Rozprawy doktorskie na temat „Attendant ants”

The butterfly family Lycaenidae (including the Riodinidae) contains an estimated 30% of all butterfly species and exhibits a diverse array of life history strategies. The early stages of most lycaenids associate with ants to varying degrees, ranging from casual facultative coexistence through to obligate association where the long-term survival of the butterfly is dependent on the presence of its attendant ants. Attendant ants guard the butterflies against predators and parasites during their vulnerable period of larval growth and pupation. The caterpillars, in return, reward the ants by providing attractive secretions from specialized glands in their cuticle. The prevalence of caterpillar-ant associations in the species rich Lycaenidae is in contrast with other Lepidoptera, where ant association appears only as isolated cases in otherwise non ant-associated lineages. This has led to the proposal that ant association may have influenced lycaenid diversification or even enhanced the rates of speciation in the group. In contrast, facultative ant-associated butterflies exhibit high levels of host plant integrity, so it is reasonable to assume that host plants may have played a significant role in their diversification. Since the influence of ants (or plants) on diversification is independent of geographic speciation modes such as vicariance or peripheral isolates, there is an underlying inference of sympatric speciation. Certain prerequisites thought to be important for sympatric speciation, such as mating on the host plant (or in the presence of the appropriate ant) as well as ant dependent oviposition preferences are characteristic of many obligate myrmecophiles. Not surprisingly, it has been suggested that evidence for sympatric speciation is more likely to be found in the Insecta since this additional mode of diversification could account for the large numbers of insect species. This thesis tested the diversification processes in obligate and facultative ant associated lycaenids using comparative methodologies in hierarchical molecular phylogenetic analyses. First, several hypotheses relating to the influence of ants on diversification in obligately ant associated lycaenid butterflies were tested in a phylogeographic analysis of the Australian endemic Jalmenus evagoras. The phylogeographic analysis revealed that regional isolation of butterfly subpopulations coincident with locally adapted ant taxa could generate a phylogenetic pattern in which related lycaenids would be seen to associate with related or ecologically similar ants. Likewise, ecological shifts in habitat preferences by lycaenids could lead to co-diversification with habitat specialist ants, even though in both cases, the ants may play only an incidental role in the diversification process. A comparative methodology was then applied in a molecular phylogenetic analysis of the genus Jalmenus to test for a signal of diversification consistent with shifts in ant partners, and to infer the processes by which ants could influence speciation. Several other specific hypotheses relating to monophyly and taxonomy were also examined. Comparative analysis of the Jalmenus phylogeny found that attendant ant shifts coincided with high levels of sympatry among sister species. This pattern could be explained by sympatric speciation; however, data suggested it was more likely that ant shifts occurred during butterfly population expansions as a result of vegetation and climate changes in the Pleistocene. Fragmentation of populations associating with novel ants could promote rapid ecological and behavioural changes and this could result in reproductive isolation of conspecifics when in secondary contact. Diversification would then continue in sympatry. In contrast, secondary contact of populations associating with the same ant species would result in homogenisation of the two lycaenid lineages or the extinction of one. A phylogeographic analysis of the facultative myrmecophiles, Theclinesthes albocincta/T. hesperia, was then undertaken to infer the evolutionary processes (such as the effects of host plant shifts) that could result in extant demographics. Species-specific questions of taxonomy, relative population ages and dispersal routes in arid Australia were also addressed. Results from the analysis suggested the two taxa were conspecific and had diversified in the late Pleistocene as a consequence of isolation in refugia in and around the arid areas of mainland Australia. However, as was the case in the J. evagoras population analysis in which attendant ant shifts were not detected, host plant shifts were not detected in the population analysis of T. albocincta/hesperia. Host plant or attendant ant shifts manifest more frequently at the species level, thus it was necessary to test the influence of host plant shifts at this higher level. The comparative methodology was then applied to a molecular phylogenetic analysis of the facultative ant-associated section Theclinesthes (comprising Theclinesthes, Sahulana and Neolucia) to test for modes of diversification consistent with host plant shifts. The relative importance of other influences on diversification was also assessed. Akin to the Jalmenus analysis, the prediction that sister species ranges should broadly overlap when a shift in host plants had taken place was upheld in the comparative analysis. Species in the genera Jalmenus and Theclinesthes were found to have diversified in the Pleistocene so were subject to the same climatic oscillations that influenced patterns of vegetation expansion and contraction across much of Australia. Thus, the similarity and predictability of relationships in the comparative analyses based on biological data suggested that host plant shifts have influenced diversification in facultative myrmecophiles by inhibiting gene flow in secondary contact in similar fashion to that of attendant ant shifts identified in the Jalmenus phylogeny. Interpretation of data in these analyses suggested that allopatric diversification was the most common mode of speciation. Isolation was inferred to be the result of fragmentation following long distance dispersal across wide expanses of marginal habitat, or vicariance following the closing of biogeographical barriers. However, attendant-ant and host-plant shifts clearly played an important role in the diversification process, and in the maintenance of species integrity among lycaenid butterflies. Furthermore, exceptions to the predicted patterns of range overlap and ecological shifts provided clues to additional modes of diversification including shifts in habitat preferences and an unusual temporal shift following changes in specific host plant phenology resulting in allochronic diversification. Inferring modes of diversification using comparative methods based on range overlap and biological traits in a phylogenetic context is not new; however, the interpretation presented in this thesis is in contrast with contemporary methods. It is clear that the patterns of species range overlap and the ecological preferences of sister taxa are intimately related among lycaenid species that diversified during the Pleistocene. As a result, different influences on diversification can be highlighted in phylogenies when applying existing comparative methodologies but without necessarily drawing the same conclusions about modes of diversification. A more inclusive explanation for patterns of range overlap among sister taxa is detailed, a consequence of which is a method for estimating rates of extinction in a phylogeny where comprehensive distributional, biological and taxonomic data are available. These patterns and predictions may be applicable to a range of taxa, especially those that have diversified in the Pleistocene. Plans for future studies are outlined.

The butterfly family Lycaenidae (including the Riodinidae) contains an estimated 30% of all butterfly species and exhibits a diverse array of life history strategies. The early stages of most lycaenids associate with ants to varying degrees, ranging from casual facultative coexistence through to obligate association where the long-term survival of the butterfly is dependent on the presence of its attendant ants. Attendant ants guard the butterflies against predators and parasites during their vulnerable period of larval growth and pupation. The caterpillars, in return, reward the ants by providing attractive secretions from specialized glands in their cuticle. The prevalence of caterpillar-ant associations in the species rich Lycaenidae is in contrast with other Lepidoptera, where ant association appears only as isolated cases in otherwise non ant-associated lineages. This has led to the proposal that ant association may have influenced lycaenid diversification or even enhanced the rates of speciation in the group. In contrast, facultative ant-associated butterflies exhibit high levels of host plant integrity, so it is reasonable to assume that host plants may have played a significant role in their diversification. Since the influence of ants (or plants) on diversification is independent of geographic speciation modes such as vicariance or peripheral isolates, there is an underlying inference of sympatric speciation. Certain prerequisites thought to be important for sympatric speciation, such as mating on the host plant (or in the presence of the appropriate ant) as well as ant dependent oviposition preferences are characteristic of many obligate myrmecophiles. Not surprisingly, it has been suggested that evidence for sympatric speciation is more likely to be found in the Insecta since this additional mode of diversification could account for the large numbers of insect species. This thesis tested the diversification processes in obligate and facultative ant associated lycaenids using comparative methodologies in hierarchical molecular phylogenetic analyses. First, several hypotheses relating to the influence of ants on diversification in obligately ant associated lycaenid butterflies were tested in a phylogeographic analysis of the Australian endemic Jalmenus evagoras. The phylogeographic analysis revealed that regional isolation of butterfly subpopulations coincident with locally adapted ant taxa could generate a phylogenetic pattern in which related lycaenids would be seen to associate with related or ecologically similar ants. Likewise, ecological shifts in habitat preferences by lycaenids could lead to co-diversification with habitat specialist ants, even though in both cases, the ants may play only an incidental role in the diversification process. A comparative methodology was then applied in a molecular phylogenetic analysis of the genus Jalmenus to test for a signal of diversification consistent with shifts in ant partners, and to infer the processes by which ants could influence speciation. Several other specific hypotheses relating to monophyly and taxonomy were also examined. Comparative analysis of the Jalmenus phylogeny found that attendant ant shifts coincided with high levels of sympatry among sister species. This pattern could be explained by sympatric speciation; however, data suggested it was more likely that ant shifts occurred during butterfly population expansions as a result of vegetation and climate changes in the Pleistocene. Fragmentation of populations associating with novel ants could promote rapid ecological and behavioural changes and this could result in reproductive isolation of conspecifics when in secondary contact. Diversification would then continue in sympatry. In contrast, secondary contact of populations associating with the same ant species would result in homogenisation of the two lycaenid lineages or the extinction of one. A phylogeographic analysis of the facultative myrmecophiles, Theclinesthes albocincta/T. hesperia, was then undertaken to infer the evolutionary processes (such as the effects of host plant shifts) that could result in extant demographics. Species-specific questions of taxonomy, relative population ages and dispersal routes in arid Australia were also addressed. Results from the analysis suggested the two taxa were conspecific and had diversified in the late Pleistocene as a consequence of isolation in refugia in and around the arid areas of mainland Australia. However, as was the case in the J. evagoras population analysis in which attendant ant shifts were not detected, host plant shifts were not detected in the population analysis of T. albocincta/hesperia. Host plant or attendant ant shifts manifest more frequently at the species level, thus it was necessary to test the influence of host plant shifts at this higher level. The comparative methodology was then applied to a molecular phylogenetic analysis of the facultative ant-associated section Theclinesthes (comprising Theclinesthes, Sahulana and Neolucia) to test for modes of diversification consistent with host plant shifts. The relative importance of other influences on diversification was also assessed. Akin to the Jalmenus analysis, the prediction that sister species ranges should broadly overlap when a shift in host plants had taken place was upheld in the comparative analysis. Species in the genera Jalmenus and Theclinesthes were found to have diversified in the Pleistocene so were subject to the same climatic oscillations that influenced patterns of vegetation expansion and contraction across much of Australia. Thus, the similarity and predictability of relationships in the comparative analyses based on biological data suggested that host plant shifts have influenced diversification in facultative myrmecophiles by inhibiting gene flow in secondary contact in similar fashion to that of attendant ant shifts identified in the Jalmenus phylogeny. Interpretation of data in these analyses suggested that allopatric diversification was the most common mode of speciation. Isolation was inferred to be the result of fragmentation following long distance dispersal across wide expanses of marginal habitat, or vicariance following the closing of biogeographical barriers. However, attendant-ant and host-plant shifts clearly played an important role in the diversification process, and in the maintenance of species integrity among lycaenid butterflies. Furthermore, exceptions to the predicted patterns of range overlap and ecological shifts provided clues to additional modes of diversification including shifts in habitat preferences and an unusual temporal shift following changes in specific host plant phenology resulting in allochronic diversification. Inferring modes of diversification using comparative methods based on range overlap and biological traits in a phylogenetic context is not new; however, the interpretation presented in this thesis is in contrast with contemporary methods. It is clear that the patterns of species range overlap and the ecological preferences of sister taxa are intimately related among lycaenid species that diversified during the Pleistocene. As a result, different influences on diversification can be highlighted in phylogenies when applying existing comparative methodologies but without necessarily drawing the same conclusions about modes of diversification. A more inclusive explanation for patterns of range overlap among sister taxa is detailed, a consequence of which is a method for estimating rates of extinction in a phylogeny where comprehensive distributional, biological and taxonomic data are available. These patterns and predictions may be applicable to a range of taxa, especially those that have diversified in the Pleistocene. Plans for future studies are outlined.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Australian School of Environmental Studies
Full Text

