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Media framing of the KwaZulu Natal and Eastern Cape Health Departments
(2025) Nomagugu Hloma, Nomagugu; Musawenkosi; Ndlovu, Musawenkosi
The media plays an essential role in representing and framing events and institutions. Its role cannot be downplayed, especially in framing health institutions and the public healthcare system. How the media frames an institution may impact its reputation and, to an extent, how the public views it. Therefore, this study investigated how selected daily newspapers in South Africa framed the health departments of KwaZulu Natal and Eastern Cape provinces. This study did not examine how these institutions were framed during the COVID-19 pandemic, as there was a high concentration of news coverage about the pandemic and varying challenges within the newsrooms. However, this investigation was concerned with the media framing of these institutions after the end of the pandemic. Using content analysis, this study examined fifty articles from the Daily Dispatch, The Herald, The Mercury, and Isolezwe newspapers. The content analysis examined the coverage of stories and how these stories were framed. The data revealed that the media covered various issues related to the health departments. These included medico-legal claims, the bankruptcy of the health departments, staffing crises and protests, supplier debt and delayed payment of suppliers, the shortage of resources, corpse negligence and unclaimed bodies, COVID-19, the increase in teenage pregnancy statistics, the increase in TB and HIV infection rates, patient safety incidents, the NHI Bill, and the expansion of services. However, the coverage was tremendously negative, with most news articles focusing on the shortage of resources and the suggested bankruptcy of the health departments due to medico-legal claims. This negative framing may negatively impact the overall trustworthiness of the health departments and the public health system of KwaZulu Natal and Eastern Cape provinces
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Open Access
An investigation of the characteristics of, and variation in the non-steady state pharmacokinetics of diphenylhydantoin after head trauma
(1995) Jooste, Jacqueline Fraser; Folb, Peter
Diphenylhydantoin (DPH) is a drug, introduced by Merritt and Putnam in 1938 (Porter and Rogawski 1992), which to date is still widely used and is effective for all types of seizures except absence seizures. This study was undertaken in an attempt to identify and explain the possible mechanisms responsible for the apparent low serum DPH concentrations measured in neurosurgical, head trauma patients, receiving a loading dose of DPH as prophylaxis against post-traumatic epilepsy (PTE). The pharmacokinetics of a single loading dose infusion of DPH, at non-steady state, were established. The impact of head trauma on the behaviour of the parent drug DPH as a protein-bound complex in serum (total DPH) and in the free unbound form in plasma (free DPH), together with the major metabolite 5-(p-hydroxyphenyl)-5-phenylhydantoin (p-HPPH), was investigated. A simple High Pressure Liquid Chromatography (HPLC) analytical method was developed to allow for the simultaneous measurement of the concentrations of DPH (total or free) and the metabolite, p-HPPH. The range of acceptable linearity, for this particular method, was established as 0.31 - 40.0 mg/L for DPH and 0.25 - 4.0 mg/L for p-HPPH. The reproducibility for the new method was depicted by a correlation coefficient (r) of 0.999 for both DPH and p-HPPH respectively. The good between-run precision of this particular method was reflected by the low coefficient of variation for DPH (4.60% - 7.98%) and p-HPPH (6.10%). In order to evaluate the impact of varying degrees of trauma on a group of neurosurgical patients a new scoring system was developed for the purposes of the study. Four scoring systems were chosen, namely the Glasgow Coma Scale (GCS), the Acute Physiologic and Chronic Health Evaluation (APACHE II) score, the Injury Severity Score (ISS) and a recently developed scoring system which is based on the evaluation of the CT Scan. These scoring systems were chosen to ensure all aspects of injury, i.e. physical, neurological, physiological and patient prognosis, could be investigated. A resultant quartile score was assigned to each of the individual scores that were rated, using StatGraphics™. Each quartile score was then summed to derive a "Total Injury Score" (TIS) describing all aspects of the injury. The TIS was well correlated with each individual score and was a good predictor of survival (p = 0.04) even though the CT scan score tended to bias the TIS by its weaker performance. A total of 25 patients who had experienced some form of neuro-trauma were admitted to the study. The median age of the group was 32 years. The loading dose given had a median value of 12.82 mg/kg (8.82 - 18.18 mg/kg). This loading dose was much lower than the recommended loading dose of 15 - 18 mg/kg. This low loading dosage was thought to be partly responsible for the low serum DPH levels noted in the neurosurgical wards. The above-mentioned analytical procedure was used to measure the drug levels thereby establishing the non-steady state pharmacokinetics (Vmax, Km and the apparent volume of distribution Vd) of a single loading dose of DPH. The median total DPH levels measured at 2, 12 and 24 hours were seen to be in the defined therapeutic range, but decreased with time as follows: 17.29 mg/L, .14.2lmg/L, and 13.75 mg/L respectively. In a similar fashion the free DPH levels decreased with time, i.e. 1.95 mg/L, 1.53 mg/Land 1.11 mg/Lat 2, 12 and 24 hours respectively after the end of the loading dose. The metabolite levels behaved differently in that the median levels increased from 0.045 mg/L at 2 hours to 0.075 mg/Lat 12 hours then decreased to 0.033 mg/Lat 24 hours. The free fraction of DPH, calculated as the percentage of free DPH relative to the total DPH level, decreased over the first periods investigated, i.e. at 2 and 12 hours (11.96 and 8.82 respectively), and then at 24 hours increased slightly (10.0%). Various investigators have described situations of increased DPH free fraction in head-trauma patients (Lund et al., 1971; Elfstrom 1977; Crowley et al., 1987; Toler et al., 1990). Others have gone further to propose that changes in protein binding, as a result of trauma, together with increases in the free fraction, result in increased plasma clearance (Boucher et al., 1987; Griebel et al., 1990; Anderson et al., 1991). No specific relationship was discernible over the 24-hour period investigated between the extent of a patient's injury (TIS) and the total serum DPH, the free plasma DPH or the serum metabolite concentration that was measured. Similarly, no relationship between the pharmacokinetic parameters of DPH and the extent of trauma was established (p > 0.05). In our group of head trauma patients the free fraction of DPH was found to be inversely correlated with serum albumin concentrations only after the initial distribution phase, i.e. 2 hours after the end of the loading dose infusion (r = -0.49: p < 0.03). Pharmacokinetic parameters were established using a clinical pharmacokinetic software program, Abbottbase™ PKS. Abbottbase™ PKS initially uses a population nomogram, based on population-typical data from a group of idiopathic epileptics, to predict serum concentrations or kinetic parameters and then to generate individualised data based on Bayesian regression methodology in a critically ill head trauma group. The accuracy of the initial non-specific population-typical nomogram is examined against the Bayesian methodology. The initial estimate, or population-typical values of the various pharmacokinetic parameters, were found to be significantly different (p < 0.0001) from those established for the trauma group by Bayesian methodology. Thus the null hypothesis was rejected. The basic Michaelis-Meneten kinetic parameters, Vmax and Km, together with the apparent volume of distribution (V d) of DPH determined over a period of 24 hours, after a loading dose infusion, are presented. The Michaelis-Menten constant, Km, and the V d for the DPH were within the normal range quoted in the literature: 4.95 µg/ml and 0.62 L/kg [42.8 L] respectively. The only remarkable finding was that the head trauma group had a much lower Vmax value (median of 4.59 mg/kg/day or 323 mg/day) than the Vmax values quoted in the literature. Head injured patients who had experienced additional body trauma appeared to have lower Vmax values than those patients with just a head injury (p < 0.05). However, it must be noted that the majority of pharmacokinetic investigations of DPH are carried out at steady state and in fairly "healthy" patients with idiopathic epilepsy. Hence there are no strictly comparable data for comparison with the present study. The lower Vmax implies that a slower rate of metabolism occurs during the first 24-hour period in the head trauma patient. The reason for this altered metabolism was difficult to assess but believed to be due to a number of factors such as altered disposition of the drug and a cumulative effect of the often complex manifestation of acute traumatic stress. These include an altered basal metabolic rate, changes in plasma protein binding, altered distribution patterns and low serum albumin (such as was found in our group: median albumin of34 g/L). A distinct relationship (p < 0.001) between the loading dose given (in mg/k$) and the serum total DPH levels measured reflected the significance of the V d when designing an appropriate loading dose for the head trauma patient. The above relationship signals the need to dose accurately in terms of patient weight to achieve adequate DPH levels during prophylaxis rather than using an empirical loading dose of either 750mg or 1000mg of DPH which is standard practice in a trauma setting. For optimal management of the critically ill head trauma patient, an individualised dosing plan is recommended which includes a weight-based loading dose followed by a blood level taken 12 - 24 hours after the end of the loading dose infusion. The level is then subjected to Bayesian analysis in order to predict a maintenance dose that will achieve and maintain adequate serum levels. Clearly, these results are preliminary and reflect the need for more in-depth investigation of the disposition of DPH in a critically ill head trauma group. Specific nomograms for various sub-populations of patients must be established to obtain accurate predictions of both the doses given and the levels achieved. This is reinforced by the suggestion of the present study that patients with head trauma (and possibly other critically ill sub-populations) should be treated with the awareness that drugs that are hepatically metabolised may have altered pharmacokinetic and pharmacodynamic properties.
