BACKGROUND: Guidelines recommend long-term treatment for opioid use disorder including the use of buprenorphine; however, little is known about patients in long-term treatment. OBJECTIVE: Examine the prevalence and patient characteristics associated with long-term treatment retention (≥1 year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine. Study Design: This is a 12-year retrospective cohort study of adults on buprenorphine in OBOT in a large urban safety-net primary care practice. METHODS: The primary outcome was retention in OBOT for ≥1 continuous year. Patients who re-enrolled multiple times in the program contributed repeated observations. Potential predictors of ≥1 year retention assessed were: age, race/ethnicity, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1 year OBOT retention were identified using generalized estimating equation logistic regression models. The different reasons for clinic disengagement by retention status (i.e. ≥1 year vs. <1 year) were also described. RESULTS: OBOT treatment periods (n=1605) among 1237 patients were assessed. Almost half, 44.7% (717/1605), of all treatment periods were ≥1 year and a majority, 53.7% (664/1237), of patients had at least one ≥ 1 year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10 year increase [1.05, 1.34]) were associated with greater odds of ≥1 year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]), compared to white, were associated with lower odds of ≥1 year retention. Relapse to substance use appeared to be a less common reason for disengagement for the ≥1 year (23.3%) compared to the <1 year (40.1%) treatment periods. CONCLUSIONS: Over half of patients were successfully retained in Office Based Opioid Treatment with buprenorphine for ≥1 year. However, significant disparities in one-year treatment retention were seen, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C. / 2018-11-09T00:00:00Z

A cognitive behavioural treatment program for chronic lower back pain was designed, implemented and evaluated. The outpatient treatment program included education sessions, goal setting, graded activity training, physical exercise, relaxation training, cognitive techniques, social skills training, and medication reduction. Three participants volunteered to participate in the eightweek treatment program. Of the three participants, only one completed the program successfully. The results were used to critically discuss and evaluate the literature. The successful participant showed significant improvement in activity levels, decrease in subjective levels of pain, as well as decreased levels of anxiety and depression. It was shown that correcting cognitive distortions (e.g. selective abstraction, catastrophising, misattribution) and challenging early maladaptive schemas of abandonment, emotional deprivation and emotional inhibition (Young, 1990) assisted in enhancing coping mechanisms and the belief that the pain episodes would be short-lived and could be controlled. There was considerable improvement for the second participant, although he chose to withdraw from the program prior to its completion. The components of the psycho-education, relaxation and stress management and exercise program were beneficial for him. The third participant failed to accept the treatment formulation, and did not engage collaboratively in the treatment program. The case is presented as a point for examining therapeutic ailures.

M. Tech. / Background: No substantiated theory exists by which chiropractic adjustments are known to correct myofascial trigger points (MTrPs). Myofascial trigger points are theorized to be either a primary muscle dysfunction or a secondary manifestation to central/ peripheral neurological mechanisms. Chiropractic adjustments are theorized to exert their therapeutic influence either primarily through biomechanical effects and/ or via neurophysiological mechanisms. Objective: The objective of this study was to investigate the effects of chiropractic adjustments on chronic, active rhomboid MTrPs, by comparing the clinical effects attained with rhomboid attachment-segment (C7-T5) relative to rhomboid innervation-segment (C4 and/ or C5) chiropractic adjustments. Setting: University of Johannesburg Chiropractic Day Clinic in Johannesburg, Gauteng. Participants: Thirty female subjects selected from the general population (from 18 to 40 years) were randomly divided into two different treatment groups of 15 each. Methods: The subjective information required the completion of the Subjective Pain and Discomfort Questionnaire, including the Numerical Pain Rating Scale (NPRS). The objective measures collected were pressure-pain threshold (PPT) and range of motion measurements using the algometer and digital inclinometer, respectively. Additionally, the change in the number of active MTrPs over the treatment period was recorded. All measurements were recorded at the first, third and fifth consultations, over a 3 to 4 week period. The data gathered were then statistically analyzed with the use of a 95% confidence interval. The nonparametric Friedman and Wilcoxon Signed Rank tests were used for the intragroup comparisons, and the Mann Whitney- U test was used for the intergroup comparisons. Interventions: Treatment group 1 received upper-thoracic/ attachment- segment chiropractic adjustments, and treatment group 2 received mid-cervical/ innervation-segment chiropractic adjustments. The research project was carried out so that both groups received 5 treatment sessions over 3 to 4 weeks. Results: There were no statistically significant results obtained for intergroup comparisons. Attachment-segment chiropractic adjustments revealed statistically significant changes in NPRS values (p=0.000), PPT values (p=0.000), cervical spine right lateral flexion range (p=0.004), thoracic spine extension (p=0.005) and left rotation range (p=0.003) over time. Innervationsegment chiropractic adjustments revealed statistically significant changes in NPRS values v ii (p=0.001), cervical spine right rotation (p=0.003), thoracic spine flexion (p=0.001) right lateral flexion (p=0.001) and left rotation (p=0.005) over time. Conclusions: This study does not suggest that attachment-segment or innervation-segment chiropractic adjustments possess greater clinical efficacy relative to one another in terms of improving the clinical picture associated with chronic, active rhomboid MTrP activity. In a further study, a larger sample size will be necessary to identify subtle changes in measurement parameters.

M.Tech. / The most susceptible and vulnerable segment of society to HIV/AIDS infection is the population sector aged between twenty and forty years old. This threatens to impact negatively on South Africa’s economic, social and human development (Whiteside and Sunter, 2001). The aim of this descriptive pilot study is to elicit a homoeopathic symptom picture of HIV positive Black females living in Gauteng, and also to compare this symptom picture to existing HIV proving pictures. Ten HIV positive Black females living in Gauteng were interviewed from a homoeopathic perspective. The participants were aged between twenty-two and forty years, and were in the asymptomatic carrier phase or the AIDS related complex (ARC) phase of HIV infection. None of the participants were receiving antiretroviral treatment. The researcher utilized a set questionnaire to conduct the interviews with. Each interview was compared to one another to determine the common themes and trends emerging from the case histories. These common features were utilized to produce a unique homoeopathic symptom picture of HIV infection in Black females. This symptom picture was compared to the existing HIV proving pictures of Stallick’s and Norland’s AIDS nosodes and Chappell’s PC1. The symptom picture was repertorised using the Cara Pro computerized repertory programme to determine possible constitutional and genus epidemicus treatment options for HIV infection as well as to evaluate the miasmatic presentation of HIV. This study indicates that the HIV proving pictures of the AIDS nosodes and PC1 closely match the unique homoeopathic symptom picture derived from this study. Possible genus epidemicus treatment options include Iodium and PC1. A wide variety of constitutional prescription options materialized from this research. This study also supports the idea that HIV/AIDS is a miasm in its own right, and is represented by aspects of the psoric, sycotic, syphilitic, tuburculinic and cancer miasms. This work is dedicated to the memory of Bongi, a fun-loving, sincere and courageous woman, and to all the HIV/AIDS sufferers in South Africa. / Dr. J. Roohani Dr. K.S Peck Dr. T.A Blake

