South African Family Practice - Volume 57, Issue 5, 2015
Volume 57, Issue 5, 2015
Author Gboyega OgunbanjoSource: South African Family Practice 57 (2015)More Less
In 2013, I wrote two successive editorials on obesity in this journal. This was in response to my concern that little action is being taken by adults, children, healthcare workers and politicians to address this serious problem, present in our public and private healthcare systems, and with disastrous health management challenges. In 2013, according to available South African national data, it was estimated that a third of all South African women were obese. The incidence in coloured, white and Indian women was similar, with approximately a quarter being obese. South African men were significantly less likely to be obese than women. Less than one tenth were obese. When disaggregated by population group, approximately 18% of all white men are obese, followed by 9% of Indians, 8% of coloureds and 6% of African men.
Author Andre MaraisSource: South African Family Practice 57, pp 4 –8 (2015)More Less
"Swimmer's ear" or acute otitis externa is a common condition involving the exterior part of the ear, including the ear canal and the pinna. Inflammation and pain are the main features, with bacterial infection mainly due to Staphylococcus aureus and Pseudomonas aeruginosa. It can easily be treated in its uncomplicated stage, and the symptoms usually do not last for more than 72 hours. Management ranges from primary care to a specialist otolaringological intervention. Several nonpharmacological treatments, in addition to various pharmacological options, are employed in the treatment and prevention of swimmer's ear. These treatments range from simple, adequate and appropriate ear cleaning, to topical antibiotics, corticosteroids and analgesics. Severe cases may require systemic antibiotics, oral anti-inflammatory drugs and even opioid analgesics.
The effects of corticosteroids and nonsteroidal anti-inflammatory drugs, including aspirin, on coagulation : reviewAuthor Eric HodgsonSource: South African Family Practice 57, pp 9 –12 (2015)More Less
The immune and coagulation systems have numerous interactions, as evidenced by the increased risk of venous thromboembolism in inflammatory bowel disease. In general, proinflammatory states are prothrombotic, while a reduction in inflammation reduces thrombotic risk. Corticosteroids, such as hydrocortisone and prednisone, tend to reduce inflammation and thus thrombosis, while being prothrombotic in non-inflammatory states, e.g. Cushing's syndrome. The nonsteroidal anti-inflammatory drugs also have a dual effect, through interaction with different cyclo-oxygenase enzyme isoforms, on platelets and the vascular endothelium.
Source: South African Family Practice 57, pp 13 –19 (2015)More Less
Gastric pain may be generalised, diffused, specific to the right or left upper quadrant (or both), and may be attributed to a range of possible causes. Types of gastric pain include dyspepsia and epigastric pain. The term "gastric pain" is not frequently encountered in the literature. Therefore, the main focus of this review is on epigastric pain and dyspepsia, both of which are frequently encountered in the clinical setting. For example, it is estimated that dyspepsia affects a quarter of the global population. Several drugs and drug classes are also linked to a range of mechanisms through which the drugs induce mucosal injury in the upper gastrointestinal tract. Therefore, this article provides an overview of the aetiology, classification, risk factors, diagnostic criteria and management strategies aimed at gastric pain, and its two more distinct gastrointestinal-related manifestations, namely epigastric pain and dyspepsia.
Author Stephani SchmidtSource: South African Family Practice 57, pp 20 –25 (2015)More Less
Chronic rhinosinusitis (CRS) has a substantial effect on the patientâ??s quality of life. It has recently been accepted that CRS has multiple distinct components, e.g. infection and inflammation, which has led to changes in the therapeutic approach. In addition, it is no longer considered practical to manage CRS as a prolonged version of acute rhinosinusitis. A CRS diagnosis is based on the type and duration of symptoms, together with an objective finding of inflammation of the nasal mucosa or paranasal sinuses. Differences in treatment are based on the presence or absence of nasal polyps.
Author J.A. KerSource: South African Family Practice 57, pp 26 –28 (2015)More Less
Heart failure is a global problem. It is estimated that approximately 38 million people worldwide experience heart failure, and this number is growing because of the ageing of nations' populations, but also because patients are rescued from death during an acute myocardial infarction, and later develop heart failure. The prevalence of heart failure is roughly 2% of the population, and up to 10% in people aged 75 years and older. It is also estimated that the lifetime risk of heart failure at the age of 40 years is approximately 20% (one in five) for both men and women. Heart failure is also increasing in low- and medium-income countries, probably because of changes in lifestyle which favour the development of obesity, hypertension and diabetes mellitus. The mortality of heart failure is worse than that associated with most cancers. Average mortality is roughly 50% within five years. However, evidence-based treatment did reduce mortality significantly. About two thirds of the economic burden of heart failure is owing to hospital admissions and re-admissions. Therefore, heart failure is also an expensive disease.
Author Nadira KhamkerSource: South African Family Practice 57, pp 29 –33 (2015)More Less
Schizophrenia is a chronic psychiatric condition. Patients with schizophrenia present clinically with psychotic, negative and cognitive symptoms, which can become evident late in adolescence or in early adulthood. The peak age for presentation is 20 years in males and 25 years in females. This chronic condition follows a relapsing remitting course, and eventually results in a chronic state of residual symptoms and functional impairment.
Author M.H. MotswalediSource: South African Family Practice 57, pp 34 –38 (2015)More Less
Skin disorders of the feet can affect the glabrous skin on the dorsal aspects, or the thick skin on the plantar aspects, thereof, or both. Some can affect one foot, and others both of them. These diseases can be inflammatory, genetically inherited, infectious and neoplastic in origin. It is important to identify them and to start treatment early. If not treated, some may lead to severe pain on walking, the inability to wear shoes, and amputation with serious disability.
Author Klaus Von PressentinSource: South African Family Practice 57, pp 45 –46 (2015)More Less
The series, "Mastering your Fellowship", provides examples of the question format encountered in the written examination, Part A of the FCFP(SA) examination. The series is aimed at helping Family Medicine registrars to prepare for this examination. Examples of these question types are presented according to a theme. The theme for this edition is infectious diseases. Model answers are available online.
Author Chris EllisSource: South African Family Practice 57 (2015)More Less
One of the advantages of general practice is that one can observe patients over a long period. Every now and again, I have had the feeling that a few of my patients seem to have "become" their illnesses. When they started out, the condition and its symptoms were vague and unformed. Slowly, as more information was obtained and labels were applied, they began to identify with the labels and almost live them. If the mask is worn long enough, they say, it becomes the face.
Remote clinical support by telephone for rural district hospital medical officers in the Eastern Cape : researchSource: South African Family Practice 57, pp 286 –290 (2015) http://dx.doi.org/10.1080/20786190.2015.1055671More Less
Background : Rural district hospitals are frequently understaffed and inexperienced medical officers must make clinical decisions with no supervision. Medical officers from rural district hospitals in the Eastern Cape attending a two-week 'in-reach' anaesthesia training course at the Port Elizabeth academic complex were provided with subsequent telephonic support that enabled them to contact an experienced anaesthetist in the urban centre with clinical problems for advice. This survey was to determine user perceptions of the utility and effectiveness of the telephonic support system.
Methods : Two questionnaires designed for both rural and urban-based doctors were completed either online or telephonically and were used to assess perceived values and limitations of the support system.
Results : A total of 17 rural doctors, of whom 14 were foreign medical graduates, were eligible and agreed to participate; all were positive about the useful role and value of the programme, although many felt that the telephonic support system needs to be more structured and formalised. Open-ended questions revealed feelings of isolation and insecurity amongst the participants.
Conclusion : The telephonic system is valuable and readily accessible. However, its ready acceptance by the participants should be viewed in the light of the lack of other resources. A systemic approach towards clinical support of medical officers in rural district hospitals should be adopted, which might include remote supervision by telephone.
