Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> http://www.scielo.org.za/rss.php?pid=2071-973620090001&lang=pt vol. 14 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Upcoming research articles in <i>Health SA Gesondheid</i></b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Weighting of items in a tutorial performance evaluation instrument: Statistical analysis and results</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100002&lng=pt&nrm=iso&tlng=pt Weighting of items in an evaluation instrument contributes to more meaningful and valid interpretations of student performance in respect of each learning outcome or item being assessed. It follows that the validity of instruments is important for meaningful inferences about students' learning performance, including their performance in tutorial groups. The Delphi technique was used to elicit experts' subjective judgement of the content validity of items in the tutorial performance evaluation instrument in rounds one and two. A sample of eight experts (n = 8) was selected by purposive, maximum variation sampling. In round three Delphi a weighted score was determined for each of the instrument items, subitems and Likert scale points through pairwise comparison by the experts. Mathematical modelling of experts' weighting comparisons, recorded on visual analogue scales, resulted in proportional weights for each item; these weights are expressed as a percentage. The final instrument comprised weighted items measured on a rating scale with points that are not equidistant. A computerised tutorial performance evaluator (TPE) was developed for accurate, economical and efficient calculation of student scores. The purpose of this article is to report on the statistical analysis and results of the weighting of items in an instrument to assess and evaluate baccalaureate nursing students' performance in problem-based learning tutorials.<hr/>Die waardebepaling van items in 'n evalueringsinstrument dra by tot 'n meer betekenisvolle en geldige interpretasie van studente se vermoë ten opsigte van elke leeruitkoms of item wat geassesseer word. Hieruit volg dit dat die geldigheid van instrumente belangrik is vir betekenisvolleafleidings betreffende studente se leervermoë, insluitend hulle prestasie in leergroepe. Die Delphi-tegniek is gebruik in rondtes een en twee om kundiges se subjektiewe oordeel oor die inhoudsgeldigheid van items in die leergroepgedragsevalueringsinstrument te bekom. 'n Steekproef van agt kundiges (n = 8) is deur doelgerigte, maksimale-variasiesteekproeftrekking gekies. Die kundiges het in rondte drie van die Delphi-tegniektoepassing deur middel van gepaarde vergelyking 'n waarde bepaal vir elk van die instrumentitems, sub-items en Likertskaalpunte. Die wiskundige modellering van kundiges se waardebepalingsvergelykings, aangeteken op visuele analogiese skale, het proporsionele gewigte vir elke item tot gevolg gehad. Hierdie gewigte word persentasiegewys voorgestel. Die finale instrument het bestaan uit items wat gemeet word teen 'n graderingskaal met punte wat nie op 'n gelyke afstand van mekaar is nie. 'n Rekenaargebaseerde leergroepgedragsevalueringsinstrument is ontwikkel vir die akkurate, ekonomiese en doeltreffende berekening van studente se punte. Die doel van die artikel is om verslag te lewer oor die statistiese analise en resultate van die waardebepaling van items in 'n instrument om baccalaureate-verpleegkundestudente se prestasie in probleemgebaseerde leergroepe te meet en te evalueer. <![CDATA[<b>Using subjective judgement to determine the validity of a tutorial performance evaluation instrument</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100003&lng=pt&nrm=iso&tlng=pt Evaluating students' learning performance is dependent on assessment criteria from which valid inferences can be made about student learning. An existing 36-item instrument used to evaluate baccalaureate nursing students' performance in problem-based learning tutorials was presented to experts in nursing for their subjective judgement of item validity. Quantitative analysis of data sets from experts' judgements was used to construct a valid measurement scale for evaluating students' tutorial performance. The objectives of the study were to determine the content validity of items in a tutorial performance evaluation (TPE) instrument and to determine the construct validity of items through paired comparison of main and sub-items in the instrument. Academic experts (n = 8) from two South African universities were selected by means of purposive, maximum variation sampling. Data were collected in three rounds of the Delphi technique, which incorporated the Subjective Judgement Model for paired comparison of instrument items. Experts' ratings were captured on a visual analogue scale for each item. Relative item weights were determined using paired comparisons. Statistical analysis resulted in ratio scale data, each item being assigned a ratio relative to its weight. It was concluded that quantitative analysis of subjective judgements is useful to determine the construct validity of items through paired comparison of items in a TPE instrument. This article presents the methodological perspectives of subjective judgement to establish instrument validity.<hr/>Die evaluering van studente se leervermoë is afhanklik van die waardebepalingskriteria waarvan geldige afleidings betreffende die student se leerervaring gemaak kan word. 'n Bestaande instrument met 36 items waarmee baccalaureus-verpleegkundestudente se prestasie in die probleemgebaseerde leertutoriale geëvalueer is, is aan kundiges in verpleegkunde gegee vir subjektiewe beoordeling van die geldigheid van die items. 'n Geldige meetinstrument vir die evaluering van studente se tutoriale prestasie is ontwerp deur van die kwantitatiewe ontleding van die datastelle op grond van die kundiges se oordeel gebruik te maak. Die doelwitte van die studie was om die inhoudsgeldigheid van items in 'n evalueringsinstrument van tutoriale prestasie te bepaal en om die konstrukgeldigheid van items te bepaal deur die gepaarde vergelyking van hoof- en sub-items in die instrument. Akademiese kundiges (n = 8) van twee Suid-Afrikaanse universiteite is deur middel van doelgerigte, maksimale variasie-steekproeftrekking geselekteer. Data is deur middel van drie rondtes van die Delphi-tegniek ingesamel, wat die subjektiewe oordeelmodel vir gepaarde vergelyking van die instrumentitems ingesluit het. Die kundiges se beoordeling is op 'n visueleanaloë-skaal vir elke item weergegee. Relatiewe itemgewigte is deur middel van gepaarde vergelyking bepaal. Statistiese ontleding het verhoudingskaaldata tot gevolg gehad, en elke item is van 'n verhouding relatief tot die gewig voorsien. Daar is bevind dat kwantitatiewe ontleding van subjektiewe beoordeling bruikbaar is om die geldigheid van 'n konstruk deur gepaarde vergelyking van items in 'n evalueringsinstrument van tutoriale prestasie te bepaal. Hierdie artikel bied die metodologiese perspektiewe van die subjektiewe beoordeling aan om die geldigheid van die instrument te bepaal. <![CDATA[<b>A qualitative investigation of south african cigarette smokers’ perceptions of fear appeal messages in anti-smoking advertising</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100004&lng=pt&nrm=iso&tlng=pt Cigarette smoking continues to pose a global health risk, including in developing countries. Fear appeal messages have been widely employed in health communication to reduce cigarette smoking, but studies provide conflicting results on their efficacy. The present qualitative study explores smokers' perceptions of fear appeal messages used in anti-smoking advertising. Focus group discussions were conducted with male and female smokers from Gauteng. A thematic analysis found that participants negatively viewed advertisements that use unrealistic images and failed to relate to the message portrayed. Information about the risks associated with smoking was perceived as patronising and as positioning smokers as ignorant and unintelligent. In addition, fear appeal messages that only focus on long-term consequences of smoking were perceived as ineffective. Participants failed to identify with content that solely relied on factual information at the expense of an emotive appeal. The findings suggest that anti-smoking communication could benefit from content that evokes shock without sacrificing realism, that it should include information about shortterm and immediately visible consequences of smoking and that it should avoid negative depictions of smokers that alienate them from the message being portrayed.<hr/>Sigaretrook dra steeds 'n wêreldwye gesondheidsrisiko, met inbegrip van in ontwikkelende lande. Vrees-oproepende boodskappe word algemeen in gesondheidskommunikasie gebruik om rookgedrag te verminder, maar studies toon teenstrydige resultate rakende die doeltreffendheid daarvan. Die huidige kwalitatiewe studie ondersoek rokers se persepsies van vrees-oproepende boodskappe soos in antirook-advertensies gebruik. Fokusgroepbesprekings is met manlike en vroulike rokers in Gauteng gehou. 