Baat as bio-etiek sonder grense: ’n gereformeerdetiese beoordeling van artikel 4 van die universele deklarasie vir bio-etiek en menseregte van UNESCO

Article 4 of the UNESCO Declaration of Bioethics and Human Rights (2005) is explained as being an ethical principle and right aimed at the health environment. Benefit is defined as good deeds towards people within the medical environment and is accepted as part of universal ethics. This principle means that the person on the one hand has a right to benefit, while on the other hand has the duty to show benefit. To display benefit to mankind is to confirm the dignity of man. From a Christian perspective, the right and ethical principle of benefit is grounded in the creation, re-creation and eschatology. Man as the image of God - as a changed man in Christ - is led by the Spirit to show benefit as love to all people within the health environment

A global bioethical perspective on organ trafficking: Discrimination, stigmatisation and the vulnerable

Organ trafficking is a growing global phenomenon that not only has abusive consequences, but is also, as far as can be determined, discriminatory and stigmatising. Currently, there is no national or global declaration that rejects organ trafficking because of the discriminatory and stigmatising results of the medical practice involved. The Universal Declaration of Bioethics and Human Rights by the United Nations Educational, Scientific and Cultural Organization (UNESCO) addresses the problem by relating organ trafficking (art. 21.5) to discrimination and stigmatisation (art. 11). Until a global declaration and an accompanying project come into existence, the UNESCO declaration can be used as an influential appeal to the world community to combat these activities together

Diabetes management in family practice

Chronic diseases pose a particular chal-lenge to the busy general practitioner. As such diabetes is often a complex disease with multiple complications. The therapeutic choices are often challenging and the practitioner must not only aim to control blood glucose but blood pressure and blood lipids as well. There is clear evidence that diabetes will increase and become a major public health problem in both developed and developing countries. Fortunately many studies have provided evidence as to how improve outcomes is these patients. The following five topics in diabetes management are featured, namely; the emerging epidemic, optimal glucose control, insulin therapy in type 1 diabetes, dyslipidaemia and hypertension.South African Family Practice Vol. 48 (10) 2006: pp. 1

Respect for vulnerability is a human right: Article 8 of the UNESCO Declaration on Bioethics and Human Rights, and senior citizens in South Africa

It is untrue that the elderly in South Africa (SA) are probably discriminated against in healthcare as the result of inadequate legislation that does not conform to international standards. The National Health Act recognises vulnerability and gives expression to it. Respect for vulnerability has not yet been introduced to fundamental political and bioethical frames of reference in SA and that is probably the reason why the concept and right have not become part of the ethical awareness in healthcare. The appeal of this article is that respect for vulnerability must be brought to conform to the Universal Declaration on Bioethics and Human Rights by declaring the ethical principle as an independent human right

History outside the classroom : the use of museums in the teaching of history

In the modern technical age in which we live , knowledge of the past is often pushed into the background As a result of this history teaching often becomes an attempt to pump an assortment of arbitrary facts into the minds of scholars by means of 'chalk and talk' methods. Educationists all over the world see this tendency as the major reason for the declining popularity of history as a school subject . In other parts of the world, such as the United States of America and Britain, education departments and teachers have faced this challenge and it seems as if the status of history as a school subject has been retrieved . In the Republic of South Africa the new core syllabuses are geared towards moving away from the earlier restricted emphasis of facts, but there is very little guidance on how teachers are to implement this 'new' approach, which focus more on the "how" of history and on the teaching of historical skills In this thesis museum visits as one of the modes of outdoor education, is studied as a possible additional alternative method of teaching history in South African schools . A study is made of what museums are and of the possible educational values of museum visits. It soon becomes clear that the major beneficial aspect of museum visits could be the acquisition of historical skills such as comprehension, application , analysis , synthesis and evaluation In order to gain insight into the practical implementation of museum visits several groups were observed while visiting the museum, after which two pilot studies were undertaken in the Kaffrarian and South African Missionary Museums with Black standard ten pupils and senior student teachers . Attention is given to aspects of administrative , teacher and pupil preparation the implementation of the visit and the types of follow-up work which could be used. During and after the implementation of the two pilot studies certain characteristic problems were experienced these are : the compilation of worksheets and cultural differences . The most important of language difficulties : It also became clear that education officers at museums find it difficult to cope with the special educational needs of the different visiting groups . For this reason an approach is advocated where the teacher compiles his own worksheet suited to the needs of his specific pupils Guidelines are given as to how pre-planned worksheets could be adapted : how different question-types could be used to compile a worksheet in which skills ascend from the simple to the complex: and how worksheets could be compiled for mixed ability groups. It is hoped that this thesis will lead to renewed interest in the use of the museum in the teaching of history and will serve as guideline for teachers planning to take history "out of its coffin"

The prevalence and associations of erectile dysfunction in a South African male diabetic urban population

Background: Erectile dysfunction (ED) is a common condition in patients with type 1 or type 2 diabetes mellitus. The prevalence and predictors in our patient population are unknown since minimal data exist for this condition in South Africa.Method: An observational, cross-sectional study was performed on 150 consecutive male patients aged ≥ 50 years, with either type 1 or type 2 diabetes mellitus, attending the Steve Biko Academic Hospital Diabetes Clinic. These patients were evaluated for diabetes mellitus control and medical complications, and for the presence of ED. Morning serum testosterone levels were determined.Results: Some degree of ED was reported in 95% of the patients, with 51% reporting serious dysfunction. Using multivariate logistic regression, it was determined that the significant factors associated with ED were age, body mass index, the peripheral neuropathy score and diuretic therapy. Differences in quality-of-life scores were seen in some ED subgroups.Conclusion: This study confirms the high prevalence of ED in diabetic male patients in a tertiary setting. It is suggested that universal screening should be performed for this population group. Multiple predictors of ED were identified in this study. ED negatively affected quality of life, but not in a statistically significant way.Keywords: cardiovascular disease, diabetes mellitus, diuretic therapy, erectile dysfunction, glycaemic control, peripheral neuropath

Unsuspected glucose abnormalities in patients with coronary artery disease

Objectives: To compare the ability of fasting glucose, glycosylated haemoglobin (HbA1c), the American Diabetic Association (ADA) score and measures of the metabolic syndrome (waist circumference, high-density lipoprotein (HDL), and triglycerides) in predicting an initial diagnosis of diabetes mellitus or abnormal glucose tolerance based on the World Health Organization (WHO) criteria.Design: A cross-sectional, diagnostic study was undertaken of 120 patients admitted to the cardiology wards of Pretoria Academic Hospital for elective coronary angiographic studies. Main outcome measures: All subjects underwent a modified glucose tolerance test whereby fasting and 2-hour post glucose (75 g) plasma glucose levels were measured. Using the revised WHO criteria, the overall incidence of diabetes was found to be 11.7% (95% confidence interval (CI): 6.5 - 19) and the overall incidence of abnormal glucose tolerance was 46% (CI: 37 - 55). Results: In univariate analysis for the diagnosis of diabetes, HbA1c (p < 0.05) yielded the largest area (0.76) under the receiver operating characteristic (ROC) curve, with a sensitivity of 21%, specificity of 99%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 91%. For the prediction of abnormal glucose tolerance, applying multivariate analysis using a logistic regression model, the combination of age, ethnic group, serum HDL, serum triglycerides and HbA1c yielded an area under the ROC curve of 0.79, sensitivity of 66%, specificity of 80%, PPV of 76% and a NPV of 71%. Conclusion: Most subjects with diabetes mellitus (9 of 14) would not have been detected if a 2-hour oral glucose tolerance test had not been done. Addition of either HbA1c or lipid parameters to the model of age and ethnic group were similar in predicting abnormal glucose tolerance. Journal of Endocrinology, Metabolism and Diabetes of South Africa Vol. 11(1) 2006: 24-2

What is wrong with my patient? How to read an article concerning diagnosis

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The Prevalence and Association of Low Testosterone Levels in a South African Male, Diabetic, Urban Population

Background: According to the literature, low serum testosterone levels are associated with diabetes mellitus. No or minimal data exist for its prevalence or predictors in South Africa.Design: This was a cross-sectional study.Setting: The setting was an academic centre, i.e. the University of Pretoria and Steve Biko Academic Hospital Diabetes Clinic.Subjects: A total of 150 consecutive male patients aged 50 years and older with diabetes mellitus were selected using convenience sampling.Outcome measures: The patients were evaluated for diabetes control and complications, and for hypogonadism symptoms. Early-morning serum testosterone levels were determined.Results: The prevalence of androgen deficiency symptoms was 94.7%. Some 50% of the men had low total testosterone levels. Using multivariate logistic regression, the significant factors associated with low total testosterone were waist circumference and known cardiovascular disease. The prevalence of symptoms of androgen deficiency was very high; 94.7% of the patients reported a significant number of symptoms listed on the Androgen Deficiency in the Aging Male questionnaire.Conclusion: This study confirms the high prevalence of low testosterone levels in diabetic male patients in a tertiary setting. Universal screening remains controversial owing to uncertainty regarding the risks and benefits of testosterone therapy in this population group. Predictors of low testosterone levels were identified.Keywords: Diabetes Mellitus, Hypogonadism, Testosteron

'Is this treatment worth while?' How to read the medical journals

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