The retention of persons on an HIV programme has been a global challenge. The success of any strategy to optimize adherence to anti-retroviral therapy (ART) depends on the intensive and effective adherence counselling and strategies. It is important to research whether persons receiving anti-retroviral therapy in public hospitals in Ghana are receiving the needed service that would optimize their adherence to the anti-retroviral therapy. Therefore, this study explored and described the experiences of healthcare professionals providing care, support and guidance to persons on ART at public hospitals in Ghana, as well as the best-practice guideline that could contribute to facilitating the ART adherence of patients. This study also explored and described the experiences of persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on ART, regarding their adherence to the therapy. The study was organized into three phases. In Phase One: a qualitative, exploratory, descriptive and contextual design was employed. The research population included healthcare professionals, providing services at the HIV clinic at the public hospitals in Ghana, namely the Korle-Bu Teaching Hospital; the 37 Military Hospital and the Ridge Hospital. The healthcare professionals comprised of doctors, nurses, pharmacists and trained counsellors employed in any of the three public hospitals. Persons receiving ART at any of the three public hospitals were also part of the research population. Semi-structured interviews were conducted with healthcare professionals and persons receiving ART. Data were collected from healthcare professionals in relation to their experiences regarding the provision of ART services, their understanding of evidence-based practice and best-practice guidelines, as well as data on the experiences of persons receiving ART in relation to their adherence to the therapy. The data were analysed using Creswell’s six steps of data analysis; and the coding of the data was done according to Tesch’s eight steps of coding. Trustworthiness was ensured by using Lincoln and Guba’s framework which comprised credibility, transferability, dependability, confirmability and authenticity. Ethical principles such as beneficence and non-maleficence, respect for human dignity, justice, veracity, privacy and confidentiality were considered in the study. In phase two, the literature was searched by using an integrative literature review approach and critically appraising the methodological quality of the guidelines in order to identify the best available evidence related to adherence to ART. In Phase Three, a best-practice guideline for facilitating adherence to ART was developed for public hospitals in Ghana based on the findings of the empirical research of Phase One and the integrative literature review in Phase Two. The guideline was submitted to an expert panel for review; and it was modified, according to the recommendations of the panel.

