Anatomical human body donation in South Africa: Inconsistencies of informed consent.

INTRODUCTION: Informed consent is critical for maintaining the ethical standards associated with the utilization of human donor bodies by tertiary education institutions. Body donation programs undertake the responsibility for procuring human donor bodies for didactic and research purposes. However, its processes require scrutiny regarding best practice guidelines and the South African National Health Act (SA-NHA) (2013). Moreover, acknowledging and addressing the current perceptions of human body donation are indispensable in bridging the gap between academia and society. This study aimed to compare informed consent documentation and procedures across South African tertiary education institutions and their affiliated human body donation programs (HBDP) in accordance with international guidelines. The findings were used to create a human body donation form template aligned to current international best practices for consideration by the South African HBDP. METHODOLOGY: A review of information and consent forms collected from South Africa's eight HBDP was conducted. The analyses consisted of a broad evaluation of information provided, ranging from the terms-of-use for human donor bodies to the commitments made by HBDP to body-donors. The results were considered in conjunction with the International Federation of Associations of Anatomists and other recent publications on informed consent in HBDP. RESULTS: Only two of the eight HBDP provided information and consent forms in more than one language. Most allowed donors to select how their bodies will be utilized - education, training and/or research. Some (6/8) made provisions for the next-of-kin to receive the cremains. Only one tertiary educational institution mentioned the occurrence of a memorial service in its documentation. An HBDF template was created aligned to current international best practices for presentation and possible adaption by SA HBDP. DISCUSSION & CONCLUSIONS: Human body donation forms (HBDF) requires thorough examination for the promotion and sustainability of HBDP. Effective communication by employing standardized non-technical terminology conveyed in language that is understandable and native to potential donors facilitates the deliverance of informed consent. Inconsistencies regarding the use and management of bodies catalyze the weakening perception of human body donation. Thus, this process of securing informed consent for body donation should be conducted in conjunction with public awareness campaigns and underpinned by the necessary policy and legislative reform.

The accuracy of the Transition Analysis of aging on a heterogenic South African population.

Transition Analysis (TA) is an age estimation method for adult skeletons at death, using three skeletal traits together, namely, the cranial sutures (CS), the pubic symphyses (PS) and the auricular surfaces (AS). In forensic anthropology, estimating age at death is vital for positive identification of an individual; however, differences in skeletal elements have been observed between sex and population affinity. The aim of this study was to determine how accurately the TA could be applied to a population that differed from the original reference samples. Scoring methods, described by the authors of this analysis, were used to age individuals (n = 290) in the South African (SA) Mixed Ancestry population, which is a heterogenic population, consisting of many gene pools from different population groups. The results were compared to the actual ages of the skeletal remains, obtained through cadaver records, and the most likely age calculated by the TA, as well as age estimation by means of the three skeletal elements individually. Results showed that there was a significant correlation between the actual and estimated ages of the study population (Pearson correlation coefficient: 0.58). The AS was the most accurate trait, whereas the PS was the least accurate trait. In addition, females' estimated ages were more accurate than males. These findings correlated with other authors in terms of the significance of the TA when applied to different populations; however, the individual trait correlations were in disagreement with other authors. The results of this study are an important contribution to anthropological literature as they indicate that there are differences between populations and sex when determining age, but that the TA is still applicable for analysis on this heterogenic population.

Use of backscattered scanning electron microscopy to quantify the bone tissues of midthoracic human ribs.

OBJECTIVES: Novel information on apartheid health conditions may be obtained through the study of recent skeletal collections. Using a backscattered scanning electron microscopy (BSE-SEM) approach, this study aims to produce bone quality and tissue mineralization data for an understudied South African population from the Western Cape province. METHODS: Using BSE-SEM imaging, cortical porosity (Ct.Po), osteocyte lacunar density (Ot.Lc.Dn), and the degree of tissue mineralization were quantified in midthoracic ribs from the Kirsten Skeletal Collection. Individuals ( n female = 75, n male = 68, and mean age = 46.3 years) were predominantly from the South Africa Colored (SAC) population group ( n SAC = 103, 72%). Full cross-sectional images of each rib were manually stitched together in Adobe Photoshop. Photomontages were imported into MATALB (Mathworks, Natick, MA) for image processing and analysis. Age-related changes in histomorphometric parameters and sex differences were examined using correlation analysis, as well as linear and nonlinear regressions. RESULTS: Young adult men have significantly less mineralized bone and fewer osteocyte lacunae, compared to women. Only men demonstrate a significant negative relationship between Ot.Lc.Dn and age. Average tissue mineralization decreases with age in women, while Ct.Po increases. Pore area (Po.Ar) does not vary with age, but pore density (Po.Dn) is highest in the perimenopause, when accelerated rates of bone turnover are first anticipated. Ct.Po is highest in the years following the predicted age of menopause, but levels off in the final decades of life. CONCLUSIONS: Men and women display disparate patterns of bone aging. Systemic disenfranchisement of non-white population groups affected bone health in South Africa, and may continue to do so today. Indicators of poor bone quality are evident in the full study sample, indicating that osteoporosis and fracture risk are not just of concern to the aged white female population.

The Influence of Body Size and Bone Mass on Cortical Bone Histomorphometry in Human Ribs.

This study examines the influence of human adult body size and bone mass on cortical bone histomorphometry, and explores microstructural variation in mid-thoracic ribs. The sample consists of 213 individuals (n female = 82, n male = 131, mean age-at-death = 47.96 ± 15.71 years) from the Kirsten Skeletal Collection, Stellenbosch University, South Africa. Maximum femur length and femur maximum head diameter are used as proxies for height and weight; total cross-sectional area, endosteal area, and cortical area are used to derive measures of bone mass. Histomorphometric variables include osteon population density (OPD) and osteon area (On.Ar). Partial correlations, controlling for age, test for significant relationships among variables. A hierarchical regression model is used to determine unique variable contributions to On.Ar and OPD. Body size measurements do not correlate with either bone mass or histomorphometric variables, suggesting that size-standardization may not be necessary in studies of rib bone microstructure. Age is the most significant factor affecting OPD, while OPD is the best predictor of On.Ar. These findings suggest that age-related secondary osteon crowding affects osteon geometry. Understanding the biological mechanisms that direct bone remodeling and determine microstructural variation is essential for interpreting histological data. Anat Rec, 301:1788-1796, 2018. © 2018 Wiley Periodicals, Inc.

Sex-specific patterns in cortical and trabecular bone microstructure in the Kirsten Skeletal Collection, South Africa.

OBJECTIVES: The purpose of this study was to provide bone histomorphometric reference data for South Africans of the Western Cape who likely dealt with health issues under the apartheid regime. METHODS: The 206 adult individuals (n female = 75, n male = 131, mean = 47.9 ± 15.8 years) from the Kirsten Skeletal Collection, U. Stellenbosch, lived in the Cape Town metropole from the late 1960s to the mid-1990s. To study age-related changes in cortical and trabecular bone microstructure, photomontages of mid-thoracic rib cross-sections were quantitatively examined. Variables include relative cortical area (Rt.Ct.Ar), osteon population density (OPD), osteon area (On.Ar), bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp). RESULTS: All cortical variables demonstrated significant relationships with age in both sexes, with women showing stronger overall age associations. Peak bone mass was compromised in some men, possibly reflecting poor nutritional quality and/or substance abuse issues throughout adolescence and early adulthood. In women, greater predicted decrements in On.Ar and Rt.Ct.Ar suggest a structural disadvantage with age, consistent with postmenopausal bone loss. Age-related patterns in trabecular bone microarchitecture are variable and difficult to explain. Except for Tb.Th, there are no statistically significant relationships with age in women. Men demonstrate significant negative correlations between BV/TV, Tb.N, and age, and a significant positive correlation between Tb.Sp and age. CONCLUSIONS: This research highlights sex-specific differences in patterns of age-related bone loss, and provides context for discussion of contemporary South African bone health. While the study sample demonstrates indicators of poor bone quality, osteoporosis research continues to be under-prioritized in South Africa.

The association between healed skeletal fractures indicative of interpersonal violence and alcoholic liver disease in a cadaver cohort from the Western Cape, South Africa.

Interpersonal violence (IPV) and heavy alcohol consumption are major problems in the Western Cape Province of South Africa. Cranio-maxillofacial fractures, particularly nasal and zygomatic bone fractures, as well as isolated radial fractures (Colles fractures) and ulnar shaft fractures (parry fractures), are indicative of IPV, while alcoholic liver disease (ALD) is the consequence of chronic alcohol abuse. We therefore aim to investigate whether a significant association exists between the prevalence of cranio-maxillofacial fractures and parry fractures and ALD in a Western Cape population. Embalmed cadavers (n = 124) used for medical students' anatomy training at the Division of Anatomy and Histology, Faculty of Medicine and Health Sciences, Stellenbosch University were studied. The cadavers were dissected according to departmental protocol. The liver of each cadaver was investigated for macroscopic pathology lesions. Tissue samples were removed, processed to wax, and sectioned and stained with hematoxylin and eosin (H&E). All soft tissue was removed from the skulls, radii, and ulnae, which were then investigated for healed skeletal trauma. The results showed 37/124 (29.8%) cadavers had healed cranio-maxillofacial fractures and 24/124 (19.4%) cadavers had morphologic features of ALD. A total of 12/124 (9.7%) cadavers showed signs of both ALD and healed cranio-maxillofacial trauma. More males were affected than females, and left-sided facial fractures were statistically more common compared to the right side. This study illustrated a significant trend between alcohol abuse and cranio-maxillofacial fractures in individuals from communities with a low socio-economic status (SES) where IPV is a major problem.