Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420120009&lang=en vol. 102 num. 9 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>A swannish song?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Taking our journals in tablet form</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Thieves of the state</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Social aspects of alcohol consumption in Russia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Port Elizabeth's tertiary care reaches crisis point</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Hope at last for foreign nurse recruitment?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900006&lng=en&nrm=iso&tlng=en <![CDATA[<b>'Help us unite healthcare' -Motsoaledi appeal to BHF</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Bridging the healthcare delivery divide</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Phillip</b> <b>Tobias</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900009&lng=en&nrm=iso&tlng=en <![CDATA[<b> Achieving weight loss and avoiding obesity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Medicine and the law Human tissue and organ transplant provisions</b>: <b>Chapter 8 of the National Health Act and its Regulations, in effect from March 2012 - What doctors must know</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900011&lng=en&nrm=iso&tlng=en <![CDATA[<b> Partial relief from the regulatory vacuum involving human tissues through enactment of Chapter 8 of the National Health Act and Regulations thereto</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900012&lng=en&nrm=iso&tlng=en <![CDATA[<b> Can a new paediatric sub-specialty improve child health in South Africa?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900013&lng=en&nrm=iso&tlng=en 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. <![CDATA[<b>The cardiovascular health of the nation - should we be advocating a low-carbohydrate high-fat diet?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900014&lng=en&nrm=iso&tlng=en 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. <![CDATA[<b>Law reform dealing with blood, tissues, organ transplants and health research</b>: <b>A lagging legal framework that is strangling innovation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900015&lng=en&nrm=iso&tlng=en 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. <![CDATA[<b>Reducing the sodium content of high-salt foods</b>: <b>effect on cardiovascular disease in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900016&lng=en&nrm=iso&tlng=en 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. <![CDATA[<b>Voluntary informed consent and good clinical practice for clinical research in South Africa</b>: <b>ethical and legal perspectives</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900017&lng=en&nrm=iso&tlng=en 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. <![CDATA[<b>Drivers' risk profile indicates the need for a graduated driving licence in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900018&lng=en&nrm=iso&tlng=en 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. <![CDATA[<b>The burden of sickle cell disease in Cape Town</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900019&lng=en&nrm=iso&tlng=en 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. <![CDATA[<b>Impact of 20-day strike in Polokwane Hospital (18 August - 6 September 2010)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900020&lng=en&nrm=iso&tlng=en BACKGROUND: Doctors' strikes have a negative effect on hospital performance indicators. Hospital mortality during such strikes is the most important indicator. OBJECTIVE: To determine the effects of the 2010 strike on Polokwane Hospital. METHODS: Information was collected from the Hospital Information System, Polokwane Hospital Casualty Department, wards and theatres. RESULTS: During the 20-day strike, a total of 262 patients were admitted to Polokwane Hospital, with 40 patients to the surgical department; 96 operations were performed in the hospital and 40 in the surgical department; and 50 deaths were reported in the hospital (8 deaths in the surgical department). During 20 days of a non-striking period in May 2010, there were 975 admissions to the hospital, with 125 to the surgical department. In the entire hospital, 340 operations were performed, and 79 in the surgical department. For this period, 61 deaths were reported in the hospital and 12 in the surgical department. CONCLUSIONS: The total number of patients admitted to the hospital and the surgical department during the strike was significantly lower than during a non-striking situation. Total mortality during the strike in Polokwane Hospital decreased, compared with the normal situation, but it increased when judged against emergency cases. However, when mortality was qualified by the number of admissions, it showed a significant increase. Strikes seriously and significantly affect service delivery. <![CDATA[<b>Cervical intra-epithelial neoplasia in HIV-positive women after excision of the transformation zone - does the grade change?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900021&lng=en&nrm=iso&tlng=en OBJECTIVE: After previously reporting the presence of disease by cytology findings after treatment for cervical intra-epithelial neoplasia (CIN) in 64.6% of HIV-infected women and in 13.0% of HIV-negative women, we aimed to determine the severity of cytological disease after treatment in HIV-infected women. METHODS: We studied HIV-infected (N=571) women treated at the Colposcopy Clinic at Chris Hani Baragwanath Hospital, Gauteng, between April 2003 and December 2006. We compared the initial histology results with Pap smears >6 months later, and evaluated factors associated with reduction in the grade of disease. RESULTS: Mean age was 36.68 (SD+7.33) years; mean parity was 2 (SD+1.46); mean CD4+ count was 242.70 cells/jd (SD+187.56); 262 (45.80%) were receiving antiretroviral treatment. Persistent disease was detected on the repeat Pap smear in 199 (65.03%); of these, 223 (72.88%) were of a lesser grade than in the original histology results. Of the 152 with histologically confirmed CIN3, 67 (44.08%) had improved to a lesser grade, and 54 (44.63%) had normal cytology results. Among the latter two subject groups (n=141) who had CIN2 histologically, 91 (64.53%) had improved, 29 (20.57%) remained unchanged, and 20 (14.88%) had CIN3; 13 (4.25%) patients with CIN1 returned for follow-up; 11 (84.62%) of these had normal Pap smears and 2 (15.38%) had CIN3. CONCLUSION: Recurrences were of a lesser degree than initial histology results. This reduction in the grade of disease was related to CD4+ count, complete excision and parity. Antiretroviral therapy use did not improve outcome, perhaps owing to low initial CD4 counts. <![CDATA[<b>South African measles outbreak 2009 - 2010 as experienced by a paediatric hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900022&lng=en&nrm=iso&tlng=en INTRODUCTION: Between 2009 and 2010, South Africa experienced a major measles outbreak, with more than 18 000 confirmed cases reported to the National Institute of Communicable Diseases. METHODS: We studied measles admissions during the outbreak to Red Cross War Memorial Children's Hospital, Cape Town, between 1 November 2009 and 31 July 2010. Factors associated with mortality were retrospectively identified from notification records and hospital admissions data. Multivariate logistic regression was used to investigate potential risk factors for death. RESULTS: In total, 1 861 children were diagnosed with measles; 552 (30%) were admitted to hospital. The most common reason for admission was pneumonia (379 (68%)) and/or diarrhoea (262 (48%)). The median age at admission was 7.36 months (interquartile range (IQR) 5.0 - 10.7). The median duration of admission was 4 days (IQR 2 - 6); total hospital admission time was 3 746 days (10.3 child-years). HIV status was known in 404 (73%) children: 39/400 (14%) were HIV-infected. Eighteen children died (3% of all admissions); 15 (83%) of them were less than 1 year old. In the regression model, HIV-infection (adjusted odds ratio (aOR) 7.55, 95% confidence interval (CI) 2.27 - 25.12) and female sex (aOR 3.86, 95% CI 1.26 - 11.84) were associated with higher odds of death. CONCLUSIONS: There was a large paediatric admission burden during the 2009 - 2010 measles outbreak in Cape Town; young children were predominantly affected. HIV-infected children had a significantly higher case fatality. <![CDATA[<b>Case fatality of patients with stroke over a 12-month period post stroke</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900023&lng=en&nrm=iso&tlng=en INTRODUCTION: Stroke is among the top 4 causes of death in South Africa and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge from hospital. METHODS: A total of 200 patients with first-time ischaemic stroke were recruited from Chris Hani Baragwanath Academic Hospital and followed up for 12 months. The Barthel Index (BI) and Rivermead Mobility Index (RMI) were used to establish patient functional ability and, by inference, stroke severity. Follow-up assessments were performed at 3, 6 and 12 months post discharge. Data analysis was largely descriptive in nature. RESULTS: Thirty-eight per cent of patients died within the 12 month follow-up period; 25.5% within 3 months of discharge. The average length of hospital stay was 6 days. Low BI scores at discharge were observed in the majority of patients who died. CONCLUSION: The 12-month cumulative mortality was high (highest at the 3-month follow-up). The short hospital stay and poor functional ability of the patients post stroke possibly left them vulnerable to bed-rest complications, such as chest infections and pressure sores. <![CDATA[<b>Recall of lost-to-follow-up pre-antiretroviral therapy patients in the Eastern Cape</b>: <b>effect of mentoring on patient care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000900024&lng=en&nrm=iso&tlng=en BACKGROUND: In 2011 an experienced HIV nurse from the UK was deployed for 3 months to act as a mentor to nurses learning to initiate antiretroviral therapy (ART) in primary care clinics in a small town in the Eastern Cape, South Africa. METHODS: A review of existing pre-ART patient files (N=286) was carried out and lost-to-follow-up (LTFU) HIV patients were recalled. RESULTS: Only 24% of patients had attended the clinics within the preceding 6 months and 20% had not attended for longer than 2 years. Two lay counsellors visited 222 patients to encourage them to return to care; 65/286 (23%) were untraceable, 11/286 (4%) had relocated, 30/286 (10%) declined, and 8/286 (3%) had died. In the 6 weeks following recall, 51/286 patients (18%) returned to the clinics. CD4 count testing was repeated and screening for tuberculosis (TB) and other opportunistic infections was performed for all patients; ART was initiated in 13/51 (25%), 1 patient tested positive for TB, and isionazid (INH) prophylaxis was initiated in 23/51 (45%). The cost of recall was R130/patient. Within 6 months, all clinics began providing full ART services, 17 professional nurses were mentored and they initiated ART in 55 patients. CONCLUSIONS: Mentoring plays an important role in professional nurse training and support. Recall of LTFU patients is feasible and effective in improving ART services in rural settings.