Preventable deaths among youth in South Africa: Measuring life expectancy in the absence of non-communicable diseases and its implications for the healthcare system

Background. Non-communicable diseases (NCDs) cause premature mortality among youth. Associated with lifestyle and behavioural choices, these diseases and deaths can and should be prevented among young people. This article presents data showing the gains in life expectancy among youth in the absence of NCD causes of death.Objectives. To estimate the levels of NCD mortality among youth (15 - 24 years of age) in South Africa (SA) and show the current and projected additional years of life gained with the elimination of heart disease, cancer and diabetes.Methods. This was a cross-sectional study using 20 years of death notification forms from SA (1997 - 2016). The data were nationally representative and the sample was 62 395 youth deaths (age 15 - 24 years) from the selected NCDs. Cause-specific mortality rates, expressed as percentages, were estimated by age group and sex. Cause-deleted life-table techniques were used to estimate current and projected life expectancy (ex) and life expectancy in the absence of specific NCDs (e–ix).Results. Death rates from NCDs are increasing over time among youth. Total death rates from cancer increased from 1.09% in 1997 - 2001 to 1.51% in 2012 - 2016. Female death rates from heart disease are almost double those for males. The number of additional years of life gained with elimination of these causes ranges from 2.2 to 10.3. Projected life expectancies show that males could gain as much as 1 additional year and females 1.06 years by 2035.Conclusions. Urgent action needs to be taken to prevent further mortality from non-communicable causes among youth. The results of this study are important to the SA healthcare system and to public health practitioners whose aim is to reduce the strain on public resources and reduce mortality among youth. Future studies should estimate the extent of NCD mortality in households and communities with the aim of developing macro-level interventions.

Gendered risk factors associated with self-harm mortality among youth in South Africa, 2006 - 2014

Background. Despite efforts to reduce self-harm mortality, death rates remain high, with almost 12% of all youth deaths in South Africa (SA) attributed to this cause. There are gendered differences in causes of death among youth, but little is known about the sex-specific risk factors.Objective. To identify the levels and sex-specific determinants of self-harm mortality among youth in SA.Methods. This was a cross-sectional study of SA death notification forms from 2006 to 2014. Descriptive and analytical statistical techniques were used, including cause-specific mortality rates, proportional mortality ratios and logistic regression models.Results. A total of 1 122 youth (15 - 24 years of age) deaths due to self-harm causes were reported over the study period, during which rates of self-harm mortality increased. More deaths of males (n=818) than females (n=304) were reported. Almost 60% of deaths (p<0.05) were of 20 - 24-year-olds, and 46.4% (p<0.05) of those who died had a secondary education. Almost 10% of females (p<0.05) were pregnant at the time of death. Hanging was the most common type of self-harm mortality among males (79.2%) and females (49.3%). While 11.0% (n=90) of self-harm deaths of males were due to poisoning, more females used this method (39.8%, n=121). The probability of self-harm mortality for males increased according to certain provinces of residence. For females the odds were higher for those who were pregnant (odds ratio (OR) 1.3; p<0.05) and non-South African (OR 1.7; p<0.05) and had secondary education (OR 1.4; p<0.05).Conclusions. The study showed gender differentials in the determinants of self-harm mortality among youth in SA. For this reason, uniform approaches to awareness campaigns need to be altered to address the specific needs of youth. While males have higher rates than females, the prevalence of self-harm mortality in pregnant females is of concern and needs to be addressed specifically, as it relates not only to suicidal ideation and behaviour but also to youth sexual and reproductive health programmes in the country.

