Dietary and fluid adherence among haemodialysis patients attending public sector hospitals in the Western Cape

Objective There has been considerable debate about the extent to which social cognitive models of health behaviour apply in developing countries. The purpose of this paper was to determine the applicability of the Theory of Planned Behaviour (TPB) in predicting dietary and fluid adherence among a sample of haemodialysis patients attending public sector hospitals in the Western Cape. Design and methods A sample of 62 historically disadvantaged patients undergoing haemodialysis completed a battery of psychometric instruments measuring attitudes, subjective norms, perceived behavioural control regarding dietary and fluid adherence, health literacy, perceived social support, and self-reported dietary and fluid adherence. Interdialytic weight gain (IDWG), predialytic serum potassium levels, and predialytic serum phosphate levels served as biochemical indicators of dietary and fluid adherence. Results Regression analyses indicated that the linear combination of attitudes and perceived behavioural control significantly accounted for 15.5% of the variance in self-reported adherence (a medium-effect size) and 11.4% of the variance in IDWG (a modest-effect size). No significant predictors were identified for predialytic serum potassium and predialytic serum phosphate levels. Interpretation and conclusions The results indicate that, while the TPB may not function in the same manner as it does in Western samples, it may have some nuanced applicability among haemodialysis patients attending public sector hospitals in the Western Cape. SAJCN Vol. 21 (2) 2008: pp. 7-1

Challenges and Solutions for Functional Neurosurgery in Developing Countries.

Functional neurosurgery techniques remain integral to the neurosurgical treatment armamentarium but data on global implementation remains scarce. In comparison to high-income countries (HIC), low- and middle-income countries (LMIC) suffer from an increased prevalence of diseases like epilepsy, which may be amenable to functional techniques, and therefore, LMIC may benefit from an increased utilization of these treatment modalities. However, functional techniques tend to be expensive and thus difficult to implement in the LMIC setting. A review was performed to assess the current status of functional neurosurgical techniques in LMIC as a starting point for future initiatives. For methodology, a review of the current body of literature on functional neurosurgery in LMIC was conducted through the United States National Library of Medicine Pubmed search engine. Search terms included "functional neurosurgery," "developing countries," "low and middle income," and other related terms. It was found that though five billion people lack access to safe surgical care, the burden of disease amenable to treatment with functional neurosurgical procedures remains unknown. Increasingly, reports of successful, long-term, international neurosurgical collaborations are being reported, but reports in the sub-field of functional neurosurgery are lacking. In conclusion, awareness of global surgical disparities has increased dramatically while global guidelines for functional techniques are currently lacking. A concerted effort can harness these techniques for wider practice. Partnerships between centers in LMIC and HIC are making progress to better understand the burden of disease in LMIC and to create context-specific solutions for practice in the LMIC setting, but more collaborations are warranted

The outcome of HIV-positive patients admitted to intensive care units with acute kidney injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

The Outcome of HIV-Positive Patients Admitted to Intensive Care Units with Acute Kidney Injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation?

Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings

Nutritional status of renal transplant patients

Objective. To assess the effect of renal transplantation on the nutritional status of patients.Design. Prospective descriptive study.Setting. Renal Transplant Clinic at Tygerberg Hospital, Western Cape.Subjects. Fifty-eight renal transplant patients from Tygerberg Hospital were enrolled in the study. The sample was divided into two groups of 29 patients each: group 1, less than 28 months post-transplant; and group 2, more than 28 months post-transplant.Outcome measures. Nutritional status assessment comprised biochemical evaluation, a dietary history, anthropometric measurements and a clinical examination.Results. Serum vitamin B6 levels were below normal in 56% of patients from group 1 and 59% from group 2. Vitamin B6 intake, however, was insufficient in only 14% of patients from group 1and10% from group 2. Serum vitamin C levels were below normal in 7% of patients from group 1 and 24% from group 2, while vitamin C intake was insufficient in 21%and14% of patients from groups 1 and 2 respectively. Serum magnesium levels were below normal in 55% of patients from group 1, and in 28% from group 2. Serum albumin and cholesterol levels increased significantly during the post-transplant period in the total sample (P = 0.0001). There was also a significant increase in body mass index (P = 0.0001) during the post-transplant period.Conclusions. Several nutritional abnormalities were observed, which primarily reflect the side-effects of immunosuppressive therapy. The causes, consequences and treatment of the vitamin B6 and vitamin C deficiencies in renal transplant recipients need further investigation

Ablative brain surgery : an overview

Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders

An investigation on permethrin-treated military uniforms against diurnal mosquitoes under field conditions

Background: Military forces are exposed to mosquito bites because of their duties. In addition to the nuisance caused by mosquito bites, they are the vector of some vector-borne diseases in many countries of the world. Impregnation of military uniforms with permethrin is one of the most effective methods of protecting military personnel. The purpose of this study was to evaluate the effect of permethrin-impregnated uniforms against diurnal mosquitoes under field conditions. Methods: In this study, one of the most common uniforms used in the Iranian military was treated by permethrin (0.125 mg. permethrin ai/cm(2)) and evaluated against the natural population of day-biting mosquitoes, in the rural area with Eight participants, three of them put on the treated uniforms and the other one of them wore the untreated uniforms and Four officers were also appointed as collectors. Results: The average number of bites in those who wore untreated uniforms (control) was 1.8/min/person (107.8/hr), while it was 0.16 (9.83/hr) for treated uniforms. The protection of treated uniforms was about 91. The knockdown rate for Culex and Aedes mosquitoes was 95.92 and 94.44, respectively. The mortality rate in Culex was 98.59 and 98.61 in Aedes mosquitoes when exposed to treated uniforms. Conclusion: In this study, military uniforms impregnated with permethrin showed significant protection against the bites of Culex and Aedes mosquitoes. This intervention can be used to protect military personnel from the bites of Culex and Aedes these mosquitoes and to reduce the diseases transmitted by these mosquitoes