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Objective: To determine if either prophylactic tramadol 50 mg or ibuprofen 400 mg/metoclopramide 10 mg result in lower maximal pain compared to placebo in women ≤63 days' gestation having a mifepristone-misoprostol medical abortion.Study Design: We conducted a randomized, placebo-controlled trial in Nepal, South Africa, and Vietnam. Participants seeking medical abortion received active treatment or placebo, taken at time of misoprostol and repeated 4 hours later. All had access to additional analgesia. The primary outcome was mean maximum pain score within 8 hours. Participants self-assessed maximum pain using an 11-point numeric rating scale recorded in paper diaries; we analyzed these data using intention-to-treat analysis. Secondary outcomes included use of additional analgesia, side effects, and satisfaction.Results: We enrolled 563 patients between June 2016 and October 2017; 5 participants failed to follow up. Mean adjusted maximum pain scores within 8 hours in both active arms were lower than placebo (tramadol: n = 188, 6.78 (95% confidence interval [CI] 6.46, 7.11); ibuprofen/metoclopramide: n = 187, 6.43 (95% CI 6.10, 6.75); placebo: n = 188, 7.42 (95% CI 7.10, 7.74); p = 0.0001). Additional analgesia was used by 97 (52.2%) participants in the tramadol group, 80 (43.0%) in the ibuprofen/metoclopramide group, and 103 (55.7%) in the placebo group, p = 0.04. More dizziness (p = 0.004), headache (p = 0.03), and vomiting (p < 0.001) occurred in the tramadol group. More participants reported experienced pain was the same or less than expected in the ibuprofen/metoclopramide group (p = 0.05); overall abortion satisfaction did not differ by group (p = 0.44).Conclusions: Compared with placebo, tramadol or ibuprofen/metoclopramide co-administered with misoprostol and repeated 4 h later resulted in lower mean maximum pain scores that failed to achieve clinical significance. Women who received ibuprofen/metoclopramide were least likely to use additional analgesia and reported fewer side effects.Implications: Given that tramadol, ibuprofen, and metoclopramide are inexpensive, globally available; and, ibuprofen and metoclopramide are included on the World Health Organization Essential Medicines List, these medicines could be considered for prophylactic pain management during medical abortion. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recent research has shown that contact with the historically advantaged can have paradoxical effects on the political attitudes of the historically disadvantaged, reducing outgroup prejudice but also reducing the motivation to acknowledge and challenge social inequalities. These effects have been attributed primarily to the role of intergroup contact in decreasing the salience of intergroup differences, encouraging common identification, and creating warm feelings. This paper explores a related but distinct process through which contact may have paradoxical consequences, focusing on its capacity to act as a vehicle for the transmission of systems-justifying ideologies. The paper presents a qualitative study of domestic labour relations in post-apartheid South Africa. Analysis of interviews with domestic workers and employers demonstrates how intergroup contact in this context was typically organised and defined in terms of paternalistic values, beliefs and practices. Interview accounts were designed to resolve the moral and political tensions associated with participation in the historically racist institution of domestic labour by (re)constituting everyday relations between 'maids' and 'madams' in the language of caring, helping and reciprocal exchange. [ABSTRACT FROM AUTHOR]

Abstract: Recent educational journals on both sides of the Atlantic have seen a resurgence of debate about the nature of educational research. As a contribution to these debates, this paper draws on theoretical and methodological ‘thinking tools’ of French sociologist Pierre Bourdieu. Specifically, the paper explores what Jenkins [Jenkins, R. (2002). Pierre Bourdieu. London: Routledge and Falmer] refers to as Bourdieu''s “reflexive epistemological pluralism” and its implications for research into higher education, with a particular focus on assessment as social practice. This particular theoretical and methodological understanding is used to critically reflect on a study conducted in 2005 on the impact of a policy on anonymous examination marking which was implemented at the University of Cape Town in 2004. The study collected both quantitative data of student examination performance pre- and post-policy implementation, as well as interviews with course conveners. The paper argues that when viewed interdependently the data offers insight into some of the “principles of vision and division” [Bourdieu, P. (1996). The state nobility: Elite schools in the field of power. Cambridge: Polity Press] at work in assessors’ judgment-making process. The assessors’ deliberations expose ideological tensions between the dual challenges of equity and excellence in the context of a historically white liberal university under transformation. [Copyright &y& Elsevier]

