The Effect of a Non-Powered, Self-Initiated Mobility Program on the Engagement of Young Children with Severe Mobility Limitations in the South African Context.

AIM: To determine the effect of a non-powered, self-initiated mobility program on the engagement of young children with severe mobility limitations, in the South African context. METHODS: A multiple-probe-across-participant design was used. Four children (aged 2-6 years) with severe mobility limitations underwent an intervention that targeted non-powered, self-initiated mobility. The intervention comprised eight sessions over a 2-week period. Engagement was measured during each baseline, intervention and postintervention session using the Individual Child Engagement Record-Revised (ICER-R). The data were presented graphically and analyzed using statistical procedures appropriate for single-subject designs. RESULTS: Participants demonstrated an improvement in engagement during the time in which non-powered, self-initiated mobility program was introduced. A reciprocal deterioration in nonengagement was also demonstrated. The results of the study are discussed in terms of various intrinsic and extrinsic factors. CONCLUSIONS: The use of a non-powered, self-initiated mobility program may be effective in improving engagement in some young children with severe mobility limitations.

Maternal mental health and caregiver competence of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa.

BACKGROUND: Maternal mental health during the perinatal period has been of interest to many researchers, with antenatal depression and postnatal depression (PND) being a leading cause of morbidity. The adverse effects of maternal depression on the offspring throughout infancy, childhood and adolescence are well documented. Studies on the mental health of persons living with HIV have also reported a high prevalence of depression. OBJECTIVES: To describe the prevalence of PND in a sample of HIV-positive and HIV-negative mothers delivering healthy singleton infants at one obstetric unit in KwaZulu-Natal (KZN) Province, South Africa, and the subsequent factors influencing neonatal behaviour and perceptions of caregiver competence. Correlations between the presence of PND and perceptions of caregiver competence (with the mother as caregiver), and between infant behaviour, the mother's confidence in her competence as caregiver, and demographic and medical variables, were also examined. METHODS: Demographic and clinical data were collected from 132 mothers at initial contact and from 32 mothers at the 6-week follow-up appointment. Mothers independently completed the Edinburgh Postnatal Depression Scale at each time point, and the Mother and Baby Scales (MABS) at the 6-week follow-up appointment. RESULTS: The prevalence of depression among all mothers at initial contact was 72.0%, remaining high (68.8%) among the mothers who returned for follow-up. There was a statistically significant correlation between depression and employment at follow-up (p=0.013), and between depression and delivery method (p=0.030). The majority of mothers reported being 'able to laugh and see the funny side of things' and 'looking forward with enjoyment to things' at initial contact and follow-up. Thoughts of self-harm were reported by 44.7% of mothers at baseline, and by 53.1% at follow-up. Although most infants scored in the average clinical band for neonatal behavioural factors in the MABS, mothers reported lack of confidence, globally and in caring for their infant. CONCLUSION: This study of maternal mental health of a sample of HIV-positive and HIV-negative mothers of infants in KZN revealed a higher prevalence of PND than reported in other studies. This population of mothers and infants is at risk of adverse outcomes of maternal depression, in addition to other possible risk factors.

The management of infant developmental needs by community nurses. Part 1: description of the responsibilities of community nurses with regard to the management of infant developmental needs.

This article is one of two that describes the responsibilities of community nurses, according to their legal scope of practice, with regard to the management of developmental needs of infants in primary health care clinics in South Africa. A subsequent article describes the development of guidelines for the support of community nurses to address the developmental needs of infants 0-2 years. While evidence confirms that developmental surveillance should be incorporated into the ongoing health care of the infant, such services are not consistently provided in health care settings and, if provided, the delivery thereof suffers from significant inadequacies. A case study strategy was used to investigate the phenomenon and content analysis utilised to analyze the data. The Transactional Model of Development was selected to interpret the data obtained in the study. Findings of the study show that infant developmental care is not included to its fullest potential in the health care delivered to infants and their families, thereby indicating that community nurses do not meet the standards of the profession with regard to the management of infant developmental needs. Health service managers need to review their commitment and type of support to community nurses, if infant developmental care, as part of community nurses' responsibilities, is to be effective and of high quality. Furthermore, community nurses and other health care professionals must recognize the nature and potential of inter-professional collaboration to ensure positive outcomes for infants with developmental delays and disabilities.

The management of infant developmental needs by community nurses. Part 2: the development of guidelines for the support of community nurses in the management of infant developmental needs.