M.A. / This action research study explored the development and workings of a monthly, openended depression and anxiety support group based in Johannesburg, Gauteng. Although the growth of mutual-aid groups has escalated over the past three decades, there is little research on support groups created solely for the purpose of servicing depression and anxiety sufferers. Researchers have indicated that support and information at these meetings may prove to be a valuable and effective intervention which helps sufferers come to terms with their condition (Miller, 1987; Stein, Zungu-Dirwayi, Wessels, Berk & Wilson, 1998). The study at hand aimed to elucidate the ways in which the depression and anxiety support group was experienced as helpful, as well as those areas which could be improved to increase the effectiveness of the group system. The support group was examined over an eleven-month period, November 1999 – October 2000, during which time the progress and experiences of three new group members was specifically observed and chronicled. Seven participants, including three members of a support group catering for black depression and anxiety sufferers, were initially sourced and screened for inclusion in the study. Although not intentional, the three subjects that finally fulfilled the criteria for inclusion in the study were all white females attending the Johannesburg support group. Relevant data on the three participants was collected systematically over this period through a process of triangulation. Methods included structured and semi-structured interviews, written reports, questionnaires and participant observation. The grounded theory approach allowed the researcher to work inductively with the data and to discern and explore the connections between elements and patterns that emerged in the analysis. An integration of the research data revealed that the group was primarily helpful to participants through the factors of universality, cohesion, didactic instruction and downward social comparison. Furthermore, the results indicated that participants presenting with prominent avoidant personality disorder (APD), as measured by the Millon Clinical Multiaxial Inventory-II, are likely to strongly value the relief from social isolation that the support group setting affords them, as well as gaining comfort from belonging to and being accepted by a group and improving their interpersonal skills. On the negative front, the group would or could not move beyond a formative, early stage of group development. As a result, its members were either caught in a repetitive cycle of exploring the same territory or lost interest after a relatively short period of time and terminated membership. Based on the findings of this study, it is suggested that members be afforded the opportunity of attending a more advanced therapy group once they feel they have gained the necessary relief from the primary support group. The support group plays a valuable role of reassuring members that they are not alone in their suffering, offering them the learning experience of being accepted by a group and introducing them to group format and protocol. However, once a foundation has been established, it is likely that members would benefit from joining a more advanced group in which interpersonal learning and role modelling is emphasized. Members need an arena where they can explore their behaviour and feelings in depth, and with other members who are functioning at a similar level. It is hoped that the findings of this study will increase understanding of support group functioning, provide suggestions for future research involving APD clients and depression and/or anxiety sufferers in support gr oup settings and make some contribution towards theory-building in this field.

M.Tech. / The worldwide dissemination of Human Immunodeficiency Virus (HIV) over the past four decades has entered our consciousness as one of the most catastrophic examples of the emergence, transmission and propagation of a virus (Department of Health, 2000; Stebbing et al., 2004). Globally, an estimated 40.3 million people are living with the virus. In 2005 alone, the World Health Organisation estimated that there were close to five million new HIV infections worldwide (UNAIDS/WHO, 2005). Southern Africa is experiencing an HIV/AIDS epidemic of shattering dimensions and, unfortunately, shows little evidence of possible future declines in HIV prevalence. It remains by far the worst-affected region, with 25.8 million people infected at the end of 2005. Of these infected, only one in ten Africans were receiving anti-retroviral treatment (ART) in mid-2005 (Dorrington et al., 2001; UNAIDS/WHO, 2005). Since South Africa carries the biggest global burden of HIV, it is difficult to provide and sustain treatment for all individuals infected with HIV (Department of Health, 2004b). Previous research on the efficacy of homoeopathic treatment in HIV has been done by Brewitt et al (1999) and Da Silva et al (2005) with beneficial results. The aim of this study was to determine the effect of homoeopathic growth factors (HoGF’s) on CD4 cell count, measurements such as weight and body mass index (BMI), symptoms associated with HIV/AIDS, and quality of life of participants living with HIV. The research was conducted on a sample of twenty five participants (n=25) drawn from a population of persons from eighteen to sixty years of age. Twenty two participants (n=22) completed the research. Participants were recruited from the Inkanyezi ARV Clinic, situated in an informal settlement in Orange Farm, south of Johannesburg, South Africa. The recruited participants were requested to read and sign the Participant Information and Consent form (Appendix A) providing them with the necessary information regarding the research. The duration of the clinical trial was thirteen weeks. Analysis of CD4 cell count, measurements of weight and body mass index (BMI) and symptoms associated with HIV/AIDS were conducted at day 1, week 5, week 9 and week 13. A quality of life questionnaire was conducted and analysed at day 1 and week 13. The HoGF medication was administered to each participant, who received sufficient medication until the next follow up consultation. This allowed the researcher to monitor patient compliance. One tablet was given three times a day, for a thirteen-week period. The participants were instructed to suck or chew the pleasant tasting, white tablet. The statistical models such as the repeated measures ANOVA analysis test, the non-parametric Wilcoxon test and the McNemar test were used to statistically analyse the data. The resultant analyses of the data have provided the following conclusions. HoGF treatment did not improve overall immune function of the participants, as there was a decrease in the average CD4 cell count of the HIV infected adults over the 13 week period. HoGF was effective in increasing immune functionality of the major symptomatic group but did not show improved immune functionality in the asymptomatic or minor symptomatic groups. There was, however, an overall decrease in the occurrence of the common symptoms of HIV seen in the entire sample group and HoGF intervention stabilised weight and BMI over the trial period. HoGF treatment also demonstrated an improvement in the quality of life of the participants. There were no reported signs of adverse side effects while on HoGF treatment. The results of this study are expected to initiate further research in the area of homoeopathy and HIV/AIDS. It is recommended that future studies include a control group with placebo for inter-group comparisons. This HoGF treatment can therefore be seen as a possible complementary treatment option for treating the common symptoms associated with HIV/AIDS in the absence of ART, and maintaining wellness in HIV patients. / Dr. R. Razlog Dr. M. Da Silva

