South African Family Practice - Volume 56, Issue 3, 2014
Volume 56, Issue 3, 2014
Source: South African Family Practice 56, pp 162 –165 (2014) http://dx.doi.org/10.1080/20786204.2014.932546More Less
Source: South African Family Practice 56, pp 166 –171 (2014) http://dx.doi.org/10.1080/20786204.2014.932547More Less
Immune-mediated inflammatory disorders include a clinically diverse group of conditions that share similar pathogenic mechanisms. Conditions such as rheumatoid arthritis (RA), psoriasis, spondyloarthropathy, inflammatory bowel disease and connective-tissue disease are characterised by immune dysregulation and chronic inflammation. This review will focus on immunopathogenic mechanisms, aspects of early disease, co-morbidity and therapy in RA.
Author James A. KerSource: South African Family Practice 56, pp 172 –173 (2014) http://dx.doi.org/10.1080/20786204.2014.932545More Less
Cardiovascular disease remains a major cause of global mortality and morbidity. Atherosclerosis is the main underlying cause in the majority of cardiovascular disease events. Traditional independent risk factors for cardiovascular disease include age, abnormal lipid levels, elevated blood pressure, smoking and elevated blood sugar levels (diabetes mellitus). These risk factors are incorporated into a risk score, such as the Framingham Risk Score (FRS), that is used to predict an individual's absolute risk of a cardiovascular event, typically over the next 10 years, e.g. 15% risk over 10 years. These risk scores are useful in predicting risk in populations, but their ability to predict a cardiovascular event in an individual patient is not accurate and varies considerably across different populations. Currently, there are three methods of calculating cardiovascular risk. These are risk charts, e.g. FRS, a non-laboratory-based risk calculation, and lastly, screening for subclinical cardiac disease.
Author Leon SnymanSource: South African Family Practice 56, pp 174 –177 (2014) http://dx.doi.org/10.1080/20786204.2014.932549More Less
Peak bone mass for spine and hip is reached in the mid-twenties and adolescents should be counselled on adequate nutrition to ensure sufficient calcium intake, regular weight-bearing exercise, maintaining normal body weight, avoiding smoking and limiting alcohol intake. These measures are important to prevent osteopenia and osteoporosis by obtaining a maximum peak bone mineral density (BMD) and to maintain it by avoiding excessive bone loss. One year before the onset of menopause, however, as a result of oestrogen deficiency, there is an increase in osteoclastic activity without a similar increase in osteoblastic activity, resulting in accelerated bone loss. The average decrease in BMD during the menopausal transition is estimated to be about 10% and a woman's risk of sustaining an osteoporotic or fragility fracture doubles for each decade after the age of fifty. Half of women older than 50 years of age will be osteopenic compared to 10% who are osteoporotic and only 40% will have normal BMD. This article gives an overview of the prevention, diagnosis and management of osteoporosis during and before menopause.
Knowledge and attitude of Nigerian personnel working at Federal Medical Centre in Nigeria on carbon monoxide poisoning from electrical power generators : researchSource: South African Family Practice 56, pp 178 –181 (2014) http://dx.doi.org/10.1080/20786204.2014.936662More Less
Background : Private portable electrical power generators are common household items in Nigeria owing to inadequate electrical power provision for the public. These engines often run indoors, emitting poisonous carbon monoxide gas. Fatalities are commonly reported as a result of carbon monoxide inhalation. This study evaluated awareness of and attitudes towards the dangers of carbon monoxide poisoning in health personnel in a Nigerian referral hospital.
Method : The study was carried out on personnel working at the Federal Medical Centre, Owo, Nigeria. The respondents were interviewed using a self-administered, semi-structured questionnaire. The obtained data were collated and analysed with SPSS®, version 16.
Results : One hundred and seventy-six health workers participated, and 157 completed and returned the survey questionnaire (89.2% response rate). Of these, 95 respondents (60.5%) were informed about carbon monoxide poisoning and 62 (39.5%) were not. Moreover, 105 respondents (73.4%) had no idea of sources of carbon monoxide poisoning. Twenty-three of the 95 informed respondents (24.2%) had received information on carbon monoxide poisoning through the newspaper. Sixty-two respondents (39.5%) indicated that they preferred to run electrical generators indoors, and 89 (56.7%) could not recognise the physical properties of carbon monoxide. Potential damage by rain (72, 53.3%), and fear of theft (38, 24.8%) and destruction of the generators by children (14, 10.4%) were the supplied reasons for running generators indoors.
