South African Family Practice - Volume 55, Issue 1, 2013
Volume 55, Issue 1, 2013
Source: South African Family Practice 55 (2013)More Less
Ethics and medicine : revisiting the Children's Act and the implications for healthcare practitioners : ethics CPD articleSource: South African Family Practice 55, pp 2 –5 (2013)More Less
Under the Constitution of the Republic of South Africa, the rights of children are protected in the same manner as are those of ordinary South African citizens. In Section 28, the Constitution also makes provision for the protection of specific children's rights. Thus, for children, constitutionally articulated rights, such as the right to autonomy (derived from the privacy rights), the right to equality, the right to education and freedom of religion, expression and association, are meaningful. It is mainly through social services for children and their families that definitive objectives are met, such as family (or alternative) care, protection from ill-treatment, neglect, abuse and degradation, and the best interests of the child. This article focuses on human rights issues that relate to children and explores the Children's Act with regard to children and informed consent, surgical operations and termination of pregnancy. It concludes that children need support from their families and communities when faced with medical decision-making, and that in the context of children, professional medical practice requires patience, dedication, honesty and mindfulness.
Source: South African Family Practice 55 (2013)More Less
Welcome, readers to 2013, which I hope will be an exciting year as we expand our presence in various international databases. The journal is currently listed on the following accredited scientific databases: Index Scopus, Index Copernicus, African Journal OnLine and Google Scholar. Our next big step is Index Medicus, so watch the space!
Source: South African Family Practice 55 (2013)More Less
Closing the prevention of mother-to-child transmission gap in Nigeria
The prevalence of chronic pain in patients attending primary healthcare facilities in south-west Tshwane
Drug interactions in primary health care in the George subdistrict, South Africa: a cross-sectional study
Source: South African Family Practice 55, pp 6 –9 (2013)More Less
It is against the doctrine of The Watchtower and Bible Tract Society for their followers, the Jehovah's Witnesses, to accept blood transfusions. For this reason, this topic remains a critical issue in medical practice and ethics. Few patients can survive a haemoglobin level of less than 5 g per decilitre without transfusion. In the medical field, Jehovah's Witnesses are widely known for their prohibition against the receipt of blood transfusions. The Watchtower Bible and Tract Society, as the church's legislating body introduced the policy on refusal of blood in 1945, stating that blood transfusion defies divine precepts. This article reviews the ethics of blood transfusion in the Jehovah's witnesses and the new blood transfusion rules in South Africa.
Source: South African Family Practice 55, pp 9 –18 (2013)More Less
The European Society of Cardiology together with the European Atherosclerosis Society published updated dyslipidaemia guidelines in 2011. SA Heart and the Lipid and Atherosclerosis Society of Southern Africa officially adopt these guidelines. This statement adapts aspects of the guidelines to the South African situation. Using the updated Framingham risk charts, interventional strategies are based according to the cardiovascular risk score and low-density lipoprotein cholesterol (LDL-C) levels. The Framingham risk score refers to the 10-year risk of any cardiovascular event, and includes four categories of risk. Treatment targets are those of the European guidelines. The LDL-C goal is 1.8 mmol/l for the very high-risk group (>30%), 2.5 mmol/l for the high-risk group (15 - 30%), and 3 mmol/l for those below 15% risk. Intensive management of dyslipidaemia in South Africa will significantly reduce the cardiovascular disease health burden.
Source: South African Family Practice 55, pp 10 –11 (2013)More Less
This article discusses various ethical and legal concepts regarding euthanasia and includes notions such as physician-assisted suicide, assisted suicide, voluntary active euthanasia, killing versus letting die, indirect euthanasia and terminal sedation. Is there a difference if death is foreseen, but not intended? This article opens up the debate and addresses pertinent issues for the family practitioner.
