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Biomedical subjects

A J Flisher

Publications and source records attributed to A J Flisher.

At least 19 recordsLinked to original sources
PubMed2006

Factors associated with teachers' implementation of HIV/AIDS education in secondary schools in Cape Town, South Africa.

This study investigated the factors influencing whether high school teachers implemented HIV/AIDS education. The independent variables included constructs derived from expectancy value theories, teachers' generic dispositions, their training experience, characteristics of their interactive context and the school climate. We conducted a postal survey of 579 teachers responsible for AIDS education in all 193 public high schools in Cape Town. Questionnaires were completed and returned by 324 teachers (56% response rate) from 125 schools. Many teachers (222; 70%) had implemented HIV/AIDS education during 2003, and female teachers were more likely to have implemented than males (74% vs. 58%). The teacher characteristics associated with teaching HIV/AIDS were previous training, self-efficacy, student-centeredness, beliefs about controllability and the outcome of HIV/AIDS education, and their responsibility. The existence of a school HIV/AIDS policy, a climate of equity and fairness, and good school-community relations were the school characteristics associated with teaching HIV/AIDS. These findings demonstrate the value of teacher training and school policy formulation. They also demonstrate the value and importance of interventions that go beyond a sexual health agenda, focussing on broader school development to improve school functioning and school climate.

Adult↗
PubMed2005

Suicide and exposure to organophosphate insecticides: cause or effect?

BACKGROUND: Suicide using pesticides as agent is recognized as a major cause of pesticide poisoning. METHODS: A literature review of mortality and morbidity studies related to suicide among pesticide-exposed populations, and of human and animal studies of central nervous system toxicity related to organophosphate (OP) pesticides was performed. RESULTS: Suicide rates are high in farming populations. Animal studies link OP exposure to serotonin disturbances in the central nervous system, which are implicated in depression and suicide in humans. Epidemiological studies conclude that acute and chronic OP exposure is associated with affective disorders. Case series and ecological studies also support a causal association between OP use and suicide. CONCLUSIONS: OPs are not only agents for suicide. They may be part of the causal pathway. Emphasizing OPs solely as agents for suicide shifts responsibility for prevention to the individual, reducing corporate responsibility and limiting policy options available for control.

Agricultural Workers' Diseases↗
PubMed2001

Adolescent contraceptive non-use and covariation among risk behaviors.

PURPOSE: To investigate whether adolescent contraceptive non-use is associated with other risk behaviors. METHODS: A multistage sampling procedure produced a sample of 913 sexually active high school students. They completed a self-administered questionnaire that required mainly "yes" or "no" answers to questions involving participation in a range of risk behaviors. A series of multivariate logistic regression models investigated the relationships between contraceptive non-use and selected hypothesised correlates, controlling for key demographic variables. RESULTS: Contraceptive non-use was not significantly associated with use of cigarettes, alcohol, or inhalants; perpetration or being a victim of violence; exposure to risk of physical injury; and suicidality. For males only, there was a significant inverse association between contraceptive non-use and use of cannabis in the previous month. This was not the case for lifetime cannabis use for either gender. There was a significant inverse relationship between contraceptive non-use and knowing the most recent partner for more than 7 days, but no association for the number of partners nor duration since the last intercourse. For females only, there was a significant inverse association between contraceptive non-use and both age and age of first intercourse. CONCLUSIONS: This study does not support the hypothesis that contraceptive non-use is a component of the "risk behavior syndrome." Decisions to participate in intercourse and to use contraception have different psychosocial foundations. Prevention efforts should prioritize relationships with new partners and younger girls who commence intercourse early.

Adolescent↗
PubMed2001

Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation.

OBJECTIVE: To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts. METHOD: The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. RESULTS: Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting. CONCLUSION: Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.

Adolescent↗
PubMed2001

Exposure to violence and its relationship to psychopathology in adolescents.

OBJECTIVES: This study aimed to establish prevalence of adolescents' exposure to violence and related symptoms in the South African context and to explore relationships between exposure and symptoms. SETTING: Four high schools in Cape Town, South Africa. METHODS: Self report questionnaires were administered to 104 students. Types of violence explored included: witnessing or being a victim of violence perpetrated by someone known to the child or in the home and witnessing or being a victim of violence perpetrated by a stranger. The Harvard Trauma Scale, Beck Depression Inventory, and Zung Self-Rating Anxiety Scale were used to assess potentially related symptoms. RESULTS: The majority of children had been exposed to at least one type of violence, and exposure to the one type of violence was related to the other type. Symptoms of post-traumatic stress disorder and depression appear to be related to most types of exposure to violence, but anxiety symptoms only to exposure to violence perpetrated by someone known to the child or in the home. CONCLUSIONS: Rates of exposure to violence, and related symptoms, were unacceptably high. Symptoms were associated with exposure to violence.

Adolescent↗
PubMed2001

Psychiatric research in South Africa: a systematic review of Medline publications.

BACKGROUND: There is debate about the future path that medical and psychiatric research in South Africa should take. In particular, there have been calls to make research more relevant to the needs of the population. There is, however, little systematically collected data on the nature, strengths, and flaws of past psychiatric research in this country. METHODS: We undertook a MEDLINE search to gather all manuscripts that fell under the umbrella of psychiatric research and published by South Africa-based authors during the years 1966-1997. Several kinds of data were collated from each of the articles, including information about the authors and the journal, as well as information on the focus and type of article. RESULTS: While publications from South Africa continue to grow in number, relatively few involve collaborative research groups and few authors write more than one paper. Many papers relevant to psychiatry were published in general medical journals and many were from general medical departments. While blacks and females have been included in research, a number of important areas have received little attention. CONCLUSIONS: Psychiatry research in South Africa requires additional fostering, including additional resources for research training and arguably additional development of subspecialty focuses. Given the limited resources, and the nature of modern research, increased emphasis on collaboration seems advisable. A number of areas in psychiatry deserve particular attention from future researchers.

Humans↗
PubMed2001

Urbanisation and adolescent risk behaviour.

OBJECTIVE: To investigate whether there is an association between the length of time lived in an urban area and selected adolescent risk behaviours. DESIGN: Cross-sectional survey in which students completed an anonymous, confidential questionnaire. SETTING: Four high schools in black communities in the Cape Peninsula, South Africa. PARTICIPANTS: A sample of 1,296 students obtained by multistage cluster sampling. MAIN OUTCOME MEASURES: Selected risk behaviours. RESULTS: There is a relationship between urbanisation and certain risk behaviours. The following risk behaviours were associated with urbanisation: use in the previous month of alcohol, cannabis, and cannabis mixed with Mandrax; being a victim of violence; perpetration of an act of violence; and suicidality. Conversely, participation in sexual intercourse and solvent sniffing in the previous month were not associated with urbanisation. CONCLUSION: Urbanisation is associated with an increase in the prevalence rates of some risk behaviours. Mental health promotion efforts may be informed by further research aimed at the identification of: (i) the characteristics of risk behaviour that determine whether it is associated with urbanisation; and (ii) where applicable, the specific aspects of the urbanisation process that contribute to an increase in risk.

Adolescent↗
PubMed2000

Risk behavior in a community sample of children and adolescents.

OBJECTIVES: First, to investigate whether there is covariation between risk behaviors, including suicidality, in a community probability sample of children and adolescents; and second, to investigate whether risk behavior is associated with selected potential correlates. METHOD: A sample of 9- to 17-year-old youths (N = 1,285) and their caretakers were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The risk behaviors were marijuana smoking, alcohol use, intercourse, fighting, cigarette smoking, and suicidal ideation/attempts. Relationships between the risk behaviors were described using odds ratios. Linear regression analyses of an index of risk behavior on the selected potential correlates of risk behavior were conducted. RESULTS: There were significant relationships between all pairs of risk behaviors. The score on the index of risk behavior was associated with stressors, lack of resources, family psychiatric disorder, psychopathology, and functional impairment. CONCLUSIONS: Clinicians should be alerted to the possibility of risk behaviors, especially in children and adolescents engaging in other risk behaviors and those with inadequate resources, stressors, functional impairment, or psychopathology.

Adolescent↗
PubMed2000

To what extent does South African mental health and substance abuse research address priority issues?

OBJECTIVE: To investigate the extent to which South African mental health research addresses priority issues. DESIGN: Cross-sectional survey of conference presentations. SETTING: The most recent conferences of the following professional societies: the Epidemiological Society of Southern Africa, the Psychological Society of South Africa, the Society of Psychiatrists of South Africa, and the South African Association for Child and Adolescent Psychiatry and Allied Disciplines. MAIN OUTCOME MEASURES: Whether the presentations addressed priority areas as defined in the list 'Selected priority areas of research' compiled by the Mental Health and Substance Abuse Thrust of the Medical Research Council, and if so which priority areas were addressed. RESULTS: There were 627 presentations, with 267 (43%) on mental health or substance abuse. Seventy-eight papers (29%) reported original research in a priority area identified by the Medical Research Council. Of these, 73 (94%) were on mental health and 5 (6%) were on substance abuse. Of the 73 papers on mental health, 33 (45%) addressed topics in health problem research, 7 (10%) aetiology research, 22 (30%) intervention research, and 11 (15%) operational and health systems research. CONCLUSION: Much South African mental health research does not address priority issues. There is a particular dearth of research addressing substance abuse research priorities. Funding mechanisms and research capacity development initiatives could help to rectify the situation.

Cross-Sectional Studies↗
PubMed2000

A model for estimating mental health service needs in South Africa.

OBJECTIVE: To develop a model for estimating the services and human resources needed to care for people with severe psychiatric conditions in a hypothetical population of 100,000 people in South Africa. METHOD: Annual mental health service needs were estimated in terms of numbers of daily patient visits (DPV) in ambulatory care, the number of beds required, and staffing. Developed within a spreadsheet format, the model allows for the adjustment of key service variables according to estimated or existing service data. RESULTS: At 100% coverage, 87 DPV, 28 acute beds, and 10 medium-long stay beds are necessary for a population of 100,000 people. This would require 35.2 full-time equivalent mental health staff: 21.3 for inpatient care, 12.0 for ambulatory care, and 1.9 for management. CONCLUSION: Because the model can produce a range of service recommendations, the assumptions that inform it should be clearly stated and justified. This method makes the assumptions on which services are planned explicit and allows for a rational approach to decision making.

Adolescent↗
PubMed1998

Psychopathology associated with suicidal ideation and attempts among children and adolescents.

OBJECTIVE: To identify the independent and differential diagnostic and symptom correlates of suicidal ideation and suicide attempts and determine whether there are gender- and age-specific diagnostic profiles. METHOD: The relationships between suicidal ideation, suicide attempts, and psychiatric disorders were examined among 1,285 randomly selected children and adolescents, aged 9 to 17 years, of whom 42 had attempted suicide and 67 had expressed suicidal ideation only. Youths and their parents were interviewed as part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, using the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3). RESULTS: Logistic regression analyses indicated that mood, anxiety, and substance abuse/dependence disorders independently increased the risk of suicide attempts, after controlling for sociodemographic characteristics. There was no significant independent contribution of disruptive disorders to suicide attempts, although its association with suicidal ideation was significant. Substance abuse/dependence independently differentiated suicide attempters from ideators. Noncriterion symptoms that remained significant predictors of suicide risk, after adjusting for psychiatric disorder, included panic attacks and aggressiveness. Perfectionism did not significantly increase suicide risk after adjusting for psychiatric disorder. The association of specific disorders and noncriterion symptoms with suicidality varied as a function of gender and age. CONCLUSION: A monolithic diagnostic risk profile for suicidality, ignoring gender- and age-specific risks, is inadequate. The contribution of substance abuse/dependence in the escalation from suicidal thoughts to suicide attempts is underscored.

Adolescent↗
PubMed1997

Seasonal variation of suicide in South Africa.

Seasonal trends in South African suicide incidence were investigated with a view to ascertaining whether they are consistent with those in the northern hemisphere regarding: (1) the existence of the expected pattern; (2) this pattern being more pronounced for less urbanized groups; and (3) the presence of a secondary fall peak for youth and females. Log-linear modelling was performed to investigate the effect of month and relevant demographic variables on the suicide counts. The 16,389 nationally registered suicide deaths during 1980-1989 were analysed. The expected pattern, with a peak in the spring (that is, in September/October) or summer and a trough in winter, was present. This pattern was more pronounced for a sub-group that is less urbanized and for another sub-group with a relatively low standard of living. The secondary peak in autumn was not present for youth or females. In the northern hemisphere, this secondary peak has been ascribed to sociodemographic factors associated with the commencement of the academic year and (for females) bioclimatic factors associated with gender-specific biological circannual rhythms. The fact that the academic year commences in summer in South Africa indicates that the present findings are consistent with the former explanation.

Adolescent↗
PubMed1997

Correlates of unmet need for mental health services by children and adolescents.

BACKGROUND: Little is known about the extent and correlates of unmet need for mental health services in community samples of children and adolescents. METHODS: Data were obtained from the 1285 parent/youth pairs interviewed at four sites in the USA and Puerto Rico in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Unmet need was defined to exist if psychopathology and associated functional impairment were present but no mental health services had been received in the previous 6 months. RESULTS: Of the total sample, 17.1% had unmet need. Adjusting for demographic variables, logistic regression analyses revealed that unmet need was significantly associated with: indicators of economic disadvantage, such as being on public assistance and not being covered by health insurance; opinions of the parents and children or adolescents that the latter had poor mental health; parental psychopathology; poor school grades; and parent-reported access barriers such as concern that the child would want to solve the problem unassisted, would refuse to attend mental health services, or would be hospitalized or taken away against the parent's will. No youth-reported access barriers were significantly associated with unmet need. CONCLUSIONS: The economic correlates of unmet need may attain increased importance in the light of current reform in health care financing in the USA. Access may be facilitated by increasing parental knowledge of mental health services and enabling children and adolescents to initiate contact with services independently of their families.

Adolescent↗
PubMed1997

Psychosocial characteristics of physically abused children and adolescents.

OBJECTIVE: To examine the association between physical abuse and selected psychosocial measures in a community-based probability sample of children and adolescents. METHOD: A sample of 9- through 17-year-olds (N = 665) and their caretakers in New York State and Puerto Rico were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Assessments included the Columbia Impairment Scale, the Instrumental and Social Competence Scale, the Diagnostic Interview Schedule for Children, the Peabody Picture Vocabulary Test, and questions regarding physical abuse. Regression analyses were conducted controlling for family income, family psychiatric history, perinatal problems, physical health, and sexual abuse. RESULTS: A history of physical abuse was reported in 172 (25.9%) of the sample. It was significantly associated with global impairment, poor social competence, major depression, conduct disorder, oppositional defiant disorder, agoraphobia, overanxious disorder, and generalized anxiety disorder but not with suicidality, school grades, or receptive language ability. CONCLUSION: A community probability sample of children and adolescents demonstrated significant associations between physical abuse and psychopathology, after controlling for potential confounders. This supports comprehensive screening for psychopathology among physically abused children and for physical abuse among those with psychopathology. Interventions aimed at improving social competence may be indicated.

Adolescent↗
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↗
PubMed1996

Aids, violence and behavioral coding: information theory, risk behavior and dynamic process on core-group sociogeographic networks.

Elsewhere we have presented a traveling-wave analysis of HIV transmission on a tightly self-interactive, geographically-focused core group social network (Wallace R. Soc. Sci. Med. 32, 847, 1991; Soc. Sci. Med. 33, 1155, 1991; Environ. Plan. A. 26, 767, 1994; Wallace R. and Fullilove M. Environ. Plan. A. 23, 1701 1991). Here we reanalyze the problem in probability space and recover a close analog of the Shannon Coding Theorem of information theory. Subsequent direct application of information-theoretic methods provides striking insight regarding the spread of disease along the sociogeographic networks of marginalized subgroups, suggesting that 'risk behaviors' for infection may constitute essential components of a behavioral code for the transmission of information within the noisy channel of a marginalized community's social networks. The code's form, including the incorporation of risk behaviors, arises as a direct consequence of the external oppressive forces which structure marginalization. This viewpoint suggests an explanation of the sometime-observed rapid transmission of both infection and of control strategies for infection along the same network, but suggests further that if risk behaviors are indeed parts of a behavioral code for the transmission of group norms, statements of individual worth or resource sharing, then high rates of relapse are inevitable, given the persistence of the external oppression which gives those behaviors symbolic value. We suggest that violent acts in particular may emerge as key behavioral symbols for 'sending a message' in socially disorganized communities, implying that school-based or other individual-oriented harm reduction strategies for violence prevention, in the absence of a comprehensive, multifactorial reform program, cannot significantly reverse the effects of continuing economic and social constraints or of public policies of planned shrinkage and benign neglect, factors primarily responsible for the disorganization of urban minority communities within the United States.

Acquired Immunodeficiency Syndrome↗
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↗