South African Family Practice - Volume 53, Issue 5, 2011
Volume 53, Issue 5, 2011
Author D. SmitSource: South African Family Practice 53, pp 245 –430 (2011)More Less
Patients suffering from allergic conditions affecting the eye present to primary healthcare providers on a daily basis. It is important to note that many of these conditions are transient in nature and do not cause any permanent damage to the eye, whereas other, more chronic forms are vision-threatening and may lead to irreversible ocular damage if misdiagnosed and not treated appropriately. In this article, the different guises of ocular allergy will be described, along with helpful hints that will aid in reaching the correct diagnosis and management of each. Conditions predominantly affecting the eyelids will be discussed first, followed by those primarily affecting the ocular surface and finally those associated with contact lens wear.
Author Gboyega OgunbanjoSource: South African Family Practice 53 (2011)More Less
On 11 August 2011, Dr Aaron Motsoaledi, the Minister of Health, launched the Green Paper on the National Health Insurance (NHI) during a post-cabinet media briefing in Pretoria. The NHI is expected to be an innovative system of healthcare funding which will give all South Africans access to appropriate, efficient and quality health services and affordable, quality health care, regardless of socio-economic status. He was succinct in his briefing that the timeline for this project is 14 years, with the first five years focused on building and preparation. Dr Motsolaedi stressed that the cornerstone of the proposed NHI is universal coverage, with a financing system that will ensure provision of essential health care to all citizens of South Africa (and legal long-term residents), regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.
Source: South African Family Practice 53, pp 403 –411 (2011)More Less
Oral contraceptives (OCs) are classified according to the dosage of ethinyloestradiol (EE) and type of progestogen, and whether the dosages of EE and progestogen stay the same during the cycle, or change in a phasic manner. Ultimately, there is no statistically significant difference in efficacy between high-dose and low-dose OCs. There is also no difference in efficacy between monophasic and multiphasic products, which, other than having a lower hormone content, have no benefit over monophasic products. Several medications, such as rifampicin, some of the anticonvulsants and certain human immunodeficiency virus (HIV) medications, may reduce the efficacy of OCs. Higher-dose OC preparations are recommended in patients taking these concomitant drugs. The effectiveness of OCs with typical use is largely dependent on compliance, which is influenced by bleeding patterns and side-effects. In this regard, the composition of an OC may play a significant role. The dosage of EE and type of progestogen may relate to specific non-contraceptive benefits, such as improvement in dysfunctional uterine bleeding, dysmenorrhoea, premenstrual tension, endometriosis, iron deficiency anaemia, hyperandrogenism and acne. The third-generation progestogens and anti-androgens are generally regarded as more "skin friendly". The cardiovascular safety of OCs has long been controversial, and although complications such as myocardial infarction and stroke have been reduced over the years with lower EE dosages, the risk of venous thromboembolism (VTE) has not decreased consistently. In fact, some of the low-dose products containing third-generation progestogens and antiandrogens may be associated with a higher risk of VTE. Breast cancer is another controversial issue that is associated with OC use. Epidemiological studies do not report an increased risk, whereas other meta-analyses do. The risk may be amplified by genetic susceptibility, although data on the subject are not consistent. An increased risk of hepatic adenoma and cervical cancer has also been noted with OC use, but the latter seems to be dependent on persistent human papillomavirus infection. On the other hand, ovarian and endometrial cancers are reduced by the use of OCs, although genetic susceptibility may also modify the risk. As indicated by several studies on risk factors relating to the safety of contraceptives, the choice of contraceptive is more complicated in patients with certain medical conditions. This is because the physiological changes and side-effects that are associated with the method may increase the risk of morbidity or mortality in these women. Before starting on a contraceptive, the woman should undergo a risk-benefit assessment to ensure the safety of the method. This is also true for OCs, and in this regard, the latest World Health Organization (WHO) safety categories may be consulted.
Author J. Van SchoorSource: South African Family Practice 53, pp 413 –417 (2011)More Less
The National Osteoporosis Foundation of South Africa (NOFSA) recently published a revised guideline for the diagnosis and management of osteoporosis. The 2010 revision is an update of the guideline published by NOFSA in 2000. The full guideline targets all healthcare workers. This article provides a brief summary of the revised osteoporosis guideline. The full NOFSA guideline is available online at www.jemdsa.co.za and www.osteoporosis.org.za.