This paper explores the experiences of caregivers in the Eastern Cape Province regarding the alleviation of child poverty, and presents a case for the expansion of monetary support to effectively address the multi-dimensional focus of child poverty in South Africa. The Social Development Approach (SDA) 1 1 Social Development Approach (SDA) addresses the “implementation of policies and programmes to meet needs, promote rights, manage social problems and facilitate maximization of opportunities to achieve social well-being and the promotion of human empowerment and social inclusion” ( Patel, 2005 ). was used together with the Child Focused Multi-dimensional Model (CFMDM) 2 2 Child Focused Multi-dimensional Model (CFMDM) is a model that is ‘child focused’ and is relevant to the child's life. It considers the different domains of deprivation, good access to quality services and, at its core, contains the absolute component that is complemented by the relative dimension which is based on the child's ability to participate fully in society and most importantly considers the applicability for different age groups. to explore the research problem. A phenomenological research design was followed by conducting semi-structured interviews and a focus group discussion with 20 participants who were purposively drawn from four urban and rural areas in the Eastern Cape. The findings concur with the view that the Child Support Grant (CSG) 3 3 Child Support Grant (CSG) is a non-contributory cash transfer programme paid to caregivers with children under the age of 18 years who meet the minimum requirements of the South African Social Security Agency (2016a, 2016b) . monetary support should be increased to better accommodate the multi-dimensional child poverty needs of the CSG recipients. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance The aim of the study was to identify and document plants traditionally used to manage HIV and treat its opportunistic infections (OIs) in Mpoza, a rural village located in the Mount Frere Alfred Nzo District, Eastern Cape Province, South Africa. Materials and methods: Semi-structured interviews and focus group discussions (FGDs) were conducted with 18 traditional health practitioners from January 2012 to August 2012 to obtain information about medicinal plants used in the management of HIV and treatment of OIs. Results Seventeen plant species belonging to 12 families were identified for the management of HIV and treatment of OIs in Mpoza. The identified plant species belonged mostly to the families Asparagaceae (12%), Araliaceae (12%), Apiaceae (12%), Xanthorrhoeaceae (12%) and Lamiaceae (12%). The remaining 40% of identified plant species was evenly split over seven families - Urticaceae, Hypoxidaceae, Leguminosae, Verbenaceae, Rosaceae, Compositae and Rutaceae. The most frequently used medicinal plants were Hypoxis hemerocallidea (85%), Asparagus densiflorus (68%) and Lessertia frutescens (68%). The leaves (43.5%) and roots (21.7%) were the most frequently used plant parts, usually prepared as infusions and decoctions for oral administration. Conclusion This study provides documentation of medicinal plants used in the management of HIV and treatment of commonly associated OIs, which might provide a potential lead that will significantly contribute in reducing the burden of HIV infections in South Africa. We envisage that this paper will provide some background for further studies in developing new, effective, safe and affordable plant-derived medicines. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance This paper presents results of an ethnobotanical survey of medicinal plants used for the management of candidiasis and related fungal infections in the Venda area, South Africa. Materials and methods Ethnobotanical data about the uses of plants were gathered from eleven rural traditional healers using semi-structured interviews. Results A total of 45 species belonging to 24 different families were identified, of which the dominant family was the Fabaceae with 13 species (28.9%) followed by the Asteraceae and Solanaceae with 3 species each (6.7 %). A total of 28 of these plant species (62.2%) have been shown to have anticandidal activity and 14 species (31%) have been recorded for antifungal uses in the literature. Amongst the 45 species recorded, 51% were trees, 33% were shrubs, and 16% were herbs. The most widely used plant species were Acacia caffra , Clerodendrum glabrum, Croton gratissimus, Elaeodendron transvaalense, Faurea saligna, Hippocratea longipetiolata, Osyris lanceolata, Richardia brasiliensis, Schkuhria pinnata, Schotia brachypetala, Spilanthes acmella, Strychnos potatorum, Vangueria infausta subsp. infausta and Withania somnifera . The plant parts mostly used in the therapeutic preparations were roots (27.7%), bark (23.2%), and a combination of roots, bark (18.7%) and leaves (14.3%). Decoctions (44.4%), infusions (20%), macerations (17.7%), burning (11.4%) and paste (6.5%) were used. Most of the herbal remedies were administered orally. The main factors threatening the conservation status of these plants are unsustainable methods of harvesting, logging for firewood, building materials and crafts. Conclusion The Venda area is rich in plant diversity and local indigenous knowledge of medicinal plants can play an important role as a model for low cost primary health care. Further studies are in progress to validate the indigenous plants recorded as traditional remedies in this area [ABSTRACT FROM AUTHOR]