In the previous article, the author described, according to the scope of practice of registered nurses, the responsibilities of community nurses with regard to the management of infant developmental needs in primary health care clinics in South Africa. In this article, the focus is on the development of guidelines for the support of community nurses in fulfilling these responsibilities. Before the development of the guidelines is addressed, a brief overview of the background of the study, assumptions of the researcher and the methodology of the study is given. The development of the set of guidelines (DEFINE HOPE) is set against the background of the drive to improve the quality of developmental care for infants and their families. As guidelines help to translate scientific information into statements, it could be valuable to community nurses to improve their delivery of developmental care. To gather evidence for the formulation of the guidelines, the researcher utilised the themes identified during the analysis process in phase one of the research; investigated research articles; and compared findings and recommendations of the articles with the research findings obtained in phase one. In addition to the research findings and literature review, a focus group (health care professionals represented in the case study), was utilised to assist with the final development and validation of the guidelines. The researcher adapted a number of desirable attributes for guidelines, which are indicated in the literature, to compile the criteria for validation of the guidelines. In conclusion, guidelines are necessary to support community nurses in finding "best practice" within their scope of practice to ensure higher quality of developmental care to families with infants 0-2 years.

Maternal mental health and caregiver competence of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa

Background. Maternal mental health during the perinatal period has been of interest to many researchers, with antenatal depression and postnatal depression (PND) being a leading cause of morbidity. The adverse effects of maternal depression on the offspring throughout infancy, childhood and adolescence are well documented. Studies on the mental health of persons living with HIV have also reported a high prevalence of depression. Objectives. To describe the prevalence of PND in a sample of HIV-positive and HIV-negative mothers delivering healthy singleton infants at one obstetric unit in KwaZulu-Natal (KZN) Province, South Africa, and the subsequent factors influencing neonatal behaviour and perceptions of caregiver competence. Correlations between the presence of PND and perceptions of caregiver competence (with the mother as caregiver), and between infant behaviour, the mother's confidence in her competence as caregiver, and demographic and medical variables, were also examined. Methods. Demographic and clinical data were collected from 132 mothers at initial contact and from 32 mothers at the 6-week follow-up appointment. Mothers independently completed the Edinburgh Postnatal Depression Scale at each time point, and the Mother and Baby Scales (MABS) at the 6-week follow-up appointment. Results. The prevalence of depression among all mothers at initial contact was 72.0%, remaining high (68.8%) among the mothers who returned for follow-up. There was a statistically significant correlation between depression and employment at follow-up (p=0.013), and between depression and delivery method (p=0.030). The majority of mothers reported being 'able to laugh and see the funny side of things' and 'looking forward with enjoyment to things' at initial contact and follow-up. Thoughts of self-harm were reported by 44.7% of mothers at baseline, and by 53.1% at follow-up. Although most infants scored in the average clinical band for neonatal behavioural factors in the MABS, mothers reported lack of confidence, globally and in caring for their infant. Conclusion. This study of maternal mental health of a sample of HIV-positive and HIV-negative mothers of infants in KZN revealed a higher prevalence of PND than reported in other studies. This population of mothers and infants is at risk of adverse outcomes of maternal depression, in addition to other possible risk factors.

Evaluation of endomyocardial biopsy in the diagnosis of cardiac rejection. A study using bioptome samples of formalin-fixed tissue.

The reliability of endomyocardial bioptome samples in detecting cardiac rejection was assessed in 26 formalin-fixed previously transplanted hearts. Thirteen human donor hearts (mean postoperative survival 128 days) and 13 baboon donor hearts (mean survival 16.5 days) were studied. Twenty samples were taken under direct vision from the endomyocardium of each heart with an Olympus bioptome catheter. A total of 397 tissue samples was examined "blindly" histologically (177 human and 220 baboon). The bioptome samples were assigned a histological rejection score and then compared with the score accorded multiple tissue sections from the same heart. Sample scores agreed with tissue section scores as follows: humans 86% (samples showed more severe alterations in 5% and less severe in 9%) and baboons 57% (samples more severe in 40% and less severe in 3%). Only 2 false-negative samples were encountered among 285 tissue samples from hearts showing rejection. Changes of rejection were equally distributed between the left and right ventricles. Endomyocardial sampling proved an accurate means of detecting the presence of rejection. In the baboon hearts the endomyocardium tended to show more severe changes than the rest of the myocardium.

Cholecystojejunocholecystostomy: a new method of biliary drainage in auxiliary liver allotransplantation.

