South African Family Practice - Volume 49, Issue 2, 2007
Volume 49, Issue 2, 2007
Medical students' attitudes towards the primary healthcare approach - what are they and how do they change? : original researchSource: South African Family Practice 49 (2007)More Less
Background: The context of the research presented in this article is the new MBChB curriculum at the University of Cape Town (UCT) that has been in operation since 2002. This new curriculum is primary health care (PHC) driven and puts emphasis on the integration of biological and psychosocial elements. The context of curriculum reform at UCT can be placed within the broader South African context, in which the South African Department of Health has made a commitment to the PHC approach. The aim of this research was to provide an understanding of medical students' attitudes towards the PHC approach. The findings presented in this article form part of a broader set of findings for a PhD research study aimed at qualitatively exploring medical students' attitudes towards and perceptions of PHC.
Methods: A qualitative approach was used and focus groups and interviews were conducted with second-, third- and fourth-year medical students at UCT. A total of 82 students were purposively selected to participate in the research. A content analytic approach was used to analyse the focus group and interview data.
Results: The students generally had a positive attitude towards the PHC approach and were positive about UCT's decision to promote this approach. Some, however, were concerned about the international relevance and status of their degree, and concerns were also raised about the contrast between the theory and reality of the approach, with many labelling PHC as idealistic. The students' responses indicated that their attitudes towards the PHC approach were open to change during the course of their academic career and were influenced by a range of factors. Some of these factors are related to the medical school environment, such as the PHC approach itself, how PHC is taught, and the views of other students and staff at UCT. Other factors that were not related to the university included personality, the students' background and exposure to health facilities, and clinical exposure outside UCT.
Conclusion: These findings raise the question of whether students are able to think and feel positively about the PHC approach, but not actually internalise the philosophy of the approach. The students' struggle with the incongruence between what is perceived as the idealistic theory of PHC and the reality of health care in South Africa is also an issue that needs to be acknowledged. These issues have international relevance, and are particularly significant in South Africa, where a commitment has been made by the South African Department of Health to the PHC approach and where doctors are set to play a vital role in its implementation and success.
The profile of the overdose patient presenting at Paarl Hospital Emergency Department : original researchSource: South African Family Practice 49 (2007)More Less
Background: Overdose is a common problem often seen in emergency departments in South Africa. A subjective evaluation by doctors and nurses at Paarl Hospital indicated that there was a high incidence of patients who had overdosed presenting at this hospital. They found this distressing and felt that there should be an enquiry into the phenomenon. The aim of this study was to determine the profile of the overdose patient presenting at Paarl Hospital, the number of cases per day of the week and per month of the year, which drugs were used most commonly, as well as the seriousness of the incident. The study also looked at whether the hospital's policy regarding psychiatric evaluation protocol was being followed. Finally, some recommendations were made concerning possible intervention efforts.
Methods: A review was done of cases involving all patients with overdoses presenting at Paarl Hospital during the period 1 July to 31 December 2005. Data was collected from 196 medical records using a data collection form.
Results:The frequency of overdoses at Paarl Hospital was found to be 1.13 cases per day. The results of the study showed that most patients were females with an average age of 27.3 years. Most patients were either unemployed or scholars from low socio-economic circumstances. Tricyclic antidepressants and paracetamol were the drugs used most commonly and 42.3% of the patients took more than one drug. Few cases of overdose resulted in serious morbidity, with only 8.5% admitted to high care. In most cases the attending doctors followed the policy of the hospital regarding psychiatric evaluation.
Conclusion: Possible preventative interventions should focus on educational initiatives in communities. Patients should be educated about the dangers of their medication and that all medication should be kept out of reach of children and preferably be locked away. Doctors should take note of the drugs most commonly used for overdosing and should be more cautious when prescribing these drugs. It is preferred that patients be seen by the social worker before being discharged, since there is no control over whether the patient will keep his / her appointment at the day hospital. The social worker should be adequately trained to identify patients needing psychiatric evaluation and be able to refer them to the appropriate mental healthcare practitioner.
Seroprevalence of HIV and frequencies of haemoglobin genotypes, ABO and Rh blood groups, among premarital couples in Port Harcourt, Nigeria : original researchSource: South African Family Practice 49 (2007)More Less
Background: Premarital screening is fast gaining ground as a prerequisite for the solemnisation of holy matrimony by many faith-based organisations in Nigeria, yet there is scanty literature on the subject.
Methods: Fifty (50) premarital heterosexual couples (50 males and 50 females) were screened for the presence of human immunodeficiency virus (HIV), haemoglobin genotypes, and ABO and Rh blood groups using standard laboratory procedures.
Results: The prevalence of HIV in this study was found to be 2.0%. The frequencies of the haemoglobin genotypes were as follows: HbAA (72%), HbAS (26%) and HbAC (2.0%), while that of ABO and Rh blood groups were: group A (22%), B (14%), AB (0%), 0 (64%), Rh 'D' positive (96%) and Rh 'D' negative (4.0%). The distribution of these variables between the sexes was statistically significant (c2 = 21.630, p < 0.01). The frequencies of the haemoglobin genotype combinations of the intending couples were as follows: HbAA/AA (52%), AA/AS (36%), AA/AC (4.0%) and AS/AS (8.0%). This distribution pattern was also found to be highly statistically significant (c2 = 38.957, p < 0.0001). The mean age of the participants was 35.48 ± 12.26 years for men and 26.32 ± 7.31 years for women (t = 10.538, p < 0.05).
