Health, masks and music : narratives of empowerment in a South African community music therapy project based in a tuberculosis hospital

This article introduces the Music Therapy Community Clinic’s (MTCC) Music for Health Project based in a tuberculosis (TB) hospital in South Africa. The value of this community music therapy project is explored from various narrative frameworks pertaining to health and the TB disease. Initially viewed from a reductionist medical narrative with a primary focus on treatment of physical symptoms, music therapy offers patients a diversion from their illness, but is perhaps a luxury rather than an essential form of therapy. The project is then considered from a narrative framework of empowerment, placing TB as a disease that predominantly affects those who are disempowered through poverty, stigmatization and isolation. Three case studies explore how community music therapy serves to empower patients on individual and collective levels, and consider possibilities this may hold for influencing the health behaviour of patients. As TB is becoming a pertinent issue worldwide, the article may offer possibilities for the role of creative approaches in the care of TB patients.http://www.intellectbooks.co.uk/journals/view-Journal,id=149/gm201

Characterization of Anaplasma marginale subsp. centrale strains by use of msp1aS genotyping reveals a wildlife reservoir

Bovine anaplasmosis caused by the intraerythrocytic rickettsial pathogen Anaplasma marginale is endemic in South Africa. Anaplasma marginale subspecies centrale also infects cattle; however, it causes a milder form of anaplasmosis and is used as a live vaccine against A. marginale. There has been less interest in the epidemiology of A. marginale subsp. centrale, and, as a result, there are few reports detecting natural infections of this organism. When detected in cattle, it is often assumed that it is due to vaccination, and in most cases, it is reported as coinfection with A. marginale without characterization of the strain. A total of 380 blood samples from wild ruminant species and cattle collected from biobanks, national parks, and other regions of South Africa were used in duplex real-time PCR assays to simultaneously detect A. marginale and A. marginale subsp. centrale. PCR results indicated high occurrence of A. marginale subsp. centrale infections, ranging from 25 to 100% in national parks. Samples positive for A. marginale subsp. centrale were further characterized using the msp1aS gene, a homolog of msp1 of A. mar-ginale, which contains repeats at the 5= ends that are useful for genotyping strains. A total of 47 Msp1aS repeats were identified, which corresponded to 32 A. marginale subsp. centrale genotypes detected in cattle, buffalo, and wildebeest. RepeatAnalyzer was used to examine strain diversity. Our results demonstrate a diversity of A. marginale subsp. centrale strains from cattle and wildlife hosts from South Africa and indicate the utility of msp1aS as a genotypic marker for A. marginale subsp. centrale strain diversity.http://jcm.asm.org2017-04-30hb2017Veterinary Tropical Disease

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Diversity and Community: Finding and Forming a South African Music Therapy

How does music therapy engage diversity? My participation within three different South African communities offers possibilities, questions and thoughts to music therapists as we form our profession in this country and perhaps also globally. In a diverse, transient community, music is able to draw people together and may help to reconcile our many differences, but can also highlight the fragmentation of this community if all individuals and groups are not considered. As I introduce music therapy to an affluent school community, I find the cultural understandings I share with community members a helpful advantage, and yet I need to consider that by working only in wealthy, resourced communities similar to my own community, I may be highlighting the divide between wealth and poverty. In this way, I compound our countries' struggle with social inequality. As I initiate a short term music therapy group in a community very different to my own, I struggle with questions of whether music therapy has any relevance here, and find myself adapting my thinking, and working closely with the community to form a music therapy practice that has value in this context. These diverse work experiences challenge music therapists to increase our awareness of pertinent national and global issues and the possibilities our profession holds for addressing these issues. We need to explore new communities whilst continually reflecting and questioning all that we do and sharing our different work experiences with one another. Otherwise, whilst our work may hold much value within a particular community, we may find ourselves addressing or compounding national or global issues and may be growing or inhibiting our profession

Health, masks and music: Narratives of empowerment in a South African community music therapy project based in a tuberculosis hospital

This article introduces the Music Therapy Community Clinic’s (MTCC) Music for Health Project based in a tuberculosis (TB) hospital in South Africa. The value of this community music therapy project is explored from various narrative frameworks pertaining to health and the TB disease. Initially viewed from a reductionist medical narrative with a primary focus on treatment of physical symptoms, music therapy offers patients a diversion from their illness, but is perhaps a luxury rather than an essential form of therapy. The project is then considered from a narrative framework of empowerment, placing TB as a disease that predominantly affects those who are disempowered through poverty, stigmatization and isolation. Three case studies explore how community music therapy serves to empower patients on individual and collective levels, and consider possibilities this may hold for influencing the health behaviour of patients. As TB is becoming a pertinent issue worldwide, the article may offer possibilities for the role of creative approaches in the care of TB patients.http://www.intellectbooks.co.uk/journals/view-Journal,id=149/gm201

