Psychosocial rehabilitation in a chronic care hospital in South Africa: views of clinical staff

Objective: The study was based at a South African hospital providing inpatient care for people with chronic mental disorders, and aimed at investigating the multidisciplinary team (MDT) members’ views, understanding and attitudes towards psychosocial rehabilitation (PSR). Method: A survey method was used, with the MDT members completing a questionnaire that tapped, inter alia, their understanding of PSR, perceived aims and goals of PSR, adequacy of their professional training to  implement PSR, availability of resources to implement PSR, and their views of chronic mentally ill patients, including their functional skills, needs and prognosis.Results: Of 114 respondents, 19.3% felt they had sufficient knowledge of PSR practice, 53.5% reported that their professional training included teaching on PSR, 90.4% wanted to undertake further training in PSR, 64.9% believed that the hospital environment lends itself to PSR, and 23.7% felt the hospital had sufficient resources to perform PSR. Most (93%) believed that patients with chronic mental disorders can improve their functioning, and 65.8% thought that such patients could make decisions for themselves. Conclusion: It is not surprising that most of the clinical staff in this investigation do not feel sufficiently equipped to perform PSR interventions, considering that past mental health policies and training failed to emphasize this component of mental health care. The need for training programmes to address this deficit is evident.Keywords: Psychosocial rehabilitation; Mental disorder; Mental illness; Ppsychosis; Mental healt

Cost and impact of scaling up interventions to save lives of mothers and children: taking South Africa closer to MDGs 4 and 5

KIMBACKGROUND:South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved. DESIGN: We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%. RESULTS:By 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23

Non-fatal suicidal behaviour in women - the role of spousal substance abuse and marital violence

Objective. To investigate the precipitants of non-fatal suicidal behaviour in women using a gender-based comparison.Design. A retrospective analysis of case records. Data were analysed using chi-square tests of significance.Subjects. One hundred men and 100 women admitted for non-fatal suicidal behaviour at a general hospital. Outcome measures. Subjects' biographical details and self reports of precipitating factors such as marital conflict, spousal extramarital affairs, alcohol abuse and marital violence.Results. Significantly more married women than men cited spousal extramarital affairs, spousal alcohol abuse and marital violence as precipitants of their self-destructive behaviours.Conclusion. The findings emphasise the role of spousal behaviour and resultant stress in precipitating non-fatal suicidal behaviour in women. Preventive efforts must focus on the psychological, social and economic empowerment of women

Pharmacological treatment of painful HIVassociated sensory neuropathy

Background. HIV-associated sensory neuropathy (HIV-SN) is a common and frequently painful  complication of HIV infection and its treatment. However, few data exist describing the frequency, type and dosage of pain medications patients are receiving in the clinic setting to manage the painful symptoms of HIV-SN.Objective. To report on analgesic prescription for painful HIV-SN and factors influencing that prescription in adults on combination antiretroviral therapy.Methods. Using validated case ascertainment criteria to identify patients with painful HIV-SN, we  recruited 130 HIV-positive patients with painful HIV-SN at Chris Hani Baragwanath Hospital,  Johannesburg, South Africa. Demographic and clinical data (including current analgesic use) were collected on direct questioning of the patients and review of the medical files.Results. We found significant associations, of moderate effect size, between higher pain intensity and lower CD4 T-cell counts with prescription of analgesic therapy. Factors previously identified as predicting analgesic treatment in HIV-positive individuals (age, gender, level of education) were not associated with analgesic use here. Consistent with national guidelines, amitriptyline was the most commonly used agent, either alone or in combination therapy. Importantly, we also found that despite the relatively high analgesic treatment rate in this setting, the majority of patients described their current level of HIV-SN pain as moderate or severe.Conclusion. Our findings highlight the urgent need for both better analgesic options for HIV-SN pain  treatment and ongoing training and support of clinicians managing this common and debilitating condition

Development of a selective fluorimetric technique for rapid trace determination of zinc using 3-hydroxyflavone

