A critical review of contemporary dance/movement therapy

This critical review aims to describe and define the field of dance/movement therapy. Attention is paid to central issues in psychology and dance studies which influence the advancement of the modality. Dance/movement therapy is a young profession, developed during the second half of this century, and must be viewed within the socio-cultural context of contemporary western industrialized societies. This work therefore firstly documents the development of dance/movement therapy in the light of recent studies into the nature of bodily expression and non-verbal communication. The phenomenological understanding of the human body is discussed, and the concept of bodyliness proposed in order to encapsulate a multi-dimensional understanding of the meanings of the human body. Dance/movement therapy is then delineated in relation to verbal psychotherapeutic traditions, as well as to the more marginalized body therapies. In this way it is hoped to provide an understanding of the historical precedents and theoretical contexts within which dance/movement therapy is emerging, and ultimately the possibly unique alternative service it may provide. As wide a variety as possible of theoretical approaches in dance/movement therapy is then described, and classified according to the predominant psychological orientation of the proponents. From this a critical review is attempted which is directed broadly at foundational considerations of the profession, rather than at any particular methodology. The enquiry focusses on directions for future possible research which will ensure sound theoretical frames of reference for the developing profession. Discussion of two examples of dance being used in the therapeutic context in South Africa concludes. This section is not a judgmental evaluation of techniques, but intended rather as documentation and broad classification of current work of this nature

Antimicrobial resistance global crisis

Antimicrobial resistance (AMR) is a global health threat. Although resistance to antimicrobial agents can occur naturally in organisms, the misuse of antimicrobials in humans and animals has led to an accelerated global crisis.http://www.specialistforum.co.zaam2020Paediatrics and Child Healt

An Evaluation of Factors Associated with Early Infant HIV Acquisition, Infant Outcomes, and 9-12 Month Infant HIV Seroreversion in the Context of PMTCT Option B+ : Prospective Data from an HIV Exposed Birth Cohort.

This PhD dissertation reports data from the very early infant diagnosis (VEID) study that was conceptualized when universal birth HIV PCR testing at Kalafong Provincial Tertiary Hospital was mandated. Three research questions were addressed: (1) What factors are associated with early infant HIV acquisition?; (2) What are the growth outcomes of HIV exposed, uninfected (HEU) infants?; and (3) What is the 9-month infant HIV seroreversion rate in the context of PMTCT Option B+ when using different rapid HIV tests? The first research chapter demonstrates that maternal HIV viral load detectable in the perinatal period, maternal combination antiretroviral therapy (cART) with a duration <1 month, and having a symptomatic infant at birth are significant predictors of early infant HIV acquisition. Small-for-gestational-age was included with the above three characteristics in multivariate analyses. Two-risk (maternal cART duration and viral load), three-risk (maternal cART duration, maternal viral load and symptomatic newborn), and four-risk (maternal cART duration, maternal viral load, symptomatic and SGA newborn) models for HIV acquisition were developed with a predictive probability score of a newborn PCR positive test of 0.28, 0.498, and 0.57 respectively. These findings could guide a targeted approach to infant HIV-testing at birth. However, using the three- and four-risk scores at a probability of 0.02 and 0.04, 20% and 24% of HIV infected infants will be missed respectively at birth compared with universal testing. Therefore, we support universal birth PCR testing within the South African PMTCT context. The second research chapter describes growth outcomes of HEU infants in relation to maternal and infant birth characteristics. Mothers were mostly breastfeeding at birth and on universal lifelong cART. Maternal to child transmission of HIV after birth were less than 1% (0.31%) and occurred mostly by 6 weeks of age. HIV infection was associated with symptoms and signs of HIV-associated immunosuppression, such as growth faltering. The hospitalization rate was 41.3/1000 person-years. Longitudinal growth trends illustrated lower weight-for-age (WAZ) and length-for-age (LAZ) in males. HEU newborns that had one or more symptoms suggestive of HIV-associated immunosuppression had lower weight trends and newborns with a birth weight <2.5kg had significantly lower WAZ, LAZ and head circumference (HC) trends. The significance of poor LAZ trends, especially in male HEU infants, remains a concern. The impact on final height and body mass index (BMI) need careful follow up to ascertain if these growth trends will have a negative impact such as higher BMI values and possibly more obesity among HEU male adolescents/young adults. Lastly, we describe seroreversion at 9 months amongst HEU infants whose mothers received cART. We observed that different rapid assays vary in performance, with specificity ranging between 45-97%. HIV ELISA testing did not document any seroreversion at nine months in our cohort. This finding highlights the need for further research to determine the age at seroreversion within the context of the PMTCT option B+ / universal maternal access to lifelong cART. It is possible that uninfected infants will remain seropositive beyond 18 months of age. Hence, future recommendations might include HIV PCR testing in infants up to 24 month of age.Thesis (PhD)--University of Pretoria, 2018.South African Medical Research Council (SAMRC)Paediatrics and Child HealthPhDUnrestricte

Risk factors for pertussis among hospitalized children in a high HIV prevalence setting, South Africa

