South African Family Practice - Volume 52, Issue 2, 2010
Volume 52, Issue 2, 2010
Healthy lifestyle interventions in general practice : part 10 : lifestyle and arthritic conditions - Osteoarthritis : CPDSource: South African Family Practice 52, pp 91 –97 (2010)More Less
Chronic musculoskeletal disease is one of the most common causes of disability worldwide with considerable economic impact in health care. Osteoarthritis (OA) is the most common chronic musculoskeletal disease affecting a large proportion of the population with an increasing predicted prevalence in the next two decades. Regular physical exercise, nutritional intervention, psychological support and other lifestyle interventions are very important components of the non-pharmacological management of patients with OA. The main rationale to include regular exercise as part of a lifestyle intervention programme for OA is to improve muscle strength and proprioception, and to promote the other general health benefits of participating in regular physical activity. Nutritional intervention should focus on weight reduction while basic nutrients that are required for healthy joints should be provided. Glucosamine and chondroitin supplemention is commonly used and may reduce pain, improve function and reduce or arrest disease progression. Psychological intervention has a particular role in assisting with pain management.
Author K. OuthoffSource: South African Family Practice 52, pp 99 –105 (2010)More Less
Given that anxiety disorders are common and chronic and often co-morbid with both medical and psychiatric conditions, effective and safe anxiolytic drugs are in great demand. Serotonergic agents, in particular the selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors, have an established track record for the pharmacological treatment of a wide range of anxiety disorders. Despite their slow onset of therapeutic action, their initial exacerbation of anxiety and some of their long-term unwanted effects, they remain the drugs of first choice in primary care. They are relatively safe and exhibit both anxiolytic and antidepressant effects. Other antidepressants, such as mirtazapine, reboxetine and agomelatine, and the 5-HT1A agonist, buspirone, are alternative agents, although the evidence of their efficacy covers a narrower spectrum of anxiety disorders. Patients with anxiety disorders who are resistant to these drugs may benefit from second-line (tricyclic antidepressants or monoamine oxidase inhibitors) or even specialist initiated thirdline (benzodiazepine, anticonvulsant or antipsychotic) therapy. None of the currently available drugs are ideal for every patient and the advantages and disadvantages of each are best considered when treatment is individualised.
Author D.J. BlomSource: South African Family Practice 52, pp 107 –113 (2010)More Less
The bulk of plasma triglycerides is carried by chylomicrons in the fed and very low density lipoproteins in the fasted state.These triglyceride-rich lipoproteins are metabolised to remnant lipoproteins by lipoprotein lipase. Hypertriglyceridaemia results if triglyceride-rich lipoproteins accumulate either due to defective clearance, overproduction or a combination of both mechanisms. Genetic and environmental factors interact in the genesis of hypertriglyceridaemia but occasionally a single factor may be dominant. At a molecular level the commonest cause of severe primary hypertriglyceridaemia is loss of function mutations in both alleles of lipoprotein lipase (LPL). The commonest environmental contributors include diabetes,diet, alcohol and medications (oestrogen, steroids, retinoids, protease inhibitors). Severe hypertriglyceridaemia can trigger acute pancreatitis while mild to moderate hypertriglyceridaemia is an independent cardiovascular risk factor. Treatment strategies are determined by the severity and aetiology of hypertriglyceridaemia as well as the patient's cardiovascular risk profile. General strategies include lifestyle modifications with restriction of dietary fat intake, cessation of alcohol intake and increased exercise. Contributing metabolic disorders should be controlled and aggravating medications withdrawn or reduced where possible. Moderate hypertriglyceridaemia may be treated with high doses of omega-3 fatty acids(4 grammes/day), fibrates, niacin or statins. Fibrates are the agents of choice in severe hypertriglyceridaemia.
Source: South African Family Practice 52, pp 114 –120 (2010)More Less
Gout is a painful, inflammatory disease that affects more men than women. The incidence of gout has increased substantially over the past few decades, as evidenced by information from the Rochester project. Some of the risk factors for the development of gout include: increased ethanol intake, high dietary purine consumption, obesity and the use of certain drugs, such as diuretics. Another important risk factor for the development of gout is hyperuricaemia.
Hyperuricaemia results from an imbalance between the rate of production and excretion of uric acid in the body. An excess of uric acid thus builds up in the body, supersaturating body fluids and leading to the formation of monosodium urate crystals. These crystals accumulate in tissue and around joints, leading to an acute gout attack.
