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A review of congenital heart defects in children with Trisomy 21 over a 5-year period at Charlotte Maxeke Johannesburg Academic Hospital
(2021) Mahomed, Raeesa Moosa Kara
Background: In the first ten years of life, mortality in Trisomy 21 (T21) is strongly associated with the presence of Congenital Heart Defects (CHDs). There is currently a lack ofl ocal and regional data regarding the prevalence, management and outcomes of children with T21 and CHDs. Objectives: To describe the prevalence, type and frequency of CHDs and revie winter ventions (cardiac catheterisation and surgery) and survival post-surgery of children with CHDs in the T21 population at a South African facility ,the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Paediatric Cardiology Unit (PCU). Methods: A retrospective, crosssectional, observational review of 177 participants at CMJAH PCU between January 2013 to December 2017 was performed. Data collected from the PCU data base and clinical records included: demographics, echocardiographic diagnosis, details of Diagnostic Cardiac Catheterisation (DCC), Interventional Cardiac Catheterisation (ICC) and surgery required and performed, age at diagnosis and intervention as well as survival post-surgery. Results: There were 128 participants with laboratory-confirmed T21 and CHD on echocardiography meeting inclusion criteria. The majority of participants were female (56.0%) and African (97.0%). The median age at presentation was six (IQR9.75) months. The prevalence of CHDs was 77/128 (60.2%) and 58/77 (75.3%) had a single CHD. The most frequent CHD was an Atrioventricular Septal Defect (AVSD) (38) (with or without another associated CHD) .DCC was required in 60/77 (77.9%) participants and 25/60 (41.6%) were performed. The median age at DCC was 15 (IQR 15) months. One participant with isolated PDA required and under went successful ICC for PDA closure at 17 months. Surgery was required in 60/77 (77.9%) of participants, while 15/60 (25.0%) surgeries were performed. Almost half of DDCs and surgeries not performed were due to participants lost to follow up (40% and 45% respectively). The median age at first surgery was 31 (IQR 24) months. The most common surgery was an AVSD repair (73%). Post-surgery survival was 93.3% at hospital discharge, 3-week and 6-month follow-up and 86.7% at 1-year follow-up . Conclusion: The prevalence, type and frequency of CHDs in the CMJAH T 21 population is comparable to global data. The age at presentation was not optimal for early intervention, and there was further delay in catheterisation and surgery. Survival post-surgery compares favourably with other centres even though surgery was performed at a much later age than the age recommended for best outcome (sixmonths). Early screening , diagnosis and intervention can prevent morbidity, mortality due to CHDs and may decrease the financial burden on the healthcare system.
Acute coronary syndromes in black South African patients with human immunodeficiency virus infection
(2011-10-19) Becker, Anthony Charles
Background: South Africa is considered to be a country in epidemiologic transition with increasing rates of cardiovascular disease. In addition, it faces an HIV pandemic, with an estimated 5.5 million people infected and five hundred thousand HIV-related deaths annually. Current evidence suggests that patients infected with HIV are at a heightened risk for acute coronary syndromes (ACS) related to traditional cardiovascular risk factors, as well as factors related to the virus and its treatment (highly active anti-retroviral therapy (HAART)). HIV infection itself may independently predispose to coronary artery disease (CAD) by promoting endothelial dysfunction, a heightened pro-inflammatory state, dyslipidaemia and thrombosis, the aetiology of which is thought to be multifactoral in nature. Protease inhibitor (PI) therapy, as part of HAART, has the potential to induce an adverse metabolic phenotype, including: dyslipidaemia, insulin resistance, endothelial dysfunction and a prothrombotic state. The attributable risk of these factors in HIV-associated CAD and ACS is currently unknown, but it seems that the risk of ACS is increased by prolonged exposure to PI’s. No data currently exists on CAD in HIV patients not receiving HAART, which is problematic considering that this makes up the majority of patients in sub-Saharan Africa and that the combination of epidemiologic transition and HIV infection has the potential for greater cardiovascular morbidity, particularly with respect to atherothrombotic events. viii Aims: The aims of this thesis are twofold. Firstly, to confirm reports of epidemiologic transition in South Africa from a broad epidemiological perspective. Secondly, by focusing on treatment-naïve HIV positive black South Africans with ACS, it aims to determine differences compared to HIV negative patients with respect to demographics and risk factors, angiographic and treatment related factors as well as markers of thrombosis and inflammation with a view to providing more focused primary and secondary prevention. Methods: All the studies contained in this thesis were conducted in the Department of Cardiology, Chris Hani Baragwanath Hospital and adhere to the declaration of Helsinki. The first of the epidemiological studies, The Heart of Soweto (HOS) study (Chapter 3), was a prospectively designed registry that recorded epidemiologic data relating to the presentation, investigations and treatment of 1593 patients from Soweto with newly diagnosed cardiovascular disease during the year 2006. The second study (Chapter 4) was a cross sectional study of patients with ACS admitted to the Baragwanath coronary care unit over the year 2004 compared to the years 1975-1980. The HIV sub-study (chapters 5-8) was a prospective single centre study conducted from March 2004 to February 2008. During this time, 30 consecutive black HIV patients presenting with ACS (ACS+: HIV+ group) were enrolled. For each HIV patient with ACS, the first presenting non-HIV black patient with ACS was selected as a case control comparator (ACS+ : HIV- group). In addition, a second control group of 30 asymptomatic HIV patients, who were matched for age, sex and ethnicity (ACS- : HIV+ group), were recruited from the HIV clinic. The methodology used to compare the groups involved: clinical and demographic data collection, routine blood test evaluation, angiographic ix analysis and specific laboratory testing of various research blood parameters (including thrombotic screening and markers of inflammation and endothelial activation). Results: Chapter 3 presents the results of the large HOS study, which showed good evidence to support the theory of epidemiologic transition in Soweto. Adding to this data are the results of Chapter 4, which clearly demonstrate a substantial increase in the number of patients diagnosed with ACS at Baragwanath in recent years. Consistent with a population in epidemiologic transition, there was more than a ten-fold increase in the rate of coronary events over two decades, paralleled by increased rates of modifiable risk factors. Chapter 5 presents the clinical and angiographic data from the HIV sub-study. HIV patients with ACS were younger and had fewer traditional risk factors for CAD except for higher rates of smoking and lower HDL cholesterol levels. HIV patients had less atherosclerotic burden angiographically, but a higher thrombus burden in the infarct related arteries, suggesting a possible prothrombotic state. In addition, HIV patients had higher rates of in-stent restenosis of bare metal coronary stents at follow up. Chapters 6 and 7 present data on the thrombotic parameters between the groups, with Chapter 6 focusing mainly on coagulation pathways and Chapter 7 focusing on antiphospholipid antibodies (aPL). Chapter 8 presents data on levels of pro-inflammatory cytokines and endothelial activation markers. Greater evidence of thrombophilia was found in HIV patients with ACS as evidenced by lower Protein C (PC) levels, higher levels of Factor VIII and a higher inflammatory burden with greater degrees of endothelial cell activation - all of which increase thrombotic risk. Antiphospholipid antibodies were more prevalent in HIV patients but did not seem to be causal in the pathogenesis of thrombosis. x Conclusion: Soweto, a large, predominantly black urban area in South Africa, is in a state of epidemiologic transition, with an increasing prevalence of modifiable cardiovascular risk factors and ischaemic heart disease. Treatment-naïve HIV positive black patients presenting with ACS have different clinical and angiographic features compared to the HIV negative population. The patients are younger, more commonly male, with high rates of smoking, lower HDL levels and less atherosclerotic burden. However, there is a higher thrombotic burden, suggesting a prothrombotic state, which was evident by lower PC levels, higher factor VIII levels with a higher inflammatory burden and a greater degree of endothelial cell activation – all factors associated with a pro-atherogenic and prothrombotic state. The exact pathogenic role of HIV, independent of associated modifiable and non-modifiable risk factors, is difficult to determine, but may be important as a contributory factor in an already “vulnerable” patient. Importantly, we identified modifiable risk factors in the HIV group. Smoking may play a crucial role in the pathogenesis of ACS in these otherwise seemingly low risk patients and remains an important target for cardiovascular risk reduction. The role of HDL in the pathogenesis and prevention of HIV-associated CAD needs to be further defined, as does the role of drug eluting coronary stents in the prevention of in-stent restenosis. Cardiovascular risk assessment and appropriate primary prevention should be an important component in the management of HIV patients, regardless of treatment status. With the anticipated increase in CVD in South Africa, further research projects appropriate to the South African context will be vital in order to explore cost effective ways to provide primary and secondary prevention in order to effectively deal with the burden of epidemiological transition as well as the cardiovascular burden likely to be imposed by the HIV pandemic.