A partir de 2007, o Projeto de Atendimento em Plantão Psicológico do Laboratório de Estudos em Fenomenologia Existencial e Prática em Psicologia (LEFE-PSA/IPUSP) disponibilizou estágio a estudantes a partir do segundo ano do curso. Esta investigação buscou conhecer a experiência de quatro plantonistas que iniciaram o seu primeiro estágio de atendimento em plantão no terceiro semestre do curso. Entrevistas individuais foram realizadas, de modo a constituírem relatos sobre este momento de formação. Como percurso metodológico, buscou-se inspiração na fenomenologia hermenêutica e na analítica do sentido como via para explicitação de saberes e impasses que surgiram nas narrativas colhidas sobre plantão. Por um lado, os relatos revelaram como o plantão se organizou para cuidar deste estudante: o atendimento era realizado com psicólogos e colegas dos últimos semestres, sendo supervisionados em grupo, além de haver aulas sobre fenomenologia existencial e aconselhamento psicológico. Por outro lado, o projeto mostrou como cada estagiário, a partir de seus questionamentos, conduziu-se de modo singular ao longo de pelo menos um ano de estágio, outro requisito para ser entrevistado. Neste sentido, evidenciou-se que o plantão contempla múltiplos dizeres e posicionamentos dos estudantes como possibilidade de propiciar um aprender pela experiência (ação). Em busca de descobrirem-se psicólogos, os estagiários disseram dos desafios e impasses encontrados neste modo de aprender, remetendo-os à crise de identidade profissional, à perspectiva fenomenológica existencial e também às limitações da própria instituição no qual este projeto de extensão ocorre. Convocados pela atenção psicológica dos supervisores, os saberes dos plantonistas mostraram-se incorporados em seu agir, sendo difícil falar sobre, mas surgindo nas reflexões sobre situações de atendimento, conversas e supervisões contadas. Neste sentido a formação surgiu como formar-ação, pela aprendizagem significativa como via privilegiada de constituição do saber de ofício do psicólogo. Assim, a investigação destacou a relevância deste estágio ocorrer nos semestres inicias pelo modo como estagiários apresentaram uma compreensão pertinente de plantão nesta perspectiva. Por essa via, manifesta-se a urgência da clínica-escola contemplar projetos de estágio que, simultaneamente, diferenciem-se dos tradicionais treinamento, observação e aplicação de técnicas, contemplando serviços que atenção às demandas da clientela, em sua amplitude
Since 2007, the project of Psychological Attendance, from the Phenomenological Existential Studies and Practice in Psychology Laboratory (LEFE-PSA-IPUSP), initiated such a practicum to students from the second year of the Psychology Course. The present investigation intended to explore and comprehend how four of those students experienced such practicum. Individual interviews were taken in order to obtain oral testimonies about that moment in their graduation formation. The methodological path was based on proposals of the hermeneutic phenomenology and the analytics of sense as a way to present knowledge and difficulties discovered according to the students narratives about Psychological Attendance. By one hand, they revealed how that practicum is organized to take care of the student: to be with a client, the freshmen students were accompanied by colleagues from final semesters or by psychologists and supervision happened in group, besides attending counselling psychology and existential phenomenology classes. On the other hand, the project showed itself as singular for one year, allowing the students narrative for this investigation. It was possible to comprehend how the psychological attendance opened to the participants many possibilities to learn through experience, by learning in action: they expressed challenges and difficulties in this path, mainly emphasizing the professional crisis identity, the existential phenomenological perspective and the limits of the educational institution for such extension project. At the same time, by the supervisors careful psychological attention, the students referred how they incorporated such knowledge in their acting by their reflexions about the experiences at the supervisions as well as with clients. It revealed the possibility of significative learning in action as pertinent to comprehend the meaning of psychologists attention, even when the practicum occurs for Psychology freshmen students. They expressed how the psychological attendance experience in such perspective is important by allowing them to know about the psychological action. Therefore, this investigation points to the urgency to changes in the curriculum of Psychology courses in order to contemplate projects that open new possibilities to the traditional practicum, directing them to the real students and clients actual needs

Orientador: Maria Evelyna Pompeu do Nascimento
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação
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Resumo: A pesquisa pretende um estudo, através da observação em campo, do modelo de atendimento em Educação Infantil implementado no município de Guarulhos - São Paulo intitulado de "Programa Educriança", através do qual mães recebem formações ligadas à Educação Infantil para que possam ter melhores condições de educarem seus filhos em suas próprias casas. Traz, num primeiro momento, por meio de pesquisas bibliográficas, um histórico das políticas públicas adotadas em Educação Infantil em diferentes tempos e lugares, além de um estudo a respeito de programas de atendimento nos quais a família é responsável diretamente pela educação de seus filhos. Num segundo momento do trabalho, traz-se à tona as características estruturais e pedagógicas do programa, demonstrando como o mesmo funciona e está sendo desenvolvido no município de Guarulhos.
Abstract: The research intends a study, through the comment in field, of the model of attendance implemented in Infantile Education in the city of Guarulhos - São Paulo intitled "Educriança Program", through which mothers receive formations about the Infantile Education to have better conditions to educate their children in its proper houses. At the first moment, by means of bibliographical research, the research brings a description of the public politics adopted in Infantile Education in different times and places, beyond a study about attendance programs in which the family is responsible directly for the education of children. In a second moment of the work, it is brought the structural and pedagogical characteristics of the program, demonstrating the developed of program in the city of Guarulhos.
Mestrado
Politicas, Administração e Sistemas Educacionais
Mestre em Educação

