South African Family Practice - Volume 54, Issue 3, 2012
Volume 54, Issue 3, 2012
Uptake of genetic counselling services by patients with cystic fibrosis and their families : original researchSource: South African Family Practice 54, pp 250 –255 (2012)More Less
Background : Although cystic fibrosis (CF) is a common genetic condition, genetic counselling services appear to be underutilised by affected families. The aim of this study was to determine the uptake of genetic counselling and mutation testing for CF by relatives of affected individuals, and the impact of introducing hospital-based genetic counselling services.
Method : The files of 153 families seen for genetic counselling for CF by staff of the Division of Human Genetics, School of Pathology, University of the Witwatersrand, and the National Health Laboratory Service (NHLS) in Johannesburg, were retrospectively reviewed from 1990 to 2006, the year when hospital-based genetic counselling services were introduced.
Results : Parents of CF probands were the largest single group (35%) of counsellees. Most individuals (66%) attended genetic counselling to gather information. Most had been referred by medical specialists (56%). Only 10% of referrals originated from general practitioners. On average, from 1990-2005, six families received genetic counselling annually, whereas in 2006, 58 families were seen. In 140 unrelated families, 1 991 relatives with carrier risks of ≥ 25% were identified. Only 11% of these relatives underwent mutation testing, and eight per cent received genetic counselling through our division over the review period.
Conclusion : Overall, referrals of family members (of affected CF individuals) to genetic counselling, by general practitioners, are poor. Uptake of genetic counselling services is greater when such services are integrated into hospital-based CF management clinics, than when offered elsewhere. The low uptake of mutation testing and genetic counselling by at-risk relatives is a concern, since these relatives are at high risk of having affected children, if their partners are CF carriers. Education of affected individuals, their close relatives, and medical practitioners, should be prioritised. This will ensure referral to genetic counselling for discussion about the risks of and available testing for CF, and other genetic conditions.
Pain as a reason for primary care visits : cross-sectional survey in a rural and peri-urban health clinic in the Eastern Cape, South Africa : original researchSource: South African Family Practice 54, pp 256 –263 (2012)More Less
Background : The burden of pain in primary care has not been described for South Africa. This study aimed to determine the prevalence of pain in primary care and to characterise pain among adult patients attending a rural and a peri-urban clinic in the Eastern Cape (EC) Province.
Method : A cross-sectional descriptive survey was conducted among adult patients attending a rural and peri-urban clinic over four days. Consecutive patients were asked whether they were in the clinic because of pain and whether the pain was the major reason for their visit. Pain was characterised using an adaptation of the Brief Pain Inventory and the Pain Disability Index. The prevalence percentage and the 95% confidence interval (CI) of pain were estimated, and the relationship with demographic variables was determined at a significance level of P < 0.05.
Results : Seven hundred and ninety-six adult patients were interviewed, representing a response rate of 97.4%. Almost three-quarters (74.6%; 95% CI: 63.2-81.4%) reported visiting the clinic because of pain. Pain was the primary reason for 393 (49.4%; 95% CI: 32.1-61.0%) visits and was secondary in 201 (25.3%; 95% CI: 12.8-33.7%) visits. The common sites of pain were the head, back and chest. The median pain score was eight on a scale of 0-10 (interquartile range: 6-8). Respondents experienced limitations in a number of activities of daily living as a result of pain.
Conclusion : Pain is a central problem in public primary care settings in the EC Province and must therefore be a priority area for primary care research. Strategies are needed to develop to improve pain management at primary care level in the province.
Conference report : 15th National Family Practitioners Conference, 11-12 May 2012 : conference reportAuthor Bob MashSource: South African Family Practice 54, pp 265 –266 (2012)More Less
The Academy of Family Physicians delivered a very successful national conference in May this year at the River Club in Cape Town. Over 300 general practitioners and family physicians attended in the interests of continuing professional development, and shared research and discussion on the conference theme, Revitalising primary care.
Author Chris EllisSource: South African Family Practice 54 (2012)More Less
Autogenic reactions are feelings or reactions which arise in the doctor while observing or listening to a patient (autos = self, genein = to produce). We are subliminally aware of these reactions, and usually, they are mostly background sensations and feelings that are suppressed while trying to diagnose and manage the patient. Mostly, the reactions that I notice are the negative ones, which are followed by a feeling of guilt that I, as a putatively benevolent healer, should succumb to such judgmental thoughts, and that they might affect my objectivity. Autogenic reactions are a part of countertransference whereby we become aware of features in the patient that are similar to our own characteristics or experiences. We often have an uncomfortable resonance with what the patient is saying or has experienced.