A model to understand HIV-related stigma and the psychosocial well-being of children orphaned by AIDS: a theory generative approach

HIV-related stigma has negatively impacted the psychosocial well-being of children who have been orphaned by AIDS-related causes. Response to reducing stigma and ensuring child well-being is hindered by the limited understanding of HIV-related stigma and how it affects the psychosocial well-being of children. Due to the call for a comprehensive understanding of HIV-related stigma, this study aimed to develop a model to understand the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS. The study implemented a mixed method, exploratory, sequential design within a theory generative approach that included concept development, statement development, model description, and model evaluation. The developed model indicated that HIV-related stigma is embedded in social interaction and mediated by children orphaned by AIDS response to stigma. HIV-related stigma and maladaptive coping strategies collectively affect several domains of child psychosocial well-being and elevate psychosocial distress. This is the first model to provide a child-centred understanding of HIV-related stigma and its consequences for psychosocial well-being. The model may be used to guide future research and inform the development of appropriate interventions.

Angle-of-incidence performance of random anti-reflection structures on curved surfaces

Random anti-reflection structured surfaces (rARSS) have been reported to improve transmittance of optical-grade fused silica planar substrates to values greater than 99%. These textures are fabricated directly on the substrates using reactive-ion etching techniques, and often result in transmitted spectra with no measurable interference effects (fringes) for a wide range of wavelengths. The inductively coupled reactive-ion plasma (ICP-RIE) used in the fabrication process to etch the rARSS is anisotropic and thus well suited for planar components. The improvement in spectral transmission has been found to be independent of optical incidence angles for values from 0° to ±30°. Qualifying and quantifying the rARSS performance on curved substrates, such as convex lenses, is required to optimize the fabrication of the desired AR effect on optical-power elements. In this work, rARSS was fabricated on fused silica plano-convex lenses using a planar-substrate optimized ICP-RIE process to maximize optical transmission in the range from 500 to 1100 nm. Results are presented from optical transmission tests of rARSS lenses for both TE and TM incident polarizations at a wavelength of 633 nm and over a 70° full field of view. These results suggest optimization of the fabrication process to account for anisotropy is not required, mainly due to the wide angle-of-incidence AR tolerance performance of the rARSS lenses.

The profile and experiences of services providers with rehabilitation services in the Western Cape

The 2010 South Africa health plan has highlighted the need to ensure a qualified workforce in order to improve access to quality health care.

Technology-mediated learning in physiotherapy education: The social construction of practice knowledge

Clinical practice is complex, requiring practitioners to interpret adiverse range of inter-related variables in order to make clinical decisions as part ofpatient management. This process is often intuitive and therefore hidden from studentsand less experienced clinicians, making the cognitive processes that inform clinicaldecision-making difficult to learn. In addition, educators still emphasise the learningof knowledge and skills through didactic teaching methods, such as lectures, in whichstudents are passive “recipients” of knowledge. Unless physiotherapy educators designactivities that aim to induct students into the professional culture and help them todevelop ways of thinking and being that go beyond knowledge and skills, our studentswill continue to struggle with clinical reasoning.In this position paper, we argue that the careful integration of technology as an adjunct to traditional lectures can be usedto facilitate discussion and interaction as a way of developing practice knowledge in students. This leads to higher cognitivefunctioning as it provides the means by which learners construct their own personally meaningful understanding of the worldthrough interaction with others. The promise of technology in physiotherapy education lies in its ability to create transformativelearning experiences through enhanced communication that is mediated by more experienced teachers or peers. If technology isused to enhance the learning environment by providing richer and more meaningful platforms for communication and discussion,it may have a role to play in the social construction of knowledge as part of contextualised learning spaces.

Physiotherapy management strategies for woman post-ceasarean section delivery in public hospitals in KwaZulu-Natal, South Africa

South Africa has seen a steady increase in the rate of caesarean section deliveries, and while physiotherapists are often requested to treat these patients, there are no guidelines on their physiotherapeutic management. Current treatment is therefore based on clinical presentations of the patient. This paper reports on the physiotherapy management strategies for women post-caesarean section delivery used at four public hospitals in KwaZulu-Natal during 2011-2012. The study used a quantitative, cross-sectional, descriptive design. The sample consisted of 31 physiotherapists who completed an anonymous self-administered questionnaire, of whom eight had not treated post-caesarean section delivery women at all in the one year period. The results showed mobilization (100%), breathing exercises (94%) and education (94%) were common choices, with 68% selecting pelvic floor exercises as part of their management strategy. The study concluded that the current physiotherapy management strategy for women post-caesarean section delivery is based mainly on the doctors’ referral. Due to their limited knowledge about physiotherapy treatment, doctors overlook other complication(s) and potential complication(s) that could benefit from treatment post-delivery. The study showed that there is a need to improve the role and influence of physiotherapists in the multidisciplinary team.

Status of undergraduate community-based and public health physiotherapy education South Africa

Curricula of health education institutions need to be periodically revised to be aligned with its context. This study explored the status of physiotherapy curricula in South Africa as point of departure for benchmarking by individual institutions. A document analysis was done of the university physiotherapy departments (N=8) in South Africa. institutional ethical clearance and permission from the heads of departments were obtained. Content analysis was used to analyse the South African Qualifications Authority exit-level outcomes and the university study guides for community placements. Most universities employed a form of service-learning, with interventions in a range of settings. Five themes emerged: practice of evidence-based physiotherapy, rendering physiotherapy services, acting professionally, communication, and collaboration. The country’s priority conditions were addressed. Teaching-learning strategies included group activities (class or education sessions), community projects, home visits and portfolios of evidence. Personal and small-group reflections were prominent. The undergraduate community physiotherapy curricula in South Africa address the health profile of the population and priorities in the health system to different degrees. The variation between universities should be interpreted with caution as the study guides only gave a limited snapshot into each institution’s curriculum. However, findings suggest that each physiotherapy university department may have gaps in preparing physiotherapy undergraduate students for the needs of the South African population and expectations of the government. Possible ways to share teaching-learning resources are recommended

Evaluation of a new clinical performance assessment tool : A reliability study

Clinical practice is an essential requirement of any graduatephysiotherapy programme. For this purpose, valid and reliable assessment toolsare paramount for the measurement of key competencies in the real-worldsetting. This study aims to determine the internal consistency and inter-raterreliability of a newly developed and validated clinical performance assessmentform. A cross-sectional quantitative research design was used, which includedpaired evaluations of 32 (17 treatment and 15 assessment) student examinationsperformed by two independent clinical educators. Chronbachs alpha was computedto assess internal consistency and intraclass correlation coefficient (ICC’s) withconfidence intervals of 95% were computed to determine the percentage agreement between paired examiners. Thedegree of internal consistency was substantial for all key performance areas of both examinations, except for timeand organisational management (0.21) and professionalism (0.42) in the treatment and evaluation examinationsrespectively. The overall internal consistency was 0.89 and 0.73 for both treatment and assessment examinations,indicating substantial agreement. With regard to agreement between raters, the ICC’s for the overall marks were0.90 and 0.97 for both treatment and assessment examinations. Clinical educators demonstrated a high level ofreliability in the assessment of students’ competence using the newly developed clinical performance assessment form.These findings greatly underscore the reliability of results obtained through observation of student examinations, andadd another tool to the basket of ensuring quality assurance in physiotherapy clinical practice assessment.

Exploring the key performance areas and assessment criteria for the evaluation of students’ clinical performance: a delphi study

Background: evaluating  students’ clinical  performance  is  an integral part of the quality assurance in a physiotherapy curriculum, however, the objectivity during clinical examination have been questioned on numerous occasions.  The  aim  of  this  study  was  to  explore  the  essential  key  clinical performance areas and the associated assessment criteria in order to develop a reliable clinical assessment form.Methods: A Delphi study was used to obtain consensus on the development of a reliable clinical performance assessment tool. The study population consisted of  purposively  selected  academic  physiotherapy  staff  from  the  University  of Western Cape as well as supervisors and clinicians involved in the examination of  physiotherapy  students  from  the  three  Universities  in  the  Western Cape.  Findings  from  the  Delphi  rounds  were analysed  descriptively. Fifty  percent  or  higher  agreement  on  an  element  was  interpreted  as  an  acceptable  level of consensus.Results: Eight key performance areas were identified with five assessment criteria per key performance area as well as the weighting per area. It was evident that evaluators differed on the expectations of physiotherapy students as well as the criteria used to assess them.Conclusions: The Delphi panel contributed to the formulation of a clinical assessment form through the identification of  relevant  key  performance  areas  and  assessment  criteria  as  they  relate  to undergraduate  physiotherapy  training. Consensus on both aspects was reached following discussion and calculation of mean ranking sores.Implications: This process of reaching consensus in determining clear criteria for measuring key performance areas contributes to the objectivity of the process of examinations.

10% Yb3+-Lu2O3 ceramic laser with 74% efficiency

We demonstrate laser oscillation at 1080 nm with more than 16 W of output power and with an optical-to-optical slope efficiency of up to 74% using a 10% Yb3+ doped Lu2O3 ceramic made by hot pressing. This represents the highest output power and efficiency obtained for a Yb3+ doped Lu2O3 ceramic and demonstrates the feasibility for power scaling.

Evaluation of the content validity, internal consistency and stability of an instrument designed to assess the HIV/AIDS knowledge of university students

OBJECTIVE

This study evaluated the content validity, internal consistency and stability of a questionnaire designed to assess the HIV/AIDS knowledge of young adults.

METHODS

The questionnaire was administered on two occasions, within two week intervals, to 219 university students in the USA (n=66), Turkey (n=53) and South Africa (n=100). The psychometric instrument contained demographic information questions and 45 knowledge questions regarding the HIV virus, ways of transmitting it, symptoms of HIV/AIDS infection and methods of prevention. Factor analysis was conducted to assess construct validity; Cronbach alphas and Pearson's product moment correlation (r) were calculated to evaluate internal consistency and stability, respectively.

RESULTS

The 45 knowledge questions produced a Kaiser-Meyer-Olkin (measure of sampling adequacy) value of 0.8133 and loaded on three factors with an overall Cronbach's alpha of 0.861. The r for the individual knowledge question was greater than 0.50 and the overall knowledge score was "almost perfect" (0.91; p<.001). For participating students from the USA, Turkey and South Africa, their r for the overall knowledge score was 0.80 (p<.001), 0.83 (p<.001) and 0.93 (p<.001), respectively.

CONCLUSIONS

Our findings revealed that the instrument is highly stable and internally consistent. The availability of this instrument may enhance HIV intervention studies internationally.

[Practice guidelines of the European Society of Hypertension for home blood pressure measurement]

Self-measurement of blood pressure at home is increasingly used in the diagnostic and therapeutic approach of hypertension. This technique allows multiple measurements of blood pressure away from the clinical setting, making it possible to improve the evaluation of cardiovascular risk. Recently new guidelines on the use of self-measured blood pressure have been made available by the European Society of Hypertension, as summarized in the present paper.

Health-promotion needs of youth with a spinal cord injury in South Africa

PURPOSE

To determine the health promotion needs through an exploration of health-related behaviours and the factors that influence the behaviour of physically disabled youth with spinal cord injury.

METHODS

A descriptive and exploratory study that utilized a qualitative approach was carried out among ten participants aged between 15 and 29 years who were purposely selected. Information was obtained from individual face-to-face interviews and a focus-group discussion.

RESULTS

The participants were involved in risky health behaviours including sedentary lifestyles, use of alcohol, tobacco, and drugs. Various factors that influenced their participation in these behaviours were identified including personal struggles with identity and adjustment issues.

CONCLUSIONS

The results emphasize that participants were involved in health-risk behaviours, which are associated with development of secondary conditions such as respiratory problems, heart diseases, and stroke. Health-promotion strategies employed for these individuals should address the psychological impact of spinal cord injury (SCI) on the individual as an influence to participation in health risk behaviours.

The impact of spinal cord injury on South African youth

Approximately 500 South Africans, mainly young people,sustain a spinal cord injury every year leading to severe lifetime physical disabilities. With advances in medicine and assistive technology, these young people are able to reach adulthood. The physical, social and  emotional adjustments, which determine the eventual successful outcome following injury, vary considerably from person to person. Some make satisfactory adjustments whereas others remain chronically distressed.This study aimed to determine the impact of SCI on youth in community settings after discharge from rehabilitation.  A qualitative approach, that utilised face-to-face interviews and focus group methods of data collection, was used. Data were drawn from ten participants selected at Conradie Spinal Rehabilitation Unit, using purposive sampling. Audiotape recorded interviews were transcribed verbatim. Strong themes that ran through the data were identified. The results of the study revealed that spinal cord injury impacts on more than just the physical capabilities of an individual. Participants identified issues such as social identity, intrapersonal and interpersonal factors, social support and employment opportunities as having a major impact on their lives once back in the community.  It is  recommended that rehabilitation professionals include issues such as identity and psychosocial adjustment into their health promotion interventions.

Measurement of high-pT single electrons from heavy-flavor decays in p + p collisions at square root of s = 200 GeV

The momentum distribution of electrons from decays of heavy flavor (charm and bottom) for midrapidity absolute value of y < 0.35 in p + p collisions at square root of s = 200 GeV has been measured by the PHENIX experiment at the BNL Relativistic Heavy Ion Collider over the transverse momentum range 0.3 < pT < 9 GeV/c. Two independent methods have been used to determine the heavy-flavor yields, and the results are in good agreement with each other. A fixed-order-plus-next-to-leading-log perturbative QCD calculation agrees with the data within the theoretical and experimental uncertainties, with the data/theory ratio of 1.71+/-0.02stat+/-0.18sys for 0.3 < pT < 9 GeV/c. The total charm production cross section at this energy has also been deduced to be sigma cc = 567+/-57stat+/-193sys microb.

The future of physiotherapy in South Africa

A brain drain in the physiotherapy profession is a cause of major concern currently among physiotherapists in South Africa. The main aim of this study was to determine the future plans of 2nd to 4th year physiotherapy students registered at the three academic institutions in the Western Cape for the 1999 academic year. It also aimed at determining the reasons why graduates chose to stay or leave South Africa. The results of the study show that an overwhelming majority (86%) of the respondents considered leaving South Africa following graduation. The reasons listed for leaving included gaining experience, financial gain and job availability. It is hoped that the results of this study will stimulate relevant role players to investigate means of persuading our graduates to stay and work in the country.

Critical issues in adolescent substance use assessment

Despite advances in methodology and instrumentation, the assessment of adolescent drug and alcohol involvement remains a complex clinical and practical process. It requires the careful and skillful implementation of procedures across a wide range of service systems and providers. While the literature identifies and provides information on singular aspects of the assessment of adolescents, few sources furnish an integrated overview of the key issues necessary for appropriate and accountable assessment. Consequently, this paper synthesizes theoretical, research, and clinical issues into a practical framework that can be used by clinical and research staff making assessment decisions. Issues discussed have been informed by the literature and by our collective experience during the 8-year development and testing of the Comprehensive Adolescent Severity Inventory (CASI).

Twice-daily, 10-day triple therapy with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori eradication in duodenal ulcer disease: results of three multicenter, double-blind, United States trials

OBJECTIVE

We assessed the safety and efficacy of 10-day twice-daily triple therapy for Helicobacter pylori (H. pylori) in three double-blind, controlled trials in patients with duodenal ulcer disease.

METHODS

H. pylori-infected patients with one or more duodenal ulcer(s) at endoscopy (studies 1, 2) or with a documented duodenal ulcer history and no duodenal ulcer or erosions at endoscopy (study 3) were randomly assigned to 10-day courses of omeprazole 20 mg b.i.d. plus amoxicillin 1 g b.i.d. plus clarithromycin 500 mg b.i.d. (OAC) or placebo plus amoxicillin 1 g b.i.d. plus clarithromycin 500 mg b.i.d. (AC). In studies 1 and 2, patients received an additional 18 days of omeprazole 20 mg q.d. (OAC group) or placebo (AC group). Endoscopy was repeated 4 wk after therapy in studies 1 and 2 and 4-6 wk after therapy in study 3. At baseline, H. pylori was diagnosed by CLOtest plus histology, or by culture. Eradication was defined as no positive biopsy test and two or more negative tests. Patients were defined as compliant if they took 75% or more of each study drug and missed < or = 3 consecutive days of the 10-day therapy.

RESULTS

Intent-to-treat populations of the three studies combined were 241 patients for OAC and 266 for AC. Of all OAC patients combined, 2% stopped study medications due to adverse events, and 93% were compliant. Per-protocol cure rates were 78% to 90% (all studies combined, 84%) for OAC vs 33% to 45% (combined, 39%) for AC (p < 0.001, OAC vs AC); intent-to-treat eradication rates were 69% to 83% (combined, 75%) for OAC vs 32% to 37% (combined, 35%) for AC; (p < 0.001, OAC vs AC).

CONCLUSION

Rigorously designed studies indicate that 10 days of twice-daily triple therapy with omeprazole, amoxicillin, and clarithromycin achieves per-protocol eradication rates of approximately 80% to 90% in the U.S.

Low rate of emergence of clarithromycin-resistant Helicobacter pylori with amoxycillin co-therapy

BACKGROUND

Patients with persistent Helicobacter pylori infection following treatment with clarithromycin or omeprazole plus clarithromycin often develop clarithromycin resistance.

AIM

To assess pre- and post-treatment antibiotic resistance in three double-blind trials of triple therapy with omeprazole, amoxycillin and clarithromycin.

METHODS

Patients with H. pylori and duodenal ulcer (studies 1 and 2) or history of duodenal ulcer (study 3) were randomly assigned to 10 day courses of omeprazole 20 mg b.d., amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. (OAC) or placebo, amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. (AC). Endoscopy was performed at baseline and 4 weeks after completion of therapy in studies 1 and 2, and at 4-6 weeks after therapy in study 3. At baseline, H. pylori was diagnosed by CLO test with confirmation by histology, or by culture. Eradication was defined as no positive biopsy test and > or = 2 negative tests. Susceptibility testing was performed using the Etest.

RESULTS

In the 91 patients with pre-treatment susceptible isolates who had persistent infection after AC, 10 developed resistance, eight had intermediate susceptibility and 73 continued to have clarithromycin-susceptible H. pylori isolates. In the 10 patients with pre-treatment susceptible isolates who had persistent infection after OAC, three developed clarithromycin resistance and seven still had susceptible isolates.

CONCLUSIONS

Use of amoxycillin co-therapy results in a low rate of clarithromycin resistance developing in patients with persistent H. pylori infection following therapy with a clarithromycin-containing regimen.

Infants in play groups: time related changes in behavior toward mothers, peers, and toys

Twenty-one 13-month-old infants, nine male and 12 female, were assigned to one of seven playgroups convening for 15 consecutive weekdays . Present at each 20-minute play session were three same-sexed peers with their mothers and an assortment of toys. There were systematic fluctuations in infants' attention to mother, peers, and toys. There findings suggest that a mother may serve different functions at different points in time: (a) as a secure base in initial sessions, (b) as a refueling stop when the infant grew tired, and (c) as an attractive alternative when the infant became bored with toys and peers. Within-day analyses revealed that activity level and toy exploration linearly decreased over time, while intentional contact with mother significantly increased. Social interaction with peers correlated negatively with interaction with mother over the course of the study. Sex differences over time were found to be significant: boys on day one were more interactive with both peers and toys but this level declined thereafter, while girls on day one spent more time in close proximity to mother and later, on subsequent days, increased their peer and toy play.