Children left behind: the effects of temporary labour migration on child care and residence patterns in rural South Africa
(2010-01-22T11:43:34Z) Kautzky, Keegan Joseph Michael
Background: The rural South African population is characterised by high and stable levels of male temporary migration and rapidly rising levels of female temporary migration, with approximately 60% of men and 20% of women between the ages of 20 and 60 years absent from the home for more than 6 months of the year. Despite the magnitude of this social phenomenon, limited research exists analysing its effect on child care and children’s residence patterns. Objectives: The purpose of this study is to examine temporary labour migration patterns as a household coping strategy in rural northeast South Africa in 2002 and 2007, describe characteristics of the children left behind, and to assess the effect of temporary migration on child care patterns, specifically analysing household variation in child care and residence by sex and refugee status of the migrant. Methods: An analytic cross-sectional study was conducted on approximately 83,000 individuals in 14,000 households in 25 villages of the Agincourt sub-district of the Bushbuckridge region of Limpopo Province. Data was collected in a special module on temporary migration incorporated into the annual Agincourt Health and Demographic Surveillance System census update in 2002 and 2007. Secondary analysis of the data utilised descriptive statistics and Pearson Chi2 tests of association. Results: The proportion of temporary migrants in the population rose between 2002 and 2007 and now constitutes nearly one-fifth of the population. Nearly three-quarters – 13% of the total population – are labour migrants. A slight increase in the proportion of female and Mozambican descent migrants is observed. Today, three-quarters of temporary labour migrants are male and one-quarter female, three-quarters are South African descent and more than one-quarter are Mozambican descent. Temporary labour migrants with children constitute nearly 6% of the total population. Temporary labour migrants overwhelmingly rely on a single care strategy. Complex care arrangements are far less common, constituting the response of only 5% of migrants. Highly complex care arrangements are rare, but do exist. Child care strategies are becoming increasingly complex over time for all migrants. Female migrants and migrants of South African descent are more likely than male and Mozambican descent migrants to rely on complex care arrangements. The overwhelming majority of migrants keep all children in the same household, maintaining relative stability in care and residence, 10% move children with them, 2% move children elsewhere for care and less than 1% move a childcarer into the household while they are away for work. Less stable child care arrangements are increasingly utilised over time. If the migrant is male, children are more likely to remain in the same household; if the migrant is female, children are more likely to move with the migrant. Approximately one-fifth of children in the population are effectively left behind by temporary labour migrants today, a decline from nearly one-third in 2002. There is significant variation in child care, residence and decision-making authority among relatives: mothers and stepmothers provide the majority of care in the absence of a migrant, with grandmothers a secondary and female siblings and aunts a tertiary source of child care.
