Treatment adherence among primary care patients in a historically disadvantaged community in the Western Cape : a qualititative study

Includes bibliographical references.The question of treatment adherence remains a concern that affects the health outcomes of patients attending public health clinics in South Africa. Patients with chronic illnesses who reside in impoverished communities face particular challenges in terms of managing the often complex aspects of their treatment. The sample for the study was selected from patients diagnosed with diabetes or hypertension attending public health clinics in the Boland area of the Western Cape. A total of 23 patients between the ages of 32 and 80 participated in the study. All participants were Afrikaans-speaking had been classified as Black or "Coloured" under the apartheid system and as such were all historically disadvantaged. Participants were selected by means of convenience sampling and were asked to participate in qualitative interviews under confidential conditions. The interviews addressed various aspects of the participants' experience of their illness and treatment and were conducted by two trained interviewers. Interviews were recorded, transcribed, and entered into Atlas.ti, a computer programme that assists in the analysis of textual data. The analysis of the data focused on the content of participants' concerns and difficulties associated with adhering to treatment recommendations. The themes that emerged from the study included participants' attribution of the origin of their illness, their experience of their illness and of the health care system, their own concerns about the consequences of poor adherence, financial and problems, psychosocial support, spirituality, alternative medicine, and patients' own understanding of the symptoms of poor adherence. The results of the study are discussed in terms of the often hierarchical relationship between health care workers and patients. Public health care workers often hold sceptical and suspicious views about their patients regarding their illness, symptoms, and level of adherence. As such, patients may be regarded in a paternalistic manner and in some cases even be admonished by health care workers for poor adherence. Yet, competing social realities often inhibit patient adherence. These include financial constraints, being labelled a patient, side effects of medication and family opposition to treatment. Adherence may also be related to the notion of responsibility for the causes of and solutions to medical problems. The results of the study were considered in terms of four models of attribution of responsibility for the origin of and solution to the medical problem as identified by Brickman, Rabinovits, Karuza, Coates, Cohn, and Kidder (1982). These models are the moral model, the compensatory model, the medical model, and the enlightenment model. The medical model is the most dominant in the South African public health system. Yet, in many instances, participants appeared to adopt other models of engaging with the causes and solutions to their illness conditions. The question of participants' understanding of the consequences of adherence is discussed in terms of the theoretical work by Pepper's (1942), who proposed four possible perspectives with which people may view the world. These world-views are formism, mechanism, contextualism, and organicism. In many instances adherence as a means of controlling somatic symptoms occurs as part of a logical and mechanistic understanding of health. However, in terms of an organismic worldview, adherence may represent an effort to restore equilibrium to the patient's constitution that has spiralled into disequilibrium as a result of disease

Review of Surgical Management of Supratentorial Extra Dural Haematoma at LGH

The Objectives:  To review the surgical management of Supratentorial EDH, at our Department. Study Design:  Retrospective Review. Setting:  Department of Neurosurgery, Lahore General Hospital / PGMI, Lahore. Materials and Methods:  This is a retrospective case series of 1536 patients of Supratentorial EDH who were treated surgically between Jan 2005 and Dec 2009. Patients' medical records were reviewed to define variables associated with outcome at the time of discharge. Variables included in the analysis were time since injury, age, gender, severity of head injury, anatomical site of hematoma on CT scan and outcome at the time of discharge (Glasgow Outcome Scale). Patients harbouring extra-cranial injuries which required operative management by other departments, e.g. laprotomy, thoracotomy, chest intubation and cases having associated brain parenchymal injury requiring intervention, were excluded. Results:  In our study of 1536 patients the mean age was 20.46 years, the minimum age was 5 and maximum 60 years. The age range was 55 years. Out of the total 1536 patients 1068 i.e. 69.5% were male and only 468 i.e. 30.5% were females. Male to female ratio was 2.29 : 1. Patients presenting with Mild Injury was the largest group. 664 out of 1536 (n) i.e. 43.2% were having a score of GCS from 13 – 15.  Conclusions:  The surgical management of EDH is a rewarding and life saving procedure and young male population seems to be a vulnerable population group. &nbsp

Women's contested politics of presence : learning from the experiences of Pakistani women parliamentarians

This study provides a case study of women’s political representation in the National Parliament of Pakistan, where a particular form of the quota approach has been adapted in a highly gendered political context. By examining the experiences of Pakistani women parliamentarians, this thesis contributes to key academic literature on gender quotas and political representation that has received a considerable attention from feminist scholars. The aim of this thesis is to explore the extent to which women’s formal representation is translated into substantive change for women. This is an empirical case study, primarily based on qualitative analyses of face-to-face in-depth semi-structured interviews of 20 women parliamentarians (out of 76) and proceedings of the parliament of the last three years (2008-11). By adapting Anne Phillips’s (1995) The Politics of Presence in entirely new and novel way, one of the major contributions this study claims to make to the theoretical literature is to analytically examine the effects of quotas from various aspects of political representation: descriptive, substantive and symbolic representation and from a broader perspectives than has hitherto been seen. It also addresses a major gap in the literature on the reasons why some quota women act more often than others in legislatures, and what factors contribute to the silence and suppression of Pakistani women leaders. It is argued that women’s presence in the political spheres is important, but that it is vital to take the particular context into account when judging whether women can and do act for women. This thesis shows that representation depends on various factors which can positively or negatively contribute towards substantive change. It also demonstrates that quotas may challenge existing gender dynamics and have various effects on women’s representation within and outside parliament. However, some gender and human rights issues may be difficult to tackle, especially those challenging the powerful feudal and tribal political elite (mainly men)

