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Biomedical subjects

N Abrahams

Publications and source records attributed to N Abrahams.

At least 19 recordsLinked to original sources
PubMed2005

Psychological distress among women suffering from couple infertility in South Africa: a quantitative assessment.

BACKGROUND: Infertility in Africa is commonly associated with negative psycho-social consequences. To date, most studies from African countries addressing these consequences have been qualitative in nature. The aim of this study was to assess psychological distress quantitatively among women suffering from couple infertility in an urban community in South Africa. METHODS: The Symptom Checklist-90-R (SCL-90-R), a standardized instrument for the measurement of current psychological symptom status, was administered to 120 women at the time of their first presentation to an infertility clinic in a tertiary referral centre. The control group comprised 120 women presenting to local family planning clinics. In addition, socio-demographic information and data pertaining to the prevalence of abuse was captured through a structured questionnaire designed for the purpose of this study. RESULTS: Women suffering from involuntary childlessness scored significantly higher on all sub-scales and the global indices of distress of the SCL-90-R when compared to controls. In addition, women who reported abuse from their male partners had significantly higher scores on six of the 12 test scales when compared to infertile women in non-abusive relationships. CONCLUSIONS: Involuntary childlessness is associated with high levels of psychological distress. Women in abusive relationships are particularly at risk. This result is in keeping with several qualitative studies from African countries which describe infertility as an overwhelmingly negative and distressing experience. Cognizance needs to be taken of these experiences and effective interventions require medical, psychological and socio-cultural strategies.

Adult↗
PubMed2004

'You are a man because you have children': experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility in South Africa.

BACKGROUND: In Africa, infertility traditionally has been viewed as a female problem. This study explores reproductive health knowledge, health-seeking behaviour and experiences related to involuntary childlessness in men suffering from couple infertility. METHODS: Twenty-seven men from a diverse cultural urban community in South Africa participated in in-depth interviews at the time of their first visit to an infertility clinic in a tertiary referral centre. RESULTS: Men had little knowledge about the physiology of human fertility, causes of infertility and modern treatment options. Awareness of male factor infertility was, however, high. Most men appeared involved in the health-seeking process. Men described their emotional reactions to childlessness and the impact of infertility on marital stability, and many reported that infertile men suffered from stigmatization, verbal abuse and loss of social status. CONCLUSIONS: These findings improve our understanding of the reproductive health needs of men suffering from couple infertility in Africa. This understanding is essential for the effective integration of male partners into modern infertility management. The need for appropriate counselling of men and, most particularly, for education of the community is recognized.

Community-Institutional Relations↗
PubMed2002

Infertility in South Africa: women's reproductive health knowledge and treatment-seeking behaviour for involuntary childlessness.

BACKGROUND: Infertility is a major reproductive health problem in Africa. This paper presents the findings of two studies which focus on the knowledge that infertile women have about fertility and the causes of infertility, their treatment-seeking behaviour and their expectations of an infertility clinic. METHODS: A total of 150 infertile women from a culturally diverse, urban community in South Africa participated in the two studies. Both qualitative and quantitative research methods were applied using in-depth, semi-structured interviews and structured questionnaires. RESULTS: The women who participated had little knowledge about human reproduction and modern treatment options for infertility. They were highly motivated to find treatment and accessed both traditional and modern health care. Treatment barriers within modern health care were identified. CONCLUSIONS: The importance of health education and counselling is recognized, and both need to be integrated into infertility management, particularly in the developing world. The introduction of clinical guidelines is recommended in order to overcome treatment barriers and improve the delivery of health services.

Adult↗
PubMed2002

'Men leave me as I cannot have children': women's experiences with involuntary childlessness.

BACKGROUND: This study explores the concerns and experiences related to involuntary childlessness of infertile women living in a diverse cultural urban community in South Africa. METHODS: In-depth interviews were conducted with 30 women seeking treatment for involuntary childlessness. Women were interviewed at the time of their first visit to an infertility clinic in a tertiary referral centre. RESULTS: All women verbalized intense emotions about their involuntary childlessness. In addition, a large number of women experienced negative social consequences including marital instability, stigmatization and abuse. CONCLUSIONS: These findings demonstrate that infertility can have a serious effect on both the psychological well-being and the social status of women in the developing world. Furthermore, the study provides insight into the cultural context of involuntary infertility in South Africa. The delivery of good infertility care in a community requires awareness of the implications of infertility and insight into the context in which these occur. Since many of the negative social implications of infertility are probably rooted in low status women in the developing world, effective intervention will ultimately require social, economical and political changes.

Emotions↗
PubMed2002

Airway management on placental support (AMPS)--the anaesthetic perspective.

Neonatal airway obstruction has been reported to have a high mortality. Antenatal diagnosis of this condition is now possible. Anaesthetic and surgical techniques have been developed that allow neonatal airway obstruction to be managed at delivery, while the fetus remains oxygenated via the placental circulation. Three case studies are presented, and the anaesthetic issues for mother and fetus/neonate are discussed with reference to previously published cases of airway management on placental support. In particular, techniques for uterine relaxation and maintenance of placental circulation are explored. The history of these procedures and issues of planning and logistics are also discussed.

Adult↗
PubMed2000

Ethical and methodological issues in conducting research on gender-based violence in Southern Africa.

International experience of carrying out research on violence against women among women who may have experienced such violence and among men who may have been violent has raised a number of ethical issues, which appear in sharp focus. This paper is based on the collective experiences derived from involvement in three large gender-based violence surveys in South Africa and one in Zimbabwe. These are broadly concerned with the safety of researchers and research subjects from violence arising because of the research project, risks of traumatisation of both respondents and researchers as violent experiences are recounted; impact of work on violence as an issue in researchers' own relationships; risks of under-reporting the extent of violence experienced or perpetrated; and the need for research efforts to be followed up in ways beneficial to women experiencing violence, such as increased support, public information, and law and policy changes. This paper discusses how these issues have pertained and been addressed in research on gender-based violence in Southern Africa and consider lessons for this and other sensitive areas of reproductive and sexual health research.

Battered Women↗
PubMed2000

Carcinoid-related angiomatous polyposis simulating Crohn disease.

Polyposis associated with ileal carcinoid tumors is a rarely described pathologic mucosal transformation that may simulate inflammatory or neoplastic polyps. We describe a case with innumerable sessile polyps and groups of large filiform-like polyps of the terminal ileum associated with submucosal carcinoid tumors and a large mesenteric carcinoid tumor mass. The clinical, radiographic, and endoscopic presentation of the polyposis, together with the presence of multiple small bowel stenotic lesions, simulated Crohn disease. We propose the descriptive terminology angiomatous polyposis to describe the striking microscopic vascular proliferation that characterizes these polyps. The distribution of these lesions, with the most profuse polyposis in the immediate proximity of the carcinoid nests, and the immunohistochemical demonstration of growth factor substances, such as transforming growth factor alpha within neoplastic cells and adjacent polyps, suggest a tumor factor-mediated stromal proliferation.

Biomarkers, Tumor↗
PubMed1998

Why do nurses abuse patients? Reflections from South African obstetric services.

Nurse-patient relationships are a substantially neglected area of empirical research, the more so in developing than developed countries. Although nursing discourse usually emphasises "caring", nursing practice is often quite different and may be more strongly characterised by humiliation of patients and physical abuse. This paper explores the question: why do nurses abuse patients, through presentation and discussion of findings of research on health seeking practices in one part of the South African maternity services. The research was qualitative and based on 103 minimally structured in-depth individual interviews and four group discussions held with patients and staff in the services. Many of the patients reported clinical neglect, verbal and physical abuse from nursing staff which was at times reactive, and at others, ritualised, in nature. Although they explained nurses' treatment of them in terms of a few 'rotten apples in the barrel', analysis of the data revealed a complex interplay of concerns including organisational issues. professional insecurities, perceived need to assert "control" over the environment and sanctioning of the use of coercive and punitive measures to do so, and an underpinning ideology of patient inferiority. The findings suggest that the nurses were engaged in a continuous struggle to assert their professional and middle class identity and in the process deployed violence against patients as a means of creating social distance and maintaining fantasies of identity and power. The deployment of violence became commonplace because of the lack of local accountability of services and lack of action taken by managers and higher levels of the profession against nurses who abuse patients. It also became established as "normal" in nursing practice because of a lack of powerful competing ideologies of patient care and nursing ethics. The paper concludes by discussing avenues for intervention to improve staff-patient relationships.

Health Services Research↗
PubMed1997

Cleaning the womb: constructions of cervical screening and womb cancer among rural black women in South Africa.

