Browsing by Subject "Afrique"

Now showing 1 - 17 of 17
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    Combined assessment (aspiration cytology and mammography) of clinically suspicious breast masses
    (1995) VAN WYK, W; Dent, D; HACKING, E; LEARMONTH, G; KOTTLER, R; GUDGEON, C; Tiltman, A
    We examined the safety and utility of the combined assessment of aspiration cytology and mammography in 705 women who had clinically suspicious or malignant palpable breast masses. Histological assessment confirmed 176 benign and 529 malignant lesions. There were no incorrect (false positive) diagnoses made in the 176 benign masses when combined assessment was used (specificity 1,0; predictive value 0,86); in isolation, however, there was a false positive cytological diagnosis («papillary carcinoma») and 3 false positive mammographic diagnoses. Benign disease (false negative) was incorrectly diagnosed by combined assessment in 4 of the 529 malignant masses (sensitivity 0,99; predictive value 0,98): cytological diagnoses were of fat necrosis (2) and benign cells on cytospin (1) and aspiration biopsy (1); mammographic diagnoses were of benign disease (2) and normality (2). Indeterminate («atypical», «suspicious») diagnoses were problematic and frequent (overall 223 (31,6%), malignant masses 137 (25,9%), benign masses 86 (48,9%); cytology 117 (16,6%), mammography 141 (20%). Thus, with the combined assessment of mammography and cytology in clinically suspicious breast masses, a decisive diagnosis was made in about two-thirds of cases allowing the safe commencement of therapy; the balance of patients required cone or excision biopsy.
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    Do South African medical students of rural origin return to rural practice?
    (2003) de Vries, Elma; REID, Steve
    OBJECTIVES: To investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural-origin graduates are currently practising in a rural area. DESIGN: This is a retrospective descriptive study. Doctors' addresses at the time of graduation were compared with their current addresses in terms of rural/urban classification, and a questionnaire survey was done. SUBJECTS: Sample A consisted of a cohort of doctors who graduated in 1991 and 1992. Sample B consisted of the 1994-1996 graduates of two medical schools. OUTCOME MEASURES: Percentage of rural-origin graduates in rural practice. RESULTS: In sample A 14.4% were rural-origin students. When comparing addresses, it was found that 38.4% of rural-origin graduates are currently practising in rural areas, compared with 12.4% of urban-origin graduates (p < 0.001). The questionnaire data showed that 45.9% of the rural-origin respondents are in rural practice, compared with 13.3% of the urban-origin respondents (p = 0.001). In sample B, 41.61% of the rural-origin graduates are in rural practice compared with 5.08% of urban-origin graduates (p < 0.001). CONCLUSION AND RECOMMENDATIONS: The findings suggest that the South African situation is similar to that in other countries, with rural-origin medical students more likely to choose rural careers than urban-origin students. Rural-origin graduates are also more likely to choose general practice. It is recommended that the selection criteria of the medical faculties be reviewed with regard to rural origin, and that the career aspirations of applicants to medical school be taken into account in selection, particularly with regard to primary care or general practice.
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    Factors associated with elevated blood lead levels in inner city Cape Town children
    (1991) von Schirnding, Y E; Fuggle, R F; Bradshaw, D
    A cross-sectional analytical study was carried out to determine risk factors for childhood lead exposure. Blood lead levels of inner-city Sub A coloured children living in Woodstock were examined in relation to information obtained by questionnaire on environmental and social factors. The mean blood lead concentration of the population was 18 micrograms/dl. Thirteen per cent of children had blood lead levels greater than or equal to 25 micrograms/dl, the present USA 'action' level. Dusty homes and homes in a poor state of repair, over-crowding, low parental education and income, and other aspects related to family structure and socio-economic status, were associated with raised blood lead levels. It is suggested that social factors assume importance in predisposing children to lead in the environment. In particular, the over-crowded nature of the homes could have a direct bearing on the quality of the care-giving environment, providing opportunity for children's activities to go unsupervised. This could lead young children to be more exposed to accessible sources of lead associated with poor housing conditions. More attention needs to be given to examining the interaction of social and environmental factors in studies of childhood lead exposure.
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    Far fewer missed opportunities for immunisation in an integrated child health service
    (1993) Harrison, David; Barron, Peter; Glass, Belinda; Sonday, Shahim; van der Heyde, Yolande
    The mobile nature of the population of Kayelitsha makes it imperative that opportunities for immunisation of children are exploited at every visit to health services. Previous studies have demonstrated a high incidence of missed opportunities for immunisation at curative health services. The occurrence of undetected opportunities for immunisation are compared at two primary care institutions: one in which curative and preventive services are provided separately, and one in which these functions are integrated. Far fewer opportunities for immunisation were missed at the integrated service, underscoring the urgency of integrating child health services throughout the country.The mobile nature of the population of Kayelitsha makes it imperative that opportunities for immunisation of children are exploited at every visit to health services. Previous studies have demonstrated a high incidence of missed opportunities for immunisation at curative health services. The occurrence of undetected opportunities for immunisation are compared at two primary care institutions: one in which curative and preventive services are provided separately, and one in which these functions are integrated. Far fewer opportunities for immunisation were missed at the integrated service, underscoring the urgency of integrating child health services throughout the country.
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    General practitioners and national health insurance - Results of a national survey
    (1999) BLECHER, M; JACOBS, T; McIntyre, D
    OBJECTIVE: To determine the attitudes of South African general practitioners (GPs) to national health insurance (NHI), social health insurance (SHI) and other related health system reforms. DESIGN: A national survey using postal questionnaires and telephonic follow-up of non-responders. SETTING: GPs throughout South Africa. PARTICIPANTS: Four hundred and forty-three GPs were randomly selected from a national sampling frame of 6,781 GPs. MAIN OUTCOME MEASURES: Acceptance of NHI and GP preferences with regard to financing, provision, benefits, coverage and the role of GPs. MAIN RESULTS: A response rate of 82.1% was achieved. Sixty-two per cent of GPs approved of the introduction of some form of social or NHI in South Africa, while 24.1% disapproved. Approval rose to 81.6% if GPs were to maintain their independent status, e.g. own premises and working hours, to 75% if additional private top-up insurance was allowed, and to 79.9% if payment was by fee-for-service. Seventy per cent of GPs in the study stated that they had the capacity to treat more patients. The most important reason given for approving of NHI was to make health care more equitable and accessible to the majority of South Africans. A high proportion of GPs approved of increasing the level of interaction between GPs and district health authorities. CONCLUSIONS: Most GPs approved of some form of social or NHI system, provided that the system did not significantly threaten their professional autonomy or economic and financial situation.
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    Health surveillance of employees on a lead mine, 1979-1989
    (1991) VAN HEERDEN, H; METS, J
    Health surveillance of employees at a lead mine in the northern Cape, employing about 1 400 people, is specifically aimed at early detection of excessive lead absorption, which is the main chemical hazard. Over a period of 9 years the blood lead level distribution showed very few values (2,5%) that exceeded 60 μg/100 ml.Health surveillance of employees at a lead mine in the northern Cape, employing about 1 400 people, is specifically aimed at early detection of excessive lead absorption, which is the main chemical hazard. Over a period of 9 years the blood lead level distribution showed very few values (2,5%) that exceeded 60 μg/100 ml.
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    Inoculation of peritoneal dialysate fluid into blood culture bottles improves culture rates
    (1993) Rayner, B L; Williams, DS; Oliver, S
    The aim of he study was to determine if direct inoculation of peritoneal fluid into Bactec blood culture bottles would improve the positive bacteriological yield compared with conventional techniques in continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis. All patients presenting with suspected peritonitis had peritoneal fluid injected directly into aerobic and anaerobic Bactec blood culture bottles as well as into sterile culture tubes. Thirty-seven paired samples were analyzed.The aim of he study was to determine if direct inoculation of peritoneal fluid into Bactec blood culture bottles would improve the positive bacteriological yield compared with conventional techniques in continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis. All patients presenting with suspected peritonitis had peritoneal fluid injected directly into aerobic and anaerobic Bactec blood culture bottles as well as into sterile culture tubes. Thirty-seven paired samples were analyzed.
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    Interventions for children with neurodevelopmental delay
    (1997) Leary, P M
    OBJECTIVES: To review studies in the scientific literature of five physical interventions commonly recommended for children with neurodevelopmental delay. DESIGN: A literature search for and a review of the results of controlled and other studies conducted in the course of the last 25 years. SETTING: Institute of Child Health, University of Cape Town. SUBJECTS: Patterning; neurodevelopmental therapy; sensory integrative therapy; optometric visual training; auditory integration therapy. OUTCOME MEASURES: Findings and conclusions drawn in the studies reviewed. RESULTS: Controlled studies fail to provide evidence to support claims made for the five interventions examined. CONCLUSIONS: In the absence of scientific evidence for efficacy patterning, neurodevelopmental therapy, sensory integrative therapy, optometric visual training and auditory integrative therapy cannot be recommended for children with neurodevelopmental delay.
