The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study. A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season. A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin. In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

Low back pain has become one of the most influential musculoskeletal diseases of modern society. It is one of most expensive diseases in terms of medical costs and increased worker absenteeism, which can lead to permanent disability and places strain on the economy as a whole. Pain has been recognised as a disease in itself, which has certain consequences when it becomes chronic. Many kinds of treatment options exist with varying degrees of success. The question is thus which treatment option is the most favourable and cost-effective. Conservative treatment is the most recommended form of treatment when no serious underlying diseases are present. Exercise has been shown to be very effective in the treatment of chronic low back pain but there are still questions regarding the use of exercise therapy. The predetermined goal of the study was to ascertain whether an aggressiveprogressive exercise programme, and specifically what kind of exercises, would be more effective in the treatment of chronic low back pain. This was achieved through a number of steps, which included an extensive literature review, the identification of an appropriate test battery with related minimum physical requirements and cut scores, subject recruitment and screening of subjects, the implementation of the intervention and the subsequent re-testing of the subjects. Once the data was completed, the next step was to make use of two case studies to assist in illustrating the effectiveness of individual patients compared to the sample as a whole. These case studies were of patients who completed the entire programme but one took longer to complete the programme. This assists in illustrating the value of maintaining exercise protocol. The results from the present study are extremely positive. The two case studies provided a glimpse of the potential value that could be added through the implementation of more aggressive-progressive exercise interventions in the treatment of chronic low back pain. The final product will greatly assist exercise therapists concerned with the treatment of chronic low back pain along with cognitive-behavioural techniques. Hopefully this study will provide insight into managing chronic low back pain in South Africa from an exercise standpoint. Secondly the study will provide practical techniques to implement in an era in which economic difficulties are rife.AFRIKAANS: Laerugpyn het een van die invloedrykste muskuloskeletale siektes van die moderne samelewing geword. Dit is een van die duurste siektes in terme van mediese koste en verhoogde siekverlof deur werkers, wat kan lei tot permanente ongeskiktheid en ’n verhoogde las plaas op die ekonomie as ’n geheel. Pyn word erken as ’n siekte op sy eie wat sekere gevolge het wanneer dit chronies begin raak. Verskeie soorte behandelingsopsies is beskikbaar met variërende grade van sukses. Die vraag is dus watter behandelingsopsie is die bruikbaarste en koste-doeltreffendste. Konserwatiewe behandeling is die mees aanbevole metode van behandeling wanneer daar geen ernstige onderliggende siektetoestande teenwoordig is nie. Dit is reeds bewys dat oefening baie doeltreffend is in die behandeling van chroniese laerugpyn. Daar bestaan egter steeds vrae rondom die gebruik van oefening as terapie.Die vooropgestelde doelwit van die studie was om te bepaal of ’n aggressiewe-progressiewe inoefeningsprogram doeltreffend sal wees in die behandeling van chroniese laerugpyn, en meer spesifiek watter tipe oefening die doeltreffendste sal wees. Die navorsing het bestaan uit ’n paar stappe wat ingesluit het ’n intensiewe literatuursoektog, die identifisering van ’n gepaste toetsbattery met verwante minimum fisieke vereistes en afsnytellings, die verkryging en evaluering van proefpersone, die implementering van die intervensieprogram en die daaropvolgende hertoetsing van die proefpersone.Nadat die invordering van die data en die gepaardgaande analise van die data voltooi is, was die volgende stap om gebruik te maak van twee gevallestudies ten einde die doeltreffendheid van die intervensieprogram vir individuele proefpersone te ilustreer deur dit te vergelyk met die groep as ’n geheel. Die twee gevallestudies was van proefpersone wat die intervensieprogram volledig voltooi het, alhoewel die een proefpersoon langer geneem het om die intervensieprogram te voltooi. Dit help om die navolgingswaarde van ’n inoefeningsprotokol te illustreer. Die resultate van die huidige studie is uiters positief. Die twee gevallestudies gee ’n mate van insig wat betref die potensiële waarde wat verkry kan word deur die implementering van ’n meer aggressiewe-progressiewe inoefeningsintervensie vir die behandeling van chroniese lae rugpyn. Die finale produk sal die nodige ondersteuning aan oefeningsterapeute bied wat onseker is oor die behandeling van chroniese laerugpyn deur middel van aggressiewe-progressiewe inoefeningsintervensies en kognitiewe gedragstegnieke. Hierdie studie sal dus die begrip en insig van die behandeling van chroniese laerugpyn in Suid-Afrika verhoog vanuit ’n oefeningsuitgangspunt. Tweedens sal die studie die gebruik van praktiese oefentegnieke aanmoedig in ’n era waarin ekonomiese tye moeilik is. / Thesis (DPhil)--University of Pretoria, 2011. / Biokinetics, Sport and Leisure Sciences / unrestricted

Text in English / Abstracts in Afrikaans and English / Ekspressiewe skryfwerk (ES) – as ‘n metode van intervensie gemik op fisiese en geesteswelstand van deelnemers – word reeds vir ongeveer drie dekades ondersoek. Klein en Boals beweer met hul 2001-studie dat ES ook ‘n positiewe invloed uitoefen op die werkende geheue van individue. Met die huidige studie word die vraag of hierdie bevinding ook van toepassing is op adolessente en jong volwassenes van Suidelike Afrika ondersoek. Dié projek betrek aanvanklik skoolleerders (N = 44) en eerstejaar universiteitstudente (N = 83) in die Suid-Kaap en met die skryfoefeninge word ‘n komponent bygevoeg by een van die eksperimentele groepe waar kognitiewe insette saam met die emosionele onthulling verlang word. Die studie-resultate toon heelwat teenstrydighede, dog die positiewe invloed van ES op die werkspan word by ‘n goeie aantal eksperimentele groep deelnemers waargeneem. Vorige navorsing dui op ‘n verlaging in die voorkoms van indringer- en vermydingsgedagtes na ES tesame met verbeterde werkspan en hierdie verband word van nader beskou deur die huidige studie. Die moontlikheid dat woordtelling per minuut as informele meting van werkspan aanvaar kan word, sowel as die moontlike verband tussen gemoedsvlak en skryfkondisie word ook met die projek ondersoek. / During the past three decades expressive writing has been in the research spotlight as an effective method of intervention in the improvement of human well-being. In 2001 a study done by Klein and Boals claimed that expressive writing also has a positive influence on the working memory of the student participants. The current study investigates the influence of expressive writing on adolescents and young adults in the Southern Africa context. Solution-focused exercises, together with emotional expression during the writing sessions, add a cognitive component to the intervention which strive to create greater impact on working memory capacity (WMC). Previous research indicate that improvement in WMC goes hand in hand with the reduction in the prevalence of intrusive and avoidant thoughts. During the current project the relationship between working memory and these thoughts is investigated. Additionally the possibility of word count as informal measure for WMC are looked at as well as a possible association between mood level and writing condition. / Psychology / M.A. (Psychology)