Comparative in vitro study of two tooth bleaching systems: colour change and enamel surface effects
(2010-01-22T09:46:20Z) Grundlingh, Andries Adam
This in vitro study compares tooth bleaching and consequences of tooth surface effects of Ozicure Oxygen Activator (O3, RSA) with Opalescence Quick (Ultradent, USA) tooth bleaching. One hundred and thirty six teeth (canines, incisors and premolars), which were caries free, had no surface defects and within the colour range 1M2 and 5M3. Teeth were randomly divided into the three experimental groups: Opalescence Quick, Ozicure Oxygen Activator and control. The three experimental groups received three treatments of one hour each over three consecutive days. Tooth colour was assessed using the VITAPAN 3D MASTER TOOTH GUIDE (VITA, Germany) and VITA Easyshade (VITA, Germany). A randomized block design was used to assess tooth colour change. A General Linear Models test for analysis of variance for a fractional design with significance set at P<0.05 was used. Both bleaching methods significantly lightened the teeth, visually (P<0.0001) and digitally (P= 0.013). Tooth colour change was seen after the first hour of tooth bleaching; thereafter there was little or no benefit. The tooth type played a significant role in tooth colour change (visually P=0.0416 and digitally P=0.004). The quality of the spectrophotometer may account for the different results found compared to the tooth guide. Scanning electron microscopy showed no effect of enamel loss following bleaching. Atomic force microscopy showed a 2.5 rougher enamel surface with Opalescence Quick.
A descriptive retrospective record review of paediatric patients with intracardiac thrombi associated with dilated cardiomyopathy at Chris Hani Baragwanath academic hospital
(2016-02-09) Morar, Deksha Faye
Intracardiac thrombi associated with dilated cardiomyopathy in paediatric patients can be a source of significant morbidity and mortality. This study looked at the prevalence, risk factors and outcomes of children complicated by intracardiac thrombi, following a diagnosis of dilated cardiomyopathy at a tertiary centre. METHODS A retrospective review of all children, between the ages of 1 and 14 years, diagnosed with dilated cardiomyopathy from August 1983 to July 2011 were assessed using the paediatric cardiology database at Chris Hani Baragwanath Academic Hospital. The study population comprised of 303 children. RESULTS The prevalence of intracardiac thrombi in the children with dilated cardiomyopathy was 13.2% (40 children). The majority were located in the left ventricle (80%). The children who developed intracardiac thrombi had a lower fractional shortening compared to the group without intracardiac thrombi (p≤0.05). 20 of these children (6.6%) had evidence of embolization (15/20 to the central nervous system). 52 of the 303 children were HIV positive (17.2%). There was no statistically significant association between HIV status and the development of intracardiac thrombi (p = 0.19). The overall mortality was 8.9%. 12 of the 27 deaths occurred in the intracardiac thrombi group showing that the children with intracardiac thrombi had a poorer outcome (p≤0.05). CONCLUSION Intracardiac thrombi is a common occurrence in paediatric patients with dilated cardiomyopathy. There is a significant relationship between the development of intracardiac thrombi and a poor fractional shortening. Patients with echocardiographic evidence of intracardiac thrombi have a worse outcome.
The effect of a scissor skills program on bilateral fine motor skills in preschool children in South Africa including skill improvement, equivalence, transferability of skills and skill retention
(University of the Witwatersrand, Johannesburg, 2010-01-27T12:43:24Z) Ratcliffe, Ingrid
The purpose of this study was to assess the improvement of scissor skills after a graded scissor skills program in preschool children in South Africa (SA). A bilateral fine motor skills assessment tool was developed for use in this research. This task-based assessment included every day activities required at school as well as personal management items. This research phase included the development of the test items and test instructions, scoring as well as validity and reliability testing of the assessment. A suitable scissor skills program was then developed for Grade 0 children in South Africa. The program was validated by a pilot study and also by a focus group of occupational therapists. Some changes were made to the picture selection, the grading of the program, as well as to teacher instructions on how to present the program before it was finalised and ready for use in the implementation phase of the research study. The implementation phase of the study included the individual assessment of 149 learners (mean age of 5 years 6 months), from three different schools in South Africa. The main aim was to establish the effectiveness of the scissor skills program by measuring skill improvement, transferability of skills and skill retention. A further aim was to compare the difference of skill levels of learners from various socio-economic backgrounds in South Africa. The results showed statistically significant improvement in scissor skills in all groups from the three different schools, as well as an ability to retain the learnt skills. Participants from lower socio-economic backgrounds demonstrated the least skill initially but made the greatest gains during the program, at times decreasing the gap between themselves and other participants. It was concluded that children benefited from a graded scissor skills program, which allowed them to improve and retain their scissor skills but improvement did not transfer to other fine motor tasks.
The identification of differentially expressed cell cycle -related genes in breast and colon cancer cell lines in response to chemotherapeutic drugs
(2010-01-27T11:15:07Z) Rupnarain, Charleen
With the high prevalence and high mortality rate of cancer in the global community, it is increasingly essential to accelerate our understanding of the disease, to identify new genetic targets for therapy, and to pursue avenues for improving on the therapies in development and in current use. The aim of this study is to identify cell cycle-related genes whose expression is influenced by the chemotherapeutic drugs curcumin, SAHA, lycopene and thalidomide in breast and colon cancer and normal cell lines. These drugs are currently not in clinical use for cancer in South Africa, and while there have been investigative studies of these chemotherapeutic agents, this study aims to identify the specific genes that are influenced by the drugs. The result of this is that several genes that were not previously documented as targets of these drugs are highlighted. The cell cycle pathway is the area of focus as loss of regulation in the cell cycle is one of the important factors involved in promoting cancer initiation and progression. In the first instance, flow cytometry was used to identify optimal drug concentrations relative to the cell cycle stages. Following this, alterations in gene expression were assessed using a PCR-based differential display after each drug treatment. Subsequently, a more focussed approach was taken in a PCR-array analysis of panels of cell cyclerelated genes. A subset of genes is identified that is implicated in oncogenic transformation in breast cancer. This has the potential to inhibit the genetic pathways involved in breast malignancy by providing targets that perhaps may not be manipulated in current therapies. The gene expression studies here suggest that lycopene and thalidomide function in inhibiting this transformation, and play significant roles in suppressing the oncogenic state of breast cancer. Curcumin and SAHA also exhibit important functions in inhibiting tumourigenesis in colon cancer. While the results propose that the drugs have clear roles in inhibiting breast and colon cancer, they are also implicated in promoting cancer. This research has defined the genes that must be carefully monitored during drug administering as they may promote these and other cancers. The availability of these results to researchers will aid in selecting the criteria for assessing the success rate of these drugs.
The in vitro and in vivo effects of Bulbine frutescens and Bulbine natalensis on cutaneous wound healing
(2010-01-27T13:28:12Z) Pather, Nalini
In recent years, there has been a growing interest in natural and traditional medicines for the treatment of wounds. Attempts to find agents that promote wound-healing and that are affordable, effective and non-toxic have a long history. In South Africa, hundreds of different indigenous plants are used to treat wounds and burns. The merits of relatively few of these have been scientifically evaluated. Bulbine natalensis and Bulbine frutescens of the Asphodelaceae family are indigenous to southern Africa and are widely used as a skin remedy. This study aimed to investigate the in vitro and in vivo effect of Bulbine natalensis and Bulbine frutescens on cutaneous wound healing. In vitro cell culture study: In vitro studies were carried out on dermal fibroblasts and human keratinocytes cultured under standard conditions using Iscove’s Modified Eagles Medium (MEM) and Dulbecco’s MEM respectively. Confluent cultures of both cell lines were treated with varying concentrations of the leaf extracts of B. frutescens and B. natalensis. These cultures were subjected to the MTT, WST-1 and BrdU assays to determine the cytotoxicity and proliferation effect of the extracts. In addition, migration of cells across a score was analysed over a 48 hour period. In vivo animal study: Excisional and incisional wounds were created on the back of 12 domestic pigs. Mirror imaged wounds were created as control wounds. The excisional wounds were biopsied at days 2, 4, 7, 10 and 16 and the incisional wounds were biopsied at day 16. The rate of closure of the wounds was also recorded. Each excisional wound was analyzed for its biochemical composition by estimating the total amount of protein, DNA, collagen and hexosamine that was present in the wound tissue. The wound healing process was documented histologically (using haematoxylin and eosin and a Mallory’s trichrome stain) and immunohistochemically (using anti- α smooth muscle actin, vascular endothelial growth factor WitsETD and transforming growth factor β receptors I and II). The incisional wounds were used to test tensile strength of the healed wounds using a tensiometer.In the in vitro studies, neither extract caused cytotoxicity to either the fibroblast or keratinocyte cells. Cell proliferation was greater than 100% at 0.1-5 and 100-300 μg/ml for Bulbine natalensis and at 0.1μg/ml for Bulbine frutescens. There was no significant difference in the effects of the two leaf extracts on cell proliferation. The biochemical analysis of the wound tissue showed a significant increase in the collagen, protein and total DNA content of both B frutescens and natalensis treated wounds when compared to the untreated wounds. There was no significant difference in the hexosamine content of both B. frutescens- and B. natalensis-treated and untreated wounds. Analysis of the wound tissue displayed an increase rate of closure of the wound tissue treated with B. frutescens and B. natalensis when compared to the untreated wounds. Full re-epithelialisation of both treated wounds occurred earlier than in the untreated wounds. These findings have important implications for the use of these extracts to treat wound healing.
