South African Family Practice - Volume 52, Issue 3, 2010
Volume 52, Issue 3, 2010
Source: South African Family Practice 52, pp 81 –84 (2010)More Less
The rising prevalence of obesity is a worldwide problem affecting not only the developed world but also developing nations such as South Africa. Excess body fat deposition is caused by an imbalance between energy intake and energy expenditure and there are many genetic and environmental factors that can influence this balance. The present article will describe these factors and discuss the complex interaction between the environment and the human genome that may underlie the current obesity epidemic.
Healthy lifestyle interventions in general practice : part 11 : lifestyle and arthritic conditions - rheumatoid arthritis : CPDSource: South African Family Practice 52, pp 176 –183 (2010)More Less
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disorder that causes symmetrical polyarthritis of large and small joints. RA affects about 0.5-1% of the population and is more common in females than males. In recent years, it has been increasingly recognised that early diagnosis and management of RA is important to prevent joint destruction, which has been shown to occur early on in the disease process. The primary effects of the disease on joints and muscles, together with physical inactivity, usually result in diminished joint range of motion, muscle weakness, decreased endurance performance, depression, poor cardiovascular health and osteoporosis. The principles of management of RA should include non-pharmacological and pharmacological management. Non-pharmacological modalities (including lifestyle interventions) are well recognised as important components of the treatment of early arthritis, including RA. The main lifestyle interventions for RA are physical exercise, dietary intervention, psychological intervention and education. The guidelines for these lifestyle interventions in patients with RA are reviewed.
Source: South African Family Practice 52, pp 184 –192 (2010)More Less
Chronic low back pain is a common problem in primary care. A history and physical examination should place patients into one of several categories: (1) Non-specific low back pain, (2) Back pain associated with radiculopathy or spinal stenosis, (3) Back pain referred from a non-spinal source or (4) Back pain associated with another specific spinal cause.
For patients who have back pain associated with radiculopathy, spinal stenosis, or another specific spinal cause, magnetic resonance imaging or computed tomography may establish the diagnosis and guide management. Because evidence ofimproved outcomes is lacking, lumbar spine radiography should be delayed for at least one to two months in patients with nonspecific pain. Acetaminophen and non-steroidal anti-inflammatory drugs are first-line medications for chronic low back pain. Tramadol, opioids, and other adjunctive medications may benefit some patients who do not respond to non-steroidal anti-inflammatory drugs. Acupuncture, exercise therapy, multidisciplinary rehabilitation programs, massage, behaviour therapy, and spinal manipulation are effective in certain clinical situations. Patients with radicular symptoms may benefit from epidural steroid injections, but studies have produced mixed results. Most patients with chronic low back pain will not benefit from surgery. A surgical evaluation may be considered for select patients with functional disabilities or refractory pain despite multiple nonsurgical treatments.
Jet lag and environmental conditions that may influence exercise performance during the 2010 FIFA World Cup in South Africa : CPDSource: South African Family Practice 52, pp 198 –205 (2010)More Less
The 2010 FIFA World Cup will be held in South Africa in June / July 2010. This is the largest international sports event ever to be held in this country. At this time 32 international football teams, with their management and supporters, will travel to South Africa. These players and visitors will be exposed to changes in time zones (those travelling from continents in the East and West) as well as different environmental conditions. In particular, for the players, the achievement of peak sporting performance during this event is most important. It is well established that, in order to achieve peak exercise performance, many variables need to be optimised. These variables include physical and mental training, rest, nutrition, team dynamics and tactics. However, adjustments to differences in time zones as well as environmental factors on and around the playing field can also have a significant impact on exercise performance. In this review, the potential effects of "jet lag", as well as several important environmental conditions, on exercise performance will be discussed. The climatic, atmospheric and weather conditions that are likely to be prevalent in each of the South African host cities at the time of the 2010 FIFA World Cup will be reviewed. Finally, practical recommendations to deal with the effects of jet lag, as well as guidelines to optimise performance under different environmental conditions that are expected during the 2010 FIFA World Cup, will be provided.
Author C. WhittakerSource: South African Family Practice 52, pp 207 –211 (2010)More Less
Erectile dysfunction (ED) affects millions of men globally and may adversely affect his, and potentially his partners', quality of life. The introduction, a decade ago, of the phosphodiesterase type 5 (PDE5) inhibitors has revolutionised the management of ED. The PDE5 inhibitors have provided an effective and patient-acceptable therapy for ED. They have had a huge impact on public awareness and understanding of this disease. This article provides an overview of erectile dysfunction and the pharmacology, efficacy, safety and optimal use of the PDE5 inhibitors.
Author J.A. KerSource: South African Family Practice 52, pp 213 –215 (2010)More Less
Heart failure is a clinical syndrome that can result from any structural or functional cardiac disorder that impairs the performance of the ventricle: either to eject blood (systolic dysfunction) [or reduced ejection function] or to fill with blood (preserved ejection fraction or diastolic heart failure).
