Psychosocial impact of the implementation of COVID-19 protocols

BACKGROUND: The COVID-19 pandemic has spread globally since the first case was diagnosed in Wuhan, China in December 2019 and we are now experiencing the fourth wave. Several measures are being taken to care for the infected and to curtail the spread of this novel infectious virus. The psychosocial impact of these measures on patients, relatives, caregivers, and medical personnel also needs to be assessed and catered for. METHODS: This is a review article on the psychosocial impact of the implementation of COVID-19 protocols. The literature search was done using Google Scholar, PubMed, and Medline. DISCUSSION: Modalities of transportation of the patient to isolation and quarantine centres have led to stigma and negative attitudes towards such individuals. When diagnosed with the infection, fear of dying from COVID-19, fear of infecting family members and close associates, fear of stigmatization, and loneliness are common among COVID-19 patients. Isolation and quarantine procedures also cause loneliness and depression, and the person is at risk of post-traumatic stress disorder. Caregivers are continually stressed out and have the constant fear of contracting SARS-CoV-2. Despite clear guidelines to help with closure for family members of people dying from COVID-19, inadequate resources make this unrealistic. CONCLUSION: Mental and emotional distress resulting from fear of SARS-Cov-2 infection, the mode of transmission, and consequences have a tremendous negative impact on the psychosocial well-being of those affected, their caregivers, and relatives. There is a need for the government, health institutions, and NGOs to establish platforms to cater to these concerns

Building the foundation for universal healthcare: Academic family medicine's ability to train family medicine practitioners to meet the needs of their community across the globe

Background: The Declaration of Astana marked a revived global interest in investing in primary care as a means to achieve universal healthcare. Family medicine clinicians are uniquely trained to provide high-quality, comprehensive primary care throughout the lifespan. Yet little focus has been placed on understanding the needs of family medicine training programs. Aim: This study aims to assess broad patterns of strengths and resource challenges faced by academic programs that train family medicine clinicians. Methods: An anonymous online survey was sent to family medicine faculty using World Organization of Family Doctors (WONCA) listservs. Results: Twenty-nine representatives of academic family medicine programs from around the globe answered the survey. Respondents cited funding for the program and/or individual trainees as one of either their greatest resources or greatest limitations. Frequently available resources included quality and quantity of faculty and reliable clinical training sites. Frequently noted limitations included recruitment capacity and social capital. Over half of respondents reported their program had at some point faced a disruption or gap in its ability to recruit or train, most often because of loss of government recognition. Reflecting on these patterns, respondents expressed strong interest in partnerships focusing on faculty development and research collaboration. Lessons learnt: This study provides a better understanding of the challenges family medicine training programs face and how to contribute to their sustainability and growth, particularly in terms of areas for investment, opportunities for government policy and action and areas of collaboration.

Child disability and family-centred care in East Africa: Perspectives from a workshop with stakeholders and health practitioners

Our understanding of child disability has undergone major changes over the last three decades transforming our approach to assessment and management. Globally there are significant gaps in the application of these 21st century models of care. There is recognition that economic, cultural, and social factors influence transitions in care and there is need to consider contextual factors.Objectives: A two-day workshop brought together key stakeholders to discuss current models of care and their application in the East African context. This article summarises workshop proceedings and identifies a broadly supported set of recommendations that serve to set a direction for health professionals, families, family-based disability organisations, communities and government. Method: Presentations followed by facilitated round-table sessions explored specific themes with participants reporting their responses communally. Future actions were agreed upon by relevant stakeholders. Results: Many barriers exist to care for children with disabilities in East Africa, including stigma and a lack of human and infrastructural resources. In addition, significant disparities exist with regard to access to medication and specialist care. The International Classification of Functioning framework needs to be translated to clinical practice within East Africa, with due recognition of the importance of family- centred care and emphasis on the life course theory for disability care. Family- centred care, educational initiatives, advocacy on the part of stakeholders and involvement of government policymakers are important avenues to improve outcomes. Conclusion: Further education and data are needed to inform family-centred care and multidisciplinary team implementation across East African care contexts for children with disabilities.