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    Intra-operative pneumatic tourniquet – perceptions of use and complications in the orthopaedic community of South Africa
    (1996) Gibson, A St Clair; Lambert, M I; Milligan, J; Merwe, W van der; Walters, J; Noakes, T D
    OBJECTIVES: To assess views on use, maintenance and side-effects of the pneumatic tourniquet in the South African orthopaedic community. METHODS: A census-type questionnaire study was conducted of all 475 orthopaedic surgeons registered with the Orthopaedic Association of South Africa during 1993/94. The chi-square test was used to determine statistical significance between different groups of respondents. RESULTS: Seventy-seven per cent of the questionnaires were returned. Ninety-nine per cent of respondents used a pneumatic tourniquet. Eighty-four per cent believed that the tourniquet may damage underlying tissue both as a result of applied pressure effects and ischaemic consequences. Fifty-four per cent of respondents personally checked the calibration of the pneumatic tourniquet, although 76% of respondents believe that the apparatus needs to be checked at least once per month. More respondents who did not check the tourniquet apparatus than respondents who did check it believe that applied pressure does not cause tissue damage (P < 0.001), that the operating room technician or hospital engineer should be responsible for checking equipment (P < 0.001), and that equipment did not need to be checked more than once every 6 months (P < 0.001). CONCLUSIONS: Although most orthopaedic surgeons are aware of the pneumatic tourniquet's side-effects, a minority appear to be unaware of the hazards of excessive applied pressure alone or excessive applied pressure caused by use of faulty equipment. It needs to be emphasised to these surgeons that regular checking of the pneumatic tourniquet apparatus is necessary in order to prevent postoperative complications ascribed to use of the tourniquet.
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    Madagascar: A pacemaker for the Agulhas Current system?
    (2006) Penven, P; Lutjeharms, J R E; Florenchie, P
    [1] Western boundary currents are driven by zonally integrated wind-stress curl over the width of subtropical basins. This cross-basin integration is interrupted in the South Indian Ocean where Madagascar presents a formidable barrier. Nevertheless, a western boundary current has been thought to exist in the Mozambique Channel, the Mozambique Current. Recent observations have however shown that no such current exists and that the flow in the channel instead consists of a train of eddies. Is this western boundary anomaly due to the presence of Madagascar? We have used a primitive equations model to investigate the flow in the South West Indian Ocean as if there were no Madagascar. We show that a normal, continuous western boundary current is then formed that constitutes a continuum with the Agulhas Current. The presence of Madagascar is shown to affect the frequency of inter-ocean exchange events south of Africa.
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    Non-invasive management of organic impotence
    (1995) Kaplan, F J; Levitt, N S; Stevens, P J; Phillips, C
    OBJECTIVE: To establish the efficacy of a vacuum device (ErecAid) in the management of organic impotence. DESIGN: Cohort study; questionnaire before and after a 6-month study period. SETTING: Groote Schuur Hospital, Cape Town. PARTICIPANTS: A total of 19 men with organic impotence, 8 diabetic and 11 with previous pelvic surgery or radiotherapy. INTERVENTION: Vacuum device (ErecAid, Osbon Medical Systems). OUTCOME MEASURE: Efficacy of ErecAid. RESULTS: Six of 8 diabetics and 6 of 11 non-diabetics reported successful intercourse, while 16 of the participants would recommend the device to others. Some difficulty with the device was experienced by 11 and only 9 described an increase in self-esteem. CONCLUSION: Although some difficulties may be experienced in the use of the ErecAid, it clearly has a role to play in the management of patients with organic impotence, who ideally should be able to select their preferred form of therapy.
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    Presenting features of primary angle-closure glaucoma in patients of mixed ethnic background
    (1993) SALMON, J
    The relative frequency with which patients present with acute or chronic angle-closure glaucoma depends on their ethnic background. In order to examine the presenting features and effects of primary angle-closure glaucoma in people of mixed ethnicity, we reviewed all «coloured» patients who presented to Groote Schuur Hospital with this diagnosis during a 5-year period. Of the 92 patients, 33 (36%) presented with acute angle-closure glaucoma and 59 (64%) with chronic angleclosure glaucoma. The level of intra-ocular pressure on presentation correlated well with the number of quadrants of angle closure (correlation coefficient: r=0,73, P<0,001). When individual eyes were assessed, a mean cup/disc ratio of ≥0,8 was present in 35% (65/184) and glaucomatous visual field loss was present in 56,5% (104/184).The relative frequency with which patients present with acute or chronic angle-closure glaucoma depends on their ethnic background. In order to examine the presenting features and effects of primary angle-closure glaucoma in people of mixed ethnicity, we reviewed all «coloured» patients who presented to Groote Schuur Hospital with this diagnosis during a 5-year period. Of the 92 patients, 33 (36%) presented with acute angle-closure glaucoma and 59 (64%) with chronic angleclosure glaucoma. The level of intra-ocular pressure on presentation correlated well with the number of quadrants of angle closure (correlation coefficient: r=0,73, P<0,001). When individual eyes were assessed, a mean cup/disc ratio of ≥0,8 was present in 35% (65/184) and glaucomatous visual field loss was present in 56,5% (104/184).
