Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420100004&lang=en vol. 100 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<B>Our journals in flux</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400001&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400002&lng=en&nrm=iso&tlng=en <![CDATA[<B>Vuvuzela sound measurements</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400003&lng=en&nrm=iso&tlng=en <![CDATA[<B>Pandemic flu (H1N1) 2009 and pregnancy</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400004&lng=en&nrm=iso&tlng=en <![CDATA[<B>Medical electives in South Africa</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400005&lng=en&nrm=iso&tlng=en <![CDATA[<B>Childhood in-hospital mortality from acute gastro-enteritis in Cape Town</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400006&lng=en&nrm=iso&tlng=en <![CDATA[<B>Gauteng's disaster management clinicians outline World Cup shortfalls</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400007&lng=en&nrm=iso&tlng=en <![CDATA[<B>Too long in the rain ... rural doctors get some relief</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400008&lng=en&nrm=iso&tlng=en <![CDATA[<B>The protracted TB struggle</B>: <B>SA ups the intensity</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400009&lng=en&nrm=iso&tlng=en <![CDATA[<B>Expanding access to ART in South Africa</B>: <B>the role of nurse initiated treatment</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400010&lng=en&nrm=iso&tlng=en <![CDATA[<B>Termination of pregnancy and children</B>: <B>consent and confidentiality issues</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400011&lng=en&nrm=iso&tlng=en <![CDATA[<B>The many symptoms of pachydermoperiostosis</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400012&lng=en&nrm=iso&tlng=en <![CDATA[<B>Measles in antiquity and the middle ages</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400013&lng=en&nrm=iso&tlng=en <![CDATA[<B>Christoffel Petrus (Staff) Pauw (09/05/1947 - 16/03/2009)</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400014&lng=en&nrm=iso&tlng=en <![CDATA[<B>Louis Frederik Coetzee (1940 - 2009)</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400015&lng=en&nrm=iso&tlng=en <![CDATA[<B>Ralph Lawrence (1920 - 2009)</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400016&lng=en&nrm=iso&tlng=en <![CDATA[<B>Provider-initiated testing and counselling for HIV</B>: <B>from debate to implementation</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400017&lng=en&nrm=iso&tlng=en <![CDATA[<B>Serious soccer, sex (work) and HIV</B>: <B>will South Africa be too hot to handle during the 2010 World Cup?</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400018&lng=en&nrm=iso&tlng=en <![CDATA[<B>Rugby and cervical spine injuries</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400019&lng=en&nrm=iso&tlng=en <![CDATA[<B>Community health care workers in South Africa are at increased risk for tuberculosis</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400020&lng=en&nrm=iso&tlng=en <![CDATA[<B>Career plans of final-year medical students in South Africa</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400021&lng=en&nrm=iso&tlng=en <![CDATA[<B>Spinal cord injuries in South African Rugby Union (1980 - 2007)</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400022&lng=en&nrm=iso&tlng=en OBJECTIVES AND DESIGN: To address an apparent increase in the number of rugby-related spinal cord injuries (SCIs) in South Africa, a retrospective case-series study was conducted on injuries that occurred between 1980 and 2007. We aimed to identify preventable causes to reduce the overall rate of SCIs in South African rugby. METHODS: We identified 264 rugby-related SCIs. A structured questionnaire was used, and it was possible to obtain information on a total of 183 players, including 30 who had died. RESULTS: SCIs increased in number in the 1980s and in 2006. Forwards sustained 76% of all SCIs, and club players 60%. Players aged 17 had the highest number of SCIs. In only 50% of cases were medical personnel present at the time of injury, and 49% of injured players waited longer than 6 hours for acute management. Of players with an SCI, 61% had a catastrophic outcome after 12 months, including 8% who died during that time; 65% received no financial compensation; and only 29% of players had medical aid or health insurance. CONCLUSION: A register of all rugby-related SCIs in South Africa is essential to monitor the magnitude of the problem, identify potential risk factors, and formulate appropriate preventive interventions. The lack of reliable denominator data limits calculation of incident rates. Players from previously disadvantaged communities in particular suffered the consequences of limited public health care resources and no financial compensation. <![CDATA[<B>Rugby and cervical spine injuries</B>: <B>has anything changed? A 5-year review in the Western Cape</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400023&lng=en&nrm=iso&tlng=en OBJECTIVES: To review the incidence of all rugby-associated cervical spine injuries in the Western Cape and identify risk factors. METHODS: We reviewed case notes and X-rays of 27 male patients with rugby-related cervical spine injuries treated at the acute spinal injury (ASCI) unit at Groote Schuur Hospital from April 2003 to June 2008, and followed up with telephone interviews. Patient profile, rugby profile, subsequent injury management from the field to definitive surgery and neurological status on admission, discharge and followup using the American Spinal Injury Association (ASIA) classification were assessed. RESULTS: Average patient age was 25.3 years; 19% of them were scholars. The highest level of education among the adults was primary school in 70% of cases. Forwards and backs had the same injury rate. Most injuries occurred outside the metropole; more occurred in the tackling phase; 39% occurred during foul play; a third of players were not stabilised with a collar on the field; and 65% were taken to an inappropriate primary contact centre. A median of 10 hours elapsed before admission to the ASCI unit. Facet dislocations occurred in 59%; 8 presented neurologically complete and remained so; and 3 presented with residual sensation, with 2 improving to normal. Three presented as ASIA C improving to D, and all Ds improved to Es. Despite their injuries, 60% said they would advise their sons to play rugby. Only 22% regretted playing. CONCLUSION: Despite a reduction in cervical spine injuries in rugby in the Western Cape, the latter mostly occur outside the metropole, where levels of education are lower, foul play is more often associated with the injury, and rapid access to medical care is generally unavailable. <![CDATA[<B>Football match spectator sound exposure and effect on hearing</B>: <B>A pretest-post-test study</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400024&lng=en&nrm=iso&tlng=en OBCJETIVES: 'To determine (i) noise exposure levels of spectators at a FIFA 2010 designated training stadium during a premier soccer league match; and (ii) changes in auditory functioning after the match. METHODS: This was a one-group pretest-post-test design of football spectators attending a premier soccer league match at a designated FIFA 2010 training stadium in Gauteng, South Africa. Individual spectator noise exposure for the duration of the football match and post-match changes in hearing thresholds were measured with pure-tone audiometry, and cochlear functioning was measured with distortion product otoacoustic emissions (DPOAEs). RESULTS: The average sound exposure level during the match was 100.5 LAeq (dBA), with peak intensities averaging 140.4 dB(C). A significant (p=0.005) deterioration of post-match hearing thresholds was evident at 2 000 Hz, and post-match DPOAE amplitudes were significantly reduced at 1 266, 3 163 and 5 063 Hz (p=0.011, 0.019, 0.013, respectively). CONCLUSIONS: Exposure levels exceeded limits of permissible average and peak sound levels. Significant changes in postmatch hearing thresholds and cochlear responsiveness highlight the possible risk for noise-induced hearing loss. Public awareness and personal hearing protection should be prioritised as preventive measures. <![CDATA[<B>Surgical practice in a maximum security prison</B>: <B>unique and perplexing problems</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400025&lng=en&nrm=iso&tlng=en The practice of general surgery in a prison population differs considerably from that in a general surgical practice. We audited surgical consultations at the Mangaung Correctional Centre from December 2003 to April 2009. We found a high incidence of foreign object ingestion and anal pathology. Understanding the medical and social aspects of prison life facilitates the treatment of inmates with surgical problems. <![CDATA[<B>Child consent in South African law</B>: <B>implications for researchers, service providers and policy-makers</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400026&lng=en&nrm=iso&tlng=en Children under 18 are legal minors who, in South African law, are not fully capable of acting independently without assistance from parents/legal guardians. However, in recognition of the evolving capacity of children, there are exceptional circumstances where the law has granted minors the capacity to act independently. We describe legal norms for child consent to health-related interventions in South Africa, and argue that the South African Parliament has taken an inconsistent approach to: the capacity of children to consent; the persons able to consent when children do not have capacity; and restrictions on the autonomy of children or their proxies to consent. In addition, the rationale for the differing age limitations, capacity requirements and public policy restrictions has not been specified. These inconsistencies make it difficult for stakeholders interacting with children to ensure that they act lawfully. <![CDATA[<B>Total perinatally related losses at Tygerberg Hospital</B>: <B>a comparison between 1986, 1993 and 2006</B>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000400027&lng=en&nrm=iso&tlng=en OBJECTIVE: To determine the leading causes of perinatal deaths and to evaluate any changes, with the inclusion of placental histology. METHOD: At perinatal mortality meetings, primary and final causes of death were assigned for the period 1 July 2006 - 30 June 2007. All singleton babies born to women residing in the metropolitan area serviced by Tygerberg Hospital were included in the prospective descriptive study. RESULTS: The total number of singleton births was 10 396. The total of perinatally related losses (TPRL) rate was 26.2 per 1 000 births. The leading primary obstetric causes of death were: infections (47 - 17.3%), spontaneous preterm labour (PTL) (41 - 15.1%), antepartum haemorrhage (APH) (40 - 14.7%), intra-uterine growth restriction (IUGR) (40 - 14.7%), fetal abnormality (31 - 11.4%), hypertensive disorders (25 - 9.2%), unexplained intra-uterine deaths (IUD) (20 - 7.4%), intrapartum hypoxia (12 - 4.4%) and maternal disease (9 - 3.3%). A total of 162 placentas were sent for histology; 58 reports changed the primary cause of death. CONCLUSION: The TPRL rate for singleton pregnancies was 26.2 per 1 000 births for the study period. The TPRL rates in 1986 and 1993 were 36.7 and 30.5 per 1 000 deliveries. Infection is now the leading primary cause of death, followed by spontaneous PTL, APH and IUGR. During the previous two study periods, APH was the leading primary cause of death, followed by spontaneous PTL. Unexplained IUDs ranked third in 1986, fourth in 1993 and seventh in this study because of the availability of placental histology. Placental histology reports changed 21.3% of the primary causes of death.