Bridging the gap: exploring the attitudes and beliefs of nurses and patients about coexisting traditional and biomedical healthcare systems in a rural setting in KwaZulu-Natal

Objectives: Health care in South Africa takes place within a diverse cultural context and includes perceptions about health that strongly link to cultural beliefs and values. Biomedical healthcare professionals, particularly nurses, are exposed to and expected to cope with cultural challenges on a daily basis, with little or no training on how to do so. In this paper, we explore nurse and patient attitudes to and beliefs about how the systems of health care coexist, what issues this raises and how nurses and patients address these issues in their daily practice.Design: The study employed an exploratory, qualitative research design.Setting and subjects: Four in-depth focus group discussions were conducted with nurses and patients at a deep rural, district hospital in northern KwaZulu-Natal. Participants were selected based on their availability and willingness to contribute to the discussion.Results: Traditional and biomedical healthcare systems coexist and are used simultaneously with the healthcare- seeking pattern of patients traversing multiple systems of care. Currently, patients and nurses have developed strategies to address this by steering a pragmatic course to minimise risks, and by doing so, bridging the gap between the two healthcare mediums.Conclusion: Further research is required to understand which illnesses are primarily seen as traditional, how this gap can be effectively addressed, and how different healthcare co-delivery models can best be utilised and evaluated.Keywords: health worker, traditional health care, biomedical health care, cultur

Accommodation and vergence response gains to different near cues characterize specific esotropias

Aim. To describe preliminary findings of how the profile of the use of blur, disparity and proximal cues varies between non-strabismic groups and those with different types of esotropia. Design. Case control study Methodology. A remote haploscopic photorefractor measured simultaneous convergence and accommodation to a range of targets containing all combinations of binocular disparity, blur and proximal (looming) cues. 13 constant esotropes, 16 fully accommodative esotropes, and 8 convergence excess esotropes were compared with age and refractive error matched controls, and 27 young adult emmetropic controls. All wore full refractive correction if not emmetropic. Response AC/A and CA/C ratios were also assessed. Results. Cue use differed between the groups. Even esotropes with constant suppression and no binocular vision (BV) responded to disparity in cues. The constant esotropes with weak BV showed trends for more stable responses and better vergence and accommodation than those without any BV. The accommodative esotropes made less use of disparity cues to drive accommodation (p=0.04) and more use of blur to drive vergence (p=0.008) than controls. All esotropic groups failed to show the strong bias for better responses to disparity cues found in the controls, with convergence excess esotropes favoring blur cues. AC/A and CA/C ratios existed in an inverse relationship in the different groups. Accommodative lag of >1.0D at 33cm was common (46%) in the pooled esotropia groups compared with 11% in typical children (p=0.05). Conclusion. Esotropic children use near cues differently from matched non-esotropic children in ways characteristic to their deviations. Relatively higher weighting for blur cues was found in accommodative esotropia compared to matched controls

Making Space for the Dissertation : a Rural Retreat for Undergraduate Students

This paper examines a residential writing retreat for final year human geography and planning students held in a youth hostel in North Yorkshire, considering how it is experienced by students. This is a curriculum innovation for the dissertation module that combines aspects of geography fieldtrip and writing workshop to support the dissertation writing process and build community. Drawing on the concept of ‘the slow university’ (Berg & Seeber, 2016; O’Neill, 2014) where the ‘slowing down’ and ‘stripping away’ of the usual structures and patterns of teaching and learning create a critical and creative space for thinking and writing, we explore whether and how the Malham retreat makes space for writing. The study is also informed by our spatial approach to the processes and content of research and teaching as geographers (Massey, 2005). Qualitative focus group evidence was gathered on the student and staff experience and used to evaluate the field trip (Breen, 2006; Krueger & Casey, 2009; Stewart & Shamdasani, 2015). This paper presents the results of this evaluation and it is argued that the retreat made space for writing in three ways: 1. The space of countryside, nature and youth hostel. 2. The formal and informal learning spaces staff and students constructed during the retreat 3. ‘Head space’- the social, psychological and emotional room the retreat made for staff and students. This model of residential writing retreat could be transferable to dissertation and other modules involving a substantive writing project on all kinds of undergraduate courses

MOBILE and the provision of total joint replacement

Modern joint replacements have been available for 45 years, but we still do not have clear indications for these interventions, and we do not know how to optimize the outcome for patients who agree to have them done. The MOBILE programme has been investigating these issues in relation to primary total hip and knee joint replacements, using mixed methods research

Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC Birth Cohort

Background: Several large population-based studies have demonstrated associations between adverse childhood experiences and later development of psychotic symptoms. However, little attention has been paid to the mechanisms involved in this pathway and the few existing studies have relied on cross-sectional assessments. Methods: Prospective data on 6692 children from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) were used to address this issue. Mothers reported on children’s exposure to harsh parenting and domestic violence in early childhood, and children self-reported on bullying victimization prior to 8.5 years. Presence of children’s anxiety at 10 years and their depressive symptoms at 9 and 11 years were ascertained from mothers, and children completed assessments of self-esteem and locus of control at 8.5 years. Children were interviewed regarding psychotic symptoms at a mean age of 12.9 years. Multiple mediation analysis was performed to examine direct and indirect effects of each childhood adversity on psychotic symptoms. Results: The association between harsh parenting and psychotic symptoms was fully mediated by anxiety, depressive symptoms, external locus of control, and low self-esteem. Bullying victimization and exposure to domestic violence had their associations with psychotic symptoms partially mediated by anxiety, depression, locus of control, and self-esteem. Similar results were obtained following adjustment for a range of confounders and when analyses were conducted for boys and girls separately. Conclusions: These findings tentatively suggest that specific cognitive and affective difficulties in childhood could be targeted to minimize the likelihood of adolescents exposed to early trauma from developing psychotic symptoms

Correlates of Complete Childhood Vaccination in East African Countries.

Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination. Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette-Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression. Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries. Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards reaching the Millennium Development Goal of reducing under-five mortality by two-thirds by 2015 and thus should be a global priority

Self-similar Bianchi models: I. Class A models

We present a study of Bianchi class A tilted cosmological models admitting a proper homothetic vector field together with the restrictions, both at the geometrical and dynamical level, imposed by the existence of the simply transitive similarity group. The general solution of the symmetry equations and the form of the homothetic vector field are given in terms of a set of arbitrary integration constants. We apply the geometrical results for tilted perfect fluids sources and give the general Bianchi II self-similar solution and the form of the similarity vector field. In addition we show that self-similar perfect fluid Bianchi VII$_0$ models and irrotational Bianchi VI$_0$ models do not exist.Comment: 14 pages, Latex; to appear in Classical and Quantum Gravit

Magneto-dilatonic Bianchi-I cosmology: isotropization and singularity problems

We study the evolution of Bianchi-I space-times filled with a global unidirectional electromagnetic field $F_{mn}$ interacting with a massless scalar dilatonic field according to the law \Psi(\phi) F^{mn} F_{mn} where \Psi(\phi) > 0 is an arbitrary function. A qualitative study, among other results, shows that (i) the volume factor always evolves monotonically, (ii) there exist models becoming isotropic at late times and (iii) the expansion generically starts from a singularity but there can be special models starting from a Killing horizon preceded by a static stage. All these features are confirmed for exact solutions found for the usually considered case \Psi = e^{2\lambda\phi}, \lambda = const. In particular, isotropizing models are found for |\lambda| > 1/\sqrt{3}. In the special case |\lambda| = 1, which corresponds to models of string origin, the string metric behaviour is studied and shown to be qualitatively similar to that of the Einstein frame metric.Comment: Latex2e, 10 page

Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study

Objectives: Limited studies have identified predictors of early and late hospital readmissions in Australian healthcare settings. Some of these predictors may be modifiable through targeted interventions. A recent study has identified malnutrition as a predictor of readmissions in older patients but this has not been verified in a larger population. This study investigated what predictors are associated with early and late readmissions and determined whether nutrition status during index hospitalisation can be used as a modifiable predictor of unplanned hospital readmissions. Design: A retrospective cohort study. Setting: Two tertiary-level hospitals in Australia. Participants: All medical admissions ≥18 years over a period of 1 year. Outcomes: Primary objective was to determine predictors of early (0–7 days) and late (8–180 days) readmissions. Secondary objective was to determine whether nutrition status as determined by malnutrition universal screening tool (MUST) can be used to predict readmissions. Results: There were 11 750 (44.8%) readmissions within 6 months, with 2897 (11%) early and 8853 (33.8%) late readmissions. MUST was completed in 16.2% patients and prevalence of malnutrition during index admission was 31%. Malnourished patients had a higher risk of both early (OR 1.39, 95% CI 1.12 to 1.73) and late readmissions (OR 1.23, 95% CI 1.06 to 128). Weekend discharges were less likely to be associated with both early (OR 0.81, 95% CI 0.74 to 0.91) and late readmissions (OR 0.91, 95% CI 0.84 to 0.97). Indigenous Australians had a higher risk of early readmissions while those living alone had a higher risk of late readmissions. Patients ≥80 years had a lower risk of early readmissions while admission to intensive care unit was associated with a lower risk of late readmissions. Conclusions: Malnutrition is a strong predictor of unplanned readmissions while weekend discharges are less likely to be associated with readmissions. Targeted nutrition intervention may prevent unplanned hospital readmissions.Yogesh Sharma, Michelle Miller, Billingsley Kaambwa, Rashmi Shahi, Paul Hakendorf, Chris Horwood, Campbell Thompso