3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
16 results
Search Results
Item Systemic lupus erythematosus: the Johannesburg experience(1986) Morrison, Richard C. A.This study is a predominantly retrospective analysis of patients in Johannesburg who presented with Systemic Lupus Erythematosus at 12 years of age or older. Johannesburg is situated at high altitude and has a high level of ultraviolet light irradiation/ a known exacerbating factor of the disease. This study draws comparisons with reported disease characteristics of lupus patients elsewhere in the world. In addition/ it examines differences in the clinical manifestations of the disease amongst the principle South African racial groups.Item A working memory intervention for HIV positive children and adolescents(2018) Fraser, ShonaIt is well known tha HIV causes a progressive encephalopathy in the immature brain and preferentially disrupted myelination in the fronto-cortical circuits. This significantly impacts executive functioning, of which working memory Is a component. Antiretroviral treatment is unable to reverse these effects, providing a compelling rationale alternative interventions for neurocognitive disability in adolescent HIV infection. Emerging research has investigated the role of cognitive training interventions in remediating working memory difficulties in children and adolescents with neurodevelopmental disorders, such as Attention Disorders, Dyslexia, and Specific Language Impairement. Such interventions depend largely on the concept of neural plasticity and the subsequent extent to which a child or adolescent's brain is plastic and can change through cognitive stimulation.Item The perceptions of occupational performance priorities for adolescents with learning difficulties(2017) Marx, LoaniOccupational therapy for adolescents with learning difficulties (LDs) is still a relatively undeveloped area of practice in contrast to paediatric services for younger populations. The purpose of the study was to explore the perceptions of adolescents with learning difficulties and their parents regarding their most important current and future occupational performance priorities (OPPs), current occupational difficulties as well as intervention and supports that have been helpful thus far. A descriptive, explorative, qualitative study design was utilised. Eighteen adolescents aged 13 – 21 years with LD and nine parents were interviewed or included in a focus group. Data was inductively coded and analysed, identifying three main themes. The main needs in terms of OPPs included understanding the adolescent perspective and developmental needs, occupational needs and preparing for the future. Occupational difficulties included developmentally-related difficulties, occupational difficulties and intervention-related difficulties. Current and previous effective support and interventions as reported by the participants entailed support and mentoring, direct interventions and the promotion of self-determination. Recommendations for implementing occupation-based practice for this population are made.Item A description of the mental health outcomes of HIV positive adolescents accessing care in Johannesburg(2017) Woollett, Nataly CarenBackground: Adolescents living with HIV are an emerging group in the global HIV/AIDS epidemic. Mental health in this population impacts HIV care, treatment, consequential morbidity and secondary transmission. Perinatally infected HIV positive adolescents (PIA) have high prevalence of mental health disorders; loss and bereavement are particularly pervasive in their lives, however little is known about the mental health of PIA retained in care in South Africa. How PIA beliefs concerning their HIV infection are affected by the cumulative effect of bereavement (particularly of parents), the failure to disclose to them the cause of death and the manner in which they learn their own HIV positive status, is a subject understudied. Similarly, there is a paucity of research on effective ways to manage such bereavement. Resilience, or positive adaptation to challenging situations, may be particularly important for PIA, who are exposed to significant stigma, risks and stressors. However, there is limited research regarding adolescents in South Africa, partly because section 71 of the National Health Act (NHA) requires parental or guardian's consent. This presents a significant barrier to research on HIV infected adolescents aged under 18 years. The aim of this research is to describe the mental health of HIV positive adolescents (13-19 years) accessing care and treatment in Johannesburg and generate evidence to inform mental health policy for this population in South Africa. The study describes the mental health outcomes of this population with a focus on how bereavement and disclosure impacts on mental health, as well as how resilience is manifest in this group. Methods: Prior to commencement of the research, an order was obtained from the High Court in Johannesburg as upper guardian of minor children for the statutory parental or guardian’s consent. For the thesis, data from three studies are presented in five published papers. These studies were conducted using a combination of qualitative and quantitative techniques resulting in a mixed methods study design. For the quantitative study, HIV positive adolescents aged 13-19 years (n=343) accessing five pediatric antiretroviral clinics in Johannesburg were assessed using standardized measures for depression (Children’s Depression Inventory), anxiety (Children’s Manifext Anxiety Scale), post traumatic stress disorder (PTSD) (Child PTSD Checklist) and suicidality (MINI International Psychiatric Interview). In addition to mental health, the survey captured information regarding HIV, sexual reproductive health and coping. Descriptive and bivariate analyses were conducted on all variables using Statistica v13. Two qualitative studies were conducted. The first purposively selected 25 participants from the larger study. The aim was to identify elements of resilience through in-depth interviews in this group of PIA. The second identified the most and least symptomatic participants (n=26) from the larger cohort on scores for mental health (depression, anxiety, post traumatic stress disorder, suicidality). Drawings and written accounts of the loss of a significant attachment figure of participants were assessed and compared by professionals (art therapists, psychologists, social workers and counsellors) in three focus group discussions. The goal of this study was to understand the influence of bereavement on mental health and the use of drawing and writing in expressing the experience of loss. Data were analysed in NVIVO 10 using a thematic approach to coding. The final paper details the process of obtaining ethical approval for research with adolescents in public health facilities through a case study (this PhD). Results: Of the enrolled 343 participants, 27% were symptomatic for depression, anxiety or PTSD; 24% reported suicidality. Results indicated high rates of comorbidity amongst depression, anxiety and PTSD. Females scored significantly higher for depression (p<.001), anxiety (p<.01), and PTSD (p<.001) than males. Those reporting suicidality also reported significantly higher on all three mental health scales suggesting that suicidal individuals are more likely to present with higher levels of depression (p<.001), anxiety (p<.001) and PTSD (p<.001). Almost 90% did not feel that they belonged in the family with which they lived. Peer violence was significantly correlated to all mental health problems, also hunger, being inappropriately touched, being hit and being female. High exposure to violence was evident and not feeling safe at home or in community increased risk for all mental health disorders. Knowing one’s HIV status, however, was protective as was having dreams for the future. The qualitative studies highlighted that despite marked stressors in the lives of these adolescents, a high degree of resilience was described. Characteristics of resilience in this group included a pertinent set of beliefs, including a belief in fate and recognition of personal strength as a consequence of managing adversity. Character traits such as a pragmatic acceptance about one’s life, actively taking responsibility, and a robust self-esteem were evident. Social behaviours included the ability to pursue and access adults and healthcare to meet developmental needs, having a desire to support and help others and challenging HIV related stigma. These characteristics were underscored by the capacity for self-reflection. The studies also revealed that PIA have limited understanding of how they became infected, vertical transmission and potential benefits of PMTCT to their future reproductive needs, despite disclosure. Most participants were experiencing complicated grieving which was impacting negatively on their mental health, ability to accept their HIV status and adhere to treatment. The drawings and written accounts of the qualitative study accentuated contextual deprivation, including high exposure to multiple and consistent losses of significant attachment figures. They also pointed to emotional deprivation and impoverishment, including unresolved complicated grieving. Views from participants emphasized missed opportunities, including failure to address the mental health concerns of this population at risk. The case study suggested that without court intervention, most of the participants, being orphans without guardians, could not have participated in the research because the statutory consent was otherwise impossible. This case study argues for exceptions to the parental consent requirement, by reason of the exclusion of Orphaned and Vulnerable Children and Youth (OVCY) from research. Inconsistent and confusing legal policy that inadvertently silences voices that most need to be heard, as well as law that is inconsistent with principles of justice, inclusiveness and autonomy, are put forward to argue for a change to the National Health Act. Conclusion: HIV positive adolescents accessing care demonstrate high levels of mental health problems that are largely unrecognized and could potentially be addressed within health systems. Recognition of mental health challenges in PIA is crucial to effective HIV care and treatment and providers need to be sufficiently sensitized to this reality. PIA need improved communication regarding vertical transmission and PMTCT to properly understand their HIV status and engage effectively in management. Honest communication about how relatives died and disclosure of HIV status is necessary to reduced stigma, complicated grieving and improve mental health. The impact of unprocessed loss early in life has long-term negative consequences for PIA. Innovative methods are required to address unmet mental health needs of this patient population. The use of non-verbal methods (drawing and writing) by healthcare professionals could be especially valuable to both patient and provider, particularly in the case of managing bereavement. PIA, who face high levels of hardship and change, nevertheless exhibit strong resiliency beliefs, traits, and behaviours. Healthcare environments have the potential to be utilized as powerful resources in fostering resilience in PIA, if characteristics of adolescent resilience are integrated into prevention and intervention programming. Finally, a balance is required between protecting adolescents from exploitation and permitting access to benefits of research. Mandating parental consent for all research does not necessarily give effect to policy. For the vast majority of South African HIV infected adolescents parental consent is not possible. Adolescents are understudied and poorly understood and although these laws are there to protect this vulnerable group, it also makes them and their problems less visible. In order to scale up interventions, careful consideration needs to be placed on how the laws can help researchers benefit adolescents. Section 71 of the National Health Act ought to be amended to facilitate valuable and necessary research concerning HIV infected orphan children and adolescents. Keywords: perinatal HIV infection, HIV positive adolescents, vulnerable youth, mental health, healthcare system, disclosure, violence, orphan, bereavement, complicated grief, drawing, resilience, research, National Health ActItem The association of nutrition on body composition and metabolic disease risk in rural South Africa children and adolescents(2017) Pedro, Titilola MinsturatBackground: The persistent burden of undernutrition, with increasing prevalence of obesity and metabolic disease risk among children and adolescents, has become a global public health problem. Research has shown that risk factors established in childhood and adolescence may contribute to the development of non-communicable diseases (NCDs) in adulthood. This is of particular concern in South Africa, given its rapid socio-economic, political and epidemiological transitions. Research into the trends of nutrition transition in rural children and adolescents, whose particular health needs have been under-served and poorly delineated in the past, provides a unique opportunity to study the e ects of rapid health transitions on development. Aim: To determine the association of nutrition, body composition and metabolic disease risk in rural South African children and adolescents. Study design: Three cross-sectional studies were undertaken to address the overall aim of this research. The speci c objectives of each study were: (1) to determine the association of nutrition on body composition and metabolic disease risk in children and adolescents; (2) to examine the associations between body mass index (BMI), disordered eating attitude and body dissatisfaction in female adolescents, and descriptive attributes assigned to silhouettes of di ering body habitus in male and female adolescents; and (3) to investigate associations between diet and cardiovascular disease (CVD) risk factors in adolescents. Method: One cross-sectional study, 3 analyses were nested within the Agincourt Health and Socio-demographic Surveillance System (HDSS) site, in the Bushbuckridge subdistrict, Mpumalanga Province, South Africa. In 2009, a random sample of 600 children and adolescents, from age groups 7 to 8 years, 11 to 12 years and 14 to 15 years, were selected from 3489 children who had participated in a 2007 growth survey. These children and adolescents had to have lived in Agincourt at least 80% of the time since birth or since 1992, when enrolment into the Agincourt Health and Socio-Demographic Surveillance System (HDSS) began. Height and weight were measured to determine BMI. Age and sex-speci c cut-o s for underweight and overweight/obesity were determined using those of the International Obesity Task Force. Body image satisfaction using Feel-Ideal Discrepancy (FID) scores, Eating Attitudes Test-26 (EAT-26), perceptual female silhouettes and pubertal assessment were collected through self-administered questionnaires. Blood pressure (systolic (SBP) and diastolic (DBP)) was measured, fasting blood samv ples were collected for the determination of glucose and lipids. Waist to hip ratio cut-o s of (WHR) >0.85 for females, >0.90 for males, waist to height ratio (WHtR) of >0.5 for both sexes, and waist circumference (WC) of >80 cm for females and >94 cm for males were used to determine the risk of adiposity. For abnormal lipids: high density lipoprotein cholesterol (HDL-C) cut-o s of >1.03 mmol/l, low density lipoprotein-cholesterol (LDL-C) of >2.59 mmol/l, triglycerides (TGs) of >1.7 mmol/l and total cholesterol (TC) of >5.17 mmol/l were used. Pre-hypertension prevalence was computed using the average of 2 readings of SBP or DBP, being >90th but <95th percentile for age, sex and height. Dietary intake was assessed using semi-quantitative food frequency questionnaire. T-test and ANOVAs for normally distributed data and