Theses and dissertations (Health Sciences)
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Item Knowledge, attitudes and perceptions of Genomic Medicine among medical students, private medical practitioners and the general public in eThekwini, KwaZulu-Natal(2019) Naidoo, Levani; Reddy, PoovendhreeThe use of genomics in public health has the potential to contribute towards the diagnoses of diseases, ensuring the efficiency of health promotion interventions and assist in developing more effective pharmaceuticals. Research conducted abroad has documented the discourse of public and medical perceptions towards genetic testing, however, there is a lack of information to inform the health sector within South Africa with respect to the knowledge and attitudes of the general public and medical sector towards genetic testing. Therefore, the aim of this study was to document and evaluate the knowledge, attitudes and perceptions surrounding the use of public health genomic (PHG) medicine. This was a quantitative cross sectional study and our convenient sample included representatives from the general public, medical students and medical practitioners within the eThekwini region in KwaZulu-Natal (n=170). Participants were required to fill out administered questionnaires which included likert scale questions. Medical practitioners from both private and public health sector in the KZN region were sampled (n=45). Medical students comprised of second year students from the UKZN Nelson R Mandela medical school who had not yet been exposed to the genetic module in their medical curriculum (n=79). Representatives of the general public included educators from private and public primary schools in Durban and surrounding areas (n=46). Descriptive and frequency analysis using mean, standard deviation and range was used for quantitative variables. Knowledge and attitude responses were stratified by gender, race and for medical practitioners by practice type. Bivariate correlations using Spearman’s rho test and principle component analysis was conducted. Scoring scales were used to determine the level of knowledge and type of attitude among participants towards predictive genetic testing. Results revealed that the knowledge of the general public, medical practitioners and medical students towards the use of public health genomics were adequate. Medical students displayed a negative attitude towards the uptake of predictive genetic testing which was contrary to the positive attitudes of the general public and medical practitioners. Stratification by gender indicated that women from the general public were more accepting of PHG despite the increased costs associated with genetic testing. We found that females were knowledgeable on the primary use of predictive genetic testing, and more Africans (77%) than Indians (46.2%) and Whites (50%) were aware that genetic testing is being offered in South Africa. Results of bivariate correlations revealed that current medical practitioners would still use predictive genetic testing despite the possible ethical, legal, and social implications for the end user. PCA (Principle Component Analysis) confirmed a strong factor loading for a willingness to use predictive genetic testing among the general public. PCA yielded a high factor loading on an awareness for the need for a proper legislative framework for PHG among medical students. Medical students articulated a need for additional training in public health genomics. In order to improve knowledge among the medical fraternity, institutions should adapt undergraduate and post-graduate curriculum to make provision for relevant PHG training that would be extended not only to medical and health care students but offered to qualified practitioners for continuous professional development training. In addition, awareness should be created on various media platforms to inform the public about the availability and costs associated with predictive genetic testing services in South Africa. Relevant stakeholders from both the public and private health sector in South Africa should be aware of the challenges that could impact on the uptake of public health genomics in South Africa, given its potential for use in the NHI (National Health Insurance) structure.Item Survey of radiation protection amongst non-radiology staff working in fluoroscopy-guided operating theatres at public health institutions in the eThekwini district of KwaZulu-Natal(2019-09-05) Hundah, Shillah Nyaradzo; Naidoo, Subradhanalene; Puckree, ThreethambalBackground Although fluoroscopy facilitates the performance of less invasive surgical techniques and therefore an increase in its use outside the radiology department, it carries with it the burden of radiation exposure. Several studies on radiation exposure during fluoroscopy-guided surgical procedures have been conducted in South Africa, but no known knowledge, attitude and practices (KAP) study has been conducted on radiation protection. Together with inadequate radiation protection practices among non-radiology theatre staff, the dearth of reported research on this subject has