CME : Your SA Journal of CPD - Volume 30, Issue 4, 2012
Volume 30, Issue 4, 2012
Author Bridget FarhamSource: CME : Your SA Journal of CPD 30 (2012)More Less
Environmental sustainability is one section of the United Nations Millennium Development Goals. Within this section, Goal 7 is to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. Recently the UN has claimed that this goal has been met three years early. But has it?
Source: CME : Your SA Journal of CPD 30 (2012)More Less
The role of the primary care medical practitioner in the management of mental illness has recently received increased emphasis and is likely to become even more important in the future. National policy on mental health focuses on increasing the integration of mental health services into primary care, with the latter becoming the main point of service delivery for the vast majority of persons with mental illness.
Source: CME : Your SA Journal of CPD 30, pp 110 –113 (2012)More Less
Approximately 35 million people worldwide have dementia and this number is predicted to increase to 115 million by 2050. Behavioural and psychological symptoms of dementia (BPSD) are a common complication of dementia and between 70% and 90% of people with dementia will experience BPSD at some point during their illness. BPSD results in significantly greater caregiver burden, higher health-related economic costs, poor quality of life and premature placement in nursing homes. The presence of BPSD has also been associated with disease progression and greater cognitive decline in Alzheimer's dementia (AD). Recognition of BPSD by the healthcare provider forms a central component of the management of patients with dementia syndromes. This article aims to provide clinicians with an overview of BPSD and an approach to management, incorporating both non-pharmacological and pharmacological strategies.
Author Wendy VogelSource: CME : Your SA Journal of CPD 30, pp 114 –117 (2012)More Less
'Depressive disorders are often familial recurrent illnesses associated with increased psychosocial morbidity and mortality. Early identification and treatment may reduce the impact of depression on the family, social, and academic functioning ... and may reduce the risk of suicide, substance abuse and persistence of depressive disorders into adulthood. Evidence supported treatment interventions have emerged in psychotherapy and medication treatment of childhood depressive disorders that can guide clinicians to improve outcomes in this population.'
This article aims to highlight current best practice in the management of major depression in children and adolescents. Mood changes with feelings of sadness, misery and unhappiness are common after disappointments or stressful life events, and usually the child or adolescent adapts. A persistent change in mood with deterioration in functioning is the central feature of depression.
Source: CME : Your SA Journal of CPD 30, pp 118 –121 (2012)More Less
Whereas the majority of trauma survivors recover without clinical sequelae, 10 - 20% of these individuals develop the syndrome of post-traumatic stress disorder (PTSD). In the USA, the National Comorbidity Survey estimated that between 5% and 9% of the general population suffer from PTSD. In the primary healthcare setting the prevalence of PTSD is estimated to be two to three times higher. The South African Stress and Health Study (SASH) - the first large population-based study of mental disorders in South Africa - found anxiety disorders, as a class, to be the most prevalent 12-month and lifetime disorder, while the 12-month prevalence of PTSD was 2.3%.
Author Don WilsonSource: CME : Your SA Journal of CPD 30, pp 122 –126 (2012)More Less
This article focuses on a pragmatic approach to the assessment of alcohol dependence and an overview of some of the most effective interventions. The acute medical management of the withdrawal process is beyond the scope of this article. This article concentrates on alcohol dependence, as this is the most common addiction. In turn, as most of the non-pharmacological interventions can be used in the general management of all addictions, regardless of the specific drug of abuse, we also focus on some of these interventions that have an established evidence base. In South Africa the goal of treatment is usually abstinence, but there is ongoing debate about moderation in alcohol use versus abstinence, particularly in managing the young individual on the path to dependence.
Author Tuviah ZabowSource: CME : Your SA Journal of CPD 30, pp 127 –130 (2012)More Less
There is an extended responsibility to the mentally ill vulnerable person over and above clinical care. The medical practitioner must recognise his or her involvement in making decisions pertaining to health and personal issues, which are dependent on the ability of the patient to function in various areas. Competence may be considered as the umbrella concept on which all other issues are dependent. The concept of competency is viewed differently from clinical and legal aspects. Some international jurisdictions have introduced more specific guidelines for recording mental capacity in legislature, indicating that legal guidelines are considered important. The ability to contract, including making a will, requires a satisfactory level of functioning.
Source: CME : Your SA Journal of CPD 30, pp 131 –133 (2012)More Less
The last 10 years have seen exciting developments in the availability of new evidence-based treatments for depression. This includes the registration of new antidepressants (ADs) as well as new information about the effectiveness of ADs and psychological therapies. Many 'alternative' therapies, including exercise, herbal remedies, green tea and massage therapies, are promoted for depression, but discussion of these is beyond the scope of this article. Most new literature and conference proceedings focus on new drugs and treatment-resistant depression, leaving little room for questioning some of the basic assumptions. Evidence-based methods of review and the global access to information through the internet have led to new questions and information about the treatment of depression.
Author T. HendersonSource: CME : Your SA Journal of CPD 30, pp 134 –137 (2012)More Less
Primary insomnia is a common condition, occurring at a rate of approximately 10% in its chronic form in the general population. It often starts with a specific problem, such as loss of a job, or a change in sleep patterns, e.g. with childbirth. It is often co-morbid with other psychiatric disturbances where the insomnia predates the other psychiatric symptoms. Advancing age is associated with reduced amount of sleep, reduced sleep efficiency and more awakenings. Women are twice as likely to develop insomnia as men. The condition becomes chronic when perpetuated by the following factors: anxiety about sleep, maladaptive sleep habits, underlying vulnerability in sleep-regulating mechanisms and persistence of the precipitant stressor.
Source: CME : Your SA Journal of CPD 30, pp 138 –143 (2012)More Less
Bleeding associated with caesarean section (CS) was the most common causal subcategory of maternal deaths from obstetric haemorrhage in South Africa in 2008 - 2010, accounting for 180 (26.2%) of the 688 maternal deaths due to haemorrhage. It has increased as a cause of death compared with previous triennia, and this is a cause of great concern. Related morbidities included obstructed labour, previous CS, abruptio placentae and placenta praevia. The majority of these deaths were clearly avoidable. The deaths occurred at all levels of public hospital and some at private hospitals, with the largest numbers at district hospitals, where the majority of CSs in SA occur.
Source: CME : Your SA Journal of CPD 30, pp 144 –145 (2012)More Less
Nicotine patches don't help pregnant smokers
Meta-analysis of individual patient data in randomised trials of self-monitoring of blood glucose in people with non-insulin treated type 2 diabetes
Offer medical treatment first for adults with stable coronary artery disease
Women can deliver safely without controlled traction on the cord
Second-line treatment failure most often due to poor adherence in low- and middle-income countries : AIDS briefAuthor Carole Leach-LemensSource: CME : Your SA Journal of CPD 30, pp 146 –147 (2012)More Less
Poor adherence rather than drug resistance appears more likely to be the cause of virological failure among patients on second-line antiretroviral therapy (ART) in resource-poor settings, according to a systematic review and meta-analysis published in the advance online edition of AIDS.