Tuberculosis in medical doctors – a study of personal experiences and attitudes

Background. The concurrent TB and HIV epidemics in sub-Saharan Africa place all healthcare workers (HCWs) at increased risk of exposure to Mycobacterium tuberculosis.Aim. This study explores personal experiences, attitudes and perceptions of medical doctors following treatment for TB within the healthcare system.Method. Sixty-two medical doctors who were diagnosed with and treated for TB during 2007 - 2009 agreed to participate and complete a semi-structured questionnaire.Results. The response rate was 64.5% (N=40). The mean age of participants was 33.7 years (standard deviation ±10.6). A correct diagnosisof TB was made within 7 days of clinical presentation in 20% of  participants, and was delayed beyond 3 weeks in 52.5%. Non-routinespecial investigations and procedures were performed in 26 participants. Complications following invasive procedures were reported by 8 participants. Multi-drug resistant TB (MDR-TB) was diagnosed in 4 participants. Nineteen considered defaulting on their treatment because of drug side-effects. The majority (n=36) expressed concerns regarding lack of infection control at the workplace, delays in TB diagnosis and negative attitudes of senior medical colleagues and administrators. Ninety per cent of participants indicated that their personal illness experiences had positively changed their professional approach to patients in their current practice.Conclusion. The inappropriate delays in diagnosis in a large number of participants, coupled with a number of negative personal perceptions towards their treatment, are cause for concern. The results further amplify the need for improved educational and awareness programmes among all healthcare personnel (including hospital administrators), adherence to national health guidelines, effective infection control measures, pre- and post-employment screening in all HCWs, and changes in attitudes on the part of senior medical colleagues and administrators

Student funding and student success: A case study of a South African university

This study sought to establish the relationship between student matriculation results, bursary funding and academic performance. It involved an analysis of 8099 undergraduates for the 2011 cohort year at one particular high education institution in South Africa. This 2011 cohort was tracked over a period of three years. Results show that in terms of student academic performance, Grade 12 National Senior Certificate results are a weak predictor of academic success, whilst grades weighted by module credits were a statistically better predictor of performance and throughput. Thus, enrolment decisions based solely on matriculation results are not recommended. No relationship was found between either the presence, or the value of individual student bursary funding, and throughput. Thus, student academic performance is not a function of bursary funding, although merit bursaries awarded on academic merit yielded the best results. Lastly, there was a statistically significant relationship between being placed in a student residence and academic performance and throughput. That is, students accommodated in official student residences were more likely to graduate within the minimum time than those who were not

Methamphetamine abuse: Oral symptoms and dental treatment needs

BACKGROUND: Methamphetamine: a highly addictive drug commonly used in South Africa. Users often present with poor oral hygiene, grossly decayed teeth and complain of a dry mouth. The prevalence of dental caries among users is high. METHODS: A cross-sectional study design was used with a convenience sample of 308 self-reported methamphetamine users who were part of an in- or out-patient rehabilitation programme at one of 22 specialised substance addiction treatment centres in the Western Cape. RESULTS: The majority were in their late twenties, unemployed and not satisfied with the appearance of their teeth. A dry mouth and a bad taste were the most common symptoms reported. More than three quarters reported "stiff" facial muscles and more than half, grinding of their teeth. The most common reason for the last dental visit was toothache and the most common treatment at that visit was dental extraction. CONCLUSION: Lower levels of education were associated with increased numbers of extractions and a higher probability of poor oral health. Xerostomia, a bad taste and "stiff" facial muscles were the most common symptoms reported. PRACTICAL IMPLICATIONS: A thorough intra-oral examination together with comprehensive note taking is crucial for the management of patients abusing methamphetamine.DHE

Relationship between firewood usage and urinary Cr Cu and As in informal areas of Cape Town

OBJECTIVES: The study investigated whether wood usage by informal food vendors and household residents in Cape Town results in the absorption of arsenic (As), chromium (Cr) and copper (Cu) owing to release of these metals in the burning of chromated copper arsenate (CCA)-treated wood. METHODS: The participants (N=78) selected included an equal number of food vendors and non-vendors from 2 informal settlements. All participants answered a questionnaire concerning exposure and were tested for urinary Cr, Cu and As, while the urine of 29 participants was also tested for toxic As (As(tox)). RESULTS: Multivariate analysis showed that the time spent in close proximity to the wood, as well as the quantity of wood used for cooking and for household use, was weakly positively associated with urinary levels of As, Cr and the sum of As, Cr and Cu. CONCLUSIONS: The study provides evidence that use of wood likely to contain CCA as a fuel for informal food outlets and household purposes may increase the absorption of inorganic As, Cu and Cr

Effect of chemical extractants on the biosorptive properties of pine cone powder: Influence on lead(II) removal mechanism

AbstractThis study examines the changes in surface properties and lead(II) adsorption mechanism of pine cone powder modified using varying ratios of toluene–ethanol mixtures.Increasing the ratio of toluene in the extractant mixture increased formation of esters and iodine capacity of the material, but reduced carboxylate ions and surface charge. Values of surface charge and iodine capacity showed no relationship with the bulk densities. Maximum lead(II) adsorption was observed for the 2:1 toluene–ethanol modified sample. Lead(II) ions adsorption was inversely related to surface charge and directly related to iodine capacity.Ion-exchange was the dominating mechanism followed by chemisorption. Physical adsorption was higher in the sample modified with the 2:1 mixture which also had the least surface negative charge. Shifts in peaks of FTIR spectra indicate that unbounded –OH and acidic groups were responsible for lead(II) bonding and the contribution of these groups were different for each sample

Adolescent antiretroviral management: Understanding the complexity of non-adherence

This case-based discussion highlights challenges in adolescent antiretroviral management, focusing on non-disclosure of status and the subsequent impact of suboptimal treatment adherence. Despite the scale-up of antiretroviral therapy (ART) and recommendations made by the World Health Organization (WHO) for ART for all human immunodeficiency virus (HIV)-infected paediatric patients, ART coverage in adolescents lags behind that in adults. Challenges of sustaining lifelong ART in children and adolescents require consideration of specific behavioural, physiological and psychosocial complexities associated with this special group. To preserve future drug options and sustain lifelong access to therapy, addressing non-adherence to treatment is critical to minimising acquisition of ART drug resistance and treatment failure. We review the psychosocial and developmental components that influence the course of the disease in adolescents and consider the complexities arising from perinatal exposure to ART and the growing risk of transmitted ART drug resistance in high-burden resourcelimited settings

COGNITIVE BEHAVIOURAL THERAPY IN SOUTH AFRICA: COUNSELLORS' EXPERIECES FOLLOWING A TRAINING PROGRAMME

Many South African communities experience high level of violence and other phenomena that potentially provoke symptoms of traumatic stress among residents. Cognitive behaviour therapy (CBT) has been demonstrated to be an effective psychological intervention to ameliorate symptom of trauma, but is seldom practised in South African community mental health settings. In order to determine the barriers to implementing CBT. 12 credentialed community counsellors participated in a two-day training workshop focused on CBT.  Counsellor were asked to implement CBT with their clients who presented with ymptom of PTSD. The counsellors were then asked to complete a questionnaire six-months after the training workshop in order to identify the barriers they experienced in implementing the treatment model. The chief barriers that counsellors identified included high workload and limited time, unsuitable clients, client drop out, and an inappropriate match between the counsellor's theoretical paradigm and the CBT model. These result are considered in the context of community mental health care in post-apartheid South Africa