'n Tematiese ontleding het gevind dat deelnemers advertensies wat onrealistiese beelde gebruik, negatief beskou en dat hulle nie met die boodskap identifiseer nie. Inligting oor die risiko's geassosieer met rook is as neerbuigend gesien en dat dit rokers as onkundig en onintelligent voorstel. Verder is gevind dat vrees-oproepende boodskappe wat slegs op langtermyngevolge van rook fokus ondoeltreffend beskou word. Deelnemers het nie met inhoud geïdentifiseer wat slegs op feitlike inligting steun ten koste van 'n emotiewe beroep nie. Die bevindinge stel voor dat antirook-kommunikasie uit inhoud kan baat wat skok uitlok, sonder om realisme prys te gee. Inhoud moet oor inligting van korttermyn- en onmiddellik sigbare gevolge van rook beskik en negatiewe uitbeeldings wat rokers van die boodskap distansieer, moet vermy word. <![CDATA[<b>Speaking to experts and patients: Recommendations for improving antiretroviral therapy (ART) adherence</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100005&lng=pt&nrm=iso&tlng=pt This article reports on the findings of a study that aimed to explore experts' and patients' opinions and recommendations regarding adherence to antiretroviral medication. This study was prompted firstly by the lack of existing local research on adherence to antiretroviral therapy (ART) and secondly by the importance of adherence, given the recent introduction of ART to the public health sector. Four experts and seven patients were interviewed. The experts had worked within the HIV/AIDS field for at least two years while the patients (chosen from public antiretroviral roll-out programmes) had been on ART for at least six months. These interviews were transcribed and analysed using thematic content analysis. This article focuses specifically on the recommendations for improving adherence that emerged from the experts' and patients' interviews. While the experts and patients generated two fairly distinct sets of recommendations (clearly informed by their different experiences and knowledge), both groups emphasised the importance of the mediating effects of social support and the healthcare provider-patient relationship in adherence to ART medication.<hr/>Gesprekke met kundiges en pasiënte: Aanbevelings ter verbetering van ART-nakoming. Hierdie artikel doen verslag oor die bevindinge van 'n studie wat kundiges en pasiënte se menings en aanbevelings ten opsigte van die nakoming van antiretrovirale medikasievoorskrifte ondersoek het. Die studie is in die eerste plek uitgevoer na aanleiding van die gebrek aan bestaande plaaslike navorsing oor die nakoming van antiretrovirale terapie (ART) en in die tweede plek na aanleiding van die belangrikheid van nakoming in die lig van die onlangse bekendstelling van ART in die openbaregesondheidsektor. Onderhoude is met vier kundiges en sewe pasiënte gevoer. Die kundiges het vir ten minste twee jaar binne die MIV/Vigs-omgewing gewerk en die pasiënte (wat uit die openbare antiretrovirale bekendstellingsprogramme gekies is) het ten minste ses maande van ART-terapie ondergaan. Die onderhoude is getranskribeer en met die gebruik van tematiese inhoudsanalise ontleed. Hierdie artikel fokus spesifiek op die aanbevelings vir die verbetering van nakoming wat uit die onderhoude met die kundiges en die pasiënte gespruit het. Terwyl die kundiges en die pasiënte twee redelik uiteenlopende stelle aanbevelings gemaak het (wat duidelik deur hulle onderskeie ondervinding en kennis beïnvloed is), het altwee groepe beklemtoon dat die bemiddelende effek van maatskaplike ondersteuning en die verhouding tussen die pasiënt en die voorsiener van gesondheidsorg 'n belangrike rol speel in die nakoming van ART-medikasievoorskrifte. <![CDATA[<b>A composite score for a measuring instrument utilising re-scaled Likert values and item weigths from matrices of pairwise ratios </b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100006&lng=pt&nrm=iso&tlng=pt A methodology is proposed to develop a measuring instrument (metric) for evaluating subjects from a population that cannot provide data to facilitate the development of such a metric (e.g. pre-term infants in the neonatal intensive care unit). Central to this methodology is the employment of an expert group that decides on the items to be included in the metric, the weights assigned to these items, and an index associated with the Likert scale points for each item. The experts supply pairwise ratios of an importance between items, and the geometric mean method is applied to these to establish the item weights - a well-established procedure in multi-criteria decision analysis. The ratios are found by having a managed discussion before asking the members of the expert panel to mark a visual analogue scale for each item.<hr/>'n Metode word aangebied waarmee 'n meetinstrument (metriek) ontwikkel kan word vir die evaluering van persone uit 'n populasie wat nie self die data vir die ontwikkeling van die metriek kan voorsien nie (bv. vroeggebore babas in die neonatale intensiewe sorgeenheid). Die kern van hierdie werkswyse is die gebruik van 'n deskundige groep wat die items vir die meetinstrument kies, gewigte aan die items toeken, en vir elke item 'n indeks opstel wat met die Likert-skaal punte geassosieer word. Die deskundiges het paarsgewyse verhoudings tussen items verskaf en die meetkundig-gemiddelde metode is hierop toegepas om die itemgewigte te verkry - 'n goedgevestigde gebruik in meerdoelwitbesluitkunde. Die paarsgewyse verhoudings is gewerf deur die deskundiges, na 'n bestuurde bespreking, vir elke item 'n visuele analoogskaal te laat invul. <![CDATA[<b>Case study as a learning opportunity among nursing students in a university</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100007&lng=pt&nrm=iso&tlng=pt The South African Qualification Authority Act (58/1995) requires that the facilitators of the education and training programme for nursing students implement teaching strategies that facilitate critical reflective thinking and lifelong learning. This article seeks to report fourth-year nursing students' experiences regarding the use of a case study approach as a learning opportunity. Much has been documented about the case study as an effective strategy to facilitate learning. A purposive convenience sampling method was used to select 24 nursing students in a South African university. Descriptive naïve sketches were used to collect data. The results were analysed using the content data analysis method (Burns & Grove 2003). Measures to ensure the trustworthiness of the study were taken in accordance with Lincoln and Guba's (1985) principles. Ethical standards for research were observed in order to maintain the integrity of the research. The research findings suggest that the case study as a learning opportunity is effective in facilitating learning, as indicated by the following three categories: increase in critical thinking skills, increased theory and practice integration and increased growth in presentation skills. These categories were conceptualised using the relevant literature in order to describe research-based recommendations regarding the use of a case study approach as a learning opportunity. It is recommended that facilitators involved in the nursing education programme make use of a case study approach as a learning opportunity at all levels of the nursing education programme.<hr/>Die Suid Afrikaanse Qualification Authority Act (58/1995) vereis dat die fasiliteerders van die onderrig en opleiding program vir verpleegkunde studente onderrig strategië implimenteer wat kritiese reflektiewe denke en lewenslange leer fasiliteer. Die dokument poog om 4de jaar verpleegkunde studente se leerervaring in verband met gevalle-studie benadering te rapporteer. Baie is al gedokumenteer oor die kern van die gevalle-studie as 'n effektiewe strategie om leer te fasiliteer. Die doelgerigte gerieflikheids steekproef metode was gebruik om 24 verpleegkunde studente in 'n Suid Afrikaanse universiteit te kies. Deskriptiewe, naïve sketse was gebruik om inligting te versamel. Resultate was ge-analiseer deur middel van die inhoud data analiese metode (Burns & Grove 2003). Mates om die vertrouens-waardigheid van die studie te verseker was gevolg volgens Lincoln en Guba (1985) se beginsels. Etiese standaarde vir navorsing was waargeneem om die integriteit van die navorsing te verseker. Navorsings bevindinge dui daarop dat die gevalle-studie as leer geleentheid effektief was in die fasilitering van leer, soos aangedui deur die volgende drie kategorië: vermeerdering van kritiese denke vaardighede; vermeerderde teorie en praktyk integrasie en vermeerderde groei in aanbiedings vaardighede. Hierdie kategorië was gekonseptualiseer deur die gebruik van toepaslike literatuur sodat navorsings-gebaseerde aanbevelinge in verband met gevalle-studie benadering as leer geleentheid beskryf kon word. Dit word aanbeveel dat fasiliteerders betrokke by die verpleeg onderrig program gebruik maak van gevalle-studie benadering op alle vlakke van die verpleeg program. <![CDATA[<b>Breastfeeding: Mothers and health practitioners in the context of private medical care in Gauteng</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100008&lng=pt&nrm=iso&tlng=pt Despite the well-documented health benefits of breastfeeding and recommendations by the Department of Health for women to exclusively