A subhepatic, whole auxiliary liver allotransplant technique, previously developed in the pig, was assessed for technical feasibility in 26 human cadaver transplants. All technical aspects of the subhepatic technique were feasible, with the exception of donor to recipient gallbladder-to-gallbladder anastomosis, which could only be performed in 50% of subjects due to excessive separation of the two gallbladders. To oversome the problem, an original technique was developed--namely, the use of an isolated, vascularized, isoperistaltic loop of jejunum to act as a conduit between donor and recipient gallbladders (cholecystojejunocholecystostomy). Cholecystojejunocholecystostomy was subsequently developed and studied in a series of live porcine auxiliary allografts. The local, reginal, and general effects seen in 14 allografted pigs with cholecystojejunocholecystostomy were compared with those seen in a parallel and identical series of 14 allografts with cholecystocholecystostomy. The subhepatic transplantation technique is described in detail for the first time. Liver biopsies, blood samples, and clinical data were obtained at weekly intervals and at 28 days all survivors were killed. Cholecystojejunocholecystostomy proved to be a successful method of biliary drainage in the pig. Thirteen of the 14 interposed jejunal loops were viable and essentially normal at autopsy, leaks and naked eye stasis were infrequent, and the histological incidence of intrahepatic cholangitis and cholestasis minimal. The local, regional, and general effects were comparable in every way with those obtained with cholecystocholecystostomy.

Pathologic findings in long-term cardiac transplants.

Since the introduction of cardiac transplantation at our institution 15 years ago, major advances have occurred in the monitoring and treatment of these patients, resulting in many long-term survivors. We defined the pathologic features in 14 cardiac transplants with survival times longer than one year. Only one heart showed no evidence of rejection, while the remaining 13 hearts showed advanced chronic rejection, which was the main cause of death or of graft failure in 11 patients. One patient died of gastric carcinoma, one of Kaposi's sarcoma, and one of cerebral embolus. The most obtrusive change in the donor hearts was an obliterative arteritis, which in the epicardial coronary arteries mimicked atherosclerosis. Superadded thrombosis often resulted in myocardial infarction. These severe vascular lesions bore no constant relationship to survival time and took from 1.1 to 12.5 years to evolve.

Sinus histiocytosis with massive lymphadenopathy. Report of a case associated with necrosis.

We describe a case of a 21-year-old man who had a generalized lymphadenopathy and arthritis. Inguinal and cervical lymph nodes showed changes typical of sinus histiocytosis with massive lymphadenopathy. Extensive coagulative necrosis of the intrasinusal histiocytes is described, a feature which, to our knowledge, is unreported previously.

Toxoplasmosis of donor and recipient hearts after heterotopic cardiac transplantation.

Toxoplasmosis of both donor and recipient hearts was diagnosed by means of endomyocardial biopsy specimens after heterotopic cardiac transplantation for dilated cardiomyopathy. Before transplantation, the donor had raised antibody titers to Toxoplasma, and the recipient was negative. When toxoplasmosis was diagnosed on the basis of endomyocardial biopsy specimen, the recipient had a greatly elevated antibody titer of 1:1,027. This suggests that the infection could have been transferred with the donor heart. The mononuclear cell response elicited by disrupted toxoplasmic cysts interferes with the diagnosis of rejection in graft biopsy specimens. Electron microscopy is valuable in confirming a light microscopic diagnosis of toxoplasmosis. Drug therapy eradicated the toxoplasmosis, but the patient died later of tuberculous meningitis.

Maternal self-efficacy and maternal perception of child language competence in pre-school children with a communication disability.

BACKGROUND: The aim of this study was to describe maternal self-efficacy beliefs within the parenting domain and maternal ratings of pre-school children's language abilities, where the child has a communication disability. The association between these two constructs was also investigated. METHOD: Twenty-five mothers completed a questionnaire consisting of two subsections: parental self-efficacy and maternal rating of child language ability. Convenience sampling was used, and mothers with children attending four special-education schools in the Pretoria area consented to participate in the study. RESULTS: The results revealed that mothers generally had high self-efficacy beliefs within certain parenting roles, in spite of the fact that their child has a communication disability. The lowest competence was reported in discipline and teaching roles. In addition, mothers' reports of patterns of child ability correlated with what has been written in the literature. Correlation statistics generally revealed weak association between the constructs, with the strongest association between the parental domain of discipline and maternal reports of their child's receptive language abilities. CONCLUSIONS: Possible reasons for the weak correlation values are proposed. These include factors that may alter the way parents of children with disabilities construct and maintain self-efficacy beliefs; as well as the fact that the two sections of the questionnaire measure maternal appraisals at two very different levels (objective observations and evaluative self-regulatory processes).