M.Tech. / Purpose: This study aims to compare the effects of chiropractic manipulation versus mobilisation on Pressure Pain Threshold in chronic posterior mechanical cervical spine pain sufferers with regards to pain, disability and cervical spine range of motion. These effects were evaluated using a questionnaire consisting of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire, and by measuring cervical spine range of motion using a Goniometer as well as Algometer readings over the restricted facet joint/s in the cervical spine. The questionnaires were completed and the range of motion readings and algometer readings were taken prior to treatment on the first, fourth and seventh consultations. Method: Thirty participants who met the inclusion criteria were divided into two groups of equal size (15 participants each). Group one received spinal manipulation to restricted cervical spine joint/s. The second group received spinal mobilisation to restricted cervical spine joint/s. Participants were treated six times out of a total of seven sessions, over a maximum three week period. Procedure: Subjective data was collected at the beginning of the first and fourth consultations, as well as on the seventh consultation by means of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire in order to assess pain and disability levels. Objective data was collected at the beginning of the first and fourth session, as well as on the seventh consultation by means of a Goniometer and Algometer in order to assess cervical spine range of motion and to measure the Pressure Pain Threshold at the restricted facet joint/s in the cervical spine. Analysis of collected data was performed by a statistician. Results: Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability, and cervical spine range of motion. Statistically significant changes were noted in group 1 and group 2 with reference to pain and disability, and in group 1 and group 2 with v reference to certain cervical spine range of motions as well as algometer readings to measure the Pressure Pain Threshold at the restricted facet joint/s. Conclusion: The results show that both spinal manipulation and mobilization are effective treatment protocols (as demonstrated clinically, and to a lesser extent, statistically) in decreasing pain and disability, and increasing cervical spine range of motion and most importantly Pressure Pain Threshold at the restricted facet joint/s in patients with chronic posterior mechanical cervical spine pain. Although the study did not allow for a definite conclusion to be drawn, the results suggest that Chiropractic manipulative therapy is an effective treatment protocol to increase the Pressure Pain Threshold in chronic posterior mechanical neck pain sufferers. The advantage of this is that the treatment modality is used to its full potential, thereby providing the patient with the best results in terms of lasting benefits. It also shows that in cases where manipulation is contra-indicated mobilization will have a similar effect, but the long term benefits are questionable.