Family APGAR and treatment outcomes among HIV patients at two ART Centers in Kumasi, Ghana

objectives: This study aimed to examine the association between Family Adaptability, Partnership, Growth, Affection and Resolve (Family APGAR) and HIV treatment outcomes. Design: A cross-sectional study using the Family APGAR questionnaire Setting: The study was conducted in Kumasi, Ghana, at the Komfo Anokye Teaching Hospital and the Kwame Nkrumah University of Science and Technology Hospital Participants: Consenting HIV-positive patients who had been on treatment for at least 12 months were recruited. Main outcome measures: The Family APGAR questionnaire was administered, and relevant data were extracted from hospital records and analysed using STATA® software. The relationship between Family APGAR and treatment outcomes was determined using Chi-squared tests or Fisher's exact test. Results: Approximately 70.1% of 304 participants were females with a mean age of 41.8 years (±9.9). At treatment initiation, 47.4% of the patients presented at World Health Organisation (WHO) clinical stages I and II and had a CD4 count ≥ 200 cells/mm3 . Females were less likely (Odds Ratio= 0.52; 95% CI=0.31 ­ 0.90, p = 0.018) to report late for treatment compared with the males. After 12 months of treatment, approximately 70% recorded undetectable viral load. Patients with functional families constituted 70.4%, which had a statistically significant relationship with viral load (p = 0.041). Conclusion: HIV care providers should incorporate family functionality evaluation into clinical practice and provide early essential support to enhance treatment outcomes

Family members' experiences of caring for a relative with substance-induced psychosis disorder

Background: When there is a lack of resources in the community to support deinstitutionalisation,family members of a relative diagnosed with substance-induced psychosis disorder (SIPD) are the most affected and vulnerable. Nevertheless, family members' care is still largely unacknowledged in the mental health sector in low- and middle-income countries. Furthermore, no prior research could be found on family members' experiences caring for a relative with SIPD in Giyani, Limpopo province, South Africa. Objectives: To explore and describe family members' experiences caring for a relative with SIPD. Method: The study employed a qualitative research design using interpretative phenomenological analysis as the research method. Telephonic interviews were conducted and analysed. Eight family members were selected to participate in the study using a purposive sampling technique. Results: The analysis of data led to the emergence of the following themes: family members experienced caring for a relative with SIPD as a destabilising responsibility; they experienced acceptance and support from significant others and the community and solace in prayer. Participants also expressed they experienced a need for support from government structures in order to care for a relative with SIPD. Conclusion: The study's findings highlighted the family members' experiences of caring for a relative with SIPD and the role of the family, community and government structures in caring for an individual with SIPD. It is evident from the challenges experienced that the family members need external interventions to develop healthy coping strategies. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by promoting effective coping amongst family members caring for a relative with SIPD.

Family-integrated diabetes education for individuals with diabetes in South-west Nigeria

Objectives: This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design: The design was a two-group Pretest Posttest quasi-experimental. Setting: The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants: People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions: PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS). Main outcome measures: A1C and diabetes knowledge. Results: Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions: Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better

Factors affecting family medicine programmes in Sub-Saharan Africa: a narrative review of recent literature

Objectives: This study sought to assess the level of anti-glycaemic medication-taking and its predictors among adults living with diabetes receiving treatment at Cape Coast Teaching Hospital (CCTH). Design: This was a cross-sectional study carried out among adults living with diabetes and receiving care at CCTH. Data on socio-demographic characteristics and anti-glycaemic medication-taking were gathered using a structured questionnaire. A scale consisting of 4 domains (filling prescribed medication; taking medications appropriately ac-cording to the instructions of healthcare professionals; practising behavioural modifications, and showing up for fol-low-up appointments) and eight items was used to measure the level of anti-glycaemic medication-taking. Descriptive statistics, chi-square test (and Fisher's exact test where appropriate), bivariate and multivariate logistic regression models were used in analysing the data. Setting: The study was carried out in the diabetes clinic in Cape Coast Teaching Hospital. Participants: The total enumerative sampling technique was used to select 250 adults living with diabetes and receiv-ing care at CCTH.Main outcome measures: Anti-glycaemic medication-taking Results: Out of 250 participants studied, 42% had high anti-glycaemic medication-taking. Predictors of anti-glycae-mic medication-taking included; forgetfulness (aOR=0.02, 95% CI: 0.00-0.64, p<0.001), patient's involvement in treatment plan (aOR=0.12, 95% CI: 0.02-0.64, p=0.014) and having good knowledge about one's medication (aOR=2.34, 95% CI: 1.10-4.98, p=0.028). Conclusion: Less than half of the sample population (42%) had high anti-glycaemic medication-taking, with forget-fulness, involvement in the treatment plan and good knowledge about anti-glycaemic medications, predicting medi-cation-taking

Family-integrated diabetes education for individuals with diabetes in South-west Niger

Objectives: This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design: The design was a two-group Pretest Posttest quasi-experimental. Setting: The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants: People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions: PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS).Main outcome measures: A1C and diabetes knowledge. Results: Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions: Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better.

Le cancer de sein diagnostiqué chez l'homme à Kinshasa: à propos de 4 cas / NA

Même si les seins des hommes sont moins développés que ceux des femmes, La littérature mondiale note que le cancer du sein chez l'homme intervient dans moins de 1 % des cas des cancers, et traditionnellement les hommes avec cancer du sein présentent un risque spécial de développer un autrecancer. Les métastases du cancer du sein sont prioritairement au niveau des os avec 62 %. Les causes du cancer du sein chez l'homme demeurent encore inconnues, toutefois les facteurs de risque qui sont documentés concernent les antécédents familiaux du cancer de sein, une prédisposition génétique dans environ 15 % de cas de cancer du sein chez l'homme, liée à une mutation génétique héritée du gène BRCA2. Durant une année (2020), nous avons reçu 4 patients avec cancer de sein au Centre d'imagerie médicale Kokolo à Kinshasa, 3 patients résidants à Kinshasa et un patient venu de la province voisine du Kongo Central; et les investigations sonographiques nous ont permis de classer ces masses tumeur maligne, d'où l'indication de la microbiopsie écho guidée. Cette dernière nous permis de conclure au carcinome infiltrant et l'immunohistochimie nous a permis de classer ces masses en Luminal à cause de la positivité des récepteurs ostrogéniques, les rendant éligibles au schéma tamoxifène. Le cancer de sein est donc aussi une réalité chez l'homme congolais de Kinshasa et du Kongo Central.

Even if men's breasts are less developed than those of women, World literature notes that breast cancer in men occurs in less than 1% of cancer cases, and traditionally men with breast cancer have a special risk of developing another cancer. Breast cancer metastases are primarily in the bones with 62%. The reasons of breast cancer in men are still unknown, however the risk factors that are documented relate to a family history of breast cancer, a genetic predisposition in about 15% of breast cancer cases in humans, linked a genetic mutation inherited from the BRCA2 gene. During the year 2020, we received 4 male patients with breast cancer at the Kokolo Medical Imaging Center in Kinshasa, 3 patients residing in Kinshasa and one patient from the neighboring province of Kongo Central; and sonographic investigations allowed us to classify these malignant tumor masses, hence the indication for echo-guided microbiopsy

Mastering your fellowship

The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online

Developing a theory of family care during critical illness

Background. The critical illness of a loved one can negatively affect all family members (FMs), leading to the interruption of family functioning and integrity. Hospitalisation is a stressful, unplanned event for both the patient and FMs and is associated with psychological disturbances, emotional distress and altered family roles and functioning. Objective. To develop a theory of family care in critical care units (CCUs) for the South African setting. Methods. Grounded theory, based on Strauss and Corbin's school of thought, was used. Audio-recorded in-depth interviews were conducted with 32 participants (9 FMs, 17 critical care nurses and 6 doctors) at a private hospital (3 CCUs) and a state hospital (10 CCUs). Data analysis involved open, axial and selective coding. Results. The theory of family care during critical illness was identified. The core concept of the theory is empowerment, informed by the underlying constructs of information sharing, proximity, garnering resources, and cultural and religious cooperation. Conclusion. The concepts of this theory can equip healthcare professionals in CCUs to provide appropriate family care for meeting the needs of patients' FMs and, in so doing, contribute to families having a more manageable critical care experience during the illness of their loved one

Morbid risk of schizophrenia amongst relatives of schizophrenia probands: a family-controlled study

