M.A. / This study was conducted in light of several feminist texts that have critiqued the diagnostic criteria for posttraumatic stress disorder in the DSM-IV-TR. These texts have argued that the current criteria, particularly Criterion A, are gender-biased and exclude many of the kinds of life events that are unique to women. This study sought to conduct an in-depth exploration of life events that do not meet the DSM-IV-TR‟s Criterion A but that nevertheless precipitated all of the other manifestations of PTSD. For the purpose of this study, two gender-specific traumatic events were selected, namely childbirth and miscarriage or stillbirth. A feminist and phenomenological approach was taken and the study was formulated as a critique of the DSM-IV-TR diagnostic criteria of PTSD. The research question was formulated as follows: Should the Criterion A definition of a traumatic event be expanded to include any experience that an individual defines as traumatic? A semi-structured interview was conducted with three participants complying with the specific population criteria. The interviews were transcribed and analysed through qualitative data analysis processes. The research methodology and analysis processes needed to be adapted due to the phenomenological nature of the research study. A comparison between the symptoms presented by the participants and the diagnostic criteria of PTSD, revealed that all three participants complied with all the DSM-IV-TR criteria except for Criterion A(1) and therefore could not be formally diagnosed with PTSD. It was also revealed that the women‟s experiences and reactions to the traumatic events were very similar, especially the fear caused due to feeling out of control. Therefore it was concluded that the essence of the traumatic experience was loss of control. The research question was positively answered, because it was concluded that each individual experiences events differently due to internal perceptions and the individualised meanings which are allocated to the event. Therefore the Criterion A definition of a traumatic event should be expanded to include any experience that an individual defines as traumatic.

Magister Artium - MA / Traumatic brain injury (TBI) has enjoyed extensive research and several therapeutic modalities, approaches and models have been developed where the main outcomes are focused on the successful return to work of individuals with brain injury. Research into women with TBI has, however, been negligible compared to research into the young adult male population. Gaining insight into how women with traumatic brain injury participate in their work environment would contribute valuable feedback to clinicians utilising return to work approaches and models. The study aimed to explore the challenges women who sustained TBI experience in the work environment after vocational rehabilitation. A qualitative research design was used to explore these experiences and perceptions from ten female participants. The method of data collection used to access the experiences and perceptions of the participants was in-depth semi-structured interviews. Furthermore semi-structured interviews were conducted with two occupational therapist, who were selected as key informants. The data from the study was analysed using thematic analysis. The study further aimed to obtain the participants` perceptions and experiences of barriers and facilitators as well as adaptation processes that influenced their ability to resume their work roles. Four themes originated from the findings of this study. Theme one describes the barriers experienced by women with TBI while returning to work in the form of barriers to work participation for women with TBI, loss of functional capacity hindering return to work, experiences of negative stigma and exploitation in the workplace, and contextual hindrances in the form of parental roles as well as public transportation systems. Theme two describes the factors that facilitated the resumption of the work role for women with TBI. Reestablishing a worker identity by means of vocational rehabilitation, utilising the Model of Occupational Self-Efficacy (MOOSE) as an approach, enabled the women with TBI to overcome their barriers and return to work. Theme three describes an inherent adaptation process where participants could come to terms with their losses, accept the present self and aspire towards a future self, by utilising personalised response approaches to overcome demands and challenges in the work context as well as experiencing success at work by adapting to the work environment. Theme four describes the participants’ views of changes needed in the rehabilitation program and services as well as policies that would aid in the quick return of women with TBI to productive roles. These suggestions are discussed as attainable through developing a multi-dimensional rehabilitation program for women with TBI as well as partnering with relevant stakeholders in the promotion of work opportunities for women with disabilities. The Model of Occupational Adaptation (MOA) was used as a framework to interpret the findings of this study; the barriers, facilitators and adaptation process were assessed as they impact on the experiences of the women with TBIs return to work. The return to work of the women with TBI was not observed only to be influenced by the personal characteristics but also by the environmental context within which the return to work process took place.