M.Tech. / Purpose: This study was undertaken in order to demonstrate the effects of static magnetic field therapy on acupuncture points in the treatment of those suffering from mechanical neck pain. Isolated spinal manipulative therapy of the cervical spine was compared to spinal manipulative therapy of the cervical spine in conjunction with magnetic field therapy on acupuncture points using both objective and subjective measurements. Before the execution of this study, it was hypothesised that both treatment protocols would be effective in the treatment of mechanical neck pain, although the combined therapy would be more effective. Method: Patients were recruited by way of advertisements placed in and around the University of Johannesburg, Doornfontein campus and their health clinic. Thirty patients with mechanical neck pain were recruited and randomly divided into two groups. Group one received manipulation to the affected joints of the cervical spine and group two received manipulation to the cervical spine combined with magnetic field therapy on acupuncture points. Procedure: Each patient in each group attended six treatment sessions; three in the first week and three in the second week. The Vernon Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale (subjective measurements) were completed by each patient and the Cervical Range of Motion instrument (objective measurements) was used to collect readings from each patient in both the control and experimental groups, subjective and objective measurements were taken before treatment one, three and six. Specific treatment protocols were then adhered to. Results: The results indicated that both treatment protocols were effective in reducing mechanical neck pain although not one group was more effective than VI the other. Both groups improved subjectively and objectively as they had cervical spinal manipulation directed at joint dysfunction. Conclusion: The experimental group who received spinal manipulative therapy to correct joint dysfunction in conjunction with magnetic field therapy on acupuncture points was not more effective than the control group who received spinal manipulation only, in the treatment of mechanical neck pain.

M.Tech.

Thesis (M.Tech.: Chiropractic)--Dept. of Chiropractic, Durban Institute of Technology, 2006. / Brunarski (1984) says that philosophically and historically, chiropractic has been uniquely orientated toward an emphasis on preventative care and health maintenance with a mechanistic and hands-on model for treatment. Instead of reductionism, chiropractors focus on holism, non-invasiveness and the sharing of the responsibilities for healing between doctor and patient. As stated in a Canadian report by Manga et al. (1993), lower back pain is a ubiquitous problem and there are many epidemiological and statistical studies documenting the high incidence and prevalence of lower back pain (Manga et al., 1993). Evans and Oldreive (2000) revealed in a study of the transversus abdominis that low back pain patients had reduced endurance of the transverses abdominis and that its protective ability was decreased. In addition, it was noted that wasting and inhibition of the other core stabiliser and co-contractor, multifidus, was present (Hides et al.,1994), both of which have been linked to the presence of low back pain (Evans and Oldreive, 2000 and Hides et al., 1994). Thus, it stands to reason that manipulation, as an effective treatment for low back pain (Di Fabio, 1992), could be effective in restoring the strength and endurance of the core stability muscles. This is theoretically supported by the fact that a restriction in motion and pain due to mechanical derangement in the low back can be effectively treated by manipulation (Sandoz, 1976; Korr (Leach, 1994); Herzog et al., 1999; Homewood, 1979; Vernon and Mrozek, 2005 and Wyke (Leach, 1994)). Homewood (1979) described that a subluxation may interfere with the nerve supply and result in a decrease in muscular activity. He hypothesized that removal of the subluxation could restore: normal physiological processes, increase muscle activity and; improve functional ability and normalize the torque ratios (Herzog et al., 1999; Korr (Leach, 1994); Nansel et al., 1993 and Rebechini-Zasadny et al., 1981). In terms of an intervention, Rebechini-Zasadny et al. (1981) and Naidoo (2002) demonstrated and inferred that manipulation to the cervical spine could affect the muscular activity supplied by those levels. They, however, suggested further studies of manipulation-induced peripheral changes in the muscles are needed, due to unaccounted for variables and small sample sizes in their respective studies This research aims to address the questions posed by the above literature, hence by investigating a high velocity low amplitude manipulation as a possible added intervention for improving local core stabilizer muscle strength, a management protocol for the chronic mechanical lower back pain could be developed. / M