Introduction: There is a dearth of data on heritability of schizophrenia in Africa. The few African studies that addressed familial psychiatric morbidity in schizophrenia involved relatively small sample sizes and addressed psychiatric morbidity only in first-degree relatives. The present study sought to improve upon the methodology of previous African studies, and widen the scope to second- and third-degree relatives with a view to enriching the field of genetic epidemiology in Africa. Methods: This study elicited information on the morbid risk of schizophrenia amongst 5259 relatives of schizophrenia probands (n = 138) and 6734 relatives of healthy controls (n = 138) through direct interview of patients, available relatives of patients and controls. Diagnosis of probands was confirmed using Mini International Neuropsychiatric Interview. Through a direct interview of 138 patients and their available relatives, a family history approach using the Family Interview for Genetic Studies was utilised to obtain information on the morbid risk for all relatives that could be recalled. The same approach was utilised for the interview of the controls (aged 45 years and above) and their relatives. Morbid risk estimates were calculated using the Weinberg shorter method. Results: Morbid risk for schizophrenia in the first-, second- and third-degree relatives of schizophrenia probands was 10.9% (95% confidence interval [CI] = 10.6­11.2), 4.2% (95%CI = 4.1­4.3) and 3.9% (95%CI = 3.6­4.2), respectively, compared with 2.6% (95%CI = 2.5­2.7), 1.6% (95%CI = 1.5­1.7) and 1.5% (95%CI = 1.4­1.6), respectively, of the healthy control group. Conclusion: The findings support the widely noted impression that schizophrenia significantly aggregates in families of schizophrenia probands more than healthy controls

Formes familiales du syndrome de Gougerot-Sjögren : étude de 22 familles multiplex

Introduction : Les facteurs génétiques du SGS, outre les modèles animaux, sont déterminés par le biais de leurs formes familiales. L'objectif de ce travail était d'étudier les aspects phénotypiques des formes familiales du SGS. Patients et méthodes : Etude réalisée dans le service de Rhumatologie du CHU Aristide Le Dantec de Dakar entre Janvier 2013 et Mars 2016, où nous avons colligé les observations de familles multiplex de SGS répondant aux critères de consensus de 2002.Résultats : Vingt-deux familles ont été colligées à partir de 22 propositus (17 femmes et 5 hommes), d'âge moyen de 31,5 ans au début apparent de la maladie. Le SGS chez ces propositus était primitif dans 8 cas et secondaire à une PR dans 14 cas. Les familles totalisaient 921 membres. Soixante- quinze (54 femmes et 21 hommes), y compris les cas index présentaient un SGS (54 primitifs et 21 secondaires), soit une prévalence de 8,14 %. Les apparentés de premiers degré atteints étaient au nombre de 46 (85%). Les autres maladies auto- immunes associées étaient une PR (16 cas), un lupus systémique (1 cas), une polymyosite (1 cas), une sclérodermie systémique (1 cas), un vitiligo (1 cas) et une maladie de Basedow (1 cas). Les autres affections répertoriées étaient : lymphome oculaire (1 cas), cancer du col de l'utérus (1 cas). L'évolution sous traitement fut favorable, sauf chez 1 cas décédé. Conclusion : Le caractère familial du SGS chez nos malades plaide en faveur de l'implication de facteurs génétiques dans le déterminisme de la maladie

Asthma Control in Cities of Developing Countries: Results of a Five-City Survey

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HIV-Positive Patients' and their Families' Comprehension of HIV- and AIDS-Related Information

Despite acknowledgement of the importance of sharing HIV- and AIDS-related information with people living with HIV; it is still unclear as to what their actual comprehension is of this information. This research was part of a larger project; Tswaragano; conducted in the North-West Province; South Africa; which explored and described the competence; ability and strengths of the family of the HIV-positive patient during home support. This research focused on Potchefstroom in the North-West Province. This article focuses on research with the objective being to explore and describe the comprehension of HIV-positive patients and their families with regard to HIV- and AIDS-related information; and to formulate recommendations to improve their comprehension of this information. A quantitative; explorative and descriptive survey design was followed. Data were collected by means of questionnaires completed by HIV-positive patients (n = 79) and their family members (n = 34). Descriptive statistical analysis by means of frequency analysis was conducted. Ethical considerations and mechanisms to enhance validity and reliability are discussed. The results indicated that both HIV-positive respondents and their families face social and financial challenges due to unemployment and low income. A strength found in this research is that the majority of respondents are linked to a church; which can be a valuable platform to share information on HIV and AIDS. With regards to sharing; sources and comprehension of HIV- and AIDS-related information; it is apparent that respondents perceived that pre- and post-counselling provided an opportunity for information sharing; but that they need health care workers to spend more time with them; to be non-judgemental and to make more use of visual aids. It furthermore seems that the majority of HIV-positive respondents in this study did comprehend the need for and negotiate for safer sexual practices. It was concluded that although HIV-positive patients and their families have relatively good levels of comprehension of HIV- and AIDS-related information; there are certain gaps in their comprehension of this information. Accordingly; recommendations regarding improving comprehension of HIV-related information were formulated. Recommendations for nursing education; research and practice were formulated. These recommendations highlight the importance of openness in communication; building trust relationships; collaboration; cultural sensitivity and empowering HIV-positive patients and their families

