Knowledge and perceptions of nursing staff on the new Road to Health Booklet growth charts in primary healthcare clinics in the Tygerberg subdistrict of the Cape Town metropole district

Objectives: The objectives of the study were to assess the perceptions of nursing staff on the Road to Health Booklet (RTHB), to assess their knowledge of the RTHB growth charts, and to determine whether the level of knowledge was acceptable for successful utilisation of the RTHB growth charts.Design: A cross-sectional descriptive survey.Setting: Twelve primary healthcare clinics in the Tygerberg subdistrict.Subjects: Nursing staff who were going to work with the RTHB on a daily basis.Outcomes measures: The knowledge and perceptions of the nursing staff on the new RTHB were measured using a self-administered questionnaire.Results: The study highlighted that the majority of the nursing staff did not possess sufficient knowledge to successfully utilise the RTHB. The mean score percentage for the total 12 knowledge questions was 55%. Less than a third (n = 13) of participants could correctly interpret the cut-off value for mid-upper-arm circumference. Only 38% and 52% correctly knew that -2 standard deviation for weight-for-age and weight-for-length represents underweight and wasting, respectively. Fifty-five per cent could correctly interpret the growth faltering graph. Forty-three per cent of participants felt the change to the RTHB was unnecessary, and 55% thought that mothers or caregivers would not easily understand the RTHB. More than half (n = 22) of the participants said that they had adequate knowledge to work with the RTHB, while the rest reported that they did not.Conclusion: The RTHB has the potential to decrease the prevalence of malnutrition in children. However, to achieve this, effective usage and understanding of the RTHB is critical.Keywords: Road to Health booklet, growth monitoring, primary healthcare clinics, knowledg

Management of severe malnutrition

CITATION: Shubl, C. 2010. Management of severe malnutrition. South African Journal of Clinical Nutrition, 23(1):Supplement:S22-S24.The original publication is available at http://sajcn.co.zaIn summary, if the Millenium Development Goals (MDGs) are to be addressed effectively, it is imperative that severe malnutrition be addressed at the international and national level, using strategies that work, and that additional resources are committed to improving hospital treatment and establishing community-based rehabilitation programmes.20 Many gaps still exist in our knowledge regarding the management of severe malnutrition at all levels. Until such time when research can fill these gaps, we will have to continue to use what guidelines have shown to produce positive results.http://sajcn.co.za/index.php/SAJCN/article/view/417Publisher's versio

The influence of socio-demographic factors on the nutritional status of children in the Stellenbosch area, Western Cape

CITATION: Kirsten, A. P., Marais, D. & Schubl, C. 2013. The influence of socio-demographic factors on the nutritional status of children in the Stellenbosch area, Western Cape. South African Journal of Clinical Nutrition, 26(3):124-131.The original publication is available at http://www.sajcn.co.zaObjectives: To determine the prevalence of overweight and obesity, as well as socio-demographic risk factors associated with childhood overweight and obesity in the Stellenbosch area, Western Cape province. Design: A cross-sectional, comparison study was conducted. Setting and subjects: A representative group of 638 children (aged 6-13 years) attending three randomly selected Stellenbosch primary schools. An additional school was selected for the pilot study. In the screening (first) phase, children were weighed and measured to calculate body mass index using international obesity task force guidelines to determine the prevalence of overweight and obesity. For the comparison (second) phase of the study, only 24 overweight and obese children and 21 children of normal weight (comparison group) (n = 45) were included. Outcome measures: Socio-demographic and eating behaviour data were collected using a structured questionnaire and compared between the overweight and obese group and the comparison group (normal weight) to identify associated risk factors. Results: The prevalence of overweight and obesity was 13%, of which 9% (n = 57) were overweight and 4% (n = 27) obese in the screening phase. In the comparison phase, socio-economic factors, such as maternal employment hours (p-value = 0.0462); family characteristics, such as the number of children in the household (p-value = 0.0231); and time spent participating in sport (p-value = 0.0450); were significantly associated with overweight or obesity. Conclusion: Preventative initiatives should proactively promote healthy eating behaviour and physical activity in children at an early age, based on previous research, particularly in girls. Involving families and schools in these initiatives is recommended, as well as a national childhood obesity monitoring system to identify children at risk, and tracking childhood obesity trends to guide evidence-based interventions to tackle this growing public health issue.http://www.sajcn.co.za/index.php/SAJCN/article/view/683Publisher's versio

Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review

Primary pure squamous cell carcinoma (SCC) of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer

National analysis of testicular and scrotal trauma in the USA

Areg Grigorian, Joshua K Livingston, Sebastian D Schubl, Bima J Hasjim, Daniel Mayers, Eric Kuncir, Cristobal Barrios, Victor Joe, Jeffry Nahmias Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA Background: To provide a descriptive analysis of scrotal and testicular trauma in the USA. Additionally, we hypothesized that motorcycle collision would have a higher association with scrotal or testicular trauma and subsequent scrotal or testicular operation, compared to a bicycle collision.Methods: The National Trauma Data Bank (2007–2015) was queried to identify adult male patients with scrotal or testicular trauma. A multivariable logistic regression analysis was performed.Results: A total of 8,030 patients (0.23%) had scrotal/testicular injury, with 44.6% involved in blunt trauma. A penetrating mechanism occurred in 50.5% of cases, with assault by firearm (75.8%) being the most common. The median age of the patients was 31 years and the median injury severity score was 8. Most had isolated scrotal or testicular trauma (74.5%), with 48.3% requiring scrotal or testicular operation, most commonly repair of laceration (37.3%). Patients involved in a motorcycle collision had higher risk for scrotal/testicular trauma (OR=5.40, CI=4.40–6.61, p=0.0004) and subsequent scrotal/testicular surgery (OR=4.93, CI=3.82–6.36, p=0.0005), compared to bicycle collision.Conclusion: Scrotal or testicular trauma is rare but occurs most commonly after assault by firearm. Most patients only have isolated scrotal or testicular trauma, but nearly half require subsequent scrotal or testicular operation. Trauma patients presenting after a motorcycle collision have a higher association of scrotal or testicular trauma and subsequent surgery when compared to those involved in a bicycle collision. Keywords: scrotal trauma, testicular trauma, testes, scrotal surgery, testicular surgery&nbsp

Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community.

BackgroundEarly evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.MethodsPrior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.ResultsOf 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05-3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28-3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00-2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12-3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30-0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01).ConclusionsPrior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission