Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420090007&lang=en vol. 99 num. 7 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>McCord Hospital</b>: <b>a century of footprints on the sands of time</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Testing for allergy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700002&lng=en&nrm=iso&tlng=en <![CDATA[<b>HPCSA</b>: <b>a mess in the Health Department's pocket</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Democracy and sustainable health care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Government 'shooting itself in both feet'</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Take government to concourt</b>: <b>ethics expert</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700006&lng=en&nrm=iso&tlng=en <![CDATA[<b>A long grind to fair remuneration</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Underpaid doctors stuck on uneven playing field</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Lp(a) and coronary disease</b>: <b>rules of engagement - when to measure and how to treat</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700009&lng=en&nrm=iso&tlng=en <![CDATA[<b>The stem cell regulatory environment in South Africa</b>: <b>cause for concern</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Entry-ticket symptoms</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700011&lng=en&nrm=iso&tlng=en <![CDATA[<b>Normalisation of deviance and medicines regulation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700012&lng=en&nrm=iso&tlng=en <![CDATA[<b>Resuscitation in major burns</b>: <b>the problem of fluid creep</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700013&lng=en&nrm=iso&tlng=en <![CDATA[<b>HIV-negative mother with an HIV-infected child</b>: <b>a diagnostic dilemma</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700014&lng=en&nrm=iso&tlng=en <![CDATA[<b>Rubella in South Africa</b>: <b>an impending Greek tragedy?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700015&lng=en&nrm=iso&tlng=en BACKGROUND: The incidence of congenital rubella syndrome (CRS) is unknown in South Africa. There is evidence that it may be significant and largely undetected, particularly in the upper socio-economic group. This may be due to incomplete routine administration of MMR vaccine in infancy and a build-up of susceptible females reaching the childbearing age group who could be exposed to the extensive reservoir of virus in the unimmunised public sector of the population. OBJECTIVE: To assess the extent of the immunity gap to rubella by testing for protective IgG antibodies and the incidence of rubella infection by testing for IgM antibodies in sera. The data obtained would also be used to model the extent of CRS. Design. Residual laboratory serum specimens from public and private laboratories were serologically tested for rubella IgG antibodies to investigate the immunity gap in the population and IgM antibodies in sera collected from the measles rashlike illness surveillance programme. Modelling exercises calculated the force of infection and the predicted incidence of CRS in South Africa. RESULTS: The serological immunity gap was significantly greater in the private sector specimens compared with the public sector - 10.7% versus 5.4%, respectively. In most years rubella caused much more rash-like illness than measles, with a significant number (5.1 - 9.6%) of rubella-positive IgM specimens occurring in women of childbearing age. CONCLUSION: Modelling of the data suggests that the extent of CRS may be grossly underestimated in South Africa. Approximately 654 cases are calculated to occur every year. It is suggested that selective immunisation of girls before puberty should be instituted together with a routine rubella immunisation programme of infants to forestall a possible future outbreak of CRS, as occurred in Greece in 1993. <![CDATA[<b>How do doctors learn the spoken language of their patients?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700016&lng=en&nrm=iso&tlng=en BACKGROUND: In South Africa, many doctors consult across both a language and cultural barrier. If patients are to receive effective care, ways need to be found to bridge this communication barrier. METHODS: Qualitative individual interviews were conducted with seven doctors who had successfully learned the language of their patients, to determine their experiences and how they had succeeded. RESULTS: All seven doctors used a combination of methods to learn the language. Listening was found to be very important, as was being prepared to take a risk or appear to be foolish. The doctors found that it was important to try out the newly learned language on patients and additionally stressed that learning the language was