Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas—conversely—these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating “disease” to responding to “illness” by acknowledging and incorporating patients’ healthworlds in patient–provider interactions

Immunogenic Human Papillomavirus Pseudovirus-Mediated Suicide-Gene Therapy for Bladder Cancer.

Bladder cancer is the second most common urological malignancy in the world. In 70% of cases it is initially diagnosed as non-muscle-invasive bladder cancer (NMIBC) and it is amenable to local treatments, with intravesical (IVES) Bacillus-Calmette-Guerin (BCG) immunotherapy being routinely used after transurethral resection of the lesion. However, this treatment is associated with significant side-effects and treatment failures, highlighting the necessity of novel strategies. One potent approach is the suicide-gene mediated therapy/prodrug combination, provided tumor-specificity can be ensured and anti-tumor immune responses induced. Using the mouse syngeneic orthotopic MB49-bladder tumor model, here we show that IVES human papillomavirus non-replicative pseudovirions (PsV) can pseudoinfect tumors with a ten-fold higher efficacy than normal bladders. In addition, PsV carrying the suicide-gene herpes-simplex virus thymidine kinase (PsV-TK) combined to Ganciclovir (GCV) led to immunogenic cell-death of tumor cells in vitro and to MB49-specific CD8 T-cells in vivo. This was associated with reduction in bladder-tumor growth and increased mice survival. Altogether, our data show that IVES PsV-TK/GCV may be a promising alternative or combinatory treatment for NMIBC

Case Report: Down-staging locally advanced head and neck cancer in an HIV infected patient in a limited resource setting

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Homogeneous Gold Catalysis through Relativistic Effects: Addition of Water to Propyne

In the catalytic addition of water to propyne the Au(III) catalyst is not stable under non-relativistic conditions and dissociates into a Au(I) compound and Cl2. This implies that one link in the chain of events in the catalytic cycle is broken and relativity may well be seen as the reason why Au(III) compounds are effective catalysts.Comment: 12 pages, 3 figures, 1 tabl

Prerequisites for National Health Insurance in South Africa: Results of a national household survey

Background. National Health Insurance (NHI) is currently highon the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key prerequisites that need to be in place before an NHI can achieve these goals.Objectives. To explore public perceptions on what changes inthe public health system are necessary to ensure acceptabilityand sustainability of an NHI, and whether South Africans areready for a change in the health system.Methods. A cross-sectional nationally representative surveyof 4 800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10.Results and conclusions. There is dissatisfaction with bothpublic and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to bewell acquainted or generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services

Rapid testing for respiratory syncytial virus in a resource-limited paediatric intensive care setting

We analysed the performance characteristics of the respiratory syncytial virus lateral flow rapid antigen assay in use when compared to a multiplex polymerase chain reaction for detection of respiratory viruses. The study was conducted at a tertiary paediatric hospital in Port Elizabeth, South Africa, from 01 January 2017 to 31 December 2018. We found the clinical sensitivity (36.8%) of the rapid test to be too low for routine diagnostic use. Knowledge of assay performance characteristics of rapid tests are important for appropriate interpretation of rapid test results

Comparative study: the effect of annealing conditions on the properties of P3HT:PCBM blends

This paper presents a detailed study on the role of various annealing treatments on organic poly(3-hexylthiophene) and [6]-phenyl-C61-butyric acid methyl ester blends under different experimental conditions. A combination of analytical tools is used to study the alteration of the phase separation, structure and photovoltaic properties of the P3HT:PCBM blend during the annealing process. Results showed that the thermal annealing yields PCBM ‘‘needle-like’’ crystals and that prolonged heat treatment leads to extensive phase separation, as demonstrated by the growth in the size and quantity of PCBM crystals. The substrate annealing method demonstrated an optimal morphology by eradicating and suppressing the formation of fullerene clusters across the film, resulting in longer P3HT fibrils with smaller diameter. Improved optical constants, PL quenching and a decrease in the P3HT optical bad-gap were demonstrated for the substrate annealed films due to the limited diffusion of the PCBM molecules. An effective strategy for determining an optimized morphology through substrate annealing treatment is therefore revealed for improved device efficiency.Web of Scienc