A Highly Scalable Monitoring Tool for Wi-Fi Networks

The paper introduces a monitoring tool that was designed for an existing network of Wi-Fi hotspots. This was done by adding data collection and visualization components to the existing network. Syslog protocol was used for data collection and left running for two months monitoring network’s performance. Google Maps was used for Visualizing overall network’s performance. The tool was tested with experts and it was compared to existing monitoring tools and It was found that the monitoring tool was more scalable and effective than traditional monitoring tools

Wireless Application Middleware

The use of middleware has been acknowledged as the principal means of simplifying distributed applications building in the enterprise. Wireless messaging middleware, in particular, allows loosely coupled distributed components and has emerged as being well suited to the wireless environment. In this paper we present a lightweight wireless messaging middleware solution which addresses the reliability and bandwidth issues associated with wireless links

A standardized necropsy protocol for health investigations of small cetaceansin southern Africa

Globally, the increasing need to conduct both research and surveillance of the health of wild animal populations has been recognized as an important tool in conservation and management. While such studies on terrestrial wildlife are frequent in the southern African sub-region, their counterparts in the marine environment seem to be largely lacking. Here we report on our experience in establishing and testing a standardized necropsy protocol for small cetaceans adapted for the local context, with the specific aim of sampling for health investigations and monitoring. The necessity, challenge and value of regional standardization in data collection specifically aimed at health investigations, inter-disciplinary collaboration, long-term data banking,and sample storage are discussed in addition to practical and safety considerations. The developed protocol, focusing on the necropsy technique and tissue sample collection, as well as a list of required equipment are available as online supplementary material.The National Research Foundation (DFG-NRF collaboration programme grant number 70714 and SEAChange grant number 74241, both awarded to S. Plön).http://www.sawma.co.zaam201

Human factors in general practice: early thoughts on the educational focus for specialty training and beyond

In the third article in the series, we describe the outputs from a series of roundtable discussions by Human Factors experts and General Practice (GP) Educational Supervisors tasked with examining the GP (family medicine) training and work environments through the lens of the systems and designed-centred discipline of Human Factors and Ergonomics (HFE). A prominent issue agreed upon proposes that the GP setting should be viewed as a complex sociotechnical system from a care service and specialty training perspective. Additionally, while the existing GP specialty training curriculum in the United Kingdom (UK) touches on some important HFE concepts, we argue that there are also significant educational gaps that could be addressed (e.g. physical workplace design, work organisation, the design of procedures, decision-making and human reliability) to increase knowledge and skills that are key to understanding workplace complexity and interactions, and supporting everyday efforts to improve the performance and wellbeing of people and organisations. Altogether we propose and illustrate how future HFE content could be enhanced, contexualised and integrated within existing training arrangements, which also serves as a tentative guide in this area for continuing professional development for the wider GP and primary care teams

Buprenorphine versus dihydrocodeine for opiate detoxification in primary care: a randomised controlled trial

Background Many drug users present to primary care requesting detoxification from illicit opiates. There are a number of detoxification agents but no recommended drug of choice. The purpose of this study is to compare buprenorphine with dihydrocodeine for detoxification from illicit opiates in primary care. Methods Open label randomised controlled trial in NHS Primary Care (General Practices), Leeds, UK. Sixty consenting adults using illicit opiates received either daily sublingual buprenorphine or daily oral dihydrocodeine. Reducing regimens for both interventions were at the discretion of prescribing doctor within a standard regimen of not more than 15 days. Primary outcome was abstinence from illicit opiates at final prescription as indicated by a urine sample. Secondary outcomes during detoxification period and at three and six months post detoxification were recorded. Results Only 23% completed the prescribed course of detoxification medication and gave a urine sample on collection of their final prescription. Risk of non-completion of detoxification was reduced if allocated buprenorphine (68% vs 88%, RR 0.58 CI 0.35–0.96, p = 0.065). A higher proportion of people allocated to buprenorphine provided a clean urine sample compared with those who received dihydrocodeine (21% vs 3%, RR 2.06 CI 1.33–3.21, p = 0.028). People allocated to buprenorphine had fewer visits to professional carers during detoxification and more were abstinent at three months (10 vs 4, RR 1.55 CI 0.96–2.52) and six months post detoxification (7 vs 3, RR 1.45 CI 0.84–2.49). Conclusion Informative randomised trials evaluating routine care within the primary care setting are possible amongst drug using populations. This small study generates unique data on commonly used treatment regimens