Browsing by Subject "Enfant"

Now showing 1 - 5 of 5
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    An apparent reduction in the incidence and severity of spinal cord injuries in schoolboy rugby players in the Western Cape since 1990
    (1999) Noakes, Timothy; Jakoet, I; Baalbergen, E
    OBJECTIVE: To determine the impact of the 1990 rugby law changes in South African schoolboy rugby on the number of schoolboys suffering paralysing spinal cord injuries in the subsequent eight rugby seasons (1990-1997) in the former Cape Province (now the Western Cape, but including Port Elizabeth and East London). METHODS: The study was a retrospective analysis of all patients with rugby-related spinal cord injuries admitted to the Conradie and Libertas Spinal Units, Cape Town, between 1990 and 1997. Data were initially collected annually from patient files. From 1993 patients were interviewed in hospital and a standardised questionnaire was completed. Data were collated and analysed. RESULTS: There were 67 spinal cord injuries in adult and schoolboy rugby players in the eight seasons studied. Fifty-four (80%) injuries were in adults and 13 (20%) in schoolboys, representing a 23% increase and a 46% reduction in the number of injured adults and schoolboys, respectively. Fifty-two per cent of those injuries for which the mechanism was recorded occurred in the tackle phase of the game; of these approximately equal numbers were due to vertex impact of the tackler's head with another object, or to illegal (high) tackles. Twenty-five per cent of injuries occurred in the ruck and maul and the remainder (23%) in the collapsed scrum. The only striking difference in the proportion of injuries occurring in the different phases of play was the absence of high-tackle injuries among schoolboys. The majority of injuries occurred at vertebral levels C4/5 (32%) and C5/6 (42%). Five players (8%) died, tetraplegia occurred in 48% and 35% recovered either fully or with minor residual disability. Playing position was recorded for half the injured players. Front-row forwards (props 33%, hookers 9%), locks (12%) wings and centres (21%) and loose forwards (15%), accounted for 90% of all injuries. CONCLUSIONS: Introduction of rugby law changes in South African schoolboy rugby in 1990 may have led to a 46% reduction in the number of spinal cord injuries in this group. In contrast, the number of these injuries in adult rugby players increased during the same time period due either to an increase in the number of adult players or to a real increase in the incidence of these injuries. More injured schoolboy than adult rugby players made total or near-complete recoveries from initially paralysing injuries (61% v. 28%). The reduced number of schoolboy injuries could not have resulted directly from the specific law changes introduced in 1990, which targeted scrum laws. Rather, the absence of illegal (high) tackle injuries among schoolboys appears to be the principal factor explaining fewer injuries in schoolboys, who suffered a higher proportion of injuries in the ruck and maul than did adult players. Accordingly we conclude that a further reduction in spinal cord injuries in adult and schoolboy rugby players in the Western Cape requires: (i) the elimination of injuries occurring in the ruck and maul, and to the tackler; (ii) the strict application of the high-tackle rule in adult rugby; and (iii) a continuing, high level of vigilance. Concern must be expressed about the continuing number of paralysing spinal cord injuries in adult rugby players.
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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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    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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    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.