South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014

PKThe South African Menopause Society (SAMS) consensus position statement on menopausal hormone therapy (HT) 2014 is a revision of the SAMS Council consensus statement on menopausal HT published in the SAMJ in May 2007. Information presented in the previous statement has been re-evaluated and new evidence has been incorporated. While the recommendations pertaining to HT remain similar to those in the previous statement, the 2014 revision includes a wider range of clinical benefits for HT, the inclusion of non-hormonal alternatives such as selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors for the management of vasomotor symptoms, and an appraisal of bioidentical hormones and complementary medicines used for treatment of menopausal symptoms. New preparations that are likely to be more commonly used in the future are also mentioned. The revised statement emphasises that commencing HT during the ‘therapeutic window of opportunity’ maximises the benefit-to-risk profile of therapy in symptomatic menopausal women

Breast cancer and HRT

No Abstract. South African Family Practice Vol. 47(6) 2005: 48-5

The HPV Vaccine - What the Family Practitioner Needs to Know

This article reviews the impact of human papilloma virus infection on the development of cervical cancer and the efficacy of newly developed HPV vaccines. These vaccines may have a major impact on the reduction of these common malignancies. South African Journal of Family Practice Vol. 50 (4) 2008: pp. 22-2

Professionalism in the intimate examination: How healthcare practitioners feel about having chaperones present during an intimate consultation and examination

Background. Despite the clear prohibition against sexual relations with one’s patients, complaints of a sexual nature against practitionersregistered with the Health Professions Council of South Africa (HPCSA) have been increasing. The HPCSA does not provide ethical guidelines regarding the use of a chaperone during intimate examinations.Aims. (i) To ascertain how a group of medical practitioners felt about the presence of chaperones during the consultation and intimate examination of patients; (ii) to determine whether they currently engage the services of chaperones; (iii) to assess how they felt about consensual sexual relationships between medical practitioners and their patients.Methods. A self-administered, questionnaire-based survey was distributed to gynaecologists and medical practitioners.Results. There was a 43% response rate with 72% of practitioners in favour of using a chaperone during an intimate examination, although only 27% always do so. Most practitioners felt that consensual sexual relationships with patients are unacceptable; 83% felt that ethical guidelines on this topic were needed.Conclusion. The HPCSA should develop guidelines on the use of chaperones to assist practitioners. With medical litigation increasing,using chaperones will benefit patients and practitioners

The efficacy of short-messaging service in a weight reduction programme amongst women in a general practice

Thesis (MNutr)--University of Stellenbosch, 2011.ENGLISH ABSTRACT: Obesity has become one of the major conditions contributing towards chronic lifestyle diseases. The management of obesity, in order to prevent chronic lifestyle disease, requires a combination of treatment modalities. There is therefore a constant need to search for innovative behavioural and awareness programmes regarding the treatment of obesity, and to develop innovative strategies to improve compliance and ultimately to change lifestyles. The notion of utilizing short message services (SMS), during a weight reduction progamme to provide regular reminders and information to achieve the aforementioned goals, was therefore used as an intervention in the study. Furthermore a questionnaire validating the effectiveness of the short message service was devised and completed by the recipients of the intervention. The purpose of the questionnaire was to statistically quantify the effectiveness of the SMS as an intervention. Each question had four graded answers, with a score allocated to each - 1 being the least effective and 4 being the most. These values were converted to percentages and according to these percentages a rating of effectiveness was ascertained. Ultimately the study set out to determine whether the intervention had a statistically significant effect on weight reduction, compliance in attending appointments and on the attrition rate. This was a double blinded randomized, controlled study in which 75 participants were recruited at a general medical practice in Gauteng. The sample comprised of three groups. Group 1 (N = 25) had no intervention; Group 2 (N = 25) received a SMS weekly and Group 3 (N = 25) received a SMS three times per week. The weight reduction programme, which included dietary modifications and lifestyle advice was standardized and remained the same for each group. The programme extended over a 12 week period and the questionnaire was completed at the end of the programme. Upon analysis of the results there was a decrease in the mean BMI and waist circumference for all the three groups, with no statistically significant difference (p-value > 0.05) between them. The percentages of the participants completing the programme in each group were – Group 1: 44%, Group 2: 60% and Group 3: 68%. The effectiveness of the intervention was manifested by the compliance of attendance at each visit and the reduced attrition rate in the intervention groups, although this was not found to be statistically significant. The analysis of the scores allocated to the responses of the questionnaire, equated to an outcome of above 75% and was assessed as being very successful in both the intervention groups. In conclusion the use of short message servicing in this weight reduction programme improved the compliance and reduced the attrition rate although not statistically and was perceived by the participants as a successful intervention.AFRIKAANSE OPSOMMING: Vetsug (obesiteit) het een van die primêre kondisies geword wat bydrae tot chroniese leefstyl siektes. Die hantering van obesiteit vereis 'n kombinasie van behandelingsmodaliteite, ten einde hierdie siektes te voorkom, Daar is dus 'n konstante soeke na innoverende gedrags- en bewustheidsprogramme rakende die behandeling van obesiteit, asook 'n behoefte om innoverende strategieë te ontwikkel om inskiklikheid te verbeter en uiteindelik leefstyle te verander. Die idee om kortboodskapdienste (SMS) gedurende 'n gewigsverliesprogramme te gebruik om gereelde aanmanings en inligting te kommunikeer ten einde die genoemde doelwitte te bereik, is aangewend as intervensie in hierdie studie. 'n Vraelys is ontwikkel wat die effektiwiteit van die kortboodskapdiens valideer, en is voltooi deur die ontvangers van die intervensie. Die doel van die vraelys was om die effektiwiteit van die SMS as 'n intervensie te kwantifiseer. Elke vraag het vier gegradeerde antwoorde gehad, met 'n telling wat aan elk toegeken is – 1 wat aandui minste effektief en 4 wat aandui die meeste. Hierdie waardes was omgeskakel tot persentasies en na aanleiding van die persentasies is 'n waarde van effektiwiteit bepaal. Uiteindelik was die doel van die studie dus om vas te stel of die intervensie ʼn statisties beduidende effek op gewigsverlies, die nakom van afsprake en uitvalskoerse het. Hierdie was 'n dubbelblind, ewekansige gekontroleerde studie waarin 75 deelnemers gewerf was by 'n algemene mediese praktyk in Gauteng. Die steekproef het bestaan uit 3 groepe. Groep 1 (N = 25) het geen intervensie gehad nie; Groep 2 (N = 25) het 'n weeklikse SMS ontvang en Groep 3 (N = 25) het 'n SMS ontvang drie keer per week. Die gewigsverliesprogramme, wat dieetaanpassings en leefstyl advies ingesluit het, was gestandardiseer en het dieselfde gebly vir elke groep. Die programme het gestrek oor 'n 12 weke periode en die vraelys was voltooi aan die einde van die programme. Analise van die resultate het 'n afname getoon in die gemiddelde LMI (Liggaamsmassa indeks) en middelomtrek vir al drie groepe, met geen statisties beduidende verskil (p-waarde > 0.05) tussen groepe nie. Die persentasies van die deelnemers wat die programme voltooi het in elke groep was Groep 1: 44%, Groep 2: 60% en Groep 3: 68%. Die effektiwiteit van die intervensie was gemanifesteer deur die inskiklikheid van bywoning tydens elke besoek en die verlaagde uitvalkoers in die intervensie groepe, alhoewel dit nie statisties beduidend was nie. 'n Analise van die tellings geallokeer aan die response tot die vraeslys, dui 'n uitkoms aan van bo 75% en was beskou as baie suksesvol in albei die intervensie groepe. Die gebruik van kortboodskapdienste (SMS) in hierdie gewigsverliesprogramme het inskiklikheid verbeter en uitvalskoerse verlaag, alhoewel nie statisties beduidend nie, en was deur die deelnemers beskou as 'n suksesvolle intervensie

A prospective study of iron status in white and black pregnant women in an urban hospital

Evaluation of the iron status (haemoglobin and ferritin concentrations, and percentage transferrin saturation) in a prospective study of 65 pregnant women (55 white and 10 black) revealed that adequate maternal iron stores during pregnancy cannot be maintained with prevailing dietary patterns. Although 80,6% of the patients had normal indices in the first trimester, only 12,3% were normal in the third. Significant depletion of iron stores occurred in the second trimester, but significant iron-deficient erythropoiesis only occurred in the third trimester. Despite the decline in iron status, iron deficiency anaemia was only seen in 7 - 8% of the patients. Even after correction for the haemodilution and increased transferrin concentrations in pregnancy, over 70% of women had depleted iron stores in the third trimester. No beneficial effect on fetal birth weights was found on withholding of maternal iron supplementation. This study clearly demonstrated that white and urban black pregnant women require iron prophylaxis to maintain iron stores

Nicotine dependence and biochemical exposure measures in the second trimester of pregnancy

Introduction: The Heaviness of Smoking Index (HSI) is validated to measure nicotine dependence in nonpregnant smokers, and in these smokers, mean salivary and serum cotinine levels are related by a ratio of 1.25. However, as nicotine metabolism increases during gestation, these findings may differ in pregnancy. We investigated the validity of HSI in pregnancy by comparing this with 3 biochemical measures; and in a search for a less-invasive cotinine measure in pregnancy, we also explored the relationship between mean blood and salivary cotinine levels. Methods: Cross-sectional analyses using baseline data from the Smoking, Nicotine, and Pregnancy Trial. Participants were 16–46 years old, 12–24 weeks gestation, smoked more than 5 cigarettes per day and had exhaled carbon monoxide (CO) readings of at least 8 ppm. Linear regression was used to examine correlations between HSI and blood cotinine, and salivary cotinine and exhaled CO. Correlation between blood and salivary cotinine was investigated using linear regression through the origin. Results: HSI scores were associated with blood cotinine (R2 = 0.20, n = 662, p < .001), salivary cotinine (R2 = 0.11, n = 967, p < .001), and exhaled CO (R2 = 0.13, n = 1,050, p < .001). Salivary and blood cotinine levels, taken simultaneously, were highly correlated (R2 = 0.91, n = 628, p < .001) and the saliva:blood level ratio was 1.01 (95% CI 0.99–1.04). Conclusions: Correlations between HSI and biochemical measures in pregnancy were comparable with those obtained outside pregnancy, suggesting that HSI has similar validity in pregnant smokers. Salivary and blood cotinine levels are roughly equivalent in pregnant smokers

Determinants of Acceptance of Cervical Cancer Screening in Dar es Salaam, Tanzania.

To describe how demographic characteristics and knowledge of cervical cancer influence screening acceptance among women living in Dar es Salaam, Tanzania. Multistage cluster sampling was carried out in 45 randomly selected streets in Dar es Salaam. Women between the ages of 25-59 who lived in the sampled streets were invited to a cervical cancer screening; 804 women accepted and 313 rejected the invitation. Information on demographic characteristics and knowledge of cervical cancer were obtained through structured questionnaire interviews. Women aged 35-44 and women aged 45-59 had increased ORs of 3.52 and 7.09, respectively, for accepting screening. Increased accepting rates were also found among single women (OR 2.43) and among women who had attended primary or secondary school (ORs of 1.81 and 1.94). Women who had 0-2 children were also more prone to accept screening in comparison with women who had five or more children (OR 3.21). Finally, knowledge of cervical cancer and awareness of the existing screening program were also associated with increased acceptance rates (ORs of 5.90 and 4.20). There are identifiable subgroups where cervical cancer screening can be increased in Dar es Salaam. Special attention should be paid to women of low education and women of high parity. In addition, knowledge and awareness raising campaigns that goes hand in hand with culturally acceptable screening services will likely lead to an increased uptake of cervical cancer screening

The ‘war on drugs’ has failed: Is decriminalisation of drug use a solution to the problem in South Africa?

This article engages in the debate surrounding decriminalisation of drug use and whether this is a possible solution to the problem of druguse in South Africa &#8211; a question becoming more prevalent in global discussions about drug policy and its efficacy. We argue that two aspects must be addressed when evaluating a policy: its philosophical justification and its efficacy. We find that criminalising drugs may be justified by the public harm principle, but it does not effectively achieve the purpose of preventing and decreasing drug use and associated burdens. Thus, we argue that prohibition is a constitutional limitation, but does not necessarily achieve its purpose in the least repressive or most effective way. Finally, we suggest that a solution to the drug problem will have to address the health needs of the drug user and the context, particularlysocio-economic, of drug use. Decriminalisation could theoretically do this by changing society&#8217;s perception of drug users, thus helping to promote a human rights-based, public health-orientated approach to the drug problem in South Africa