Biomedical subjects

B A Robertson

Publications and source records attributed to B A Robertson.

At least 19 recordsLinked to original sources

PubMed1999

Performance of the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3) in an informal settlement area in South Africa.

OBJECTIVE: To investigate the performance of the Xhosa Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3) in a community study of African children and adolescents in Khayelitsha, a largely informal settlement area in Cape Town, South Africa. METHOD: A cross-sectional community study of 500 youths aged 6 to 16 years was undertaken using a systematic sampling strategy based on random starting points in the community. Three trained Xhosa-speaking lay interviewers administered the DISC-2.3 to youths and their parents in their homes. Additional questions included degree of impairment, selected risk factors, and service use. RESULTS: The administration of the Xhosa DISC-2.3 in an informal settlement area was both feasible and acceptable to respondents. Psychiatric disorder with impairment was recorded for 76 (15.2%) of the children and adolescents. Consultation had been sought in only 20 cases, mostly from medical doctors, except for 3 who had attended indigenous healers. Rates of disorder were significantly higher among respondents who were living in unserviced areas or who came from homes where food was needed. CONCLUSIONS: The DISC is a potentially useful instrument even in the presence of major constraints on conducting epidemiological research.

Adolescent↗

PubMed1998

Expression of schizophrenia in black Xhosa-speaking and white English-speaking South Africans.

OBJECTIVE: To investigate whether schizophrenia manifests itself differently in Xhosa-speaking South Africans, compared with English-speaking white South Africans. DESIGN: A comparative study of the presentation of schizophrenia in two groups of patients. SETTINGS AND SUBJECTS: A sample of 63 patients (43 Xhosa-speaking and 20 English-speaking) admitted to a large psychiatric hospital for the first time with a diagnosis of schizophrenia. OUTCOME MEASURES: The Present State Examination (PSE) was used to confirm the clinical diagnosis of schizophrenia. The Relatives' Rating of Symptoms and Social Behaviour (KAS-R) was used to obtain information on the behavioural and emotional expression of schizophrenia. RESULTS: A significantly higher prevalence of aggressive and disruptive behaviour was reported by relatives of Xhosa-speaking patients with schizophrenia of recent onset compared with English-speaking patients. The PSE elicited significantly more delusions of persecution, sexual and fantastic delusions, self-neglect and irritability in the Xhosa-speaking patients. CONCLUSION: Significant differences in the presentation of schizophrenia, but not its core symptoms, were identified in Xhosa-speaking blacks and English-speaking whites.

Adult↗

PubMed1997

A survey of professional activities of psychiatrists in South Africa.

To obtain information about practicing psychiatrists in South Africa, a questionnaire was mailed in 1993 to all 378 registered psychiatrists, of whom 210 (55.6 percent) responded. After selected data for nonrespondents were obtained, information was available for 357, or 94.4 percent of registered psychiatrists. Of the 261 psychiatrists practicing in South Africa, 147 (56.3 percent) were in full-time private practice. There were 6.4 psychiatrists per million population, with large discrepancies between provinces. Only 7 percent of psychiatrists spent any time working in rural areas, and only 10.8 percent could communicate in one or more African languages. These findings emphasize the magnitude of the challenge of developing a primary mental health care system in postapartheid South Africa.

Confidence Intervals↗

PubMed1997

Post-traumatic stress disorder in children exposed to violence.

OBJECTIVES: To investigate to what extent local children exposed to community violence develop post-traumatic stress disorder (PTSD), whether the symptom profile is typical or atypical, and how detection can be improved. DESIGN: A cross-sectional study of two samples of children with a high risk of past exposure to violence. SETTING AND SUBJECTS: Sixty Xhosa-speaking children aged 10-16 years; 30 from the Children's Home which serves Khayelitsha, and 30 from a school in a violent area of Khayelitsha. OUTCOME MEASURES: A shortened version of the Survey of Exposure to Community Violence (SECV) was administered to determine exposure to violence. Structured questionnaires and a clinical assessment were used to elicit symptoms and make psychiatric diagnoses. RESULTS: All 60 children reported exposure to indirect violence, 57 (95%) had witnessed violence, and 34 (56%) had experienced violence themselves. Twenty-four (40%) met the criteria for on or more DSM-III-R diagnoses and 13 (21.7%) met the criteria for PTSD. CONCLUSIONS: Community violence places children at a high risk of developing serious psychiatric disorders and many children develop PTSD. None of the children in the school sample had received intervention prior to the study, pointing towards an urgent need for increased community and professional awareness of children at risk.

