A complementary model for medical subspecialty training in South Africa

The shortage of healthcare workers and doctors in the developing world compared with the developed world is problematic, and will continue to be so owing to the ongoing migration of qualified professionals and the inability of the state to remedy the shortfalls. This will seriously hamper the government’s National Health Insurance plan and the sustainability of South Africa (SA)’s healthcare sector. Furthermore, it is well known that the duration of medical training in SA is exceptionally long, which discourages trainees. Medical corporates have taken a limited initiative to fund education projects in collaboration with academic institutions. These projects have been unstructured, mostly ad hoc, and poorly co-ordinated. The private corporate medical sector has expressed a desire to become involved on a much larger scale by means of more formalised structures. Given this background, the primary objective of our research was to develop a business model to complement the current academic medical subspecialty training

Borassus aethiopum Mart. (Arecaceae) in Limpopo province with a key to South African palms

Background: Borassus aethiopum Mart. commonly occurs in many parts of tropical Africa and in South Africa it is restricted to the Leydsdorp region where it is conspicuous along the Selati River. The species is sometimes considered to have been introduced to South Africa due to its disjunct distribution. It has remained poorly studied and little is known about the local populations of this palm. Objectives: This study provides a descriptive treatment and documents the population structure of B. aethiopum in this area, and presents a key to the six indigenous palm species of South Africa. Methods: All accessible populations were surveyed and documented, and eight transects were randomly placed to gather data on size class distributions. B. aethiopum and other indigenous palm species were compared morphologically. Results: The population structure analyses of B. aethiopum revealed a monotonic decline, but the permutation index suggested that the species is prone to recruitment events. This is supported by patches that are dominated by specific height classes. Leaf shape and size, fruit size and geographical distribution were the diagnostic characters most useful to recognize the species of South African indigenous palms. Conclusion: Borassus aethiopum is distinguishable from other South African palms based on stem, leaf and fruit characters. It is considered as indigenous to Granite Lowveld as the palm is part of the natural vegetation and is characterized by a size class distribution reflecting a stable population

Enterococcal endocarditis - a case treated with teicoplanin and amoxycillin

The study aimed to determine the antibacterial therapy effective in the cure of endocarditis caused by Enterococcus faecalis resistant to clinically achievable levels of vancomycin. Isolation of the causative enterococcus had been achieved by direct inoculation of the resected valve into the culture medium in theatre. The patient was known to have had an aortic valve defect since childhood and had recently undergone splenectomy following trauma. Blood cultures were negative prior to valve replacement. A perivalvular abscess was noted at operation. In vitro minimal bactericidal results and serum activity were the basis of the postoperative choice of drugs. The minimal bactericidal level of teicoplanin was 250 µg/ml and that of amoxycillin 64 µg/ml. Neither is achievable with the advocated dosage. A combination of these two cell-wall-active agents successfully eliminated the infection. Acting at two different sites in the synthesis of the bacterial cell wall, teicoplanin and amoxycillin were found to be bactericidal in vitro at the trough levels of the antibiotics in the serum. The patient recovered fully

A vote of confidence: election management and public perceptions of electoral processes in South Africa

The aim of this article is to examine the performance of the Electoral Commission (IEC) of South Africa. The analysis not only confines itself to the 2011 local government elections, but also examines how the IEC, through the use of a Voter Participation Survey (VPS) and an Election Satisfaction Survey (ESS), has been evaluated by the voters over the past local government elections. Results from these surveys show overwhelming endorsement of the Electoral Commission alongside noteworthy generally positive attitudes regarding voting intention. However, despite the positive findings, signs of a growing sense of political disillusionment are evident among South Africans. The article examines some of the reasons for the disillusionment, places it in an international context where political values are changing, and also suggests ways for the IEC to address it going forward

Protest blues : public opinion on the policing of protest in South Africa

Abstract: The policing response to rising protest action in the country has received increased attention in the last decade. This is particularly due to concerns over confrontations during which protestors have been arrested, injured and in some instances killed by the police. Despite the criticism voiced by various stakeholders about the manner in which the police manage crowd gatherings, relatively little is known about the views of South African adults on the policing of protest action and the factors that shape such attitudes. To provide some insight, the study presented in this article draws on data from a specialized module on protest‐related attitudes and behaviour that was fielded as part of the 2016 round of the Human Sciences Research Council’s South African Social Attitudes Survey (SASAS) series. This nationally representative survey included specific questions probing the public’s overall evaluation of the performance of the police in dealing with protests and the justifiability of the use of force in policing protest action. The paper will present the national pattern of results based on these measures and then determine the extent to which there exist distinct underlying socio‐demographic cleavages. A combination of bivariate and multivariate analysis will also be undertaken to provide an understanding of the role of the perceived effectiveness, acceptability and reported participation in protest (especially disruptive and violent actions) in shaping views regarding policing protest. The article concludes with a discussion that reflects on the implications of the research for the policing of protest action in future, taking into account the appreciable rise in the incidence of protest since the mid‐2000s as well as the mounting tensions between state institutions and communities over the political, moral and constitutional arguments for and against such actions

Suicide cases investigated at the state mortuary in Bloemfontein, 2003–2007

Background: Up to 8 000 South Africans commit suicide annually. This study aimed to investigate the profile of suicide cases in Bloemfontein and the southern Free State province.Methods: A cross-sectional descriptive study was performed. Suicides in the Bloemfontein and southern Free State areas (Xhariep and Motheo districts) investigated at the state mortuary in Bloemfontein in 2003 to 2007 were included. Data were collected retrospectively by using a specially designed data-capturing form.Results: A total of 469 suicide cases were included in the study. The estimated suicide rate for this part of the Free State province was 10.9/100 000 of the population per year. The majority (82.1%) of the victims were men. In total, 338 (72.1%) of the victims were black, 122 (26.0%) were white, five (1.1%) were coloured and three (0.6%) were Indian. The most common methods were hanging (262; 55.9%), shooting (99; 21.1%) and overdosing on pills (43; 9.2%). Most cases (57.8%) occurred in victims 21 to 40 years of age. Five (1.1%) victims were children younger than 11 years of age, while 12 (2.6%) were older than 65 years. More than half (267 cases; 56.9%) of the suicide victims were unemployed. The majority(43.1%) of suicides occurred in January to April of each year, with the highest incidence (67 cases; 14.3%) in January. Conclusion: The rate of suicide and the profile of victims with regard to the variables investigated corresponded to findings reported from other studies. The information obtained could make a meaningful contribution to suicide-preventionprogrammes.Keywords: suicide; profile; rate; prevention; Free State Provinc

Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

Background. Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation.Objective. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients.Methods. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions.Results. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens.Conclusions. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases.