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Biomedical subjects

L D Saunders

Publications and source records attributed to L D Saunders.

48 records · Page 3Linked to original sources
PubMed1985

Clinical competence of paediatric primary health care nurses in Soweto.

Primary health care (PHC) nurses provide care at polyclinics in Soweto. Our study assessed nurse competence in the clinical detection of important respiratory signs in 337 consecutive paediatric patients with respiratory complaints. The patients were then independently re-examined by two paediatricians, one of whom was arbitrarily chosen as a 'standard doctor'. The standard doctor found 95 patients with important respiratory signs; nurses detected the same signs in 45 and the other doctor in 44 patients. Therefore nurses detected important signs as well as could be expected, considering the inter-observer variation between doctors. The nurses did, however, significantly overdiagnose one condition, follicular tonsillitis. Our results suggest that the Soweto paediatric PHC nurses detect clinical signs with as much accuracy as doctors. This study adds to the available evidence that adequately trained and supervised nurse practitioners can provide high-quality health care.

Clinical Competence↗
PubMed1984

Tuberculosis management in Soweto.

Despite the availability of highly effective therapy, tuberculosis (TB) remains a major problem in South Africa, even in urban centres such as Soweto which is relatively well provided with health services. We therefore assessed two aspects of TB management in Soweto: (i) the proportion of known tuberculous patients adequately treated; (ii) whether case finding through investigation of home contacts of notified patients was effective. In 1978 patients with TB were required to take chemotherapy for at least a year. Only 28% of newly notified patients attended the clinics frequently enough and/or were hospitalized long enough to obtain 80% or more of the treatment they required during that first year. A major part of this problem of non-compliance was infrequent attendance; these patients received therapy of an adequate duration, but at an inadequate dosage. At least 17% of patients over 10 years of age had tubercle bacilli in their sputa on microscopy more than 4 months after therapy was started. About two-thirds of known home contacts were investigated by the health services in accordance with their stated policy, and 5% of contacts were subsequently notified. Home-contact tracing therefore seems worthwhile.

Adolescent↗
PubMed1983

Why don't patients return for antihypertensive treatment in Soweto?

Out of an inception cohort of 91 newly treated hypertensive patients at a Soweto polyclinic only 16 (18%) attended regularly during the year after their first visit. Visits were made to the homes of the 75 non-compliant patients between 18 and 21 months after the patient's first visit to establish the reasons for non-attendance. Five of the 75 (7%) had died, 16 (21%) were not available for an interview and 54 (72%) were interviewed. These 54 patients gave many different reasons for not returning regularly. The most common reasons were: (i) they did not remember being told that they had hypertension and that they needed to return for more treatment--14 patients; (ii) they had been away from Soweto--7 patients; (iii) they had been unable to take time off work--6 patients; (iv) they considered themselves to be regular attenders--5 patients; (v) they had not felt ill--5 patients; and (vi) they experienced unwanted side-effects--4 patients. Only 2 patients said that they had received regular treatment elsewhere. In the light of these results different approaches designed to improve both attendance and medication compliance are being developed and evaluated.

Aged↗
PubMed1982

Queueing and patient flow at a Soweto polyclinic.

We studied all 265 adult patients who came to a Soweto polyclinic on 18 March 1980. The objectives were: (i) to determine the flow of patients and the time spent in the polyclinic; (ii) to use computer models to predict the effects of altering numbers of staff and/or the introduction of an appointment system; and (iii) to elicit information relating to the feasibility of introducing an appointment system. The results show that of the 265 patients, 80% arrived before 10h00 and 1% arrived after 13h00. Forty-one per cent of these patients waited in 5 or more queues. Of the 245 patients for whom the amount of time spent in the clinic was available the mean time spent in the clinic was 171 minutes, with a range of 16 - 375 minutes. The mean time spent receiving attention was 24 minutes. IBM's GPSS/360 programme was not found to be useful for running computer-simulated flow models. Of 241 patients who returned questionnaires, 65% said they would like the introduction of an appointment system and 70% would be able to make appointments relatively easily. An appointment system might considerably reduce time being wasted. The practicalities of such a system in terms of the functioning of the clinic must still be carefully investigated. We suggest that a feasible appointment system be introduced and its effect on patient satisfaction and flow carefully monitored.

Appointments and Schedules↗
PubMed1982

Hypertension management and patient compliance at a Soweto polyclinic.

The aim of our study was to assess the quality of hypertension detection and management at the Senaoane polyclinic for Black patients in Soweto and to determine the degree of patient compliance with antihypertensive drug treatment. We reviewed the records of 2,200 consecutive new patients who were 15 years of age or older. The blood pressures of 84% of the patients were measured at their first visit to the polyclinic. Of the patients seen initially by primary health care nurses, 98% were managed correctly according to the blood pressure management protocol that these nurses had been trained to use. Of 55 patients started on antihypertensive drug treatment at their first visit to the polyclinic, 31% did not visit the polyclinic again during the next year. Only 15 patients (27%) were compliant, i.e. they attended often enough during the following year to allow them to receive 80% or more of the necessary drugs. These 15 patients had substantial reductions in their diastolic blood pressures (mean reduction 21 mmHg). We regard poor compliance as the major factor preventing the polyclinic from reducing morbidity and mortality in hypertensives. Strategies for improving compliance need to be developed and evaluated for different poor compliance groups. These groups can be defined according to the severity of the hypertension and the pattern of poor compliance ("early drop-outs' v. "irregular attenders').

