M.Tech.

M.Tech.

Schizophrenia, the most common of the psychoses, is a challenging subject for the beginning social worker in a psychiatric setting. The purpose of this study, after reviewing the nature and cause of schizophrenia and indicating how it is currently treated in mental hospitals and clinics, is to assess (a) whether casework is an appropriate treatment method for this disorder; and (b) if so, what modification of casework is necessary to meet the schizophrenic person's needs. Schizophrenia is no longer regarded as a purely psychiatric concern. Current treatment aims at reduction of symptoms and improvement in social adjustment of the schizophrenic patient, not "cure" of the underlying pathology. According to modern psychiatry, the central problem in schizophrenia is the social malfunctioning of the patient, and social workers in the community as well as in clinical settings are being called upon with increasing frequency to aid in the treatment of this disorder. As foundation for this study, the orthopsychiatric literature available over the past decade on the psychopathology and treatment of the schizophrenic has been critically reviewed. From this material and from the personal experience of the writer in casework service to hospitalized schizophrenic patients, current concepts on the nature and cause of schizophrenia are defined, and present treatment measures evaluated. Casework as a method for treating schizophrenia is analyzed, and the phases of study, social diagnosis, planning and implementing treatment is applied to the schizophrenic patient's central problems, defense mechanisms, and impaired ego-functioning. "Ego breakdown" in schizophrenia is assessed, and contrasted with the ego-functioning of the normal, neurotic and sociopathic personality types. The conclusions of this study can only be applicable to schizophrenia in general, not to specific cases. Schizophrenia is psychogenic in origin, originating in early childhood when extreme anxiety and insecurity in the child are caused by faulty relationships with the parents, and in particular with the mother. The treatment of choice for schizophrenia is psychotherapy, with adjunctive physical therapies used to reduce symptoms and increase accessibility to personal contact. The supportive treatment method of casework and most of its techniques are eminently suited to treating the schizophrenic patient: the modifying treatment method, clarification, catharsis and interpretation of underlying conflicts, are not. The casework approach to the schizophrenic differs decidedly from that used with clients possessing stronger egos, who can tolerate the anxiety aroused by self-examination. The goals of casework with the schizophrenic patient are support of the constructive parts of the patient's personality, strengthening of his ego-functioning, and maintenance of his psychotic defenses until more constructive defenses are rebuilt. The schizophrenic patient's central problems are his withdrawal from reality due to fear, and his basic mistrust of people. A reality-oriented approach, directed to helping the patient cope more effectively with everyday problems, is used to overcome the schizophrenic patient's distrust and to renew his contact with the real world. / Arts, Faculty of / Social Work, School of / Graduate

This study is from a social work viewpoint and examines the nature and classification of the cases of alcoholism admitted to the Psychiatric Ward of a General Hospital. It gives particular emphasis to underlying personality factors and their relation to cause and cure. The case material was gleaned from records compiled by members of the medical staff and delineates three categories of alcoholics, namely, (a) those who can be helped by case-work treatment, b) those who cannot be helped by case-work because of deep-seated problems, but whose families can be helped, and (c), those who cannot be helped by either direct or indirect means. The findings of this study indicate the need for case-work services (a) in screening alcoholic patients who probably cannot benefit from treatment, (b) in determining the best treatment procedure for those who can be treated, (c) in working with other professional personnel in an integrated team approach to treatment, (d) in helping the patient with rehabilitation from the hospital, and (e), in preventive work in the community. / Arts, Faculty of / Social Work, School of / Graduate