Comparative study of tricuspid valve repair using ring vs. synthetic band in severe functional tricuspid valve regurgitation

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease remains a common problem. There are different surgical techniques for tricuspid valve repair; however, the superiority of one approach over the other has not been proven. Our objective was to compare the short-term results of ring versus synthetic band annuloplasty to repair functional severe tricuspid regurgitation in patients with left-sided valve lesions. Methods: This retrospective study includes 60 patients who underwent left-sided valve replacement with concomitant tricuspid valve repair for severe tricuspid regurgitation. Patients were divided into group A (n= 30), patients with rigid rings, and group B (n= 30), patients with synthetic bands. Results: The preoperative demographic and clinical data were non-significant between both groups. In the preoperative data, the tricuspid annular plane systolic excursion (TAPSE) was significantly higher in the ring group (2.84 ± 0.53 vs. 2.3 ± 0.4, P< 0.001). Hospital stay was more prolonged in group B (10.05 ± 1.57 vs. 11.7 ± 2.76 days, P=0.006). There were no differences in other operative and postoperative data between groups. After a six-month follow-up, both groups had no significant difference regarding the clinical data or the degree of tricuspid valve regurgitation. Conclusion: Tricuspid valve annuloplasty with a rigid ring or synthetic band for tricuspid regurgitation could have a good short-term outcome

Meningitis in Closed Head Injury 2 Years Experience at Lahore General Hospital

During the time period of January 2006 till December 2007 there were 114300 patients with closed head injuries admitted at The Department of Neurosurgery Lahore General Hospital Lahore. The patients with closed head injury who developed meningitis were 17 and presented with headache, vomiting and neck stiffness. Headache was the commonest symptom. Diagnosis was made with the help of post contrast CT scan brain and CSF examination. Majority of patients admitted with head injury were adults while among patients who developed meningitis predominantly were children. Road traffic accident was the commonest cause of trauma. Majority developed meningitis within 6 weeks of trauma. There was no patient who developed meningitis after 12 weeks. Glasgow coma score at admission was above 8 in most of the patients. All patients were treated with combination of antibiotics for 6 to 12 weeks. Clinically outcome was moderate disability and good recovery in most of the cases. Conclusion:  Meningitis may occur following closed head injury. Its incidence is more in children than in adults. Responsible organism is not commonly identified on CSF examination. Outcome is reasonably good after proper management. Prophylactic antibiotics to all patients with closed head injury are not required

Non-localizing Fever as Urinary Tract Infection in Children

Introduction: Urinary tract infection (UTI) is one of the commonly diagnosed bacterial infections of childhood. However, fever without a localizing point often remains the diagnostic dilemma and not diagnosing UTI could have devastating result for an otherwise easily manageable entity.Materials and Methods: All febrile children aged 2 months to 10 years without an apparent cause of fever were enrolled and evaluated for possible UTI.Results: A total of 304 children were recruited; 140 were males and 164 females. Of 304 who had fever without any apparent signs, 40 had UTI. The prevalence of UTI was 13.2% in the study group.Conclusions: Urinary tract infection presenting as fever without any focus was present in 13.2% of hospitalized patients favouring urine examination to rule out UTI in all febrile children without definite source of fever.Keywords: Child; E Coli; Fever; Urinary tract infections

Five years Review of Failed Back Surgery Syndrome (FBSS) at Dept of Neurosurgery Unit-I, Lahore General Hospital Lahore

Objective:  To report our data of cases of failed back surgery syndrome (FBSS) and surgical and non surgical etiologies. Materials and Methods:  A review of cases of Failed back surgery Syndrome (FBSS), from 2003 to 2008 man-aged at The Neurosurgery Department Lahore General Hospital Lahore/PGMI, was conducted. The inclusion criterion was Re-admission within one year of their previous lumbar disk surgery at our department or other teaching institutes. 39 patients were found and included in the review. Two groups of patients were created on the basis of whether patient managed conservatively or re-explored. Important Data was recorded, analyzed and is presented. Results:  Out of the total 39 patients 15 (38.46%), were managed conservatively and included in group A. Twenty four 61.5% patients who were managed surgically with re-exploration and were grouped as B. 26 patients were male and 13 were female. Group A:  In this group 15 (38.46%), were included. These patients did not have a radicular element in their history of recurrent backache, and symptoms were vague.  Group B:  In group B, 24 (61.5%) patients were included. All these patients presented at re-admission with backache and radiculopathy. The time since previous surgery was not more than One year in all these patients.  Conclusion:  The failure of back surgery remains a challenge for the surgeons. There is a constant search for the causes and the pathogenesis of this syndrome and the best method of treatment. Recurrent disc is the commonest cause of failed back syndrome which responded well with reexporotive

Role of Academic Leadership in Change Management for Quality in Higher Education in Pakistan

Currently, higher education is performing multi tasks for the development of a nation. It prepares and trains the work force for the 21st century. Higher education has broaden the fields of knowledge due to which different changes are occurring in every field of life as well as in the field of higher education and invites the academic leaders to integrate these changes and innovations for effective working in the global age. These changes have created many challenges to academic leaders, now academic leaders are responsible to trace these changes and add them for excellence in higher education. In some situations, academic leaders feel pressure as change management is necessary for advancement, while on the other hand local and cultural norms create some hurdles for them. It is up to academic leaders to motivate faculty members to accept these changes for the improvement of the standards of higher education and also prepare the faculty members to integrate these changes for fitness in the globalization. The objectives of the present study were to know the opinion of the faculty members about the change management and role of academic leaders to accept this change and implement for the betterment of higher education. The sample for the study was the faculty members of higher education institutions taken from Islamabad and Lahore. It is found that Integration of change is necessary for improvement in quality of higher education and it is the responsibility of the academic leaders to play their role for working in change management

Evaluation of Adult Literacy Programmes in Psychological Perspectives

Adults are unique group of people to teach and if proper attention is paid they can boost up economical development of the country. Targets of adult literacy programs can be best achieved keeping in mind the psychology of adults. The present study was conducted to investigate the role of adult literacy teachers, content of adult literacy programs and method of teaching in psychological perspectives. The study was qualitative in nature and interviews along with focus group discussions were applied. The sample of the study consisted of 420 respondents including 360 adult female neo-literates, 48 literacy teachers and 12 supervisors randomly selected from six districts out of three geographical regions of the Punjab (Province). The data was analyzed by sorting, coding and categorizing the responses. The main findings of the study were; the adult literacy teachers treated the adult learners harshly in the centers, teachers did not motivate the learners towards study, teachers did not encourage the learners in their progress, teaching method confused most of the learners, the content of adult literacy program was not according to the needs and aspirations of the target group. Key words: Adult learners; teachers; content; method; psychology Résumé: L'enseignement vise uniquement sur le groupe d'adultes et si l'attention appropriée est accordée, ils peuvent stimuler le développement économique du pays. Les objectifs des programmes d'alphabétisation des adultes peuvent être mieux réalisés en tenant compte de la psychologie des adultes. La présente étude a été menée pour étudier le rôle des enseignants de l'alphabétisation des adultes, le contenu des programmes d'alphabétisation des adultes et la méthode de l'enseignement dans des perspectives psychologiques. L'étude a été de nature qualitative et des interviews avec des groupes de discussion ont été appliquées. L'échantillon de l'étude consistait en 420 répondants dont 360 adultes féminines néo-alphabètes, 48 enseignants d'alphabétisation et 12 superviseurs choisis au hasard dans six districts des trois régions géographiques du Punjab (Province). Les données ont été analysées par le tri, le codage et la catégorisation des réponses. Les résultats principaux de cette étude sont: dans les centres, les enseignants d'alphabétisation des adultes les ont traités de façon dure; les enseignants n'ont pas motivé les apprenants vers l'étude; les enseignants n'ont pas encouragé les apprenants dans leurs progrès; la méthode d'enseignement a confondu la plupart des apprenants; le contenu du programme d'alphabétisation des adultes ne correspondait pas aux besoins et aux aspirations du groupe ciblé.Mots-clés: apprenants adultes; enseignants; contenu; method; psychologi

Kisspeptin and attributes of infertile males and females: A cross-sectional study in a subset of Pakistani population

Kisspeptin, a peptide hormone, plays a pivotal role in fertility and neuroendocrine regulation of hypothalamo-pituitary-gonadal axis. Increased kisspeptin and reproductive hormones are responsible for fertility in male and females. This study aimed to explore the role of kisspeptin on hypothalamo-pituitary-gonadal axis by comparing the levels of kisspeptin in fertile and infertile subjects and identifying single nucleotide polymorphisms (SNPs) of KISS1 gene in exon 2 and exon 3 of infertile male and female cohorts. A cross-sectional study was carried out on 80 males (44 infertile and 36 fertile) and 88 females (44 in each group). Significantly high levels of kisspeptin (KP), follicle-stimulating hormone (FSH), luteinizing hormone and testosterone were observed in fertile male and female subjects except low FSH levels in comparison with infertile female subjects. One polymorphism in exon 2 (E1225K [G/A 3673]) and three in exon 3 (P1945A [C/G 5833]; Insertion of T at 6075; G2026G [C/G 6078]) in infertile group were detected, with low KP and hormonal levels. Male subjects had abnormal sperm parameters and unsuccessful attempt of intracytoplasmic sperm injection in females. Expression of SNP in exon 2 and exon 3 of KISS1 could be responsible for alteration in release of reproductive hormones and gonadal functions, hence causing infertility