created the need for this study. This study therefore aimed to determine the KAP relating to non-radiology staff during fluoroscopy-guided operating procedures at public health institutions in the eThekwini district of KwaZulu-Natal. The relationships between KAP, demographic factors and intentions to implement radiation protection practices were related to the theory of planned behaviour. Methodology Ethical approval and gatekeeper permissions were obtained from the relevant stakeholders. A quantitative cross-sectional survey was adopted to collect data from non-radiology staff in fluoroscopy-guided operating theatres at eThekwini district public health institutions. Random stratified sampling was used to obtain a sample of 179 participants. A validated questionnaire was administered over 12 weeks. Respondents signed a consent form prior to participating and no names were provided on the questionnaire for purposes of confidentiality. Data were analysed using descriptive and inferential statistical tests such as the Chi- square test, Fisher‟s exact test and Spearman‟s rho correlation coefficient. Results The response rate was 54%, the respondents‟ mean age was 38.46 ± 9.47 years, and the majority (66.7%) were female. The respondents demonstrated moderate radiation-related knowledge (61.22%) and exceptional attitude (98.98%), but poor radiation protection practices (3.06%). The respondents‟ specialty, profession and hospital where they are working demonstrated a significant association with their KAP scores (p < 0.05). There are significant positive correlations between knowledge and attitude (r = 0.270, p = 0.021), and attitude and intention (r = 0.348, p = 0.008), and significant negative (inverse) correlations between knowledge and practice (r = -0.264, p = 0.017), and attitude and practice (r = -0.280, p = 0.014). There are no significant correlations between knowledge and intention, and intention and practice (p > 0.05). Conclusion Although the respondents have good knowledge and attitude, their radiation practices are poor. This indicates a need for further radiation protection training and improved awareness of and research into exact levels of radiation exposure and the consequences of such exposure.Item Invitro antibacterial activity of imidazole and triazole-based antimicrobials against Carbapenem Resistant Enterobacteriaceae(2019-09-05) Radebe, Siyabonga Protus; Ndlovu, Thandie SylphIntroduction The frequency of serious bacterial infections has increased due to the high prevalence of HIV infection, contributing to the increasing rates of multi-drug organisms which include carbapenem-resistant Enterobacteriaceae (CRE). This trend has become a serious challenge to the health care system of South Africa, resulting in the higher use of immunosuppressive and cytotoxic drugs to treat serious bacterial infections. Optimal treatment for infections caused by CRE is yet unknown. The benefits of imidazole and triazole antimicrobials have become very topical due their diverse spectrum of pharmacological properties, but its efficacy against bacterial infections has not been tested in the South African context. Aim The primary aim of this study was to determine the antibacterial effects of selected imidazole and triazole-based antimicrobials against Carbapenem-Resistant Enterobacteriaceae. Methodology Different concentrations of test drugs (ketoconazole, metronidazole and fluconazole) were used to prepare sensitivity disks and four pathogenic strains of Carbapenem Resistant Enterobacteriaceae (K. pneumonia, E. coli, S. marcescens and C. freundii) obtained from Lancet Laboratory in Durban were used to determine the antibacterial activity of the selected test drugs, using Disk Diffusion, Modified Agar Diffusion and Minimum Inhibition Concentration (MIC) method, described by Bauer et al. 1966. Results Antimicrobial Susceptibility Testing revealed that, test drugs selected for this study have no inhibition activity against CRE test organisms and biochemical tests also showed that imidazole and triazoles antimicrobials have no adverse effects on the CRE organisms. Conclusion Although the results obtained in this study indicated no activity of against CRE, laboratory studies are still necessary in modification of the imidazole and triazoles to synthesize derived drugs to confirm and optimize the antibacterial potency of these compounds.Item An exploratory inquiry into the implementation of prehospital thrombolysis in the treatment of acute myocardial infarction : a case study of a private emergency medical service within South Africa(2019-09-05) Lynch, Andrew Clifford; Sobuwa, Simpiwe; Castle, NicholasIntroduction Patency and the restoration of an occluded artery both during and after ST-segment myocardial infarction or STEMI remains the highest priority in acute coronary care. The gold standard of reperfusion therapy is percutaneous coronary intervention, which represents the internationally recommended practice for STEMI. Although technically a non-surgical procedure, percutaneous coronary intervention constitutes a specialised practice, and therefore remains subjective to the limitations of existing clinical resource capacity. Facilities supporting this procedure require specialised equipment and highly trained medical personnel, both of which are often unavailable in the developing and/or underdeveloped regions of South Africa. Thrombolysis, however, also plays a critical role in the management of STEMI, and is recommended in instances where percutaneous coronary intervention is inaccessible or when time delays are present. In 2009, the Health Professions Council of South Africa (HPCSA) allocated thrombolysis to emergency care practitioners in a move which, it was hoped, would improve patient access to reperfusion therapy for STEMI and, ultimately, the country’s national healthcare profile. Unfortunately, since its approval for use by emergency care practitioners, thrombolysis has yet to be integrated effectively into prehospital practice. The current study aimed to analyse the factors associated with the implementation or lack thereof regarding prehospital thrombolysis, despite the evidence and principles supporting its application. Methodology The research used a case study based on data that was obtained through individual, semi- structured interviews. Participants in various positions in a private emergency medical service were purposefully selected to participate in the study. The requisite data was collected through the interviews with participants, and was grounded in their perspectives, observations, knowledge and experience regarding the implementation of prehospital thrombolysis. Collected data was analysed through both a theoretical and data-driven approach, with the consolidated framework for implementation research conceptualising the data, and thematic analysis facilitating data coding procedures. Findings This study identified four primary themes, eight sub-themes and ultimately a total of 14 discussion points relating to the barriers to prehospital thrombolysis. The primary themes comprised interventional characteristics, inner-organisational settings, outer-organisation settings as well as the characteristics of the individuals involved. Within these primary themes, eight sub-themes recognised barriers relating to cost, complexity, cosmopolitanism, implementation climate, readiness for implementation, leadership engagement, knowledge or beliefs and self-efficacy. The 14 discussion points were focused specifically on these topics and, in a broader sense, also acknowledged the patterns as well as interrelationships between the themes. Conclusions and recommendations Implementation, as a process and science, continues to be underestimated, and within healthcare, affects populations who may have otherwise benefited from new, evidence-based practices, guidelines or policies. Healthcare implementation requires strategic planning, and until key pieces of this process are realised, and implementation gaps filled, the potential to improve outcomes through new practices such as early thrombolytic therapy, will continue to be lost. To narrow implementation gaps, the science, which constitutes this domain, requires further merit, not only from prehospital healthcare providers, but across all healthcare disciplines, especially when attempting change. Greater capacity is required for implementation research and special focus should be dedicated towards extending existing relationships between healthcare deliverance systems, specifically in terms of the continuum of care. To formulate the safest and most cost-effective means of delivering prehospital thrombolysis, South African emergency medical service providers as well as allied and even other healthcare organisations need to consider at least one or more implementation strategies to foster a stepwise progression towards this ideal.Item The relationship between Anti-Müllerian Hormone (AMH) levels and pregnancy outcomes in patients undergoing in- vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI)(2019-09-05) Umarsingh, Shalini; Adam, Jamila Khatoon; Ramdeo, AnilIntroduction ABSTRACT Woman are born with a lifetime supply of oocytes, these oocytes gradually decrease in both quantity and quality with age. Anti-Müllerian Hormone (AMH) is a hormone secreted by cells in the developing oocyte sacs (follicles). AMH has become an important predictor of ovarian reserve. Low AMH levels can forecast reduced response to gonadotropins in In-Vitro Fertilization (IVF) cycles a well as pregnancy rate. Accurate and detailed tests should be conducted that can aid in predicting the chance of a pregnancy through IVF. The clinician together with the patients can make an educated decision about whether to continue with the treatment or review other options that may be viable. Many medical studies have found that a woman’s AMH concentration in the blood can predict how many oocytes they can produce during IVF treatment. On this basis, tests have become available to measure AMH and other markers that indicate fertility changes and the state of advancement of ovarian ageing. Aim and Objectives The aim of the study was determine the relationship between Anti-Müllerian Hormone levels and pregnancy outcomes in patients undergoing in-vitro fertilization or intra- cytoplasmic sperm injection (ICSI). The objectives were as follows: (1) To determine whether there is a correlation in patients presenting with low AMH and low oocyte reserve; (2) To examine if AMH levels affect the oocyte quality; (3) To evaluate the correlation between AMH level and a positive pregnancy outcome. Methodology A total of 50 patients were recruited from C.A.R.E (Centre of Assisted Reproduction and Endocrinology) Clinic in Westville who were undergoing IVF treatment. The blood samples were taken at room temperature. Serum was used to determine estrogen (E2), progesterone (P4), luteinizing hormone (LH), anti-müllerian hormone (AMH), and follicle stimulating hormone (FSH) levels. Levels were determined using an ultra-sensitive enzyme-linked immunosorbent assays (ELISA) (Beckman Coulter). Two stimulation protocols were used to harvest a maximum number of oocytes. The long protocol used Lucrin Subcut 10 units daily and Lucrin Depo 3.75mg for down regulation. Stimulation drugs were Gonal F®, Menopur®, Puregon®, Clomid®, Fertomid® and Fostimon® The short protocol consisted of GnRH antagonist with Cetrotide 0.25mg primed with Logynon ED. No down regulation was required. The patient started on day 2 or day 3 of the menstrual cycle, Cetrotide 0.25mg is given to suppress the LH. The same drugs were used for stimulation as per the long protocol. The patients’ blood serum was tested to measure the amount of Estrogen in her body prior to the collection of oocytes. In all patient’s ovulation was induced using 5000 – 10 000 IU hCG (Pregnyl®, Ovitrel®) trigger injection, provided the lead follicle had reached a diameter of 19mm. Oocyte retrieval was performed trans-vaginally under ultra sound guidance 36 hours after the administration of the hCG. The fluid containing the oocytes was aspirated using an oocyte recovery needle and forwarded to the IVF laboratory where the oocytes were identified, rinsed in culture media and were incubated at 37°C in IVF incubators. After 2-4 hours incubation period the cumulus complex was removed from the oocyte using the enzyme hyaluronidase and glass pipettes. Following denudation, the oocytes were placed back into the incubator until the ICSI was performed. Maturation and morphological features of the oocytes were noted before the ICSI. The features of each oocyte were evaluated using an inverted microscope. Fertilization was assessed 19-21 hours after the ICSI was performed and was characterized by the presence of two pronuclei to show the result of the union between the male and female genetic material to form a zygote cell. Embryos were grown up to Day 3 (8 cell stage), Day 5 (blastocyst stage) or Day 6 (hatching blastocyst) and transferred into the patient. A pregnancy test was performed 14 days post transfer. Results 50 patients that met the inclusion criteria were recruited for the study. From the initial sample size of 50, 42 presented with data that could be analysed whilst 8 patients had oocytes that where abnormal and did not result in a transfer. The data from these 8 patients were not included in the study due to poor embryo development. According to the AMH levels, 52.4% of patients were in High Category, 40.5% were in the Normal and 7.1% were in the Low to Normal Category. A cross-tabulation of the number of oocytes retrieved; the number of oocytes mature, and the number of oocytes fertilized was done. Not all eggs obtained were at the metaphase 2 stages and had to be matured in the incubator overnight and injected with sperm the following day. A Chi-square test for Independence was performed to check whether there is an association between the number of oocytes fertilized and the AMH category. A Chi-squared value of 18.5, degrees of freedom = 12, with a p = 0.10 was found. Therefore, showing no statistically significant relationship between the numbers of embryo’s fertilized versus AMH category (p > 0.05). A Chi- squared test were done of AMH category and Number of embryos transferred was done resulting in a value of 6.384 with df = 4 and a cross tabulation ensued a p- value of 0.172. There was thus not a significant association between AMH category and No. of embryos transferred. A cross-tabulation and a Chi-square test were done of AMH category and the day of embryo transfer was done. A Chi-square value of 14.117, 6 degrees of freedom and p = 0.028 was observed. There was a statistically significant relationship between the AMH category and the day of embryo transfer (p< 0.05). A cross-tabulation of AMH category and Pregnancy outcome was calculated. It can also be seen that of the 22 cases reported in the High category, 6 resulted in a positive pregnancy, 17 cases where the AMH category was “Normal”, 6 resulted in a positive outcome (6/12 = 50.0%), while out of the 3 cases where the AMH category was “Low to Normal“ there were no pregnancies reported. The Chi-squared test for independence of AMH category and Pregnancy outcome gave a Chi-Squared value of 0.502, 2 degrees of freedom and p = 0.778. Race and pregnancy outcome were calculated using a cross tabulation and a Chi- square test for independence gave a Chi-squared value of 2.246, with 3 degrees of freedom and p = 0.532 (p > 0.05). To determine if a statistical significance exists between AMH and age, E2 and FSH a Pearson Correlations was performed. Table 12 shows the Pearson analysis between E2 and AMH. The Pearson Correlation coefficient of 0.151 with p = 0.341 (p<0.05) indicates a very weak/ no statistically significant relationship between E2 and AMH. AMH and age produced a coefficient of -0.028 thus showing a weak, negative correlation with p = 0.859 (p> 0.05). A stronger relationship between these two variables was expected as it is known that as age increase, AMH should decrease. Pearson Correlation between the AMH and FSH produced a coefficient of -0.185 thus showing a weak, negative correlation with p = 0.240 (p> 0.05). The Pearson Correlation between FSH and age also showed that there was no statistical significance, p = 0.583 (p > 0.05) but a very weak negative correlation (Pearson Correlation -0.087). Pearson correlation between the number of oocytes and age also did not show any statistically significant relationship (p = 0.082; p<0.05). Pearson Correlation value of -0.271 shows a weak negative relationship. No significant relationship was shown between AMH and number of oocytes using a Pearson Correlation test (p = 0.191), number of mature oocytes (p = 0.300) and number of oocytes fertilized (p = 0.146). The number of oocytes, mature oocytes and oocytes fertilized all showed a weak positive relationship to AMH (0.206, 0.164, and 0.228, respectively). Conclusion In conclusion, while appropriate reference values are being created per age category and until the consequences of having a low or high AMH for one’s age are being established, AMH should only be determined in the context of clinical studies. At present, the most important clinical role of AMH at this stage is to serve as a red-flag for reduced ovarian reserve in women of reproductive age who must undergo further diagnostics. As per the study conducted, we can deduce that AMH can accurately predict ovarian reserve but cannot predict the oocyte quality or a positive pregnancy outcome. The more oocytes obtained, increases a patient’s chance of more viable embryos and therefore, improving chances of a healthy pregnancy and ultimately a live birth. This thesis has established a definite role for AMH as a forecaster for both current and future individual fertility.Item Epidemiological evaluation of circulating levels of Copeptin and Fibronectin during pregnancy(2019-09-05) Deepnarain, Kayshia; Govender, Nalini; Reddy, PoovendhreeBackground: Despite efforts to reduce problems associated with child and maternal health, the United Nations International Children’s Emergency Fund (UNICEF) corporation reported, that low and middle-income countries such as South Africa remains burdened with this issue. Based on this premise and the recent interest in copeptin (CPP) and fibronectin (Fn) as promising biomarkers in pregnancy related disorders, this study aimed to establish baseline levels of CPP and Fn in normotensive pregnancies complicated with HIV. Objectives: The objectives of this study were to determine circulating levels of CPP and Fn together with leucyl/cystinyl aminopeptidase (LNPEP) and cystatin C in normotensive pregnancies and to evaluate the association between these biomarkers and different demographic and clinical parameters (e.g. BMI, BP, Hb levels, maternal age and HIV status) throughout gestation. Methodology: This study stemmed from a previous cohort study conducted between 2015 and 2016 at the Cato Manor Primary Health Care facility in KwaZulu-Natal, South Africa. A total of 41 normotensive pregnant women aged between 18-45 years were selected through convenient sampling and evaluated at 10-20 weeks, 22-30 weeks and 32-38 weeks gestation. Archived serum samples were evaluated using Enzyme Linked Immunosorbent Assays to measure circulating levels of CPP and Fn. Additionally, markers of renal function were evaluated by measuring serum levels of cystatin C and LNPEP. Biomarker profiles and epidemiological and demographic characteristics were quantitatively analysed using STATA (version 15). P<0.05 was considered statistically significant. Results: Among the 41 participants, 28 were HIV positive of which 18 were on the Prevention of Mother to Child Transmission programme. A total of 23 participants were anaemic. Less than half the population were nulliparous and nulligravida. Fluctuations in biomarker concentrations were observed throughout pregnancy with CPP, LNPEP and cystatin C showing an overall decrease between 10 and 38 weeks gestation whilst Fn increased in the second gestational period and then decreased in the third gestational period. Slightly lower recordings were indicated for both systolic and diastolic blood pressures within the HIV positive group, except at gestational period 3, where systolic blood pressure was higher amongst the HIV positive group. On the other hand, haemoglobin levels were higher in the HIV positive group throughout pregnancy. Conclusion: The baseline levels of CPP, Fn, LNPEP and cystatin C measured in this study are expected to be used for comparison or as reference values to identify the presence of pregnancy related disorders in other studies of similar design and control groups.Item An assessment of the Somatology extended curriculum programme at the Durban University of Technology(2019-09-05) Makgobole, Mokgadi Ursula; Bass, Gregory Hylton; Puckree, LinaSince the beginning of democracy in South Africa post 1994, the debate in South African Higher Education has progressed from, initially, increasing disadvantaged student access to higher education to improving student success and improving throughout rates and high attrition amongst the previously disadvantaged students. In order to increase access of students from disadvantaged educational backgrounds and improve success in higher education, institutions have introduced additional programmes such as Extended Curriculum Programmes (ECP). The ECP is an alternative curriculum structure that creates the space needed to equip underprepared students with skills to assist them to succeed in higher education. The Somatology programme at the Durban University of Technology (DUT) introduced the ECP in 2005. However, there is limited published research on the impact of the ECP in the Somatology programme since its inception. Using a mixed convergent parallel design, and following a post-positivist paradigm, this dissertation aimed to assess the impact of the Somatology ECP on students’ throughput, success and dropout rates and to understand the general satisfaction of the students placed in the ECP with being placed in the ECP. In order to establish quantitative data, a retrospective analysis of the student records of all students that had been registered at the Somatology programme at the Durban University of Technology for the period 2005 to 2013 was sourced from DUT’s Institutional Management Information System (MIS). The throughput and dropout rates were analysed using descriptive statistics, ANOVA, and t-test. The data obtained is valid as access to the MIS system is restricted and only authorised DUT staff have access to MIS data. In contrast, the qualitative phase prospectively focus on students who graduated from the Somatology programme via the ECP. A simple random sampling technique was used to select a total of 15 participants who were interviewed using semi-structured interviews. The qualitative data generated was analysed using thematic content analysis. The quantitative analysis found that there was a marked improvement in the throughput rate of students who enrolled via the ECP programme. However, no significant difference was recorded in the throughput (P>0.05) and dropout rates (P>0.05) of the ECP when compared with the mainstream cohort (P>0.05) over the period under study. In addition, the overall success rate of the ECP cohort were comparable to that of the mainstream (P>0.05) showing that the interventions delivered on the ECP were successful for students entering the Somatology programme considered underprepared for higher education. In probing the factors that had influenced the improved throughput rate, a key finding from the qualitative analyses was that participating students attributed their ultimate success to the additional interventions given in the ECP. The ECP students felt they were at an advantage when it came to assessments compared to mainstream. In light of the study findings, this dissertation found that the Somatology ECP was a successful programme as there was an improvement in the academic success of the students in terms of their throughput and dropout rates of the cohort studied.Item The effect of dry needling on trapezius muscle activity and post needling soreness in participants with latent trapezius myofascial trigger points(2019-09-05) Peter, Steven J.; Kretzmann, HeidiBackground: Dry needling (DN) is an established and effective modality which is used globally for the treatment of myofascial trigger points (MFTPs). Post-needling soreness (PNS) is a common side effect which is felt shortly after DN at the site of needle insertion and peaks at 24 hours post-treatment. Research of its effects on muscle activity, range of motion, numerical pain rating scale and pain pressure threshold exist but focuses on pre- and post-needling measurements and a follow up measurement at 24 hours. This study objectively tried to investigate the effects of DN in the first few hours after treatment, in terms of pain pressure threshold (PPT), range of motion (ROM), surface electromyography (sEMG), and post needling soreness. Objectives To determine the effect of dry needling latent myofascial trigger points (LMFTPs) in the upper trapezius muscle with respect to: numerical pain rating scale (NRS), PPT, ROM and sEMG in the first four hours after treatment. Methodology This was a quantitative pre-test post-test design study with repeated follow up measurements. Through a purposive convenient sampling strategy, 15 asymptomatic volunteers were recruited into the study. Baseline readings were taken for the NRS, sEMG, PPT and ROM readings were then taken. After baseline readings were taken, the LMFTP was dry needled, and the measurements were taken again in the same order. The measurements were taken every hour for four hours post needling. IBM SPSS version 25 was used to analyse the data. A p value <0.05 was considered as statistically significant. Comparison of measurements over time were achieved using non-parametric Friedman tests for paired data. Post hoc tests were done in the case of a significant Friedman’s test in order to determine which pairs of measurements differed. Correlations between the changes over time of each measurement were done using non-parametric Spearman’s correlation. Results For the NRS there was a statistically significant increase in perceived pain at the first measurement post treatment (p < 0.001). While there was no significant difference in algometer measurements over time (p = 0.321). CROM showed an improvement in all tested movements: ipsilateral PA rotation (p < 0.001), contralateral PA rotation (p < 0.001), ipsilateral lateral flexion (p = 0.001) and contralateral lateral flexion (p < 0.001). With regards to sEMG root mean square (RMS) There was no difference between the time points (p = 0. 534). The following correlations were noted: Changes in contralateral and ipsilateral PA rotation were strongly positively correlated together (rho = 0.711). Changes in ipsilateral PA rotation was negatively correlated with change in 1- minute rest (rho = -0.569). Changes in contralateral PA rotation was positively correlated with change in mean contraction (rho = 0.527). Conclusions In conclusion, the results of this study show that DN of LMFTPs in the upper trapezius muscle may be effective at improving CROM without eliciting a strong PNS effect or a significant drop in PPT. As this is one of the few studies that exist to test objective and subjective results in the first four hours after needling, it is difficult to draw strong conclusions.Item The effect of talocrural joint manipulation on muscle activity of the lower limb, balance, pain and disability in participants with chronic ankle instability syndrome(2019-09-05) McLaren, Murray James; O’Connor, Laura; Puckree, ThreethambalBackground and Purpose: Ankle sprain injuries are prevalent in both the sporting and general population and can develop into chronic ankle instability syndrome (CAIS). When this occurs, there is a tendency for the ankle to re-sprain following an acute ankle sprain. Deficits in proprioception and neuromuscular control, specifically of the peroneal muscles, may lead to altered balance and postural stability in patients with CAIS. Recent research suggests that the ankle invertors and plantarflexors are also affected. Joint manipulation has been shown to result in reduced pain and improved foot and ankle functioning in individuals with CAIS, however, the exact mechanism(s) through which joint manipulation brings about these effects is not clear and the field of extremity joint manipulation on arthrogenic muscle inhibition (AMI) is under-investigated. This study aimed to determine the immediate effect of talocrural joint manipulation on postural stability and the muscle activity of the ankle invertors, evertors and plantarflexors by assessing surface electromyography (sEMG) of these muscles during static single-limb postural stability testing. Subjective outcomes of pain and disability were also measured through the use of the foot and ankle disability index (FADI). Methods: This study used a randomized, single blinded placebo controlled pre-test, and a repeated post-test measures experimental design. A sample of 42 participants, with grade I or II CAIS, aged 18-45 years, were randomly allocated into two groups. One group received a long axis distraction talocrural joint manipulation and the other group, a sham manipulation. General pain and disability (FADI), postural stability (Biosway Portable Balance System) and muscle activity (Biopac wireless EMG system) measurements were taken before the intervention. Muscle activity and postural stability were assessed again immediately after the intervention and then again 20 minutes later. Postural stability and muscle activity were measured both with participants’ eyes opened and eyes closed. FADI measurements were taken 24 hours after the intervention. Results: The two groups were comparable at baseline for age, gender, body mass index, pain and disability, postural stability and muscle activity (p > 0.050). An inter-group analysis showed a significant improvement in FADI (p= 0.005) and general pain scores (p= 0.039) when compared to the placebo group post-manipulation. There were no significant changes in the manipulation group for muscle activity and postural stability when compared to the placebo group (p > 0.050). Intra-group analysis showed an overall improvement over time for eyes opened postural stability in the manipulation group (p= 0.040) and decreased fibularis longus muscle activity in the placebo group with eyes open balance testing (p= 0.047) and eyes closed balance