An identification of the Social and Emotional Needs of People Living with Post-Lingual Hearing Loss

Hearing loss is associated with challenges in achieving effective communication which can constrain an individual’s ability to participate in social and work environments, affecting their social and emotional well-being. Through a thematic analysis of focus groups, interview and survey responses from 41 people experiencing post-lingual hearing loss, we identified an overarching theme of adjusting to impaired communication and three sub-themes in which we were able to identify the unmet social and emotional needs of people who are hard of hearing. In light of our analysis we discuss and offer recommendations specific to meeting the needs of this population

A symptom-specific quality of life questionnaire for dysphagia.

M. Med. Sc. University of KwaZulu-Natal, Durban 2014.Dysphagia is a common clinical problem. It is a distressing symptom which impacts negatively on the quality of life (QOL) of patients. There is increasing recognition that assessing QOL gives a broader perspective when deciding on and assessing the effect of treatment of our patients. An abstract concept, QOL is perceived by many clinicians in South Africa as difficult to measure and hence they are reluctant use it to help with therapeutic decision making. There is a dearth of QOL information from third-world countries and there is no locally developed or validated tool to measure it. If we are to provide more holistic health care to our patients this situation needs to be rectified and an appropriate tool developed. Aim: To develop a quality of life questionnaire specific for dysphagia relevant to our local population and validated it against established international questionnaires. The newly developed questionnaire needs to be comprehensive enough to measure general QOL as well as specific enough to be able to detect differences in QOL before and after treatment. Furthermore it needs to be brief and simple so as to be clearly understood and completed by our patient population with varied literacy competencies. Methods: We formulated a questionnaire related to dysphagia and other symptoms commonly associated with it and named it the Greys Dysphagia Quality of Life (GREYS DQOL) questionnaire. The questionnaire contained questions pertaining to generic QOL issues as well as to dysphagia-related QOL issues. We administered the questionnaire to a sample of patients together with two other internationally used questionnaires. One of the international questionnaires, the Short Form 36 (SF-36) quality of life questionnaire is a fully validated generic quality of life questionnaire which is extensively used world-wide and in South Africa. The other, the Dysphagia Score (DS), is a dysphagia-specific questionnaire used internationally to assess patients with conditions presenting with dysphagia. We compared the results of the three questionnaires as well as the compliance of patients in answering the three questionnaires. Demographic data collected included age, gender and level of education. Results: One hundred patients were entered into the study. The majority were males in their sixth and seventh decade of life. Most patients had no established diagnosis at the time of the study, but of those who did have a diagnosis, the most common cause of the dysphagia was malignant obstruction of the oesophagus. The literacy level amongst our patients was found to be low. Twenty three patients received no formal schooling and only 11 patients completed school to matriculation level. The quality of life of our sample population was poor according to all three questionnaires. The mean score for patients on the SADQOL questionnaire was 61 where a score of 0 indicates the best quality of life possible and a score of 100 indicates the worst quality of life possible. The mean score for patients on the SF-36 was 30, where 0 indicates the worst possible quality of life and 100 the best possible quality of life. The mean score for patients on the dysphagia score was 7, where 0 is the best score and 10 the worst. The results of the new questionnaire correlated well with that of the international questionnaires, confirming test-validity. The compliance of patients in answering questions in the GREYS DQOL questionnaire was superior to that of the internationally used questionnaires. The level of education influenced the scores of the SF-36 but not those of the GREYS DQOL and DS. This makes the GREYS DQOL more appropriate for use in our patient population. Conclusion: The GREYS DQOL questionnaire is simpler to comply with and correlates well with established international tools. We therefore consider it to be a good tool for assessing quality of life of patients presenting with dysphagia in South Africa. It can be used to assess QOL in our patients at initial presentation and after treatment is administered and is understood well by our patient population

Self-expanding metal stent placement for oesophageal cancer without fluoroscopy is safe and effective

Background. Self-expanding metal stents (SEMS) are widely used to palliate patients with oesophageal cancer. Placement is usually done under endoscopic and fluoroscopic guidance. We have developed an exclusively endoscopic technique to deploy these stents. This article documents the technique and periprocedural experience.Patients and methods. All patients who had SEMS placement for oesophageal cancer at Grey’s Hospital, Pietermaritzburg, South Africa, over a 5-year period (2007 - 2011) were reviewed. Stenting was performed without radiological guidance using the technique documented in this article. At endoscopy, the oesophageal lesion was identified, dilated over a guidewire if necessary, and a partially covered stent was passed over the wire and positioned and deployed under direct vision. Data were captured from completed procedure forms and included demographics, tumour length, the presence of fistulas, stent size and immediate complications.Results. A total of 480 SEMS were inserted, involving 453 patients, of whom 43 required repeat stenting. There were 185 female patients (40.8%) and 268 male patients (59.2%). The mean age was 60 years (range 38 - 101). There were 432 black patients (95.4%), 15 white patients (3.3%) and 6 Indian patients (1.3%). The reasons for palliative stenting were distributed as follows: age >70 years n=95 patients, tumour >8 cm n=142, tracheo-oesophageal fistula (TOF) n=29, and unspecified n=170. One patient refused surgery, and one stent was placed for a post-oesophagectomy leak. Repeat stenting was for stent migration (n=15), tumour overgrowth (n=26) and a blocked stent and a stricture (n=1 each). Complications were recorded in six cases (1.3%): iatrogenic TOF (n=2), false tracts (n=3) and perforation (n=1). All six were nevertheless successfully stented. There was no periprocedural mortality.Conclusion. The endoscopic placement technique described is a viable and safe option with a low periprocedural complication rate. It is of particular use in situations of restricted access to fluoroscopic guidance

Oesophageal cancer in South Africa: The long timeline from onset of symptoms to definitive management

Background: In rural South Africa, most patients with oesophageal cancer have delayed presentations with debilitating symptoms and inoperable disease. This study was undertaken to quantify the delay between onset of symptoms and definitive treatment in a cohort of patients in rural South Africa, presenting to a state hospital in KwaZulu-Natal. The study also sought to establish reasons for delays in seeking medical attention and identify ways to encourage earlier presentation. Methods: It was a two-armed study of patients with oesophageal cancer seen at Greys Hospital in Pietermaritzburg. One was a retrospective chart review establishing a timeline. The second part was a prospective study between June and November 2012 where data were collected by means of patient interviews. Results: One hundred and thirteen charts were reviewed. The time from first symptoms to definitive management ranged from 2 to 14 months (average 7 months). Forty-six patients were interviewed. All experienced dysphagia but 83% were only prompted to seek help after weight loss. The duration of symptoms prior to first clinic or hospital attendance was 0–12 months (average 3 months). The reasons for the delay included the following: 41% of patients did not consider dysphagia a significant symptom, 24% had no money, 19% sought the help of traditional healers first and 15% said the hospital was too far away. Conclusion: There are long delays in the management of oesophageal cancer in our setting. The delays are prehospital as well as within the health care system. Lack of knowledge about oesophageal cancer symptoms and limited access to health care contributed to delays in management. Targeted quality improvement interventions are necessary. Patient education and improved referral systems are vital in encouraging earlier presentation

Oesophageal cancer in Area 2 of Kwazulu-Natal: predictors of late presentation.

BACKGROUND: There are limited prospective data sets on clinical characteristics, stage of presentation and treatment of patients with Oesophageal Squamous Cell Carcinoma (OSCC) in South Africa. This study aimed to assess the frequency and severity of clinical characteristics associated with late presentation of patients with OSCC presenting to a cancer referral centre in KwaZulu-Natal, South Africa. METHODS: A prospective consecutive series of patients presenting with confirmed OSCC treated at Greys Hospital in 2016/2017 were enrolled. Data collected included: age, gender, home language, referral centre, clinical and laboratory characteristics: dysphagia score, Eastern Cooperative Oncology Group (ECOG) performance status, body mass index (BMI), serum albumin, tumour pathology and treatment administered. RESULTS: One hundred patients were analysed. Ninety four percent spoke isiZulu. The mean age was 61 with a male to female ratio of 1.5:1 Ninety percent had palliative treatment as their overall assessment precluded curative treatment. Five patients underwent curative treatment. The age standardised incidence (ASR) was 25.2 per 100 000. The factors associated with late presentation and their frequency were: advanced dysphagia grade ( </=2 in 68%), malnutrition (BMI <18.5kg/m2 in 49%), hypoalbuminaemia (serum albumin < 35 g/l in 70%), poor performance status (ECOG</=2 in 50% ) and moderate to poor tumour differentiation in 95% of patients. CONCLUSION: OSCC in Kwazulu-Natal has double the ASR of South Africa and places a significant burden on the region's health care system. Factors associated with late presentation occur in the majority and alone or in combination preclude curative therapies. The frequency of these factors serve as a benchmark for comparison, and reduction in their frequency may indicate effectiveness of interventions designed to improve awareness and access to proper care

Self-expanding metal stent placement for oesophageal cancer without fluoroscopy is safe and effective

Background. Self-expanding metal stents (SEMS) are widely used to palliate patients with oesophageal cancer. Placement is usually done under endoscopic and fluoroscopic guidance. We have developed an exclusively endoscopic technique to deploy these stents. This article documents the technique and periprocedural experience.Patients and methods. All patients who had SEMS placement for oesophageal cancer at Grey’s Hospital, Pietermaritzburg, South Africa, over a 5-year period (2007 - 2011) were reviewed. Stenting was performed without radiological guidance using the technique documented in this article. At endoscopy, the oesophageal lesion was identified, dilated over a guidewire if necessary, and a partially covered stent was passed over the wire and positioned and deployed under direct vision. Data were captured from completed procedure forms and included demographics, tumour length, the presence of fistulas, stent size and immediate complications.Results. A total of 480 SEMS were inserted, involving 453 patients, of whom 43 required repeat stenting. There were 185 female patients (40.8%) and 268 male patients (59.2%). The mean age was 60 years (range 38 - 101). There were 432 black patients (95.4%), 15 white patients (3.3%) and 6 Indian patients (1.3%). The reasons for palliative stenting were distributed as follows: age &gt;70 years n=95 patients, tumour &gt;8 cm n=142, tracheo-oesophageal fistula (TOF) n=29, and unspecified n=170. One patient refused surgery, and one stent was placed for a post-oesophagectomy leak. Repeat stenting was for stent migration (n=15), tumour overgrowth (n=26) and a blocked stent and a stricture (n=1 each). Complications were recorded in six cases (1.3%): iatrogenic TOF (n=2), false tracts (n=3) and perforation (n=1). All six were nevertheless successfully stented. There was no periprocedural mortality.Conclusion. The endoscopic placement technique described is a viable and safe option with a low periprocedural complication rate. It is of particular use in situations of restricted access to fluoroscopic guidance

Persepsies t.o.v. die sosio-politieke rol van vakbonde, stakings en vakbonddemokrasie

Perceptions regarding the socio-political role of labour unions, strikes and trade union democracy. The aim of this study was to determine the perceptions of trade union members and the general public with regard to the socio-political role of the emergent trade unions!. A further aim was to determine whether or not respondents regarded those unions as democratic organisations. The findings of this investigation indicate that the respondents viewed strikes and the socio- political role of trade unions positively. The trade unions mentioned were further regarded as democratic organisations. Opsomming Die doel van hierdie ondersoek was om die persepsies van vakbondlede en die breer publiek t.o.v. die sosio-politieke rol van sogenaamde "emergent" vakbonde1 te peil. Daar is ook gepoog om vas te stel of die "emergent" vakbonde as demokratiese organisasies beskou word, al dan nie. Die bevindinge van hierdie ondersoek was dat die respondente 'n posihewe siening van stakings en die sosio-politieke rol van vakbonde het. Verder word die genoemde vakbonde ook as demokratiese organisasies beskou

Harnessing the Cool Factor: The Effects of Social Status and Identity Development on Willingness to Engage in Pro-environmental Behaviours

Recent research has demonstrated the powerful influence of socially oriented approaches for changing behaviour and promoting pro-environmental behaviour. The aim of the current study was to extend on that research by investigating how increasing the social desirability of pro-environmental behaviour influences individual‘s self reported intentions to engage in pro-environmental behaviours. Using a sample of 93 participants including university students and members of the general public, the present research examined the relationship between social status and an individual‘s intentions to engage in both public and private pro-environmental behaviours. Additionally, the research investigated how this relationship differed for younger and older participants who vary in their stage of identity development. Consistent with recent research it was expected that participants would report higher intentions to engage in pro-environmental behaviours if the behaviours were linked to high social status individuals of the same age group. It was further hypothesised, based on Erikson‘s theory of psychosocial development, that this relationship would be stronger for younger participants compared to older participants because they are still developing their identity and identity development is subject to peer influence. The predicted two-way interaction did not emerge, however the effects of age and social status were moderated by participants‘ need for social success. As expected, the effects of social status were only significant for younger participants. Amongst younger participants, unexpectedly, social status only impacted environmental intentions for those low in need for social success. Participants who had a low need for social success had weaker intentions to engage in environmental behaviours when these actions were linked with high status individuals than when linked with low status individuals. Explanations for the findings are discussed