Stigma, treatment beliefs, and substance abuse treatment use in historically disadvantaged communities

Objective: Access to substance abuse treatment among historically disadvantaged communities (HDCs) in Cape Town, South Africa is limited, despite a growing demand for services. Although research has reported on structural barriers to treatment access, nonstructural factors remain largely unexplored. The aim of this paper is to describe two nonstructural influences on the use of substance abuse treatment services for people from HDCs: stigma and negative beliefs about treatment. Method: Findings from the qualitative component of a multi-method study are reported. In-depth interviews were conducted with 20 key informants, all of whom worked or lived in HDCs in the greater Cape Town area. Content and thematic techniques were used to analyse data. Results: According to key informants (i) stigma towards individuals with substance use disorders was prevalent in HDCs and negatively impacted on attempts to access services; (ii) negative beliefs about the quality and effectiveness of treatment were commonplace and acted as barriers to the use of existing services; and (iii) several factors contributed to these nonstructural barriers including media representations of both individuals with substance use disorders and treatment facilities for these disorders. Conclusion: This paper moves beyond the description of structural barriers to treatment to describe how two nonstructural factors, stigma and negative beliefs about treatment, hinder treatment seeking for substance use disorders. Recommendations for addressing these barriers include efforts to (i) shift discourses about substance abuse treatment, (ii) improve service quality, and (iii) address myths and misconceptions about treatment

Stigma, treatment beliefs, and substance abuse treatment use in historically disadvantaged communities

Objective: Access to substance abuse treatment among historically disadvantaged communities (HDCs) in Cape Town, South Africa is limited, despite a growing demand for services. Although research has reported on structural barriers to treatment access, nonstructural factors remain largely unexplored. The aim of this paper is to describe two nonstructural influences on the use of substance abuse treatment services for people from HDCs: stigma and negative beliefs about treatment. Method: Findings from the qualitative component of a multi-method study are reported. In-depth interviews were conducted with 20 key informants, all of whom worked or lived in HDCs in the greater Cape Town area. Content and thematic techniques were used to analyse data. Results: According to key informants (i) stigma towards individuals with  substance use disorders was prevalent in HDCs and negatively impacted on attempts to access services; (ii) negative beliefs about the quality and effectiveness of treatment were commonplace and acted as barriers to the use of existing services; and (iii) several factors contributed to these nonstructural barriers including media representations of both individuals with substance use disorders and treatment facilities for these disorders. Conclusion: This paper moves beyond the description of structural barriers to treatment to describe how two nonstructural factors, stigma and negative beliefs about treatment, hinder treatment seeking for substance use disorders. Recommendations for addressing these barriers include efforts to (i) shift discourses about substance abuse treatment, (ii) improve service quality, and (iii) address myths and misconceptions about treatment

Examining the impact of HIV&AIDS on South African educators

Our aim in this study was to examine the impact of HIV&AIDS on South African educators. A cross-sectional survey was conducted in public schools combining HIV testing and a face-to-face interview with participants from a nationally representative sample of public educators. The results show that HIV is highly prevalent among South African public educators (12.7%) and the educators who are absent from school for longer periods (20 days or more) compared with those who are absent for less than four days have higher HIV prevalence (16.8% vs 11.95%). Educators also spend time away from teaching while they attend funerals for colleagues who have died (6.7%), for family members (13.4%) and for members of their communities (47.6%). This makes them feel depressed (71%). These results suggest that HIV&AIDS has an impact on the quality of education. There is a need to prevent new HIV infections and reduce morbidity through the implementation of comprehensive integrated prevention and treatment programmes targeted at educators. There is also a need to support educators in coping with the problem of HIV&AIDS at work and in the community

Thrombotic disorders (part 1)

Thromboembolic conditions are the leading cause of mortality, estimated to account for 1 in 4 deaths worldwide in 2010. Over time, the incidence and mortality rates of these conditions have improved in developed countries, but are increasing in developing countries. The haemostatic system comprises 6 main components, i.e. (i) platelets; (ii) vascular endothelium; (iii) coagulation proteins; (iv) natural anticoagulants; (v) the fibrinolytic system; and (vi) natural antifibrinolytic factors. A delicate balance exists between procoagulant and anticoagulant factors within the vascular system. Numerous acquired or inherited conditions may tip the balance either way, i.e. towards a prothrombotic or prohaemorrhagic state. In this issue of CME, the first of a 2-part series on thrombophilic disorders, the subject of discussion is on inherited varieties that the general practitioner is likely to encounter. This review is primarily based on venous thrombosis

Assessing user behaviour and acceptance in real-world automated driving: the L3Pilot project approach

