Training, guideline access and knowledge of antiretroviral interactions: Is the South African private sector being left behind?

BACKGROUND: South Africa (SA) has the largest antiretroviral therapy programme in the world. While the majority of the country accesses healthcare in the public sector, 15.2% access private healthcare. In 2019, dolutegravir was introduced as first-line treatment for HIV. Dolutegravir has clinically significant interactions with numerous commonly used medicines, e.g. rifampicin and cation-containing medicines such as calcium and iron. They require dosage adjustments, detailed in public and private HIV guidelines. OBJECTIVES: To describe SA healthcare workers' guideline access, training and knowledge of dolutegravir's interactions, focusing on differences between the public and private sectors. METHODS: A cross-sectional, descriptive study was done using an online survey of healthcare workers in the field of HIV in SA, conducted by the National HIV and TB Healthcare Worker Hotline. Convenience sampling was used, with electronic dissemination to users of the hotline and by relevant HIV-focused organisations. Simple descriptive statistics and statistical analyses were used. RESULTS: A total of 1 939 surveys were analysed, with 22% from the private sector. Training on the dolutegravir guidelines was received by significantly fewer healthcare workers in the private sector v. the public sector: 42.4% (95% confidence interval (CI) 37 - 48) v. 67.5% (95% CI I 65 - 70), respectively. Significantly fewer healthcare workers in the private sector had access to the guidelines (63.8%; 95% CI 59 - 69 v. 78.8%; 95% CI 77 - 81). When asked if they were aware that dolutegravir has interactions, just over half (56.9%) of healthcare workers in the private sector responded 'yes', 24.6% responded 'no' and 18.5% did not answer. Of those who were aware that dolutegravir has interactions, 48.9% knew that dolutegravir interacts with calcium, 44.6% with iron and 82.0% with rifampicin. Private sector knowledge of dosing changes was lower for all interacting drugs, with the difference only significant for calcium and iron. Private sector healthcare workers reported significantly lower levels of counselling on dolutegravir use in all appropriate situations. CONCLUSION: Private sector healthcare worker access to HIV training and guidelines requires attention. In a high-burden HIV setting such as SA, it is vital that healthcare workers across all professions, in both the public and private sector, know how to adjust antiretroviral dosing due to clinically significant interactions. Without these adjustments, there is a risk of treatment failure, increased mother-to-child transmission and morbidity and mortality.

Encephalopathy after persistent vomiting: Three cases of non-alcohol-related Wernicke's encephalopathy.

Wernicke's encephalopathy (WE) is a medical emergency. Although WE is commonly viewed in the context of alcoholism, it can be caused by thiamine deficiency secondary to persistent vomiting. Non-alcohol-related WE may be more catastrophic in onset and less likely to present with the classic features than WE with alcoholism as a cause. We describe three cases of WE due to persistent vomiting without alcoholism in patients with hyperemesis gravidarum, drug-induced hyperlactataemia, and an acute gastrointestinal illness in an already malnourished individual. Our cases highlight the importance of recognising WE when undernutrition, which may be caused by gastrointestinal disease or surgery, or malignancy, is compounded by vomiting. Expert guidelines suggest that WE must be considered in the emergency room in any individual with disturbed consciousness of unknown cause. Treatment is with parenteral thiamine before glucose administration.

Evaluation of soy-based surface active copolymers as surfactant ingredients in model shampoo formulations.

OBJECTIVE: A new non-toxic soybean oil-based polymeric surfactant (SBPS) for personal-care products was developed and extensively characterized, including an evaluation of the polymeric surfactant performance in model shampoo formulations. METHODS: To experimentally assure applicability of the soy-based macromolecules in shampoos, either in combination with common anionic surfactants (in this study, sodium lauryl sulfate, SLS) or as a single surface-active ingredient, the testing of SBPS physicochemical properties, performance and visual assessment of SBPS-based model shampoos was carried out. RESULTS: The results obtained, including foaming and cleaning ability of model formulations, were compared to those with only SLS as a surfactant as well as to SLS-free shampoos. Overall, the results show that the presence of SBPS improves cleaning, foaming, and conditioning of model formulations. CONCLUSIONS: SBPS-based formulations meet major requirements of multifunctional shampoos - mild detergency, foaming, good conditioning, and aesthetic appeal, which are comparable to commercially available shampoos. In addition, examination of SBPS/SLS mixtures in model shampoos showed that the presence of the SBPS enables the concentration of SLS to be significantly reduced without sacrificing shampoo performance.

Factors affecting recruitment and retention of rehabilitation professionals in Northern Ontario, Canada: a cross-sectional study.

