Motor Development in Children Living within Resource Poor Areas of the Western Cape

Introduction: In 1986, Irwin-Carruthers tested 681 Black African babies from the Western Cape and concluded that the South African sample was in advance of the Denver sample both in fine and gross motor behaviour. This study was to determine whether the motor development of isiXhosa speaking children from the same area was still advanced compared to their North American counterparts. Method: The Bayley Scales of Infant Development-II were administered to 86 children attending well baby clinics, between the ages of 1-36 months. Results: The mean motor developmental quotient was 92 (SD=15). Twenty eight percent of the sample was either significantly or mildly delayed. No socio-economic or maternal characteristics were associated with this score. Conclusion: The reasons for the decrease in performance are not clear. The socio-economic situation of the mothers was poor and there were a large number of single mothers whose sole source of income was government child support grants. It is likely that the cause of the decrease is multi-factorial. The mothers are clearly in need of emotional and financial support. It is suggested that the introduction of stimulation programmes might be useful in reducing the long term impact of this delayed development

How do Zimbabweans value health states?

Background Quality of life weights based on valuations of health states are often used in cost utility analysis and population health measures. This paper reports on an attempt to develop quality of life weights within the Zimbabwe context. Methods 2,384 residents in randomly selected small residential plots of land in a high-density suburb of Harare valued descriptors of 38 health states based on different combinations of the five domains of the EQ-5D (mobility, self-care, usual activities, pain or discomfort and anxiety or depression). The English version of the EQ-5D was used. The time trade-off method was used to determine the values, and 19,020 individual preferences for health states were analysed. A residual maximum likelihood linear mixed model was used to estimate a function for predicting the values of all possible combinations of levels on the five domains. The model was fit to a random subset of two-thirds of the observations, with the remaining observations reserved for analysis of predictive validity. The results were compared to a similar study undertaken in the United Kingdom. Results A credible model was developed to predict the values of states that were not valued directly. In the subset of observations reserved for validation, the mean absolute difference between predicted and observed values was 0.045. All domains of the EQ-5D were found to contribute significantly to the model, both at the moderate and severe levels. Severe pain was found to have the largest negative coefficient, followed by the inability to wash and dress oneself. Conclusion Despite a generally lower education level than their European counterparts, urban Zimbabweans appear to value health states in a consistent manner, and the determination of a global method of establishing quality of life weights may be feasible and valid. However, as the relative weightings of the different domains, although correlated, differed from the standard set of weights recommended by the EuroQol Group, the locally determined coefficients should be used within the Zimbabwean context

Making the user more efficient: Design for sustainable behaviour

User behaviour is a significant determinant of a product’s environmental impact; while engineering advances permit increased efficiency of product operation, the user’s decisions and habits ultimately have a major effect on the energy or other resources used by the product. There is thus a need to change users’ behaviour. A range of design techniques developed in diverse contexts suggest opportunities for engineers, designers and other stakeholders working in the field of sustainable innovation to affect users’ behaviour at the point of interaction with the product or system, in effect ‘making the user more efficient’. Approaches to changing users’ behaviour from a number of fields are reviewed and discussed, including: strategic design of affordances and behaviour-shaping constraints to control or affect energyor other resource-using interactions; the use of different kinds of feedback and persuasive technology techniques to encourage or guide users to reduce their environmental impact; and context-based systems which use feedback to adjust their behaviour to run at optimum efficiency and reduce the opportunity for user-affected inefficiency. Example implementations in the sustainable engineering and ecodesign field are suggested and discussed

The prevalence and functional impact of musculoskeletal conditions amongst clients of a primary health care facility in an under-resourced area of Cape Town

BACKGROUND:The extent of disease burden of musculoskeletal conditions (MSC) not due to injury has not been well determined in sub-Saharan Africa. The 1999 Global Burden of Disease study estimated the prevalence of osteoarthritis and rheumatoid arthritis to be 150/100,000 compared to 1,500/100,000 in Europe. The objective of the study was to determine the prevalence of MSC and the functional implications in a sample of people attending community health centres in Cape Town, South Africa. METHODS: A cross-sectional, descriptive study was conducted in clinics in two resource poor communities. Phase I consisted of screening and those who screened positive for peripheral or spinal joint pain went on to complete Phase II, which included the Stanford Health Assessment Questionnaire. RESULTS: 1005 people were screened in Phase I. Of these, 362 (36%) reported MSC not due to injury in the past three months. Those with MSC had higher rates of co-morbidities in every category than those without. The mean Disability Index for those with MSC was mild to moderate and moderate to severe in those over 55 years. CONCLUSIONS: Although the sample may not be representative of the general community, the prevalence is considerably greater than those reported elsewhere even when the population of the catchment area is used as a denominator, (367/100 000). The common presentation of MSC with co-morbid diabetes and hypertension requires holistic management by appropriately trained health care practitioners. Any new determination of burden of disease due to MSC should recognise that these disorders may be more prevalent in developing countries than previously estimated

