Adaptation and validation of a self-report measure of youth-friendly primary healthcare services.

AIM: To adapt the Youth-Friendly Health Services-World Health Organization+ questionnaire to suit the health needs of youth in the South African context, and estimate its psychometric properties. BACKGROUND: Youth-friendly health services promote health-seeking behaviour amongst young people. The perceptions of youth and adolescents are thus important whilst assessing the youth-friendliness of health services. METHODS: We conducted six focus group interviews to evaluate the clarity and relevance of the questionnaire items and adapted the questionnaire which was was administered to 101 youth who visited primary healthcare clinics. We reduced the number of items through quantitative analysis of responses and item analysis. Cronbach's alpha was used to optimize internal consistency reliability. Experts established a baseline of youth-friendliness. We ranked the responses from the youth against the baseline of youth-friendliness and used independent two sample t-test to test for construct validity of the final adapted version, titled Youth-Friendly Health Services- South Africa. RESULTS OR FINDINGS: After the focus group interviews, we rephrased 27 items, removed four items and added eight items. We reduced the questionnaire to 57 items whilst optimizing internal consistency reliability. The statistical analysis supported construct validity. CONCLUSION: The Youth-Friendly Health Services-South Africa is the first English validated version and demonstrates good psychometric properties. IMPLICATION FOR NURSING PRACTICE AND HEALTH POLICY: The Youth-Friendly Health Services-South Africa can be useful to evaluate the youths' satisfaction with the health care and nursing service they receive. This study's findings indicate that the original questionnaire can be adapted for use in different contexts to shape local and global nursing practice and policies.

Risks associated with communication delays in infants from underserved South African communities.

BACKGROUND: For optimal development young children need warm, responsive, enriched and communicative environments for learning social, language, and other skills. Infants and toddlers exposed to psychosocial risk lack enriched environments and may present with communication delays. AIM: To investigate the relationship between psychosocial risks and communication delays in infants from underserved communities in South Africa. SETTING: Primary healthcare facilities in Tshwane district, South Africa. METHODS: A parent interview and Rossetti Infant Toddler Language Scales were used to collect data from caregivers of 201 infants aged 6­12 months, selected through convenience sampling. Associations between communication delays and risks were determined (Chi-square and Fisher's exact tests). A log-linear model analysis was used to model the simultaneous effect of significant risks on the probability of having communication delays. RESULTS: Communication delays were present in 13% of infants. Infants with two or more siblings, born from mothers aged 18­29 years who own their house, had a 39% chance of presenting with communication delays. CONCLUSION: Developmental screening and early intervention is important in primary healthcare contexts in South Africa, as a clear relationship has been established between three risk factors and communication delays in infants.

Developmental screening in South Africa: comparing the national developmental checklist to a standardized tool.

BACKGROUND: Worldwide, more than 200 million children in low- and middle-income countries have developmental delays and/or disabilities. In South Africa the only nationally implemented developmental 'screening' tool is integrated as part of 'The Road to Health Booklet (RTHB). METHOD: The study employed a comparative cross-sectional within-subject design to evaluate the accuracy of the RTHB developmental checklist against a standardized international tool i.e. the PEDS tools, consisting of the PEDS and PEDS:DM. A total of 201 participants were included through convenience sampling at primary health care facilities in Tshwane, South Africa. RESULTS: Sensitivity of the RTHB developmental checklist is low, but specificity is high. The RTHB developmental checklist failed to identify more than half the infants at risk of delays or disorders. The nationally implemented developmental checklist is ineffective to identify at-risk infants. It should be adapted and validated or replaced in order to improve identification of at-risk infants.

Adjuvant chemotherapy for operable breast cancer in postmenopausal women.

Survival figures of women with operable breast cancer reached a plateau 40 years ago. It was only with the advent of adjuvant chemotherapy that these figures showed a dramatic improvement. Data obtained in 105 postmenopausal women with operable breast cancer, treated at our clinic, are presented. Patients with axillary node disease were treated on four different protocols: cyclophosphamide + methotrexate + fluoro-uracil (CMF) with or without immunotherapy was compared with CMF + vincristine + prednisone, while other studies compared observation only with CMF + prednisone and CMF + prednisone + tamoxifen. Patients older than 65 years received tamoxifen or placebo. Patient discriminants and treatment regimens are discussed. Results indicating that certain subsets of postmenopausal women definitely need adjuvant chemotherapy are presented. The literature is briefly reviewed and the motivation for our new studies explained.

Adjuvant chemotherapy for operable breast cancer in premenopausal women.

Surgery alone does not cure breast cancer, and adjuvant chemotherapy has changed the management of this disease. Data obtained in 81 premenopausal women with operable breast cancer, treated at our clinic, are presented. Patients with axillary node disease were treated on three different protocols: cyclophosphamide + methotrexate + fluoro-uracil + vincristine + prednisone (CMFVP), cyclophosphamide + methotrexate + fluoro-uracil (CMF), and CMF + immunotherapy with methanol extract residue of BCG (CMF + MER). Patient discriminants and treatment regimens are discussed. Analysis of the results obtained in 49 patients in one study showed an extension of disease-free survival to 4,25 years, that CMFVP was superior to CMF with or without MER, and that immunotherapy was not beneficial. The literature is briefly reviewed and the motivation for our newer studies stated.