Rehabilitation services in a district health system: managers’ perceptions

The growth of rehabilitation services in a specific district in the Eastern Cape has been of concern to the majority of the therapists working in that setting between 2012 and 2015. With the importance of primary health care as the driver of South Africa’s National Health Insurance scheme, and the need for rehabilitation services increasing, the investigation of the perceptions of managers who oversee rehabilitation services is pertinent. The objectives of the study were to explore and describe the perceptions of managers regarding rehabilitation services in a district health system and to make recommendations to the Provincial Department of Health regarding the management of rehabilitation services at a district level based on the managers’ perceptions. A qualitative, exploratory, descriptive, contextual research design was used as minimal information relating to the topic was found. The complexity of perceptions, their influence on behaviour and the environment, are wellexplored using these design approaches. Purposive sampling and semi-structured interviews were used to elicit meaningful responses from managers familiar, and tasked, with the oversight of the rehabilitation service. Data analysis was performed utilising Tesch’s model of thematic synthesis. To ensure rigour within the research Lincoln and Guba’s model of trustworthiness was followed. The ethical principles of respect for persons, beneficence and justice were upheld in the study. A thick description was utilised when reporting the findings and a literature control was done to place the findings in the present literature on the topic. The study has provided insights and perceptions of an important layer within the district health system. These perceptions are meaningful, as they influence the manner in which policy and plans are interpreted and implemented, and decisions are made within the environment of rehabilitation services. Three major themes arose from the data analysis process, namely: The managers’ reported positive factors regarding rehabilitation services, they identified challenges affecting the implementation of rehabilitation services in the District Health System, and they provided suggestions for the improvement of rehabilitation services in the District Health System. The positive views held by those in management positions indicate that there are strong foundations on which to build the rehabilitation service, and features of the system that need to be acknowledged, continued and strengthened. The challenges experienced by this layer of management point to aspects that need to be addressed in order to improve and optimise the impact of the inclusion of rehabilitation services in Primary Health Care. The findings in this study clarify these challenges, and if these are not addressed, the goals of the progressive health care system which South Africa is trying to implement cannot be fully achieved. Furthermore, the discrepancies and gaps that exist between urban and rural, and better and poorer resourced districts are likely to widen. The limitations of the study were identified and recommendations were made for practice (management), education and research

Influence of methionine supplementation of growing diets enriched with lysine on feedlot performance and characteristics of digestion in Holstein steer calves.

ObjectiveTwo trials were conducted in order to examine the effects of level of supplemental methionine on productive performance, dietary energetic, plasma amino acid concentration, and digestive function.MethodsDietary treatments consisted of a steam-flaked corn-based diet containing urea as the only source of supplemental nitrogen supplemented with no supplemental amino acid (control), or control plus 1.01% lysine and 0.032%, 0.064%, 0.096%, or 0.128% methionine. In Trial 1, 150 Holstein steer calves (127±4.9 kg) were utilized to evaluate the influence of treatments on growth-performance, dietary energetic, plasma amino acid concentration during the first 112 days of growing period. During the initial 56-d period calves received the 5 experimental diets. During the subsequent 56-d period all calves were fed the control diet.ResultsDuring the initial 56-d period, methionine supplementation increased (linear effect, p<0.01) plasma methionine. In the presence of supplemental lysine, increases on level of methionine in diet did not affect average daily gain. However, increased gain efficiency (quadratic effect, p = 0.03) and estimated dietary net energy (NE; linear effect, p = 0.05). Estimated metabolizable methionine supply was closely associated (R2 = 0.95) with efficiency NE utilization for maintenance and gain. During the subsequent 56-d period, when all calves received the control diet (no amino acid supplementation), plasma amino acid concentrations and growth performance was not different among groups. However, the effects of methionine supplementation during the initial 56-period carried over, so that following a 56-d withdrawal of supplementation, the overall 112-d effects on gain efficiency (quadratic effect, p = 0.05) dietary NE (linear effect, p≤0.05) remained appreciable. In Trial 2, 5 cannulated Holstein steers were used to evaluate treatment effects on characteristics of digestion and amino acid supply to the small intestine. There were no treatment effects on flow of dietary and microbial N to the small intestine. Postruminal N digestion increased (p = 0.04) with increasing level of supplemental methionine. Methionine supplementation linearly increased (p<0.01) duodenal flow of methionine. Likewise, lysine supplementation increased an average of 4.6% (p = 0.04) duodenal flow of lysine. In steers that received non-supplemented diet, observed intestinal amino acid supply were in good agreement with expected.ConclusionWe conclude that addition of rumen-protected methionine and lysine to diets may enhance gain efficiency and dietary energetics of growing Holstein calves. Observed amino acid supply to the small intestine were in good agreement with expected, supportive of NRC (2000, Level 1)

Influence of Kaolinite Clay Supplementation on Growth Performance and Digestive Function in Finishing Calf-fed Holstein Steers.

Two experiments were conducted to examine the influence of kaolinite clay supplementation (0%, 1%, or 2% diet dry matter [DM] basis) on characteristics of digestion (Trial 1) and growth performance (Trial 2) in calf-fed Holstein steers fed a finishing diet. In Trial 1, 6 Holstein steers (539±15 kg) with ruminal and duodenal cannulas were used to evaluate treatment effects on characteristics of digestion. Kaolinite clay supplementation decreased total tract DM digestion (linear effect, p<0.01) without effects (p≥0.10) on site and extent of digestion of organic matter, neutral detergent fiber, starch and N, or ruminal microbial efficiency. There were no treatment effects on ruminal pH, volatile fatty acids molar proportions or estimated methane production. In Trial 2, 108 Holstein steers (132.4±5.6 kg) were used in a 308-d study to evaluate growth performance and carcass characteristics. There were no treatment effects (p>0.10) on average daily gain (ADG) and gain efficiency (ADG/dry matter intake). Kaolinite supplementation tended (linear effect, p = 0.08) to increase dietary net energy (NE) during the initial 112-d period. However, the overall (308-d) effect of supplementation dietary NE was not appreciable (p>0.20). However, due to the inertness of kaolinite, itself, the ratio of observed-to-expected dietary NE increased with kaolinite supplementation. This effect was more pronounced (linear effect, p 0.03) during the initial 224 d of the study. Overall (308 d), kaolinite supplementation tended to increase (linear effect, p = 0.07) dietary NE by 3% over expected. Kaolinite supplementation did not affect carcass weight, yield grade, longissimus area, kidney, pelvic and heart fat, and quality grade, but decreased (linear effect, p = 0.01) dressing percentage. It is concluded that kaolinite supplementation up to 2% of diet DM may enhance energetic efficiency of calf-fed Holstein steers in a manner independent of changes in characteristics of ruminal and total tract digestion

Investigation of the properties of the combustion products generated by building fires

Issued as Quarterly progress reports [1-3] and Final report, Project no. E-16-647, School of Aerospace Engineering; Project no. G-33-633, School of Chemistr

Effect of energy density and virginiamycin supplementation in diets on growth performance and digestive function of finishing steers.

ObjectiveThis study was determined the influence of virginiamycin supplementation on growth-performance and characteristics of digestion of cattle with decreasing dietary net energy value of the diet for maintenance (NEm) from 2.22 to 2.10 Mcal/kg.MethodsEighty crossbred beef steers (298.2±6.3 kg) were used in a 152-d performance evaluation consisting of a 28-d adaptation period followed by a 124-d growing-finishing period. During the 124-d period steers were fed either a lesser energy dense (LED, 2.10 Mcal/kg NEm) or higher energy dense (HED, 2.22 Mcal/kg NEm) diet. Diets were fed with or without 28 mg/kg (dry matter [DM] basis) virginiamycin in a 2×2 factorial arrangement. Four Holstein steers (170.4±5.6 kg) with cannulas in the rumen (3.8 cm internal diameter) and proximal duodenum were used in 4×4 Latin square experiment to study treatment effects on characteristics of digestion.ResultsNeither diet energy density nor virginiamycin affected average daily gain (p>0.10). As expected, dry matter intake and gain efficiency were greater (p<0.01) for LED- than for HED-fed steers. Virginiamycin did not affect estimated net energy value of the LED diet. Virginiamycin increased estimated NE of the HED diet. During daylight hours when the temperature humidity index averaged 81.3±2.7, virginiamycin decreased (p<0.05) ruminal temperature. Virginiamycin did not influence (p>0.10) ruminal or total tract digestion. Ruminal (p = 0.02) and total tract digestion (p<0.01) of organic matter, and digestible energy (p<0.01) were greater for HED vs LED. Ruminal microbial efficiency was lower (p<0.01) for HED vs LED diets.ConclusionThe positive effect of virginiamycin on growth performance of cattle is due to increased efficiency of energy utilization, as effects of virginiamycin on characteristics of digestion were not appreciable. Under conditions of high ambient temperature virginiamycin may reduce body temperature

Breast hypertrophy and gynaecomastia in HIV-associated lipodystrophy, a problematic side-effect of life-saving antiretroviral therapy

A research report submitted to the Faculty of Medicine, University of the Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of Medicine in the division of Plastic and Reconstructive Surgery. Johannesburg 2014With 67% of the world’s human immunodeficiency virus (HIV) infected population existing in Sub-Saharan Africa and recent access to highly active antiretroviral therapy (HAART); demand for plastic surgical intervention in addressing HIV-associated lipodystrophy has expanded dramatically. This study assessed the prevalence of lipodystrophy in a random clinic cohort, the demand for surgical correction, and risk of treatment non-compliance A questionnaire and database cross-sectional review of 554 patients was performed over a three-month period at the Themba Lethu Clinic, Johannesburg, South Africa. A total of 479 patients completed the questionnaire, 83% were female. Nearly 90% of patients were currently being treated, or had been treated with stavudine (d4T). The prevalence of lipodystrophy was 11.7%. Nearly 5.9% of patients had considered stopping treatment due to changes in body morphology following the onset of HAART, 47% of patients interviewed would consider surgery to correct unwanted physical changes following treatment with HAART. Male patients were satisfied by physical changes in their body habitus following treatment (pre-treatment satisfaction 38% vs. post-treatment satisfaction of 94%). Female patients had 6.5 times more breast hypertrophy related symptoms than in their pretreatment state. This study identified a prevalence of 11.7% of patients with HIV-associated lipodystrophy. A total of 3.8% of all patients would consider non-compliance on the basis of this side effect alone. The demand for surgical correction is significant, extends beyond patients diagnosed with HIV-associated lipodystrophy, and needs to be addressed

Influence of ruminal degradable intake protein restriction on characteristics of digestion and growth performance of feedlot cattle during the late finishing phase.

Two trials were conducted to evaluate the influence of supplemental urea withdrawal on characteristics of digestion (Trial 1) and growth performance (Trial 2) of feedlot cattle during the last 40 days on feed. Treatments consisted of a steam-flaked corn-based finishing diet supplemented with urea to provide urea fermentation potential (UFP) of 0, 0.6, and 1.2%. In Trial 1, six Holstein steers (160 ± 10 kg) with cannulas in the rumen and proximal duodenum were used in a replicated 3 × 3 Latin square experiment. Decreasing supplemental urea decreased (linear effect, P ≤ 0.05) ruminal OM digestion. This effect was mediated by decreases (linear effect, P ≤ 0.05) in ruminal digestibility of NDF and N. Passage of non-ammonia and microbial N (MN) to the small intestine decreased (linear effect, P = 0.04) with decreasing dietary urea level. Total tract digestion of OM (linear effect, P = 0.06), NDF (linear effect, P = 0.07), N (linear effect, P = 0.04) and dietary DE (linear effect, P = 0.05) decreased with decreasing urea level. Treatment effects on total tract starch digestion, although numerically small, likewise tended (linear effect, P = 0.11) to decrease with decreasing urea level. Decreased fiber digestion accounted for 51% of the variation in OM digestion. Ruminal pH was not affected by treatments averaging 5.82. Decreasing urea level decreased (linear effect, P ≤ 0.05) ruminal N-NH and blood urea nitrogen. In Trial 2, 90 crossbred steers (468 kg ± 8), were used in a 40 d feeding trial (5 steers/pen, 6 pens/ treatment) to evaluate treatment effects on final-phase growth performance. Decreasing urea level did not affect DMI, but decreased (linear effect, P ≤ 0.03) ADG, gain efficiency, and dietary NE. It is concluded that in addition to effects on metabolizable amino acid flow to the small intestine, depriving cattle of otherwise ruminally degradable N (RDP) during the late finishing phase may negatively impact site and extent of digestion of OM, depressing ADG, gain efficiency, and dietary NE

Influence of dietary nonstructural carbohydrate concentration on growth performance and carcass characteristics of Holstein steers

Objective Since very little information exists about the topic; in this experiment we compare, in a long-term finishing program, the growth-performance responses and carcass characteristics of Holstein steers where non-structural carbohydrate concentration of the diet is reduced from 64% to 51% (dry matter basis). Methods Sixty Holstein steer calves (129±2.2 kg) were blocked by initial weight into five groups and randomly assigned within weight groupings to 10 pens. Calves were fed with a steam-flaked corn-based finishing diets containing 51% higher fiber (HF) or 64% lower fiber (LF) nonstructural carbohydrates. Non-structural carbohydrates concentrations were manipulated substituting dried distiller grain with solubles and alfalfa hay for flaked corn. Cattle were weighed every 112 days and at the end of the experiment (day 308) when the cattle were harvested and carcass characteristics were evaluated. Results Steers fed the HF diet showed improvement (8.8%) in average daily gain (ADG) during the initial 112-d period. This effect was followed by a numerical trend for greater ADG throughout the remainder of the study so that overall ADG tended to be greater (4.9%, p = 0.06) for the HF than for LF. There were no treatment effects on dry matter intake. Gain efficiency and estimated dietary net energy (NE) were greater 8.3% and 5.2%, respectively for HF during the initial 112-d period. Overall (308-d) gain efficiency and estimated dietary NE were similar for both dietary treatments. However, due to differences in tabular dietary NE, the ratio of observed:expected dietary NE tended to be greater (4.1%, p = 0.06) for the HF vs LF diet. There were no treatment effects on carcass characteristics except for a tendency toward a slightly greater (0.5%, p = 0.09) estimated carcass yield. Conclusion Reducing the non-structural carbohydrate concentration of a conventional steam-flaked corn-based growing finishing diet for Holstein steers can effectively enhance growth performance, particularly during the early growing and late finishing phases