INTRODUCTION: Historically, Northern Ontario, Canada, has been an underserviced area for health care, including the rehabilitation professions of occupational therapy, physiotherapy, speech-language pathology and audiology. The Rehabilitation Studies and Northern Studies Stream programs were created in the 1990s to improve the recruitment and retention of rehabilitation professionals to Northern Ontario. However, no recent research has been conducted examining the factors that lead to rehabilitation professionals relocating to and remaining in the region. METHODS: A cross-sectional survey of rehabilitation professionals living and working in Northern Ontario was administered in 2009. Information collected included demographics and a rating of the personal and professional factors that had an impact on an individual's decision to continue living and working in Northern Ontario. RESULTS: A total of 345 individuals completed the survey (response rate 57%). Multiple personal and professional factors were closely linked to recruitment and retention with differences noted between those individuals originally from Northern Ontario and those who were not. Rural or remote education experiences and rural/remote origin were identified as important recruitment factors while job satisfaction and lifestyle options were important factors for retention of rehabilitation professionals to rural and remote areas of practice. CONCLUSIONS: This study has provided updated information specific to the recruitment and retention of rehabilitation professionals in Northern Ontario, Canada. These findings support previous work examining health professions worldwide and have clear implications for educational programs, funding agencies, and health human resource planning in underserviced areas.

Cannabis use and first-episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation.

BACKGROUND: Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms. METHOD: Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points--at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded. RESULTS: Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up. CONCLUSIONS: Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.

Pulsed laser deposition of antimicrobial silver coating on Ormocer microneedles.

One promising option for transdermal delivery of protein- and nucleic acid-based pharmacologic agents involves the use of microneedles. However, microneedle-generated pores may allow microorganisms to penetrate the stratum corneum layer of the epidermis and cause local or systemic infection. In this study, microneedles with antimicrobial functionality were fabricated using two-photon polymerization-micromolding and pulsed laser deposition.The antibacterial activity of the silver-coated organically modified ceramic (Ormocer)microneedles was demonstrated using an agar diffusion assay. Human epidermal keratinocyte viability on the Ormocer surfaces coated with silver was similar to that on uncoated Ormocer surfaces. This study indicates that coating microneedles with silver thin films using pulsed laser deposition is a useful and novel approach for creating microneedles with antimicrobial functionality.

Barnacle reattachment: a tool for studying barnacle adhesion.

Standard approaches for measuring adhesion strength of fouling organisms use barnacles, tubeworms or oysters settled and grown in the field or laboratory, to a measurable size. These approaches suffer from the vagaries of larval supply, settlement behavior, predation, disturbance and environmental stress. Procedures for reattaching barnacles to experimental surfaces are reported. When procedures are followed, adhesion strength measurements on silicone substrata after 2 weeks are comparable to those obtained using standard methods. Hydrophilic surfaces require reattachment for 2-4 weeks. The adhesion strength of barnacles in reattachment assays was positively correlated to results obtained from field testing a series of experimental polysiloxane fouling-release coatings (r = 0.89). The reattachment method allows for precise barnacle orientation, enabling the use of small surfaces and the potential for automation. The method enables down-selection of coatings from combinatorial approaches to manageable levels for definitive field testing. Reattachment can be used with coatings that combine antifouling and fouling-release technologies.

Randomized controlled trial of teaching practice nurses to carry out structured assessments of patients receiving depot antipsychotic injections.

BACKGROUND: A third of patients with schizophrenia are out of contact with secondary services. Many of these patients receive maintenance medication as depot antipsychotics from practice nurses, most of whom have negligible training in mental health. AIM: To examine the impact of a structured assessment on the process of care and clinical status of schizophrenia patients by practice nurses who received a one-day training course. METHOD: All identified patients were randomly allocated to structured assessments and outcome, measured by the number of assessments and the changes in care recorded in primary care notes. A comprehensive assessment of clinical and social functioning and level of unmet need in intervention and control patients was carried out after one year by an independent researcher. RESULTS: A high rate of consultation and clinical need in this patient group was demonstrated. Practice nurses were more diligent in carrying out assessments than general practitioners (GPs), but there was no impact on treatment patterns or clinical outcome. CONCLUSIONS: Structured assessments by practice nurses are feasible with this patient group, but training, targeted at both nurses and GPs, is needed if this intervention is to translate into health gain.

Modified brow lift: an adjunct to blepharoplasty.

PURPOSE: This report evaluates the efficacy of the modified supratrichial brow lift technique. The indications for the procedure, as well as the advantages, effectiveness, and complications are reviewed. PATIENTS AND METHODS: Thirty-six modified supratrichial brow lift procedures were performed bilaterally on 34 female and two male patients. The procedure was used in conjunction with a blepharoplasty in 32 patients and alone in four patients. RESULTS: The procedure improved the cosmetic result in the 32 patients with lateral brow ptosis who had a concomitant upper eyelid blepharoplasty. No complications were encountered. CONCLUSION: The modified supratrichial brow lift can improve the cosmetic result in patients with lateral brow ptosis undergoing an upper eyelid blepharoplasty.

Rhytidectomy: use of the short flap.

PURPOSE: This study compares the use of the short and long flap rhytidectomy. PATIENTS AND METHODS: Thirty short flap rhytidectomies and 20 long flap rhytidectomies were compared for indications, operating time, complications, and patient satisfaction. Flaps 6 cm or less in length were considered short flaps. RESULTS: The short flap technique was used more frequently on younger female patients. The use of this technique resulted in fewer complications and shortened operating and anesthesia times. Patient satisfaction was the same with both procedures. CONCLUSION: The short flap technique is appropriate for the younger patient with minimal nasolabial folds, jowls, rhytids, actinic damage, and less extensive signs of aging. When this technique is used on a suitable patient, the results are cosmetically gratifying.

Neuroendocrine assessment of serotonin (5-HT) function in chronic fatigue syndrome.

Prolactin and cortisol responses to dl-fenfluramine challenge were examined in 11 patients with chronic fatigue syndrome and in 11 healthy controls who were age and gender matched. After obtaining two baseline samples, each subject was given 60 mg of dl-fenfluramine orally and further blood samples were drawn hourly during the following five hours in order to measure prolactin and cortisol levels. There was no difference in either baseline or fenfluramine-induced hormonal responses between patients with chronic fatigue syndrome and controls. There was also no correlation between depression scores on HAM-D and hormonal responses in patients with chronic fatigue syndrome. The findings of this study do not support a role for 5-HT in chronic fatigue syndrome.

Polychlorinated biphenyl levels in the tissues of exposed and nonexposed humans.

Polychlorinated biphenyls (PCBs) are synthetic chemicals, manufactured in volume from about 1929 to the 1970s. Environmental contamination by PCBs has been documented in various substances, including human tissue. PCBs have been measured in human tissue by a variety of analytical methods. PCB levels have been reported as an approximation of total PCB content expressed in terms of a commercial mixture, by identification and quantification of chromatographic peaks, or by qualitative and quantitative characterization of specific congeners. Until recently, the coplanar mono-ortho- and di-ortho substituted PCBs, which are especially toxic and present in significant concentration in humans from industrial countries, had not been measured in human tissues. Examples of various types of commonly used analyses are presented in general population subjects and in persons who experienced special exposure. In this paper, the usefulness of PCB blood determinations following potential exposure is demonstrated, and their application in health studies is illustrated from a number of case studies. Coplanar PCB, mono-ortho-substituted and di-ortho-substituted PCB levels in human blood are presented and compared with polychlorinated dioxin (PCDD) and polychlorinated dibenzofuran (PCDF) levels in the U.S. population. Dioxin toxic equivalents for the two groups of chemicals are calculated and compared. It is found that mono-ortho-substituted and, to a lesser extent, coplanar PCBs, contribute substantially to dioxin toxic equivalents (TEq) in blood from U.S. adults. Because of substantial PCB contribution to dioxin toxic equivalents, total dioxinlike toxicity can only be determined if dioxins, dibenzofurans, and dioxinlike PCBs are measured.(ABSTRACT TRUNCATED AT 400 WORDS)

Anxiety disorder in a case of Arnold-Chiari malformation.

This report describes a patient who suffered concurrently from panic disorder with agoraphobia and Arnold-Chiari malformation. Surgical correction of the neuroanatomical anomaly altered the patient's symptom pattern, enabling a more clear delineation of her anxiety disorder.

Health promotion and disease prevention for the international traveler.

International travel is becoming increasingly popular with Americans, whether for business or pleasure. Approximately 10 to 15 million U.S. citizens travel abroad each year, and more than 8 million of these travel to developing nations. Travelers risk exposure to viral, bacterial and parasitic diseases not often encountered in the United States. Clients planning an international journey should be encouraged to obtain advice from their primary care practitioner. This article reviews the health care needs of the international traveler, including predeparture evaluation, required and recommended immunizations, and advice on disease-prevention measures.

The Spielberger Anger Expression Scale: some psychometric data.

Some general population norms for the Spielberger, Johnson et al. (1984) Anger Expression Scale (AX) are reported for a sample of over 1000 adults tested in a general health survey of a New Zealand community. Factor analysis confirmed the independence of the Anger/In and Anger/Out subscales, and the measure was found to have satisfactory levels of reliability.