Is there an association between bacterial vaginosis infection and HIV-1 infection acquisition among women aged 18-35 years in Soweto
(2010-01-29T06:57:47Z) Chimbatata, Nathaniel Weluzani Banda
BACKGROUND Studies suggest an association between Bacterial Vaginosis (BV) and HIV infection; however, its temporal effect has not been greatly investigated. METHODS This is a secondary data analysis of a cohort study: set out to describe the association between BV infection and HIV acquisition. There were 750 participants enrolled in the primary cohort study. The main exposure, BV, was measured from a gram stain slide prepared from a vaginal swab. The slide was read in a laboratory qualitatively and scored by Nugents scoring. A score of 7 or above was considered positive for BV. The outcome variable (HIV) was determined by dual rapid tests and confirmed in the laboratory by a third generation ELISA. Descriptive statistics was done to describe demographic characteristics and the prevalence of BV and STIs. HIV incidence rate was calculated. Kaplan Meier survival time analysis and log rank test for significance were performed. Cox regression (univariate and multivariate) was done to determine association of BV with HIV infection. RESULTS The baseline prevalence of BV was 52 %, 95 % CI; 45 – 59. There were 21 HIV seroconversions experienced of which 7 had BV results missing and were excluded in the analysis. The remaining 14 seroconversions were followed for a mean time of 0.40 of a year and accumulated follow up time at risk of 286 person years, this represented an HIV incidence rate of 4.9 per 100 person years of follow up, 95 % CI: 2.9 – 8.27. Kaplan Meier curves revealed a higher risk of HIV-1 acquisition among women who were BV positive than the women who were BV negative. A log rank test showed that the v probability of seroconversion was different among the women depending on BV status, chi-square value 3.8, p 0.05. Controlling for confounding variables, seroconversion was high, but not significant, among BV positive women, adjusted hazard ratio 3.21; 95 % CI; 0.85-12.12, p value 0.08. CONCLUSION This study suggests that BV increases HIV seroconversion risk though statistical significance was not achieved. Vaginal cleansing education, screening and treating women with BV could maintain normal vaginal flora and reduce their susceptibility to HIV.