AbstractA sensitive and a selective spectrofluorimetric method have been developed for the rapid determination of trace levels of zinc. The method is based on complex formation between zinc and 3-hydroxyflavone (3HF), which displays an intense emission signal around 478nm. The analytical performance of the method was examined by considering the factors that affect the complex formation such as pH, mole ratio of the metal and solvent type. The optimum conditions for the complex formation were metal to ligand stoichiometric ratio of 1:1 at pH 7.5 with 0.1M Tris buffer. Under these conditions the detection limit attained was 1.5ppb. The method was appropriately validated and yielded relative standard deviations of less than 2% (n=5), which was considered acceptable. It was successfully applied to the trace determination of zinc in drinking water, hair shampoo and pharmaceutical samples

New imaging approaches for improving diagnosis of childhood tuberculosis

K

Evaluation of a global blended learning MBA programme

This paper evaluates the design and implementation of a UK university’s global blended learning MBA programme which combines e-learning with face-to-face teaching. The primary aim of the research was to investigate the learning experience and perceptions of the students, and to use the findings to evaluate the effectiveness of the course design and delivery system. Action research was used, with longitudinal data collected over a threeyear period (2008–2010). Three survey rounds were conducted focussing on Oman, one of the UK University’s main overseas learning collaborating centres. The three rounds yielded 116 valid responses in total. The first survey showed a fairly high level of student satisfaction with the programme but also indicated areas that needed further improvement. The impacts of subsequent changes in the programme were investigated in the second and third surveys. Feedback from these helped develop further changes in the learning content and delivery approach of the programme. The study contributes to a better understanding of global blended learning initiatives, and offers insights to managers on improving course management, enriching learning content, enhancing teaching quality, and improving students’ satisfaction levels

Operational Research in Education

Operational Research (OR) techniques have been applied, from the early stages of the discipline, to a wide variety of issues in education. At the government level, these include questions of what resources should be allocated to education as a whole and how these should be divided amongst the individual sectors of education and the institutions within the sectors. Another pertinent issue concerns the efficient operation of institutions, how to measure it, and whether resource allocation can be used to incentivise efficiency savings. Local governments, as well as being concerned with issues of resource allocation, may also need to make decisions regarding, for example, the creation and location of new institutions or closure of existing ones, as well as the day-to-day logistics of getting pupils to schools. Issues of concern for managers within schools and colleges include allocating the budgets, scheduling lessons and the assignment of students to courses. This survey provides an overview of the diverse problems faced by government, managers and consumers of education, and the OR techniques which have typically been applied in an effort to improve operations and provide solutions

Knowledge of breast cancer and its early detection measures among rural women in Akinyele Local Government Area, Ibadan, Nigeria

BACKGROUND: Breast cancer is the commonest cancer among women in Nigeria and globally. In Nigeria, late presentations of breast cancer cases have also been consistent for three decades. In an environment where there is no established national screening program for breast cancer, it is pertinent to assess the knowledge of breast cancer and its early detection measures. The objective of this study therefore, was to assess rural women's level of knowledge of breast cancer and its early detection measures. METHODS: The knowledge of various aspects of breast cancer; etiology, early warning signs, treatment modes and early detection measures; was assessed among women in two randomly selected health districts in Akinyele Local Government in Ibadan. The assessment was performed with the use of a self-structured validated questionnaire administered by trained interviewers to 420 women randomly selected from the two health districts. The various aspects of facts about breast cancer were scored and added together to determine respondents' level of knowledge RESULTS: The mean score of knowledge of breast cancer was 55.4 SD 5.4 (range of scores obtainable was 26–78), while the mean score for knowledge of early detection of breast cancer was 24.8 SD 2.3 (range of scores obtainable was 12–36). The leading source of information about breast cancer was "elders, neighbors and friends" and 63(15.4%) acknowledged this source, while only 18 (4.4%) respondents acknowledged health workers as source. Only 54 (13.3%) claimed to have heard about breast self- examination (BSE) however, and the leading source of information about BSE were health workers. Nine (2.2%) of respondents claimed this source. CONCLUSION: This study revealed that respondents lacked knowledge of vital issues about breast cancer and early detection measures. It also revealed that health workers were not forthcoming with information to the public thereby constituting a challenge to community health nurses and other health workers, to provide vital information to the public