Wilcoxon-Mann- Whitney test was used to determine signi cant di erences by sex and by pubertal stages for EAT-26 and EAT-26 sub-scores. Chi square tests were done to determine signi cant associations between the categorical variables. Bivariate linear regression was employed to test associations and signi cant tests were set at the p<0.05 level. Results: Study component (1): Stunting levels were higher in the boys than in the girls in mid to late childhood and combined overweight and obesity prevalence was higher in girls than in boys. The girls' BMI was signi cantly greater at ages 11 and 12 years than that of the boys [girls: 18 3.4, 95% con dence interval (CI): 17.33- 18.69; boys: 17 2, 95% CI: 16.46-17.25; p-value 0.004] and at ages 14-15 years (girls: 22 4.1, 95% CI: 20.82-22.47; boys: 19 2.4, 95% CI: 18.39-19.38; p-value < 0.001). Prehypertension (de ned as < 90th centile for age, sex and height) was higher in girls (15%) than boys (10%). Further, impaired fasting glucose was detected in 5.3% of girls and 5% of boys. High-density lipoprotein cholesterol (>1.03 mmol/l) concentrations were observed in 12% of the girls and 0.7% of the boys, which is indicative of cardiometabolic risk. Study component (2): The prevalence of overweight and obesity was higher in girls than boys in early and mid to post pubertal stages. The majority (83.5%) of the girls reported body image dissatisfaction (a desire to be thinner or fatter). The girls who wanted to be fatter had a signi cantly higher BMI than the girls who wanted to be thinner (p=0.001). There were no di erences in EAT-26 score between pubertal groups, or between boys and girls within the two pubertal groups. The majority of the boys and the girls in both pubertal groups perceived the underweight silhouettes to be \unhappy" and \weak" and the majority of girls in both pubertal groups perceived the normal silhouettes to be the \best". Study component (3): Added sugar and sweets contributed 10% and maize meal and vi bread contributed 7.2% to the total number of food items consumed respectively. Girls had higher intakes of total fat, saturated fat and cholesterol after adjusting for dietary energy intake and age (all p<0.001). The prevalence of combined overweight and obesity was 13.8% in girls and 3.1% in boys (p<0.001). In addition, indicators of adiposity were higher in females, abnormal waist circumference (WC) (6.7%), waist to hip ratio (WHR) (22.0%) and waist to height ratio (WHtR) (18.0%), compared to males, (0%), (3.1%) and (6.2%) respectively (all p<0.001). Girls had higher low-density lipoprotein (LDL) (12(9.3%) vs. 3(2.3%), p=0.01), total cholesterol (17(12.7%) vs. 5(3.5%), p<0.001) and were more pre-hypertensive (28(15.3%) vs.15(8.4%), p=0.04) than the boys. Furthermore, the bivariate associations between dietary intakes (total energy, total carbohydrate (CHO), total dietary fat and saturated fat) and anthropometric indices (BMI and WC) showed that body mass index (BMI) was associated with total energy (p=0.05) and BMI and WC were associated with total fat (p=0.01, p=0.03) and saturated fat (p<0.001, p=0.02) in females respectively. Conclusions: In conclusion, this thesis highlights that girls in rural South Africa had a higher prevalence of combined overweight and obesity than did boys, stunting was more prevalent amongst boys than girls in mid to late childhood and metabolic risk factors that were associated with adiposity, and linked to diet, were higher in girls than in boys. This study has provided useful information for targeting critical health promotion intervention programmes to optimise child nutrition as part of a noncommunicable disease preventative strategy, especially, in remote areas in rapidly transitioning South Africa.Item The use of tobacco in Johannesburg high school youth(1996-03-28) Goldstein, Susan, JaneTobacco is a major cause of morbidity and mortality world-wide. Smoking rates in South Africa have been increasing over the past decade. The promotion of health by targeting anti smoking campaigns at school going children is a common strategy throughout the world. The aim of this study was to examines the extent and nature of cigarette smoking in high schools in Greater Johannesburg in 1994, in order to inform health promotion programmes dealing with tobacco controItem Perceptions about adolescent body image and eating behaviour(2017) Laxton, KimIntroduction. Eating disorders are an important group of mental illnesses in Psychiatry. The aetiology is multifactorial, developing from distorted beliefs around body image and shape, with resultant abnormal eating behaviours. This study explores the views and perceptions of a group of university students regarding their peers’ body image and shape and eating behaviours, which they experienced (at the time) during their senior high school years. The majority of these students attended high schools in Johannesburg. Method. This was an explorative, qualitative study using qualitative methods. A sample of 153 participants was voluntarily recruited from students in the Faculty of Health Sciences at the University of the Witwatersrand. A manually distributed anonymous questionnaire was used, with questions about their high school peers’ personality traits, early and late childhood experiences, eating behaviour, and the last three years of high school environment. Questions