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This work is linked to the strict sensu Education Postgraduate Program, Master Level / PPGE, Concentration Area "Society, State and Education" Search Line "Teacher Training and Teaching and Learning Process” and the Research Group on Education and Teacher Training (GPEFOR). Its object of analysis is the program "Stay with me"(2005, 2009), recently renamed "the School Dropout Combat Program," (2013), implemented in the State of Paraná to combat cases of neglect and evasion, with the following problem: What are the possible intentions to be seized in the discourse on school permanence in the programs "FICA" and "the School Dropout Combat" of Paraná? Aiming to meet and respond to the presented problem, we used the indirect research - literature and documents, which general objective was based on analyzing the relationship between Programs and school permanence, whereby the main objectives were present the laws that deal with assiduity, permanence and compulsory education; analyze the speech put in Program Guidelines Notebooks; verify whether the measures adopted with truant students are effective in the fight against abandonment and avoidance by means of data collected; and discuss the issue of successfully staying tied to the school learning. For documentary research, we visited ten schools belonging to the Regional Center of Laranjeiras do Sul - PR in order to collect data from infrequent students in the years 2012, 2013 and 2014, which allowed us to understand the relationship of the proposed measures the Program with the permanence of these students. The analysis of data collected under the highlighted considerations of the chosen theoretical framework: Bakhtin (2014), Mészáros (2008, 2011), Vigotski (1930, 1984, 2000, 2014), Saviani (2009, 2013), Duarte (1999, 2001, 2007, 2008), Faleiros (2009), Frigotto (1989, 2002), Kuenzer (1992), Martins (2009, 2013), Shiroma (2002, 2005, 2011), among others, allowed us to highlight, among several findings, the limitations of the program and school permanence; to remain successful is to have the appropriation of scientific knowledge in its fullest forms; that it is necessary to reduce pedagogical bureaucracy functions and take the responsibility of the welfare functions of the school, who end up shifting its primary social role, which is the act intentionally so that there is learning of scientific knowledge produced by mankind.
Esta dissertação está vinculada ao Programa de Pós-Graduação stricto sensu em Educação, Nível de Mestrado / PPGE, Área de Concentração “Sociedade, Estado e Educação”, Linha de Pesquisa “Formação de Professores e Processos de Ensino e de Aprendizagem” e ao Grupo de Pesquisa em Educação e Formação de Professores (GPEFOR). O seu objeto de análise é o Programa “Fica comigo” (2005, 2009) recentemente renomeado “Programa de Combate ao Abandono Escolar” (2013), implementado no Estado do Paraná para combater os casos de abandono e evasão, com o seguinte problema: Quais as intencionalidades possíveis de serem apreendidas no discurso sobre permanência escolar nos Programas “FICA” e “Combate ao Abandono Escolar” do Estado do Paraná? Na busca de atender e responder à problemática apresentada, utilizamos da pesquisa indireta – bibliográfica e documental, cujo objetivo geral baseou-se em analisar as relações existentes entre os Programas e a permanência escolar, por meio do qual os objetivos específicos pautaram-se em apresentar as leis que tratam sobre frequência, permanência e obrigatoriedade escolar; analisar o discurso posto nos Cadernos de Orientações do Programa; verificar se as medidas adotadas com alunos infrequentes são eficazes no combate ao abandono e evasão por meio de dados coletados; e problematizar a questão da permanência com sucesso atrelada à aprendizagem escolar. Para a pesquisa documental, visitamos dez escolas pertencentes ao Núcleo Regional de Educação de Laranjeiras do Sul – PR, a fim de coletar dados dos alunos infrequentes nos anos de 2012, 2013 e 2014, que nos permitissem perceber a relação das medidas propostas pelo Programa com a permanência desses alunos. A análise dos dados coletados sob as destacadas considerações dos referenciais teóricos eleitos: Bakhtin (2014), Mészáros (2008, 2011), Vigotski (1930, 1984, 2000, 2014), Saviani (2009, 2013), Duarte (1999, 2001, 2007, 2008), Faleiros (2009), Frigotto (1989, 2002), Kuenzer (1992), Martins (2009, 2013), Shiroma (2002, 2005, 2011), entre outros, permitiram evidenciar, entre diversas constatações, as limitações existentes entre o Programa e a permanência escolar; que permanecer com sucesso é ter a apropriação dos conhecimentos científicos em suas formas mais plenas; que se faz necessário desburocratizar as funções pedagógicas e tirar a responsabilidade das funções assistencialistas da escola, que acabam deslocando o seu papel social precípuo, que consiste no agir intencionalmente para que haja aprendizagem dos conhecimentos científicos elaborados pela humanidade

Magister Public Health - MPH (Public Health)
The prevalence of diabetes in Africa has been on the increase. A prevalence of 1%- 10% has been reported by different authors in different regions in Nigeria. The International Diabetes Federation estimates that 1.9% of Nigerians are diabetic and most of them have complications at the time of diagnosis. Laboratory measurement of Glycosylated hemoglobin (HbA1c) is the method of choice for monitoring glycaemic control but due to its cost and limited availability, most developing countries use fasting plasma glucose (FPG) measurement (which is less reliable) to assess glycaemic control. Most diabetic patients in Nigeria have poor glycaemic control and several factors have been implicated especially socio-economic, behavioral and treatment-related factors. Understanding the reasons for poor glycaemic control is essential in order to reduce the rate of diabetes complications.

