Evaluating neuropsychiatric symptomology in HIV-positive patients on efavirenz in public-sector clinics and psychiatric hospitals
- Gaida, Razia, Grobler, Christoffel
- Authors: Gaida, Razia , Grobler, Christoffel
- Date: 2017
- Subjects: Drugs -- Side effects -- South Africa , HIV (Viruses) -- Enzymes , Antiretroviral agents -- South Africa , Anti-infective agents -- Side effects -- South Africa
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/29772 , vital:30776
- Description: Background: South Africa has the highest number of people living with human immunodeficiency virus (HIV) infection in the world. In 2014, an estimated 10.2% of the population was HIV-positive which amounted to 5.51 million people. Efavirenz forms part of the triple therapy backbone used in South Africa and is part of the firstline treatment for HIV. Efavirenz has been strongly associated with causing neuropsychiatric side effects in at least 50.0% of patients to whom it is prescribed. These side effects cause hesitation amongst healthcare professionals to prescribe this agent to patients with active mental illnesses. Aim: The aim of the study was to evaluate the neuropsychiatric side effects of efavirenz in HIV-positive psychiatric and non-psychiatric patients and to determine whether this drug may be recommended for use in an HIV-positive psychiatric patient population. Method: The study was divided into two parts, namely a quantitative portion and a qualitative portion. The quantitative study was a prospective drug utilisation study, while the qualitative portion consisted of semi-structured interviews carried out with healthcare professionals working with people living with HIV/AIDS (PLWHA). The study included five municipal clinics in the Nelson Mandela Metropole as well as two public-sector psychiatric facilities in the Eastern Cape where medical records were reviewed to obtain the information required. Patients were followed in both instances for a period of 24 weeks with follow-up assessments carried out at two, four, 12 and 24 week intervals. In terms of the qualitative study, nurses at the clinics and doctors at the hospitals were contacted and appointments for interviews were made. The interviews were recorded using a voice recorder and were transcribed and analysed using theoretical framework analysis. Results: The review of 126 medical records at the clinics revealed that no patient had suffered from or complained of a neuropsychiatric side effect. This may indicate that patients were not suffering from clinically significant side effects, side effects were not being adequately recorded by healthcare staff, or the healthcare staff were not questioning patients regarding side effects. A total of 26 hospitalised patients were followed for 24 weeks in the psychiatric facilities. Almost half of the patients using efavirenz experienced an improvement in symptoms to the extent that they were iii discharged from the facility. The majority of patients (66.7%) not on an efavirenzcontaining regimen did not improve to the point of discharge. Healthcare staff were vague when providing a definition of neuropsychiatric side effects. There were conflicting ideas on whether or not efavirenz should be used in patients with an active psychiatric illness. Conclusions: Further studies need to be performed in public-sector institutions to obtain a clearer picture of the side effects experienced by patients using efavirenz. Healthcare staff need to be encouraged to keep complete records to allow for meaningful analysis. The further integration of mental health services into existing HIV programmes is essential for holistic treatment. Patients in psychiatric hospitals demonstrated that even patients with psychiatric disorders on efavirenz can experience positive outcomes and stabilisation of psychiatric symptoms, which may indicate that these may not have due to efavirenz use. Further elucidation concerning the use of efavirenz in patients with psychiatric disorders, a description of the neuropsychiatric side effects, as well as management strategies must be provided in subsequent HIV guidelines.
- Full Text:
- Date Issued: 2017
- Authors: Gaida, Razia , Grobler, Christoffel
- Date: 2017
- Subjects: Drugs -- Side effects -- South Africa , HIV (Viruses) -- Enzymes , Antiretroviral agents -- South Africa , Anti-infective agents -- Side effects -- South Africa
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: http://hdl.handle.net/10948/29772 , vital:30776
- Description: Background: South Africa has the highest number of people living with human immunodeficiency virus (HIV) infection in the world. In 2014, an estimated 10.2% of the population was HIV-positive which amounted to 5.51 million people. Efavirenz forms part of the triple therapy backbone used in South Africa and is part of the firstline treatment for HIV. Efavirenz has been strongly associated with causing neuropsychiatric side effects in at least 50.0% of patients to whom it is prescribed. These side effects cause hesitation amongst healthcare professionals to prescribe this agent to patients with active mental illnesses. Aim: The aim of the study was to evaluate the neuropsychiatric side effects of efavirenz in HIV-positive psychiatric and non-psychiatric patients and to determine whether this drug may be recommended for use in an HIV-positive psychiatric patient population. Method: The study was divided into two parts, namely a quantitative portion and a qualitative portion. The quantitative study was a prospective drug utilisation study, while the qualitative portion consisted of semi-structured interviews carried out with healthcare professionals working with people living with HIV/AIDS (PLWHA). The study included five municipal clinics in the Nelson Mandela Metropole as well as two public-sector psychiatric facilities in the Eastern Cape where medical records were reviewed to obtain the information required. Patients were followed in both instances for a period of 24 weeks with follow-up assessments carried out at two, four, 12 and 24 week intervals. In terms of the qualitative study, nurses at the clinics and doctors at the hospitals were contacted and appointments for interviews were made. The interviews were recorded using a voice recorder and were transcribed and analysed using theoretical framework analysis. Results: The review of 126 medical records at the clinics revealed that no patient had suffered from or complained of a neuropsychiatric side effect. This may indicate that patients were not suffering from clinically significant side effects, side effects were not being adequately recorded by healthcare staff, or the healthcare staff were not questioning patients regarding side effects. A total of 26 hospitalised patients were followed for 24 weeks in the psychiatric facilities. Almost half of the patients using efavirenz experienced an improvement in symptoms to the extent that they were iii discharged from the facility. The majority of patients (66.7%) not on an efavirenzcontaining regimen did not improve to the point of discharge. Healthcare staff were vague when providing a definition of neuropsychiatric side effects. There were conflicting ideas on whether or not efavirenz should be used in patients with an active psychiatric illness. Conclusions: Further studies need to be performed in public-sector institutions to obtain a clearer picture of the side effects experienced by patients using efavirenz. Healthcare staff need to be encouraged to keep complete records to allow for meaningful analysis. The further integration of mental health services into existing HIV programmes is essential for holistic treatment. Patients in psychiatric hospitals demonstrated that even patients with psychiatric disorders on efavirenz can experience positive outcomes and stabilisation of psychiatric symptoms, which may indicate that these may not have due to efavirenz use. Further elucidation concerning the use of efavirenz in patients with psychiatric disorders, a description of the neuropsychiatric side effects, as well as management strategies must be provided in subsequent HIV guidelines.
- Full Text:
- Date Issued: 2017
An econometric analysis of the impact of economic freedom on economic growth in the SADC
- Authors: Gorlach, Vsevolod Igorevich
- Date: 2011
- Subjects: Economic development -- South Africa , Economic development
- Language: English
- Type: Thesis , Masters , MCom
- Identifier: vital:8983 , http://hdl.handle.net/10948/1539 , Economic development -- South Africa , Economic development
- Description: The conventional approach to increasing economic growth - increasing inputs, such as labour and capital, is not always possible. The wider, fundamental sources of economic growth need to be considered too. Foreign aid is a temporary lifeline and does not spur economic growth. Conversely, financial assistance negatively affects growth and can hamper development prospects. Economic freedom and economically freer countries have been associated with higher growth rates, higher per capita incomes, greater volumes of trade, prosperity and overall wellbeing. By improving their economic freedom, deregulating the economy and allowing economic freedom to prosper, countries can experience sustained GDP growth. Previous studies have shown that economic freedom and economic growth are exponentially related - and that by initially becoming freer, countires can increase their growth rates at higher rates. The main objective of the SADC is to achieve development and economic growth, to alleviate poverty and enhance the standard and quality of life for the peoples of Southern Africa. The SADC is attempting to achieve economic integration through macroeconomic convergence. A number of macroeconomic variables have been set to act as primary indicators. These include inflation, fiscal balance, public debt and the current account balance. By introducing the concept that economic freedom can lead to higher growth rates and being able to identify economic freedom, it makes it possible to investigate how the SADC can achieve its set goals by becoming freer. By investigating individual components that constitute the overall freedom index, it becomes possible to establish the relationship that exists between this viriable and economic growth. This will illustrate where deregulation and freedom are most effective and where policy decisions need to be highlighted. The 2008 economic crisis revealed that countries that decreased their economic freedom have fared worse than countries allowing freedom to prosper. Government fiscal stimulus has had no positive impact on growth rates; the negative effects of reducing economic freedom will onlky be fully seen in future years. However, the majority of the SADC countries showed a relatively strong fiscal stance during the recession. This study established whether that a positive relationship between economic freedom and economic growth in the SADC. Secondly, the direction of causality that economic freedom leads to economic growth. The findings reveal that economic freedom fosters economic growth in general, and for the SADC in particular. Empirical evidence has been found for the SADC; and the implications of becoming freer are more fully explained.