Analyse anthropologique de la gestion de la crise d'adolescence par les familles à Yaoundé

L'adolescence est une période de transition entre l'enfance et l'âge adulte. Elle est caractérisée par un changement physique qui peut provoquer un déséquilibre comportemental, pouvant aller jusqu'à des crises d'hystéries, des dépressions ou des trajectoires de violence. Ce passage peut être une période d'affrontement mais aussi d'identification et d'adhésion. Un adolescent en pleine crise doit se sentir exister, quitte à faire des erreurs. Il a donc besoin de l'aide des adultes, qui eux-mêmes à cheval entre la tradition et la modernité, éprouvent quelquefois des difficultés à apporter une réponse efficace aux besoins des enfants en crise. Aussi l'étude s'est-elle proposé d'interroger les stratégies parentales de gestion de la crise d'adolescence à Yaoundé.MÉTHODES. Nous avons mené une étude transversale analytique d'avril 2011 à Janvier 2012 auprès de 256 parents d'adolescents au quartier "Damase" de Yaoundé. Pour ce faire, à l'aide d'un questionnaire direct, structuré, fermé et administré. Les données ont été traitées à l'aide du logiciel SPSS.16, analysées à l'aide du khi² pour la dépendance entre les variables, et de l'odds ratio pour quantifier le risque de survenue de la crise.RÉSULTATS.Les parents étaient peu outillés pour une prise en charge adéquate de la crise d'adolescence grave. Bien que 83,2% d'entre eux ait entendu parler de la crise d'adolescence, et que 62,1% avait su la définir, seul 13,1% d'entre eux avait entendu parler de la crise d'adolescence pathologique, dont 32,4% de parents d'adolescent en crise pathologique. Les adolescents qui vivaient dans les familles recomposées avait 12 fois plus de chance de développer une crise d'adolescence grave que les autres (OR = 0,08). Le mode de gestion le plus utilisé en cas de crise d'adolescence était le modèle traditionnel à travers le style autocratique (42,4%), bien que les libertés individuelles préconisent l'usage du style démocratique. En l'absence de structures d'aides, 19% des parents avaient opté pour le style désengagé, dont 32,2% de parents d'enfants en crise pathologique.CONCLUSION.L'étude suggère une réponse intégrée et intersectorielle à ce problème de santé publique, qui est ancrée dans une famille camerounaise en transformation. Cette réponse apporterait aux parents une aide structurelle complémentaire pour un accompagnement adéquat de cette phase naturelle du développement de l'enfant, y compris la prise en charge efficace de la crise d'adolescence pathologique

Psychosocial burden of sickle cell disease on the family, Nigeria

Background: Sickle Cell Disease (SCD); the most common genetic disorder amongst Black people; poses a significant psychosocial burden on the sufferers; the caregivers and their families. Objective and methods: From 01 January 2011 to 30 September 2011 the caregivers of children with SCD treated at the Paediatric Haematology Clinic of the University Teaching Hospital in Ado-Ekiti; Nigeria; were included in a study; using a structured questionnaire and a validated; culture-relevant disease burden interview to assess the psychosocial burden of SCD on these caregivers. Three main objective psychosocial domains and some subjective domains; including the caregivers' coping ability were assessed. Results: A total of 225 caregivers; consisting of 202 mothers (89.8); 15 grandmothers (6.7) and 8 fathers (3.6) were studied. In 53.3of the families; the care of children with SCD adversely affected the provision of their basic needs; with 73.3of the caregivers stating that time spent caring for the child made them lose income or financial benefits; 19.6of the caregivers had to take out loans to meet the expenditure of the patient's illness. Caring for children with SCD reportedly made 42.2of the caregivers neglect other family members. In addition; 14.2of the families experienced moderate to severe disruption in their day-to-day interactions within the family to the extent that 12.4frequently quarrelled due to the child's illness. Conclusion: Caregivers are faced with enormous financial; interpersonal and psychological problems. Social support should be available to alleviate caregivers' and/or family members' burdens

