The phrase 'swan song' refers to a belief dating from ancient Greece that the swan is completely silent during its lifetime until the moment just before death, when it sings one beautiful song. This incorrect belief has been frequently reiterated in poetry and art. 'Swan song' is generally used as a metaphorical phrase for a final gesture, effort or performance given just before death or retirement. As my role in the SAMJ draws to a close, it seems appropriate to provide a 'swannish' song as it is possible that I and my editor colleague, Dan Ncayiyana, may in future still figure on these pages, though in much lesser roles. But firstly I (we) wish our successor, the new editor, all of the best for the future in this role!
South African readers of the SAMJ may be interested to know that some recently described features of alcohol consumption appear too in parts of Russia, where there are similar factors that predispose to alcohol abuse: relative cheapness of alcoholic products, ease of access, boredom, unemployment, peer pressure, etc. Concerning alcohol advertising, there has not been much advertising of wines and spirits since 1985, when the anti-alcohol campaign began. Previously, however, there had been some indirect advertising.
I do not discount what has historically occurred and, according to Erasmus' article, is apparently still occurring. A decade after my internship, I still recall calculating that I was, in effect, earning R12 per hour at that time. The culture dictated that one 'sucked it up' - and that is what we did. In the academic institutions where I've recently worked, however, this attitude seems to have changed. Hospitals are now limiting the hours that interns work. I trust that this policy will spread to involve the former institutions, from my intern days, where this unfortunate practice is apparently still in place.
Almost across disciplines, health care in the Port Elizabeth Provincial Hospital Complex (PEPHC) has deteriorated so badly in the past six months that short-staffed departmental heads are unapologetically cutting back on vital patient services to focus only on the very sick and dying.
An infuriating logjam in the enlistment of vitally needed foreign qualified nurses for South Africa stands to be broken with the hiring of the dynamic rural healthworker recruitment NGO, Africa Health Placements (AHP) - but bureaucrats will need to add their own muscle to clear two vital obstructions.
The government's appeal to private healthcare to help it achieve universal coverage had two immediate priorities, namely fighting HIV/AIDs and TB and building human resources, Health Minister, Dr Aaron Motsoaledi, told 900 private healthcare conference delegates in late July.
In an ironic bit of healthcare delivery innovation, a district hospital originally designed to treat race groups separately is now inadvertently paving the way for National Health Insurance. One team of doctors and nurses treats all private and public patients equally, using the same facilities.
The effect of the vast variety of nutrients on metabolic outcome and health is complex. A large number of factors play a role in the type and quantity of food consumed in free-living conditions. It is therefore obvious that prescribing a restrictive diet regimen that favours 1 or 2 nutrients at the expense of the others is a poor tool to manage long-term health and weight.
Where provisions that were in the Human Tissue Act have been left out of the National Health Act they have been included in its regulations. However, new provisions in the latter Act provide strict controls for the transplantation of organs into non-South African citizens or non-permanent residents, and outlaw the charging of fees for human organs. The provisions also expand the list of persons who can give consent to donations from deceased persons to include 'partners', who now take precedence over all other relatives except spouses. Some of the matters in the Human Tissue Act that were not covered by the National Health Act have now been included in the regulations, such as: (i) the parties responsible for determining death of a person whose organs are to be removed for transplantation purposes; (ii) the requirement that tissue must be harvested within 24 hours from donated bodies; (iii) the removal of eye tissue; (iv) the exclusivity of rights in respect of tissue donations; and (v) confidentiality and publicity regarding tissue and organ transplants.
Human tissue legislation is complex. An exhaustive understanding of the law, thorough understanding of human tissue biology and pathophysiology and an appreciation of the diversity of the areas covered in this field, is critical. The importance of interdisciplinary co-operation in the drafting, interpretation and implementation of legislation in this area cannot be overemphasised. Several factors underscore this, including the complexity and volume of the information involved, rapid advances in science, reciprocal dependence of the law and science on one another for relevance and accuracy, and above all the need to ensure that the patient's well-being and safety are not compromised. The development of technology also must be encouraged in a non-obstructive legislative setting.
Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the healthcare needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs. The proposed re-engineering of primary healthcare will be limited by the skewed distribution of staff and the lack of suitable skills. A 'community' placement during specialist training, and the creation of a sub-specialty in Community Paediatrics and Child Health, could address the skills shortage and possibly attract health personnel to under-served areas through creating an appropriate career path. This proposal would also support the Department of Health's encouraging plans to re-engineer primary healthcare.
A spate of articles in the lay press have advocated a low-carbohydrate high-fat diet for cardiovascular health, questioning 'What's cholesterol got to do with it?' and whether cholesterol-lowering drugs, particularly statins, are doing more harm than good.