Adolescent↗

PubMed1997

Conduct disorder among children in an informal settlement. Evaluation of an intervention programme.

OBJECTIVES: This study aimed to evaluate the effectiveness of a 12-week intervention programme for conduct-disordered boys aged 10-16 years. DESIGN: A descriptive study comparing a group of boys who participated in an intervention programme with a non-participant group. SETTING: All the participants were resident in Khayelitsha and the programme was conducted at Empilweni, a community mental health project in Site C, Khayelitsha. SUBJECTS: Nine of the 15 boys who were referred to Empilweni for serious conduct problems participated in the intervention; the remaining 6 were non-participants. OUTCOME MEASURES: The New York Teacher Rating Scale (NYTRS) and selected modules of the Diagnostic Interview Schedule for Children (DISC) were administered before and immediately after the treatment programme, and again after a 6-month interval. RESULTS: Six months after the intervention, the treatment group showed a significant reduction in defiance, physical and delinquent aggression, as well as additional conduct problems. The non-treatment group only showed a significant reduction in defiance. CONCLUSIONS: The study results suggest that short-term community-based group therapy may be effective in treating delinquent behaviour among boys in an informal settlement. The feasibility of promoting such interventions as part of national violence prevention programmes requires serious consideration.

Adolescent↗

PubMed1996

Risk-taking behaviour of Cape Peninsula high-school students. Part IX. Evidence for a syndrome of adolescent risk behaviour.

OBJECTIVES: To ascertain whether the notion of a syndrome of adolescent risk behaviour (which includes problem drinking, marijuana use, having experienced sexual intercourse, 'general deviance' and cigarette smoking) is valid for this setting; and to investigate whether suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome. DESIGN: Cross-sectional survey utilising a self-completed questionnaire; for both sexes, relationships between behaviours were documented as odds ratios. SETTING: High schools in the Cape Peninsula, South Africa. SUBJECTS: 7,340 students from 16 schools in the three major education departments. OUTCOME MEASURES: Participation in the following behaviours: alcohol bingeing, cannabis smoking, sexual intercourse, knife-carrying at school, cigarette smoking, attempting suicide, failure to use a seat belt, and walking home at night from beyond the neighbourhood. RESULTS: All the odds ratios were greater than 1. There were statistically significant odds ratios between all the pairs of risk behaviours included in the 'original' syndrome of risk behaviour except for cigarette smoking and having had sexual intercourse in the case of girls. There were statistically significant relationships between all these risk behaviours, suicidal behaviour, and behaviours that exposed the adolescent to risk of physical injury, except for failure to use a seat belt and: (i) suicidal behaviour for both sexes; and (ii) walking home alone at night and having had sexual intercourse in the case of girls. CONCLUSION: The notion of a syndrome of adolescent risk behaviour is valid for this population, and both suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome.

Adolescent↗

PubMed1996

Risk-taking behaviour of Cape Peninsula high-school students. Part X. Multivariate relationships among behaviours.

OBJECTIVE: To investigate the relationship between adolescent risk behaviours, taking into account their influence upon one another. DESIGN: Cross-sectional survey utilising a self-completed questionnaire; stepwise logistic regression analyses were carried out, stratified for gender. SETTING: High schools in the Cape Peninsula, South Africa SUBJECTS: 7,340 students from 16 schools in the three major education departments. OUTCOME MEASURES: The outcome variables for each regression model were: cigarette smoking, cannabis smoking, alcohol bingeing, sexual intercourse, knife-carrying at school, walking home at night from beyond the neighbourhood, attempting suicide, and failure to use a seat belt. For each model, 26 risk behaviours served as independent variables. RESULTS: For each model, between 3 and 9 variables qualified for inclusion for each gender. There was a substantial association between many forms of substance abuse. In the previous 12 months, suicidal thoughts or statements of suicidal intent were predictors of a suicide attempt. Several variables involving injury were predictors of exposure to danger in getting home at night, and this was a predictor of substance abuse. Cannabis smoking, alcohol bingeing and exposure to danger in getting home at night were predictors of and were predicted by having had sexual intercourse. CONCLUSION: There are significant relationships between many adolescent risk behaviours, even when the influence of other risk behaviours is taken into account. The probability of adverse sequelae of risk behaviours, such as exposure to danger in getting home at night and sexual intercourse, is increased by the presence of selected other risk behaviours.

