Reasons for doctor migration from South Africa

Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons,medical professionals, often from sub-Saharan Africa, are actively recruited by developed countries. Doctors in South Africa are esteemed for the highstandard of training they receive locally, a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has, however, been reported extensively that push factors usually play a much greater role in doctors’ decision to leave their countries of origin, than do pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions, high levels of crime and violence, political instability, lack of future prospects, HIV/AIDS and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled  individuals, source countries also face substantial monetary implications caused by the migration of doctors. Government subsidy of medical students’ training could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who had emigrated from South Africa.Methods: The investigation was conducted in 2005 as a descriptive study of participants found primarily by the snowball sampling method. Theinitial participants were known to the researcher. Participants had to be graduates from South African medical schools/faculties, living abroad andin possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information,consent letters and questionnaires were either hand-delivered or e-mailed, and completed forms and questionnaires were returned via these routes.Participation was voluntary.Results: Twenty-nine of 43 potential participants responded, of which 79.3% were male and 20.7% female between the ages of 28 and 64 years(median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985), and the year of leaving the country ranged from 1993 to 2005 (median 2002). The majority (72.4%) were in private practice before they left, 27.5% had public service appointments and 17.3% were employed by private hospitals. Seventy-nine per cent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand, United Arab Emirates, Bahrain, United Kingdom, Canada, Yemen and Australia. Forty-one per cent of respondents indicated that they would encourage South African young people to study medicine, although 75% would recommend newly graduated doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2% of the respondents, better job opportunities by 79.3%, and the high crime rate in South Africa by 75.9%. Only 50% of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country.Approximately one-fifth (17.9%) of the respondents indicated that they already had family abroad by the time they decided to emigrate.Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations,followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously, theresults presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa thanbefore. In order to prevent the loss of medical expertise from a society already in need of quality healthcare, issues compelling doctors to look forgreener pastures should be addressed urgently and aggressively by stakeholders

The prevalence and perception of obesity and its association with the lifestyle of women at the Mangaung University Community Partnership Project healthcare centre, Bloemfontein

Background: This investigation was prompted by the increase of obesity in developing countries with the simultaneous increased risk of preventable noncommunicable diseases. We aimed to determine the prevalence of obesity among women serving a predominantly black peri-urban community, who visited a healthcare centre in Bloemfontein. We also wanted to establish their perceived weight status, and any correlation between obesity, level of education, employment status and monthly income. Method: A cross-sectional analytical design was used. In June 2007, clinic-attending women aged 18-50 years were selected by a systematic sampling method to participate in the study. A self-administered questionnaire investigated participants’ socio-economic status, body image perception, psychological well-being, self-reported health status and physical activity. Body mass indices (BMIs) were calculated from weight and height measurements. Results: A total of 304 women completed the study, of whom 98 (32.2%) were overweight and 134 (44.1%) were obese, with a mean BMI of 30.1 kg/m2 [standard deviation (SD) 6.9 kg/m2]. More than half (53.4%) of the obese women perceived themselves as not obese. Approximately 84% of the participants were educated to secondary level, or higher. A significant difference in the employment status of the obese and non-obese participants (26.9% and 16.5% employed, respectively) was noted (p-value = 0.0013). The obese participants reported significantly less low self-esteem (29.5%) than the nonobese participants (42.4%) (p-value = 0.0250). Conclusion: The high prevalence of overweight and obesity, and the fact that 53.4% of the obese participants did not perceive themselves as such, poses a challenge for healthcare providers. Health-promotion strategies should aim to inform women about the health risks of overweight and obesity, and address misconceptions regarding perceived weight status.Keywords: overweight, obesity, women, socio-economic status, perceived weight statu

Revival of the magnetar PSR J1622-4950: observations with MeerKAT, Parkes, XMM-Newton, Swift, Chandra, and NuSTAR