Conclusion : The health-related dangers of carbon monoxide poisoning as a result of operating electrical generators indoors were poorly appreciated, even by health workers. There is a need for wider public education on the subject in Nigeria, and especially in the mass media and at schools and hospitals.
Intubation and mechanical ventilation : knowledge of medical officers at a South African secondary hospital : researchAuthor Linda Van DeventerSource: South African Family Practice 56, pp 182 –185 (2014) http://dx.doi.org/10.1080/20786204.2014.936667More Less
Background : Medical officers frequently need to initiate the management of critically ill patients requiring endotracheal intubation and mechanical ventilation. The knowledge of hospital-based medical officers at a South African secondary hospital was evaluated on indications for endotracheal intubation and the initiation of mechanical ventilation in adults (defined as persons aged 13 years and older).
Method : Data were collected through questionnaires using 18 multiple-choice questions. Questionnaires consisted of a short test on the basic principles of intubation and the initiation of mechanical ventilation.
Results : Forty-four medical officers participated in this study, conducted in 2008. The mean test score for medical officers taking the test was 6.2, with a range of 2-10, out of a possible 15 marks. 77.3% of participants answered fewer than half of the questions correctly. Nobody answered more than 70% of the questions correctly. More than two thirds of the medical officers could not correctly identify indications for endotracheal intubation, 97.7% of medical officers could not correctly identify all of the contraindications to orotracheal intubation, and 97.7% were unable to choose appropriate initial ventilator settings.
Conclusion : Most medical officers at this secondary hospital were lacking in essential knowledge needed to make decisions on which patients required intubation and how to initiate mechanical ventilation. Pre- and postgraduate training on these basic principles needs to improve.
Tablet computers for recording tuberculosis data at a community health centre in King Sabata Dalindyebo Local Municipality, Eastern Cape : a proof of concept report : researchSource: South African Family Practice 56, pp 186 –189 (2014) http://dx.doi.org/10.1080/20786204.2014.936666More Less
Background : Data at primary healthcare (PHC) clinics are handwritten in registers by nurses for submission to the District Health Information System (DHIS). Compared to pen and paper, data capture, using handheld computers, has fewer errors, is more efficient and is readily accepted by users. This study describes the process of developing a tablet computer programme to capture data, and explores nurses' experiences of using tablets at a community health centre.
Method : OpenDataKit® was used to design XForms for touchscreen entry. Data for tuberculosis screening were captured by nurses on Android® 9.7-inch tablets over a week. Their experience was explored by means of a focus group interview.
Results : Data were recorded for 24 patients and seamlessly transferred for analysis. Nurses thought that the tablets were easy to use and saved time. They would be happy to use tablets in preference to pen and paper. They expressed a desire to extend the use of tablets to other areas of their work.
Conclusion : Tablet computers were readily accepted by the nurses. They are a feasible alternative to pen and paper for recording data at point of care. This tablet-based system could be used to transfer PHC data directly to the DHIS.
Cardiovascular risk factors in a treatment-naïve, human immunodeficiency virus-infected rural population in Dikgale, South Africa : researchSource: South African Family Practice 56, pp 190 –195 (2014) http://dx.doi.org/10.1080/20786204.2014.936665More Less
Objective : The objective was to determine lipid levels and cardiovascular risk factors in treatment-naïve, human immunodeficiency virus (HIV)-infected rural African people in Limpopo province.
Design : This was a case control study.
Setting and subjects : The setting was Dikgale Health and Demographic Surveillance System Centre, Limpopo province. Treatment-naïve, HIV-infected and HIV-negative people participated in the study.
Outcome measures : Demographic, lifestyle and chronic disease data were collected using the World Health Organization stepwise approach to surveillance (STEPS) questionnaire. Biochemical parameters were tested using standard biochemical methods. HIV testing and CD4 counts were performed using the Alere Determine HIV 1/2 Ag/Ab kit and The Alere Pima Analyser. Insulin resistance, low-density lipoprotein cholesterol (LDL cholesterol), and non-high-density lipoprotein cholesterol (non-HDL cholesterol) levels were calculated.