Outbreak of Rift Valley fever affecting veterinarians and farmers in South Africa, 2008

Background. During 2008, Rift Valley fever (RVF) virus re-emerged in South Africa as focal outbreaks in several provinces. Aims. To investigate an outbreak affecting cattle farmers and farm workers, and the staff and students of a veterinary school, assess the prevalence of infection during the outbreak, document the clinical presentation of cases, and identify potential risk factors. Methods. We conducted a cross-sectional serological survey of exposed veterinarians and farmers, who were examined to determine the presence of current or recent illness. Blood specimens were collected for virus isolation, nucleic acid detection and serology. A subset was interviewed using a standardised questionnaire to obtain data on recent exposures and risk factors for infection. Results. Of 53 participants potentially exposed to infected domestic ruminants, 15% had evidence of recent infection and 4% evidence of past exposure to the RVF virus. The prevalence of acute infection was 21% in veterinarians compared with 9% in farmers and farm workers. After a mean incubation period of 4.3 days, the most frequent symptoms experienced included myalgia (100%), headache (88%) and malaise (75%). No asymptomatic cases were identified. Transmission by direct contact with infected animals was the major risk factor in these professional groups. Performing animal autopsies was significantly associated with acute infection (risk ratio 16.3, 95% confidence interval 2.3 - 114.2). Conclusions. Increased risks associated with veterinary practices highlight a need for the use of personal protective equipment, and identify veterinarians as a primary target group for future vaccination

The incidence of incomplete abortion and the prevalence of abortion-related morbidity in South African public hospitals, 2018

Background. The occurrence of abortion-related morbidity indicates limited access to safe abortion. Globally, unsafe abortions remain a persistent, yet preventable, cause of maternal mortality. South Africa (SA) is internationally recognised for its progressive reproductive rights framework, supported by its Constitution and laws. However, evidence suggests that women encounter barriers to accessing safe abortions, including stigma, resistance from healthcare providers, a shortage of trained professionals and a lack of awareness of their rights. We hypothesised that, 20 years after the promulgation of the Choice on Termination of Pregnancy Act, the incidence of incomplete abortion (ICA) and the prevalence of abortion-related morbidity would change, influenced by access to safe abortion and the introduction of medication abortion. We wanted to compare our data with 2000 and 1994 survey results to assess change. Objectives. To estimate the incidence of incomplete abortion and describe the prevalence of abortion-related morbidity in SA public hospitals in 2018. Methods. This was a cross-sectional, retrospective study. We selected a stratified random sample of public hospitals. We extracted data from medical records of women who presented with ICA during a predetermined 21-day period in 2018. Data were captured directly into a REDCap database. To estimate the national incidence of ICA, we used population estimates for 2018, comprising 17 199 227 women aged 12 - 49 years, and 1 200 436 live births. The prevalence of ICA morbidity is reported. We compared the rates in this study with those reported from similar studies in 2000 and 1994. Results. We found 913 medical records of women presenting with ICA in the 56 public hospitals. ICA incidence was 367 (274 - 459) per 100 000 women aged 12 - 49 years. The average age of the women was 27 years, and the majority had a previous pregnancy before the ICA. A large proportion (73.9%) of women were in the first trimester. There was no sign of infection in 92.5% of records, no organ failure in 99.1% of records and there were no deaths. There was no change in the ICA incidence when compared with the 1994 and 2000 results. Women’s mean age and having a previous pregnancy were similar in the three studies (1994, 2000 and 2018). The proportion of women presenting in the first trimester increased over time: 60.5% in 1994, 67.1% in 2000 and 73.9% in 2018. There has been a decline in the prevalence of abortion-related morbidity, demonstrated by lower levels of severity, no signs of infections and no organ failure. Conclusion. ICA incidence has not changed, but related morbidity is declining. Various factors could explain our findings, but the lack of change in ICA incidence indicates that access to formal abortion care has not improved over the past 20 years

Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study

Abstract