Mit und inmitten von Chaos arbeiten

Das Support Programme for Abuse Reactive Children wurde von der Teddy Bear Clinic (einer Non-Profit-Organisation, die zum Schutz missbrauchter Kinder gegründet wurde) in Südafrika als Reaktion auf die Zunahme von minderjährigen Straftätern, deren Opfer ebenfalls minderjährig sind, initiiert. Dieses Kurzzeitprogramm zielt darauf ab, jungen Ersttätern eine ganzheitliche Rehabilitation anzubieten, welche konventionelle Diversionsansätze mit kreativen Programmen, einschließlich Gruppenmusiktherapie kombiniert. Basierend auf der Durchsicht meiner Therapieprotokolle befasst sich dieser Artikel mit Herausforderungen und positiven Entwicklungen, die ich im Laufe der Zeit als Musiktherapeutin des Programms von 2006 bis 2016 erlebt habe. Obwohl ich diese Arbeit oft als chaotisch empfand, legen die Ergebnisse nahe, dass durch die gemeinsame Entwicklung mit Teilnehmern der Gruppenmusiktherapie, Klinikmitarbeitern und der breiten Öffentlichkeit eines kontextspezifischen Musiktherapieprogramms, die Musiktherapie eine zunehmend relevante und wertvolle Ergänzung des Diversionsprogramms ist. Fortwährende Herausforderungen dieser Arbeit werden ebenfalls hervorgehoben. The Support Programme for Abuse Reactive Children, was initiated by the Teddy Bear Clinic (an NPO established to protect abused children) in South Africa in response to the increase of child-on-child offenders in this country.  This short-term programme aims to offer holistic rehabilitation to first time young sex offenders and incorporates conventional diversion approaches alongside creative programmes, including group music therapy. Based on a review of my session notes, this paper considers challenges and positive developments I experienced over time as the programme’s music therapist from 2006 to 2016. Although I often experienced this work as chaotic, findings suggest that through co-creating a context-specific music therapy programme alongside group members, clinic staff and the broader community, music therapy has offered an increasingly relevant and valuable complement to the diversion programme. Continuing challenges within this work are also highlighted.Le programme de soutien aux enfants réactifs victimes de maltraitance a été lancé par la Teddy Bear Clinic (une organisation à but non lucratif créée pour protéger les enfants maltraités) en Afrique du Sud, en réponse à l'augmentation du nombre de délinquants mineurs par enfant dans le pays. Ce programme à court terme vise à offrir une réadaptation holistique aux jeunes délinquants sexuels pour la première fois et intègre des approches conventionnelles de déjudiciarisation à des programmes créatifs, notamment la musicothérapie de groupe. Basé sur un examen des notes de session, cet article considère les défis et les évolutions positives vécus au fil des ans en tant que musicothérapeute du programme de 2006 à 2016. Bien que ce travail ait souvent été chaotique, les conclusions suggèrent qu'en créant un environnement spécifique au contexte, programme de musicothérapie aux côtés des membres du groupe, du personnel de la clinique et de la communauté au sens large, la musicothérapie offre un complément de plus en plus pertinent et précieux au programme de déjudiciarisation. Les défis permanents de ce travail sont également mis en évidence.Il programma di sostegno per l'abuso di bambini reattivi, è stato avviato in Sud Africa dalla Teddy Bear Clinic (una NPO istituita per proteggere i bambini vittime di abusi), in risposta all'aumento della delinquenza tra minorenni in questo Paese. Questo programma a breve termine mira a offrire una riabilitazione olistica ai delinquenti sessuali minorili incensurati, e integra approcci di diversione accanto a programmi creativi, compresa la musicoterapia di gruppo. Basato su una recensione delle mie note di sessione, questo articolo prende in considerazione le sfide e gli sviluppi positivi che ho sperimentato nel tempo come musicoterapista del programma dal 2006 al 2016. Nonostante abbia spesso trovato questo lavoro caotico, i risultati suggeriscono che, attraverso la co-creazione, un programma di musicoterapia di specifico contesto che abbia affiancato membri del gruppo, staff clinico e la più ampia comunità, ha offerto un complemento sempre più rilevante e valido al programma di diversione.  Inoltre, sono evidenziate le sfide continue all'interno di questo lavoro.  (Traduzione di Claudio Cominardi)【要旨】  反応性虐待の子どものサポートプログラムは、国内の子供に対する性的虐待の増加に応じて、南アフリカのTeddy Bear クリニック（被虐待児保護のために設立されたNPO）によって始まった。この短期間のプログラムの目的は、若い初犯の性犯罪者に全人的なリハビリテーションを提供し、グループ音楽療法を含むクリエイティブなプログラムと従来型のダイバージョンアプローチを併用することである。本稿では、筆者がプログラムの音楽療法士として2006年から2016年までの間をかけて経験した課題と前向きな進展ついて、セッション記録に基づき考察している。筆者はこの実践を混沌として経験することが少なくなかったが、グループメンバーとクリニックのスタッフまた幅広いコミュニティと共に、この状況に特化した音楽療法プログラムを共同制作することで示唆を見出し、音楽療法は次第にダイバージョンプログラムに対して適切で有効な補完手段となった。この実践の次の課題についても述べられている。&nbsp

Celebrating 15 Years of Music Therapy Training in South Africa

In 2014, the Music Therapy Master’s training course at the University of Pretoria, South Africa, celebrated its 15th anniversary. To mark the occasion, two showcases held in Gauteng and Port Elizabeth celebrated the work that is being done by music therapists and community musicians across the country, both those with many years of experience, students and recent graduates. This report of the showcases highlights the calibre of exciting music therapy projects that are emerging and developing within diverse contexts and communities throughout our country