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    Quality of asthma care: Western Cape Province, South Africa
    (2009)
    Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. Methods. The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. Results. Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. Conclusion. The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.
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    The 'dop' system around Stellenbosch--results of a farm survey
    (1998)
    OBJECTIVES: To document the number of farms operating a 'dop' system (payment of workers with alcohol instead of wages), to estimate the number of farm workers affected, to describe how the system operated and to characterise adverse social conditions on the farms. POPULATION: Farms served by the mobile clinics of the Cape Metropolitan Council's Health Department in the Stellenbosch area. METHODS: Cross-sectional prevalence survey. Nurses collected data from patients attending mobile clinics. RESULTS: A prevalence of 9.5% was detected in respect of farms operating the dop system, with an estimated 780 workers affected. The most common practice was a daily provision of 750 ml wine to male workers. Social conditions on the farms in question were poor and wages were low. Child malnutrition was the most common health problem identified. CONCLUSION: The dop system, although illegal, has been documented to occur in the Stellenbosch area. Programmes to address the dop system and alcohol abuse, based on a primary health care approach, are a priority in the rural areas of the Western Cape.
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    The burden of imported malaria in Gauteng Province
    (2010) Weber, Ingrid B; Baker, Lee; Mnyaluza, Joy; Matjila, Maila J; Barnes, Karen; Blumberg, Lucille
    OBJECTIVES: To describe the burden of malaria in Gauteng Province, and to identify potential risk factors for severe disease. DESIGN: We conducted a prospective survey of malaria cases diagnosed in hospitals throughout Gauteng from December 2005 to end November 2006. OUTCOME MEASURES: Malaria frequency, severity, and treatment. Results. We identified 1 701 malaria cases; 1 548 (91%) were seen at public sector hospitals and 153 (9%) at private hospitals; 1 149 (68%) patients were male. Median age was 27 years (range 1 month - 89 years). Most (84%) infections were acquired in Mozambique. Disease severity did not differ by age or sex. Patients who were South African-born were more likely to have severe disease (OR=1.43 (1.08 - 1.91)), as were patients who experienced a delay >48 hours between onset of symptoms and diagnosis or treatment (OR=1.98 (1.48 - 2.65)). While most patients appropriately received quinine, only 9% of severe malaria cases received the recommended loading dose. CONCLUSIONS: The incidence of malaria in Gauteng was higher than previously reported, emphasising the need to prevent malaria in travellers by correct use of non-drug measures and, when indicated, malaria chemoprophylaxis. Disease severity was increased by delays between onset and treatment and lack of partial immunity. Providers should consult the latest guidelines for treatment of malaria in South Africa, particularly about treatment of severe malaria. A change in drug policy to artemisinin combination therapy for imported uncomplicated malaria in non-malaria risk provinces should be strongly considered.
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    The referral letter: a problem of communication
    (1991) Lachman, P I; Stander, I A
    This cross-sectional descriptive study assesses the letters sent with referred patients and makes appropriate recommendations. During the 6-month period 1 July-31 December 1987, 9288 letters were photocopied at the admissions offices of the hospital. Detailed analysis of 1143 (12,3%) letters was undertaken. The private sector, i.e. general practitioners, was the largest referral agency, followed by community-based day hospitals.This cross-sectional descriptive study assesses the letters sent with referred patients and makes appropriate recommendations. During the 6-month period 1 July-31 December 1987, 9288 letters were photocopied at the admissions offices of the hospital. Detailed analysis of 1143 (12,3%) letters was undertaken. The private sector, i.e. general practitioners, was the largest referral agency, followed by community-based day hospitals.
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    Women doctors in medical professional organisations in South Africa – a report by the Women in Medicine Workgroup
    (2003) Kane-Berman, Jocelyne; Hickman, Rosemary
    OBJECTIVES: To determine the level of representation of women doctors in medical professional organisations in South Africa historically and currently, and if not adequate, to ascertain the reasons for women's limited participation in medico-political activities. DESIGN: A descriptive study of the membership of South African medical professional organisations and their executive structures. OUTCOME MEASURES: The number and percentages of women doctors as members and at executive level in medical professional organisations compared with the number of registered women practitioners. RESULTS AND CONCLUSIONS: Women are inadequately represented at all levels in the great majority of organisations for which information was provided. In view of the rapidly increasing number of women doctors the profession and its professional bodies need to take active steps to promote the participation of women in these organisations.