Bouncing forward: families living with a type I diabetic child

Background: Despite the multitude of challenges that families living with a child with diabetes face, they have been found to adapt to such an extent that diabetes is viewed as a manageable condition. This study was concerned with the factors that enable these families to adapt. The internationally acclaimed Resiliency Model of Stress, Adjustment and Adaptation served as the framework to conceptualise the families’ adjustment and adaptation processes.Methods: The study was triangular in nature, with an exploratory, descriptive approach; non-probability purposive and snowball sampling techniques were employed. Sixteen families participated in the research. A biographical questionnaire, which included an open-ended question, to be completed in written format, was used in conjunction with seven structuredquestionnaires to gather relevant data. These seven structured questionnaires were an operationalisation of some of the key concepts and processes of the Resiliency Model. Descriptive statistics were used to describe the biographical information.Quantitative data were analysed by means of correlation analysis, while qualitative data were analysed by means of content analysis.Results: Various resilience factors were highlighted, including family time and routines, communication, hardiness, the acceptance of the diabetes, adherence to a treatment regimen, the obtaining of knowledge and skills, and working together as a family unit in managing the diabetes.Conclusions: Family plays a powerful role both in the treatment of chronic illness and in paediatric practice. This article highlights the central role of family in the management of type I diabetes and provides practitioners with insight into the challenges that families face, as well as the strengths that can be developed to improve their resilience in relation to this chronic illness. The identified variables are valuable, in that they can be used as a map to guide prevention and intervention efforts in helping families live with type I diabetes.Keywords: Type I diabetes; family resilience; the Resiliency Model of Family Stress, Adjustment and Adaptation; chronic illness management; family adaptation; family challeng

A guide to performing skin-prick testing in practice: tips and tricks of the trade

Atopy can manifest in childhood as infantile eczema (atopic dermatitis), allergic rhinitis and asthma. In practice, it is critical to identify the offending allergen in atopic individuals. This will not only influence therapeutic interventions, but may also have a significant impact on the individual’s quality of life. The most common clinical test for allergy detection is the introduction of an allergen directly into the skin in the form of a skin-prick test. Skin-prick testing is recommended in the diagnostic workup for allergies because it is reliable, safe, convenient, inexpensive, minimally invasive, and has the advantage of multiple allergen testing in one, 15- to 20-minute, test. Skin-prick testing can be performed from birth onwards. Although there is a small risk of developing anaphylaxis, the test remains safe to perform in a consultation room or at the patient’s bedside. Worldwide, a skin-prick test remains the test of choice for allergy because of its convenience and cost-effectiveness. A globally accepted guideline for skin-prick testing is still lacking and would be beneficial to both patient and physician.Keywords: allergy, indications, contraindications, cut-off points, measurement

Editorial

Intellectual disability in the Esidimeni tragedy: Silent death

Challenges for Malaria Elimination in Zanzibar: Pyrethroid Resistance in Malaria Vectors and Poor Performance of Long-Lasting Insecticide Nets.

Long-lasting insecticide treated nets (LLINs) and indoor residual house spraying (IRS) are the main interventions for the control of malaria vectors in Zanzibar. The aim of the present study was to assess the susceptibility status of malaria vectors against the insecticides used for LLINs and IRS and to determine the durability and efficacy of LLINs on the island. Mosquitoes were sampled from Pemba and Unguja islands in 2010--2011 for use in WHO susceptibility tests. One hundred and fifty LLINs were collected from households on Unguja, their physical state was recorded and then tested for efficacy as well as total insecticide content. Species identification revealed that over 90% of the Anopheles gambiae complex was An. arabiensis with a small number of An. gambiae s.s. and An. merus being present. Susceptibility tests showed that An. arabiensis on Pemba was resistant to the pyrethroids used for LLINs and IRS. Mosquitoes from Unguja Island, however, were fully susceptible to all pyrethroids tested. A physical examination of 150 LLINs showed that two thirds were damaged after only three years in use. All used nets had a significantly lower (p < 0.001) mean permethrin concentration of 791.6 mg/m2 compared with 944.2 mg/m2 for new ones. Their efficacy decreased significantly against both susceptible An. gambiae s.s. colony mosquitoes and wild-type mosquitoes from Pemba after just six washes (p < 0.001). The sustainability of the gains achieved in malaria control in Zanzibar is seriously threatened by the resistance of malaria vectors to pyrethroids and the short-lived efficacy of LLINs. This study has revealed that even in relatively well-resourced and logistically manageable places like Zanzibar, malaria elimination is going to be difficult to achieve with the current control measures

Cuticle thickening associated with pyrethroid resistance in the major malaria vector Anopheles funestus