also learning a culture. The importance of motivation in language learning, the value of being immersed in the language one is trying to learn, and the role of prior experience in language learning, were commonly mentioned. The doctors deeply valued the improved rapport and deeper relationships with patients that resulted from their language learning efforts. <![CDATA[<b>Seroprevalence and HIV-associated factors among adults with severe mental illness</b>: <b>a vulnerable population</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700017&lng=en&nrm=iso&tlng=en BACKGROUND: Adults with severe mental illness (SMI) display an increased prevalence of HIV compared with the general population. Recommendations for provider-initiated testing in South Africa lack robust evidence because the studies - mainly from low-prevalence regions - overestimate the risk of HIV among adults with SMI. OBJECTIVE: We aimed to assess whether the mentally ill are a vulnerable population in South Africa. Methods. All new admissions to an acute psychiatric ward from July to December 2000 were tested for HIV anonymously and the results linked with socio-demographic and clinical data. We did a restricted analysis of black females from a population-based survey of black females with SMI. RESULTS: There were 216 admissions, of whom 206 were included in the analysis. The seroprevalence of HIV-1 was 29.1% (confidence interval 27.8 - 32.4); seroprevalence of HIV among the women was 40%. The following predicted HIV positivity: female (odds ratio (OR) 3.5 (1.7 - 6.9)), infections of the chest or central nervous system (OR 3.2 (1.4 - 7.5)), age group 30 - 39 years (OR 2.3 (1.1 - 4.8)) and aggression on admission. The age and sex ratios among the SMI group were similar to the general population. Adults with SMI have an almost three times greater prevalence of HIV than the general population, after controlling for age and gender. CONCLUSIONS: Adults with SMI are a vulnerable population; therefore, provider-initiated HIV testing and other prevention and treatment programmes must be tailored to their needs. <![CDATA[<b>Cytomegalovirus antibodies among healthy blood donors at Lagos University Teaching Hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700018&lng=en&nrm=iso&tlng=en OBJECTIVES: Cytomegalovirus (CMV) is found worldwide in all geographical locations and socio-economic groups and is the virus most frequently transmitted to a developing child before birth. This study aimed to determine the prevalence and risk factors for CMV antibodies among healthy blood donors at Lagos University Teaching Hospital (LUTH). METHODS: A cross-sectional study was carried out among consecutively recruited replacement blood donors attending the blood donor clinic at LUTH. A 5 ml blood sample was collected from each consenting participant and serum-assayed for CMV IgG/IgM using an enzyme-linked immunosorbent assay (ELISA)-based kit. RESULTS: A total of 122 healthy donors were recruited; 96% of the donors were IgG anti-CMV positive while 19.5% were IgM anti-CMV positive. Previous history of blood transfusion was not significantly related to CMV positivity. CONCLUSIONS: The seroprevalence of CMV appears to be very high in this environment among healthy blood donors. Based on previous studies that showed a decrease in the incidence of CMV disease when blood is screened for CMV (IgM), the incidence of the disease can be decreased in Lagos if blood is screened for CMV. <![CDATA[<b>Diagnostic testing in allergy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009000700019&lng=en&nrm=iso&tlng=en OBJECTIVES: Cytomegalovirus (CMV) is found worldwide in all geographical locations and socio-economic groups and is the virus most frequently transmitted to a developing child before birth. This study aimed to determine the prevalence and risk factors for CMV antibodies among healthy blood donors at Lagos University Teaching Hospital (LUTH). METHODS: A cross-sectional study was carried out among consecutively recruited replacement blood donors attending the blood donor clinic at LUTH. A 5 ml blood sample was collected from each consenting participant and serum-assayed for CMV IgG/IgM using an enzyme-linked immunosorbent assay (ELISA)-based kit. RESULTS: A total of 122 healthy donors were recruited; 96% of the donors were IgG anti-CMV positive while 19.5% were IgM anti-CMV positive. Previous history of blood transfusion was not significantly related to CMV positivity. CONCLUSIONS: The seroprevalence of CMV appears to be very high in this environment among healthy blood donors. Based on previous studies that showed a decrease in the incidence of CMV disease when blood is screened for CMV (IgM), the incidence of the disease can be decreased in Lagos if blood is screened for CMV.