South African Family Practice - Volume 51, Issue 4, 2009
Volume 51, Issue 4, 2009
Author Gboyega A. OgunbanjoSource: South African Family Practice 51 (2009)More Less
As usual, the CPD section of the SA Family Practice journal features relevant articles for family practitioners and we start this edition with an informative article on swine flu compiled by M Venter and L Blumberg of the National Institute of Communicable Diseases, South Africa.
Source: South African Family Practice 51, pp 276 –278 (2009)More Less
Within three months of its discovery, the new Influenza A (H1N1) swineflu strain has spread to such an extent that a pandemic has been declared by the World Health Organization (WHO). Although most cases seem to be mild, cases of severe disease have also been reported and by 6 July 2009, 94 912 cases and 429 deaths were reported worldwide. At this point the WHO concluded that further spread within and to new countries is inevitable and sustained community transmission will make it impossible to confirm all cases by laboratory testing. In South Africa the 100 case mark was reached on 16 July 2009 and the laboratory testing strategy was modified. All cases of suspected swine flu will no longer be tested by the National Institute for Communicable Diseases (NICD) although continued monitoring of cases of severe or fatal respiratory illness will continue. This also places the responsibility on the health care provider to manage mild cases, treat moderate to severe cases and request confirmatory diagnostic tests and report appropriate cases. By the 19th of August 2009 the Number of laboratory confirmed cases in South Africa stood at 3544 including 6 deaths. This review aims to guide the clinician on these decisions.
Source: South African Family Practice 51, pp 280 –282 (2009)More Less
HIV is one of the most prevalent diseases and causes of mortality in sub-Saharan Africa. Pleural disease is common in the population of this region, especially pleural effusion. The disease is associated with a significant mortality rate, and correct diagnostic and therapeutic management is essential to optimising the possibility of a favourable outcome.
Modern management of rheumatoid arthritis - making a case for early aggressive medical treatment : CPDAuthor M. TiklySource: South African Family Practice 51, pp 284 –290 (2009)More Less
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that affects approximately 1% of the adult population. Some 30 to 40% of patients experience work disability within five years of onset of the disease, but early aggressive medical treatment has vastly improved the long-term outcome of RA. The combination of simple clinical tools to measure disease activity, the use of traditional disease-modifying anti-rheumatic drugs (DMARDs) early in the course of the disease and the introduction of targeted biologic agents for DMARD-resistant disease has greatly reduced the risk of joint deformities, physical disability and premature death. The family practitioner, by suspecting RA early in its course and jointly monitoring efficacy and toxicity of DMARDs with the rheumatologist, plays a pivotal role in improving the care and outcome of the RA patient.
Source: South African Family Practice 51, pp 292 –295 (2009)More Less
Antismoking campaigns and government legislation have resulted in a decline in smoking. However, the use of smokeless tobacco (SLT) is on the increase. Smokeless tobacco is non-smoked tobacco used either intranasally or intraorally. The increase in its use is possibly due to the perception that SLT is a safe alternative to smoking. SLT includes tobacco products such as snuff (sniffed or placed in the oral cavity) and tobacco leaves (which are chewed). In South Africa, traditional and social practices influence SLT use. While the adverse health outcomes associated with smoking are well established, some health risks attributable to SLT use have not been studied conclusively, especially those that affect the cardiovascular system. Although some studies have found some relationships between SLT use and adverse health outcomes, others have found SLT use to be associated with risks not higher than those in non-users. This article reviews the available literature on the use of SLT, the associated health risks and adverse health outcomes with the aim of providing a scientific basis on which primary care physicians can make rational decisions when confronted with current SLT users or those who contemplate using SLT as a nicotine harm-reduction substance.
Author K. OuthoffSource: South African Family Practice 51, pp 298 –302 (2009)More Less
Depression and sexual dysfunction are both common in the general population. When they co-exist they have the potential to impact negatively on each other in a bidirectional manner. Medication used to treat depression may cause additional problems with the sexual response cycle; although no drug is completely innocent, serotonergic agents such as selective serotonin reuptake inhibitors reuptake inhibitors (SNRIs) are most frequently implicated in antidepressant-induced sexual dysfunction. Adherence to long-term treatment may be compromised, which may have serious consequences. Various psychological and pharmacological strategies, including the ad hoc use of sildenafil, may offer some respite.