Gout can be divided into four phases, namely asymptomatic hyperuricaemia, acute gout attacks or recurrent gout, intercritical gout and chronic tophaceous gout. Various treatment options are available for gout, and the treatment for each gout patient is determined by the stage of the disease. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, corticotropin and colchicine are used for the treatment of acute gout attacks. Allopurinol and probenecid are used for long-term hypouricaemic therapy, while NSAIDs and colchicine are prescribed for the prophylaxis of future gout attacks.
All of these treatments have side effects, ranging from mild to life-threatening in nature. There is a need for novel gout therapies that have fewer side effects but are still as effective.
Source: South African Family Practice 52, pp 121 –127 (2010)More Less
Many conditions within the oral cavity require the use of a mouthwash. This can vary from breath fresheners to treatment of life threatening secondary infections such as oral mucositis in patients undergoing bone marrow transplant therapy. The use of mouthwashes requires a correct diagnosis of the oral condition and a thorough knowledge of the product in question to achieve effective treatment. It is the objective of this review to help health care workers in South Africa make the correct choice of treatment when dealing with diverse conditions of the oral cavity.
Author J.A. KerSource: South African Family Practice 52, pp 128 –129 (2010)More Less
Source: South African Family Practice 52 (2010)More Less
A 49-year-old housewife had complained of an itchy facial rash for four years. She denied using steroid creams and skin lighteners. On examination, dark grey papules were found on her face, with some coalescing into plaques (see Figures 1 and 2). A skin biopsy revealed many perifollicular non-caseating granulomas (see Figure 3). Periodic Acid-Schiff stains for fungi, Ziehl-Neelson stains for M tuberculosis, and Fite-Ferraco stains for M leprae were negative.
Author Pierre De VilliersSource: South African Family Practice 52 (2010)More Less
On Sunday 25 April 2010 the South African government finally made a 180-degree turn in the HIV /AIDS policy of Thabo Mbeki and his minister of Health, the late Manto Thsabala-Msimang. President Zuma launched an ambitious campaign to establish the HIV status of 15 million South Africans over the next 12 months. The HIV Counselling and Testing (HCT) Campaign, as it is formally known, is widely considered to be the single most important intervention aimed at turning the tide against HIV in South Africa. The aim of the campaign is to offer free HIV counselling and testing to all people living in South Africa. Health practitioners will be expected to offer counselling and testing to every patient consulting them.
Identification of sources from which doctors in the private sector obtain information on HIV and AIDS : original researchSource: South African Family Practice 52, pp 137 –141 (2010)More Less
Background : Doctors need to constantly update their knowledge and obtain information in order to practise high-quality medicine. Antiretroviral drugs have been available only since around 1996, therefore many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients. Where doctors source their general medical knowledge has been established, but little is known about where doctors source information on HIV / AIDS. This study investigated where private sector doctors from the eThekwini Metro obtain information on HIV and AIDS for patient management.
Methods: A descriptive cross-sectional study among 133 private general practitioners (GPs) and 33 specialist doctors in the eThekwini Metro of KwaZulu-Natal, South Africa, was conducted with the use of questionnaires. The questionnaires were analysed using SPSS version 15. A p value of < 0.05 was considered statistically significant.
Results: The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6%versus 78.8%; p < 0.05) as sources of HIV information. More than 90% of doctors reported that CME courses contributed to better management of HIV and AIDS patients.
Conclusion: Private sector doctors in the eThekwini Metro obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients.
Knowledge of and misconceptions about the spread and prevention of HIV infection among older urban women attending the Tshwane District Hospital, South Africa : original researchSource: South African Family Practice 52, pp 142 –148 (2010)More Less
Background: Statistics around the world show a rapid increase in HIV infection in the older population. Many older women remain sexually active and are therefore exposed to heterosexual transmission of HIV infection. Older women are most likely considered respected opinion leaders within the families and communities and are likely to influence others' attitudes and behaviours. An increase in knowledge through information plays a fundamental role and is a prerequisite for behavioural change that may prevent new HIV infections. The purpose of the current study was to assess the knowledge and misconceptions regarding the spread and prevention of HIV in older women attending the Tshwane District Hospital (TDH) in South Africa.
Methods: A prospective cross-sectional study of 100 women, aged 50 to 80 years, attending the TDH out-patient section during November and December 2006 was done. The levels of knowledge were determined by using a directed questionnaire.
Results: Eight per cent of the participants answered all the questions correctly, showing knowledge gaps in the remaining 92% (95% confidence interval: 86.7%-97.3%). Many participants were unaware of the protective effects of condom use, especially female condoms, and of HIV spread by anal transmission, the sharing of needles and blood transfusion. Three or more misconceptions were present in 48% of the participants, such as HIV spread by casual contact, the sharing of personal items, air-borne infection, mosquito bites, HIV testing and AIDS prevention or cure by traditional medicines or alternatives. Sixty-two per cent of the older women were found to have adequate knowledge (95% confidence interval: 52%-71.5%), knowing the basic concepts regarding HIV transmission.
