Communication about HIV and death: Maternal reports of primary school-aged children's questions after maternal HIV disclosure in rural South Africa

Introduction: Children's understanding of HIV and death in epidemic regions is under-researched. We investigated children's death-related questions post maternal HIV-disclosure. Secondary aims examined characteristics associated with death-related questions and consequences for children's mental health. Methods: HIV-infected mothers (N = 281) were supported to disclose their HIV status to their children (6–10 years) in an uncontrolled pre-post intervention evaluation. Children's questions post-disclosure were collected by maternal report, 1–2 weeks post-disclosure. 61/281 children asked 88 death-related questions, which were analysed qualitatively. Logistic regression analyses examined characteristics associated with death-related questions. Using the parent-report Child Behaviour Checklist (CBCL), linear regression analysis examined differences in total CBCL problems by group, controlling for baseline. Results: Children's questions were grouped into three themes: ‘threats’; ‘implications’ and ‘clarifications’. Children were most concerned about the threat of death, mother's survival, and prior family deaths. In multivariate analysis variables significantly associated with asking death-related questions included an absence of regular remittance to the mother (AOR 0.25 [CI 0.10, 0.59] p = 0.002), mother reporting the child's initial reaction to disclosure being “frightened” (AOR 6.57 [CI 2.75, 15.70] p=<0.001) and level of disclosure (full/partial) to the child (AOR 2.55 [CI 1.28, 5.06] p = 0.008). Controlling for significant variables and baseline, all children showed improvements on the CBCL post-intervention; with no significant differences on total problems scores post-intervention (β -0.096 SE1.366 t = -0.07 p = 0.944). Discussion: The content of questions children asked following disclosure indicate some understanding of HIV and, for almost a third of children, its potential consequence for parental death. Level of maternal disclosure and stability of financial support to the family may facilitate or inhibit discussions about death post-disclosure. Communication about death did not have immediate negative consequences on child behaviour according to maternal report. Conclusion: In sub-Saharan Africa, given exposure to death at young ages, meeting children's informational needs could increase their resilience

Do we assess what we set out to teach in obstetrics: An action research study

Background. Medical education empowers students to transform theoretical knowledge into practice. Assessment of knowledge, skills and attitudes determines students’ competency to practice. Assessment methods have been adapted, but not evaluated, to accommodate educational challenges. Objectives. To evaluate whether assessment criteria align with obstetrics learning outcomes. Methods. We conducted a collaborative action research study, in which we reviewed and analysed learning outcomes and assessments according to Bigg’s model of constructive alignment. Data were analysed as per levels of Bloom’s taxonomy. Results. Final-year students have two 3-week modules in obstetrics, with 75% overlap in learning outcomes and assessments. Ninety-five percent of learning outcomes were poorly defined, and 11 - 22% were inappropriately assessed. Summative assessments were comprehensive, but continuous assessments were rudimentary without clear educational benefit. There is a deficiency in assessment of clinical skills and competencies, as assessments have been adapted to accommodate patient confidentiality and increasing student numbers. The lack of good assessment practice compromises the validity of assessments, resulting in assessments that do not focus on higher levels of thinking. Conclusion. There was poor alignment between assessment and outcomes. Combining the obstetrics modules, and reviewing learning outcomes and assessments as a single entity, will improve the authenticity of assessments

Making Antibiotic Choices: Formula Derivation and Usage in the Rational Selection of Antibiotics in the Empirical Treatment of Infections

Purpose: To develop mathematical formulae to aid the selection of antibiotics most appropriate in the empirical treatment of infections.Methods: Formulae quantifying the characteristics of antibiotics with regard to their cost and activity against associated bacterial isolates of given infections were derived from probability laws. Data from records of culture sensitivity test results were compiled and analysed to ascertain bacterial pathogen associations with infections and their sensitivities to prescribed antibiotics. Applicability of derived formulae was demonstrated in the rational selection of antibiotics most appropriate in the empirical treatment of urinary tract infections (UTIs) in selected hospitals in Lesotho.Results: Escherichia. coli, followed by Klebsiella spp, Proteus spp, non-haemolytic Streptococci, Streptococcus pyogenes and then, Pseudomonas spp were identified as the most common uropathogens at the hospitals studied. Two mathematical formulae were derived and used in quantifying activity and cost characteristics of prescribed antibiotics. Cefotaxime, followed by ciprofloxacin - were considered most appropriate for use in treating UTIs empirically among inpatients of the hospitals.Conclusion: Quantifying and using procedurally antibacterial activities and cost characteristics of antibiotics provides a suitable means of making antibiotic choices in the empirical treatment of infections.Keywords: Antibiotics, Derived formulae, Rational selection, Empiric treatment, Urinary tract infection, Lesotho

Allergic fungal sinusitis secondary to Acremonium species causing unilateral visual loss

A wide range of fungi have been associated with Allergic Fungal Sinusitis (AFS) or Eosinophilic fungal rhinosinusitis ( EFRS) as it is known in some institutions. To our knowledge, this is the first reported case of aggressive, invasive AFS due to Acremonium species occurring in an immunocompetent patient and leading to unilateral visual loss. Literature on AFS is reviewed.Key words: Eosinophilic fungal rhinosinusitis, Allergic fungal sinusitis, Acremonium species, visual loss