breastfeed for approximately the first six months of life and continuation beyond one year, a large percentage of South African women do not breastfeed their infants, or only do so for a short period of time. No national South African statistics are available but figures emerging from the attendance of mothers at a baby clinic on the West Rand in Gauteng indicated the following: 64% of the mothers breastfeed up to six weeks, after which the figure rapidly declines to less than 20% at three months (Truter 2007). Several studies have assessed the attitudes of health care personnel towards breastfeeding, but little is known of the type of information given to breastfeeding mothers by private medical practitioners who are the frontline of contact with clients and who may convey information that either promotes or discourages breastfeeding. The following question was thus formulated: With regard to breastfeeding, what are the constraints to breastfeeding in private practice? Therefore, in order to understand the constraints to breastfeeding, the purpose of this study was to assess the breastfeeding information given to pregnant women by health professionals in private practice. The specific objectives of the study were to determine the breastfeeding recommendations made by private health professionals during pregnancy, to describe the management of breastfeeding in the consulting rooms of private medical practitioners, and to describe women's experiences of breastfeeding in private hospitals. In Phase 1 of the study the population comprised all mothers who attended a support group for new mothers at a private post-natal clinic In Phase 2 the population comprised all mothers who attended a community baby clinic or support group. The sample consisted of all primigravidae who breastfed or attempted to breastfeed in the first six weeks. Purposive convenient sampling, as described by Babbie and Mouton (2002:166), was used in both phases of the study. All participants chose a gynaecologist as the primary care giver and delivered in various private hospitals in Johannesburg. Data were collected by means of an anonymous questionnaire, compiled from national and international literature, as well as personal interviews. Data from the questionnaires were analysed by hand. Descriptive statistics were applied. The interviews were analysed according to the descriptive analysis suggested by Tesch (in Creswell, 1994:155). Themes that emerged were clustered and coded. A co-coder, experienced in the field of qualitative research, assisted with the analysis of the transcripts of the interviews. A literature control was conducted to validate the findings. Ethical considerations were based on the DENOSA Ethical Standards for Nurse Researchers (1998:2.3.2-2.3.4). Themes and sub-themes were identified.<hr/>Ten spyte van die goed gedokumenteerde gesondheidsvoordele van borsvoeding en die aanbevelings van die Departement van Gesondheid dat vroue vir ongeveer die eerste ses weke tot een jaar uitsluitlik moet borsvoed, word gevind dat 'n groot aantal Suid-Afrikaanse vroue hul babas nie borsvoed nie, of slegs vir 'n kort tydperk borsvoed. Geen nasionale Suid-Afrikaanse statistiek is beskikbaar nie, maar 64% van moeders wat 'n babakliniek besoek het op die Wes Rand in Gauteng borsvoed steeds op ses weke, waarna die aantal borsvoedende moeders verminder tot minder as 20% op drie maande (Truter 2007). Verskeie studies het die houding van gesondheidspersoneel ten opsigte van borsvoeding bepaal, maar min is bekend oor die tipe inligting wat deur die mediese praktisyn aangebied word. Hierdie praktisyn het eerstehandse kontak met die kliente en mag inligting aanbied wat borsvoeding kan bevorder of belemmer. Die volgende vraag is dus geformuleer: Met betrekking tot borsvoeding, wat is die beperkinge in privaat praktyk? Die doel van hierdie studie was om vas te stel watter borsvoedinginligting deur gesondheidspersoneel in privaatpraktyk aan swanger vroue oorgedra word. Die doelwitte van die studie was om die aanbevelings om te borsvoed te bepaal, om die behandeling en sorg in die spreekkamer van die geneesheer te beraam, en om die vroue se belewenisse van borsvoeding in privaat hospitale te ondersoek. In Fase 1 van die studie het die populasie bestaan uit alle moeders wat 'n ondersteuningsgroep by 'n privaat nageboortekliniek bygewoon het. In Fase 2 was die populasie alle moeders wat 'n ondersteuningsgroep bygewoon het en 'n babakliniek besoek het. Die steekproef het bestaan uit alle primigravidae wat borsvoed of probeer het om te borsvoed gedurende die eerste ses weke. Doelgerigte gerieflikheidssteekproef neming, soos beskryf deur Babbie and Mouton (2002:166), is in albei fases van die studie gebruik. Alle deelnemers het 'n ginekoloog as primêre sorggewer gebruik en het in verskillende Johannesburgse hospitale gekraam. Data is deur middel van anonieme vraelyste, saamgestel uit nasionale en internasionale literatuur, ingesamel sowel as deur middel van persoonlike onderhoude. Data vanaf die vraelyste is deur die navorser ontleed en beskrywende statistiek is toegepas. Die onderhoude is ontleed volgens die beskrywende analise voorgestel deur Tesch (in Creswell, 1994:155). Temas is saamgevoeg en gekodeer.'n Mede-kodeerder was behulpsaam met die ontleding van die transkripsies van die onderhoude. Literatuur is aangewend as kontrole om die bevindinge te valideer. Etiese oorwegings is gebaseer op die DENOSA Etiese Standaarde vir Verpleegnavorsers (1998:2.3.2-2.3.4). Temas en subtemas is geïdentifiseer. <![CDATA[<b>Caring for terminal AIDS patients: The experiences of caregivers in a palliative care institution</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100009&lng=pt&nrm=iso&tlng=pt This research focused on the lived experiences of caregivers working with Acquired Immune Deficiency Syndrome patients, particularly patients who die from this disease whilst resident in a formal institution. A qualitative, exploratory, descriptive, and contextual research design with a phenomenological approach to inquiry was utilised. 13 unstructured interviews, which were audio-taped, were conducted with caregivers working full-time in a formal institution caring for patients who are dying from AIDS. The transcribed interviews were analysed using Tesch's method of descriptive analysis (in Creswell 1994:115). One central theme emerged, namely that in their daily duty (at their place of work), caregivers experienced various challenges as a result of having to deal with the death of their patients suffering from AIDS, and five sub-themes were formulated from further analysis. The five sub-themes were: •Caregivers experienced emotional challenges in caring for patients dying of AIDS •Caregivers experienced a difference in death and dying of adults as opposed to children •Caregivers experienced the rationalisation of death and dying differently •Caregivers experienced that faith in God gives them strength to cope with death and dying •Caregivers experienced caring for patients as fulfilling and meaningful to them despite the sadness of death and dying. The participants face the death of their patients daily, from a disease that causes untold suffering to the patients, family members and to the caregivers themselves, who wish they could prevent the anguish, the pain and the inability of the medical profession to do more than they are at present towards curing this disease. They described their emotional experiences, which included the various challenges that they face as a result of having to deal with the death and dying of their patients suffering from AIDS. The information shared by these participants formed the foundation of the broad guidelines that were developed in order to provide support for such caregivers.<hr/>Die fokus van hierdie navorsing was op die beleefde ervaringe van die versorgers wat met Verworwe Immuniteitsgebreksindroom pasiënte werk, veral pasiënte wat sterf aan die siekte terwyl hulle in 'n formele inrigting is. 'n Kwalitatiewe, eksploratiewe, beskrywende en kontekstuele navorsingsontwerp met 'n fenomenologiese benadering was gebruik. 