the subcutaneous study, however, were congruent with that observed after oral treatment. In order to confirm an association between altered insulin sensitivity and antidepressant action and demonstration by recent studies that thiazolidinediones may augment the efficacy of existing antidepressants, we therefore investigated whether concomitant treatment with gliclazide (an insulin releaser and insulin desensitizer) or pioglitazone (an insulin sensitizer) may alter the antidepressant–like effects evoked by chronic treatment with imipramine. Pioglitazone did not positively or negatively affect the antidepressant effect of imipramine, although gliclazide tended to decrease the anti–immobility effects induced by this antidepressant. Taken together and considering the current available literature, this finding supports evidence linking the insulin–PPAR pathway to depression. However, further explorative studies are required to delineate the role of insulin sensitivity and glucose homeostasis in depression and antidepressant response. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2012.