Author Karen KochSource: South African Family Practice 57, pp 291 –292 (2015) http://dx.doi.org/10.1080/20786190.2014.978099More Less
Silodosin is a specific alpha-1A receptor inhibitor newly available in South Africa. It offers a real solution to symptoms of BPH especially in those patients with moderate prostate enlargement experiencing nocturia, frequency and incomplete voiding. It can be safely used in patients who cannot tolerate non-selective alpha blockers. The main side-effect is anejaculation, but this seldom leads to drug discontinuation. The rapid action and ongoing effectiveness of the drug offers swift relief for patients.
The use of readily available biomarkers to predict CD4 cell counts in HIV-infected individuals : researchSource: South African Family Practice 57, pp 293 –296 (2015) http://dx.doi.org/10.1080/20786190.2015.1073895More Less
Background : The use of readily available biochemical investigations to predict the CD4 cell count in HIV-infected patients may provide clinicians with insight regarding disease severity at first contact. The aims of the study were to determine the relationship of calculated globulin and white cell count (WCC) with CD4 cell count.
Methods : Data were collected prospectively from ambulatory HIV-infected, anti-retro viral therapy (ART) naive patients at the HIV clinic of King Edward Hospital, Durban, between 2010 and 2012.
Results : The mean age of the participants was 39 ± 9.53 years and 70% were female. Median calculated globulin and WCC was 49 g/l and 4.74 x 109 cells/l respectively, whilst the CD4 cell count was 244 cells/mm3. A significant positive correlation was demonstrated between CD4 cell count and WCC (r = 0.25, p < 0.001). WCC and albumin were identified as potential surrogate markers for CD4 count ≤ 200 cells/mm3. Combination of WCC with either albumin or globulin predicts a CD4 count of less than 200 cells/ mm3 with moderate accuracy.
Conclusion : The use of combined biomarkers may influence initiation of Pneumocystis jiroveci pneumonia prophylaxis in resource-limited settings. Further evaluation is warranted to assess the role of these markers in disease progression and ART.
Retrospective analysis of the prevalence and causes of anaemia in hospitalised elderly patients : researchSource: South African Family Practice 57, pp 297 –299 (2015) http://dx.doi.org/10.1080/20786190.2015.1071538More Less
Introduction : Anaemia is common in the elderly. Little is known regarding anaemia in hospitalised elderly patients in South Africa. A retrospective study determined the prevalence and causes of anaemia in elderly patients hospitalised for acute medical problems.
Methods : Patients with anaemia were identified from the computerised database of a geriatric unit. Laboratory tests and clinical information on these patients were reviewed to determine the cause of the anaemia defined according to the WHO criteria (haemoglobin level ≤ 12 g/l for women and ≤ 13 g/l men).
Results : Of 759 consecutive geriatric patients, 236 (31.1%) were anaemic. The majority (n = 150; 63.6%) were female, with a mean age of 82.2 years. The male patients had a mean age of 80.8 years. The mean haemoglobin values were 10.7 g/l and 10.2 g/l for male and female patients, respectively. In 96 (40 7%) patients, the cause of anaemia could not be determined. Of the remaining 140 patients, 25.7% had anaemia of chronic disorders, 24.3% had iron deficiency anaemia and 13.6% had multiple causes.
Conclusion : Approximately one-third of hospitalised elderly patients were anaemic on admission, although many were not adequately investigated. Chronic disorders and iron deficiency were the most common causes of anaemia.
Author A. RossSource: South African Family Practice 57, pp 300 –305 (2015) http://dx.doi.org/10.1080/20786190.2015.1071537More Less
Background : International studies have shown that the best strategy for the long-term staffing of rural facilities is the recruitment and training of students of rural origin. However, the crisis in education in South Africa means that these rural students are the least likely to access institutions of higher learning to train as healthcare professionals (HCPs). The aim of this study was to explore the educational experiences of six HCPs of rural origin working in rural areas.