Knowledge, attitudes and reported practices of general practitioners related to adult female patients with urinary incontinence in greater Johannesburg
(2010-01-28T08:09:44Z) Padayachey, Moganambal
BACKGROUND There is an extraordinary common medical condition that affects millions of people, mostly women. It is associated with high levels of disability, discomfort and loss of productivity. People seldom talk about it and suffer in silence and have a fear of being ridiculed or embarrassed. It is not breast cancer, nor osteoporosis, nor heart disease nor is it depression. It is urinary incontinence – the loss of bladder control, which affects the lives of millions of people globally. General Practitioners (GP‟s) do not have a good knowledge about the topic and are therefore not managing Urinary Incontinence (UI) appropriately. AIM To assess the knowledge, attitudes and reported practices of general practitioners related to adult female patients with urinary incontinence in Greater Johannesburg. OBJECTIVES To determine the demographics of the respondents belonging to the various Independent Practitioner Associations (IPA's). Variables include age, sex, year qualified, postgraduate qualifications, and the number of years in clinical practice. To determine the demographics of the respondents practice. Variables include, age distribution, gender distribution, and the number of patients seen with urinary incontinence per month. To determine the knowledge of the respondents regarding urinary incontinence in adult females. Variables include prevalence, aetiology, types of urinary incontinence, associated risk factors and reversible factors. v To determine the attitudes of the respondents regarding urinary incontinence in adult females. Variables include feelings of empathy, frustration, etc. To determine the management of the respondents regarding urinary incontinence in adult females. Variables include access of referral facilities, screening, examination, investigation, and medication. METHODS The study was done amongst the Independent Practitioner Associations in the greater Johannesburg area. A questionnaire was administered to GP‟s attending IPA meetings, data was collected with regards to the demographics of the GPs and their practices as well as the knowledge, attitudes and reported practices of the GPs. RESULTS The response rate cannot be calculated as the number of GPs who attended the IPA meetings is not known. One hundred and thirteen respondents met the inclusion criteria for the study. The data was collected over a 10-month period during 2006. Males accounted for 76 (68.5%) and females for 35 (31.5%) of all respondents. Two (1.8%) respondents had three postgraduate qualifications, 11 (9.7%) respondents had two postgraduate qualifications and 38 (33.6%) respondents had one postgraduate qualification. The prevalence of patients with UI was higher amongst female respondents, 33 (97.1%) as compared to male respondents 67 (88.2%). Feelings of empathy was experienced by 94 (88.7%) respondents and 81 (81%) respondents would never avoided the discussion about UI with patients. Most respondents rated their knowledge on aetiology 82 (78.1%), diagnosis 79 (73.8%), investigation 58 (54.2%) and management 58 (54.7%) as good and very good.
Occupational health and safety activities of Port Elizabeth's integrated Department of Labour Inspectorate in 2005
(2010-01-28T07:06:42Z) Huna, Bulelwa Daniswa Denise
This study was aimed at describing the nature of Occupational Health and Safety (OHS) inspections and blitzes conducted in the Port Elizabeth Integrated Department of Labour (DoL) in 2005, the nature and number of prohibitions, contraventions, as well as improvement notices issued. The objectives were to determine the number of OHS inspections conducted in the Port Elizabeth Labour Centre (PELC) in 2005; to describe the nature of the inspections and the type of industries inspected in the PELC in 2005; and to determine the frequency and nature of prohibitions, contraventions and improvement notices issued. The data was obtained from the PELC. The results of the study revealed that the inspectorate conducted a total of 1258 and this exceeded the target of 800 OHS inspections for the PELC. However, it is questionable how this target was developed. The target is not representative and does not give an overall picture of conditions in the workplace. The results indicated that inspectors were not competent in conducting boiler inspections as well on Major Hazardous Installation (MHI) since none of these inspections were conducted. On the inception of the OHS task team, there was a sudden increase in inspections conducted in the construction industry in October 2005 as well as the rate of finalisation of incidents in November 2005 and this was attributed to the fact that they were not conducting inspections on other labour laws and were only focusing on OHS. An assessment of the inspectors’ inspection checklists revealed that the inspections were being reduced to just a yes or no tick exercise, with no recommendation on appropriate action to be taken by the employer. It became evident that the inception of a special team in September 2005 contributed to an increased number of OHS inspections, since they were only focusing on OHS issues. This team ensured that in November 2005 there were 43 incidents finalised as compared to the 101 finalised over 11 months. They also ensured that a total of 258 OHS inspections were conducted from September 2005 to December 2005. Although these inspectors were not fully competent in addressing health