Browsing by Author "Nothling, Jani"
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- ItemAanvaarding van roetine MIV berading en toetsing in die konteks van die gesondheidsoortuigingsmodel(Stellenbosch : Stellenbosch University, 2011-12) Nothling, Jani; Kagee, Ashraf; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.ENGLISH ABSTRACT: South Africa is one of the countries with the highest HIV prevalence rates worldwide and younger age groups are often disproportionately affected. Knowledge of HIV status is regarded as an important prevention strategy for reducing HIV transmission and infection and it is viewed as a means to access antiretroviral therapy. Routine HIV Counseling and Testing (RCT) can significantly increase knowledge of HIV status, but it is unclear whether RCT will be accepted if offered. The aim of this study was to determine whether the main dimensions of the Health Belief Model (HBM) namely, perceived susceptibility, perceived severity, perceived benefits and perceived barriers can predict acceptance of RCT. A second objective of the study was to determine if the variable of the HBM, namely cue’s to action could significantly contribute to predicting acceptability of RCT. A sample of 1113 students at the University of Stellenbosch in the Western Cape Province of South Africa completed a structured questionnaire, measuring the acceptability of RCT. Multiple regression analysis was used to analyze the data and it was found that the main dimensions of the HBM could explain 25.1% of the variance in acceptance of RCT. It was however found that the variable perceived severity did not make a significant individual contribution to predicting acceptability of RCT. The addition of the variable cues to action also did not make a significant individual contribution to the prediction of RCT. It was therefore found that the HBM could partially, but not in its entirety, predict acceptability of RCT among the student population. Interventions should therefore aim to increase perceived benefits of RCT, reduce perceived barriers to RCT and facilitate correct personal risk assessment in order to increase perceived susceptibility.
- ItemEpigenomic analysis of posttraumatic stress disorder in female rape survivors in South Africa(Stellenbosch : Stellenbosch University, 2021-03) Nothling, Jani; Hemmings, Sian M. J.; Seedat, Soraya, 1966-; Abrahaams, Naeema; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.ENGLISH SUMMARY : Compared to other trauma types, rape is associated with a high risk of developing posttraumatic stress disorder (PTSD). Women are at increased risk of developing PTSD compared to men and are also more frequently victims of sexual assault. PTSD is a complex, multifactorial disorder and an array of demographic, trauma-related, psychological and genetic putative risk and protective factors mediate or contribute to the development and course of the disorder. Few studies have comprehensively investigated demographic and psychological risk and protective factors for PTSD in a longitudinal prospective design, especially beyond the 3-month post-rape period and in low- to medium-income countries. There are currently no known epigenome-wide association studies (EWASs) investigating differential methylation in relation to PTSD in (1) an African population and (2) a sample of rape-exposed women exclusively. There are also no known studies investigating longitudinal change in the hypothalamic-pituitary-adrenal (HPA) axis associated candidate gene FK506 binding protein (FKBP5) in relation to PTSD in a sample of rape-exposed women exclusively. In this study we investigated the demographic, rape/assault-related, psychological, genetic (FKBP5) and epigenetic (epigenome-wide differential methylation) risk and protective factors associated with the development and course of PTSD symptoms over six months. Self-report measures and specimen collection was completed at baseline (within 20 day after the rape), 3-months and 6-months post-rape as part of the Rape Impact Cohort Evaluation (RICE) study. The RICE sample consisted of 852 Black African rape-exposed women, between the ages of 16 and 40 years and from a low socio-economic background. We found that baseline demographic, rape/assault-related and psychological protective factors were not significant predictors of PTSD symptoms over time. Baseline depression and rape stigma were significant psychological risk factors for the development and course of PTSD post-rape. We also identified one intergenic CpG site (cg01700569) that was differentially methylated in relation to PTSD status at 3-months post-rape on a genome-wide level. Thirty-four differentially methylated regions were identified and included a region in the HPA-axis-associated adenylate cyclase activating polypeptide 1 (ADCYAP1) gene and the neuroendocrine-associated brain-specific serine/threonine-protein kinase 2 (BRSK2) gene. Decreased BRSK2 and ADCYAP1 methylation at 3-months and 6-months post-rape was associated with increased PTSD symptom scores at the same time-points. Decreased FKBP5 methylation was a predictor of increased PTSD symptom scores at 3-months and 6-months post-rape. High childhood trauma and the CC genotype of FKBP5 rs1360780 resulted in decreased FKBP5 methylation and increased PTSD scores at baseline. The study builds on existing literature, highlighting the psychological risk factors for the development and course of PTSD in rape-exposed women. Methylation findings also build on the existing literature regarding the role of epigenetics in PTSD, although the genome-wide finding implicating differential methylation of BRSK2 in the development of PTSD is a novel finding in human studies. The study provides evidence that both psychological and biological factors have an impact on the symptom trajectory of PTSD and that both should be considered when designing and implementing interventions for the treatment of PTSD post-rape.
- ItemGenome-wide differentially methylated genes associated with posttraumatic stress disorder and longitudinal change in methylation in rape survivors(Springer Nature, 2019) Nothling, Jani; Abrahams, Naeemah; Toikumo, Sylvanus; Suderman, Matthew; Mhlongo, Shibe; Lombard, Carl; Seedat, Soraya; Hemmings, Sian Megan JoannaENGLISH ABSTRACT: Rape is associated with a high risk for posttraumatic stress disorder (PTSD). DNA methylation changes may confer risk or protection for PTSD following rape by regulating the expression of genes implicated in pathways affected by PTSD. We aimed to: (1) identify epigenome-wide differences in methylation profiles between rape-exposed women with and without PTSD at 3-months post-rape, in a demographically and ethnically similar group, drawn from a low-income setting; (2) validate and replicate the findings of the epigenome-wide analysis in selected genes (BRSK2 and ADCYAP1); and (3) investigate baseline and longitudinal changes in BRSK2 and ADCYAP1 methylation over six months in relation to change in PTSD symptom scores over 6 months, in the combined discovery/validation and replication samples (n = 96). Rape-exposed women (n = 852) were recruited from rape clinics in the Rape Impact Cohort Evaluation (RICE) umbrella study. Epigenome-wide differentially methylated CpG sites between rape-exposed women with (n = 24) and without (n = 24) PTSD at 3-months post-rape were investigated using the Illumina EPIC BeadChip in a discovery cohort (n = 48). Validation (n = 47) and replication (n = 49) of BRSK2 and ADCYAP1 methylation findings were investigated using EpiTYPER technology. Longitudinal change in BRSK2 and ADCYAP1 was also investigated using EpiTYPER technology in the combined sample (n = 96). In the discovery sample, after adjustment for multiple comparisons, one differentially methylated CpG site (chr10: 61385771/ cg01700569, p = 0.049) and thirty-four differentially methylated regions were associated with PTSD status at 3-months post-rape. Decreased BRSK2 and ADCYAP1 methylation at 3-months and 6-months post-rape were associated with increased PTSD scores at the same time points, but these findings did not remain significant in adjusted models. In conclusion, decreased methylation of BRSK2 may result in abnormal neuronal polarization, synaptic development, vesicle formation, and disrupted neurotransmission in individuals with PTSD. PTSD symptoms may also be mediated by differential methylation of the ADCYAP1 gene which is involved in stress regulation. Replication of these findings is required to determine whether ADCYAP1 and BRSK2 are biomarkers of PTSD and potential therapeutic targets.
- ItemThe perspectives of users of antiretroviral therapy on structural barriers to antiretroviral therapy adherence in South Africa(Medpharm Publications, 2012) Kagee, Ashraf; Nothling, Jani; Coetzee, BronwyneBackground: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet, suboptimal adherence to ART and retention in care of patients still persists and, by many accounts, is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa. Method: In this qualitative study, semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa. Results: The results of the interviews were categorised according to poverty-related, institution-related and social barriers to clinic attendance and pill-taking, which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work, transport expenses, long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity, stigma and discrimination. Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors, such as a healthcare-enabling environment, might play an important role in influencing healthcare-promoting behaviour among patients.
- ItemTrauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees(BioMed Central, 2014-04) Fjeldheim, Celine B.; Nothling, Jani; Pretorius, Karin; Basson, Marina; Ganasen, Keith; Heneke, Robin; Cloete, Karen J.; Seedat, SorayaAbstract Background: Emergency healthcare workers, including trainees and individuals in related occupations are at heightened risk of developing posttraumatic stress disorder (PTSD) and depression owing to work-related stressors. We aimed to investigate the type, frequency, and severity of direct trauma exposure, posttraumatic stress symptoms and other psychopathology amongst paramedic trainees. In order to create a risk profile for individuals who are at higher occupational risk of developing PTSD, we examined risk and resilience factors that possibly contributed to the presence and severity of posttraumatic symptomatology. Methods: Paramedic trainees (n = 131) were recruited from a local university. A logistic regression analysis was conducted using the explanatory variables age, gender, population group, trauma exposure, depression, alcohol abuse, alcohol dependence, resilience and social support. Results: 94% of paramedic trainees had directly experienced trauma, with 16% meeting PTSD criteria. A high rate of depression (28%), alcohol abuse (23%) and chronic perceived stress (7%) and low levels of social support was found. The number of previous trauma exposures, depression, resilience and social support significantly predicted PTSD status and depression had a mediating effect. Conclusion: There is a need for efficient, ongoing screening of depressive and PTSD symptomatology in trauma exposed high risk groups so that early psychological supportive interventions can be offered. Background Emergency healthcare workers, including trainees and individuals in related occupations are at heightened risk of developing posttraumatic stress disorder (PTSD) and depression owing to work-related stressors. We aimed to investigate the type, frequency, and severity of direct trauma exposure, posttraumatic stress symptoms and other psychopathology amongst paramedic trainees. In order to create a risk profile for individuals who are at higher occupational risk of developing PTSD, we examined risk and resilience factors that possibly contributed to the presence and severity of posttraumatic symptomatology. Methods Paramedic trainees (n = 131) were recruited from a local university. A logistic regression analysis was conducted using the explanatory variables age, gender, population group, trauma exposure, depression, alcohol abuse, alcohol dependence, resilience and social support. Results 94% of paramedic trainees had directly experienced trauma, with 16% meeting PTSD criteria. A high rate of depression (28%), alcohol abuse (23%) and chronic perceived stress (7%) and low levels of social support was found. The number of previous trauma exposures, depression, resilience and social support significantly predicted PTSD status and depression had a mediating effect. Conclusion There is a need for efficient, ongoing screening of depressive and PTSD symptomatology in trauma exposed high risk groups so that early psychological supportive interventions can be offered.