testing (p= 0.023). Conclusion: The results of this study showed that talocrural joint manipulation had a positive effect on pain and disability in individuals with CAIS. No significant differences were found between the intervention and placebo groups for limb muscle activity and postural stability. Intra-group analysis showed that the manipulation had a positive effect on eyes-open postural stability performance and that there may have been a trend of an effect of manipulation counteracting muscle fatigue experienced in the fibularis longus of the placebo group. Further investigation to further elucidate the effect of manipulation in CAIS is recommended.Item Experiences of the post basic nursing students with chronic illness in selected colleges in KwaZulu-Natal, South Africa(2019-09-05) Buthelezi, Phindile P.; Ngxongo, T. S. P.; Radana, N.Introduction and background: Chronic illness is an illness, disease or disorder that persists for a long period, often for the remainder of the person’s lifetime. Post-basic nursing (PBN) students are at greater risk of having chronic illness because of their age compared to the younger basic nursing students. Usually students in PBN courses experience challenges balancing life and school demands and end up having elevated stress levels. The situation is compounded when the student is also ill, especially when the illness is chronic and uncontrolled. Aim of the study: The aim of the study was to explore and describe the experiences of the PBN students with chronic illness in in selected campuses of the KwaZulu-Natal College of Nursing (KZNCN). The objectives of the study were to: Explore and describe the experiences of PBN students with chronic illness in selected campuses of the KZNCN, identify the challenges if any that are experienced by PBN students with chronic illness in selected campuses of the KZNCN, and to determine the support measures that are essential to facilitate academic performance and achievements for PBN students with chronic illness in selected campuses of the KZNCN. Method: A qualitative research design using an exploratory descriptive approach was used to conduct the study. The Health Behaviour Model was used to explore and describe the experiences of the PBN students with chronic illness. The study identified the predisposing factors, enabling factors and need factors, which, according to Andersen’s Health Behaviour Model, are the three dynamic characteristics that influence behaviour. The sample size was guided by data saturation, which was reached after ten interviews and confirmed with five additional interviews. Data was collected from PBN students who were doing their training in the two main campuses of KwaZulu-Natal Nursing College in eThekwini District between July and August 2018 using one-on-one semi-structured interviews. Data was analysed using thematic analysis guided by Tesch’s method of data analysis. Findings: The six themes that emerged from the interviews were: additional demands on the life of the student, fear and anxiety, acceptance and support received, discrimination and lack of confidence, other compounding and some motivating factors. These findings reflected the challenges that were experienced by the PBN students with chronic illness. These, together with the motivational factors, guide the determination of support measures that are essential to facilitate academic performance and achievements for PBN students with chronic illness. Conclusion: Both the demands of training and that of chronic illness cause added stress on a PBN student and have the potential to adversely affect both the studies and the health of the PBN student. PBN students with chronic illness suffer from emotional stress caused by trying to balance between the effects of illness, the side effects of medication and the demands of the PBN programme. Support from various sources including family, peers, employers, education institutions and educators is important to facilitate the academic achievement of these students. Recommendations: Recommendations are made in relation to policy formulation and implementation, service delivery, nursing education and research. Protocols on care management and support of PBN students with chronic illness should be available in academic institutions so as to guide the educators in supporting such students. The PBN students with chronic illness and the education institutions need to work together to establish and continue good communication to facilitate and maintain a clear understanding of what is required to support them and to be clear on what can, and cannot, be done so that expectations are possible and realistic. The unique issues related to students with chronic illness can be addressed through pre-service and in-service training programmes for educators to make them understand how to handle the situation. A broader study involving other provinces, educators and peers is recommended. In addition to further research on PBN students with chronic illness, research on technological resources essential to support students with chronic illness is recommended.