Source: South African Family Practice 53, pp 419 –424 (2011)More Less
This article aims to inform clinicians about the current knowledge on aminoglycoside-induced vestibulotoxicity through a review of the literature. The effects of vestibulotoxicity are irreversible and may be profoundly disabling. It would appear that the sooner vestibular rehabilitation therapy is instituted, the more favourable the prognosis is. Thus, early referral and management are essential. Vestibulotoxicity is a commonly overlooked aetiology when assessing dizzy patients. This could be due to the difficulty that patients have in describing vestibular symptoms in general, as well as the absence of vertigo as a presenting complaint. Discussion includes the clinical presentation of vestibulotoxicity and its sequelae, as well as strategies to assess and monitor patients.
Author L. JohnstonSource: South African Family Practice 53, pp 433 –436 (2011)More Less
Breast milk remains the best source of nourishment for infants, and as such all mothers should be encouraged to breastfeed. However, in exceptional circumstances breastfeeding may not be possible, and under such circumstances parents may seek a suitable alternative. Infant formula is the only product recognised by the Codex Alimentarius Commission of the United Nations as a suitable breast-milk substitute. Worldwide various infant formulas are available and deciding on a suitable formulation may seem daunting. Understanding the basics behind the composition of formulas may facilitate this decision-making process when selecting an appropriate infant formula.
Source: South African Family Practice 53, pp 437 –439 (2011)More Less
Childhood asthma is characterised by episodes of wheezing and coughing, particularly at night. The cough is typically non-productive of sputum and is irritating and persistent. It is most troublesome in the early hours of the morning, especially between 1-2 am. Chronic cough may be a presenting symptom in young children. Wheezing, chest tightness, and shortness of breath become more obvious in children older than three years.
Author J.A. KerSource: South African Family Practice 53, pp 441 –442 (2011)More Less
Secondary hypertension is rare and the diagnosis may be challenging although, on occasion, there are clinical features indicative of a specific underlying cause. The more commonly encountered causes include renal parenchymal and vascular disease, phaeochromocytoma, endocrine causes, sleep apnoea and drugs.
Source: South African Family Practice 53, pp 445 –447 (2011)More Less
Detecting and treating mental illness in general practice has always been challenging. Newer pharmacological agents like agomelatine, indicated for major depressive disorder, have a different and possibly superior side-effect profile than conventional antidepressants. Since side-effects of antidepressants is a major reason for non-compliance, it is hoped that this will improve treatment rates and compliance. Despite these newer treatments, the general practitioner is challenged to detect psychiatric disorders and treat and monitor recovery during a 10-minute consultation. This feature explores some of the factors that influence low detection rates, and introduces a unique DVD set that discusses 13 psychiatric disorders in a uniquely South African way.
Idiopathic acquired progressive left facial hemiatrophy (Parry-Romberg syndrome) in a 21-year-old man in semi-urban, south-west Nigeria : case studySource: South African Family Practice 53, pp 452 –454 (2011)More Less
Idiopathic progressive hemifacial atrophy, or Parry-Romberg syndrome, is a rare entity, seldom described in medical texts. Though first described in 1825, as yet there are no clear-cut diagnostic criteria. It is of interest mainly because of the numerous features with which it may be associated, which are largely in the central nervous system, and, more importantly, because it can easily be confused with localised scleroderma en coup de sabre. Some classify it as one of the trophoneuroses; others believe it is a variant of localised scleroderma. Most of the sufferers present because of the attendant cosmetic loss from the facial disfigurement. Treatment is multifactorial, and includes facial reconstructive surgery and immunosuppressants. Here we present the case of a 21-year-old Nigerian with idiopathic progressive left hemifacial atrophy. To the best of our knowledge, it is probably the first case from Nigeria to be reported in literature.
Author Pierre J.T. De VilliersSource: South African Family Practice 53 (2011)More Less
From 24-30 October, we celebrated international Open Access Week, a global event in its fifth year. According to www.openaccessweek.org, the event is "...an opportunity for the academic and research community to continue to learn about the potential benefits of Open Access, to share what they've learned with colleagues, and to help inspire wider participation in helping to make Open Access a new norm in scholarship and research.
