A diabetes profile of the eight districts in the public health sector, Eastern Cape Province, South Africa

Background. The International Diabetes Federation (IDF) recently reported that there are 1.8 million South Africans with diabetes, and estimates an additional undiagnosed population of 69% of the total number of diabetics. The African continent is expected to see the highest increase in diabetes globally by 2045. Healthcare measures to manage this surge in diabetes and its related complications should be tailored to Africa’s unique challenges; however, the epidemiolocal data essential for policy development are lacking. Bridging the data gap will guide funding distribution and the creation of evidence-based initiatives for diabetes.Objectives. To investigate the frequency, age proportion and distribution of new patients diagnosed with diabetes in the public healthcare sector of Eastern Cape (EC) Province, South Africa (SA).Methods. All data collected to date were obtained from the EC District Health Information System. According to the information collected from the Department of Health, diabetes-related data collection fields were implemented in 2013, which resulted in this 4-year study. Additional open-source data on population estimates, mortality and medical aid coverage were provided by Statistics SA.Results. Of the eight districts in the province, O R Tambo was recorded as having the highest average proportion of new patients diagnosed with diabetes. A positive correlation was found between the calculated incidence of disease and the diabetes mortality rate.Conclusions. The study showed an annual growth in the incidence of diabetes in the EC since 2014, and highlights the issue of an increasing burden of diabetes in the rural population. This increase is consonant with predictions by authoritative bodies on the growing burden of diabetes in Africa. The pattern of distribution highlights the deprived district of O R Tambo contradicting the well-known link between diabetes and urbanisation

Feedback as a means to improve clinical competencies: Consultants’ perceptions of the quality of feedback given to registrars

Background. Effective supervision by consultants in postgraduate medical education involves the process of feedback. Giving feedback may be challenging for consultants who have no formal training in this process, which may be further compounded in heterogeneous diverse settings.Objective. To explore consultants’ perceptions of feedback to registrars in a multicultural, multilingual diverse academic hospital setting.Methods. Thirty-seven consultants consented to completing a questionnaire on what, when, where, how often, and how feedback was provided, as well as on the type and effect of feedback to registrars. Descriptive statistics were used to analyse the data. Differences between groups were calculated using Pearson’s χ² test for independent variables, with a p-value of <0.05 regarded as being statistically significant.Results. Only 40% of consultants reported that they provided feedback often or always and 62.2% reported that standards were not predetermined and communicated to registrars. When feedback was provided, it was based on concrete observations of performance (78.4%), it incorporated a plan for improvement (72.9%) and it supplied information on techniques performed incorrectly (72.9%). Only 40.5% of consultants provided feedback on procedures performed correctly. Moreover, only half of the consultants believed they were proficient at giving feedback.Conclusion. Consultants need to develop the art of giving feedback through appropriate training so that they are more comfortable and proficient with the various aspects of feedback, leading to a positive effect on enhancing registrar training

Distribution, incidence, prevalence and default of patients with diabetes mellitus accessing public healthcare in the 11 districts of KwaZulu-Natal, South Africa

Background. The global increase in the prevalence of diabetes mellitus is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu-Natal Province (KZN), South Africa. Data are routinely collected at all public healthcare facilities in the province and are aggregated per facility.Objective. To investigate the distribution, incidence and prevalence of diabetes in the public healthcare sector of KZN.Methods. Data collected by the DHIS for all patients with diabetes in KZN from 1 January 2010 to 31 December 2014 inclusive were analysed. Additional open-source databases were accessed to enable further exploration of the data collected.Results. The study showed that the majority (38.7%) of patients with diabetes on the public sector register were from the district of eThekwini. Positive correlations were found between the prevalence of diabetes, the mortality rate and the number of defaulters (patients with diabetes who did not return for regular treatment).Conclusions. Provincial estimates of the prevalence of diabetes in this study were higher than the known national prevalence. This may be due to the large proportion of Indians in KZN, who have a genetic predisposition to diabetes mellitus. However, allowance must be made for possible inaccurate data collection at source with miscounting of individuals. This study supports the global trend of an association between diabetes and urbanisation and highlights the need for regular diabetes screening and education, particularly in the public healthcare domain

Self-identity discrepancy theory: Exploring returning South African Cuban-trained medical students sense of belonging

Background: The Nelson Mandela-Fidel Castro Collaboration programme (NMFCMC) between South Africa and Cuba was established in 1996. South African students, undergo five years of medical training in Cuba and finish the final eighteen months of training in South Africa. These students experience academic difficulties on their return. Methods: All twelve NMFCMC students enrolled at the University of KwaZulu-Natal in 2015 participated in this study. Data were elicited using focus group interviews, narrative interviews, found photovoice and the Collage Life Story Elicitation Technique. Results: Challenges faced by participants resulted in identity discrepancy, which in turn promoted unfavourable attitudes, affect, psychological and physical behaviours towards participants’ belongingness. Conclusion: Returning NMFCMC students experienced difficulties in assimilation due to identity discrepancies and frustrated sense of belonging. Focusing on reinforcing positive aspects of identity, and interpersonal relationships through moderating the tendency of local teachers and students to emphasise the “otherness” of the NMFCMC student is crucial

Gastrointestinal Dysfunction in a Parkinson’s Disease Rat Model and the Changes of Dopaminergic, Nitric Oxidergic, and Cholinergic Neurotransmitters in Myenteric Plexus

This study aims to explore the gastrointestinal dysfunction and the changes of dopaminergic, nitric oxidergic, and cholinergic neurons in the myenteric plexus of a Parkinson’s disease (PD) rat model. A PD rat model was induced through unilateral substantia nigra administration of 6-hydroxydopamine. Four weeks later, the feces in 1 h and residual solid food in stomach at 2 h after feeding were measured. Changes in tyrosine hydroxylase (TH) in substantial nigra, TH, choline acetyltransferase (ChAT), and neuronal nitric oxide synthase (nNOS) in gastric antrum and colon tissue were examined by immunohistochemistry. Reverse transcription (RT) polymerase chain reaction (PCR) and Western blot were used to evaluate and compare the levels of messenger RNA (mRNA) and protein expression of TH, ChAT, and nNOS in the GI tract between normal and 6-hydroxydopamine-lesioned rats. Compared with control samples, the number of TH+ cells in the damaged side of substantia nigra of 6-hydroxydopamine-lesioned rats decreased significantly (P < 0.01). The weight and water content of the fecal matter decreased (P < 0.01), and the percentage of residual solid food increased (P < 0.01). The average integrated optical densities of TH-positive areas in the gastric antrum and colon tissue increased significantly (P < 0.01), nNOS decreased significantly (P < 0.01), and there were no significant changes in ChAT (P > 0.05). TH and nNOS mRNA levels in the gastric antrum and proximal colon decreased (P < 0.01), there were no significant changes in ChAT mRNA levels (P > 0.05). The protein levels of TH in the GI tract were significantly increased (P < 0.01), nNOS significantly decreased (P < 0.01), and ChAT had no significant changes (P > 0.05). 6-Hydroxydopamine-lesioned rats had delayed gastric emptying and constipation that might be related to the gastrointestinal TH increase and nNOS decrease. These symptoms were not related to changes in cholinergic transmitters

Motivated strategies for learning and their association with academic performance of a diverse group of 1st-year medical students

Background. Most instruments, including the well-known Motivated Strategies for Learning Questionnaire (MSLQ), have been designed in western homogeneous settings. Use of the MSLQ in health professions education is limited.Objective. To assess the MSLQ and its association with the academic performance of a heterogeneous group of 1st-year medical students.Methods. Eighty-three percent of 1st-year medical students consented to participate in this quantitative study. The MSLQ consisted of a motivation strategies component with six subscales, while the learning strategies component had nine subscales. Demographic and academic achievement information of the students was also collected. Stata version 13 (StataCorp LP, USA) was used for the statistical analyses of all data.Results. Female students displayed significantly higher motivational scores. Students with prior educational experience and those who attended peermentoring sessions had significantly higher learning strategy scores. Significant but moderate relationships were found between academic performance and the motivation strategies subsumed within the categories ‘task value’ and ‘self-efficacy for learning performance’. In terms of the ‘learning strategy component’, ‘critical thinking’, and ‘time and study environment’, the composite score was significantly but poorly correlated to academic performance.Conclusion. Overall, limited correlations were found between the MSLQ scores and academic performance. Further investigation of the use of the MSLQ and its association with academic achievement is recommended, with greater focus on specific learning events than on course outcomes. This study highlights the importance of evaluating an instrument in a specific context before accepting the findings of others with regard to the use of the instrument and its correlation with academic performance

Feedback as a means to improve clinical competencies: Registrars’ perceptions of the quality of feedback provided by consultants in an academic hospital setting

Background. The training of novices, in any field, to achieve the optimum state of cognitive, clinical, technical and professional development requires a variety of teaching methodologies, including the process of feedback. Feedback is defined as a process where the desired standard of proficiency in a task has already been established and communicated to the student before gaps in performing the task or in the level of knowledge are identified. The process of feedback has often been evaluated and has consistently revealed students’ dissatisfaction with the amount and type of feedback they receive in their clinical and postgraduate training, as they perceive it to be inadequate, inappropriate or non-existent.Objectives. To investigate the perceptions of the quality of feedback received by a diverse, heterogeneous population of registrars in postgraduate training at an academic hospital.Methods. A study was conducted using a questionnaire to determine the perceptions of all registrars in the six major clinical training programmes with regard to the quality, efficacy and effectiveness of feedback received during clinical training. Descriptive statistics were used to interpret the responses of the registrars, with mean values being calculated.Results. Perceptions of the quality of feedback received differed across disciplines.Overall, the registrars rated the feedback they received as poor. The majority (51.4%) reported that both formal and informal feedback was only sometimes, even rarely, received during all encounters with consultants. Others (51.3%) felt that the feedback received was unacceptable, and did not perceive it to be based on concrete observations of performance. The proficiency of consultants in giving feedback was scored as unacceptable by 64.8% of registrars.Conclusion. Registrars in training regard feedback as an essential componentof their postgraduate medical education and as an important component of achieving clinical competence. More formalised processes need to be implemented. The majority of registrars agreed that consultants required training in providing feedback effectively