The L3Pilot project, funded by H2020, is conducting the first large-scale piloting of SAE Level 3 automated driving in Europe. The main aim of the project is to address a number of key questions in a step towards introducing automated vehicles on European roads. This paper discusses the approach taken by the L3Pilot project, to evaluate user behaviour in, and acceptance of, automated driving in real-world pilots. Although some technical challenges associated with the development and demonstration of such technologies are well-documented, current methodologies, such as those used to evaluate Field Operational Tests (FOTs), offer little guidance about assessing the impact of automated driving on users’ behaviour and acceptance. This paper outlines the methods used and developed for assessing user behaviour and acceptance within the project, summarises some of the methodological challenges involved in collecting data during an automated driving pilot, and discusses some approaches we have developed to solve these multifaceted challenges

Core competencies required by toxicology graduates in order to function effectively in a Poisons Information Centre : a Delphi study

CITATION: Marks, C. J., Louw, A. J. N. & Couper, I. 2020. Core competencies required by toxicology graduates in order to function effectively in a Poisons Information Centre : a Delphi study. African Journal of Emergency Medicine, 10(4):73-180, doi:10.1016/j.afjem.2020.05.011.The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicineIntroduction The availability of trained Medical Toxicologists in developing countries is limited and education in Medical Toxicology remains inadequate. The lack of toxicology services contributes to a knowledge gap in the management of poisonings. A need existed to investigate the core competencies required by toxicology graduates to effectively operate in a Poisons Information Centre. The aim of this study was to obtain consensus from an expert group of health care workers on these core competencies. This was done by making use of the Delphi technique. Methodology The Delphi survey started with a set of carefully selected questions drawn from various sources including a literature review and exploration of existing curricula. To capture the collective opinion of experts in South Africa, Africa and also globally, three different groups were invited to participate in the study. To build and manage the questionnaire, the secure Research Electronic Data Capture (REDCap) web platform was used. Results A total of 134 competencies were selected for the three rounds and in the end consensus was reached on 118 (88%) items. Panel members agreed that 113 (96%) of these items should be incorporated in a Medical Toxicology curriculum and five (4%) should be excluded. Discussion All participants agreed that effective communication is an essential skill for toxicology graduates. The curriculum can address this problem by including effective pedagogy to enhance oral and written communication skills. Feedback from panellists indicated that the questionnaires were country-specific and not necessarily representative of all geographical locations. This is an example of the ‘battle of curriculum design’ where the context in which the curriculum will be used, will determine the content. Conclusion The Delphi method, based on three iterative rounds and feedback from experts, was effective in reaching consensus on the learning outcomes of a Medical Toxicology curriculum. The study results will ultimately improve education in Medical Toxicology.https://www.sciencedirect.com/science/article/pii/S2211419X20300513?via%3DihubPublisher’s versio

Chitosan polyplex mediated delivery of miRNA-124 reduces activation of microglial cells in vitro and in rat models of spinal cord injury

AbstractTraumatic injury to the central nervous system (CNS) is further complicated by an increase in secondary neuronal damage imposed by activated microglia/macrophages. MicroRNA-124 (miR-124) is responsible for mouse monocyte quiescence and reduction of their inflammatory cytokine production. We describe the formulation and ex vivo transfection of chitosan/miR-124 polyplex particles into rat microglia and the resulting reduction of reactive oxygen species (ROS) and TNF-α and lower expression of MHC-II. Upon microinjection into uninjured rat spinal cords, particles formed with Cy3-labeled control sequence RNA, were specifically internalized by OX42 positive macrophages and microglia cells. Alternatively particles injected in the peritoneum were transported by macrophages to the site of spinal cord injury 72h post injection. Microinjections of chitosan/miR-124 particles significantly reduced the number of ED-1 positive macrophages in the injured spinal cord. Taken together, these data present a potential treatment technique to reduce inflammation for a multitude of CNS neurodegenerative conditions.From the Clinical EditorThe treatment of spinal cord injury remains an unresolved problem. Secondary damage is often the result of inflammation caused by activated microglia and/or macrophages. In this article, the authors developed their formulation of chitosan/miR-124 polyplex particles and investigated their use in the suppression of neuronal inflammation. This exciting data may provide a new horizon for patients who suffer from spinal cord injury

Inherited bleeding disorders

Abnormal bleeding is a common clinical presentation in general practice, and a rational approach to this problem is therefore required. Investigation of a suspected bleeding disorder necessitates a comprehensive history, thorough physical examination and systematic laboratory work-up. Inherited bleeding disorders (IBDs) typically manifest in childhood, but may present later in life after a haemostatic challenge (such as trauma, surgery, tooth extraction). This two-part CME series is intended to provide insight to the medical practitioner on the clinical spectrum, diagnosis and management of bleeding disorders. Bleeding due to inherited disorders is the subject of discussion in part 1 (current issue), and in part 2 (forthcoming issue) the focus is on bleeding from acquired causes. Patients diagnosed with an IBD should ideally be referred to a dedicated tertiary healthcare facility, e.g. haemophilia centre, for management and follow-up