Source: South African Family Practice 53, pp 459 –461 (2011)More Less
There is an urgent need to preserve the traditional diet in the Mediterranean countries and to stress its important contribution to the public health. The traditional Mediterranean diet can be revitalised within a modern environment and lifestyle and be adopted not only by inhabitants of the Mediterranean region, but also by people in other countries as a health-promoting model. The Mediterranean diet can significantly decrease the risk of overall mortality.
Occupational exposure to blood-borne or body fluid pathogens among medical interns at Addington Hospital, Durban : original researchSource: South African Family Practice 53, pp 462 –466 (2011)More Less
Background: Healthcare workers are at risk of transmission of hepatitis B and C and human immunodeficiency viruses following accidental exposure to blood and body fluids. Interns are a vulnerable group of healthcare workers, cited as having the highest incidence of accidental needle-stick injuries and splashes with blood or body fluids. The main reason is thought to be a lack of experience and confidence, and underdeveloped dexterity skills, all of which increase risk of exposure. Since the introduction of the new two-year internship, to date no study has been carried out in South Africa comparing the incidence of occupational exposure between first- and second-year interns.
Methods: A descriptive study design was devised and a structured questionnaire distributed to all interns employed at Addington Hospital in December 2008. All the interns had completed either one or two years of internship. Data were analysed using the SPSS software package and chi-square tests were applied for comparable variables.
Results: The response rate was 83% (53/64). During 2008, 29 (55%) interns had at least one incident of accidental exposure to blood or body fluids. Eighteen (62%) were first-year interns and 11 (38%) were second-year interns (p < 0.01). In total, there were 42 exposures, of which 64% (27/42) were percutaneous and 36% (15/42) mucosal. First-year interns experienced 70% (19/27) of the needle-stick injuries and 73% (11/15) of the mucosal exposures (p < 0.01). A significant difference was noted between the first- and second-year interns (p < 0.01).
Conclusion: The high level of exposure of interns to blood and blood products highlights the need for improvement in occupational health safety to prevent transmission of pathogens. Closer supervision of first-year interns and more focus on undergraduate awareness and skills development is necessary.
Gender discrepancies in the HIV/AIDS Community Home-Based Care Programme in Kanye, Botswana : original researchAuthor S.M. Kang'etheSource: South African Family Practice 53, pp 467 –473 (2011)More Less
The aim and objective of this paper is to discuss the gender discrepancies associated with caregiving based on empirical findings from the Kanye HIV/AIDS Community Home-Based Care (CHBC) Programme. The research study was explorative and descriptive in nature and qualitative in design. It used focus group discussions among the caregiver respondents and one-on-one interviews with the CHBC nurses. The findings indicate that the caregiving role among women, and spilling over to girl children, is a result of socialisation that is deeply ingrained in the belief systems of cultures and communities, presents a state of gender exploitation and a human rights denial, is reinforced by the forces of patriarchy, and contributes immensely to the feminisation of poverty. The study recommends gender mainstreaming and analysis in all the institutions of social development, as well as poverty mitigation measures and education to surmount the effects of gender imbalances, gender inequality and gender inequity.
Anthropometric profile of HIV-uninfected and HIV-infected women aged 25-44 years in Mangaung, Free State : original researchSource: South African Family Practice 53, pp 474 –480 (2011)More Less
Background: Obesity and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) affect significant numbers of black women in South Africa.
Method: Using township maps, a random sample of 500 black women residing in Mangaung in the Free State was selected to participate in this study in the year 2000. The women were divided into two age groups, namely 25-34 years (n = 273) and 35-44 years (n = 215). Anthropometric measurements, including height, weight [to calculate the body mass index (BMI)] and waist circumference (WC) were taken. Fat percentage was measured with bioelectrical impedance. HIV status was determined using a microparticle enzyme immunoassay method. Socio-demographic status, health status, dietary intake, level of physical activity, body perception and attitude toward weight control, as well as prevalence and risk of lifestyle diseases were determined as part of the larger study.
Results: Sixty-one per cent of younger women (25-34 years) and 38% of older women (35-44 years) were infected with HIV. In younger HIV-infected women, median BMI, WC and fat percentage were significantly lower than in HIV-uninfected women.
Conclusions: HIV infection rates were found to be higher among younger than older women. The prevalence of obesity was high overall. Median BMI values ranged between 24.4 kg/m2 and 27.6 kg/m2. A large percentage of all women fell in the unhealthy fat percentage category (excessive body fat), ranging between 65.9% of HIV-infected young women and 79.3% of older HIV-infected women. HIV, even in the asymptomatic stage, influences anthropometric indicators.