Methods : This was a qualitative study using unstructured interviews supplemented by photomemory and collage development. All interviews were transcribed verbatim and themes were developed. Appropriate ethical permission was obtained prior to the study.
Results : HCPs of rural origin found the journey from rural scholar to HCP to be tough. Personality characteristics such as tenacity, determination, problem-solving skills, self-belief and hard work were essential for success - but not sufficient on their own. In addition these HCPs needed social support, academic and social mentoring as well as comprehensive financial support.
Conclusions : HCPs of rural origin have the potential to provide long-term staffing for rural hospitals. However, if rural healthcare institutions are serious about finding long-term solutions to their staffing challenges, attention needs to be given to finding and appropriately supporting local scholars.
Source: South African Family Practice 57, pp 306 –312 (2015) http://dx.doi.org/10.1080/20786190.2015.1071536More Less
Background : Nigeria still grapples with low family planning (FP) use and a high fertility rate. This study explores the factors associated with the unmet need for FP and the coldspots of unmet need for FP in Nigeria.
Methods : The 2013 Nigerian Demographic Health Survey (NDHS) data was used to investigate the unmet need for FP in Nigeria. A geo-additive model was specified to simultaneously measure the fixed, nonlinear, spatial and random effects inherent in the data. The fixed effect of categorical covariates was modelled using the diffuse prior, the nonlinear effect of continuous variable was modelled using the P-spline with second-order random walk, the spatial effects followed Markov random field priors while the exchangeable normal priors were used for the random effect of the community. The binomial distribution was used to handle the dichotomous nature of the dependent variable.
Results : North East (OR: 1.8404, CI: 1.6170, 2.0941), North West (OR: 1.1145, CI: 1.1454, 1.1789), primary education (OR: 1.0441, CI: 0.9680, 1.1286), Hausa (OR: 2.7031, CI: 2.3037, 3.1513), birth interval greater than 12 months (OR: 1.0909, CI: 1.0447, 1.1379), community (OR: 1.6733, CI: 1.5261, 1 7899) and states (OR: 6.0879, CI: 2.5995, 29.6274) significantly increased the unmet need for FP.
Conclusion : The unmet need for FP in Nigeria is positively associated with the Northern region, low level of education and birth interval.
Experiences and opinions of first-year students at a previously disadvantaged medical university in South Africa about alcohol consumption : researchSource: South African Family Practice 57, pp 313 –317 (2015) http://dx.doi.org/10.1080/20786190.2015.1071539More Less
Background : The use of alcohol amongst first-year students in institutions of higher learning is problematic as it often leads to social and academic problems, for instance high dropout rates and high-risk sexual behaviour. Research on first-year students' opinions regarding their own use of alcohol at the University of Limpopo, Medunsa Campus, was seen as pertinent as this institution trains medical doctors, dentists and other health professionals. The findings could inform appropriate interventions by policy-makers at the institution. This paper presents the qualitative data nested from a larger study on alcohol use among first-year medical students.
Methods : A sample of 217 first-year students was obtained, to whom a questionnaire was administered which included open-ended questions formulated from discussions with a focus group of eight first-year students. The open-ended questions were formulated in a manner that allowed participants to give an account of their experience and opinions related to the drinking of alcohol. Thematic content analysis was used to analyse qualitative data.
Results : The participants comprised 90 (41.5%) females, 13 (6%) White, 196 (90.3%) Black, 4 (1.8%) Asian and 4 (1.8%) Coloured students. The study revealed substantive views relating to first-year students' opinions and experiences of alcohol consumption. Themes gleaned from the interpretation were awareness, physical location of the campus, economic opportunities, health considerations, identity, belief in alcohol use, and interventions.
Conclusion : The results indicate that first-year students have varying opinions and experiences concerning alcohol consumption at the University of Limpopo (Medunsa campus). Social identity and peer pressure are motivating factors in students' use of alcohol.