Abstract: Mitigation of the tuberculosis (TB) and HIV syndemic is undermined by critical clinical, operational and social challenges of which the social aspects have been least explored. This paper examines the lived experience of TB disease and HIV from the perspective of affected individuals to analyze how they may think about their dual illness; how they understand their illness with TB in relation to HIV, and vice versa; and how they characterize their (stigmatized) experiences in the context of their perceptions and identities. From February–August 2009, qualitative, semi-structured interviews were conducted with 40 adults with HIV and TB disease at three ambulatory clinics in KwaZulu-Natal, South Africa. Subjective meanings of illness experience were analyzed using modified grounded-theory. Emergent themes on illness perception and disclosure revealed how patients constructed dichotomous identities associated with TB and HIV through social constructs of moral susceptibility and (im)permanence. Each identity was associated with relatively disparate degrees of stigma as a product of labeling, negative stereotyping and discrimination. HIV bore the least desirable identity and invoked the greatest stigma. However, the confluence of the two epidemics rendered TB symbolic and symptomatic of HIV, and enhanced the visibility of AIDS. Dual illness thus introduced a paradox to patients'' identity constructions, and produced a unique, overlapping double stigma. This facilitated new forms of stigma against TB, and aggravated existing stigma against HIV. It also conferred visibility to some forms of extra-pulmonary TB. Patients managed their double stigmas through novel forms of information sharing that relied on segregating their dual illness identities. Patients deflected the dominant stigma of HIV through concurrent processes of HIV ‘othering’ – their symbolic distancing from persons affected by HIV, and ‘covering’ – their selective disclosure of illness (and identity associated) with TB over that of HIV. Findings call for greater consideration to the complex role of stigma in the delivery of TB/HIV healthcare. [Copyright &y& Elsevier]

It is becoming increasingly difficult to manage and expand statutory conservation areas (i.e., parks and formally protected areas). Therefore, alternative opportunities for land conservation merit closer attention. This paper examines the extent to which privately owned conservation areas contribute to biodiversity representation. Gap analyses were performed for a large semi-arid region in South Africa with a comprehensive database of private conservation areas. The distribution of private conservation areas was compared to statutory conservation areas using several landscape characteristics: biome and vegetation variant, elevation class, ecological process area, total area, and threat status (endangerment). Conservation target achievement for the vegetation variants was also assessed, as was the degree to which private conservation areas complemented statutory conservation areas by representing different landscape characteristics. The number of targets achieved nearly tripled if private conservation areas were considered in addition to statutory conservation areas. Further, private conservation areas significantly complemented statutory conservation areas in the types of biomes, elevation classes, and threat status classes conserved. Private conservation areas were especially important in conserving lower elevation habitat, and by association, endangered vegetation. This particular relationship is expected to be common worldwide. Our results indicate that private lands conservation deserves an increased allocation of resources for both research and implementation. [Copyright &y& Elsevier]

Clinical trials for the treatment of schizophrenia now often include cognitive assessments in addition to clinical ratings of symptoms. Recently, these trials have included cross-national assessments. It is not clear if translated psychological tests produce consistent results across different languages. This paper presents the results of a study of the comparability of the results of cognitive assessments in different English-speaking countries and a number of countries where tests were translated into other languages. Performance on tests of executive functioning, verbal and visuo-spatial learning and memory, language skills, psychomotor speed, and vigilance was compared across the first episode patients with schizophrenia (n=301) assessed in six different languages (English, French, Finnish, German, Hebrew, and Afrikaans), including two different countries where patients were assessed in English and other languages: Canada (French) and South Africa (Afrikaans). The variance in performance across the sites tested in English was as large as the variance between English and non-English speakers when all tests were considered. Performance differences across English and other languages were found only for executive functions, vigilance, and psychomotor speed, with executive functioning differences nonsignificant when education was considered. No differences were found between English and non-English speakers in Canada. These results suggest that the translation of tests of memory and verbal skills can lead to consistent results across translated versions of the tests. Differences between countries were greater than differences between languages, suggesting the need to consider representativeness of patient samples in terms of local educational attainment. In general, these data support the validity of cross-national neuropsychological assessments. [Copyright &y& Elsevier]