Student nurses' views regarding disclosure of patients' confidential information : original researchSource: South African Family Practice 53, pp 481 –487 (2011)More Less
Background: Nurses have a moral duty to maintain the confidentiality of patients' information. Challenges to maintaining confidentiality often arise because of competing moral claims of the patient, his/her family members and doctors.
Methods: A qualitative, descriptive and contextual study was conducted to explore and describe the views of student nurses regarding the disclosure of patients' information. Sampling to select 17 student nurses in their final year of nursing training was adopted purposefully. Data were collected by means of focus group and individual interviews, and then analysed using the Tesch descriptive analysis method.
Results: Two themes emerged from analysis of the data, reflecting the participants' views regarding the disclosure of confidential patient information. The themes were: maintaining the confidentiality of patients' information, and factors influencing the disclosure of information.
Conclusions: The findings indicate that student nurses are aware of the challenges inherent in practice, where patients' confidentiality might sometimes be compromised.
Acceptance and uptake of voluntary HIV testing among healthcare workers in a South African public hospital : original researchSource: South African Family Practice 53, pp 488 –494 (2011)More Less
Background: Healthcare workers are seen as being at the centre of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) management. They are also at risk of HIV infection from occupational exposure to blood-borne pathogens during their daily work activities. Although many studies on HIV/AIDS and its management have been carried out globally, only a few address HIV counselling and testing among healthcare workers. The aim of this study is to determine factors associated with the acceptance and uptake of voluntary HIV testing among healthcare workers in a public hospital in KwaZulu-Natal.
Method: A cross-sectional quantitative descriptive survey was conducted among healthcare workers in a public hospital, by means of self-administered questionnaires. Written informed consent was obtained from each participant prior to participation in the study.
Results: A response rate of 239 (59.4%) was achieved from a targeted population of 402 healthcare workers. Of the 239 participants, 208 (87.0%) indicated that they would accept having an HIV test, while 217 (90.7%) reported having had HIV counselling and testing. There were positive associations between participants' having had HIV counselling and testing and having a close relative living with HIV/AIDS (p-value = 0.032), previous accidental exposure to blood-borne pathogens (p-value = 0.003) and the number of years of their work experience (p-value = 0.0006). No significant associations were noted between participants who reported having undergone HIV counselling and testing in the previous year, and their demographic variables, such as age (0.766), gender (0.876), marital status (0.715), and knowledge of hospital policy on post-exposure prophylaxis (0.5669).
Conclusion: The findings of this study showed high levels of acceptance (208, 87.0%) and uptake (217, 90.7%) of HIV counselling and testing among healthcare workers in the designated public hospital. Several factors influenced this.
Source: South African Family Practice 53, pp 495 –500 (2011)More Less
Background: In April 2008, the first case of pertussis since 1998 was diagnosed in the Free State province. The outbreak that occurred over a 12-month period is described in this article.
Method: This is a case series of 18 children diagnosed with pertussis in Bloemfontein, Free State province, between April 2008 and March 2009. The clinical diagnosis was confirmed by means of a Bordetella polymerase chain reaction test done on a nasal swab. Data were collected from every child with a confirmed diagnosis of pertussis.
Results: Eighteen cases of pertussis were diagnosed in the 12-month period; 15 in the public sector and three in the private sector. A peak of cases was observed in the autumn and early winter months. Twelve infants were under six months of age and were thus regarded as "pre-vaccinated". Fourteen children required admission to hospital, of whom five required intensive care. No deaths occurred. The cost of managing these children was high.
Conclusions: Pertussis is not commonly diagnosed in South Africa. Young children are worst affected by the disease. Ongoing surveillance is needed. A vaccination plan to prevent pertussis in South Africa requires consideration.
Author Solani MathebulaSource: South African Family Practice 53 (2011)More Less
Cardiovascular disease (including ischaemic heart disease and stroke) remains the most common cause of death. Traditional risk factors for cardiovascular disease (such as hypertension, hyperlipidaemia and cigarette smoking, among others) allow doctors to identify, monitor and treat high-risk patients. However, a large proportion of cardiovascular morbidity and mortality is not explained by these risk factors. As a result, there is a possibility of finding additional variables for cardiovascular risk stratification.
Author Chris EllisSource: South African Family Practice 53 (2011)More Less