13 ongestruktueërde onderhoude, wat op 'n audioband opgeneem was is gehou met versorgers wat voltyds in 'n formele inrigting sorg vir pasiënte wat aan VIGS sterf werk. Tesch se metode van beskrywende analise was gebruik om die transkribeerde onderhoude te analiseer (in Cresswell 1994:115). Een sentrale tema het na vore gekom, naamlik dat versorgers tydens die uitvoering van hulle daaglikse pligte (in die werk) 'n verskeidenheid uitdagings ondervind het as gevolg van hul pasiënte wat sterf van VIGS en vyf sub-temas is geformuleer deur verdure analise. Hierdie vyf sub-temas was: •Versorgers ervaar emosionele uitdagings tydings die versorging van pasiënte wat van VIGS sterf •Versorgers ervaar n verskil in die dood en sterfte van volwassesnes teenoor die van kinders •Versorgers ervaar die rasionaliseering van dood en sterfte verskillend •Versorgers ervaar dat vertroue in God hulle krag gee om die dood en sterfte beter te hanteer •Versorgers ervaar dat die versorging van pasiënte wat sterf of sterwend is vervullend is ten spyte van die hartseer van dood en sterfte. Die deelnamers ervaar die dood van hul pasiënte daagliks van 'n siekte wat ongetelde lyding vir hulself, die pasiënt en hul familie veroorsaak. Die versorgers wens dat hulle kon die angs en die pyn voorkom, sowel as die ombekwaamheid van die mediese beroep om huidiglik meer te kan doen om die siekte te genees. Hulle beskryf hul emosionele ervaringe wat die verskillende uitdagings wat hul ervaar as gevolg van hul betrokkenheid by die dood en afsterwe van hul pasiënte aan VIGS. Die inligting wat deur hierdie deelnemers gedeel word, vorm die basis van die ontwikkeling van breë riglyne om die versorgers te ondersteun. <![CDATA[<b>The relationship between family-of-origin and marital satisfaction</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100010&lng=pt&nrm=iso&tlng=pt The aim of this article is to explore the relationship between marital satisfaction and family-of-origin factors amongst couples with children. Locke and Wallace's Marital Adjustment Test and the McMaster Family Assessment Device were used to measure marital satisfaction and family-of-origin factors respectively. Family-of-origin factors, such as problem solving, communication, roles, affective involvement and behavioural control were investigated. The sample consisted of 47 married couples. A significant relationship was found between roles and affective responsiveness as family-of-origin factors and marital satisfaction, while roles as a family-of-origin factor played an important role in the wife as well as her husbands' marital satisfaction. The findings emphasise the importance of functioning in the family-of-origin as a potential determinant of future marital satisfaction.<hr/>Die doel van hierdie artikel is om die verwantskap tussen huweliksbevrediging en gesin-van-oorsprong-faktore onder pare met kinders te ondersoek. Locke en Wallace se Marital Adjustment Test en die McMaster Family Assessment Device is gebruik om onderskeidelik huweliksbevrediging en gesin-van-oorsprong-faktore te meet. Gesin-van-oorsprong-faktore, soos probleemoplossing, kommunikasie, rolle, affektiewe betrokkenheid en gedragsbeheer is ondersoek. Die steekproef het uit 47 getroude pare bestaan. 'n Beduidende verwantskap is tussen rolle en affektiewe responsiwiteit as gesin-van-oorsprong-faktore en huweliksbevrediging gevind, terwyl rolle as 'n gesin-van-oorsprong-faktor 'n belangrike rol in die vrou sowel as die man se huweliksbevrediging gespeel het. Die bevindinge beklemtoon die belangrikheid van funksionering in die gesin van oorsprong as 'n potensiële determinant van toekomstige huweliksbevrediging. <![CDATA[<b>Prescribing patterns of medicine classified as 'antidepressants' in South African children and adolescents</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100011&lng=pt&nrm=iso&tlng=pt The main objective of this study was to characterise prescribing patterns of medicine classified as 'antidepressants' (hereafter simply referred to as antidepressants) in children and adolescents in the private health care sector of South Africa. A retrospective drug utilisation design was used to identify patients aged 19 years and younger from a South African pharmaceutical benefit management company's database, whom were issued at least one antidepressant between 1 January 2006 and 31 December 2006. Prescribed daily dosages (PDDs) were calculated using the Statistical Analysis System® program. A total of 1 013 patients received a mean number of 2.88 (SD 3.04) prescriptions per patient. Females received more prescriptions than their male counterparts, with the highest prevalence in the 15≤19 years age group. The pharmacological groups most prescribed were the selective serotonin reuptake inhibitors (43.0%) and the tricyclics (42.7%), with imipramine (22.04%) and amitriptyline (19%) as the most commonly prescribed drugs. Approximately 30% (n = 2 300) of all antidepressants in the study population were prescribed off-label. Amitriptyline and clomipramine were prescribed at daily dosages higher than recommended in children and adolescents aged 9 ≤ 15 years. Lithium, trimipramine, trazodone and sulpiride were prescribed at sub-therapeutic dosages in adolescents. This study provided insight in the prescribing patterns of medicine classified as antidepressants in South African children and adolescents. These drugs, however, have many indications. Further research is needed to determine reasons why specific drugs are prescribed in this population.<hr/>Die algemene doelstelling van hierdie studie was om die voorskrifpatrone van middels wat as 'antidepressante' geklassifiseer word (hierna verwys na as slegs antidepressante) wat vir kinders en adolessente in die Suid-Afrikaanse private gesondheidsorgsektor voorgeskryf word, te beskryf. 'n Retrospektiewe medisyneverbruiksontwerp is gebruik om pasiënte 19 jaar en jonger, wat in die periode van 1 Januarie 2006 tot 31 Desember 2006 ten minste een voorskrif vir 'n antidepressant ontvang het, in die databasis van 'n Suid-Afrikaanse farmaseutiese voordelebestuursmaatskappy te identifiseer. Voorgeskrewe daaglikse dosisse (VDDs) is bereken deur van die program Statistical Analysis System® gebruik te maak. 'n Totaal van 1 013 pasiënte het 'n gemiddeld van 2.88 (SA 3.04) voorskrifte per pasiënt ontvang. Vroue het meer voorskrifte as hul manlike eweknieë ontvang, met die hoogste voorkoms in die ouderdomsgroep 15 ≤ 19 jaar. Die farmakologiese groepe selektiewe serotonienheropnameremmers (43.0%) en die trisikliese antidepressante (42.7%) is die meeste voorgeskryf, met imipramien (22.04%) en amitriptilien (19%) as die mees algemeen voorgeskrewe middels. Ongeveer 30% (n = 2 300) van alle antidepressante in die studiepopulasie is voorgeskryf vir indikasies waarvoor dit nie geregistreer is nie. Amitriptilien en klomipramien is teen daaglikse dosisse hoër as die aanbevole vir 9≤15-jarige kinders en adolessente voorgeskryf. Litium, trimipramien, trasodoon en sulpiried is teen sub-terapeutiese dosisse vir adolessente voorgeskryf. Hierdie studie het insig verleen ten opsigte van die voorskrifpatrone van middels wat as antidepressante geklassifiseer word vir Suid-Afrikaanse kinders en adolessente. Hierdie middels het egter baie gebruike. Verdere navorsing word benodig om redes te bepaal waarom sekere middels in hierdie populasie voorgeskryf word. <![CDATA[<b>Obesity: A preliminary report of an introductory service-learning course on the role of pharmacy students in health promotion</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100012&lng=pt&nrm=iso&tlng=pt Lifestyle diseases such as obesity have been neglected in developing countries partly due to a more urgent focus on infectious diseases in these countries. The incidence of obesity is on the increase in developing countries, with a marked rise in childhood obesity. A health promotion activity employing service-learning principles required final year pharmacy students to prepare a pilot-tested computer-based quiz, using a pre- and post-intervention test design, along with other learning material, for participants at the 2007 Sasol National Festival of Science and Technology (SciFest). Interactive models, posters and information leaflets were used in explaining the prevention and control of obesity to learners. The results showed that the pre-existing knowledge of the participants was good. There was a further improvement after the educational intervention. Activities such as this are important in heightening awareness of obesity in learners as it is likely to reduce the incidence of obesity later in life. Furthermore, the activity also served to increase awareness of the role of pharmacists in the prevention of lifestyle diseases such as obesity.<hr/>Leefwysesiektes soos obesiteit word verwaarloos in ontwikkelende lande weens die fokus op aansteeklike siektes. Voorvalle van obesiteit het verdriedubbel in ontwikkelende lande, met 'n skerp styging in kinderobesiteit. Die huidige gesondheidsprogram bied 'n indiensopleidingskursus aan, waar finalejaar-aptekerstudente 'n loodsprogram aanbied met behulp van 'n rekenaar vasvraprogram waar 'n voor- en na-toets saam met ander leermateriaal gebruik word vir bywoners van die 2007 Sasol Nasionale Wetenskapfees. Interaktiewe modelle, plakkate en inligtingspamflette is as hulpmiddels gebruik om die voorkoming en beheer van obesiteit aan leerders te illustreer. Die resultate het gewys dat die kennis van die deelnemers goed was. Dit het ná opvoedkundige raadgewing verder verbeter. Projekte soos hierdie is belangrik om leerders van obesiteit bewus te maak, aangesien dit baie moontlik die voorkoms van obesiteit later in deelnemers se lewens kan verminder. Die projek poog verder om bewustheid oor die rol wat aptekers in die voorkoming van leefwysesiektes soos obesiteit kan speel, te verhoog. <![CDATA[<b>Informed consent in clinical trials: Perceptions and experiences of a sample of South African researchers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100013&lng=pt&nrm=iso&tlng=pt The implementation of informed consent (IC) in clinical trials presents many challenges, especially in developing countries. This study explored the experiences and reported practices regarding the implementation of IC in clinical trials in South Africa. Data were gathered through semi-structured interviews with a range of stakeholders in clinical trials in two provinces. The interviews were analysed to identify themes and issues relating to IC. The findings show that IC practices involve attention being paid to both formal requirements and informal practices to attain IC. Research assistants or trial counsellors were found to play a critical role in facilitating the IC process. It is recommended that more recognition be given to the important role of trial counsellors in clinical trials, and that they be given more formal training, support and supervision.