Source: South African Family Practice 52, pp 217 –218 (2010)More Less
ACE inhibitors are often prescribed in the treatment of hypertension, heart failure and kidney disease. These drugs are on the Essential Drugs List, and are therefore used at primary to tertiary health care levels in South Africa. Angioedema is considered a rare, but potentially fatal side-effect of this agent, with a reported incidence of 0.1-0.2% worldwide. Its incidence in the South African population is, however, unknown.
Health, illness and disability - psychosocial approaches, second edition, Ross Eleanor & Deverell Andee : book reviewAuthor Wilma J. KotzeSource: South African Family Practice 52 (2010)More Less
Author Pierre De VilliersSource: South African Family Practice 52 (2010)More Less
It was a cold and rainy day in the Cape and we ran together from the office to my car parked outside in the freezing and wet street. We both took a minute to get back our breaths after the frantic sprint for cover, wiping the cold rain from our faces, and then, just before I could turn the key to start the car, she said in her distinct Namaqualand Afrikaans voice "Ek wonder wat Bafana môre gaan maak teen Frankryk. Ek hoop darem hulle wen, maar die Franse is 'n goeie span." (I wonder what the South African soccer team will do tomorrow against France. I hope they win, but France is a strong team). She is the cleaner in my office, a small and quiet Nama woman. I am her boss, a white Afrikaans male. She did not finish high school and I completed many years of tertiary education. I am almost twice her age and probably earning at least ten times her salary. There is a cultural, gender, ethnic, age and socio-economic gap as wide as the Fish River Canyon between us.
Source: South African Family Practice 52, pp 223 –226 (2010)More Less
The shared consultation is a concept that differs from shared decision making and shared care. It involves two or more health professionals in the consultation of a patient during the same illness episode. Commonly, the health professionals are a primary-care doctor and a clinical nurse practitioner. On the basis of clinical experience, a number of models of the relationship in such situations are described, viz the consultant, the master-servant, the teacher-pupil and the teamwork models. Issues of communication within the consultation, the patient as a person, continuity of care, and clarification of roles and responsibilities are highlighted. More investigation is required to explore this further.
Relationships between overweight, obesity and physical fitness of nine- to twelve-year-old South African children : original researchSource: South African Family Practice 52, pp 227 –233 (2010)More Less
Background: South African children show the same tendencies in overweight and obesity as children in developed countries a decade ago. Childhood overweight is associated with chronic diseases, early mortality in adulthood and psycho-social effects with lifelong consequences. This study aimed to determine relationships between overweight, obesity and physical fitness of nine- to twelve-year-old South African children.
Methods: Anthropometric (body-mass index [BMI], fat percentage) and physical fitness (cardiovascular endurance, body composition, muscle strength, muscle endurance, flexibility) measurements were obtained from 280 children aged nine to twelve years (128 boys, 152 girls) using the Fitnessgram and Bruininks-Oseretsky Test of Motor Proficiency II. International cut-off points were used to categorise children into normal-weight, overweight or obese categories. Data were analysed using descriptive statistics, Spearman rank order correlation and variance of analysis.
Results: One in five children was overweight or obese, while girls were twice as likely as boys to be obese. Aerobic capacity and muscle strength, especially leg strength, decreased progressively with an increase in BMI. A progressive but nonsignificant decline was found in muscle endurance with increasing BMI, while flexibility showed the poorest relationships with various degrees of weight. Variance of analysis indicated significant relationships between BMI, cardiovascular endurance and strength (p < 0.05), while different relationships were found when gender was taken into consideration.
Conclusions: Health-enhancing physical fitness of young children is negatively affected by overweight and obesity, and intervention strategies are recommended to improve the quality of life of such children, but also to prevent early mortality during adulthood.
Understanding participation in a hospital-based HIV support group in Limpopo Province, South Africa : original researchSource: South African Family Practice 52, pp 234 –239 (2010)More Less
Background: Support groups are an appropriate way of delivering psychosocial support to people living with HIV / AIDS, especially in low-resource countries. The aim of the study was to understand why people with HIV attended psychosocial support groups.
Methods: This was a qualitative study design using focus-group discussions in which support-group members volunteered to participate. Five focus groups were involved in the study.
Results: The participants attended because they were referred by a health-care worker, wanted information, wanted emotional support, accompanied an ill relative or knew about the support group. Perceived benefits included receiving psychological support, accepting one's HIV status, reducing stigma and isolation, increasing hope, forging new friendships, helping others, obtaining HIV-related information, developing strategies to change behaviour, gaining access to medical care at the adjoining HIV clinic and receiving food donations. Negative aspects of attending the support group included the large size of the support group, long queues at the HIV clinic, concerns about confidentiality and negative staff attitudes towards the participants. Leaders were concerned about conflict, burn-out and impractical protocols. Access to disability grants was also a concern.
Conclusions: Support groups can assist members to cope with the various challenges associated with living with HIV / AIDS through offering structured emotional, informational, instrumental and material support. Support group sizes should be limited. A structured curriculum containing up-to-date information about ART should also be offered to support groups. Social workers should furthermore be involved to facilitate access to appropriate social grants. Finally, support group leaders should receive appropriate training and regular debriefing.