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Open Access
Coagulation disturbances and fibronectin fragmentation in preeclampsia
(1995) De Jager, Celeste Annemarie; Kirsch, Ralph; Shephard, Enid; Robson, Simon
Preeclampsia or gestational proteinuric hypertension (GPH) is a major cause of maternal death worldwide. Patients may present with hypertension and proteinuria alone or may develop progressively more severe disease, ending in a fulminant syndrome with disturbed coagulation, vascular injury and end-organ damage. The reasons for this progression are unclear and can only be reversed by termination of pregnancy. There are currently no early, generally acceptable, laboratory markers of disease severity. We have shown that patients with severe preeclampsia have significantly raised plasma levels of plasminogen activator-I, tissue plasminogen activator. fibronectin and fibrin(ogen) degradation product. The tissue plasminogen activator and fibrin(ogen) degradation product concentrations were found to progressively increase with progression of the syndrome. These findings support the hypothesis of the participation of disturbed coagulation and vascular injury processes in the aetiology of preeclampsia. The additional finding that the endothelium of umbilical cords from patients with preeclampsia was disrupted and characterised by increased deposits of fibronectin further supports of this proposal. Plasma fibronectin from patients with preeclampsia was found to be degraded, with fibronectin from plasma of patients with severe preeclampsia having larger amounts of low molecular weight fibronectin degradation products than the plasma from patients with mild preeclampsia. Comparison of the apparent molecular weights of these fibronectin degradation products, with those generated from pure fibronectin by plasmin, suggest that they may arise from the action of plasmin. These fibronectin degradation products were found to inhibit the opsonic activity of intact fibronectin and to cause an underestimation in the determination of plasma fibronectin concentration by enzyme-linked immunosorbent assay. Furthermore, plasma fibronectin degradation products and fibronectin degradation products, generated by plasmin cleavage of intact pure fibronectin, were able to disrupt endothelial monolayers in in vitro culture. This was not due to cytotoxic activity, but rather due to the generation of urokinase plasminogen activator from the endothelial cells, and subsequent urokinase plasminogen activator conversion of plasminogen to plasmin. The ability of a 29 kilodalton heparin-binding fragment to cause this disruption suggests that heparin-binding fragments may, in part, be responsible for the observed effect on endothelial cells in culture. It is tenable from the results of this study that fibronectin degradation products, generated as a result of initial endothelial damage, perpetuates further damage to the endothelium. Escape of these products into the maternal circulation may be postulated to give rise to maternal endothelial cell damage and the generalised organ failure observed in preeclampsia.