Adolescent↗

PubMed1995

Informed consent--a survey of doctors' practices in South Africa.

OBJECTIVE: To examine doctors' practices with regard to informed consent. DESIGN: Cross-sectional, descriptive survey. PARTICIPANTS AND SETTING: All full-time consultants and registrars in the Departments of Medicine, Obstetrics and Gynaecology, Paediatrics and Child Health, Paediatric Surgery and Surgery at the University of Cape Town were included. The overall response rate was 63% (160/254). MEASUREMENT: Data were collected by means of self-administered, semi-structured questionnaires. RESULTS: Most doctors (79%) felt it was their responsibility to ensure that patients and parents were fully informed about diagnostic and therapeutic interventions. Many (62%) supported a patient-centred standard for determining the type and amount of information to disclose. Doctors disclose most of the legally required information except for information about alternative forms of treatment and remote serious risks. They almost never provide information on medical costs. The most common reasons for not obtaining informed consent were the doctors' tendency to 'tell' patients/parents what they intend doing and their belief that patients/parents expect doctors to know what is medically best for them. Language, inadequate communication skills and lack of time were, surprisingly, seldom viewed as obstacles to the obtaining of informed consent. Findings were independent of discipline (medical or surgical) and doctors' status (consultant or registrar). Doctors who treat children were significantly less likely to obtain consent for certain interventions. CONCLUSION: Doctors meet many, but not all, of the legal requirements for informed consent. The findings question whether informed consent as envisioned by the law exists in reality. Cross-cultural research is needed to clarify patients' and parents' expectations of informed consent.

Comprehension↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part IV. Alcohol use.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for alcohol use are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the sample, 53.2% reported ever using alcohol; 26.2% had used it recently and 15.4% reported episodes of binge drinking in the previous 14 days. Drinking patterns varied according to school standard, home language, and gender. Males reported higher rates of alcohol use and for both genders rates increased with age. Overall, the prevalence of drinking was highest among adolescents whose home language was English. The proportion of Xhosa-speaking females who drank was very low. The prevalence of binge drinking in particular was identified as being of concern. The findings indicate a need for preventive action and further local research in this area.

Adolescent↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part I. Introduction and methods.

In this study, risk-taking behaviour of Cape Peninsula high-school students was investigated. Suicidal behaviour, cigarette smoking, alcohol consumption, drug use, road-related behaviour, violent behaviour and sexual behaviour were included. This article, the first in a series, describes the rationale and methodology of the project. Sixteen schools were selected so as to yield a representative sample of schools in the three major education departments in the Cape Peninsula (administered by the Department of Education and Training and the Houses of Assembly and Representatives). The final sample size was 7,340 school students. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. The results are presented by standard and home language(s), and gender. Limitations of the study include its cross-sectional nature; the possibility of under- and over-reporting; the exclusion of important groups of adolescents such as absentees and dropouts, and those attending specialised and private schools; and not being able to present the results separately for each education department.

Adolescent↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part II. Suicidal behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for suicidal behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. During the previous 12 months, 19% of students had seriously thought about harming themselves in a way that might result in their death, 12.4% had told someone that they intended to put an end to their life, and 7.8% had actually tried to put an end to their life. There were different trends according to gender, standard and language(s) spoken at home. Of those who had made a suicide attempt during the previous 12 months, 85.7% indicated that they had seriously thought about doing so, while 57.7% had told someone that they intended putting an end to their life. There is in many cases no continuity from suicidal ideation to communicating suicidal intent to an actual attempt.

Adolescent↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part III. Cigarette smoking.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for cigarette smoking are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the students 18.1% indicated that they smoked at least 1 cigarette per day. Of these, 66.9% had tried to stop. Of those who did not smoke at least 1 cigarette per day, 41.2% had smoked previously and 3.6% intended to start smoking. There were different trends according to gender, standard, and language(s) spoken at home. Of note was the small percentage of Xhosa-speaking females who smoked. There is an urgent need for smoking prevention programmes in schools.

Adolescent↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part V. Drug use.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for drug use are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Cannabis was the illicit drug most widely used; 7.5% had smoked cannabis, and 2.4% had done so in the previous 7 days. A small subgroup (1.6%) of students had smoked cannabis and methaqualone (Mandrax) together. Reported lifetime use of injectable drugs was 0.5%, and 10.9% had sniffed solvents, 2.6% having done so in the previous 7 days. There were different trends according to gender, standard, and language(s) spoken at home. Of particular note was the small proportion of Xhosa-speaking females who were involved with drug use. The results suggest that the majority of drug use among school students is experimental. A small number of adolescents abuse drugs and are at risk for its associated problems; intervention is indicated for this group.

Adolescent↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part VI. Road-related behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the findings for road-related behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. During the previous year, 8.5% of the students had been involved in a motor vehicle accident, and 7.4% had been injured in a pedestrian accident. Of those who had driven a vehicle, 63.2% reported driving without a licence; 16.1% drove an overcrowded vehicle; and 8% reported driving under the influence of alcohol or cannabis. Of those who had been on a motorcycle, 47.9% reported riding without a helmet. Despite the availability of seat belts, 37.3% had failed to wear one on the last occasion they were in the front seat of a vehicle. Variations according to gender, standard, and home language(s) were identified. The prevalence of risk behaviour was higher in males, who also showed a more pronounced increase in such behaviour with age. The need for accident prevention programmes remains urgent.

Accidents, Traffic↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part VII. Violent behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for violent behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the total sample, 12.7%, 9.6% and 13.8% reported that they had been physically injured by another person at school, at home and in other settings, respectively; 11.0% had injured another person during the previous year; 5% had committed an act of vandalism; and 9.8% of males and 1.3% of females had carried knives at school. Other trends according to gender, school standard, and home language were identified. Males were more likely to be the perpetrators and victims of violent behaviour; for both genders the extent of victimization decreased with increasing standard; and fewer Xhosa-speaking students than students in other language groups perpetrated incidents of violent behaviour. The potential for intervention programmes is assessed in a context where much violence is determined by sociopolitical factors.

Adolescent↗

PubMed1993

Risk-taking behaviour of Cape Peninsula high-school students. Part VIII. Sexual behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for sexual behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments, of whom 79.7% answered the section dealing with sexual behaviour. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the sample, 17.4% indicated a previous episode of heterosexual intercourse. The median age at first intercourse was 15.1 years. The median number of partners in the previous 12 months was 1.0. The median number of weeks since the most recent coital episode was 6.6; on this episode 76.6% had known their partners for more than 7 days, while 60.5% had done something to avoid pregnancy. The most frequently used method of contraception was injectable steroids for Xhosa-speaking students and condoms for the other students. Males and Xhosa-speaking students appear to be particularly at risk for the adverse consequences of sexual activity. The HIV epidemic has increased the urgency of introducing meaningful sexuality education in South African schools.

Adolescent↗

PubMed1993

Cultural issues in the psychiatric assessment of Xhosa children and adolescents.

Traditional healers living in Guguletu, Cape Town, were interviewed about their practices in order to ascertain whether or not there are cultural/indigenous expressions of psychological distress or dysfunction in black children and adolescents. Besides bedwetting, fits and school anxiety, five other 'syndromes' were described: ukuphambana, ukuphaphazela, amafufunyane, umoya and ukuthwasa. Although detailed case studies are required to establish the internal validity and exact nature of these 'syndromes', it is clear that any systematic study of psychiatric disorders in Xhosa children and adolescents needs to take them into account.

Adolescent↗

PubMed1991

Effects of supravital fluorochromes used to analyze the in vivo homing of murine lymphocytes on cellular function.

A number of supravital fluorochromes are available to study lymphocyte homing in vivo. These include fluorescein isothiocyanate (FITC), which binds to cell surface proteins; Hoechst 33342, which binds to AT rich regions of cellular DNA; and the lipid bilayer incorporated dyes PKH-2 and PKH-26. The relative advantages and disadvantages of each of these probes for analyzing murine lymphocyte homing are as yet poorly understood. We evaluated the effects of each dye on labeling efficiency, as well as cell viability, homing, mitogen responsiveness and cytotoxicity. PKH-26 provided long-term labeling (up to 15 days) with the least detrimental effects on cellular function. Detection of FITC in vivo was impaired by tissue autofluorescence, and the dye acted as a co-mitogen for lectin or IL-2-induced proliferation. Hoechst 33342 eluted from cells over a few hours and inhibited lymphocyte proliferation. PKH-2 had detrimental effects on cell viability and resulted in the down-modulation of peripheral lymph node homing receptor expression. None of the probes interfered with the induction of cytotoxic lymphocytes by IL-2. While these fluorochromes are easy to use and provide powerful tools to analyze the lymphocyte localization in vivo, our experiments demonstrate that important limitations are imposed by each probe that need to be considered by investigators during the design and interpretation of experiments.

Animals↗