Thesis (MPhil)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: There have been new infections of HIV despite campaigns aimed at arresting the further spread of the epidemic particularly the new infections. This study sought to investigate whether HIV positive individuals disclose their status to their sexual partners. The study looked at both longtime partners and casual partners. The overall aim was to find the factors that contribute to non-disclosure or to disclosure to sexual partners by HIV positive individuals. The specific objectives were to identify prevailing levels of HIV sero-status disclosure among people living with HIV who were attending the ARV clinic; to identify people living with HIV’s attitude towards HIV status disclosure; to establish factors contributing to disclosure or non-disclosure among people living with HIV; to establish if there is a difference between disclosure rates between ‘long time’ sex partners and casual/’once-off’ sex partners and to provide guidelines to counsellors on how to educate HIV positive people on disclosure. The objectives were achieved by using a quantitative research design through the use of questionnaires targeting 50 HIV positive individuals attending the ARV clinic at Katutura Hospital in Windhoek Namibia. The questionnaire was self-administered and consisted of close-ended questions and one open-ended question which helped collect the quantitative data. The quantitative data was then analyzed using statistical tools (graphs, tables and charts). Results showed that HIV positive individuals are aware of the importance of disclosure. The results showed that majority of the participants did not disclose for fear of abandonment. Some did not disclose because they thought that their partner was also already infected. As for casual sex partners, some did not disclose because they wanted ‘to infect someone since they were also infected by someone’. Some said that they were drunk and hence did not disclose. Participants disclosed because they wanted moral support, they did not want to infect their partners and that they wanted their partners to get tested as well. One of the recommendations was that there is a need to encourage couple counselling in cases of married couples or ‘live-in’ couples to reduce the need for disclosure. It was also recommended that HIV/AIDS health workers need special training to enhance their skills on how to educate HIV positive individuals about disclosure. The link between risky sexual behavior and alcohol abuse was highlighted and it was recommended that there is a need to educate people, particular teenagers, the link between the two.
AFRIKAANSE OPSOMMING: Die doel van hierdie studie was die bepaling van die mate waartoe persone wat MIV-positief is en klinieke bywoon hulle MIV-status bekendmaak. Die studie is by die Katutura hospitaal in Windhoek, Namibië gedoen en 50 MIV-positiewe pasiënte is as steekproef gebruik. ‘n Vraelys wat die pasiënte self ingevul het is in die studie gebruik en data is op ‘n beskrywende wyse ontleed. Resultate het aangetoon dat MIV-positiewe pasiënte wel bewus is van die belangrikheid om hulle MIV-status bekend te maak. Laasgenoemde pasiënte doen dit egter nie, hoofsaaklik uit vrees vir stigma, diskriminasie en verwerping. Sommige pasiënte maak ook nie hulle status bekend nie omdat hulle bloot aanvaar dat die persoon met wie hulle saambly ook MIV-positief is en die bekendmaking van status dus onbelangrik is. Een van die belangrikste aanbevelings wat in die studie gemaak word is dat getroude paartjies aangemoedig moet word om MIV-voorligting by te woon, hulle te laat toets en hulle status bekend te maak. Dit word ook verder aanbeveel dat MIV/Vigs-gesondheidswerkers spesiale opleiding moet kry in hoe om persone wat MIV-positief is te oorreed om hulle MIV-status bekend te maak. Die studie sluit af deur te wys op die belangrike verwantskap tussen seksuele risikogedrag en die misbruik van alkohol. Daar word sterk gepleit dat die gemeenskap, en veral tienderjariges, bewus gemaak moet word van hierdie gevaar.

This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 &ndash
49 years of age being most affected. As previously 
mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the 
progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it 
difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that 
females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on 
gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will 
only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those 
living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this 
disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The 
primary aim of this study was to compare the Beck&rsquo
s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale &ndash
(the Depression component) (HADS-D) as a screening tool 
 
for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach&rsquo
s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish 
the sociodemographic and disease profiles of the participants under study.

