South African Family Practice - latest Issue
Volume 58, Issue 4, 2016
Author Gboyega A. OgunbanjoSource: South African Family Practice 58 (2016)More Less
On 10 December 2015, South Africa's Health Minister Dr. Aaron Motsoaledi, released the long awaited National Health Insurance (NHI) White Paper (version 40) providing the background and justification of the country's moves to join other countries like Brazil, United Kingdom and Thailand in introducing universal healthcare coverage. The document explains that healthcare in South Africa is comprised of a two-tiered system divided along socio-economic lines. The private medical aid sector comprising of 83 medical aid schemes that fund healthcare services for about 16 percent of the population. The paper noted that spending through medical schemes in South Africa is the highest in the world and is six times higher than in Organisation for Economic Co-operation and Development (OECD) countries. The White Paper clearly states that the NHI will deliver a comprehensive package of health services that include services such as rehabilitation and palliative care, mental health care including that related to substance abuse and maternal and child health care.
Source: South African Family Practice 58, pp 5 –8 (2016)More Less
Major depressive disorder (MDD) is an insidious disease and affects up to 15% of the global population. Although MDD responds to a wide range of pharmacological treatment options, a number of factors, i.e. not adhering to treatment for at least 4-12 months, contribute to antidepressants not being highly effective. In an attempt to aid clinicians in improving the adherence rates among MDD patients, the current paper will divulge in more detail the possible explanations of why individuals with MDD find it difficult to adhere to prescribed regimens.
Source: South African Family Practice 58, pp 10 –14 (2016)More Less
Erectile dysfunction (ED) is a trivial condition with a prevailing incidence worldwide. Phosphodiesterase-5 inhibitors (PDE-5) have revolutionised the treatment of ED and are regarded as one of the most successful drug groups in modern medicine. Generally PDE-5 inhibitors are well tolerated and the incidence of side-effects is low, however a small percentage of individuals experience headache, flushing and abdominal discomfort, resulting in discontinuation of therapy. This has led to the development of second generation PDE-5 inhibitors, displaying more selectivity for the PDE-5 enzyme thereby reducing treatment interruption and improving compliance. Several other treatment modalities, including testosterone replacement therapy and prostaglandin administration are available for resistant or failed first-line treatment. This review provides an update on the current, and future, available drugs used in the management of ED.
Source: South African Family Practice 58, pp 16 –21 (2016)More Less
Obesity is a growing phenomenon and a global concern. It is well-known that it plays a significant role in the development of several preventable diseases. The physiological mechanisms in regulating energy intake and expenditure are complex and remain a target area for current and future research. The absence of a golden standard in determining the body's composition provides for various measurement techniques, each with its own advantages and disadvantages. Lifestyle changes and reduced caloric intake form the backbone of any pharmacological intervention. A myriad of therapeutic agents are available which offer the provision for individualised treatment.
Author G.L. MuntinghSource: South African Family Practice 58, pp 22 –25 (2016)More Less
In the past 10 years or so, many alternatives to warfarin have been developed the first being the novel oral anticoagulants (NOAC) or better referred to as direct oral anticoagulants (DOAC) or target-specific oral anticoagulants (TSOAC). These drugs have some definite advantages and disadvantages that should be clear to physicians before prescribing any of them for patients. Many clinical trials have provided definitive information about the efficacy and safety of DOACs, yet many physicians remain sceptical about prescribing these drugs due to lack of answers to real world questions. The concerns are directed towards appropriate patient selection (the choice should be made according to age, renal function, compliance, cost, clinical condition, intake of other drugs), the mechanism of switching between agents, how these drugs affect routine laboratory tests and when monitoring is needed. Knowledge of other drugs that interact with the DOAC and management of severe bleeding will be reviewed and recommendations will be given to all of these concerns.
Author Oppel B.W. GreeffSource: South African Family Practice 58, pp 27 –29 (2016)More Less
About 60 - 80% of patients visiting their family practitioner have at some stage in their lives suffered from low back pain. The annual incidence in adults aged 35 - 55 years in developed countries is up to 45%. The differential diagnosis is broad and includes muscular strain, primary spine disease like discherniation or degenerative arthritis, systemic diseases like metastatic cancer and regional diseases like aortic aneurisms. In the majority of cases, a specific diagnosis can not be made. Most patients will improve in 1 - 4 weeks and will only need treatment for the acute symptoms after the initial history and physical examination. If, however, the pain recurs or gets worse, the patient must be thoroughly examined and specific diagnosis can become a challenge.
Source: South African Family Practice 58, pp 31 –34 (2016)More Less
Neuropathic pain affects a large proportion of the population and reduces a person's ability to perform optimally. In South Africa, there are a host of factors that hinder the correct diagnosis and treatment of neuropathic pain. Patients suffering from neuropathic pain are treated sub-optimally with NSAIDS and opioids as first-line therapy. In 2012, a South African guideline on neuropathic pain was released, which stated that opioid therapy should be reserved for last-line treatment only. More recently, melatonin, commonly known as the neurohormone that regulates the circadian rhythm, has come to light as a therapeutic treatment option in the neuropathic pain setting. Early clinical trials showed a link between melatonin and chronic pain, which includes neuropathic pain. The MT2 receptor has also been specifically linked to the control of neuropathic pain and inflammation.
Source: South African Family Practice 58, pp 35 –39 (2016)More Less
On a regular day, healthcare providers will be contacted by one or more health seekers presenting with cough as a symptom. Cough has been considered an important physiological reflex that protects the airways from aspiration of foreign materials. Cough is one of the most common symptoms for which people seek medical attention from their healthcare practitioners. The common classifications for cough include acute, sub-acute and chronic cough. Such classification is time dependant. Acute cough is generally self-limiting, while subacute and chronic coughs have various different causes. There are many different causes of cough, and the common causes of persistent coughs include: upper airway cough syndrome, asthma, gastroesophageal reflux disease (GORD) and even pharmacological therapy. There are other important causes of chronic cough especially in the Southern African region that include: pulmonary tuberculosis (TB), environmental diseases, and others, which will not be covered by this article. Management of subacute and chronic coughs should be individualised according to their cause. Currently, there is no evidence to suggest acute coughs need to be treated. Moreover, there is poor evidence to recommend the use of over the counter (OTC) cough syrups in the management of acute coughs.
Source: South African Family Practice 58, pp 40 –42 (2016)More Less
Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane
Investigation of the coexistence of CKD and non-communicable chronic diseases in a PBM company in South Africa
Anti-epileptic prescribing patterns in the South African private health sector (2008-2013)
More than scales and tape measures needed to address obesity in South Africa
The role of locus of control in nyaope addiction treatment
Self-reported knowledge and use of emergency contraception among women presenting for termination of pregnancy
Source: South African Family Practice 58, pp 43 –48 (2016)More Less
The series, "Mastering your Fellowship", provides examples of the question format encountered in the written examination, Part A of the FCFP (SA) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.
Author Chris EllisSource: South African Family Practice 58 (2016)More Less
I was in one of the first groups of private general practitioners to volunteer to work for the new National Health Insurance clinics. As I trained in the British NHS and first went into an NHS clinic practice over 45 years ago I was interested to revisit primary care practice. The work, I found, was very rewarding but unfortunately after a year I had to give up my sessions due to my own ill health. I am going to select just one clinical condition, hypertension,to illustrate gaps that appeared in my knowledge of current primary care practice. It was surprising to see so many morbidly obese patients, mainly female, with hypertension. Their weights were between 90 to 130 kg or above and their BMIs were usually above 35, a reasonable number over40 and a few above a BMI of 50.