Class of 2011 Abstract / OBJECTIVES: To compare fixed equianalgesic doses of morphine and fentanyl with regard to analgesic response for patients who presented to the ED with moderate to severe pain. METHODS: A retrospective cohort study of clinical data obtained through patient medical record review. Median pain reduction on the numeric pain scale was compared between the morphine and fentanyl groups. Independent variables of interest included: Age, sex, weight, initial pain score, injury severity, triage severity and injury type. RESULTS: : Pain scores were reported to be worse in the fentanyl group, p= 0.0002. However pain reduction was similar between the groups; median (IQR) of 2 (1-3) and 2 (1-4) in the morphine and fentanyl groups respectively, p= 0.6707. Injuries were more severe in the fentanyl group; injury severity score (ISS) median (IQR) of 5 (1-9) and 9 (3-12), p=0.0312 and more patients in the fentanyl group required additional opioids within 30 min of their first ED opioid dose, 15 (18%) and 31 (37%), p=0.006. CONCLUSION: Patients in both the morphine and fentanyl groups received similar analgesic response. Patients in the fentanyl group had a higher severity of injury, received higher doses of opioids from the EMS, and required the second dose of opioid sooner than patients in the morphine group.

Abstract Traumatic Brain Injury (TBI) is a global epidemic (Schwarzbold et al., 2008). According to Brey (2006), a brain injury occurs every 21 second in the United States, which results in 1.5 million head injuries annually. The purpose of this project was to educate psychiatric personnel regarding the needs of the TBI population and to measure learning and retention. This is a quality improvement project that utilized a pretest and posttest design with an educational intervention. The intervention was administered electronically via Microsoft PowerPoint. Results were measured with the Wilcoxon Signed Rank Test. A total of 17 participants completed the pretest and posttest, and 11 completed the second posttest; the second posttest administered six weeks after the initial posttest. The results show that knowledge increased from pretest to posttest, (p < 0.05), however, retention of the material did not occur per test results, (p ≥ 0.05). There is no other research to compare to these results. Therefore, more research and educational intervention are needed to educate psychiatric personnel regarding the needs of the TBI patient.

Child-centred play therapy is not the preferred treatment approach for Posttraumatic Stress Disorder (PTSD), because of the limited research demonstrating this treatment as a proper approach for childhood trauma. The purpose of this case study was to explore and describe the process of child-centred therapy with a four-year-old child with PTSD. An exploratory descriptive case study approach was utilised as it allowed for an in-depth description of a phenomenon in its therapeutic context. Data was collected through multiple sources to establish a comprehensive database. The data was analysed through Alexander’s content analysis and Guba’s model of trustworthiness. Findings included themes observed in the research participant dealing with PTSD of perfectionism, control, shame, mistrust, needing control, and perfectionism. The therapist’s application of Axline’s principles indicated these principles being enough for treating PTSD in a child. Some of those principles had immediate impact while others were cumulative in their effect.

Due to the increasing healthcare costs and reduced length of hospital stay it is becoming increasingly important to identify individuals who are ‘at risk’ of experiencing long-term health issues. The purpose of the study was to: (1) determine if resilience, self efficacy and depression changed from inpatient to 3-month follow up; (2) examine the relationship between resilience, self efficacy, depression, and quality of life (social roles/activity limitations) at inpatient and 3-month follow up; and (3) identify if resilience at inpatient is related to change scores in selfefficacy and depression at 3-month follow up. Results from the paired sample t-test indicated that participants did not experience a significant change from inpatient to 3-month follow up in resilience or self-efficacy, but a significant decrease in depression was observed. Findings also indicated significant correlations between resilience, self-efficacy, and depression during inpatient stay and resilience, self-efficacy, depression, and quality of life at 3-month follow up. However, there was no relationship found between resilience and change scores in self-efficacy and depression. Future resilience research should continue to identify the variables that are most strongly related to resilience so effective interventions can be developed that improve rehabilitation outcomes, decrease secondary and chronic conditions as well as aid in the successful reintegration of individuals into their lives after a traumatic injury.

The purpose of the project is to evaluate various pastoral care methods which are employed to assist parents whose child has died in traumatic circumstances. In the light of this evaluation, then to propose an alternative approach which the pastor can exercise to support and help bereaved parents. This thesis considered the variety of pastoral care methods by means of a literature review. A questionnaire was then sent to pastors from different denominations. The information gleaned from completed questionnaires was used to prepare a review of pastoral care at “ground level”, that is to form an idea of how the general run of pastors dealt with such cases. In addition, a number of parents were interviewed with regard to their experience of the pastoral care which they received when their child had died in traumatic circumstances. The outcome of the thesis suggests that the perceptions of pastors and parents differed widely as to what constituted appropriate pastoral care. This study seeks to address this discrepancy and to formulate a proposed pastoral care method which can be used by any pastor in the event of the traumatic death of a child. The applicability of this thesis is somewhat limited by the fact that the sample used is relatively small. As a consequence other areas and communities might produce a different result. / Dissertation (MA (Theology) : Practical Theology)--University of Pretoria, 2008. / Practical Theology / unrestricted

Traumatic brain injury (TBI) is one of the leading causes of death and disability in children. The prefrontal cortex (PFC) is most susceptible to injury which leads to deficits in executive function, sociability, and cognitive flexibility. The oxytocin (OT) system plays a significant role in the modulation of species-typical social behaviors, such as social recognition and memory. Intranasal OT (IN-OT) has been shown to be neuroprotective against neuronal insults and social deficits through various mechanisms. Due to this and OT’s role in the modulation of social behaviors, it is possible that IN-OT could improve the social deficits caused by a PFC injury. The primary goal of this study was to determine the effects of a TBI on the development of the OT system. The secondary goal was to address the efficacy of IN-OT as a treatment for the social deficits observed following a TBI. For these studies, animals received a single cortical contusion injury bilaterally damaging the medial pre-frontal cortex. Immediately following injury (1-2 minutes), animals were given a single dose of IN-OT (20 μg, 1 μg/1 μl Ringer’s solution), placebo, or no treatment and sacrificed at days 1, 14, and 30 post-injury. Animals were assessed using behavioral and histological measures. It was predicted that animals that received IN-OT would demonstrate fewer social deficits on the behavioral measures and a smaller lesion size. Additionally, it was expected that a TBI would increase inflammation levels and decrease the levels of OT and OT receptors compared to sham animals. The results indicate that OT treatment did not significantly improve histopathological outcomes. However, the vehicle that was utilized impaired outcomes. Additionally, there was minimal changes to the OT system at the injury site, in the anterior olfactory nucleus, and in the caudate putamen due to injury. But vehicle treatment altered the expression levels of the OT peptide and receptors. Behaviorally, OT treatment improved performance in the Morris water maze in TBI animals compared to vehicle-treated and untreated TBI animals, but not other behaviors. However, vehicle-treated, and OT-treated animals were more likely to be aggressive than expected and untreated sham animals were less likely to be aggressive than expected. Taken together, it was observed that administration of a hypotonic saline solution following TBI significantly increases pathophysiology after TBI, and these effects translate into increased aggression levels. Although, learning and memory remained unaffected by the vehicle. Thus, further studies are needed to examine the effects of OT on TBI for behavioral and pathophysiological improvements.

Chronic Traumatic Encephalopathy (CTE) is a neuropathological disease that has been associated with contact sports involving repetitive brain injury. This disease is becoming more well-known due to an increase in media coverage, most notably for its possible association with professional football players. This has led to growing concern for the risks of participating in contact sports and the need for further research. There still remains much to be learned about this neurodegenerative disease. The current understanding of the epidemiology and risk factors for this disease are limited by biases in methodology, generalizability, and the use of retrospective data. The only method to diagnose CTE is via autopsy, which has contributed to some of these limitations. The pathogenesis of the disease involves hyper-phosphorylated (p-tau) tau accumulation in distinct areas in the cerebral cortex, leading to neuronal disfunction. The most accepted risk factor for this disease is recurrent brain trauma. Clinically, it can present with varying cognitive, mood, and behavior symptoms and different ages of onset, which often leads to a misdiagnosis of other neurodegenerative diseases. There are a few proposed treatments for CTE but more clinical trials must be performed before any are accepted in clinical practice. One potential modifying factor for CTE symptomology is cognitive reserve (CR). CR is an individual brain’s ability to cope with insults such as neuropathological disease, trauma, and the normal ageing process. Higher CR has shown to have a positive effect on other neuropathologies such as Alzheimer’s Disease (AD). This led to a preliminary study of CR which showed that one measure of CR, occupational attainment, was associated with delayed onset of symptoms of CTE. Our study builds upon this preliminary study by also examining the effect of CR on clinical symptoms of CTE. We expand on this study by using a previously validated tool to measure CR, including aspects such as education, occupational attainment, and social/leisure activities. Our study also includes subjects from other contact sports at varying levels of participation. The results of our study will provide a better understanding of the relationship between CR and clinical symptoms of CTE. This will allow future research to build upon these results and continue to advance our knowledge of this disease. These advances allow changes to be made in clinical practice and athletic organizations in order to improve an individual’s quality of life.

No description available.