Provision and need of HIV/AIDS services in the City of Tshwane Metropolitan Municipality, 2010

Objectives. To determine the need for HIV/AIDS service provision in the City of Tshwane Metropolitan Municipality (CTMM), especially in municipal areas. Methods. The Foundation for Professional Development initiated the Compass Project. Using a questionnaire, data were collected during May - June 2010 from organisations providing HIV/AIDS services in the CTMM (organisational information and types of HIV/AIDS services). The need for HIV counselling and testing (HCT), antiretroviral treatment (ART), prevention of mother-tochild transmission (PMTCT), and care for orphans and vulnerable children (OVC) was estimated using data from various sources. Results. A total of 447 service providers was included in the study: 72.3% non-governmental organisations (NGOs); 18.1% in the public sector; 5.1% in the private sector; and 4.5% faithbased organisations. The majority of the prevention- (70.2%) and support-related services (77.4%) were provided by NGOs, while the majority of treatment-related services originated from the public sector (57.3%). Service need estimates included: HCT – 1 435 438 adults aged 15 - 49 years (11 127/service provider); total ART – 75 211 adults aged 15+ years (1 213/service provider); ART initiation – 30 713 adults aged 15+ years (495/service provider); PMTCTHCT – 30 092 pregnant women (510/service provider); PMTCTART – 7 734 HIV+ pregnant women (221/service provider); and OVC care – 54 590 children (258/service provider). Conclusions. Service gaps remain in the provision of HCT, PMTCT-ART and OVC care. ART provision must be increased, in light of new treatment guidelines from the Department of Health.S Afr Med J 2012;102:44-4

Malaria incidence in Limpopo Province, South Africa, 1998–2007

<p>Abstract</p> <p>Background</p> <p>Malaria is endemic in the low-altitude areas of the northern and eastern parts of South Africa with seasonal transmission. The aim of this descriptive study is to give an overview of the malaria incidence and mortality in Limpopo Province for the seasons 1998–1999 to 2006–2007 and to detect trends over time and place.</p> <p>Methods</p> <p>Routinely collected data on diagnosed malaria cases and deaths were available through the provincial malaria information system. In order to calculate incidence rates, population estimates (by sex, age and district) were obtained from Statistics South Africa. The Chi squared test for trend was used to detect temporal trends in malaria incidence over the seasons, and a trend in case fatality rate (CFR) by age group. The Chi squared test was used to calculate differences in incidence rate and CFR between both sexes and in incidence by age group.</p> <p>Results</p> <p>In total, 58,768 cases of malaria were reported, including 628 deaths. The mean incidence rate was 124.5 per 100,000 person-years and the mean CFR 1.1% per season. There was a decreasing trend in the incidence rate over time (p < 0.001), from 173.0 in 1998–1999 to 50.9 in 2006–2007. The CFR was fairly stable over the whole period. The mean incidence rate in males was higher than in females (145.8 versus 105.6; p < 0.001); the CFR (1.1%) was similar for both sexes. The incidence rate was lowest in 0–4 year olds (78.3), it peaked at the ages of 35–39 years (172.8), and decreased with age from 40 years (to 84.4 for those ≥ 60 years). The CFR increased with increasing age (to 3.8% for those ≥ 60 years). The incidence rate varied widely between districts; it was highest in Vhembe (328.2) and lowest in Sekhukhune (5.5).</p> <p>Conclusion</p> <p>Information from this study may serve as baseline data to determine the course and distribution of malaria in Limpopo province over time. In the study period there was a decreasing trend in the incidence rate. Furthermore, the study addresses the need for better data over a range of epidemic-prone settings.</p