Results : The mean age of participants (years) was 49.7 ± 16.6. More HIV-infected than HIV-uninfected women consumed alcohol (25.4% vs. 11.9%, p-value < 0.05), and the prevalence of abdominal obesity was higher in HIV-uninfected than in HIV-infected women (74.6% vs. 54.8%, p-value < 0.05). Levels of total cholesterol (TC), HDL cholesterol, non-HDL cholesterol, LDL cholesterol and apolipoprotein A1 (ApoA1) were significantly lower in the HIV-infected than in the HIV-uninfected group. The prevalence of low HDL cholesterol was higher in HIV-infected than in HIV-uninfected people (62.4% vs. 41.6%, p-value < 0.01). HIV infection increased the likelihood of low HDL cholesterol by 2.7 times (p-value 0.001). Male gender and alcohol use decreased the likelihood of low HDL cholesterol by 61% (p-value 0.002) and 48% (p-value 0.048), respectively. HIV infection was associated with low HDL cholesterol, ApoA1, LDL cholesterol and TC. Low CD4 count was associated with low body mass index, LDL cholesterol and high diastolic blood pressure.
Conclusion : The prevalence of cardiovascular risk factors was equally high in HIV-infected and in HIV-uninfected rural people, except for low HDL and alcohol consumption, which were significantly higher in HIV-infected people, while abdominal obesity was significantly higher in HIV-uninfected people. There is a need to raise awareness of cardiovascular risk factors in rural people in Limpopo province.
Assessment of the physical activity, body mass index and energy intake of HIV-uninfected and HIV-infected women in Mangaung, Free State province : researchSource: South African Family Practice 56, pp 196 –200 (2014) http://dx.doi.org/10.1080/20786204.2014.936663More Less
Background : Declining levels of physical activity at workplaces, during leisure time and when travelling, accompanied by increasing exposure to the mass media, are major determinants of the global obesity epidemic. This study aimed to assess physical activity, the body mass index (BMI) and energy intake of human immunodeficiency virus (HIV)-uninfected and HIV-infected black women in Mangaung.
Method : A random sample of 500 black women was selected in Mangaung. Physical activity levels, dietary intake and BMI were determined in younger and older women, aged 25-34 and 35-44 years, respectively.
Results : Of the 488 women who qualified for participation, 61% of the younger women and 38% of the older women were HIV-infected. Low physical activity levels were reported in most women, and more than 50% were overweight or obese. The BMI of HIV-infected younger women with low physical activity levels (24.9 kg/m2) was significantly lower than that of the HIV-uninfected younger women (27.2 kg/m2) (p-value 0.02). The energy intake of older HIV-infected women with low physical activity levels was significantly lower (10 090 kJ) than that of the older HIV-infected women in the normal to high physical activity category (14 519 kJ) (p-value 0.03).
Conclusion : A more active lifestyle and energy-reduced diet that focuses on food quality could partially address BMI parameters in HIV-uninfected women. Safeguarding a lean BMI in HIV-infected women, by increasing physical activity levels while maintaining current energy intake, with an emphasis on healthy eating practices, could support quality of life.
Anaesthesia training for interns at a metropolitan training complex : does it make the grade? : researchSource: South African Family Practice 56, pp 201 –205 (2014) http://dx.doi.org/10.1080/20786204.2014.936664More Less
Background : Most anaesthesia-related mortality that occurs in level 1 hospitals in South Africa is avoidable. Improving training during internship, and consequently the skills of community service officers, could lead to safer anaesthesia practices.
Objectives : The objectives of the study were to determine whether or not the timing of the anaesthesia rotation during internship and other factors affected the outcome of the assessment at the end of the anaesthesia rotation, and to compare the perceptions of first- and second-year interns regarding their confidence levels at the end of their rotation.
Method : We conducted a retrospective study that compared 298 intern assessments over a three-year period. It included the assessment of interns by senior doctors in respect of three cases, an overall assessment of the interns' performance, and the number of cases carried out by them. In addition, a questionnaire was used to assess the interns' confidence levels at the end of the rotation.
Results : Little variation in the results was evident across comparisons of the year of internship, gender and age. Comparison according to university showed a slight variation. A wide variation in the number of obstetric cases (range 5-58) and endotracheal intubations (range 6-54) was observed. Over 80% of interns, regardless of the year, were confident enough to administer general anaesthesia and perform an endotracheal intubation. However, this perception of confidence by interns did not relate to the assessment of their competence.
Conclusion : The variance in the ability of interns to perform anaesthesia could not be accounted for by the training year, institution of undergraduate study, age or gender. It is likely that the assessment technique used did not provide a true reflection of the acquired skills or longevity of knowledge by interns. Further research in this area is recommended.