Browsing by Subject "Homme"

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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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    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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    Comparison of body fatness measurements by near-infrared reactance and dual-energy X-ray absorptiometry in normal-weight and obese black and white women
    (2010) Jennings, Courtney L; Micklesfield, Lisa K; Lambert, Mike I; Lambert, Estelle V; Collins, Malcolm; Goedecke, Julia H
    The aim of the present study was to compare body fat percent (BF %) using single-site near-IR reactance (NIR) and dual-energy X-ray absorptiometry (DXA) in a cohort of normal-weight (BMI < 25 kg/m2) black (n 102) and white (n 71); and obese (BMI > or = 30 kg/m2) black (n 117) and white (n 41) South African women (18-45 years). NIR-derived BF % was significantly correlated with DXA-derived BF % in all groups: normal-weight black (r 0.55, 95 % CI: 0.40, 0.67, P < 0.001) and white (r 0.69, 95 % CI: 0.53, 0.79, P < 0.001) women; obese black (r 0.59, 95 % CI: 0.46, 0.70, P < 0.001) and white (r 0.56, 95 % CI: 0.30, 0.74, P < 0.001) women. NIR under-predicted BF% compared to DXA in black women (normal-weight, - 4.36 (sd 4.13) % and obese, - 3.41 (sd 3.72) %), while smaller mean differences were observed in white women (normal-weight, - 0.29 (sd 4.19) % and obese, - 0.81 (sd 3.09) %), irrespective of normal-weight or obese status (P < 0.001). In obese subjects, NIR-derived BF % did not measure values greater than approximately 45 %, while the maximum DXA-derived measure was 58 %. In conclusion, although there was a significant relationship between NIR- and DXA-derived BF %, NIR under-predicted BF % in normal-weight and obese black South African women compared to DXA, but to a greater extent in subjects with very high levels of adiposity (>45 %). The results of single-site NIR as a measure of BF % should therefore be interpreted with caution, particularly in women of African descent and in those with very high levels of adiposity.
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    Dosage adjustment in medical patients with renal impairment at Groote Schuur Hospital
    (2010) Decloedt, Eric; Leisegang, Rory; Blockman, Marc; Cohen, Karen
    BACKGROUND: Many drugs are eliminated by the kidneys and therefore may require dose adjustment in patients with renal impairment. The need for dose adjustment is frequently neglected by prescribers. METHODS: We reviewed folders of patients admitted to the Groote Schuur Hospital general medical wards between January and March 2008. Patients with renal impairment, defined as an estimated glomerular filtration rate (eGFR) < or = 50 ml per minute per 1.73 m2, were identified. In-patient prescriptions were captured if they were written after clinical notes indicated impaired renal function, or > or = 1 day after renal function tests were performed. We determined what proportion of these prescriptions required dose adjustment and whether drug doses were appropriately adjusted. RESULTS: We found renal impairment in 32% (97/301) of medical admissions. There were 615 prescription entries for the 97 patients with renal impairment. Dose adjustment was required in 19% (117/615) of prescription entries, and only 32% (37/117) of these prescription entries were correctly dose adjusted. Of 97 patients, 69 received one or more drugs that required dose adjustment (median 1, range 1 - 5). All drug doses were correctly adjusted in 12% (8/69) of patients. Importantly, in the majority of patients (59% (41/69)) no doses had been correctly adjusted. CONCLUSION: Consistent with international studies, drug dose adjustment in patients with renal impairment in a South African hospital was frequently neglected. Strategies to alert clinicians of the need for dose adjustment in renal impairment should be considered, including automated eGFR reporting and computerised aids to guide drug dosing, that account for renal impairment.
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    Effects of long-term organophosphate exposures on neurological symptoms, vibration sense and tremor amongst South African farm workers
    (1998) London, Leslie; Nell, V; Thompson, M L; Myers, J E
    OBJECTIVES: This study assessed the relationship between long-term exposure to organophosphate insecticides and neurological symptoms, vibration sense, and motor tremor after control for the effect of past poisoning and acute exposure. METHODS: This cross-sectional study included 164 pesticide applicators and 83 nonspraying reference workers on deciduous fruit farms. The workers were tested on the Vibratron II, on tests of dynamic and static tremor, and for a set of neurological and "dummy" symptoms. Exposure was derived with the use of a job-exposure matrix for pesticides in agriculture. RESULTS: Compared with nonapplicators, current applicators reported significantly more dizziness, sleepiness, and headache and had a higher overall neurological symptom score. This association remained statistically significant after multiple logistic regression analyses controlling for a range of confounders and effect modifiers [odds ratio (OR) 2.25, for current applicators having high neurological score, 95% confidence interval (95% CI) 1.15-4.39]. The average lifetime intensity of organophosphate exposure was nonsignificantly associated with both neurological (OR 1.98, 95% CI 0.49-7.94) and "dummy" symptoms (OR 2.37, 95% CI 0.54-10.35). Previous pesticide poisoning was significantly associated with the neurological scores (OR 4.08, 95% CI 1.48-11.22) but not with the "dummy" symptoms. Vibration sense outcomes were associated with age and height, but not with the organophosphate exposure measures. In the multiple linear regression modeling for tremor intensity in the dominant hand, recent organophosphate exposure in the past 10 days was a significant predictor (partial correlation coefficient = 0.04), but none of the long-term organophosphate exposure measures were significant. CONCLUSIONS: Strong evidence was found for an association between symptom outcomes and past organophosphate poisoning and between symptom outcomes and current spray activity. In contrast to symptoms, there was no association between either past poisoning or current spray activity and vibration sense or tremor outcome. Long-term organophosphate exposure did not appear to predict symptoms, vibration sense, or tremor outcome.
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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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    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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    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 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.