Law is an important component of the regulation of the use of the human body or body parts, new medical developments, and research on human subjects. Complex moral, ethical and public policy considerations must often be balanced when determining the boundaries between academic freedom, promoting public health, and protecting patients and research participants. Despite the implications of revolutionary scientific developments, the South African parliament has struggled to create a principled framework for biomedicine and research.
Background. Average salt intake in South African (SA) adults, 8.1 g/day, is higher than the 4 - 6 g/day recommended by the World Health Organization. Much salt consumption arises from non-discretionary intake (the highest proportion from bread, with contributions from margarine, soup mixes and gravies). This contributes to an increasing burden of hypertension and cardiovascular disease (CVD).
Objectives. To provide SA-specific information on the number of fatal CVD events (stroke, ischaemic heart disease and hypertensive heart disease) and non-fatal strokes that would be prevented each year following a reduction in the sodium content of bread, soup mix, seasoning and margarine.
Methods. Based on the potential sodium reduction in selected products, we calculated the expected change in population-level systolic blood pressure (SBP) and mortality due to CVD and stroke.
Results. Proposed reductions would decrease the average salt intake by 0.85 g/person/day. This would result in 7 400 fewer CVD deaths and 4 300 less non-fatal strokes per year compared with 2008. Cost savings of up to R300 million would also occur.
Conclusion. Population-wide strategies have great potential to achieve public health gains as they do not rely on individual behaviour or a well-functioning health system. This is the first study to show the potential effect of a salt reduction policy on health in SA.
Most differences, shortcomings and contradictions regarding voluntary informed consent for participation in clinical research relate to the South African-specific guidance documents, i.e. South African Guidelines for Good Practice in the Conduct of Clinical Trials with Human Participants in South Africa (2006) and Ethics in Health Research: Principles, Structures and Processes (2004). These documents do not fulfil all the ethical and legal requirements for voluntary informed consent for clinical research participation in South Africa. International guidance documents reflect the minimum of the ethical requirements for the conduct of clinical research. Country-specific documents should be updated and aligned with relevant legislative and legal principles of that jurisdiction to ensure that research participants are adequately protected. The South African-specific guidance documents therefore require revision to address these deficiencies.
Background. Current driver mortality estimates do not consider the great differences in exposure across the population, giving a false impression that driver deaths are lowest in the youngest age group. Interventions to reduce risk among the younger age group include graduated driver licensing (GDL) - a three-phase licensing system for novice drivers consisting of a learner's permit, a provisional license, and a full license.
Objectives. We calculated driver fatality rates per 10 000 registered drivers in each age group and assessed the need for stricter licensing conditions for novice and younger drivers.
Methods. Age-specific driver mortality rates were calculated using Western Cape Province 2008 mortuary data. The total number of licensed drivers in each age group served as the denominator. Incidence rate ratios were calculated using the age group of 65 - 79 years as the reference. Chi-square test of trend on incidence rate ratios for the age groups was done. Statistical significance was set as p<0.05.
Results. There were 339 driver deaths; mean age was 39.4±13.8 years, and males accounted for 80% of the deaths. Age-specific driver mortality rates were highest in the youngest age group (15 - 19 years). There was a significant progressive decrease (except for the age group 45 - 49 years) in the risk of death from road traffic injuries with increasing age compared with the age group ≥65 years (chi2 for trend p<0.0001).
Conclusion. This study showed a relationship between driver's mortality risk and younger age, and underscores the need for introduction of a GDL programme in South Africa.
Background. South Africa has a low incidence of sickle cell disease (SCD). However, its demographics are changing because of immigration from sub-Saharan African countries where SCD is prevalent.
Objectives. We aimed to determine the frequency of SCD presenting to the Haematology/Oncology Service at Red Cross War Memorial Children's Hospital in Cape Town and to measure the associated disease burden.
Methods. This was a retrospective cross-sectional study of patients first attending the Haematology Service between January 2001 and June 2010.
Results. A total of 58 SCD patients were indentified, with an annual frequency that increased over the study period by 300 - 400%. Up to 93.1% (n=54) were originally from other African countries, mainly the Democratic Republic of Congo (62.1%, n=36). One patient had sickle D-Punjab genotype, and all the other patients had the homozygous sickle cell anaemia genotype (Hb SS). Their haematological parameters demonstrated a normocytic anaemia with high white cell counts. The mean number of clinic visits per patient per year was 22.2 (range 0 - 64), and the mean number of hospital admissions per patient per year was 1.2 (range 0 - 5). All the patients were on antibiotic prophylaxis. The majority had at least one blood transfusion (65.5%, n=38), and a significant proportion required intravenous analgesia on admission (29.3%, n=17) and hydroxyurea treatment (36.2%, n=21).
Conclusions. Over the past 10 years the frequency of SCD has increased considerably, imposing a significant burden and new challenges to the health services in Cape Town.