in each section were deconstructed and categorised into subthemes. Subthemes were further deconstructed into replicated ideas. These subthemes and ideas were presented in hierarchical tables. Findings in this study were compared with the literature. Results. The most commonly described subtheme of participants’ perceptions of high school peers’ personality traits was “poor self-confidence”. The most replicated subthemes of views on peers’ childhood experiences were “personal conflict with members of the family”, “a disruptive home environment” and “mother’s attitude”. In terms of peers’ eating behaviour, a subtheme on “body shapes” included “fat”, “skinny” and “fit” and “muscular” bodies. In terms of the high school environment, the subtheme of “bullying and peer discrimination” was regarded as important, while “the impact of media” was regarded as extremely important. Fifty percent of participants viewed body image to be important for social status. There were mixed views on whether specific programmes should be introduced to identify pupils at risk. Conclusion. Although bullying and peer pressure have been described as contributing factors in the development of eating behaviour problems in high school learners, as perceived by a group of university students, the most prominent potential contributing factor considered was the media, specifically social media. This finding could contribute to further research looking at the role of social media, not only its relationship in the potential development of a Psychiatric Illness, but possibly, too, its role in the educational and rehabilitation process.Item The perceived impact of a skills training workshop supported by the book, HIV & AIDS, on grandmothers' communication with pre-adolescent and adolescent grandchildren in their care about sex, sexuality and HIV and AIDS in Alexandra(2016) Simmonds, JaneHIV continues to be a major public health issue in South Africa with young people still a high risk. Evidence suggests that children who have lost one or both parents are at greater risk of acquiring HIV. South African grandmothers, and other older family members, are increasingly responsible for' raising grandchildren in the absence of parents. Conversations about sex, sexuality and HIV and AIDS need to be part of growing up.Sexual reproductive health (SRH) communication between parents and their children has been shown to promote safer sexual choices.Where grandmothers, and other older family members,are the primary caregivers,this responsibility is shifting to them.There are a number of barriers, including cultural beliefs, selfZefficacy, age and gender that impede SRH conversations between older caregivers and the children they care for.The overall aim of this study was to explore the phenomenon of an group of grandmothers in Alexandra in communicating about sex, sexuality and HIV and AIDS with the pre-adolescent and adolescent children that they care for, before and subsequent to a skills training workshop on sex, sexuality and HIV and AIDS. Materials and methods: This was a qualitative evaluation study that explored the experiences of grandmothers or older caregivers when talking to their grandchildren or children in their care about sex, sexuality and HIV and AIDS before and after a brief intervention over seven months. This study drew on a phenomenological approach using content analysis. The intervention consisted of a two-hour training workshop using the book,HIV & AIDS by Marina Appelbaum as a tool to facilitate SRH communication.Data collection occurred at three points in time.The study used convenience sampling and ten grandmothers or older female caregivers who were the primary caregivers of pre-adolescent and adolescent grandchildren aged 10 to 18 years volunteered to participate in the study.Of the ten participants, six women participated in a focus group three weeks after the skills training workshop. Five of the ten women from the baseline interviews were interviewed a second time three to six months after the skills training workshop. Data was collected utilising individual inZdepth interviews pre- and three to seven months post intervention,and through a focus group discussion three weeks post intervention.Thematic analysis was conducted and inductive codes and themes were identified from the interviews. Results: Grandmother and older caregiver conversations about SRH matters with pre-adolescent and adolescent grandchildren and children in their care were hindered by a number of factors. These included taboo and cultural issues; the personal experiences of the grandmothers with SRH communication during their childhood; the generation gap; gender; the lack of selfZefficacy regarding SRH content; knowledge about HIV and AIDS and how to actually speak about sex, sexuality and HIV and AIDS. In addition, a number of other hardships in the grandmothers and older caregivers lives were barriers to making having these SRH conversations a priority.The intervention highlighted that grandmothers and older caregivers appreciated the need to have these conversations with their grandchildren and children in their care and were prepared to overcome these barriers in order to promote safer sexual behaviour for the grandchildren.The skills training workshop helped to shift the fears about SRH communication and the participants responded very positively to the skills training workshop expressing how much more confident they felt about addressing SRH topics after the intervention. In addition, selfZefficacy was strengthened with participants reporting that they had attempted SRH conversations with the children in their care after the skills training workshop.However, the grandmothers and older women felt that further training was required for them. In addition, they felt that skills training workshops for their grandchildren were also needed. Conclusions: Overall, the findings in this study demonstrated the value and need for interventions to facilitate SRH communication between grandmothers and older caregivers and the grandchildren and children in their care. As grandmothers and older women are committed and involved primary caregivers of the children in their care, and in spite of numerous barriers to SRH conversations, they are prepared to speak to their grandchildren about this topic. In addition, they recognise the value of this communication in keeping their grandchildren and children in their care healthy and promoting safer sexual choices. In light of the active role played by grandmother in raising grandchildren, SRH interventions are needed to assist the role of grandmothers in talking about sex,sexuality and HIV and AIDS. The skills training workshop made a significant contribution to increasing SRH communication although participants recommended that additional workshops were required for themselves and the grandchildren and children that they care for.In addition,interventions need to recognise the day-to-day difficulties experienced by grandmothers and older women in bringing up third generation children.Item The efficacy of a 12-week exercise intervention in 11-16 year old adolescents with autism spectrum disorder(2016-10-17) Neophytou, NataliaBACKROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, which often results in an array of motor impairments. These motor impairments often lead to reduced performance in activities of daily living (ADLs) as well as in societal tasks which require specific motor abilities and skills. Individuals with ASD have also been reported to have significantly lower physical activity levels compared to typically developing individuals. Motor impairments and these lower physical activity levels have led to various health problems including obesity, cardiovascular disease and insulin resistance syndrome. It may therefore be necessary to intervene in the population, to reduce sedentary-related health risks as well as attempt to improve motor impairments. Since exercise has been shown to be an effective therapeutic modality in reducing motor impairments and improving cardiovascular fitness, the efficacy of exercise interventions within the ASD population needs to be established. OBJECTIVE: To determine the efficacy of a 12 week exercise intervention by assessing the change in posture, body composition, balance, coordination, agility, gait and physical fitness pre- and post-exercise intervention in adolescents with autism aged 11 to 16 years. METHODS: A randomised control trial was conducted to assess the efficacy of an exercise intervention programme in 27 adolescents with ASD (mental age 5.6 ± 1.8 years). The sample was divided into 2 groups (intervention (n=16) and control (n=11)) using randomisation software. Validation of a 12-week exercise intervention was conducted by an expert panel via an online form. The intervention included an aerobic warm up, upper, core and lower body exercises, balance exercises, agility drills, fine motor skill training and a brief aerobic cooldown. All participants were tested pre- and post-intervention, and the intervention group participated in the exercise intervention bi-weekly for 12 weeks, while the control group received their usual standard care. Posture was assessed using a posture grid, and scores out of 10 were given per body area, where good posture = 10, average posture = 5 and poor posture = 0. Body composition, and physical fitness were assessed using the Brockport Physical Fitness Test (BPFT), and balance and coordination were assessed using the MABC-2 test and checklist. Gait was assessed using Dartfish two-dimensional video analysis, and agility was assessed using a standard agility T-test. Data analysis was performed using Stata version 13.1. Descriptive data were expressed as means and standard deviations. To compare variables during pre-and post- intervention within groups for continuous variables, the Wilcoxon signed-rank test was used. To compare variables during pre and post intervention within groups, for categorical variables, Mc Nemar’s test for symmetry was used. Fisher’s exact test was used for categorical variables. Significance was accepted at 95% (p< 0.05). RESULTS: Overall compliance to the intervention was 88.78%; high functioning individuals demonstrated 97.24% compliance, while low functioning individuals demonstrated 77.89% compliance. Posture: there was a significant increase in the overall posture scores (p=0.0004), specifically in the ankle area (p=0.0183) in the intervention group. Cardiovascular fitness: the intervention group showed significant decreases in resting systolic blood pressure (p=0.0069), and systolic blood pressure taken one minute following exercise (p=0.0007). A significant decrease in resting Heart rate (p=0.0046), as well as in heart rate taken one minute following exercise (p=0.0096) was also seen. Anthropometry: although the intervention groups’ weight and body fat percentage did not significantly decrease, there was a significant reduction in BMI (p=0.0130) post intervention. Strength: handgrip strength significantly increased in the non-dominant hand only (p=0.0289), yet there was an overall increase in strength in both hands. The intervention group improved significantly in the amount of curl-ups they were able to perform following the intervention (p=0.0094). Flexibility: for the majority of the flexibility parameters, no significant changes were seen from pre to post testing besides in the intervention group for the sit and reach test for the non-dominant limb (p=0.0088). Manual dexterity: In the MABC-2 test (for age-band 3) there was a significant difference seen in the intervention group (p = 0.200) for the turning pegs item for the non-dominant hand in the intervention group. Coordination: a significant difference was seen in the intervention (p=0.0007) and control group (p=0.0112) for the throwing activity. No conclusive information regarding the efficacy of exercise for this component was however noted. Balance: the intervention group was able to hold their balance for a significantly (p=0.0028) longer time post intervention (17.0 ± 11.0 s) compared to pre intervention (10.5 ± 9.2 s) in the two-board balance task. Agility: there was a significant (p=0.0061) improvement in the agility times from pre (27.4 ± 12.1s) to post (23.0 ± 9.9s) intervention in the intervention group. Gait: there were no significant differences seen following the intervention for all gait parameters. CONCLUSION: A 12 week exercise intervention significantly improved overall posture, cardiovascular fitness, BMI, hamstring flexibility, coordination, balance and agility in individuals with ASD. Handgrip strength and manual dexterity also improved . This therefore suggests that exercise may be a viable therapeutic intervention in the ASD population.Item Ethico-legal concerns in relation to adolescent sexual intercourse(2016-03-01) Chirkut, ShivaniGenerally, consensual adolescent sexual intercourse is fraught with a number of negative outcomes such as socio-economically, where unplanned pregnancies occur, and medically with the spread of sexually transmitted diseases that require treatment. The Sexual Offences and Related Matters Amendment Act 32 of 2007, hereunder referred to as the Sexual Offences Act (“SOA”), criminalised consensual sexual intercourse between adolescents aged from 12 to less than16 years. Since the inception of the SOA in 2007, there seemed to have been relatively little evaluation of the practical effect of sections 15 and 16 of the SOA on society. This changed in 2011 when two non-profit organisations, The Teddy Bear Clinic for Abused Children and RAPCAN (Resources Aimed at the Prevention of Child Abuse and Neglect) who were the first and second applicants respectively, challenged the constitutionality of certain sections of the SOA. These sections are: - section 15 – entitled “Acts of consensual sexual penetration with certain children (statutory rape)”; - section 16 – entitled “Acts of consensual sexual violation with certain children (statutory sexual assault); and - section 56(2) – which deals with defences in respect of sections 15 and 16. In October 2013, the Constitutional Court declared sections 15 and 16 inconsistent with the Constitution. That declaration was suspended for a period of 18 months to enable Parliament to correct the defects in the statute. It is widely known that adolescents still engage in consensual sex with each other regardless of the law. The issues invite an evaluation of the current legislation in the context of the health and social issues that surround them. In addition, the impact of the current applicable legislation on the present realism needs to be scrutinised. It is essential for alternative interventions to be established which will aid in reducing the negative impact of consensual adolescent sexual intercourse. This research report looks at interventions that could be introduced to prevent adolescent sexual intercourse and alleviate the negativity of outcomes. Furthermore, the report aims to suggest an ethical, structured approach to reduce the current negative outcomes of adolescent sexual intercourse. In order to accomplish this I first describe the legislation that applies to consensual adolescent sexual intercourse of children between the ages of 12 and 16 years old. This brought to the fore the health practitioner’s practical experiences of problems associated with this legislation. In addition, I identify and discuss some ethical problems that health practitioners are confronted with in relation to consensual adolescent intercourse, in terms of having to balance their professional legal and ethical obligations. Finally, I propose some recommendations that will inform educational organisations on the relevant information to be included in sexual and reproductive health education campaigns. Furthermore, recommendations are made to relevant national policy-making departments to make strategic decisions regarding health and social interventions for adolescent sexual and reproductive health services.