Current thoughts on total hip replacement

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Spirit(ed) away: preventing foetal alcohol syndrome with motivational interviewing and cognitve behavioural therapy

Foetal alcohol syndrome (FAS) is a growing concern in South Africa. In the Western Cape, prevalence rates for FAS are the highest in the world. Not surprisingly, the Western Cape also has some of the highest levels of alcohol consumption per capita. Although FAS is primarily caused by alcohol consumption during pregnancy, the high rate of FAS in South Africa originates from a multitude of complex factors. These factors include heritage, poverty, high levels of unemployment and low-paid menial jobs, depression, low self-esteem, low self-efficacy, increased accessibility to alcohol, lack of recreation, poor education, familial pressure, denial, cultural misconceptions and the smaller physiques of some of the women in the Western Cape. Holistic and comprehensive macro- and micro-level approaches are necessary in order to change the alcohol consumption trend that has developed over the last 300 years. No single strategy will reduce or eliminate the burden of alcohol misuse in this society. However, as the presented discussion suggests, combining the spirit of motivational interviewing (MI) with cognitive behavioural therapy (CBT) practice, borrowed from health psychological interventions for lifestyle-related chronic health conditions, holds promise for reducing the prevalence of FAS within Western Cape communities. These individual-based approaches have yet to be employed in South Africa despite the wealth of evidence that demonstrates their potential in targeting high-risk groups and reducing per capita alcohol consumption

Spirit(ed) away: preventing foetal alcohol syndrome with motivational interviewing and cognitive behavioural therapy

Foetal alcohol syndrome (FAS) is a growing concern in South Africa. In the Western Cape, prevalence rates for FAS are the highest in the world. Not surprisingly, the Western Cape also has some of the highest levels of alcohol consumption per capita. Although FAS is primarily caused by alcohol consumption during pregnancy, the high rate of FAS in South Africa originates from a multitude of complex factors. These factors include heritage, poverty, high levels of unemployment and low-paid menial jobs, depression, low self-esteem, low self-efficacy, increased accessibility to alcohol, lack of recreation, poor education, familial pressure, denial, cultural misconceptions and the smaller physiques of some of the women in the Western Cape. Holistic and comprehensive macro- and micro-level approaches are necessary in order to change the alcohol consumption trend that has developed over the last 300 years. No single strategy will reduce or eliminate the burden of alcohol misuse in this society. However, as the presented discussion suggests, combining the spirit of motivational interviewing (MI) with cognitive behavioural therapy (CBT) practice, borrowed from health psychological interventions for lifestyle-related chronic health conditions, holds promise for reducing the prevalence of FAS within Western Cape communities. These individual-based approaches have yet to be employed in South Africa despite the wealth of evidence that demonstrates their potential in targeting high-risk groups and reducing per capita alcohol consumption.Keywords: foetal alcohol syndrome, preventative health, spirit of motivational interviewing, cognitive behaviour therapy, Western Cap

A 5-year profile of the incidence of total joint replacement in South Africa (1985 - 1989)

This survey was conducted to determine the number of total joint replacements (TJRs) carried out annually in South Africa from 1985 to 1989 and the nwnber of surgeons performing these procedures. During this period there was a 28% increase in the number of TJRs performed annually with an average increase of 20% in total hip replacements and 40% in total knee replacements. The number of surgeons involved in joint replacement during the survey period decreased by 7% in state-subsidised institutions but increased by 57% in the private sector. This is reflected in the number of TJRs performed each year, which has remained static in the state institutions but exhibits a threefold increase in the private sector. This probably reflects a shift in emphasis in state health care policy

αvβ3 and α5β1 integrin-specific ligands: From tumor angiogenesis inhibitors to vascularization promoters in regenerative medicine?

Integrins are cell adhesion receptors predominantly important during normal and tumor angiogenesis. A sequence present on several extracellular matrix proteins composed of Arg-Gly-Asp (RGD) has attracted attention due to its role in cell adhesion mediated by integrins. The development of ligands that can bind to integrins involved in tumor angiogenesis and brake disease progression has resulted in new investigational drug entities reaching the clinical trial phase in humans. The use of integrin-specific ligands can be useful for the vascularization of regenerative medicine constructs, which remains a major limitation for translation into clinical practice. In order to enhance vascularization, immobilization of integrin-specific RGD peptidomimetics within constructs is a recommended approach, due to their high specificity and selectivity towards certain desired integrins. This review endeavours to address the potential of peptidomimetic-coated biomaterials as vascular network promoters for regenerative medicine purposes. Clinical studies involving molecules tracking active integrins in cancer angiogenesis and reasons for their failure are also addressed.Prémios Santa Casa Neurociências - Prize Melo e Castro for Spinal Cord Injury Research; Portuguese Foundation for Science and Technology [Doctoral fellowship (PD/BDE/127835/2016) to L. A. Rocha; IF Development Grant to A. J. Salgado; national funds through grant TUBITAK/0007/2014]. This article has been developed under the scope of the projects NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER); This work has been funded by FEDER funds, through the Competitiveness Factors Operational Programme (COMPETE), and by National funds, through the Foundation for Science and Technology (FCT), under the scope of the project POCI-01-0145-FEDER-007038info:eu-repo/semantics/publishedVersio

The effectiveness of using the workplace to identify and address modifiable health risk factors in deprived populations

Objectives To establish whether a programme of targeted health screening, with referral to appropriate interventions, offered to an employed but socioeconomically deprived group was effective in overcoming barriers to uptake of such services and improving a range of surrogate health markers for participants. Methods Low-paid local government employees from socially and economically deprived areas in North-East England were invited to attend a free health check. Health checks were conducted within working hours and close to their worksite, and included assessment of a range of lifestyle and health-related risk factors, including those associated with cardiovascular disease (CVD). A range of additional interventions were offered where indicated. Participants were invited to repeat screening approximately 9 months later. Results 635 (20% response rate) employees in the target age group (≥40 years) attended the first check. Most health risk markers improved in those (N=427) attending both health checks, as did the mean CVD risk score (t=2.86, p=0.004). 269 referrals were made to the intervention programmes. Conclusions This workplace programme had a positive impact on cardiovascular health, but attendance rates were low. These findings suggest that workplace health screening activities may have the potential to improve health in a group often considered hard to reach by other routes, but do not offer a straightforward solution in overcoming barriers to access for such subgroups within the working population

Reproductive Failure in UK Harbour Porpoises Phocoena phocoena : Legacy of Pollutant Exposure?

This research was supported by a Marie Curie International Outgoing Fellowship within the Seventh European Community Framework Programme (Project Cetacean-stressors, PIOF-GA-2010-276145 to PDJ and SM). Additional funding was provided through the Agreement on the Conservation of Small Cetaceans of the Baltic, North East Atlantic, Irish and North Seas (ASCOBANS) (Grants SSFA/2008 and SSFA / ASCOBANS / 2010 / 5 to SM). Analysis of Scottish reproductive and teeth samples was funded by the EC-funded BIOCET project (BIOaccumulation of persistent organic pollutants in small CETaceans in European waters: transport pathways and impact on reproduction, grant EVK3-2000-00027 to GJP), and Marine Scotland (GJP). Samples examined in this research were collected under the collaborative Cetacean Strandings Investigation Programme (http://ukstrandings.org/), which is funded by the Department for Environment, Food and Rural Affairs (Defra) and the UK’s Devolved Administrations in Scotland and Wales (http://sciencesearch.defra.gov.uk/Defaul​t.aspx?Menu=Menu&Module=More&Location=No​ne&Completed=0&ProjectID=15331) (grants to PDJ, RD). UK Defra also funded the chemical analysis under a service-level agreement with the Centre for Environment, Fisheries and Aquaculture Science (grants to RJL, JB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Combined assessment (aspiration cytology and mammography) of clinically suspicious breast masses

We examined the safety and utility of the combined assessment of aspiration cytology and mammography in 705 women who had clinically suspicious or malignant palpable breast masses. Histological assessment confirmed 176 benign and 529 malignant lesions. There were no incorrect (false positive) diagnoses made in the 176 benign masses when combined assessment was used (specificity 1,0; predictive value 0,86); in isolation, however, there was a false positive cytological diagnosis («papillary carcinoma») and 3 false positive mammographic diagnoses. Benign disease (false negative) was incorrectly diagnosed by combined assessment in 4 of the 529 malignant masses (sensitivity 0,99; predictive value 0,98): cytological diagnoses were of fat necrosis (2) and benign cells on cytospin (1) and aspiration biopsy (1); mammographic diagnoses were of benign disease (2) and normality (2). Indeterminate («atypical», «suspicious») diagnoses were problematic and frequent (overall 223 (31,6%), malignant masses 137 (25,9%), benign masses 86 (48,9%); cytology 117 (16,6%), mammography 141 (20%). Thus, with the combined assessment of mammography and cytology in clinically suspicious breast masses, a decisive diagnosis was made in about two-thirds of cases allowing the safe commencement of therapy; the balance of patients required cone or excision biopsy