- Full Text:
- Date Issued: 2011
- Authors: Gorlach, Vsevolod Igorevich
- Date: 2011
- Subjects: Economic development -- South Africa , Economic development
- Language: English
- Type: Thesis , Masters , MCom
- Identifier: vital:8983 , http://hdl.handle.net/10948/1539 , Economic development -- South Africa , Economic development
- Description: The conventional approach to increasing economic growth - increasing inputs, such as labour and capital, is not always possible. The wider, fundamental sources of economic growth need to be considered too. Foreign aid is a temporary lifeline and does not spur economic growth. Conversely, financial assistance negatively affects growth and can hamper development prospects. Economic freedom and economically freer countries have been associated with higher growth rates, higher per capita incomes, greater volumes of trade, prosperity and overall wellbeing. By improving their economic freedom, deregulating the economy and allowing economic freedom to prosper, countries can experience sustained GDP growth. Previous studies have shown that economic freedom and economic growth are exponentially related - and that by initially becoming freer, countires can increase their growth rates at higher rates. The main objective of the SADC is to achieve development and economic growth, to alleviate poverty and enhance the standard and quality of life for the peoples of Southern Africa. The SADC is attempting to achieve economic integration through macroeconomic convergence. A number of macroeconomic variables have been set to act as primary indicators. These include inflation, fiscal balance, public debt and the current account balance. By introducing the concept that economic freedom can lead to higher growth rates and being able to identify economic freedom, it makes it possible to investigate how the SADC can achieve its set goals by becoming freer. By investigating individual components that constitute the overall freedom index, it becomes possible to establish the relationship that exists between this viriable and economic growth. This will illustrate where deregulation and freedom are most effective and where policy decisions need to be highlighted. The 2008 economic crisis revealed that countries that decreased their economic freedom have fared worse than countries allowing freedom to prosper. Government fiscal stimulus has had no positive impact on growth rates; the negative effects of reducing economic freedom will onlky be fully seen in future years. However, the majority of the SADC countries showed a relatively strong fiscal stance during the recession. This study established whether that a positive relationship between economic freedom and economic growth in the SADC. Secondly, the direction of causality that economic freedom leads to economic growth. The findings reveal that economic freedom fosters economic growth in general, and for the SADC in particular. Empirical evidence has been found for the SADC; and the implications of becoming freer are more fully explained.
- Full Text:
- Date Issued: 2011
Using information visualization techniques to support web service discovery
- Authors: Beets, Simone
- Date: 2011
- Subjects: Information visualization , Web services , Information visualization -- Computer programs
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10457 , http://hdl.handle.net/10948/1659 , Information visualization , Web services , Information visualization -- Computer programs
- Description: The increasing number of web services published over the Web highlights the need for an effective method for users to find appropriate web services. Existing web service discovery methods do not effectively aid a user in finding suitable web services. The current methods provide textual lists of web services that the user is required to explore and manually evaluate. Thus, these methods lead to time-consuming and ineffective web service discovery. The aim of this research was to investigate using information visualization (IV) techniques to effectively support web service discovery. The node-and-link network IV technique was selected as the most appropriate IV technique to visualize web service collections. A prototype, called SerViz, was developed as a tool for interactive visualization of web service collections incorporating the node-and-link IV technique and an alphabetical list-based technique. SerViz used the Programmable Web web service collection as the sample web service collection. A usability evaluation was conducted to compare these techniques. Ninety percent of participants preferred the network IV technique for visualizing web service collections. The network IV technique was also faster for browsing. Several usability problems were identified with the network IV technique. This motivated a need for implementing an alternative IV technique in SerViz. The node-and-link tree IV technique was selected as it was more structured than the network IV technique. A usability evaluation was conducted to compare the network and tree IV techniques. Participants slightly preferred the tree IV technique as the technique to visualize web service collections. The tree IV technique was faster for browsing the web service collection while the network IV technique was faster for searching and filtering. This research has determined that IV techniques can be used to effectively support web service discovery. Future work will involve using IV techniques to support collaborative web service discovery. Keywords: Web Service Discovery, Information Visualization, Web Service Collections, Information Visualization Techniques.
- Full Text:
- Date Issued: 2011
- Authors: Beets, Simone
- Date: 2011
- Subjects: Information visualization , Web services , Information visualization -- Computer programs
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10457 , http://hdl.handle.net/10948/1659 , Information visualization , Web services , Information visualization -- Computer programs
- Description: The increasing number of web services published over the Web highlights the need for an effective method for users to find appropriate web services. Existing web service discovery methods do not effectively aid a user in finding suitable web services. The current methods provide textual lists of web services that the user is required to explore and manually evaluate. Thus, these methods lead to time-consuming and ineffective web service discovery. The aim of this research was to investigate using information visualization (IV) techniques to effectively support web service discovery. The node-and-link network IV technique was selected as the most appropriate IV technique to visualize web service collections. A prototype, called SerViz, was developed as a tool for interactive visualization of web service collections incorporating the node-and-link IV technique and an alphabetical list-based technique. SerViz used the Programmable Web web service collection as the sample web service collection. A usability evaluation was conducted to compare these techniques. Ninety percent of participants preferred the network IV technique for visualizing web service collections. The network IV technique was also faster for browsing. Several usability problems were identified with the network IV technique. This motivated a need for implementing an alternative IV technique in SerViz. The node-and-link tree IV technique was selected as it was more structured than the network IV technique. A usability evaluation was conducted to compare the network and tree IV techniques. Participants slightly preferred the tree IV technique as the technique to visualize web service collections. The tree IV technique was faster for browsing the web service collection while the network IV technique was faster for searching and filtering. This research has determined that IV techniques can be used to effectively support web service discovery. Future work will involve using IV techniques to support collaborative web service discovery. Keywords: Web Service Discovery, Information Visualization, Web Service Collections, Information Visualization Techniques.
- Full Text:
- Date Issued: 2011
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