BACKGROUND: Malaria in South Africa is primarily transmitted by Anopheles funestus Giles. Resistance to pyrethroid insecticides in An. funestus in northern Kwazulu/Natal, South Africa, and in neighbouring areas of southern Mozambique enabled populations of this species to increase their ranges into areas where pyrethroids were being exclusively used for malaria control. Pyrethroid resistance in southern African An. funestus is primarily conferred by monooxygenase enzyme metabolism. However, selection for this resistance mechanism is likely to have occurred in conjunction with other factors that improve production of the resistance phenotype. A strong candidate is cuticle thickening. This is because thicker cuticles lead to slower rates of insecticide absorption, which is likely to increase the efficiency of metabolic detoxification. RESULTS: Measures of mean cuticle thickness in laboratory samples of female An. funestus were obtained using scanning electron microscopy (SEM). These females were drawn from a laboratory colony carrying the pyrethroid resistance phenotype at a stable rate, but not fixed. Prior to cuticle thickness measurements, these samples were characterised as either more or less tolerant to permethrin exposure in one experiment, and either permethrin resistant or susceptible in another experiment. There was a significant and positive correlation between mean cuticle thickness and time to knock down during exposure to permethrin. Mean cuticle thickness was significantly greater in those samples characterised either as more tolerant or resistant to permethrin exposure compared to those characterised as either less tolerant or permethrin susceptible. Further, insecticide susceptible female An. funestus have thicker cuticles than their male counterparts. CONCLUSION: Pyrethroid tolerant or resistant An. funestus females are likely to have thicker cuticles than less tolerant or susceptible females, and females generally have thicker cuticles than males. In pyrethroid resistant An. funestus, this increase in cuticle thickness is likely to have developed as an auxiliary to the primary mode of pyrethroid resistance which is based on enzyme-mediated detoxification

SCHOOLING BEHAVIOUR OF SARDINE SARDINOPS SAGAX IN FALSE BAY, SOUTH AFRICA

The schooling behaviour of sardine Sardinops sagax in False Bay on the south coast of South Africa was studied in October 1995 using high-resolution sonar and a hull-mounted, echo-integration unit. School formation and disintegration were studied, and school shape, packing density, swimming behaviour and inter- and intra-school event rates were quantified. Mean fish density was 29.5 fish m-3 (SD 46 fish m-3), but it varied between schools by a factor of about 100 (from 2 to 233 fish m-3). Tracked schools moved at average speeds of 0.67–1.59 m s-3. Schools changed shape on average every 2.08 minutes, and underwent either splits or merges with other schools on average every 5 minutes. Relationships between the geometric dimensions and biomass of the schools were established.Afr. J. mar. Sci. 25: 185–19

Setting a research agenda for progressive multiple sclerosis: The International Collaborative on Progressive MS

Despite significant progress in the development of therapies for relapsing MS, progressive MS remains comparatively disappointing. Our objective, in this paper, is to review the current challenges in developing therapies for progressive MS and identify key priority areas for research. A collaborative was convened by volunteer and staff leaders from several MS societies with the mission to expedite the development of effective disease-modifying and symptom management therapies for progressive forms of multiple sclerosis. Through a series of scientific and strategic planning meetings, the collaborative identified and developed new perspectives on five key priority areas for research: experimental models, identification and validation of targets and repurposing opportunities, proof-of-concept clinical trial strategies, clinical outcome measures, and symptom management and rehabilitation. Our conclusions, tackling the impediments in developing therapies for progressive MS will require an integrated, multi-disciplinary approach to enable effective translation of research into therapies for progressive MS. Engagement of the MS research community through an international effort is needed to address and fund these research priorities with the ultimate goal of expediting the development of disease-modifying and symptom-relief treatments for progressive MS

The impact of chronic pseudomonal infection on pulmonary function testing in individuals with cystic fibrosis in Pretoria, South Africa

Background. Colonisation of the airway by Pseudomonas in cystic fibrosis has been reported to be an important determinant of decline in pulmonary function.Objective. To assess pulmonary function decline and the presence of bacterial colonisation in patients with cystic fibrosis (CF) attending a CF clinic in a developing country. Methods. A retrospective audit of patients attending the CF clinic at Steve Biko Academic Hospital, Pretoria, South Africa, was performed. The data included spirometric indices and organisms routinely cultured from airway secretions (Pseudomonas aeruginosa (PA) and Staphylococcus aureus (SA)).Results. There were 29 study subjects. Analysis of variance for ranks (after determining that baseline pulmonary function, age, gender and period of follow-up were not contributing to pulmonary function decline) revealed a median decline in forced expiratory volume in 1 second, forced vital capacity and forced expiratory flow over 25 - 75% expiration of 12%, 6% and 3%, respectively, for individuals colonised by PA. There was no pulmonary function decline in individuals not colonised by PA, or in individuals colonised by SA. Conclusion. Pulmonary function decline in this South African centre is significantly influenced by chronic pseudomonal infection. Other influences on this phenomenon should be explored.