Conclusion: There is a significant need for HIV-related preventive health education in older women, not only to decrease potential high-risk behaviours, but also to reduce unnecessary feelings of anxiety and misconceptions. Family physicians, due to their unique role, might be able to use the present study in their practices in order to optimise the planning and structuring of awareness interventions and prevention programmes.
Source: South African Family Practice 52, pp 149 –153 (2010)More Less
Background: The shortage of doctors and their maldistribution between urban and rural areas contribute to inequitable health care delivery. Strategies are being sought by the government and universities to address these challenges. At the Nelson R Mandela School of Medicine of the University of KwaZulu-Natal the admissions policy ensures greater access to rural students and curricular interventions have been introduced to increase an awareness of the plight of vulnerable communities. This study attempted to ascertain the career intentions of final-year medical students and the influence of area of origin and gender on the location of their proposed future practice.
Methods: The 2005 final-year cohort was surveyed by means of an anonymous questionnaire. Demographic information, area of origin and career intentions were canvassed. Students of rural origin were identified as those who matriculated from rural schools and lived more than 200 km from the nearest city. The data were analysed descriptively.
Results: Female and rural students accounted for 63% and 11% of the sample respectively. Women were less likely than men to practise in rural areas. Thirty-five per cent indicated a preference for a public government service career as opposed to a private medical (26%) career. Slightly more than 13.7% (n = 26) of the cohort wished to pursue practice or postgraduate careers overseas. Nearly 62% (n = 90) of the students in the current cohort received government subsidies for their studies.
Conclusions: The increased intake of students from rural origin and curricular attempts to increase social awareness of vulnerable rural communities are inadequate to alter the perceptions of medical graduates towards rural practice. While government initiatives and medical schools are starting to work together to service rural communities, alternative strategies need to be explored to entice physicians to rural practice.
Knowledge, attitudes and behaviours of adolescents in relation to STIs, pregnancy, contraceptive utilization and substance abuse in the Mhlakulo region, Eastern Cape : original researchSource: South African Family Practice 52, pp 154 –158 (2010)More Less
Background: Sexually transmitted infections (STIs) and HIV / AIDS are a major problem in South Africa. This, coupled with a high incidence of teenage pregnancy, alcohol and drug abuse, is of grave concern, especially its impact among the young (15-24 years) and in economically poor, rural populations. This study aimed to assess the youthsâ?? knowledge, attitudes and behaviours regarding STIs, teenage pregnancy, contraception and substance abuse.
Methodology: This is an interview-based, descriptive study. The sample design employed a stratified sample (using schools as strata) of young people aged 15 to 24 years in three schools in the Mhlakulo region, Eastern Cape province. From each school, a sample of learners from grades 10 to 12 was selected randomly. Questionnaires covering relevant parameters were used to interview the learners, after which the data were assimilated and analysed.
Results: A total of 150 learners were surveyed (86 females and 64 males). In total, 56% of them knew about STIs. About 88% of the participants learned about STIs from health care workers/nurses/doctors/clinics, the media, educators, the school and friends. Most preferred to communicate to friends (38.67%) and siblings (28%); only 15% communicated with parents. Among the sexually active, 54% reported the use of condoms; of these only 62% used them consistently. Of the participants, 7.33% had more than five sexual partners. Of the young women, 12.8% reported to have fallen pregnant with one-sixth of them wanting to become pregnant. Thirty per cent of those pregnant had to quit school, but did return subsequently. Common contraceptives used were condoms (54%) and pills (58%). Twenty-two per cent of the youths admitted to the use of recreational drugs at some time; most of these were related to alcohol (19.33%). A small fraction (1.33%) used dagga (cannabis).
Conclusion: There is lack of knowledge of STIs and their prevention and condom and contraceptive use among young people of this community. Sexual promiscuity and teenage pregnancy in the group is a cause for concern. Substance abuse is another important problem that requires urgent attention.
Source: South African Family Practice 52, pp 159 –160 (2010)More Less
Complementary and alternative medicine for attention deficit/hyperactivity disorder : an Eastern Cape study : scientific letterSource: South African Family Practice 52, pp 161 –162 (2010)More Less
Author Ian CouperSource: South African Family Practice 52 (2010)More Less
Source: South African Family Practice 52 (2010)More Less