Source: South African Family Practice 51, pp 306 –308 (2009)More Less
Strikes are rare events in the history of medicine. Mainly their occurrences have been initiated by junior doctors as is the case in South Africa. In the most recent strike action by South African doctors, the root cause appears to be the long-overdue salary increases with specific attention focused on the government's failure to implement the Occupation Specific Dispensation (OSD). It is quite difficult to separate fact from exaggeration during doctors' strikes due to media hype and the variety of players involved. Proximity to life and death and contractual obligations are put forward as the reasons doctors are judged by standards higher than ordinary mortals. For patients, some of the harms occurred may include the following: work-loss (if employed), wasted money for transport, treatment delays, prolongation of suffering, irreversible damage to health, dangerous drug interruptions and death. Concerning doctors, some benefits of a strike action may result in financial gain, improved working conditions which may contribute to less emotional pressure and even a degree of dissuasion from emigrating.
Author L. AlfordSource: South African Family Practice 51, pp 318 –321 (2009)More Less
Either through referral by a medical practitioner or self-referral many patients with musculoskeletal problems receive some form of physical therapy. There are several highly trained professional groups who deliver this treatment. Due to lack of regulation, however, there are also many untrained and unregistered therapists delivering treatments for musculoskeletal conditions. For a number of reasons firm evidence-based protocols on physical therapy management are limited. This combined with the aforementioned means that practice can vary markedly. It is thus important for general practitioners to be able to make some assessment of physical therapy quality. This paper aims to unveil some of the practices of physical therapists, discuss issues related to treatment and make suggestions on what constitutes quality physical therapy.
Medical students' use of caffeine for 'academic purposes' and their knowledge of its benefits, side-effects and withdrawal symptoms : original researchSource: South African Family Practice 51, pp 322 –327 (2009)More Less
Background: Caffeine is often used for its benefits, which include increased vigilance. It does have side-effects, however, such as palpitations and withdrawal symptoms that include headaches and drowsiness. Tertiary education often requires students to study for extended hours, especially during periods of increased workload prior to tests and examinations. Medical students, who have to master a very large volume of academic work in a limited period of time, are no exception. This cross-sectional study investigated caffeine use for 'academic purposes' by first- to third-year medical students at the University of the Free State in 2006, and their knowledge of its benefits, side-effects and withdrawal symptoms.
Methods: Data were collected by means of an anonymous, self-administered questionnaire that was completed by students during formal class time, arranged in advance with the relevant lecturers. Questionnaires were available in Afrikaans and English. A pilot study was conducted on 20 physiotherapy students to test the questionnaire. Chi-squared and Kruskall-Wallis tests were used to compare categorical and numerical variables, respectively. Ethical approval to perform the investigation was granted by the Ethics Committee of the Faculty of Health Sciences, University of the Free State.
Results: A 90.5% (360/389) response rate was obtained. Ninety-four per cent of participants used caffeine, with academic purposes (62.6%) among the three most frequent reasons given for its consumption. Other reasons included social consumption (70%) and preference for the taste (72.4%). Coffee (88.2%) was the most commonly consumed caffeinated product among these students, followed by energy mixtures and tablets (37.9%), and soft drinks (36%). Third-year students were the heaviest consumers of coffee for academic purposes. An increase in caffeine consumption for academic purpose was directly related to progression from first- to third- year of the medical course. The average scores for questions on the benefits, side-effects and withdrawal symptoms were all below 1.5 out of 5. Misconceptions about caffeine were also identified. With regard to the benefits of caffeine, the most commonly cited misconception was that it could be used as a substitute for sleep (26.7% of respondents). The most common misconception regarding its side-effects was that it caused hot flushes (21.9%), while aggression (27.2%) was cited as the most common misconception regarding caffeine withdrawal.
Conclusions: The high percentage of caffeine usage and low scores in the caffeine knowledge test indicated that most participants were using caffeine without having sufficient knowledge of its benefits, side-effects and withdrawal symptoms. It is recommended that awareness programmes on the side-effects and symptoms of caffeine withdrawal should be implemented by the student health and counselling facilities on campus. The display of posters in strategic venues and distribution of pamphlets could assist in the dissemination of information on this extensively consumed substance.