Gender differences in health and health care utilisation in various ethnic groups in the Netherlands: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>To determine gender differences in health and health care utilisation within and between various ethnic groups in the Netherlands.</p> <p>Methods</p> <p>Data from the second Dutch National Survey of General Practice (2000–2002) were used. A total of 7,789 persons from the indigenous population and 1,512 persons from the four largest migrant groups in the Netherlands – Morocco, Netherlands Antilles, Turkey and Surinam – aged 18 years and older were interviewed. Self-reported health outcomes studied were general health status and the presence of acute (past 14 days) and chronic conditions (past 12 months). And self-reported utilisation of the following health care services was analysed: having contacted a general practitioner (past 2 months), a medical specialist, physiotherapist or ambulatory mental health service (past 12 months), hospitalisation (past 12 months) and use of medication (past 14 days). Gender differences in these outcomes were examined within and between the ethnic groups, using logistic regression analyses.</p> <p>Results</p> <p>In general, women showed poorer health than men; the largest differences were found for the Turkish respondents, followed by Moroccans, and Surinamese. Furthermore, women from Morocco and the Netherlands Antilles more often contacted a general practitioner than men from these countries. Women from Turkey were more hospitalised than Turkish men. Women from Morocco more often contacted ambulatory mental health care than men from this country, and women with an indigenous background more often used over the counter medication than men with an indigenous background.</p> <p>Conclusion</p> <p>In general the self-reported health of women is worse compared to that of men, although the size of the gender differences may vary according to the particular health outcome and among the ethnic groups. This information might be helpful to develop policy to improve the health status of specific groups according to gender and ethnicity. In addition, in some ethnic groups, and for some types of health care services, the use by women is higher compared to that by men. More research is needed to explain these differences.</p

Splinting or surgery for carpal tunnel syndrome? Design of a randomized controlled trial [ISRCTN18853827]

BACKGROUND: Carpal tunnel syndrome is a common disorder, which can be treated with surgery or conservative options. However, there is insufficient evidence and no consensus among physicians with regard to the preferred treatment for carpal tunnel syndrome. Therefore, a randomized controlled trial is conducted to compare the short- and long-term efficacy of surgery and splinting in patients with carpal tunnel syndrome. An attempt is also made to avoid the (methodological) limitations encountered in earlier trials on the efficacy of various treatment options for carpal tunnel syndrome. METHODS: Patients of 18 years and older, with clinically and electrophysiologically confirmed idiopathic carpal tunnel syndrome, are recruited by neurologists in 13 hospitals. Patients included in the study are randomly allocated to either open carpal tunnel release or wrist splinting during the night for at least 6 weeks. The primary outcomes are general improvement, waking up at night and severity of symptoms (main complaint, night and daytime pain, paraesthesia and hypoesthesia). Outcomes are assessed up to 18 months after randomization

Moderate altitude but not additional endurance training increases markers of oxidative stress in exhaled breath condensate

Oxidative stress occurs at altitude, and physical exertion might enhance this stress. In the present study, we investigated the combined effects of exercise and moderate altitude on redox balance in ten endurance exercising biathletes, and five sedentary volunteers during a 6-week-stay at 2,800 m. As a marker for oxidative stress, hydrogen peroxide (H(2)O(2)) was analyzed by the biosensor measuring system Ecocheck, and 8-iso prostaglandin F2alpha (8-iso PGF2alpha) was determined by enzyme immunoassay in exhaled breath condensate (EBC). To determine the whole blood antioxidative capacity, we measured reduced glutathione (GSH) enzymatically using Ellman's reagent. Exercising athletes and sedentary volunteers showed increased levels of oxidative markers at moderate altitude, contrary to our expectations; there was no difference between both groups. Therefore, all subjects' data were pooled to examine the oxidative stress response exclusively due to altitude exposure. H(2)O(2) levels increased at altitude and remained elevated for 3 days after returning to sea level (p </= 0.05). On the other hand, 8-iso PGF2alpha levels showed a tendency to increase at altitude, but declined immediately after returning to sea level (p </= 0.001). Hypoxic exposure during the first day at altitude resulted in elevated GSH levels (p </= 0.05), that decreased during prolonged sojourn at altitude (p </= 0.001). In conclusion, a stay at moderate altitude for up to 6 weeks increases markers of oxidative stress in EBC independent of additional endurance training. Notably, this oxidative stress is still detectable 3 days upon return to sea level