Autotransplantation of the lung: experimental studies on the cape baboon

Autotransplantation of the left lung was performed on 15 adult baboons with an 8-day survival rate of 80% and a long-term survival rate of 60%. On 5 of the survivors a subsequent contralateral pneumonectomy was performed without mortality. Most deaths occurred early in the series due to technical problems. A surgical technique has been standardized and with further experience in this field the mortality associated with autotransplantation of the lung in baboons should be less than 10%. Xenon-l33 ventilation-perfusion studies of the transplanted lung demonstrated a significant reduction in perfusion, and to a lesser extent of ventilation. Ventilation rapidly recovered towards normal but perfusion only approached normal values several months after transplantation. These physiological alterations may be due to the denervation attendant upon complete removal of tlu lung with reimplantation. The jilt! imbalance does not appear to be of major consequence when a contralateral pneumonectomy is performed. The autotransplanted lung appears to be a valuable model for studying the effects of lung transplantation alone, without the problems of rejection. These studies seem to be particularly valuable in the primate who closely resembles the human anatomically and physiologically. Further studies are currently in progress

Examining the link between the antecedents of relationship commitment and loyalty within the road transport industry of South Africa

Abstract: The study investigates the extent to which the relationship commitment by customers of road transport service providers is influenced by trust, communication, shared values and the attractiveness of alternatives. In turn, the influence of the extent of their commitment towards future loyalty is determined. Design/methodology/approach – An explanatory research design was followed and data was collected from road transport service provider customers using self-administered questionnaires. A total of 120 responses were suitable for analysis. Multiple regression analysis as well as the one-way analysis of variance (ANOVA) technique was used to analyse the results and to uncover the interrelationships between constructs..

Comparison of adherence measures using claims data in the South African private health sector

Background. Medication adherence measurement is becoming increasingly important. Biological assays and markers, directly observed therapy, self-reports, pill counts and surveys have been successfully used to assess adherence under various circumstances, but may be limited by cost, ethical concerns and self-reported bias. Administrative claims data, in addition to offering a solution to these limitations, provide access to large study populations under real clinical practice situations, and in a timely and effective manner. With the wide range of adherence measures determined from claims data available – some of which have been found to be mathematically equivalent – researchers are often faced with the decision of choosing which is appropriate. An assessment of the various measures is therefore important for better understanding and to facilitate future adherence studies using administrative data.Objectives. To compare different adherence measures using data from a medicines claims database in South Africa (SA), employing montelukast for the purpose of illustration.Methods. This retrospective, cross-sectional research used data from 1 January 2006 to 31 December 2015 from a privately owned pharmaceutical benefits management (PBM) company in SA. Claims for montelukast were identified and adherence was determined using the continuous multiple-interval measure of oversupply (CMOS), compliance ratio (CR), modified medication possession ratio (MPRm), refill compliance rate (RCR), continuous single-interval measure of medication acquisition (CSA) and proportion of days covered (PDC) capped at 1. The measures were compared with the medication possession ratio (MPR) as the reference.Results. The MPR, CMOS and CR were equivalent, each yielding an adherence value of 86%. The MPRm, RCR and average CSA yielded higher adherence values of 96.9%, 117.2% and 129.0%, respectively, whereas the PDC produced a lower adherence value of 76.0%. The measures that used the entire study period as the denominator produced consistent results compared with the measures that used the difference between claims dates as denominator.Conclusions. The MPR is considered the most widely used metric to measure adherence using administrative data, but it may not always be applicable owing to the type of data available. Adherence computed using the CR, CMOS and PDC capped was found to be comparable to the MPR, and they may therefore be used as alternatives.

Professionele aanspreeklikheid van ouditeure teenoor derdes op grond van nalatigheid

People in the professional occupations such as auditors, lawyers, architects and engineers have a duty to treat their clients with solicitude. This duty arises from the nature of their calling and from the professional service that they offer their clients. This has led to the situation where members of the professions have increasingly been held responsible for damage suffered by third parties as a result of the neglect of their professionally inherent obligation of solicitude. Fraud scandals, such as those of Enron in the USA and Masterbond, PSC Guaranteed Growth and Tigon locally, have once again caused the focus to fall upon the professional responsibility of auditors.The question that is increasingly being asked is: when and under what circumstances will an auditor be held responsible towards a third party in his professional capacity for the negligent performance of his duties? For the purposes of this article, the focus will only be placed on the responsibility of the auditor on the grounds of his duty to report in terms of section 300 of the Companies Act. The distinctive rules and also the specific application of the general principles of delict in such cases are discussed in this article

TOR1A mutation-related isolated childhood-onset generalised dystonia in South Africa

Background. Childhood-onset generalised dystonia is commonly caused by TOR1A mutations and is known to respond well to pallidal deep-brain stimulation (DBS) surgery. The incidence and prevalence of monogenic dystonia in individuals from Africa and specifically of African ancestry are unknown, and no local cases of TOR1A mutation dystonia are found in the literature.Objectives. To describe our experience with the outcome of TOR1A mutation-positive patients with isolated generalised dystonia (IGD) of childhood onset who were treated with pallidal DBS.Methods. All patients with TOR1A mutations from Steve Biko Academic Hospital and the Pretoria Neurology Institute in Pretoria, South Africa (SA), who underwent DBS for IGD of childhood onset were identified. We conducted a retrospective analysis of their demographics, clinical presentation and time to generalisation, genetic status and family history, and response to DBS treatment of the internal segment of the globus pallidus (GPi), utilising pre- and post-surgical scores of the United Dystonia Rating Scale (UDRS).Results. Three patients, all of black African ancestry, were identified. The median age at onset was 12 years and the median time to surgery from dystonia generalisation was 3 years. Two children presented with cervical-onset dystonia. Two patients were related, representing the only two with a positive family history. All three patients had a positive outcome after surgery, with improvement of 67 - 90% on the UDRS recorded at last follow-up.Conclusions. TOR1A mutations are found in SA patients of black African ancestry, with age of onset and generalisation comparable to those described in international studies. However, onset with cervical dystonia was more common than previously reported. Response to GPi DBS was excellent in all patients.