Second-stage primary Caesarean deliveries : are maternal complications increased? : original researchSource: South African Family Practice 51, pp 328 –331 (2009)More Less
Background: Second-stage Caesarean sections (CSs) are known to be associated with increased complications but most reports originate from tertiary hospitals, which attend to high-risk patients. Complication rates may differ in district hospitals, which attend to low-risk patients.
Methods: This was a retrospective study carried out at a district maternity unit in Durban. The hospital records of all CSs over an eight-month period were reviewed and obstetric and neonatal complications of second-stage CSs were compared with a group of first-stage CSs performed during the study period.
Results: There were 4 654 deliveries, including 1 257 CSs, in the study period. The CS rate was 27.2%. Of 617 (8.5%) emergency CSs, 53 were performed in the second stage of labour. The maternal and neonatal complication rates were low and no statistical differences were found between the patients who had second-stage or those who had first-stage CSs, except for increased blood loss, blood-stained urine, prolonged operative times and postoperative fever for second-stage CSs.
Conclusions: Second-stage CSs performed in a district hospital are associated with increased maternal complication rates but not with neonatal complications.
Source: South African Family Practice 51, pp 332 –336 (2009)More Less
Background: Stretch marks or striae distensae are tears in the dermis, above which the epidermis remains intact. Striae result from rapid expansion of the underlying tissue, e.g. during puberty, pregnancy or rapid weight gain. The prevalence of striae is high (up to 80% in most populations). Many of the successful treatment modalities for striae (laser, surgery, prescription-only medication) entail high costs, often with the involvement of private medical practitioners. The objective of the study was to investigate the effect of a topical application (Bio-Oil) on striae in 20 healthy Caucasian women. The study was performed according to standard good clinical practice guidelines.
Methods: The study was conducted among 20 healthy Caucasian women with bilateral abdominal striae. The women used the test product on one side of their abdomen twice a day for 12 weeks, and their normal moisturising routine on the other side. Assessment methods were: 1) subjective visual self-assessment, using both the Patient and Observer Scar Assessment Scale (POSAS) and a directed difference (i.e. comparison of sides), and 2) objective laboratory visual assessment (blinded) using the same scales.
Results: The subjective visual self-assessment yielded statistical significance at four weeks in terms of improvement of the treated striae when compared to the untreated sites, using both the POSAS and directed difference. Objective laboratory visual assessment, using the POSAS and directed difference, showed a statistical improvement on the treated side from week 2 onwards.
Conclusions: The test product (Bio-Oil) significantly improved the appearance of striae on the treated side of the abdomen as assessed by both subjective and objective assessments. This study has shown that it is possible to improve the appearance of striae with the topical application of a relatively low-cost, non-medicinal product.
The infant-feeding practices of mothers enrolled in the prevention of mother-to-child transmission of HIV programme at a primary health care clinic in the Mpumalanga province, South Africa : original researchSource: South African Family Practice 51, pp 337 –339 (2009)More Less
Purpose: To determine whether mothers attending a primary health care (PHC) clinic in the Mpumalanga province, South Africa for post-delivery prevention of mother-to-child transmission (PMTCT) of the Human Immunodeficiency Virus (HIV) follow-up care were adhering to the recommendation of exclusive infant-feeding practices, and to identify possible areas for improvement of the PMTCT of HIV services at the clinic.
Setting: A municipal PHC clinic in White River, a semi-urban town in Mpumalanga, South Africa.
Design: A cross-sectional descriptive study using a structured infant-feeding questionnaire.
Subjects: All mothers attending the clinic for post-delivery PMTCT of HIV follow-up care during a four-month period from 1 November 2007 to 29 February 2008.
Results: A total of 33 mothers with infants attended the clinic during the period. All 33 mothers took part in the questionnaire study. Thirty questionnaires were subsequently found suitable for analysis. The mothers were predominantly rural, with low levels of education and no formal employment. Their ages ranged from 22 to 42 years, with a mean of 30.7 years. Fifteen (50%) of the 30 mothers practised exclusive replacement feeding (ERF), 8 (27%) practised exclusive breast-feeding (EBF), and 7 (23%) practised mixed feeding.