BACKGROUND : In low- and middle-income countries, including South Africa, the epidemiology of pertussis in relation to immunization, nutritional, and HIV status is poorly described. This article reports on risk factors in South African children hospitalized with pertussis. METHODS : A prospective, hospital-based, sentinel surveillance programme for pertussis was conducted in Gauteng Province, South Africa. Hospitalized children ( 10 years) meeting the surveillance criteria for clinically suspected pertussis were screened and enrolled. Nasopharyngeal specimens were collected for real-time multiplex PCR and culture of Bordetella species. RESULTS : Bordetella pertussis was detected in 6.2% (61/992) of children. Pertussis was significantly more prevalent in infants younger than 3 months (9.8%; 38/392) and in young children between the ages of 5 and 9 years (12%; 4/34) (p = 0.0013). Of the 61 confirmed pertussis cases, 17 were too young for vaccination. Of the remaining 44 infants, vaccination DTP1 was administered in 73% (32/44) of pertussisconfirmed patients who were eligible, DTP2 in 50% (16/32), DTP3 in 54% (14/26), and DTP4 in 56% (5/9) of vaccine-eligible cases at 18 months of age. B. pertussis infection was less likely in children immunized at least once (5%, 32/692) than in unvaccinated children (10%, 24/230) (p = 0.0001). HIV exposure and infection status were determined in 978 (99%) patients: 69% (678/978) were HIV-unexposed and uninfected and 31% (300/978) were HIV-exposed. Of these HIV-exposed patients, 218 (22%) were proven HIV-exposed and uninfected and 82 patients were HIV-infected (8.4%, 82/978). HIV prevalence was similar in pertussis-positive (6%, 5/82) and pertussis-negative (6%, 55/896) children (p = 0.90). B. pertussis infection was unrelated to poor nutritional status. CONCLUSIONS : In South Africa, B. pertussis poses a greater risk to infants who are too young for the first vaccine dose, those who are not vaccinated in a timely manner, and those who do not receive all three primary doses. HIV infection and HIV exposure were not associated with pertussis infection.A research grant from Sanofi Pasteur.http://www.elsevier.com/locate/ijidam2018Paediatrics and Child Healt

Diagnostic testing practices for diarrhoeal cases in South African public hospitals

BACKGROUND : Stool samples submitted for diagnostic testing represent a proportion of diarrhoeal cases seeking healthcare, and an even smaller proportion of diarrhoeal cases in the community. Despite this, surveillance relies heavily on these laboratory results. This study described diarrhoeal diagnostic practices and aetiological agents of diarrhoea in patients admitted to three South African public hospitals in order to understand biases in surveillance data, and inform guidelines, diagnostic and laboratory practices to improve clinical management. METHODS : A doctors’ survey was conducted to determine sample submission, diarrhoeal treatment and barriers to submitting samples for testing. Results for all samples submitted for routine diagnostics were obtained from the NHLS Central Data Warehouse. An enhanced surveillance study enrolled patients with acute diarrhoea at the same hospitals over the same period. Differences between routine culture results and molecular testing from the surveillance study were described. RESULTS : Stool samples were seldom submitted for diagnostic testing (median of 10% of admitted cases). Current diagnostic guidelines were not useful, hence most doctors (75.1%) relied on their own clinical judgement or judgement of a senior clinician. Although most doctors (90.3%) agreed that diagnostics were helpful for clinical management, they reported patients being unwilling to provide samples and long laboratory turnaround times. Routine diagnostic data represent cases with chronic diarrhoea and dysentery since doctors are most likely to submit specimens for these cases. Pathogen yield (number of pathogens detected for samples tested for specific pathogens) was significantly higher in the surveillance study, which used molecular methods, than through routine diagnostic services (73.3% versus 8.2%, p < 0.001), including for viruses (48.9% versus 2.6%, p < 0.001), bacteria (40.1% versus 2.2%, p < 0.001) and parasites (16.2% versus 3.6%, p < 0.001). Despite viruses being commonly detected in the surveillance study, viral testing was seldom requested in routine diagnostic investigations. CONCLUSIONS : Comprehensive diagnostic and treatment guidelines are required for diarrhoeal diseases. These guidelines should be informed by local epidemiological data, where diagnostic testing is reserved for cases most likely to benefit from specific treatment. Optimisation of current diagnostic processes and methods are required for these cases, specifically in terms of minimising turnaround times while maximising diagnostic acumen.The ANDEMIA study was supported by the German Federal Ministry of Education and Research.http://www.biomedcentral.com/bmcinfectdisam2023Medical VirologyPaediatrics and Child Healt

Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa.