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A presente dissertação aborda a participação das entidades religiosas na política pública destinada a infância e adolescência em Juiz de Fora no período posterior ao Estatuto da Criança e do Adolescente. Trata-se de compreender os desafios que se colocam na atualidade em relação à implementação do Estatuto num cenário em que muita experiência com a tradição conservadora do assistencialismo, do paternalismo e do clientelismo ainda permanece como mecanismo para o enfrentamento da questão social. Além disso, as mudanças do Estado na condução das políticas sociais têm recolocado na agenda a relevância das ações filantrópicas e revalorizado a atuação religiosa neste campo. A intervenção deste tipo de instituição na área social em nosso país não é recente, pelo contrário, marcou a origem do atendimento neste campo atuando pelo viés da caridade, da benemerência, do “amor ao próximo”. No entanto, a existência de experiências locais de inserção de grupos religiosos nas ações sociais de enfrentamento a pobreza contrasta com o que efetivamente sabemos sobre eles, suas práticas e contribuição efetiva. Este trabalho buscou analisar a relação das entidades religiosas com a política de atendimento destinada a crianças e adolescentes no município através da adequação das mesmas aos princípios e diretrizes desta política, em consonância ao Estatuto da Criança e do Adolescente, e também da relação estabelecida com o Conselho Municipal dos Direitos da Criança e do Adolescente – CMDCA/JF, com o Poder Público Municipal no seu órgão gestor e “executor”, e com o próprio Estatuto. Para tanto, realizamos dezesseis entrevistas com dirigentes das entidades de atendimento e três entrevistas com conselheiros de direito. Entrevistamos também a coordenadora da Equipe de Monitoramento e Avaliação da Secretaria de Política Social, órgão responsável pelo monitoramento das entidades registradas no CMDCA. Optamos ainda pela observação participante no Conselho num período de quatro meses, buscando apreender a dinâmica de funcionamento do mesmo e o jogo de correlação de forças nesse espaço, que supúnhamos ter um peso significativo nas discussões e encaminhamentos à política. Além da participação nas reuniões plenárias quinzenais, participamos também de dois eventos promovidos pelo Conselho. O procedimento metodológico foi complementado com o levantamento e análise documental referente à política municipal de atendimento a infância e adolescência em Juiz de Fora, às entidades de atendimento e ao Conselho Municipal dos Direitos da Criança e do Adolescente. Pretendeu-se contribuir com o debate dos direitos de cidadania e da democracia e com a apreensão dos desafios da Política para a infância e adolescência na escala municipal, arena onde o embate entre filantropia e cidadania acontece.
This dissertation deals with the participation of religious organizations in public policy for the children and adolescents in Juiz de Fora, in the period after the Statute for Children and Adolescents. It is about understanding the challenges faced at the present time in relation to the implementation of the Statute, in a scene of great experience with the conservative tradition of welfarism, paternalism and patronage still remains as a mechanism for the confrontation of the social issue. Moreover, changes of State in the conduct of social policies are back on the agenda the relevance of the shares philanthropic and revalued the religious activity in this field. The intervention of this kind of institution in the social area in our country is not recent, however, marked the origin of the attendance in this area acting by the charity, the benevolent act, the love of each other. However, the existence of local experiments of insertion of religious groups in social actions to confront poverty contrasts with that, actually, we know about them, their practices and effective contribution. This work searched for analyze the relationship of religious organizations with the policy of attendance for children and adolescents in the town, through the adequacy of them to the principles and guidelines of this policy, according to the Statute of the Child and Adolescent, and also the relationship established with the City Council on the Rights of the Child and Adolescent - CMDCA/JF, with the Municipal Public Power in its manager and “executor” institution, and with its own Statute. Then we performed sixteen interviews with the leaders of the organizations of attendance and three interviews with advisors of law. We also interviewed the coordinator of the Monitoring and Evaluation Team of the Department of Social Policy, the institution responsible for monitoring the organizations registered in the CMDCA. We still decided for the participated observation in the Council, in a period of four months, seeking to apprehend the dynamics of its operation and the game of correlation of forces in this area, that we supposed to have a significant weight in the discussions and referrals to the policy. In addition to the participation in the plenary sessions fortnightly, we also participated in two events promoted by the Council. The methodological procedure was complemented with the survey and the documentary analysis with reference to the municipal policy of attendance for children and adolescents in Juiz de Fora, to the organizations of attendance and to the City Council on the Rights of Children and Adolescents. The intention of this work is to contribute with the discussion of the rights of citizenship and democracy and the apprehension of the challenges of policy for children and adolescents in the municipal scale, arena where the collision between philanthropy and citizenship happen.

