The prevalence and rehabilitation needs of individuals with locomotor disability in Mitchell's Plain

Locomotor disability is a problem, reported prevalence ranging from 1% to 8.6%. Only a limited number of studies have been done in South Africa. They used different methodologies and definitions, thus leading to the variation in prevalence reported. A further factor influencing prevalence is that some locomotor disabilities are area-specific. This study aimed to determine the prevalence and rehabilitation needs of individuals with locomotor disability in Mitchell's Plain, for planning intervention strategies as part of this community based rehabilitation service. A cross sectional study design was employed. A stratified proportional cluster sampling technique was used to select 36 clusters resulting in a sample size of2424 people. Screening questions recommended by the WHO were used to identify people with impairments (Phase I). Further screening (Phase II), of those identified with impairments, using a questionnaire based on the ICIDH categories, identified people with disabilities. People with locomotor disabilities were grouped together and qualitative analysis through case studies was done on sub-groups where common themes manifested. 12.9% reported some form of impairment; 3.9% adults could be classified as having disabilities. Amongst adults with disabilities, 2.7% had locomotor disabilities. Consistent with the literature, disability increased with age, was more frequently reported amongst females, and was associated with lower socio-economic class. Multiple impairments were frequently reported, with the most common impairment being musculo-skeletal conditions. Use of health services occurred in the public sector with the local Day Hospital used as frequently as more distant tertiary hospitals. The study revealed the need for improved and accessible medical and rehabilitation services in the community. Their poor ability to integrate functionally and economically into the community, was reflected in the high proportion of people with mobility and occupational handicap categories. Low levels of education worsened the impact on occupational handicap. It was further evident that multiple impairments amongst the elderly lead to greater dependence of people with locomotor disability on their care-givers. Even though the need for assistive equipment was high, much of assistive equipment owned was not being used. A further handicapping factor for the disabled using assistive equipment was their environment which restricted the use of assistive equipment. High locomotor disability prevalence was confirmed in this study. Major unmet needs were identified in the handicap categories of physical mobility and economic self-sufficiency. Domiciliary based intervention was recommended as the most appropriate rehabilitative intervention for the severely physically disabled persons

Caring, learning, improving quality and doing research: Different faces of the same process

The aim of this article is to describe the similarities between the consultation process, the quality improvement (QI) process, action- and problem-based learning and participatory action research (PAR). We feel this understanding adds value to our work in enabling personal development as practitioners, fostering teamwork and demystifying the different concepts. Learning to understand the different processes becomes easier, as they have a lot in common. All four of these spiral processes follow a number of steps. They start with building a relationship/team with a patient, students, co-workers or co-researchers. The next step is identifying the problem. The present situation, as well as the required state (setting standards), is identified. An intervention can then be planned, with a follow-up evaluation to see if the situation has improved. The spiral may continue with a follow-up plan. As authors we believe that we can conclude from this that health workers, teachers, managers and researchers can learn from each other and work together more readily if they understand that they share a common action process.SA Fam Pract 2004;46(7): 26-2

Issues in medicine: The crisis in South African family practice

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What helps volunteers to continue with their work?

Aim: The aim of the study was to understand what volunteers perceived to be the factors helping them to continue working as volunteers, thereby assisting project leaders to improve the recruitment procedures, as well as quality of service, in the future. Methodology: A focus group interview was held with the 14 most active volunteers in order to understand their perceptions about their work and their ability to continue their work as volunteers. The recorded interview was transcribed, translated and analysed. Findings: The volunteers feel that their work consists of various forms of support to patients. They see themselves as mediators (advocates) for the patients within the health care services. They have difficulties with some patients, who have high expectations of them. They also feel deeply about the difficulties experienced by many patients, particularly poverty. They are strongly motivated by their desire to help their own community. This is reinforced when they are thanked by patients whose health has improved as a result of the assistance they provided. They feel that, as people, they have gained knowledge and confidence. The support from the project coordinators/fieldworkers is very important to them. Conclusions: The findings above represent what would be motivational in general: internal motivation, the ability to see the importance of your work, positive feedback, a plan to deal with difficulties and support from senior colleagues. It is therefore important to ensure such support and cooperation at various levels. Keywords: Home-based care, volunteers, AIDS, motivation. For full text, click here: SA Fam Pract 2004;46(1) :25-2