BACKGROUND: Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure. METHODS: Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed. RESULTS: Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB. Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no statistically significant differences in baseline characteristics between HIV positive infants who returned for an exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst these HIV positive children < 18 months would be 43.6%. CONCLUSIONS: Early ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014

Hepatitis A virus seroprevalence among children and adolescents in a high‑burden HIV setting in urban South Africa

Hepatitis A virus (HAV) infection is one of the most important global causes of viral hepatitis. Recent reviews suggested that HAV endemicity in South Africa could shift from high to intermediate. A hospital-based HAV seroprevalence study was conducted between February 2018 and December 2019 in Pretoria, South Africa. Systematic sampling was performed on children and adolescents (1–15 years) who attended outpatient services. Participants with a known HIV status and valid HAV serology results were included. Of the 1220 participants, the median age was 7 years (IQR: 4–11), with 648 (53.11%) males and 572 (46.89%) females. Of 628 (51.48%) HIV-infected participants, most (329, 71.83%) were both immunologically and virologically controlled or had low-level viremia (74, 16.16%). Almost three-quarters (894, 73.28%) were living in formal dwellings, and just over half (688, 56.39%) had access to clean water sources inside the house. Increasing age was associated with testing HAV IgG-positive (OR 1.25; 95% CI 1.20–1.30, p < 0.001), with 19.8% of participants one year of age compared with 86.7% of participants 15 years of age. This study suggests that South Africa has an intermediate HAV seroprevalence, with rates < 90% by 10 years of age (68.6%). Increased age and informal dwellings are statistically associated with HAV seropositivity, while HIV status does not significantly influence HAV seropositivity.DATA AVAILABILITY : Raw data were generated at Kalafong Provincial Tertiary Hospital and the University of Pretoria. Derived data supporting the fndings of this study are available from the corresponding author [NdP] on request.A Research Grant by Sanofi Pasteur.http://www.nature.com/scientificreportsam2023Paediatrics and Child Healt

Loss of detectability and indeterminate results : challenges facing HIV infant diagnosis in South Africa's expanding ART programme

BACKGROUND. Early infant diagnosis with rapid access to treatment has been found to reduce HIV-associated infant mortality and morbidity considerably. In line with international standards, current South African guidelines advocate routine HIV-1 polymerase chain reaction (PCR) testing at 6 weeks of age for all HIV-exposed infants and ‘fast-track’ entry into the HIV treatment programme for those who test positive. Importantly, testing occurs within the context of increasing efforts at prevention of mother-to-child transmission (PMTCT) by means of maternal and infant antiretroviral therapy (ART). In addition, infants already initiated on combination ART (cART) may be retested with PCR assays for ‘confirmatory’ purposes, including assessment prior to adoption. The potential for cART to compromise the sensitivity of HIV-1 PCR assays has been described, although there are limited and conflicting data regarding the effect of PMTCT regimens on HIV-1 PCR diagnostic sensitivity. METHODS. We describe a case series of three infants with different ART exposures in whom HIV diagnosis, confirmation or the result of retesting for adoption purposes were uncertain. RESULTS. These cases demonstrate that ART can be associated with a loss of detectability of HIV, leading to ‘false-negative’ HIV-1 PCR results in infants on cART. Furthermore, current PMTCT practices may lead to repeatedly indeterminate results with a subsequent delay in initiation of cART. CONCLUSION. The sensitivity of HIV-1 PCR assays needs to be re-evaluated within the context of different ART exposures, and diagnostic algorithms should be reviewed accordingly.http://www.samj.org.zaam201

South African Higher Education Institutions at the Beginning of the Covid-19 Pandemic: Sense-Making and Lessons Learnt

After the unprecedented changes experienced in higher education due to the Covid-19 pandemic, there is a need to integrate initial thoughts and reflective experience to decide on the way forward. This study aimed to reflect on, and make sense of the events related to South African higher education institutions HEIs at the onset of the COVID-19 pandemic by using the Cynefin framework. Data from a rapid review of online media at the onset of the Covid-19 pandemic and a collaborative autoethnography session 1 year since lockdowns were implemented are used to present perspectives for the sense-making process. This offers insights to both ends of the spectrum as it highlights the evolution of processes taking place at multiple levels from government policies to institutional practices, as well as how this impacted on both staff and students. The Cynefin framework demonstrated sense-making efforts in the disordered, to the chaotic, to the complex, then to the complicated and eventually to the simple domain. Each domain ushered in its peculiarities and highlighted the issues ranging from vulnerabilities experienced in the higher education sector, to trying to reconfigure the academic year, to dealing with wicked problems, to eventually relying on expert assistance to navigate the virtual university space. Trying to establish causality in the simple domain proved challenging as the information available during the time was sparse. Despite these challenges, the lessons learnt include the importance of the sense-making process among all academic staff, the significance of collaboration and team efforts and the need to adapt leadership and self-leadership approaches to the changed ways of working in higher education institutions

Recommendations for the medical evaluation of children prior to adoption in South Africa

The current legislative framework in South Africa (SA) supports adoption as the preferred form of care for children with inadequate or no parental or family support. There are an estimated 3.8 million orphans in SA, with approximately 1.5 - 2 million children considered adoptable. As a means of improving services, newly drafted adoption guidelines from the National Department of Social Development will in future require both non-profit and private sector adoption agencies to obtain a medical report on a child prior to placement. However, no local guidelines specify what an appropriate medical examination entails or how it should be reported. For the purposes of proposing and developing such guidelines, an open forum was convened at the Institute of Pathology, University of Pretoria, in March 2013. These ‘Recommendations for the medical evaluation of children prior to adoption in South Africa’ emanate from this meeting