Features of integrated professional training for physically disabled people in a community-based rehabilitation programme in the rural and urban areas of Congo : original researchSource: South African Family Practice 52, pp 240 –244 (2010)More Less
Background: The rehabilitation of physically disabled people has been explored from the perspectives of patients, health professionals, rehabilitation agencies, etc. However, no study has linked disability types, training programmes and career prospects. In this study, we therefore evaluated the professional integration of trained disabled people.
Methods: This retrospective survey included all physically disabled people admitted to two rehabilitation centres in Congo between 1996 and 2005. Data collection used registers from two units, the medical unit and the rehabilitation unit, to obtain information on age, sex, disability type, follow-up training, present living activity and field of training. We defined 'professional integration' as being when the current profession matched the training received at the rehabilitation centre.
Results: The percentage of participants with integrated training was 96.8% (95% CI; 92.1-98.7%). In the urban setting, 6.7% (95% CI; 2.6-16.1%) of the trainees were not integrated, while all were integrated in the rural setting. Trainees aged between 16 and 25 years and those 51+ years represented 12.5% (95% CI; 4.9-28%) and 50% (95% CI; 25.3-74.6%) of the non-integrated cases respectively. Paralysis from poliomyelitis was the most common [62.9% (95% CI; 54.3-70.8%)] disability, and the non-integrated participants included people with poliomyelitis [1.2% (95% CI; 0.2-6.7%)], general paralysis [10.5% (95% CI; 2.9-31.3%)] and sight disorders [50% (95% CI; 9.4-90.5%)]. Tailoring was the main field of training [57.4% (95% CI; 48.7-65.7%)], and high numbers of participants with non-integrated training worked in tailoring, shoe making, welding and computer repair.
Conclusions: Despite a high rate of integration in Congo, professional training and subsequent integration would still benefit from a comprehensive approach that considers the type of disability, training and socio-demographic features. Further studies targeting alumni from the training programmes and their ongoing assessment are warranted.
Reconstructed Living Lab : supporting drug users and families through co-operative counselling using mobile phone technology : original researchSource: South African Family Practice 52, pp 245 –248 (2010)More Less
Background: There is a recognised problem with drug taking in South Africa. In socially deprived areas immediate help for drug users and their families is a problem. As part of their work in a community in tension, Impact Direct Ministries (IDM) and Reconstructed Living Lab (RLabs) in Cape Town provide a drug advisory service using mobile phone technology that can support multiple conversations. It is staffed by trained volunteers and is available to drug users and their families.
Methods: This article investigates historical counselling help for drug users. It explains the importance of family involvement in the life-changing process of a drug user and the importance of co-operative counselling. The Drug Advice Support (DAS) service provided by IDM and RLabs is introduced as a case study to explore how mobile phone technology can support the co-operative counselling model in a Living Lab context.
Results: The advantages of the DAS technology and what it offers to community-based organisations are discussed. Data on relatives of drug users using the system are included.
Conclusion: The use of mobile phone technology has advantages for community-based organisations acting as a first point of contact to drug users and their families. Minimal cost to the person in crisis and the organisation serves as an example. The co-operative counselling model it employs is also of benefit. As the community experiencing tension due to the problem of drug abuse becomes aware of this service, help and support for family members will increase in time.
Barriers to the successful implementation of school health services in the Mpumalanga and Gauteng provinces : original researchSource: South African Family Practice 52, pp 249 –254 (2010)More Less
Background: The level of development of a country is measured by the health status of its children. The higher the mortality and morbidity rates in children, the more the country is challenged to improve its health care system. Although South Africa accepted the Convention on the Rights of the Child (CRC) in 1996 thereby committing itself to prioritisation of children, the implementation of school health services in South Africa has deteriorated to levels that contravene these rights. The promotion of health in schools requires a strong political commitment that will influence all levels of policy making, in other words national, provincial and local, towards an integrated and coordinated school health programme.
Methods: A qualitative, explorative and descriptive study was conducted to identify barriers that led to poor implementation and a decline of school health services in the Mpumalanga and Gauteng provinces. The data-collection method of choice for this study was focus group discussions, which were conducted with all intersectoral role-players involved in school health programmes. To ensure broad representation of the various stakeholders, 10 participants were selected from five districts in each of the two provinces. This resulted in 50 participants per province.
Results: The study findings reveal the following as barriers that hamper successful implementation of comprehensive school health programmes:
- Barriers related to governance, for example lack of national policy guidelines for school health services and failure of government to prioritise school health services
- Programme-related issues, such as lack of intersectoral collaboration and unrealistic nurse-learner ratios
- Management-related issues, such as lack of support by management and managers' limited knowledge of the Health-promoting Schools Initiative
- Community-related issues, such as health professionals not including the communities in school health programmes
Author J.R. SnymanSource: South African Family Practice 52 (2010)More Less
Author M.R. JobsonSource: South African Family Practice 52 (2010)More Less