and s afety issues their momentary focus on OHS activities ensured that they made a difference in the rate of finalisation of incidents. However, when some of the cases were taken to court no successful prosecution could be obtained because there are no OHS focused prosecutors, which have a clear understanding of Act. Discussions with the inspectors revealed that there was a lack of morale and loss of interest in their work, thus causing them not to put in much effort. These discussions revealed that this lack of morale was caused by the frustrations they often experienced in the execution of their duties due to lack of training as well as lack of cooperation from the employers. Furthermore, the inspectors revealed that the great number of resignations from inspectors who were leaving for greener pastures left them with a lot of work with no financial incentive. It also became apparent that there was no objective strategy underlying the number of inspections required relative to the purpose of the inspections, taking into account the nature and complexity of the industry that is to be inspected. The failure of the Service Delivery Unit to give a direction on how qualitative inspections should be measured demoralised them because the focus was only on the quantity (240 inspections per annum) of inspections that are to be conducted by each inspector. It is recommended that training, which should include a proper career path be conducted for inspectors to improve the inspectors’ capability and to motivate them. Strong relations with the South African Police Services and the Department of Justice should be promoted to ensure effectiveness of service delivery. These relations will ensure that inspectors are readily assisted by the police when they deal with uncooperative employers. Training of prosecutors will ensure that they understand the OHSA and its implementation and therefore effectively defend cases that are taken to court. The targets set for inspections should be scientifically supported and take into account the nature and complexity of the production processes. Lastly, revision of salary packages should be looked into to ensure retention of competent staff. The above recommendations will only be effective if the Business Unit Manager and the Regional Manager address them through the National Department of Labour since their implementation will affect all inspectors.
Providers' responses to the patients' rights charter in South Africa: a case study in policy implementation
(2010-01-28T11:52:57Z) Raphaely, Nika Thandiwe
Abstract The Patient Rights’ Charter is one of several progressive health policies in South Africa with disappointing implementation in practice. Barriers to implementation have already been described. Policy analysis theory and empirical studies suggest that power and resistance may contribute to implementors’ responses to policies. This secondary analysis of existing semistructured interviews with health providers in Limpopo explicitly examined the influence of power and resistance on their implementation of the Patients’ Rights Charter. Open coding yielded themes of implementation experience, to which a deductive analysis applied a heuristic framework, derived from the literature, to examine power and resistance. The critical importance of implementors in translating policy into practice, and of discursive manifestations of power, were reiterated. Resonances in the data of the functionalist ‘sick role’ brought together surveillance, expert knowledge and the loss of health workers’ influential voice, in a way not previously discussed. Implications for future management strategies are considered.
A radiation dose review for paediatric fluoroscopy in an Academic South African referral hospital
(2017) Venter, Mauritz
INTRODUCTION Children are more sensitive to radiation and it is therefore important to reduce their exposure. There are currently no published data on South African paediatric fluoroscopic upper GIT, contrasted enemas and vesico-urethrogram dosage reference levels. AIM To determine the dose area product (DAP) values in common paediatric fluoroscopic examinations: Upper GIT studies, contrasted enemas and vesico-urethrograms. The primary endpoint was comparing our median and upper third quartile DAP values to international standards. METHOD We adhere to the Radiological Society of South Africa (RSSA)/South African Society of Paediatric Imaging’s (SASPI) guidelines to minimise radiation exposure. The upper third quartile and mean DAP values were collected between March 2013 and March 2016 for each study, categorised into four age groups (0–1, 2–5, 6–10 and 11–15 years) and stratified by our three major examinations. The data were compared to literature from the National UK Radiological Protection Board. RESULTS DAP values for upper GIT studies were significantly lower in the three younger age groups. There was no significant difference in the oldest age group. DAP values for vesico-urethrograms were significantly lower in the youngest age group. There was no significant difference in the three older age groups. For our contrasted enemas, there were no suitable data for comparison. CONCLUSION By following the RSSA / SASPI guidelines, our overall DAP values compared better than the UK National Patient Dose Database in the younger age groups and no worse in the older age groups.
The right of access to health care services in South Africa: a critical analysis of the realisation of the right
(2010-01-28T13:36:29Z) Peter, Lulamile Lester

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