Patients' thoughts on patient-retained medical records

Background: Patient-retained cards and, later, patient-retained booklets were introduced in an effort to improve continuity of care in a primary care setting at Tzaneen Clinic in the Greater Tzaneen Municipality of Limpopo Province, South Africa. Previously, the only continuity was maintained through a clinic-retained patient register, referral letters or information the patients provided themselves. The Patient-Retained Booklet of Lesotho provided motivation for this project. Methods: A qualitative study was conducted using focus group discussions to explore the patients' thoughts on retaining their own records. In the transcribed interviews, themes were identified through the cut-and-paste method and the results where interpreted and compared with currently available literature. Results: The participants thought patient-retained records were helpful. They felt that the records function as ‘medical identification' and could be used in the case of an emergency, that they provide important background information about the patient, and that they enable continuation of care at other facilities. Retaining the documents was also thought to motivate the patients to act on the advice given, and the records also served as a reminder to take their medication and about the dates of follow-up visits. It also was thought to personify the clinician-patient relationship. Conclusion:The process of exploring patients' perceptions can be empowering. The patient-retained records gave the patients an opportunity to participate in their own health. It is a simple tool to improve quality in primary care by improving continuity of care and providing a helpful tool for future behavioural change. The recommendations that arose from this study are that the use of the patient-retained medical health record booklet should be continued and its use should be encouraged throughout the district; staff should be motivated to use it and to standardise the information that is recorded; and health planners should be motivated to implement a standardised patient-retained record booklet. SA Fam Pract 2004;46(7): 30-3

Who are good home-based care volunteers?

Aim: The aim of the study was to describe the characteristics of volunteers who remained active in the home-based care project located in Tzaneen (Limpopo Province) and thereby assist the project leaders to improve the recruitment and quality of the service in the future. Methodology: Structured questionnaires were completed with all the available volunteers trained during 1999. The questionnaires were quantitatively analysed manually. Results: Ninety-six (96) people attended the introductory phase of the home-based care course during 1999. Seventy-one (71) were volunteers and 25 were people living with HIV. Forty-six (46) of the participants completed the questionnaires (44 volunteers plus two people living with HIV working as volunteers). Twenty-seven (27) volunteers could not be traced, as they were no longer active in the project. The following factors were associated with active volunteers: 1. Married 2. Female 3. >30 years of age 4. Breadwinners themselves or have a husband/spouse who is the breadwinner. Conclusions: Presently, most of the active volunteers are married, female, older than 30 and are the breadwinner themselves or have a husband who is the breadwinner. Key words: Home-based care, volunteers, Aids, characteristics For full text, click here: SA Fam Pract 2004; 46(2) : 29-3

Isolation of antigenic peptides of Cowdria ruminantium and their encoding genes using a genome-derived phage display library

The development of new and effective vaccines and immunodiagnostic reagents requires the characterisation of antigenically relevant proteins and their interactions with the products of the immune system. Phage display technology was investigated as a means of elucidating some of the antigenic properties of the rickettsial parasite, Cowdria ruminantium (Cowdria). Randomly fragmented gene-derived libraries have been useful in elucidating viral and other epitopes, but only limited work has been done with entire genomes. A phage display library expressing a repertoire of Cowdria peptides was constructed. It was sufficiently large to represent the organism's genome, but lacked phages displaying peptides coded for by genes containing a Pvu II restriction enzyme site, including the one coding for the major antigenic protein 1 (MAP1). This was considered advantageous since MAP1 is immunodominant and has already been well characterised. Affinity selection with antibodies against Cowdria proteins other than MAP1 allowed several antibody-reactive peptides to be isolated. These selected sequences were placed in the context of the genome by screening a lambda bacteriophage library and by comparison with Cowdria DNA sequences. Apart from showing that antigenic mimics were present in the phage display library, six open reading frames encoding putative Cowdria proteins were identified. All had similarities to, or motifs in common with, membrane proteins and are thus likely to be exposed to the host's humoral immune system. Some of the proteins identified were larger than the antigens used to elicit the antibodies used for selection, probably as a result of the presence of cross-reactive epitopes. Despite limitations experienced when extending a fragmented-gene approach for epitope location to genomes, it was possible to identify an antigenic region on MAP1 by comparison with selected mimics. In addition, binding peptide sequences were identified with two monoclonal antibodies that had been raised against non-Cowdria antigens. An epitope on the VP7 protein of bluetongue virus was identified and peptides were found that reacted with a monoclonal antibody directed against malignant catarrhal fever virus. Thus, apart from being able to identify several potentially important Cowdria epitopes and genes, the fragmented-genome library holds promise as a universal reagent for identifying useful mimics

The procedural skills of rural hospital doctors

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Chicken single-chain antibody fragments directed against recombinant VP7 of bluetongue virus

VP7, the major structural core protein of bluetongue virus, is conserved among the 24 bluetongue virus serotypes. The gene encoding VP7 of serotype 4 was expressed in Escherichia coli. A semi-synthetic chicken antibody library was screened with the resulting protein. Six single-chain antibody fragments (scFvs) were isolated. Immune sera blocked the binding of four of the six scFvs in enzyme-linked immunosorbent assays. These scFvs recognised recombinant VP7 coated directly onto a plastic surface. Their behaviour therefore differs from that of scFv F10 which was selected earlier on directly immobilised bluetongue virus and which binds to VP7 only when it is captured by an immobilised immunoglobulin directed against bluetongue virus.Department of Science and Technologyhttp://www.tandfonline.com/loi/cfai20ab201