Conclusion: More than three-quarters of the mothers practised the recommended exclusive infant-feeding methods for PMTCT of HIV, with ERF as the most popular choice. However, the infant-feeding practices could not be generalised as the attendance of mothers for post-delivery follow-up care at the clinic was very poor during the study period. This poor attendance was attributed to frequent non-availability of free formula milk for the programme. Better quality counselling is needed to further increase the adherence to exclusive infant-feeding practices, and to improve the uptake of post-delivery follow-up care.
The beliefs and practices of Tshivenda-speaking multiparous women on contraception : a qualitative study : Original researchSource: South African Family Practice 51, pp 340 –342 (2009)More Less
Background: The aim of the study was to understand the beliefs and practices of multiparous women on the use of contraceptives.
Methods: This was a qualitative study using focus group interviews involving women from five different groups, namely: modern church, traditional church, traditional healers, care group and 'stokvel'.
Results: Women in all the groups were aware of various contraceptive methods and had experience of some of the methods. Women from the traditional church and healers groups did not believe in modern contraception. The traditional church group used water and tea for family planning and were discouraged by their church from using modern contraception. The traditional healers group used a method called ''u fhahea'' in Tshivenda or ''to hang'' i.e. herbal mixtures were placed in a clay pot, bottle, or animal coat and safely hidden until a woman was ready to conceive. The other three groups believed in and used modern contraceptive methods. The latter groups expressed that contraception gave them a sense of control to decide the number and appropriate space between children. The following reasons were given for not using or stopping contraception: infertility, enlargement of vagina, itchy watery vaginal discharge, malpresentation of fetus, decreased sexual desire, excessive weight gain or loss and disturbances of menstrual cycle. These reasons were believed to be responsible for family breakdown and inability of women to perform their normal household chores.
Conclusions: This study has provided some insight into the beliefs and perceptions of women on contraception especially within the black African context. Beliefs based on religious and traditional practices influence the use of contraception in certain social groups, while perceptions about side-effects of contraceptives cause some women in other social groups not to use or suspend the use of contraception. Family planning programmes should be structured in such a way that the views of women in a particular community are considered.
Source: South African Family Practice 51, pp 343 –345 (2009)More Less
Background: Domestic violence is a global concern. Domestic violence refers to violence inflicted on a partner (mostly females) within the context of the family or an intimate relationship. It is known to be responsible for numerous hospital visits undertaken by women, although they mostly fail to complain of abuse. There is paucity of data on domestic violence mainly due to under-reporting and lack of investigation.
Methods: We set out to investigate the pattern of violence among pregnant women attending antenatal clinic at ECWA Evangel Hospital, Jos, Nigeria. In all 215 women who were screened using the modified Abuse Assessment Screen (AAS) survey instrument (developed by McFarlane) had experienced domestic violence.
Results: Results showed verbal, physical, sexual and emotional violence at prevalence rates of 38.0%, 26.5%, 10.7% and 1.4%, respectively. A total of 14.0% had experienced a combination of physical and verbal abuse while 7.0% had experienced a combination of physical and sexual violence. Fulltime housewives and self-employed women were most abused, of which 82.7% had no definite timing pattern.
Conclusion: The results suggest that the major forms of domestic violence are verbal, physical, sexual and emotional, and the violence has poor timing specificity.
Author D. O'MahonySource: South African Family Practice 51, pp 346 –347 (2009)More Less
Accidental hand grenade blast injuries in the Transkei region of South Africa : a case report : case studySource: South African Family Practice 51, pp 348 –350 (2009)More Less
During the apartheid era in South Africa explosive blasts were common. Transkei was the lynchpin of the government's homeland policy, and a major centre for the struggle against apartheid. Weapons and ammunition were stolen from the South African factories and army warehouses and were stored in safe places in Transkei.
This is a report on a group of children who were herding cattle in a field and found an M26 hand grenade. They were playing with it when it accidentally detonated. Six of the eight children died instantly, while the other two sustained minor injuries. The M26 hand grenade had been designed to harm by expelling high-velocity fragments. The result is extensive mutilation of the body, particularly to those close to the blast. In this report the nature and severity of injuries are described. The mechanisms of injury and possible criteria used to predict injuries caused by explosions are discussed and preventive measures are suggested.
Report on the 29th ICOH, International Congress on Occupational Health held in Cape Town from 22 to 27 March 2009 : correspondenceAuthor I. GovenderSource: South African Family Practice 51 (2009)More Less