How Compliant are Beverage Employees to Occupational Health and Safety Regulations

This observational study was undertaken to identify thehealth and safety violations of employees at a specific beverage manufac-turing company. A site inspection and observation of all employees employedat this specific beverage company was conducted by the researcher over 2 days. Employees were observed for 12 hours per day with the morningshift on Day 1 and the afternoon shift on Day 2. A sample of conveniencewas used in that every employee who was present on those days was included. Descriptive statistics were used to analyze the data set. There were a total of 212 employees and 332 behaviours observed during thisstudy period. Unsafe handling and behaviour was observed in 55% of observations. Incorrect manual lifting techniques was the most frequent health and safety violation observed. In the 48 manual lifting behaviours observed, correct practice was observed in only three cases. It is clear thatmore healthcare education and practical training is required in the area of manual lifting techniques. It is clear that more practical training is required in the area of manual handling

Pain in amaXhosa women living with HIV/AIDS: a cross-sectional study of ambulant outpatients

Background: Pain is one of the most commonly reported symptoms in people living with HIV/AIDS, whether or not they are receiving anti-retroviral therapy. A recent systematic review identified a paucity of studies exploring pain in women in low and middle income countries. The prevalence and characteristics of pain in women living with HIV/AIDS may differ from that of men as many chronic pain conditions are more prevalent in women. The aims of this study were to establish pain prevalence, characteristics and management in amaXhosa women living with HIV/AIDS. In addition, we aimed to identify whether there were associations between pain in this population and the psychosocial factors of employment, education, self-efficacy, depression, post-traumatic stress disorder, health related quality of life and childhood trauma. Methods: A cross-sectional study of 229 women who had undergone HIV testing and were registered patients at a community health centre was conducted. Data were collected by interview with a demographic questionnaire, the Brief Pain Inventory-Xhosa, Childhood Trauma Questionnaire–Xhosa, Harvard Trauma Questionnaire–Xhosa for PTSD, Self-Efficacy for Managing Chronic Disease 6-Item Scale-Xhosa; the EQ-5D health related quality of life instrument, and the Beck Depression Inventory. Results: 170 of the women had pain, a prevalence rate of 74.24% (95%CI 68.2 – 79.47%). The women reported significant pain with pain severity of 5.06 ± 1.57 and pain interference of 6.39 ± 1.96 out of 10. Only two women were receiving adequate pain management according to the pain management index. Participants reported a mean of 2.42 ± 1.21 different anatomical sites of pain. There were more unemployed participants in the group with pain and they had significantly fewer years of schooling. Those with pain had lower self-efficacy; health related quality of life and increased depression and PTSD symptom severity. Conclusion: This study highlights that pain is a common problem for amaXhosa women living with HIV/AIDS. These data emphasise the need to prioritise pain assessment and management in amaXhosa women living with HIV/AIDS. Routinely assessing for the presence of pain in women with HIV/AIDS has the potential to improve pain management and minimise the impact of pain on function

The effect of the contract-relax-antagonist-contract (CRAC) stretch of hamstrings on range of motion, sprint and agility performance in moderately active males: A randomised control trial

Background: Although stretching is done routinely to prevent injury during explosive sport activities, there is some concern that effective stretching might negatively impact on performance. Objectives: This study’s main objective was to investigate the impact of a specific stretch (CRAC), in which the muscle to be stretched, hamstrings, is actively contracted then relaxed. This is then followed by the antagonist muscle (quadriceps) contracting. Secondly, the impact of the stretch on performance was examined. Methods: A randomised control trial was used. Forty healthy active males between 21 and 35 years of age were assigned to either receive three repetitions of CRAC or rest. Hamstring flexibility and the Illinois Agility Test were the primary outcome measures. Results: The intervention was effective in improving hamstring flexibility by 37% immediately post-application and this was maintained for eight minutes thereafter. It had no significant effect on agility or sprint times. Conclusions: CRAC applied to stretch the hamstring muscles of active males resulted in a large increase of active knee extension range of motion, without decreasing performance. CRAC appears to be a safe and effective method of increasing the length of the hamstrings pre-sport activity and should be utilised by sports physiotherapists if deemed necessary and beneficial following initial assessment