Current knowledge of idiopathic scoliosis among practicing physiotherapists in South Africa

Thesis (MScPhysio)--Stellenbosch University, 2020.ENGLISH ABSTRACT : Background: The knowledge of Idiopathic Scoliosis has been assessed in Poland, the United States of America (USA), and the United Kingdom (UK) and all the studies concluded that the knowledge of idiopathic scoliosis (IS) among physiotherapy students is limited with respect to the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guidelines. Early recognition and the correct initial management is essential in this progressive disorder, and thus physiotherapists should be aware of the basic criteria involved in the screening, diagnosis, and treatment of IS patients. Aim and Objective: The aim of this project was to ascertain the current level of basic knowledge on Idiopathic Scoliosis (IS) among registered practicing physiotherapists that express an interest in the orthopaedic, muscular, manual and manipulative therapy in South Africa. Furthermore, an objective was to compare the knowledge between the physiotherapists that are registered with the Orthopaedic Manipulative Physiotherapy Group (OMPG) and the physiotherapists that are not registered with this group but who are also interested in orthopaedic, muscular, manual or manipulative therapy. The last objective was to identify any knowledge gaps that exist and the potential for future research studies on IS. Methodology: This was a descriptive study and an online survey was used to collect the data. A previously designed and tested 10-question survey consisted of the majority of the questionnaire. The questions were based on the 2011 SOSORT Guidelines and assessed the following aspects of IS: definition, cause, development, prevalence, diagnosis, treatment, and bracing. The questionnaire also included opinionated questions on the types of physical activity that would be beneficial/harmful to patient’s scoliosis and familiarity with conservative treatment methods for IS. An additional five questions consisted of evidenced based conservative treatment and to ascertain confidence with the assessment, management and education of IS patients. The study was advertised in South African OMPG physiotherapy newsletters with the aim to attract physiotherapists that manage and are interested in the orthopaedic care of patients. The newsletters contained an online link to the information leaflet, consent form, and questionnaire (Appendices A, B, and C). These methods of advertising attracted a diverse group of actively practicing physiotherapy populations of different ages, backgrounds, experiences, with the aim to reduce selection bias and sampling error. Results: Two hundred and twenty-three (223) Physiotherapists spread across the 9 different provinces/regions of South Africa met the inclusion criteria and formed part of the study. One hundred and sixteen (116) of these physiotherapists were members of the OMPG, and the other 107 physiotherapists were not members of the OMPG but expressed an interest in the orthopaedic, muscular, manual or manipulative fields. The analysis showed that 73.5% was able to correctly identify the aetiology of IS and 86% was able to identify when IS is likely to develop. Forty-eight percent (48%) of the physiotherapists correctly identified IS as a three-dimensional deformity, and 41% of the participants incorrectly thought that IS is a lateral curvature of the spine. The participants had a poor understanding of the prevalence, diagnosis, and treatment involved in IS affected clients with only 16%, 17%, and 26% respectively providing the correct responses. Forty-two-point six percent (42.6%) of the physiotherapy group correctly identified when bracing should be recommended for patients with IS. The study further indicated a lack of knowledge regarding the methods of conservative treatment and scoliosis schools available worldwide, with more than 76% of the group not being aware of any of the schools or recognised any treatment methods used for scoliosis rehabilitation. In 85% of the questions, the OMPG group performed better than the non-OMPG group. In 42% of the questions in the survey, the OMPG group achieved a higher than 50% ‘correct’ response rate compared to the non-OMPG group who only managed to achieve a higher than 50% in 28% of the questions. Conclusion: Our findings showed that about one third (33.6%) of the physiotherapists participating in the study could answer more than 50% of these questions correctly and 16.5% could answer 70% of the questions correctly in relation to the widely accepted guidelines on IS management. The findings indicate a lack of knowledge regarding IS patient prevalence, screening, recognition, diagnosis and treatment. The responses and results in the OMPG group were better than the non-OMPG group but still very low especially due to the fact that only 28% of the OMPG group correctly identified the conservative treatment involved with IS. Future research studies should be aimed at identifying the prevalence of IS at a national level in SA. Investigating the content curriculum at under-graduate level in SA, referral strategies for IS patients in SA, and comparing the management of IS in the private and public sectors of SA.AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar.Master

A critical engagement with theological education in Africa

The higher education landscape has arguably become one of the most arduous to traverse. More so in the African context, where a host of variables continiously challenge educators to reflect critically on their philosophies and practices as they engage an ever-changing audience. In this book, a critical engagement with theological education in Africa is offered. As the book originates from South Africa, it is presented as a South African perspective, although contributors are situated accross the African continent and abroad. The common denominator is that all contributers are, in some way or another, invested in theological education in Africa. The main contribution of this collaborative work is to be sought in the insights it offers on four main areas of theological education: A historical and current orientation on theological edcuation in Africa, some paradigm shifts in theological education in Africa, ministerial formation needs versus theological education challenges, and a critical reflection on elective models and methods. The book presents the original and innovative research of scholars for fellow scholars involved in theological higher education as it is grounded in the respective fields of interest of each contributor. It contributes to a better understanding of the complex African theological higher education landscape that is also mindful of post-COVID-19 realities. Methodologically the work draws on a combination of methods, including literature studies, empirical work, and in some cases sectional offerings from doctoral studies, as indicated in the various chapters

A critical engagement with theological education in Africa

The higher education landscape has arguably become one of the most arduous to traverse. More so in the African context, where a host of variables continiously challenge educators to reflect critically on their philosophies and practices as they engage an ever-changing audience. In this book, a critical engagement with theological education in Africa is offered. As the book originates from South Africa, it is presented as a South African perspective, although contributors are situated accross the African continent and abroad. The common denominator is that all contributers are, in some way or another, invested in theological education in Africa. The main contribution of this collaborative work is to be sought in the insights it offers on four main areas of theological education: A historical and current orientation on theological edcuation in Africa, some paradigm shifts in theological education in Africa, ministerial formation needs versus theological education challenges, and a critical reflection on elective models and methods. The book presents the original and innovative research of scholars for fellow scholars involved in theological higher education as it is grounded in the respective fields of interest of each contributor. It contributes to a better understanding of the complex African theological higher education landscape that is also mindful of post-COVID-19 realities. Methodologically the work draws on a combination of methods, including literature studies, empirical work, and in some cases sectional offerings from doctoral studies, as indicated in the various chapters

Allergen specificity of early peanut consumption and effect on development of allergic disease in the Learning Early About Peanut Allergy study cohort

BACKGROUND: Early introduction of dietary peanut in high-risk infants with severe eczema, egg allergy, or both prevented peanut allergy at 5 years of age in the Learning Early About Peanut Allergy (LEAP) study. The protective effect persisted after 12 months of avoiding peanuts in the 12-month extension of the LEAP study (LEAP-On). It is unclear whether this benefit is allergen and allergic disease specific. Objective: We sought to assess the effect of early introduction of peanut on the development of allergic disease, food sensitization, and aeroallergen sensitization. METHODS: Asthma, eczema, and rhinoconjunctivitis were diagnosed based on clinical assessment. Reported allergic reactions and consumption of tree nuts and sesame were recorded by questionnaire. Sensitization to food allergens and aeroallergens was determined by means of skin prick testing and specific IgE measurement. RESULTS: A high and increasing burden of food allergen and aeroallergen sensitization and allergic disease was noted across study time points; 76% of LEAP participants had at least 1 allergic disease at 60 months of age. There were no differences in allergic disease between LEAP groups. There were small differences in sensitization and reported allergic reactions for select tree nuts, with levels being higher in the LEAP consumption group. Significant resolution of eczema and sensitization to egg and milk occurred in LEAP participants and was not affected by peanut consumption. CONCLUSION: Early consumption of peanut in infants at high risk of peanut allergy is allergen specific and does not prevent the development of other allergic disease, sensitization to other food allergens and aeroallergens, or reported allergic reactions to tree nuts and sesame. Furthermore, peanut consumption does not hasten the resolution of eczema or egg allergy

Kinetics and Ligand-Binding Preferences of Mycobacterium tuberculosis Thymidylate Synthases, ThyA and ThyX

Mycobacterium tuberculosis kills approximately 2 million people each year and presents an urgent need to identify new targets and new antitubercular drugs. Thymidylate synthase (TS) enzymes from other species offer good targets for drug development and the M. tuberculosis genome contains two putative TS enzymes, a conventional ThyA and a flavin-based ThyX. In M. tuberculosis, both TS enzymes have been implicated as essential for growth, either based on drug-resistance studies or genome-wide mutagenesis screens. To facilitate future small molecule inhibitors against these proteins, a detailed enzymatic characterization was necessary.After cloning, overexpression, and purification, the thymidylate-synthesizing ability of ThyA and ThyX gene products were directly confirmed by HPLC analysis of reaction products and substrate saturation kinetics were established. 5-Fluoro-2'-deoxyuridine 5'-monophosphate (FdUMP) was a potent inhibitor of both ThyA and ThyX, offering important clues to double-targeting strategies. In contrast, the folate-based 1843U89 was a potent inhibitor of ThyA but not ThyX suggesting that it should be possible to find ThyX-specific antifolates. A turnover-dependent kinetic assay, combined with the active-site titration approach of Ackermann and Potter, revealed that both M. tuberculosis enzymes had very low k(cat) values. One possible explanation for the low catalytic activity of M. tuberculosis ThyX is that its true biological substrates remain to be identified. Alternatively, this slow-growing pathogen, with low demands for TMP, may have evolved to down-regulate TS activities by altering the turnover rate of individual enzyme molecules, perhaps to preserve total protein quantities for other purposes. In many organisms, TS is often used as a part of larger complexes of macromolecules that control replication and DNA repair.Thus, the present enzymatic characterization of ThyA and ThyX from M. tuberculosis provides a framework for future development of cell-active inhibitors and the biological roles of these TS enzymes in M. tuberculosis

Appropriate age range for introduction of complementary feeding into an infant’s diet

Peer reviewedPublisher PD

COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)