<hr/>Die implementering van ingeligte toestemming (IT) in kliniese proewe bied menige uitdagings, veral in ontwikkelende lande. Hierdie studie het die ervarings en vermelde praktyke betreffende die implementering van IT in kliniese proewe in Suid-Afrika ondersoek. Data is ingewin deur middel van semi-gestruktureerde onderhoude met 'n verskeidenheid van rolspelers in kliniese proewe in twee provinsies. Onderhoude is ontleed om herhalende temas rakende IT te identifiseer. Bevindings toon dat IT-benaderings die voldoening aan formele vereistes sowel as die gebruikmaking van informele metodes behels. Daar is bevind dat navorsingsassistente 'n kritieke rol in die fasilitering van die IT-proses speel. Daar word aanbeveel dat meer erkenning gegee word aan die rol van proefvoorligters in kliniese proewe, dat hulle meer formele opleiding ondergaan, dat hulle beter ondersteuning ontvang en dat daar beter oor hulle toesig gehou word. <![CDATA[<b>Perception of seriousness and preventive health actions of patients with type 2 diabetes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100014&lng=pt&nrm=iso&tlng=pt Diabetes mellitus is one of the most common chronic health conditions in the world. Though type 2 diabetes is a very serious condition, it is the complications that go with it that cause major morbidity and mortality. It is possible for a person with type 2 diabetes to lead a normal, happy life with the adequate treatment and motivation. The treatment involves increased physical activity, reducing weight if overweight, following a healthy diet and oral drugs or insulin injections. Patients deliver 95% of their care. According to the Health Promotion Model a nurse can support patients by focussing on the benefits of the treatment, teaching them to overcome management barriers and by giving positive feedback. The purpose of this study was to determine whether type 2 diabetes patients who were educated and counselled at a Centre for Diabetes in Limpopo Province, South Africa, perceive their condition as serious and change their lifestyle to prevent complications. The design was an exploratory, contextual, quantitative survey. A convenient sample (n=40) was chosen from patients attending the Centre for Diabetes. The data method was self-report using a pre-testing questionnaire and descriptive statistics to analyse the data. The results of the study indicate that though the majority of the groups' physical measurements were above normal (obesity 85%, hypertension 35%, HbA1c 65% and waist circumference 70%), they perceived the diabetes diagnosis as not serious (87.5%) and well controlled (87.5%). Solutions for educating individuals to change their lifestyles to prevent complications when they are feeling well have not yet been found.<hr/>Diabetes mellitus is 'n algemene chroniese gesondheidstoestand. Alhoewel tipe 2-diabetes 'n ernstige toestand is, veroorsaak komplikasies die meeste morbiditeit en mortaliteit. Dit is moontlik vir 'n persoon met tipe 2-diabetes om 'n normale, gelukkige lewe te lei met die nodige behandeling en motivering. Behandeling behels verhoogde fisiese aktiwiteit, gewigsverlies, 'n gesonde dieet en orale medikasie of insulienbehandeling. Pasiënte is egter verantwoordelik vir 95% van hul behandeling. Volgens die Gesondheidsbevorderingsmodel kan 'n verpleegkundige 'n pasiënt ondersteun deur te fokus op die voordele van behandeling, voorligting om probleme te oorkom en deur positiewe terugvoering. Die doel van die studie was om te bepaal of die pasiënte met tipe 2-diabetes wat voorligting en berading by 'n Sentrum vir Diabetes in Limpopo Provinsie ontvang, hul toestand as ernstig beskou en of hulle hul lewenswyse verander ten einde komplikasies te voorkom. Die ontwerp was 'n ondersoekende kwantitatiewe opname. Die gerieflikheidsteekproef was veertig deelnemers (n=40). Die data-insamelingsmetode was self-rapportering deur middel van 'n vraelys en die data is met behulp van beskrywende en statistiese analise ontleed. Die resultate dui daarop dat die meerderheid van die groep se fisiese lesings hoër as normaal was (oorgewig 85%, hipertensie 35%, HbA1c 65% en middellyn 70%). Die meeste van die deelnemers (87.5%) het hul diagnose van tipe 2 diabetes as nie ernstig nie en goed gekontroleerd beskou. Die oplossing oor hoe om mense te leer om hul lewenswyse te verander om komplikasies te voorkom terwyl hulle op die oomblik nog goed voel, is nog nie bepaal nie. <![CDATA[<b>Comparison of three school feeding strategies for primary school chidren in an informal settlement in Gauteng, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100015&lng=pt&nrm=iso&tlng=pt The aim of this study was to compare the impact of three school feeding strategies on the nutritional status of primary school children aged six to 13 in an informal settlement in Gauteng. The methods included dietary surveys and anthropometric and biochemical measurements of a sample of 160 primary school children allocated to three different school feeding intervention groups. One group (n=60) received a whole wheat pilchard and spinach vetkoek , a second received food according to the Government Primary School Nutrition Programme (PSNP) (n=60), and a third (n=40) received fruit. The children were given these items every day for seven months, except during school holidays and weekends. The baseline anthropometric measurements indicated that 13.6%, 20.9% and 10.8% of the children in the vetkoek, PSNP and fruit groups respectively were underweight (<5th percentile for weight-for-age) and 17.3%, 23.6% and 5.2% were stunted (<5th percentile for height-for-age). The post-intervention results indicated that the children in all three groups had improved significantly in weight and height, and in dietary intakes of zinc and iron. The results of this study indicated that all three feeding strategies contributed to an improved nutritional status. Providing fruit as a school feeding strategy may be the most affordable and easy to implement. More research is recommended to measure the impact of these strategies on a longterm basis.<hr/>Die doel van die studie was om die impak van drie skoolvoedingstrategieë op die voedingstatus van ses tot dertien jaar oue laerskoolkinders in 'n informele nedersetting in Gauteng te bepaal. Die metodes het die volgende ingesluit: dieetopnames, antropometriese en biochemiese metings in 'n steekproef van 160 laerskoolkinders, wat ewekansig in drie skoolvoedingintervensiegroepe verdeel is. Die groepe het bestaan uit 'n volkoring sardyn-en-spinasie-vetkoek groep (n=60), die Government Primary School Nutrition Programme (PSNP) groep (n=60), en 'n vrugtegroep (n=40) wat hierdie items elke dag vir sewe maande, behalwe vir skoolvakansies en naweke, ontvang het. Die antropometriese metings voor die intervensie het bevind dat 13.6%, 20.9% en 10.8% van die kinders ondergewig (<5de persentiel vir gewig-vir-ouderdom) was in die vetkoek-, PSNP- en vrugtegroep, respektiewelik, en 17.3%, 23.6% en 5.2% se groei is belemmer (<5de persentiel vir lengte-vir-ouderdom). Die na-intervensieresultate het aangedui dat die kinders in al drie die groepe se gewig, lengte, sowel as sink en ysterinname betekenisvol verbeter het. Die resultate van hierdie studie het aangetoon dat al drie die voedingstrategieë bygedra het tot 'n verbeterde voedingstatus. Die voorsiening van vrugte as 'n skoolvoedingstrategie is egter bekostigbaar en maklik om te implementeer. Meer navorsing om die impak op die langtermyn te toets, word aanbeveel. <![CDATA[<b>Nurses' and doctors' perceptions regarding the implementation of a triage system in an emergency unit in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100016&lng=pt&nrm=iso&tlng=pt Triage assessment of patients on arrival at an emergency unit is an essential function in quality emergency care provision, and is a cost-effective and time saving venture. This study investigated nurses' and doctors' perceptions about the implementation of the Cape Triage Score in one emergency unit. The challenges encountered prior to the implementation of the Cape Triage Score and the roles and core competencies of the triage nurse were addressed as well as the strengths and weaknesses of the Cape Triage Score. In this descriptive, quantitative and exploratory study, 15 nurses and doctors completed questionnaires. The challenges decreased and the sorting of patients improved after the implementation of the Cape Triage Score. Other strengths of this system included that the triage nurse prioritised patients, as opposed to the receptionist or the administrative staff; and nurses could undertake preliminary investigations without waiting for doctors' orders to do so. The weaknesses of the implemented Cape Triage Score included that it was not fully functional 100% of the time, and that it was difficult to maintain during peak admission periods due to a shortage of nurses. The recommendations included that management should be convinced of the system's benefits; nurses should perform the triage function on a rotation basis; more nurses should be available during peak periods; and that the administrative and reception staff should also be orientated about the triage system.<hr/>Triage assessering van pasiënte met hulle aankoms by 'n ongeluk/noodeenheid is 'n noodsaaklike funksie van noodsorgvoorsiening, en is 'n koste-effektiewe en tydbesparende onderneming. Hierdie studie het die persepsies van dokters en verpleegkundiges ondersoek betreffende die implementering van die Cape Triage Score in een noodeenheid. Die uitdagings wat ervaar is voor die implementering van die Cape Triage Score, die rolle en kernvaardighede van die triage verpleegkundige asook die swak en sterk punte van die Cape Triage Score is aangespreek. In hierdie beskrywende, kwantitatiewe en verkennende studie het 15 verpleegkundiges en dokters vraelyste voltooi. Uitdagings het verminder en die prioritisering van die pasiënte het verbeter na die implementering van die Cape Triage Score. Ander sterk punte van die stelsel het ingesluit dat die triage verpleegkundige die pasiënte geprioritiseer het, nie die ontvangsdame of die administratiewe personeel nie, en verpleegkundiges kon voorlopige ondersoeke doen sonder om op doktersbevele te wag. Die swakhede van die geïmplementeerde Cape Triage Score het ingesluit dat dit nog nie ten volle 100% van die tyd gefunksioneer het nie, en dat dit moeilik was om triage gedurende spitstye te handhaaf as gevolg van 'n tekort aan verpleegkundiges. Die aanbevelings het ingesluit dat bestuur oortuig moet word van die voordele van die stelsel, verpleegkundiges triage funksies op 'n rotasiebasis moet uitvoer, meer verpleegkundiges beskikbaar moet wees gedurende spitstye; en dat administratiewe en ontvangspersoneel ook georiënteer moet word ten opsigte van die triage stelsel. <![CDATA[<b>Nurses' perceptions about Botswana patients' anti-retroviral therapy adherence</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100017&lng=pt&nrm=iso&tlng=pt Anti-retroviral drugs (ARVs) are supplied free of charge in Botswana. Lifelong adherence to anti-retroviral therapy (ART) is vital to improve the patient's state of well-being and to prevent the development of strains of the human immunodeficiency virus (HIV) that are resistant to ART. Persons with ART-resistant strains of HIV can spread these to other people, requiring more expensive ART with more severe side-effects and poorer health outcomes. The purpose of this exploratory, descriptive, qualitative study was to determine nurses' perspectives on Botswana patients' anti-retroviral therapy (ART) adherence, and to identify factors which could promote or hinder ART adherence. Four ART sites were randomly selected and all 16 nurses providing ART services at these sites participated in semi-structured interviews. These nurses indicated that patients' ART adherence was influenced by service-related and patient-related factors. Service-related factors included the inaccessibility of ART clinics, limited clinic hours, health workers' inability to communicate in patients' local languages, long waiting times at clinics and delays in being informed about their CD4 and viral load results. Nurses could not trace defaulters nor contact them by phone, and also had to work night shifts, disrupting nurse-patient relationships. Patient-related factors included patients' lack of education, inability to understand the significance of CD4 and viral load results, financial hardships, non-disclosure and non-acceptance of their HIV positive status, alcohol abuse, the utilisation of traditional medicines and side effects of ART. The challenges of lifelong ART adherence are multifaceted involving both patient-related and service-related factors. Supplying free ARVs does not ensure high levels of ART adherence.<hr/>Anti-retrovirale middels (ARMs) word gratis verskaf in Botswana. Lewenslange getroue nakoming van ARM voorskrifte is noodsaaklik om die pasiënt se algehele staat van welsyn te verbeter en om die ontwikkeling te voorkom van stamme van die menslike immuun-gebrek virus (MIV) wat weerstand bied teen anti-retrovirale behandeling (ARB). Persone met ARB-weerstandbiedende MIV stamme kan dit versprei na ander mense toe, wat duurder ARB vereis met swakker gesondheidsuitkomste. Die doel van hierdie verkennende, beskrywende, kwalitatiewe studie was om te bepaal wat verpleegkundiges se sienings is oor pasiënte in Botswana se nakoming van ARB, en om faktore te identifiseer wat die ARB-nakoming kan bevorder of benadeel. Vier ARB terreine was ewekansig gekies en al 16 verpleegkundiges wat ARB dienste by die terreine verskaf, het deelgeneem aan semi-gestruktureerde onderhoude. Hierdie verleegkundiges het aangedui dat pasiënte se ARB handhawing beïnvloed word deur diens-verwante en pasiënt-verwante faktore. Diens-verwante faktore behels die ontoeganklikheid van ARB klinieke, beperkte kliniekure, gesondheidswerkers se onvermoë om in pasiënte se plaaslike tale te kommunikeer, lang wagtye by klinieke en vertragings om ingelig te word oor uitslae van CD4 en virale tellings. Verpleegkundiges kan nie pasiënte opvolg of telefonies kontak wat versuim om op te daag vir behandeling nie. Verpleegkundiges moet nagskofte werk wat pasiënt-verpleegkundige verhoudings onderbreek. Pasiënt-verwante faktore behels pasiënte se gebrekkige opvoeding, hulle onvermoë om die belangrikheid van uitslae van CD4 en virale tellings te verstaan, finansiële ontberinge, nie-openbaarmaking en nie-aanvaarding van hulle MIV positiewe status, alkohol misbruik, die gebruik van tradisionele medisynes en die newe-effekte van ARB. Die uitdagings van lewenslange ARB handhawing is veelsydig en behels beide pasiënt-verwante en diens-verwante faktore. Die verskaffing van gratis ARMs verseker nie ARB handhawing nie. <![CDATA[<b>Experiences of health care providers managing sexual assault victims in the emergency unit Part 1: Background and methodology</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100018&lng=pt&nrm=iso&tlng=pt The objective of this study was to explore and describe the experiences of health care providers managing sexual assault victims in the emergency unit of a community hospital in the Nkangala district in the Mpumalanga Province. A qualitative, phenomenological design was applied. Purposeful sampling was used to select participants from health care providers who were working in the emergency unit and had managed more than four sexual assault victims. Data were collected by means of individual interviews and analysed according to the Tesch method of data analysis by the researcher and the independent co-coder. Main categories, subcategories and themes were identified. Participants expressed their emotions, challenges and police attitudes and behaviours as well as inconsistencies in guidelines and needs identification. It was recommended that members of the multidisciplinary team engage in community activities and that the community participate in matters pertaining to sexual assault. Government should develop clear guidelines that are applicable to rural and urban South Africa. Health care sciences should aim to train more forensic nurses. All relevant departments should work together to alleviate the complications caused by sexual assault incidents.<hr/>Die doel van hierdie studie was om die ervaringe van gesondheidsorgverskaffers wat slagoffers van seksuele aanranding in die ongevalle-eenheid van 'n gemeenskapshospitaal in die Nkangala-distrik in die provinsie van Mpumalanga hanteer, te verken en te beskryf. 'n Kwalitatiewe fenomenologiese ontwerp is toegepas. Doelbewuste steekproefneming is gebruik om deelnemers te selekteer uit die groep gesondheidsorgverskaffers wat in die ongevalle-eenheid werksaam was en meer as vier slagoffers van seksuele aanranding hanteer het. Data is by wyse van individuele onderhoude ingesamel en volgens die Tesch-metode van data-analise deur die navorser en die onafhanklike medekodeerder geanaliseer. Hoofkategorieë, subkategorieë en temas is geïdentifiseer. Deelnemers het uitdrukking gegee aan hulle emosies, uitdagings, die houding en gedrag van polisiebeamptes, teenstrydighede in riglyne en behoefte-identifikasie. Aanbevelings is dat multidissiplinêre spanlede betrokke moet wees by gemeenskapsaktiwiteite en dat die gemeenskap moet deelneem aan sake wat verband hou met seksuele aanranding. Die regering moet duidelike riglyne ontwikkel wat op landelike en stedelike Suid-Afrika van toepassing is. Gesondheidsorgwetenskappe moet daarop gerig wees om meer forensiese verpleegkundiges op te lei. Alle toepaslike departemente moet saamwerk om die komplikasies te verlig wat deur voorvalle van seksuele aanranding veroorsaak word. <![CDATA[<b>Experiences of health care providers managing sexual assault victims in the emergency unit Part 2: Discussion of results and literature control</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100019&lng=pt&nrm=iso&tlng=pt The objective of this study was to explore and describe the experiences of health care providers managing sexual assault victims in the emergency unit of a community hospital in the Nkangala district in the Mpumalanga Province. A qualitative, phenomenological design was applied. Purposeful sampling was used to select participants from health care providers who were working in the emergency unit and had managed more than four sexual assault victims. Data were collected by means of individual interviews and analysed according to the Tesch method of data analysis by the researcher and the independent co-coder. Main categories, subcategories and themes were identified. Participants expressed their emotions, challenges and police attitudes and behaviours, as well as inconsistencies in guidelines and needs identification. It was recommended that members of the multidisciplinary team engage in community activities and that the community participate in matters pertaining to sexual assault. Government should develop clear guidelines that are applicable to rural and urban South Africa. Health care sciences should aim to train more forensic nurses. All relevant departments should work together to alleviate the complications caused by sexual assault incidents.