Adolescent↗
PubMed1980

A demographic and socio-economic profile of a rural black South African community.

Demographic data regarding households in a Black rural community in the Eastern Transvaal were collected. Detailed socio-economic and health data were collected from a 10% random sample of households (response rate 92,5%). These data will be used for planning and evaluating a community health project. An extremely high infant mortality rate (198,1/1 000 live births), very low household incomes (median monetary household income R20 - R50 per month), low rates of immunization (39,4% of children under 12 years old had not been immunized), and gaps between the knowledge and practice of and the expressed desire for family planning were striking features.

Adolescent↗
PubMedDate not supplied

Pesticide food poisoning from contaminated watermelons in California, 1985.

Aldicarb, a carbamate pesticide, is the most potent pesticide in the market and has a LD50 of 1 mg/kg. In the United States it is illegal to use aldicarb on certain crops, e.g., watermelons, because it is incorporated into the flesh of the fruit. Once an accidental or illegal use of such a potent pesticide occurs, there is no easy way for the agricultural or public health system to protect the populace. This paper describes the impact of one such event upon the health of individuals and the institutions of California. On July 4, 1985, California and other western states experienced the largest known outbreak of food-borne pesticide illness ever to occur in North America. This was attributed to watermelons contaminated through the illegal or accidental use of aldicarb by a few farmers in one part of the state. Within California, a total of 1,376 illnesses resulting from consumption of watermelons was reported to the California Department of Health Services (CDHS). Of the 1,376 illnesses, 77% were classified as being probable or possible carbamate illnesses. Many of the case reports involved multiple illnesses associated with the same melon among unrelated individuals. Seventeen individuals required hospitalization. There were 47 reports of illness involving pregnant women, two of whom reported having subsequent stillbirths. Thirty-five of the remaining pregnant women were followed-up 9 mo after the epidemic; no additional stillbirths were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Cost effectiveness of Streetworks' needle exchange program of Edmonton.

OBJECTIVE: To conduct a cost-effectiveness analysis of the Edmonton Streetworks needle exchange program, in terms of the additional cost per HIV infection averted. The main outcome measures were needle use with and without Streetworks, HIV cases averted, and program costs. METHODS: We conducted interviews and HIV saliva tests on a sample of street-involved intravenous drug users (IDU) who are regular Streetworks' clients. Outcomes were used in a cost-effectiveness model. RESULTS: It is projected that the program has a cost-effectiveness of $9,500 (Canadian) per HIV infection delayed for one year. CONCLUSIONS: The discounted cost per case averted is less than the cost of a case of AIDS. Continuing the program is a dominant strategy.

Adult↗
PubMedDate not supplied

Acute care hospital morbidity in the Blood Indian Band, 1984-87.

Acute care hospital morbidity of the Blood Indian Band was compared with that of all Albertans between April 1, 1984 and March 31, 1987. The Blood Indians had over 2.5 times as many hospital separations and 2.2 times as many patient days as the Albertans. The highest separation rare ratios by ICD-9-CM chapter for both Blood males and females were for endocrine, metabolic and nutritional disorders. Blood females had higher rate ratios for hospitalizations for all chapters except neoplasms and Blood males had higher rate ratios for all except congenital anomalies and neoplasms. For individual conditions, Blood males had the highest separation rate ratios for alcohol dependence syndrome, gastritis/duodenitis and diabetes mellitus. Bronchitis/emphysema and diabetes mellitus had the highest rate ratios for Blood females. The results are consistent with those reported in other studies of North American Indians. Their health status is more consistent with a developing country than that expected in Canada and does not appear to be improving.

Acute Disease↗
PubMedDate not supplied

Unintentional house fire deaths in Alberta 1985-1990: a population study.

We extracted data from the Medical Examiner's files for all fire deaths in Alberta reported to the Medical Examiner's for the period 1985-1990. Of the 320 fire deaths, 183 (57%) were unintentional deaths from house fires. The highest house fire death rates occurred in children 0-4 years and in adults > or = 80 years of age (2.9 and 3.2 per 100,000 per year). The majority (53%) of fatal house fires occurred in single detached dwellings but the rate of fatal house fires was 9.0 times higher in moveable dwellings than in single detached dwellings. At least 61 (33%) of unintentional fatal house fires were caused by smokers' material. Blood alcohol levels above 0.8 g/L were found in 84 (59%) of victims tested and in 39 (76%) of victims of fires caused by smoking materials. 143 (78%) house fire deaths were due, at least in part, to inhalation of toxic fumes. The cause of fatal house fires in Alberta is multifactorial. However, particular attention should be paid towards the lethal combination of cigarettes and alcohol in preventing these fires.

Accidents, Home↗
PubMedDate not supplied

Survey of local environmental health programs in Alberta.

As part of a larger initiative to develop a contemporary model for local environmental health services, a survey of Alberta health unit-based programs was undertaken. The objectives were to (a) obtain a comprehensive profile of environmental health services, and (b) identify current and emerging issues in these programs. Three survey instruments were designed for three respondent groups: chief executive officers, program managers and environmental health officers/public health inspectors. Results suggest an expanding scope of activities and issues faced by these programs. The most prevalent emerging issues noted were in the areas of chemical/ toxic exposures, injury prevention, indoor air quality and public risk perception. Issues receiving the greatest attention were food safety and waste management. Review of program management capacities suggested difficulties in coping with the increased pressures faced by these programs. Improvements recommended by respondents included increased resources, more educational and professional development opportunities, improved information systems and improved legislation.

Administrative Personnel↗