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Open Access
Beyond transition: the evolution of theological method in South Africa: a cultural approach
(1995) Pityana, Nyameko Barney; Villa-Vicencio, Charles
This thesis proceeds from the understanding that theology will remain vital and relevant as the new South Africa is being constructed. Of necessity, that requires that a different theological outlook should be attempted. Such an outlook is one which takes seriously the changes that continue to take place in the country, it critiques the relevance and meaning of the concepts of national unity and reconciliation which have become the defining ideology of the new South Africa. As South Africans, we enter this new dispensation with a cacophony of discordant voices. South African theologies have grown out of the matrix of divergent life-worlds advancing different and warring ideologies. There are theologies which originate from Europe inspired by European and American intellectual movements. There are theologies of Africa, either as traditional African religion or as African theology or black theology. Likewise the dominant cultural outlook has been imported from Europe and the cultures of Africa remain subaltern cultures in theological formation. Pluralism in South Africa, therefore, is a fact and the dynamics of that pluralism need to be understood. The thesis examines culture in society. The analysis explores the various dimensions of culture. Particular significance is directed towards culture as expressed in postmodern and critical social theory schools. Special attention is paid to the communicative action theories of Jurgen Habermas. This enables us to place culture within the context of contemporary social science theories. Second, culture is treated from the perspective of revolutionary theory from Gramsci to Cornel West. The work of Franz Fanon and Amilcar Cabral, among others, receives attention. From there culture as an aspect of the theory of religion is examined. The work of social scientists, among them Clifford Geertz, is analysed. Theological issues, from theologies of pluralism like that found in the works of David Tracy, Lesslie Newbigin, among others, as well as the philosophical problems that arise, are examined. Theological method that starts from the human condition and proceeds by a method of construction, as in Gordon Kaufman, leading to a critical examination of theological method, is discussed. The dialogue between theologians and Jurgen Habermas becomes a valuable tool of critical theology. The comparative elements of the thesis are useful to test the theories outlined in the previous chapters. To do so, the work of Leonardo Boff and liberation theology in Brazil is critically examined. Boff provides an object lesson for the possibilities of a systematic theology within a pluralist culture, a conservative church and an unjust social and political system. We see how interaction with issues on the public agenda have set his theological project apart: he dialogues with the indigenous cultures, tests himself against Afro-Brazilian religions and takes seriously the popular religion of the poor. This methodology is compared and contrasted with that of contextual theology in South Africa especially the Kairos Document and Professor Charles Villa-Vicencio' s THEOLOGY OF RECONSTRUCTION (1992). A note of caution is appropriate even at this early stage. One will not attempt an exhaustive treatment of Leonardo Boff' s vast output. Boff is here a dialogue partner, an interlocutor against whom ideas get tested. The next comparative element in the thesis is four-pronged: African theology, black theology and Afro Brazilian and popular religions in Brazil. What this shows is the adaptability of subject religions and yet their capacity to remain subversive even within the dominant religions. South African theology can never be complete without acknowledging its indebtedness to the religions of Africa and to dialogue with African theology. The thesis seeks to transform the theatre of struggle into a forum for dialogue and common action. The thesis ends with a discussion of the implications of this theology especially as far as the validity claims are concerned: truth, rationality and coherence. Is it possible, after all, to have a South African theology? Is the 'fusion of horizons' a worthwhile objective? Second, insight into the religion of the ordinary people of South Africa is provided by an analysis of the narratives collected by the Cape Town researchers for the W.C.C. 's Theology of Life project. What do the stories of the people tell about the way in which we 'do' theology? What are the lessons which we can learn about our theological endeavours? The findings of the thesis are presented in six theses. The theses are an outline of the elements for a viable, creative theology for South Africa that will endure beyond the period of transition and will, in the process, get South African Christians talking to one another in a meaningful manner. This work will not attempt that project but set a framework for such a theology.
