Stimulant use among prehospital emergency care personnel in Gauteng Province, South Africa

Background. Emergency medical service (EMS) personnel are exposed to high levels of psychological, physical and emotional stressors. There has been an increase in stimulant use among healthcare professionals worldwide. There is a paucity of data pertaining to the use of stimulant products among EMS personnel in South Africa (SA).Objectives. To determine the prevalence of and other aspects pertaining to use of stimulant products among EMS personnel in Gauteng Province, SA.Methods. A prospective cross-sectional study using a questionnaire-based model was used to survey EMS personnel in Gauteng.Results. Of the 315 respondents who completed the questionnaire, 310 (98.4%) reported use of stimulant products, 295 (93.7%) consumed tea/coffee, 187 (59.4%) consumed commercial energy drinks, 60 (19.0%) used caffeinated energy-enhancing tablets, 14 (4.4%) used non-caffeinated prescription stimulant medications, 50 (15.9%) used illicit drugs, 134 (42.5%) exceeded the recommended daily allowance (RDA) of caffeine, 201 (63.8%) exceeded the RDA of sugar, 231 (73.3%) experienced difficulty remaining awake during a shift, 148 (47.8%) used stimulants off shift, and 71 (22.5%) experienced insomnia. Common reasons for use of stimulants were enjoyment (n=218; 69.2%), to stay awake (n=125; 39.7%) and improvement of physical and mental performance (n=94; 29.8%).Conclusions. The high prevalence of stimulant use among respondents is a cause for concern. Strategies to address it should be aimed at promoting awareness and education, improving working conditions, enhancing support structures, and regulating the stimulant content of commercial products.

Developing an outcomes-based charter to direct teaching and assessment of medical professionalism

Background. Components of professionalism in undergraduate medical studies at the University of  Pretoria (UP) were previously defined as nine ‘Golden Threads’. Although specific outcomes were  formulated for the threads, the need for more explicit professional standards became increasingly evident. The restructuring of the health system in South Africa contributed to the need for more explicit standards. The Charter for Medical Professionalism was developed during 2006 - 2008 as a reference document within the local context to serve as a standard for professionalism in the medical curriculum. Another aim was to guide academics in medical studies to act as good role models of professional behaviour.Objective. To document the development of the Charter for Medical Professionalism and to evaluate  lecturer and student perceptions on the formulation of the Charter to make appropriate changes and increase acceptance.Methods. The project took the form of action research, and a working group comprising academics from UP’s Faculty of Health Sciences developed the Charter from relevant source documents, employing thematic and content analysis and recursive abstraction. An online survey was conducted to assess lecturer and student acceptance of the Charter.Results. The outcomes-based approach was perceived as acceptable and appears to broaden the scope of assessment of professionalism.Conclusion. Inclusion of outcomes proposed by other work groups relating to research, practice   management, teaching, mentoring and leadership roles of the medical doctor may be considered in future

THE FUTURE OF WILDFLOWER RESEARCH AND DEVELOPMENT IN SOUTH AFRICA - THE LACHENALIA CASE STUDY

This paper reports the socio-economic impact of the lachenalia research program of the ARCRoodeplaat Vegetable and Ornamental Plant Institute (ARC-Roodeplaat) over the period 1965-2010. Data were collected from researchers, the local propagator and the market agent in Holland, using guidelines and questionnaires. A financial and economic analysis were conducted. The results of both were negative, unless increased productivity, early entry into all potential markets and a decreased research gestation period were assumed. Additional impacts were qualitatively assessed. The program contributed to employment creation, the preservation of biodiversity, capacity building and beneficial institutional linkages. The management information generated by the study was used in planning and priority setting at the institute.Crop Production/Industries, Research and Development/Tech Change/Emerging Technologies,

Allergic sensitisation in South Africa: Exploring regional variation in sensitisation

Background. Allergy is a common health problem in South Africa (SA), and a rational approach to allergy testing is essential to ensure cost-effective as well as optimal patient diagnosis and management.Objectives. To review allergy testing data with respect to current national testing recommendations, and to explore the regional variations in sensitisation.Methods. Retrospective data review on allergy testing from a private pathology provider in SA over a 2-year period. Data on skin-prick testing (SPT) and allergen-specific IgE testing originating from all the provinces of SA were collected and analysed with regards to allergen positivity rate and regional sensitisation patterns.Results. Among the patients (N=45 0320) tested for a suspected inhalant allergy, 46% tested positive. Only 45% of these received additional testing for the nine recommended inhalant allergens included in the current national testing protocol. Among the patients (N=6 775) who received SPT for a suspected inhalant allergy, 59% yielded one or more positive results. The most frequent sensitising allergens were house dust mite (Dermatophagoides pteronyssinus) and grass pollen. The house dust mite, Blomia tropicalis, was a significant sensitiser in coastal regions. SPT identified two other important regional allergens which are not included in the current recommendations for inhalant allergen-specific IgE testing.Conclusions. The current diagnostic recommendations include allergens that demonstrate significant sensitisation in all regions of SA. Two additional allergens that show significant regional sensitisation in the South African population were identified. These findings may aid the recommendations for the most appropriate and cost-effective approach to allergy testing of symptomatic patients in SA

Non-compliance with treatment by epileptic patients at George Provincial Hospital

Non-compliance with anti-epileptic drug treatment in the George area, resulting in recurrent seizures and visits to the emergency department of the George Provincial Hospital, has been identified as a social and economic problem. The aim of this study was to determine the socio-economic and medical factors, the information given to patients by healthcare workers, and the understanding of patients living with epilepsy who presented to the emergency department with seizures. Methods A descriptive study design was employed and the data-collection tools were a questionnaire and structured interview. Results The median age of the study population was 32 years. The patients had suffered from epilepsy for a median of two years and visited a clinic for a median of seven times a year. The median education level was primary school and three quarters had no employment or government grant. The majority did not understand the disease, the side effects of the medication and why they should be on medication. In addition, it became apparent from patient reports that healthcare workers showed a lack of counselling skills, time and appropriate knowledge. Conclusions There is a general lack of understanding of epilepsy by the patient. Not only were the patients uninformed, but they also showed apathy towards the management of their condition.South African Family Practice Vol. 49 (9) 2007: pp. 1

Compliance with hygiene practices among healthcare workers in the intensive care unit

Background. Intensive care unit (ICU)-related healthcare-associated infections (HCAIs) are two to three times higher in lower-income countries than in higher-income ones. Hand cleansing and other hygiene measures have been documented as one of the most effective measures in combating the transmission of HCAIs. There is a paucity of data pertaining to hygiene practices in the ICU in developing countries.Objectives. To determine compliance with hygiene practices among healthcare workers in a tertiary hospital ICU.Methods. Hygiene practices of healthcare workers in a tertiary academic hospital ICU in Johannesburg, South Africa, were discreetly observed over an 8-week period. Compliance with hand cleansing and other hygiene practices was documented and analysed. Retrospective consent was obtained, and subject confidentiality was maintained. Results. A total of 745 hygiene opportunities were observed. Of the 156 opportunities where handwashing with soap and water was indicated (20.9%), compliance was noted in 89 cases (57.1%), while an alcohol-based hand rub was inappropriately used in 34 cases (21.8%) and no hand hygiene was performed in the remaining 33 cases (21.1%). Of the 589 opportunities where an alcohol-based hand-rub was indicated, it was used in 312 cases (53.0%). Compliance with the donning of disposable surgical gloves, disposable plastic aprons and being ‘bare below the elbows’ was noted in 114 (90.6%), 108 (71.1%) and 355 (47.7%) opportunities, respectively, where these were indicated.Conclusions. Overall compliance with hygiene measures among healthcare workers in the ICU was suboptimal in this study, but in keeping with general international trends. Regular retraining of staff, frequent reminders, peer oversight and regular audits may improve compliance

Crystallization of recombinant Bacteroides fragilis glutamine synthetase (GlnN) isolated using a novel and rapid purification protocol

Glutamine synthetase enzymes (GSs) are large oligomeric enzymes that play a critical role in nitrogen metabolism in all forms of life. To date, no crystal structures exist for the family of large (1 MDa) type III GS enzymes, which only share 9% sequence identity with the well characterized GSI and GSII enzymes. Here we present a novel protocol for the isolation of untagged Bacteroides fragilis GlnN expressed in an auxotrophic Escherichia coli strain. The rapid and scalable two-step protocol utilized differential precipitation by divalent cations followed by affinity chromatography to produce suitable quantities of homogenous material for structural characterization. Subsequent optimizations to the sample stability and solubility led to the discovery of conditions for the production of the first diffraction quality crystals of a type III GS enzyme

Plant Immunity Directly or Indirectly Restricts the Injection of Type III Effectors by the \u3ci\u3ePseudomonas syringae\u3c/i\u3e Type III Secretion System

Plants perceive microorganisms by recognizing microbial molecules known as pathogen-associated molecular patterns (PAMPs) inducing PAMP-triggered immunity (PTI) or by recognizing pathogen effectors inducing effector-triggered immunity (ETI). The hypersensitive response (HR), a programmed cell death response associated with ETI, is known to be inhibited by PTI. Here, we show that PTI-induced HR inhibition is due to direct or indirect restriction of the type III protein secretion system’s (T3SS) ability to inject type III effectors (T3Es). We found that the Pseudomonas syringae T3SS was restricted in its ability to inject a T3E-adenylate cyclase (CyaA) injection reporter into PTI-induced tobacco (Nicotiana tabacum) cells. We confirmed this restriction with a direct injection assay that monitored the in planta processing of the AvrRpt2 T3E. Virulent P. syringae strains were able to overcome a PAMP pretreatment in tobacco or Arabidopsis (Arabidopsis thaliana) and continue to inject a T3E-CyaA reporter into host cells. In contrast, ETI-inducing P. syringae strains were unable to overcome PTI-induced injection restriction. A P. syringae pv tomato DC3000 mutant lacking about one-third of its T3E inventory was less capable of injecting into PTI-induced Arabidopsis plant cells, grew poorly in planta, and did not cause disease symptoms. PTI-induced transgenic Arabidopsis expressing the T3E HopAO1 or HopF2 allowed higher amounts of the T3E-CyaA reporter to be injected into plant cells compared to wild-type plants. Our results show that PTI-induced HR inhibition is due to direct or indirect restriction of T3E injection and that T3Es can relieve this restriction by suppressing PTI

Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults

Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD riskPeer reviewedFinal Accepted Versio

Accompaniment needs of nursing students related to the dying patient

Nurse educators are responsible for accompanying students towards becoming capable, competent professional nurses who are a credit to themselves, their patients, colleagues and profession. Student nurses need, therefore, to be taught to render comprehensive nursing care to patients in all stages of their lives, including when they are dying. Being confronted with human suffering and death is challenging and traumatic. Those exposed to such events on a daily basis need to have a solid foundation of self preservation to see past the pain of suffering and to bring light and hope to those in need. A young student nurse will only experience positive growth and development in these circumstances if she is also cared for and guided with understanding. The researcher utilized a qualitative, explorative, descriptive and contextual design based on the phenomenological approach to enquiry. The following question was asked at the beginning of each unstructured phenomenological interview: “How was if for you to care for a dying or deceased patient?” The central theme identified that student nurses experience turmoil in their different relationships in their accompaniment of the dying patient. Guidelines based on the central theme and sub-themes that emerged from raw data, as well as literature, are offered as strategies to promote/enhance optimal accompaniment of student nurses caring for the dying patient