Associations between Family Suicide and Personal Suicidal Behaviour among Youth in Kwazulu-Natal; South Africa

Background: For every suicide; a minimum of six people are affected. Given the increasing number of suicide deaths in South Africa; the associations between the suicide of a family member and personal suicidal behaviour were explored in grade 8 students.Method: Grade 8 students were asked to participate with parental consent and child assent. Demographic questionnaires were completed and formal psychometric assessment instruments were used.Results: Thirty-five (15.98) students reported knowing that a family member had committed suicide. The mean age was 13.3 years (range 13-15 years). There were significant associations between family suicide and students' self-reported involvement in physical fights; use of alcohol and concerns about physical health. Family suicide was associated with personal suicidal ideation; suicidal plans and suicide attempts. Higher scores were reported on the scales assessing depression; perceived stress and feelings of hopelessness by those having had a family member commit suicide. There were low scores for having a sense of mastery; self-esteem and perceived social support among those who had experienced a family member commit suicide.Conclusion: Significant associations were found between the suicide of a family member and personal suicidal behaviour among the participants. There appear to be negative associations at a psychological level for the youth in a family in which a family member has committed suicide. Family practitioners play an important role in the identification and management of suicidal behaviour. While there are organisations in South Africa that offer help to the family and friends of those who have committed suicide; specific programmes directed towards child/adolescent survivors appear to be limited; and this needs to be addressed. The limitations of the study are discussed

Uptake of Genetic Counselling Services by Patients with Cystic Fibrosis and Their Families

Background: Although cystic fibrosis (CF) is a common genetic condition; genetic counselling services appear to be underutilised by affected families. The aim of this study was to determine the uptake of genetic counselling and mutation testing for CF by relatives of affected individuals; and the impact of introducing hospital-based genetic counselling services.Method: The files of 153 families seen for genetic counselling for CF by staff of the Division of Human Genetics; School of Pathology; University of the Witwatersrand; and the National Health Laboratory Service (NHLS) in Johannesburg; were retrospectively reviewed from 1990 to 2006; the year when hospital-based genetic counselling services were introduced.Results: Parents of CF probands were the largest single group (35) of counsellees. Most individuals (66) attended genetic counselling to gather information. Most had been referred by medical specialists (56). Only 10 of referrals originated from general practitioners. On average; from 1990-2005; six families received genetic counselling annually; whereas in 2006; 58 families were seen. In 140 unrelated families; 1 991 relatives with carrier risks of ? 25 were identified. Only 11of these relatives underwent mutation testing; and eight per cent received genetic counselling through our division over the review period.Conclusion: Overall; referrals of family members (of affected CF individuals) to genetic counselling; by general practitioners; are poor. Uptake of genetic counselling services is greater when such services are integrated into hospital-based CF management clinics; than when offered elsewhere. The low uptake of mutation testing and genetic counselling by at-risk relatives is a concern; since these relatives are at high risk of having affected children; if their partners are CF carriers. Education of affected individuals; their close relatives; and medical practitioners; should be prioritised. This will ensure referral to genetic counselling for discussion about the risks of and available testing for CF; and other genetic conditions

The Role of Ubuntu in Families Living with Mental Illness in the Community

Background: Families living with mental illness are a vulnerable group in the community. In the African culture; it is accepted that families are embedded safely in a community. In accordance with the principles of Ubuntu; people with mental illness should be well supported and cared for by their families and the wider community. Traditionally; people with mental illness are institutionalised; out of sight of the family and the general population. However; the deinstitutionalisation of mental health services has changed the structure and mode of caring for people with mental illness. The family and community are now regarded as the dominant care givers and providers.Method: A qualitative grounded theory method was used.Results: This article discusses research in progress that demonstrates how families in the community experienced stigma and isolation in the community; as well as crime. There was little support from the community in assisting families to shoulder their burden of care. In this article; we reflect on the possibility that the spirit of Ubuntu may well assist families living with mental illness; despite the burden that communities have to shoulder when fulfilling their own family obligations.Conclusion: In a community in which Ubuntu is the underpinning life philosophy and way of life; these values could be reinstated and revived to promote the survival and recovery of families living with mental illness in the community; and to reintroduce humanness in the community