<hr/>Die doel van hierdie studie was om die ervaringe van gesondheidsorgverskaffers wat slagoffers van seksuele aanranding in die ongevalle-eenheid van 'n gemeenskapshospitaal in die Nkangala-distrik in die provinsie van Mpumalanga hanteer, te ontgin en te beskryf. 'n Kwalitatiewe fenomenologiese ontwerp is toegepas. Doelbewuste steekproefneming is gebruik om deelnemers te selekteer uit die groep gesondheidsorgverskaffers wat in die ongevalle-eenheid werksaam was en meer as vier slagoffers van seksuele aanranding hanteer het. Data is by wyse van individuele onderhoude ingesamel en volgens die Tesch-metode van data-analise deur die navorser en die onafhanklike medekodeerder geanaliseer. Hoofkategorieë, subkategorieë en temas is geïdentifiseer. Deelnemers het uitdrukking gegee aan hulle emosies, uitdagings, die houding en gedrag van polisiebeamptes, teenstrydighede in riglyne en behoefte-identifikasie. Aanbevelings is dat multidissiplinêre spanlede betrokke moet wees by gemeenskapsaktiwiteite en dat die gemeenskap moet deelneem aan sake wat verband hou met seksuele aanranding. Die regering moet duidelike riglyne ontwikkel wat op landelike en stedelike Suid-Afrika van toepassing is. Gesondheidsorgwetenskappe moet daarop gerig wees om meer forensiese verpleegkundiges op te lei. Alle toepaslike departemente moet saamwerk om die komplikasies te verlig wat deur voorvalle van seksuele aanranding veroorsaak word. <![CDATA[<b>Asthma control limitations in selected primary health care clinics</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100020&lng=pt&nrm=iso&tlng=pt Primary health care services worldwide are currently experiencing many quality-related problems. Efforts to improve these services appear to be sporadic and unsatisfactory. Investigations have revealed (Sharma & Sharma 2007) that one of the main causes for this state of affairs can be identified as neglected or inadequate documentation of patient/case history. The health care provider (HCP) should be equipped to improve the quality of health care and to take the lead in assuaging the predicament. The present study was undertaken to assess the correlation between asthma control and patient-related case history notes as recorded via the HCP. The data were obtained retrospectively from the patient notes of all asthmatic patients (including children and pregnant women) who attended six selected clinics in the North West Province of South Africa (Dr Kenneth Kaunda Municipal District). The analysis of the data collected from the patient clinic books confirmed the suspicion of poor quality of documentation, although the documentation in certain categories rendered some positive results. When compared to the GINA® guidelines, none of the patients had been controlled properly and only a small number (18.4%) had been controlled partly (GINA 2008). Asthma control may be enhanced when a standard template is developed for completion by the HCP. It is envisaged that this will ensure that vital information regarding asthma control is documented in order to contribute to satisfactory chronic disease control.<hr/>Primêre gesondheidsorgdienste wêreldwyd ondervind tans menige gehaltediens-verwante probleme, terwyl pogings om dit te verbeter sporadies en onbevredigend voorkom. Navorsing toon (Sharma & Sharma, 2007) dat een van die hoofoorsake hiervan die onvoldoende dokumentasie van die pasiënt of die geval se geskiedenis of nalating om te dokumenteer, is. Die gesondheidsorgverskaffer (GSV) moet toegerus word om die gehalte van gesondheidsorg te verbeter en leiding te neem om die verknorsing te hanteer. Hierdie studie het die korrelasie tussen asmabeheer en pasiëntgeskiedenis, soos genoteer deur 'n GSV, ondersoek. Dié data is retrospektief van die klinieknotas van alle asmapasiënte (kinders en swanger vroue ingesluit) verkry wat die ses klinieke in Noordwes Provinsie, Suid-Afrika (Dr. Kenneth Kaunda Munisipale Distrik), besoek het. Die analise van die data wat uit pasiënte se kliniekboekies versamel is, het die vermoede oor die swak gehalte van dokumentasie bevestig, alhoewel daar positiewe uitkomste was in sekere kategorieë se dokumentasie. Wanneer die dokumentasie met die GINA®-riglyne vergelyk word, is dit duidelik dat geen van die pasiënte optimaal bestuur is nie en slegs 'n klein groepie (18.4%) gedeeltelik bestuur is (GINA 2008). Asmabeheer sou kon verbeter deur 'n standaard templaat te ontwikkel wat die GSV kan voltooi. Daar word voorsien dat dit die dokumentering van die nodige inligting oor asmabeheer sal verseker en sodoende kan bydra tot die bevredigende bestuur van kroniese siektes. <![CDATA[<b>The experiences of remaining nurse tutors during the transformation of nursing colleges</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100021&lng=pt&nrm=iso&tlng=pt The transformation of public services and education in South Africa is part of the political and socio-economic transition to democracy. Changes are occurring in every field, including that of the health services. A qualitative study was undertaken to investigate the experiences of the remaining nurse tutors at a school of nursing during the transformation of nursing colleges and the downsizing of staff. The study on which this article is based was aimed at describing the experiences of those individuals undergoing changes in their work environment, with the purpose of contributing to recommendations regarding the 'survival' of transformation and the downsizing of the workplace. Three themes emerged by way of the narrative descriptions and unstructured in-depth interviews conducted during the study. The first theme, revolving around affective responses, relates to the emotions, low morale, depressive moods and anxiety caused by the transformation and downsizing. The second theme, relating to the cognitive and perceptual view of transformation, revealed the thoughts, beliefs, and opinions of the remaining nurse tutors regarding the change. The perceptions of, and opinions about how, nursing education and human dignity have been affected by this transformation were also expressed. The third theme consists of the coping responses made by the nurse tutors in the form of work-related personal and social adjustments to the transformation of the nursing colleges. The maintenance of ongoing communication and participation by the nurse tutors, as part of their counselling process, is advised.<hr/>Die transformasie van die openbare dienste en onderwys in Suid-Afrika vorm deel van die politieke en sosio-ekonomiese oorgang tot demokrasie. Veranderinge vind plaas op elke terrein, wat ook gesondheidsdienste insluit. 'n Kwalitatiewe studie is onderneem om die belewing van die oorblywende verpleegdosente verbonde aan 'n verplegingskool te ondersoek te midde van die transformasie van verpleegkolleges en personeelvermindering wat plaasvind. Die studie het beoog om die belewing van indiwidue gedurende veranderinge by hul werksomgewing te beskryf, met die doel om by te dra tot aanbevelings wat personeel sou kon help om transformasie en personeelvermindering by die werkplek te 'oorleef'. Drie temas het uit die narratiewe beskrywings en ongestruktureerde in-diepte onderhoude na vore gekom. Die eerste tema, affektiewe response, sluit in emosies, lae moraal, depressiewe gemoed en angs wat deur transformasie en personeelvermindering veroorsaak word. Die tweede tema, kognitiewe en perseptuele betekenis, toon die gedagtes, oortuigings en menings van oorblywende verpleegdosente rakende die transformasie en personeelvermindering aan. Persepsies en opinies van hoe verpleegonderrig en menslike waardigheid geraak is, is ook weergegee. Die derde tema toon die hanteringsresponse, wat werkverwante, persoonlike en sosiale aanpassings van verpleegdosente gedurende die transformasie van verpleegkolleges beskryf. Daar word aanbeveel dat goeie kommunikasie en deelname in die berading van verpleegdosente gehandhaaf word. <![CDATA[<b>A comparative study of Klimakt-Heel® and Femolene ultra in the managemente of typical climacteric symptoms</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100022&lng=pt&nrm=iso&tlng=pt The climacteric is described as the physiological cessation of menses due to a decrease in ovarian function. Typically, women between the ages of 44 and 57 years old are symptomatically affected by it. During this stage of life, a woman may experience what is referred to as 'typical climacteric symptoms' of varying intensity, including vasomotor reactions, increased perspiration, sleeping problems, mood changes, headaches, joint pains and urogenital problems. The aim of this study was to determine the effectiveness of Femolene Ultra (phytotherapeutic preparation) and Klimakt-Heel® (homeopathic preparation) in the treatment of typical climacteric symptoms. Thirty female volunteers between the ages of 44 and 57 years suffering from climacteric symptoms were recruited and asked to complete the Patient Profile and Case History Form and to sign a Patient Information and Consent Form. These participants were randomly placed in two groups of fifteen. One group received Femolene Ultra and the other received Klimakt-Heel® for a period of 12 weeks. The trial was blinded as neither the researcher nor the participant was aware of which treatment was being administered. Blood samples were taken to ascertain the 17ß oestradiol levels before and after the 12-week period. The Kupperman Menopause Index (KMI) was used as a self-report measure and completed at four-weekly intervals. For statistical purposes, the Wilcoxon Signed Rank Test, from the class of non-parametric distribution-free tests, was used. Both products served to decrease the typical climacteric symptoms significantly within the 12-week period. Femolene Ultra decreased the average Kupperman Menopause Index (KMI) score by 63% (26.2 to 16.4) and Klimakt-Heel® decreased the average score by 54% (28.4 to 15.28), although more participants in the Klimakt-Heel® group experienced amelioration of climacteric symptoms. The results are not conclusive, but they do provide an interesting base-line on which further research can be built.<hr/>Die oorgangsleeftyd word beskryf as die fisiologiese einde van menstruasie weens verminderde eierstokfunksie. Oor die algemeen gesproke sal alle vroulike persone tussen die ouderdomme van 44 en 57 daardeur geraak word. Gedurende hierdie tydperk mag hulle ervaar waarna verwys word as 'tipiese simptome van die oorgangsleeftyd' insluitend vasomotoriese reaksies, vermeerderde sweet, slaapprobleme, gemoedsveranderinge, hoofpyne, gewrigspyne en urogenitale probleme. Die doel van die studie was om vas te stel hoe doeltreffend Femolene Ultra (phytotherapeutiese preparaat) and Klimakt-Heel® (homeopathiese preparaat) is vir die behandeling van tipiese oorgangsimptome. Dertig vroulike vrywilligers tussen die ouderdomme 44 en 57 jaar wat aan die simptome van die oorgangsleeftyd gely het het die pasiëntprofiel en -gevallegeskiedenis voltooi en het 'n pasiëntinligtings- en toestemmingsvorm geteken. Hierdie deelnemers is lukraak in twee verskillende groepe van vyftien geplaas. Een groep het Femolene Ultra vir 'n tydperk van 12 weke ontvang en die ander groep het Klimakt-Heel® vir dieselfde tydperk ontvang. Bloedmonsters is geneem om die 17 ß oestradiolvlakke voor en na die 12-weekperiode vas te stel. Die Kupperman Menopouse Indeks is as 'n selfrapportmaatreël gebruik en met vier-weeklikse intervalle voltooi. Statisties is die Wilcoxon rangsomtoets van die klas van nie-parametriese verspreidingsvrye toetse gebruik. Albei produkte het bewys dat dit die tipiese simptome van die oorgangsleeftyd betekenisvol tydens die 12-weekperiode verminder het. Femolene Ultra het die gemiddelde Kupperman Menopouse Indekstelling met 63% verminder en Klimakt-Heel® het die gemiddelde telling met 54% verminder, alhoewel meer deelnemers in die Klimakt-Heel®-groep 'n verbetering in die simptome van die oorgangsleeftyd ervaar het. Die resultate is nie afdoende nie maar dit verskaf tog 'n interessante basis waarop verdere navorsing gegrond kan word. <![CDATA[<b>Health, well-being and wellness: An anthropological eco-systemic approach</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100023&lng=pt&nrm=iso&tlng=pt More than two decades ago, Fritjof Capra commended - and indeed advocated - a paradigm shift in health science and care. In his book The Turning Point (1982) he talks of a major shift from the preoccupation with micro-organisms to a careful study of the 'host organism and its environment', of 'significant attempts to develop a unified approach to the mind/body system' in Western medicine, of 'a new holistic paradigm' (as opposed to 'the old biomedical paradigm') regarding the problem of health and healing, of 'a holistic and humanistic approach to primary care', and of 'a holistic therapy' as opposed to 'the traditional biochemical practice of associating a physical disease with a specific physical cause'. Our concern in this article is with the paradigm shift advocated by Capra in this book and the progress that has since been made.<hr/>Meer as twee dekades gelede het Fritjof Capra 'n pleidooi gelewer vir 'n paradigmaskuif vanaf die biomediese model na 'n meer holistiese, ekosistemiese model van gesondheid en genesing. Die vraag wat in hierdie artikel aan die orde kom is of praktisyns in die veld van die gesondheidswetenskappe sedertdien daarin geslaag het om die oorgang na die aanbevole paradigma te maak. 'n Oorsig van die literatuur sedert 1982 toon dat die skuif nog nie regtig gemaak is nie. 'n Ander literatuuroorsig toon voorts dat die terme 'gesondheid', 'well-being' en 'wellness' as uitruilbaar beskou word en dat hulle betekenisse meermale afhang van die gebruikskonteks. Op grond van hulle bespreking van die antropologiese ekosistemiese benadering tot gesondheid en genesing stel die outeurs voor dat die terme 'gesondheid' en 'wellness' as korrelatiewe gebruik word, en dat die term 'well-being' gebruik word vir al die domeine van menslike lewe en bestaan wat kan bydra tot gesondheid, oftewel 'wellness'. <![CDATA[<b>Elements of effective nutrition education for adults with diabetes mellitus in resource-poor settings: A review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362009000100024&lng=pt&nrm=iso&tlng=pt This review article highlights the key factors that need consideration in planning an effective nutrition education programme for adults with type 2 diabetes mellitus in resource-poor settings. Type 2 diabetes is increasing to epidemic levels globally. Low socio-economic status is associated with poorer health outcomes and a higher economic burden. Individuals with diabetes cite dietary adherence as the most difficult self-care area. Effective nutrition education achieves the desired goals and outcomes, which include appropriate change in dietary behaviour, improved glycaemic control, plasma lipid levels, blood pressure and body weight, as well as improved potential mediators (knowledge, skills and attitudes). Elements that contribute to a successful nutrition education programme include interventions tailored to the needs, abilities and socio-cultural context of the target group, the active involvement of the patient, a behaviour-focused approach based on appropriate theory, suitable delivery methods and individual/group approaches. Adequate contact time with an educator (> 10 hours), the educator's competence, provision of social support and follow-up intervention are also crucial. Effectively educating diabetic individuals from resource-poor settings in nutrition is a challenging task. It needs innovative and skilled educators who are sensitive to the unique needs of the target group and who use appropriate approaches to address these needs.<hr/>Hierdie artikel beklemtoon die sleutelfaktore wat in oorweging geneem moet word wanneer 'n ef-fektiewe voedingsopleidingprogram vir volwassenes met tipe 2-diabetes uit hulpbron-arm agter-gronde beplan word. Tipe 2-diabetes is besig om globaal tot epidemiese vlakke toe te neem. Lae sosio-ekonomiese status word geassosieer met swakker gesondheidsresultate en 'n hoër ekonomiese las. Dieetnakoming word deur persone met diabetes as die moeilikste selfversorgingsgebied uitgewys. Doeltreffende voedingsopleiding bereik die gewenste doelwitte en resultate wat toepaslike veranderings in dieetgedrag, verbeterde glisemiese beheer, verbeterde bloedlipiede, bloeddruk en liggaams-gewig, en verbeterde potensiële bemiddelaars (kennis, vaardighede en houdings), insluit. Elemente wat tot 'n suksesvolle voedingsopleidingprogram bydra, sluit ingrypings in wat geskoei is op die behoeftes, vaardighede en sosiaal-kulturele konteks van die teikengroep, aktiewe betrekking van die pasient, gebruik van 'n benadering wat ingestel is op gedrag en gegrond is op toepaslike teorie, toepaslike metodes van aflewering en individuele/groepbenaderings, geskikte duur en kontaktyd (> 10 uur), een wat vir sosiale ondersteuning en opvolgintervensie sorg, en deur 'n bedrewe verskaffer bemiddel word. Om diabetiese individue uit hulpbron-arm agtergronde op te lei in voeding is 'n uitdagende taak wat vindingryke en bedrewe opvoeders verg. Hierdie opvoeders moet sensitief wees vir die unieke behoeftes van die teikengroep en toepaslike benaderings volg om genoemde behoeftes aan te spreek.