New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100x larger than during its dormant state. The X-ray flux one month after reactivation was at least 800x larger than during quiescence, and has been decaying exponentially on a 111+/-19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.Comment: Published in ApJ (2018 April 5); 13 pages, 4 figure

A Hierarchical Probabilistic Model for Rapid Object Categorization in Natural Scenes

Humans can categorize objects in complex natural scenes within 100–150 ms. This amazing ability of rapid categorization has motivated many computational models. Most of these models require extensive training to obtain a decision boundary in a very high dimensional (e.g., ∼6,000 in a leading model) feature space and often categorize objects in natural scenes by categorizing the context that co-occurs with objects when objects do not occupy large portions of the scenes. It is thus unclear how humans achieve rapid scene categorization

Transcriptome-wide association study reveals candidate causal genes for lung cancer.

We have recently completed the largest GWAS on lung cancer including 29,266 cases and 56,450 controls of European descent. The goal of our study has been to integrate the complete GWAS results with a large-scale expression quantitative trait loci (eQTL) mapping study in human lung tissues (n = 1,038) to identify candidate causal genes for lung cancer. We performed transcriptome-wide association study (TWAS) for lung cancer overall, by histology (adenocarcinoma, squamous cell carcinoma and small cell lung cancer) and smoking subgroups (never- and ever-smokers). We performed replication analysis using lung data from the Genotype-Tissue Expression (GTEx) project. DNA damage assays were performed in human lung fibroblasts for selected TWAS genes. As expected, the main TWAS signal for all histological subtypes and ever-smokers was on chromosome 15q25. The gene most strongly associated with lung cancer at this locus using the TWAS approach was IREB2 (pTWAS = 1.09E-99), where lower predicted expression increased lung cancer risk. A new lung adenocarcinoma susceptibility locus was revealed on 9p13.3 and associated with higher predicted expression of AQP3 (pTWAS = 3.72E-6). Among the 45 previously described lung cancer GWAS loci, we mapped candidate target gene for 17 of them. The association AQP3-adenocarcinoma on 9p13.3 was replicated using GTEx (pTWAS = 6.55E-5). Consistent with the effect of risk alleles on gene expression levels, IREB2 knockdown and AQP3 overproduction promote endogenous DNA damage. These findings indicate genes whose expression in lung tissue directly influences lung cancer risk

Calibration and performance of the ISO Long-Wavelength Spectrometer

The wavelength and flux calibration, and the in-orbit performance of the Infrared Space Observatory Long-Wavelength Spectrometer (LWS) are described. The LWS calibration is mostly complete and the instrument's performance in orbit is largely as expected before launch. The effects of ionising radiation on the detectors, and the techniques used to minimise them are outlined. The overall sensitivity figures achieved in practice are summarised. The standard processing of LWS data is described

Comparative determination of HIV-1 co-receptor tropism by Enhanced Sensitivity Trofile, gp120 V3-loop RNA and DNA genotyping

BACKGROUND: Trofile is the prospectively validated HIV-1 tropism assay. Its use is limited by high costs, long turn-around time, and inability to test patients with very low or undetectable viremia. We aimed at assessing the efficiency of population genotypic assays based on gp120 V3-loop sequencing for the determination of tropism in plasma viral RNA and in whole-blood viral DNA. Contemporary and follow-up plasma and whole-blood samples from patients undergoing tropism testing via the enhanced sensitivity Trofile (ESTA) were collected. Clinical and clonal geno2pheno[coreceptor] (G2P) models at 10% and at optimised 5.7% false positive rate cutoff were evaluated using viral DNA and RNA samples, compared against each other and ESTA, using Cohen's kappa, phylogenetic analysis, and area under the receiver operating characteristic (AUROC). RESULTS: Both clinical and clonal G2P (with different false positive rates) showed good performances in predicting the ESTA outcome (for V3 RNA-based clinical G2P at 10% false positive rate AUROC = 0.83, sensitivity = 90%, specificity = 75%). The rate of agreement between DNA- and RNA-based clinical G2P was fair (kappa = 0.74, p < 0.0001), and DNA-based clinical G2P accurately predicted the plasma ESTA (AUROC = 0.86). Significant differences in the viral populations were detected when comparing inter/intra patient diversity of viral DNA with RNA sequences. CONCLUSIONS: Plasma HIV RNA or whole-blood HIV DNA V3-loop sequencing interpreted with clinical G2P is cheap and can be a good surrogate for ESTA. Although there may be differences among viral RNA and DNA populations in the same host, DNA-based G2P may be used as an indication of viral tropism in patients with undetectable plasma viremia

The ISO long-wavelength spectrometer

The Long-Wavelength Spectrometer (LWS) is one of two complementary spectrometers aboard the European Space Agency's Infrared Space Observatory (ISO) (Kessler et al., 1996A&A...315L..49D). It operates over the wavelength range 43-196.9μm at either medium (about 150 to 200) or high (6800 to 9700) spectral resolving power. This Letter describes the instrument and its modes of operation; a companion paper (Swinyard et al, 1996) describes its performance and calibration

Synchrotron radiation-based experimental determination of the optimal energy for cell radiotoxicity enhancement following photoelectric effect on stable iodinated compounds

This study was designed to experimentally evaluate the optimal X-ray energy for increasing the radiation energy absorbed in tumours loaded with iodinated compounds, using the photoelectric effect. SQ20B human cells were irradiated with synchrotron monochromatic beam tuned at 32.8, 33.5, 50 and 70 keV. Two cell treatments were compared to the control: cells suspended in 10 mg ml1 of iodine radiological contrast agent or cells pre-exposed with 10 mM of iodo-desoxyuridine (IUdR) for 48 h. Our radiobiological end point was clonogenic cell survival. Cells irradiated with both iodine compounds exhibited a radiation sensitisation enhancement. Moreover, it was energy dependent, with a maximum at 50 keV. At this energy, the sensitisation calculated at 10% survival was equal to 2.03 for cells suspended in iodinated contrast agent and 2.60 for IUdR. Cells pretreated with IUdR had higher sensitisation factors over the energy range than for those suspended in iodine contrast agent. Also, their survival curves presented no shoulder, suggesting complex lethal damages from Auger electrons. Our results confirm the existence of the 50 keV energy optimum for a binary therapeutic irradiation based on the presence of stable iodine in tumours and an external irradiation. Monochromatic synchrotron radiotherapy concept is hence proposed for increasing the differential effect between healthy and cancerous tissue irradiation

Genetically defined elevated homocysteine levels do not result in widespread changes of DNA methylation in leukocytes

BACKGROUND:DNA methylation is affected by the activities of the key enzymes and intermediate metabolites of the one-carbon pathway, one of which involves homocysteine. We investigated the effect of the well-known genetic variant associated with mildly elevated homocysteine: MTHFR 677C>T independently and in combination with other homocysteine-associated variants, on genome-wide leukocyte DNA-methylation. METHODS:Methylation levels were assessed using Illumina 450k arrays on 9,894 individuals of European ancestry from 12 cohort studies. Linear-mixed-models were used to study the association of additive MTHFR 677C>T and genetic-risk score (GRS) based on 18 homocysteine-associated SNPs, with genome-wide methylation. RESULTS:Meta-analysis revealed that the MTHFR 677C>T variant was associated with 35 CpG sites in cis, and the GRS showed association with 113 CpG sites near the homocysteine-associated variants. Genome-wide analysis revealed that the MTHFR 677C>T variant was associated with 1 trans-CpG (nearest gene ZNF184), while the GRS model showed association with 5 significant trans-CpGs annotated to nearest genes PTF1A, MRPL55, CTDSP2, CRYM and FKBP5. CONCLUSIONS:Our results do not show widespread changes in DNA-methylation across the genome, and therefore do not support the hypothesis that mildly elevated homocysteine is associated with widespread methylation changes in leukocytes