This paper investigates the impact of the Stepping Stones Creating Futures (SSCF) intervention on young women in informal settlements in eThekwini, South Africa. Specifically, whether following participation in the intervention the young women experienced a reduction in intimate partner violence, strengthened agency and shifted gender relations. Where changes occurred, it examines how they occurred, and barriers and enablers to change. SSCF is a gender transformative and livelihoods strengthening intervention using participatory, reflective small groups. Qualitative research was undertaken with fifteen women participating in the SSCF randomised control trial between 2015 and 2018. The women were followed over 18 months, participating in in-depth interviews at baseline, 12- and 18-months post intervention. To supplement these, eight women were involved in Photovoice work at baseline and 18 months and seven were included in ongoing participant observation. Data were analysed inductively. Data revealed many women changed their behaviours following SSCF, including: having more power within relationships, improved communication and relationship skills, increased resistance to controlling partners, shifting relationship expectations, emergence of new femininities and improved livelihoods. Despite these important shifts many women did not report a reduction in IPV. Nonetheless we argue most of the women, following the intervention, became more agentic. Drawing on the notion of 'distributed agency' as developed by Campbell and Mannell (2016), we show that SSCF bolstered the women's distributed agency. Distributed agency recognizes small agentic acts that women take, acts which to them are significant, it further notes that agency is temporal, fluid, dynamic and context specific. Women do not 'either have agency or not', rather being agentic depends on time, context and the particular incident. These findings provide an important contribution to the limited application of distributed agency and femininities work in informal settlements and are critical for policy and intervention science to reduce IPV and support women's agency. • South African informal settlements have high rates of intimate partner violence. • The Stepping Stones Creating Futures intervention strengthened young women's agency. • Women developed new skills, reduced violent confrontations and improved livelihoods. • However, many women remained in violent relationships. • Participatory, group-based, gender transformative interventions can reduce violence. [ABSTRACT FROM AUTHOR]

Introduction: South Africa has seen a sharp increase in treatment admission trends for opioids despite beliefs that rates of opioid use remain low and do not represent a major problem. To advocate for the extension of Opioid Use Disorder (OUD) treatment and harm minimisation services in South Africa, better estimates of the extent of opioid use is needed. This paper responds to this need by describing (i) trends in treatment utilization for opioid-related problems in South Africa and (ii) differences in the profile of patients accessing treatment for different classes of opioids - heroin, 'nyaope' and codeine use.Methods: Data were collected from 83 specialist treatment centres participating in the South African Community Epidemiology Network on Drug Use between 2012 and 2017. Descriptive analyses were conducted to describe the sociodemographic profile of patients and multiple logistic regression was used to explore socio-demographic and clinical factors associated with admission to treatment for opioid use disorders (OUD) .Results: From January 2012 to December 2017, data from 11 2032 treatment episodes were collated. Of these, 20 319 (18.1%) were from patients admitted for an OUD. Over time, the proportion of overall opioid-related admissions increased significantly from 16.1% of all admissions in 2012 to 20.0% in 2017 (p <0.001). Data also suggests a significant increase in the overall proportion of patients reporting injection drug use, from 1.6% in 2013 to 3.5% in 2017 (p <0.001). Clear differences in employment status, referral sources between classes of opioids were also noted.Conclusion: Over the last 5 years, South Africa has seen an increase in the proportion of opioid related disorders (OUD) treatment admissions. Public health interventions, evidence-based harm reduction approaches and improving access to treatment are among the interventions urgently needed to reduce the harms associated with the increased use of opioids in South Africa. [ABSTRACT FROM AUTHOR]