Acceptability of human papillomavirus vaccination among academics at the University of KwaZulu-Natal, South Africa : researchAuthor Muhammad Ehsanul HoqueSource: South African Family Practice 57, pp 318 –321 (2015) http://dx.doi.org/10.1080/20786190.2015.1078157More Less
Background : The South African Government has recently implemented the human papillomavirus (HPV) vaccination programme through the school health system. For the vaccination programme to be effective, it is important to investigate the acceptability of the vaccines among university academics. The objective of this study was to determine the awareness and acceptability of HPV vaccination among university academics, and to investigate whether health information increases the acceptability of the vaccines.
Materials and methods : This was a cross-sectional study conducted among academics from the University of KwaZulu-Natal - excluding medical school academics. Data were collected using a self-administered anonymous questionnaire, via an online survey.
Results : It was found that most academics were aware of cervical cancer and HPV infections. The health information regarding HPV infections and vaccines had significantly increased the acceptance of HPV vaccine for their daughters (79% to 88%, p < 0.05). There was a knowledge gap regarding the safety and effectiveness of the vaccines.
Conclusion : University academics need to be educated on this preventable disease so that they can provide accurate information to their students, who are in the high-risk population for cervical cancer.
The impact of Ready-to-Use Supplementary Food (RUSF) in targeted supplementation of children with moderate acute malnutrition (MAM) in South Africa : researchSource: South African Family Practice 57, pp 322 –325 (2015) http://dx.doi.org/10.1080/20786190.2015.1078153More Less
Objective : To describe catch-up growth in children with moderate acute malnutrition (MAM) on targeted supplementation using Ready-to-Use Supplementary Food (RUSF).
Methods : An impact study was done to determine anthropometric changes in children aged 12-60 months who received RUSF (175 kcal/kg/day) for six weeks, managed as outpatients and followed up for 12 weeks until a final assessment.
Results : Default rates were high, with 30% of children returning to the primary healthcare facility for follow-up only once or twice. Despite significant improvement in height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC), 70.5% of the sample remained in the same malnutrition classification and only 26% recovered. The growth velocity of children with a lower initial WHZ was significantly higher (r = -0.15, p < 0.05) than those with less wasting, but only 20% grew at a rate to achieve catch-up growth. The mean growth velocity decreased as the intervention period continued.
Conclusion : All median anthropometric indicators improved with RUSF supplementation. However, catch-up growth or recovery occurred in only 20-25% of children included in the study. These findings create questions about the value of supplementation in the absence of blanket food distribution or other interventions to address food security.
Beliefs about medication, medication adherence and seizure control among adult epilepsy patients in Kimberley, South Africa : researchSource: South African Family Practice 57, pp 326 –332 (2015) http://dx.doi.org/10.1080/20786190.2015.1078152More Less
Background : Patients with epilepsy regularly present to the Kimberley Hospital Complex's emergency department and are managed and discharged but within a short period present again to casualty with seizures. This study aimed to explore whether beliefs about medication have any relationship with treatment adherence and seizure control among adult patients with epilepsy attending the hospital and clinics in Kimberley.
Methods : In this descriptive observational study, participants included patients presenting to casualty with seizures, and epileptic patients collecting their antiepileptic drugs. Participants completed a questionnaire that included the Morisky eight-item medication adherence scale and Belief about Medication Questionnaire.
Results : The majority of the 197 participants were male (61.9%), unemployed (84 3%), and reporting two or more seizures annually (67.0%). The age range was between 19 and 68 years (mean age 40 years). High adherence was reported by 107 (54.6%) participants. The relationship between adherence and seizure control was not statistically significant. There was a statistically significant correlation between medication concerns and harm, and adherence but no correlation between medication overuse and adherence.
Conclusion : Patients' beliefs about medications can influence their adherence; beliefs about medication did not influence the control of the patient's seizures. Patients' medication adherence did influence the seizure control in this sample.