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Open Access
The effects of static stretching on the hamstring musculotendinous unit
(1996) Hughes, Heather-Grace; Schwellnus, MP
A series of nine studies was undertaken to investigate the effect of static stretch on hamstring musculotendinous flexibility. For each study, an average of ten subjects were used. One limb had the experimental stretch procedure performed on it, while the opposite limb acted as the control. The overall findings can be divided into 4 sections. Section 1 deals with the determination of the optimal static stretching session. Section 2 deals with tr,e determination of the optimal stretching programme. Section 3 deals with the effect of warm up on the optimum static stretching session. Section 4 deals with the effect of limb position and stretch procedure on the optimum static stretching session. Section 1 was comprised of two studies. In the first study, the ideal duration of static stretch was determined. This was done by comparing the effect of 10, 20, 30, 60, 90, 120 and 240 second duration stretches on hip joint range of motion (ROM). Analysis of results showed a significant (p<0.01) change in hip flexion ROM with all the durations of stretch except for with 10 seconds static stretch duration. No significant differences (p<0.05) were observed between the 30, 60 and 90 seconds durations, but these durations did show significantly (p<0.05) larger increases in ROM than the other durations. In the second study, the ideal number of stretch repetitions (frequency) was determined. This was done by comparing the effect of 1, 2, 3, 4, 5, 7 and 9 repetitions of 30 seconds each on hip joint ROM. Analysis of results showed a significantly (p<0. 01) larger increase in ROM with 2 repetitions compared with 1 repetition. A significantly (p<0.01) larger increase was also observed with 3 repetitions compared with 2 repetitions. There were no differences (p<0.01) between 3, 4, 5, 7 and 9 repetitions. The findings of Section 1 indicate that the ideal stretch session consists of a stretch of 30 to 90 seconds duration, repeated 3 to 9 times. Section 2 was also comprised of two studies. In the first study, retention of increased ROM after the optimum static stretching session (as determined in Section 1), was determined. This was done by measuring hip joint ROM before the ideal stretching session. This measurement was repeated immediately after the stretching session, and at 1, 2, 3, 4, 5, 6, 12 and 24 hours after the stretching session. Analysis of results -showed a significant difference (p<0.05) between the measurement taken before the stretching session and those taken, immediately after, and at 1, 2, 3, and 4 hours post stretch. A significant difference (p<0.05) was also found between the measurement taken immediately post stretch and the initial measurement, as well as between the measurement post stretch and the 12 and 24 hours post stretch measurements. These findings indicate that increased ROM after the optimum static stretching session was retained for 4 to 6 hours. In the second study, the cumulative effect over 3 weeks, of repeated 3 x daily optimum static stretching sessions, was determined. Subjects were placed onto the above programme and hip joint ROM was measured on days 1, 2, 4, 7, 9, 11, 14, 16, 18 and 21 of the programme. Analysis of results showed a significant (p<0.05) increase in hip joint ROM on day 7 of the programme when compared with the initial measurement. Further analysis showed a significant (p<0.01) increase on day 9 compared with the initial measurement. The findings of Section 2 indicate that the ideal stretching programme of 3 daily optimum static stretching sessions, results in permanent changes in hip joint ROM on days 7 to 9 on such a programme. In Section 3, the effects of active warm up only, static stretch only, and active warm up combined with active stretch, on hip joint ROM were compared. Analysis of results showed that active warm up alone had no effect on hip joint ROM. Both static stretch only and static stretch combined with active warm up significantly (p<0.01) increased hip joint ROM. There were no significant differences (p<0.05) between these two groups. The findings of Section 3 indicate that active warm up alone does not increase hip joint ROM. Combined with static stretching, hip joint ROM shows significant increases but not more than static stretching alone. In Section 4, the effects of limb position and stretch procedure on the optimum static stretching session, were compared. Static stretching in two limb positions were assessed; in the erect position and in the supine position. Additionally, in the erect position weight bearing and non-weight bearing stretch procedures were performed, and in the supine position, self-assisted and assistant-assisted stretch procedures were performed. Analysis of results showed that there was a significant difference (p<0.01) between change of ROM with static stretching in the supine compared to the erect position. There were no significant differences (p<0.01) when comparing the 2 procedures within either the erect or the supine positions. The findings of Section 4 indicate that static stretching in supine position, results in larger increases in ROM, than the erect position. The findings of the series of studies, indicates that the optimum static stretching session consists of 30 to 90 seconds of static stretching, repeated 3 to 9 times. The optimum stretching programme consists of 3 daily optimum stretching sessions, which will result in permanent increases in hip joint ROM on day 7 to 9 of the stretching programme. In addition, warm up alone is of no benefit to hip joint ROM unless added to the optimum static stretching session. The optimum stretching session should also be performed in the supine position rather than the erect position, in order to obtain the largest increases in ROM.