MPH, Maternal and Child Health, Faculty of Health Sciences, University of the Witwatersrand
Due to the high prevalence of HIV in South Africa, all pregnant women are offered an HIV test as part of the package of services offered during ante natal care (ANC). All women who present to an ANC clinic for the first time for that given pregnancy are given group talks about HIV and the availability of services to protect their children from HIV through Prevention of Mother to Child Transmission (PMTCT) services. Following these group discussions, all the women are then counselled on a one on one basis and are offered an HIV test. Women who decide not to take the test can opt out of testing at this stage, those who do go ahead and test are also offered post test counselling after which their test result is given to them. All HIV tests are conducted using rapid HIV test kits which make results known within 15 minutes, the results are given to the women on the same day of testing. Women whose CD4 count is below the antiretroviral treatment(ART) initiation threshold† are fast tracked onto ART , those whose CD4 is above the threshold should then be referred to other services which can help them maintain their health.1 These services are part of the Comprehensive Care, Management and Treatment (CCMT) approach. They include: CD4 count monitoring; treatment for opportunist infections; social workers, and support groups for psychosocial support.2 For purposes of this study, these services are collectively referred to as Wellness services. Thus PMTCT should serve as a gateway to either ART or Wellness services. This study therefore sought to describe the linkages between PMTCT, ART and Wellness by reviewing service utilisation levels and referral systems at sampled health facilities in Soweto. Data for this study were collected via a cross sectional record review of PMTCT registers and an ART initiation register at sampled health facilities. PMTCT registers were reviewed for the period January to March 2008 to determine what service had been given to pregnant women who accessed PMTCT services for the first time during that period † In his speech on World AIDS Day (December 1st 2009) President Jacob Zuma announced that CD4 count threshold for treatment initiation will be raised from 200 to 350 as of April 2010. 0707048E 2 and which follow on services they had been referred to. ART registers were reviewed for the period January to August 2008 to determine which of the pregnant women who had been referred to ART from the PMTCT service points at the sampled clinics accessed the service. Key informant interviews were also conducted with staff at PMTCT, ANC, ART and voluntary counselling and testing (VCT) service points at the sampled facilities. Descriptive statistics were run using SPSS version 17.0, comparisons were done using OpenEpi and key informant interview data were thematically analysed using Atlas TI version 5.2.0. Records at the PMTCT clinics showed that of the 1350 women who attended ANC clinics at the sampled facilities between January and March 2008, all but one agreed to test for HIV. Twenty-nice percent (388) tested positive for HIV. Of these 388 HIV positive women, 20% (77 women) had CD4 counts below 200 and were therefore eligible for initiation of ART. Review of records at the ART clinic showed that only 23% (n = 18, N = 77) of all ART eligible women had accessed the service. Review of the PMTCT register also showed that a significant proportion, 37% (n = 144, N =388), of women who tested HIV positive did not return to the clinics for their CD4 count results. These women therefore missed opportunities to access other follow on services to which they could have been referred and possibly ART as 31% (24 women) of these women were also eligible for ART. Review of records at Wellness services was not possible as no indications were made in the PMTCT registers of follow on services other than ART to which HIV positive women were referred. Thus the greater majority of women who were eligible for ART (77% of the 77 eligible women) did not access ART which they required to help them maintain their physical wellbeing. These women missed the opportunity to access holistic health care services, it is not known if they accessed ART services at other health facilities. Without the required antiretroviral therapy, it is highly likely that their women’s health status deteriorated such that they faced higher chances of morbidity and ultimately mortality. 0707048E 3 The review of records at both PMTCT and ART service points showed poor data management systems as referrals from PMTCT to ART were not always documented against client names in the PMTCT registers. Communication systems between the service points were also found to be poorly structured as there were no systematic feedback mechanisms on clients referred and seen. Linkages to Wellness services were even more poorly structured as no referrals to services which fall under Wellness were documented in the PMTCT registers. Key informants interviewed suggested several possible reasons why PMTCT and ART services were not being fully utilised as was evidenced by the of 37% of women who were not retained in care as they did not return for CD4 results and the low ART utilisation rate of 23%. Possible reasons suggestions were: ignorance of the need to access ANC services, preference for traditional medicine, fear of stigmatisation within their communities and poor staff attitudes towards patients. The key informants also suggested measures they thought could improve utilisation, these include hire of more staff, improved staff wages, improved interdepartmental communication and a bottom up approach to service improvement. A suggestion was also made to include PMTCT messaging in general HIV/AIDS information education communication material so as to raise awareness of the availability of PMTCT interventions. Although there were linkages between PMTCT, ART and Wellness services, these linkages were poorly developed and drop out from services was high. Efforts to follow up on patients or to retain them in care were not well developed as the data management systems employed by the service points were not consistently used nor did they facilitate patient monitoring and follow-up. Furthermore, the structural and managerial separation of the ART service point from PMTCT as well as the lack of standard protocols for referral to Wellness introduced barriers to service utilisation for women who required these services.

This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 – 49 years of age being most affected. As previously mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The primary aim of this study was to compare the Beck’s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale –(the Depression component) (HADS-D) as a screening tool for depression.Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach’s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish the sociodemographic and disease profiles of the participants under study.
Magister Psychologiae - MPsych

Purpose: The main objective of the current study was to investigate and monitor the auditory status in a group of adult patients with AIDS receiving antiretroviral therapy (ART) and other therapies in a hospital outpatient clinic in Gauteng, South Africa. Specific objectives included estimating the prevalence of hearing loss and the presence of other otologic effects over and above hearing impairment (tinnitus, aural fullness, disequilibrium, and so forth); assessing the type, degree and configuration of the hearing loss; exploring the type of hearing symptom onset; documenting case history data such as signs and symptoms of each participant and identifying any associations between obtained signs and symptoms and hearing loss; documenting the names of all medications used and their possible impact on hearing function (specifically ototoxicity monitoring of ART); and comparing the results of the experimental group to those of a control group.

AIM: To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.

Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash
449 per 100 000 women from 1992 to 2006, and 38 &ndash
46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours
an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented
refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area.

Truancy is one of the problems that exist in schools and affect learners' performance. The aim of the current study was to determine how truancy manifests and also to explore the life world of truants in secondary schools. From the literature review, the two types of truancy, namely blanket truancy and post-registration truancy were described. Various programmes and approaches used in truancy intervention were explored. An empirical investigation was undertaken with a sample of 758 Grade 10 learners from three secondary schools. The results indicated that significantly more males than females engaged in truancy. There is also a significant dependency between learning problems and truancy. The results of the study were analysed and recommendations for intervention and for further study were made.
Educational Studies
M.Ed. (Guidance and Counseling)