Source: South African Family Practice 55, pp 12 –14 (2013)More Less
Placental rituals and other birth-by rituals are common in various societies. They often include culturally determined behavioural sequences which operate as anxiety-releasing mechanisms. They also serve to offer a spiritual means of "control" over the future health and welfare of mother, child, and even the community. As long as such rituals do not cause harm, they should be respected for the role that they play and be left alone. This article discusses the ethical and legal considerations regarding post-birth rituals and their relevance to South Africa, with special reference to the South African Human Tissue Act.
Source: South African Family Practice 55, pp 15 –16 (2013)More Less
The word "placebo", first used during funeral ceremonies in the 14th century, is derived from old Latin and means "I shall please". At the time, it was practice among Roman Catholics to hire professional mourners to wail vespers for the dead. Placebo Dominio regione vivorium translates from Psalm 116: 9 as "I shall please the Lord in the land of the living". Professional mourners served as stand-ins for the family of the deceased. They "walked" before the holy being by acting in a manner which pleased Him. Over time and in many circles, the term came to connote a substitution for the actual.
Author C. WhittakerSource: South African Family Practice 55, pp 20 –25 (2013)More Less
Chronic obstructive pulmonary disease affects millions of people, has a major impact on quality of life and has become an important cause of death worldwide. Over the past decade, a better understanding of COPD has been gained, while research into new therapies and treatment strategies has provided significant treatment advances. In this article, the different therapeutic classes that are available for COPD will be reviewed, including combination therapy and the recommended stepwise approach for disease management.
The management of acute low back pain in adults : a guide for the primary care physician, Part II : CPD reviewAuthor S.W. BrightonSource: South African Family Practice 55, pp 26 –32 (2013)More Less
When a patient presents with acute low back pain (LBP), any red flag warnings of serious disease should first be excluded. Yellow and blue flag warnings of psychological factors should be noted. A psychological opinion of patients with substantial psychological distress could be sought. Advice may be offered on the benign nature of non-specific LBP. The person should be encouraged to be physically active and to continue with normal activities as far as possible. A structured exercise programme, that includes aerobic activity, movement instruction, muscle strengthening, postural control and stretching, should be devised. A combined exercise and psychological treatment programme that includes a cognitive behavioural approach can be considered in patients with significant disability or substantial psychological distress. A course of acupuncture may also be added. Manual therapy, including spinal manipulation, could be considered. Paracetamol should be the first medication option. If this is inadequate, a non-steroidal anti-inflammatory drug or weak opioid, or both, can be added. Individual risks for side-effects and the patient's preference should be taken into account. Strong opioids should be considered in patients in severe pain, but for short-term use only. Antidepressants and gabapentine or pregabolin can be considered when there is a neurogenic component of the pain. Consider obtaining a surgical opinion on patients who have completed an optimal package of care and who still have persistent severe non-specific LBP. Progressive neurological fallout requires a surgical opinion.
Source: South African Family Practice 55, pp 33 –40 (2013)More Less
The red eye is a clinical problem that is encountered regularly in most primary healthcare settings. A wide spectrum of diseases may cause a red eye. Fortunately, most are relatively benign, but many potentially sight-threatening conditions may manifest in a similar way. From the history and examination, the primary care physician must be able to differentiate between features that make primary care treatment possible and high-risk features that necessitate immediate referral. This article includes a discussion on features that distinguish benign from sight-threatening causes of red eye. Unilateral red eye, pain (a deep ache), deep redness, decreased visual acuity and photophobia signify more sinister causes. The red eye has an extensive differential diagnosis. Some of the common causes are conjunctivitis, subconjunctival haemorrhage, episcleritis, scleritis, anterior uveitis and acute glaucoma. Generally, patients who present with red eye can be divided into two groups: those who can be treated at primary care level and those who need secondary or tertiary level care. Other distinguishing features include a pattern to the redness, the type of discharge, the presence of increased lacrimation and photophobia, as well as corneal haze. However, these are not always easily employed as differentiating factors. Therefore, this article lists specific and basic features which can be used to identify the various causes of the red eye.
