Rural health and transformation in South Africa

No Abstract. South African Medical Journal Vol. 96(8) 2006: 676-67

The contribution of South African curricula to prepare health professionals for working in rural or under-served areas in South Africa: A peer review evaluation

Setting. The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to examine strategies that would increase the production of health professionals who choose to practise in rural and under-served areas in South Africa. Objectives. We aimed to identify how each faculty is preparing its students for service in rural or under-served areas. Methods. Peer reviews were conducted at all nine participating universities. A case study approach was used, with each peer review constituting its own study but following a common protocol and tools. Each research team comprised at least three reviewers from different universities, and each review was conducted over at least 3 days on site. The participating faculties were assessed on 11 themes, including faculty mission statements, resource allocation, student selection, first exposure of students to rural and under-served areas, length of exposure, practical experience, theoretical input, involvement with the community, relationship with the health service, assessment of students and research and programme evaluation. Results. With a few exceptions, most themes were assessed as inadequate or adequate with respect to the preparation of students for practice in rural or under-served areas after qualification, despite implicit intentions to the contrary at certain faculties. Conclusions. Common challenges, best practices and potential solutions have been identified through this project. Greater priority must be given to supporting rural teaching sites in terms of resources and teaching capacity, in partnership with government agencies

Factors Impacting on Organisational Learning in Three Rural Health Districts

Background: Access to quality health care in rural areas may be compromised not only by the inadequate numbers of skilled professional staff, but also by the lack of skills of the health professionals who are employed in rural facilities, due to inadequate continual professional learning and staff development. The objective of this paper is to examine the factors impacting on professional staff attendance of informal learning sessions in rural district hospitals and primary healthcare clinics.Methods: Structured, self-administered surveys, adapted from the Dimensions of a Learning Organization Questionnaire, were completed byprofessional staff on duty during data collection in 18 rural hospitals and their associated primary healthcare services facilities in three rural districts.The impacts of characteristics of staff, such as age, gender, professional experience and length of service, staffing levels, and the dimensions of alearning organisation, viz leadership, culture of change and teamwork, on attendance of learning sessions were considered.Results: Among professional nurses, attendance of learning sessions was significantly associated with the number of years of professionalexperience, length of service at the health facility, and scores on the teamwork dimension. While in the case of professional nurses attendance was not correlated with the staffing levels, the percentage of posts filled at the respective facilities and the assessment of hospital leadership as being supportive of learning were significant predictors of attendance among doctors.Conclusions: Despite severe staff shortages in these rural districts, at facilities where there was a perception of leadership and teamwork theprofessional staff generally attended learning sessions

The community involvement of nursing and medical practitioners in KwaZulu-Natal

BackgroundThe basis of the health system in South Africa is purported to be primary health care (PHC), as defined by the Alma Ata Declaration of 1978. This approach emphasises community involvement in all health-related activities, but it would appear that a very limited or selective PHC approach is actually being pursued in South Africa, without meaningful community participation or ownership. This study explores the involvement of exemplary medical and nursing clinical practitioners in non-clinical community-wide activities in terms of the primary health care approach, which demands a broader scope of practice than primary medical care.MethodsThe objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. Seventeen primary care clinicians in KwaZulu-Natal, half of whom were professional nurses and the rest medical practitioners, were purposively selected through their district managers. A team of four medical students was trained to collect the data and interviewed the subjects in their places of work using open-ended questions. The interviews were recorded, translated where necessary, and transcribed. Content analysis was carried out as a team, with the identification of major and minor themes.ResultsThe findings of this study were consistent with studies from other countries, with some interesting differences. The major themes that emerged from the data included the wide range of activities that subjects were involved in, the importance of relationships, the context of poverty, the frustrations of this kind of work, and the respondents' motivations. These are illustrated by numerous verbatim quotes from the respondents. Minor themes were the roles that the respondents play in the community, the difficulty of obtaining funding, and experiences in starting up. Significantly, the fact that the role of clinicians in the community emerged as only a minor theme rather than a major theme in this study indicates the absence of expectation and policy in this area of practice in South Africa. In the light of the supposed centrality of the primary healthcare approach in the national health system, this is a serious gap. ConclusionThe lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.For full text, click here:SA Fam Pract 2006;48(8):16-16

Effects of consecutive days of match play on technical performance in tennis

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Elite tennis is characterised by repeated bouts of up to 5-set match play, yet little is known about the technical requirements of shots played. This study therefore investigated technical performance changes over consecutive days of prolonged, simulated tennis match play. A total of 7 well-trained men tennis players performed 4 consecutive days of competitive 4-h match play. Matches were notated to determine between-day changes in groundstroke and serve performance, as well as point and match durations. Changes ≥75% likely to exceed the smallest important effect size (0.2) were considered meaningful and represented as effect size ± 90% confidence interval. Effective playing time reduced on days 3 and 4, alongside likely increases in “stretch” groundstrokes over the 4 days (mean effect size ± 90% confidence interval; 0.57 ± 0.38) and “stretch” backhand returns on days 2 and 3 (0.39 ± 0.54 and 0.67 ± 0.55). Relative unforced errors increased on day 4 (vs. day 2; 0.36 ± 0.22) and second-serve winning percentage reduced after day 1 (−0.47 ± 0.50). Further, a likely increase in emotional outbursts characterised day 3 (vs. day 2; 0.73 ± 0.57). Consecutive-day match play impairs hitting accuracy, stroke positioning and emotional responses; an understanding of which prepares players for elite-standard tennis tournament play

Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes

Background: Tobacco-related illnesses are leading causes of death and healthcare use. Our objective was to determine whether implementation of a hospitalinitiated smoking cessation intervention would reduce mortality and downstream healthcare usage. Methods: A 2-group effectiveness study was completed comparing patients who received the ‘Ottawa Model’ for Smoking Cessation intervention (n=726) to usual care controls (n=641). Participants were current smokers, >17 years old, and recruited during admission to 1 of 14 participating hospitals in Ontario, Canada. Baseline data were linked to healthcare administrative data. Competing-risks regression analysis was used to compare outcomes between groups. Results: The intervention group experienced significantly lower rates of all-cause readmissions, smoking-related readmissions, and all-cause emergency department (ED) visits at all time points. The largest absolute risk reductions (ARR) were observed for allcause readmissions at 30 days (13.3% vs 7.1%; ARR, 6.1% (2.9% to 9.3%); p<0.001), 1 year (38.4% vs 26.7%; ARR, 11.7% (6.7% to 16.6%); p<0.001), and 2 years (45.2% vs 33.6%; ARR, 11.6% (6.5% to 16.8%); p<0.001). The greatest reduction in risk of allcause ED visits was at 30 days (20.9% vs 16.4%; ARR, 4.5% (0.4% to 8.7%); p=0.03). Reduction in mortality was not evident at 30 days, but significant reductions were observed by year 1 (11.4% vs 5.4%; ARR 6.0% (3.1% to 9.0%); p<0.001) and year 2 (15.1% vs 7.9%; ARR, 7.3% (3.9% to 10.7%); p<0.001). Conclusions: Considering the relatively low cost, greater adoption of hospital-initiated tobacco cessation interventions should be considered to improve patient outcomes and decrease subsequent healthcare usage

Characterization of kinetic and kinematic parameters for wearable robotics

The design process of a wearable robotic device for human assistance requires the characterization of both kinetic and kinematic parameters (KKP) of the human joints. The first step in this process is to extract the KKP from different gait analyses studies. This work is based on the human lower limb considering the following activities of daily living (ADL): walking over ground, stairs ascending/descending, ramp ascending/descending and chair standing up. The usage of different gait analyses in the characterization process, causes the data to have great variations from one study to another. Therefore, the data is graphically represented using Matlab® and Excel® to facilitate its assessment. Finally, the characterization of the KKP performed was proved to be useful in assessing the data reliability by directly comparing all the studies between each other; providing guidelines for the selection of actuator capacities depending on the end application; and highlighting optimization opportunities such as the implementation of agonist-antagonist actuators for particular human joints

The impact of inter‐flood duration on non‐cohesive sediment bed stability

© 2019 John Wiley & Sons, Ltd. Limited field and flume data suggests that both uniform and graded beds appear to progressively stabilize when subjected to inter-flood flows as characterized by the absence of active bedload transport. Previous work has shown that the degree of bed stabilization scales with duration of inter-flood flow, however, the sensitivity of this response to bed surface grain size distribution has not been explored. This article presents the first detailed comparison of the dependence of graded bed stability on inter-flood flow duration. Sixty discrete experiments, including repetitions, were undertaken using three grain size distributions of identical D50 (4.8 mm); near-uniform (σg = 1.13), unimodal (σg = 1.63) and bimodal (σg = 2.08). Each bed was conditioned for between 0 (benchmark) and 960 minutes by an antecedent shear stress below the entrainment threshold of the bed (τ*c50). The degree of bed stabilization was determined by measuring changes to critical entrainment thresholds and bedload flux characteristics. Results show that (i) increasing inter-flood duration from 0 to 960 minutes increases the average threshold shear stress of the D50 by up to 18%; (ii) bedload transport rates were reduced by up to 90% as inter-flood duration increased from 0 to 960 minutes; (iii) the rate of response to changes in inter-flood duration in both critical shear stress and bedload transport rate is non-linear and is inversely proportional to antecedent duration; (iv) there is a grade dependent response to changes in critical shear stress where the magnitude of response in uniform beds is up to twice that of the graded beds; and (v) there is a grade dependent response to changes in bedload transport rate where the bimodal bed is most responsive in terms of the magnitude of change. These advances underpin the development of more accurate predictions of both entrainment thresholds and bedload flux timing and magnitude, as well as having implications for the management of environmental flow design. © 2019 John Wiley & Sons, Ltd. © 2019 John Wiley & Sons, Ltd

Casimir forces on a silicon micromechanical chip

Quantum fluctuations give rise to van der Waals and Casimir forces that dominate the interaction between electrically neutral objects at sub-micron separations. Under the trend of miniaturization, such quantum electrodynamical effects are expected to play an important role in micro- and nano-mechanical devices. Nevertheless, utilization of Casimir forces on the chip level remains a major challenge because all experiments so far require an external object to be manually positioned close to the mechanical element. Here, by integrating a force-sensing micromechanical beam and an electrostatic actuator on a single chip, we demonstrate the Casimir effect between two micromachined silicon components on the same substrate. A high degree of parallelism between the two near-planar interacting surfaces can be achieved because they are defined in a single lithographic step. Apart from providing a compact platform for Casimir force measurements, this scheme also opens the possibility of tailoring the Casimir force using lithographically defined components of non-conventional shapes