This thesis examines the posttreatment stability and relapse in long- and short-term studies. It attempts to identify potential predictors of relapse by specifically evaluating the stability and relapse associated with nonextraction treatment, extraction versus nonextraction treatment, and early versus late extraction treatment. It provides values for the percent relapse and rate of relapse of the parameters evaluated and compares the long-term and short-term studies in order to potentially provide information about the effectiveness or shortcomings of the various treatment types in maintaining a stable posttreatment outcome and about the progression of relapse over time. The results yielded the following findings. Among the significant posttreatment results, no parameter showed consistency in the posttreatment outcome with any specific treatment type. The parameters that were found to undergo the greatest percent relapse were the mandibular intercanine width, following by mandibular arch length, and mandibular interfirst molar width, while those with the highest rate of relapse were the mandibular intercanine width, following by the mandibular arch length, and the mandibular incisor irregularity. Overall, the long-term studies experienced greater percent relapse than the short-term studies. On the other hand, greater rates of relapse were noted in the short-term studies compared to the long-term studies. The rate of relapse was greater in the extraction patients compared to the nonextraction patients ( excluding the results for the overbite and the mandibular intersecond premolar width). In addition, both the percent relapse and rate of relapse were greater in the late extraction group compared to the early extraction group (excluding the mandibular intercanine width). In conclusion, the long-term versus short-term results suggest that relapse continues to occur several years postretention and suggests that greater relapse occurs soon after the end of the retention phase and gradually less as time passes. In addition, the rate of relapse results suggest that nonextraction treatment is more stable than extraction treatment. Lastly, the percent relapse and rate of relapse results suggest that early extraction treatment is more stable than late extraction treatment.

Submitted to the Department of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science Epidemiology and Biostatistics, 2012 / TB is a high burden disease (prevalence: 940/100,000 in 2006) with high morbidity and mortality in South Africa and the primary health care facilities are well position to provide primary TB care in accordance to the national TB control guidelines and achieve desired treatment outcome targets. This study followed the TB management at Thandukukhanya clinic from 2000-2005 and found among others that the number of TB cases tripled, the TB cure rate progressively declined and DOTS support dwindle over the six years. The study was motivated by 26% decline in TB cure rate at Mkhondo sub-district from 2003 – 2005 and 76% increase in TB default in the same period. The TB cure rate in 2005 was 37% compared to 85% national target. The poor treatment outcome prevails despite availability of DOTS support in the program. In addition, the number of drug resistant TB has increased in the past years and extremely drug resistant TB emerged in the past three years in South Africa

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No description available.

MTech

MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, 2009 / South Africa is ranked fourth on the list of 22 high-burden TB countries in the world. Intensifying the prevalence of TB in South Africa is the high TB/HIV co-infection rate, with 44% of new TB patients testing positive for HIV. This burden is intense for rural communities due to poverty and return of people with TB/HIV co-infection who previously migrated for employment. In rural South Africa, TB is the leading cause of mortality in HIV-infected persons, but limited information is available about predictors of death. This study measures TB treatment outcomes in Rixile clinic and assesses predictors of TB mortality. Rixile HIV clinic is based in Tintswalo hospital, Acornhoek, Bushbuckridge, Mpumalanga province. This current study uses secondary data collected through a prospective cohort study conducted by PHRU and RADAR from March 2003 to March 2008 on 3 to 6 monthly intervals. Chi-square and logistic regression statistical tests were used to assess predictors of TB Mortality. TB mortality among study participants was 62.5% during the pre-ARV rollout period (March 2003- October 2005), and treatment completion was 31.7%. Some 5.8% participants interrupted treatment during the pre-ARV rollout period as compared to 4.5% during the ARV rollout period (November 2005- March 2008). TB mortality among study participants was 7.5% during ARV rollout and treatment completion increased to 84.4%. Factors associated with TB mortality were age (p=0.006), sex (p=0.017), BMI (p< 0.001), marital status (p=0.004), education (p=0.03), alcoholic beverages consumption (p=0.04), and ARV treatment (p<0.001). However, only age, sex, and ARV treatment were found to predict TB mortality. The proportion of TB treatment completion was higher and TB mortality was lower during ARV roll-out compared to pre-ARV roll-out. Being at the age of 40 to 75 years, not being on ARV treatment and male sex predicts TB mortality in this population. There is a need to expand ARV treatment and intensify TB care services for older people, particularly males living with HIV in this rural community.