Author M.L.I. MashitishoSource: South African Family Practice 55, pp 41 –44 (2013)More Less
Hypertension and diabetes co-exist. The prevalence of hypertension is higher in patients with type 2 diabetes mellitus, while patients with hypertension have a higher incidence of developing type 2 diabetes mellitus. Hypertension in patients with diabetes is linked to cardiovascular disease, strokes, the progression of renal disease and diabetic retinopathy. Any 10 mmHg drop in blood pressure is associated with a reduction in the rate of diabetes-related mortality by 15%, myocardial infarction by 11% and microvascular complications of retinopathy or nephropathy by 13%. According to the Society for Endocrinology, Metabolism and Diabetes of South Africa, target blood pressure in patients with hypertension and diabetes is between 120/70 mmHg and 140/80 mmHg. Different studies have demonstrated that adequate blood pressure control improves outcomes, especially strokes, when the blood pressure target is achieved. The United Kingdom Prospective Diabetes Study (UKPDS) 38 reported that tight blood pressure control in patients with type 2 diabetes mellitus reduced the risk of diabetes-related deaths, complications related to diabetes, progression to diabetic retinopathy and deterioration in visual acuity. Tight blood pressure control in patients with type 2 diabetes mellitus also reduces the costs of complications. In UKPDS 39, it was found that by preventing diabetes-related complications in patients with hypertension, the choice of antihypertensive drugs to control blood pressure was less important than the blood pressure control. It is very important for clinicians to be familiar with the different classes of drugs that are commonly used to control hypertension in patients with type 2 diabetes mellitus. This information will assist clinicians to prevent or delay the progression of diabetic complications. The drug classes that are commonly used in the management of hypertension in patients with diabetes mellitus are angiotensin-converting enzyme inhibitors, calcium-channel blockers, angiotensin II-receptor blockers, thiazide diuretics and beta blockers.
Author R.J. BaigrieSource: South African Family Practice 55, pp 47 –52 (2013)More Less
Colorectal cancer affects approximately 1:20 of the population and in South Africa is largely managed by general surgeons. Management of this disease has undergone very significant changes over the last two decades. Until very recently, only two academic general surgery departments included a specialist colorectal unit, and this remains so in the majority of our universities. This has resulted in a generation of surgical graduates who are unfamiliar with, and unskilled in current best management practices for this disease. Rectal cancer is particular challenging and attracts extremely high morbidity and mortality, with poor oncological outcomes. Repeatedly, outcome has been shown to be worse in the hands of generalists, rather than specialist colorectal surgeons, of whom there are very few in the country. This review presents the most important advances of the last 20 years and highlights current controversies and frontiers.
Source: South African Family Practice 55, pp 53 –55 (2013)More Less
Chronic fatigue syndrome (CFS) refers to marked and prolonged fatigue, for which no indentifiable cause can be found. Despite the presence of extensive symptoms, diagnosis is made when there is profound fatigue, lasting for a duration of six months, or longer. CFS is frequently seen in association with psychiatric illnesses,such as depression and anxiety, but has not been shown to be casually related to any particular psychiatric disease.
Source: South African Family Practice 55, pp 56 –58 (2013)More Less
There are recommendations to guide parents to help their infants make the transition from milk to weaning foods, but they differ in their focus in developed or developing countries and on the physiological and behavioural reasons that underlie the introduction of weaning foods. According to recommendations, ideally, term infants should begin weaning at six months, while breastfeeding should continue for two years. The recommendations on nutrients in complementary foods are based on the nutrient gap between the composition and volume of breast milk after approximately six months of exclusive breastfeeding and the physiology of infant nutritional requirements.
Spirit(ed) away : preventing foetal alcohol syndrome with motivational interviewing and cognitive behavioural therapy : forumSource: South African Family Practice 55, pp 59 –64 (2013)More Less
Foetal alcohol syndrome (FAS) is a growing concern in South Africa. In the Western Cape, prevalence rates for FAS are the highest in the world. Not surprisingly, the Western Cape also has some of the highest levels of alcohol consumption per capita. Although FAS is primarily caused by alcohol consumption during pregnancy, the high rate of FAS in South Africa originates from a multitude of complex factors. These factors include heritage, poverty, high levels of unemployment and low-paid menial jobs, depression, low self-esteem, low self-efficacy, increased accessibility to alcohol, lack of recreation, poor education, familial pressure, denial, cultural misconceptions and the smaller physiques of some of the women in the Western Cape. Holistic and comprehensive macro- and micro-level approaches are necessary in order to change the alcohol consumption trend that has developed over the last 300 years. No single strategy will reduce or eliminate the burden of alcohol misuse in this society. However, as the presented discussion suggests, combining the spirit of motivational interviewing (MI) with cognitive behavioural therapy (CBT) practice, borrowed from health psychological interventions for lifestyle-related chronic health conditions, holds promise for reducing the prevalence of FAS within Western Cape communities. These individual-based approaches have yet to be employed in South Africa despite the wealth of evidence that demonstrates their potential in targeting high-risk groups and reducing per capita alcohol consumption.
Social exclusion of students with visual impairments at a tertiary institution in KwaZulu-Natal : original researchSource: South African Family Practice 55, pp 66 –72 (2013)More Less
Objectives : People with visual impairment experience exclusion and marginalisation from family, mainstream school, the community and university. The experience of social exclusion is multistructural, multidimensional and complex. This article is based on a study that aimed to describe the social exclusion of students with visual impairment at a tertiary institution where the authors are employed.
Design : The study was qualitative. It used an exploratory design to provide compelling data on the insider perspectives of students.
Setting and subjects : Fifteen students participated in the study, of whom nine were men and six women. Eleven students were partially sighted and four were blind. All the subjects were from the university where the authors are employed.
Results : The study established that participants' exclusion from access to opportunities and development left them psychologically, socially, financially and emotionally scarred.
Conclusion : The study established that visual impairment and poverty were related and that women experienced oppression on two counts. The first was because of their disabled status and the second was oppression by other female students at the university. Recommendations are for changes within families, schools, communities and universities.
Prevalence of end-digit preference in recorded blood pressure by nurses : a comparison of measurements taken by mercury and electronic blood pressure-measuring devices : original researchSource: South African Family Practice 55, pp 73 –77 (2013)More Less
Objectives : When compared with the use of a mercury sphygmomanometer, the use of a validated digital blood pressure (BP) measuring device eliminates the risk of exposure to mercury. Digital devices are also associated with a lesser degree of end-digit preference (EDP). EDP refers to the occurrence of a particular end digit more frequently than would be expected through chance alone. There have been only a few reports from Africa on the occurrence of EDP in BP measurement. This study examined EDP in BP taken by nurses before and after the introduction of a digital BP-measuring device.
Design : The design was a retrospective study.
Settings and subjects : We reviewed the BP readings of 458 patients who presented at the dedicated clinic for people living with human immunodeficiency virus/acquired immune deficiency syndrome of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, before and after the introduction of the digital BP-measuring device.
Outcome measures : The prevalence of end-digit zero of systolic and diastolic BP readings before and after the introduction of the digital device was compared using McNemar's test.
Results : There was a large and significant fall in end-digit zero when BP readings that were taken using the mercury and digital devices were compared (systolic 98.1% vs. 10.9%, p-value < 0.001; diastolic 97.1% vs. 14.9%, p-value < 0.001 (McNemar's test).
Conclusion : There was a significant reduction in the frequency of end-digit zero when BP was taken with the digital device rather than the mercury device. Regular training and certification of healthcare workers in BP measurement is recommended to ensure a high quality BP measurement standard.