Conclusion: This study observed a low prevalence of HIV among the premarital couples and a relatively high frequency of HbAS/AS couples. The ABO and Rh blood groups were found to be stable and consistent with previous reports. For the prevention of hereditary blood diseases, haemolytic disease of the newborn and transmission of HIV to offspring, premarital testing should be encouraged.
Profile of the geriatric patient hospitalised at Universitas Hospital, South Africa : original researchSource: South African Family Practice 49 (2007)More Less
Background: The elderly population in Africa is unevenly distributed across the continent, with the highest percentage of elderly living in the Southern African region. In 1996, the elderly population of South Africa (65 years and older) was roughly 6.7%, and was calculated to be 10.4% by 2025. If the latter expectation is anywhere near realistic, it stands to reason that the Department of Health should make timely provision for the care of these future patients, as the prevailing disease patterns within a population change as that population ages. Thus, there is an urgent need for profiles of elderly patients in order for adequate training to be implemented and for beds and equipment to be ready when needed.
Methods: A retrospective study was undertaken of all data available from a clinical audit done at Universitas Hospital's Geriatric Unit. All patients aged 65 years and older who were admitted by Internal Medicine's Geriatric Unit over four years were analysed in order to compile a profile of geriatric patients hospitalised at Universitas Hospital.
Results: The study group consisted of 791 elderly patients. Their average age was 81 years (range: 65 to 101 years of age) and they were hospitalised for an average of 11 days, with an average use of five medications per patient. Women represented 66% of the patients and the mortality rate was 17% in the total study group. The main admitting clinical problems were hypertension, heart failure, ischemic heart disease and anaemia. Most of the patients did not smoke or use alcohol. Out of a group of 523(due to the fact that it was a retrospective study, data for this criteria were only available for 523 of the 791 patients), 235 (45%) were self-supporting and 32% were known to use living aids. The majority of the patients were single and an equal amount were living in old age homes and with their families. The main special examinations used in their treatment were chest X-rays, nuclear examinations of the liver, ECG, heart sonar and CT of the brain, and gastroscopies. Almost all of the patients had undergone full blood count analysis and U+E determinations, and in more than 50% of cases, creatine, albumin and glucose measurements were taken.
Conclusion: For successful geriatric care at Universitas Hospital there will be a need for at least 11 days hospitalisation, and a unit with good training in internal medicine, psychiatry, urology, orthopaedy and oncology. The main supporting services will be physiotherapy, occupational therapy and social welfare. Laboratory analyses will include full blood count, urea and electrolyte measurements, urine examination, and creatine and glucose measurements. Special investigations will mainly be radiology and cardiology sonar examination. How well we care for elderly patients in the future will be an indicator of the quality of our healthcare system in general. We need to redesign our social insurance and welfare systems to fit the realities of our current situation.
Source: South African Family Practice 49, pp 5 –7 (2007)More Less
Information flow is the key to improving health development, especially in developing countries. African medical publications are poorly represented in the major medical electronic databases. African Index Medicus (AIM) is a joint initiative between the World Health Organisation (WHO) and the Association for Health Information and Libraries in Africa (AHILA) to store regionally-generated biomedical information. Proposed in 1980 and initiated in 1993, AIM was reactivated in 2005 and now emphasises full text accessibility and web publishing. To promote the use of AIM and the sharing of health knowledge, the WHO has provided national focal points with training, computers and scanners. Publishing still faces the challenge of strengthening networks of national focal points and African medical editors, as well as transferring technology and experience to African countries. There also remain the more basic constraints of costs, training, marketing and the low status of both research and publishing. The Special Programme for Research and Training in Tropical Diseases further found problems of underfunding, irregular publication schedules, low quality articles and a lack of international visibility. A TDR (Research and Training in Tropical Diseases) survey in early 2006 revealed that although there is increased health research and journal activities in African countries, the challenges of quality, content and accessibility remain. Since its inception in 2002, the Forum of African Medical Editors has held three training workshops for editors to correct some of these problems. AIM will soon be part of the WHO Global Health Library; both provide access to health information that will contribute to meeting the millennium development goals for health. These initiatives promise more health information for resource-poor settings, especially in Africa.
Author B. RaynerSource: South African Family Practice 49, pp 22 –24 (2007)More Less
Hypertension is one of the most important risk factors for death, heart failure, ischaemic heart disease, stroke and chronic kidney disease. Treatment of hypertension to particularly to goal blood pressure (BP) prevents these complications. In South Africa the reported control rates for treated hypertensives using a goal BP < 140/90 mm Hg is about 40%. Control of hypertension remains an elusive goal. The reasons for this are complex, but doctor inertia is emerging as an important barrier to better control rates.
Author D. AsmalSource: South African Family Practice 49, pp 27 –28 (2007)More Less
Varicella, a childhood disease, is caused by the varicella-zoster virus (VZV). Primary infection occurs when the virus comes into contact with the mucosa of the respiratory tract or conjunctiva. At these sites, viral multiplication occurs with subsequent haematogenous spread. VZV persists predominantly in the sensory ganglia of the cranial and spinal nerves. Shingles is the result of a reactivation of this residual latent virus. A number of triggers may cause a reactivation of this infection and this manifests as a painful vesicular eruption in a dermatomal distribution.
Common opportunistic infections in HIV infected infants and children : part 2 : non-respiratory infections : review articleSource: South African Family Practice 49, pp 40 –45 (2007)More Less
Increased susceptibility to infections is the major cause of disease, end organ damage and death in human immunodeficiency virus (HIV)-infected children. This article will focus on prevention, diagnosis and management of the most common and less common severe infections that are specifically associated with HIV-related immune compromise, as well as some aspects relating to immune reconstitution inflammatory syndrome (IRIS).