In South Africa problems with current cervical screening uptake, including low coverage and loss of screened women to follow-up, have been identified. This paper presents the findings of an anthropological study of rural Black women's perceptions and understandings of cervical symptomatology, screening and cancer conducted among three different language groups in South Africa. The data collected indicate that women were screened when presenting with symptoms of reproductive tract infection, with the result that for many the smear came to be associated with the diagnosis and treatment of sexually transmitted diseases (STDs). In some cases the smear was said itself to "clean" the womb. The results were often interpreted by women as signifying womb "dirtiness" and confirming the presence of symptomatic reproductive disease for which they had initially presented to the biomedical facility. Several barriers to screening were identified including fear of vaginal exposure, expectation of pain, being asymptomatic, and gender of the practitioner. In addition women perceived womb cancer to be invariably terminal, knowledge which was constructed from personal and community experience of the illness. The illness was closely associated with (usually female) "promiscuity". The authors discuss the implications of the data for healthworkers and health promotion specialists, in particular the association of the smear with STDs, the way in which women are recruited for screening, the perceived terminality of womb cancer, and the processes by which local knowledge about illness is constructed. The findings demonstrate the importance of medical anthropology in contributing towards the provision of effective and locally appropriate healthcare.

Adult↗
PubMed1997

Barriers to cervical screening: women's and health workers' perceptions.

Cancer of the cervix is the most common cause of cancer mortality among Black South African women. Mortality can be reduced by an effective screening programme. Such a programme is being considered for implementation in South Africa. It is important that the implementation of a national screening programme be based on solid understanding of the current situation as well as the anticipated barriers to the effectiveness of the programme. This qualitative study was done at three rural sites in order to explore the barriers to effective utilisation of cervical screening from the perspectives of women and health workers. The aim was to inform the local service organisers as well as the policy process when planning the new screening programme. There were interesting similarities and differences between the barriers that were identified by the health workers and those by the women. Those identified by the health workers included several structural problems associated with the service such as busy clinics and problems of access including lack of transport, the mobility of the people and opposition from men. None of the women spoke of these service and access factors. Women emphasised issues surrounding the actual procedures which were based on their experiences and information they had gained from friends and other community networks. The barriers identified by women are amenable to change through careful attention to health education and the circumstances of the test. If the new screening policy is to be implemented nationally and be successful in recruiting cervical cancer cases, nurses will have a key role in identifying and overcoming barriers to smear uptake at a local level. This study has shown the importance of listening to patients in this process.

Adult↗
PubMed1992

Teachers' knowledge, attitudes, and beliefs about child abuse and its prevention.

In considering the great responsibility placed upon teachers to involve themselves in child abuse prevention, education, and detection, the National Committee for Prevention of Child Abuse (NCPCA) conducted a nationwide survey of teachers from 40 school districts in 29 randomly selected counties. The survey explores teachers knowledge, attitudes, and beliefs about child abuse and its prevention. Five hundred and sixty-eight teachers responded, revealing that while the majority of teachers confront child abuse among their students, they are provided insufficient education on how to address it. Other findings are reported with respect to teachers' reporting behavior, potential barriers to reporting, child assault prevention programs, and corporal punishment in schools.

Adolescent↗
PubMed1979

Thrombus formation on catheters in new born lambs.

Catheters were inserted into the aorta and inferior vena cava of newborn lambs by cutdown on the femoral vessels and directly into the umbilical vein. The lambs were killed after six days and the amounts of thrombus surrounding the cathethers were measured. Most catheters inserted into the umbilical vein looped within the liver and only a few passed directly into the portal vein or through the ductus venosus into the vena cava. On different types of catheters inserted via the femoral artery or femoral vein, there were significant differences both in the proportion with thrombus and the amount of thrombus. There were also significant differences in renal infarctions caused by different types of catheters.

Animals↗
PubMed1978

The Stocks suction bullet.

The Stocks suction bullet is a device allowing maintenance of positive pressure ventilation, continuous distending pressure and high inspired oxygen concentrations during tracheal toilet in intubated patients. The effectiveness of this device was studied using an experimental apparatus and a dummy lung to represent neonates being treated with either C.P.A.P. or I.P.P.V. and P.E.E.P. By using appropriate combinations of suction catheter type and size, bullet lumen size, ventilator settings and suction pressure limit, it was possible to maintain during suctioning ventilation peak pressures between 50% and 100% of presuction levels and continuous distending pressures (P.E.E.P. or C.P.A.P.) at or in excess of 80% of presuction levels.

Airway Obstruction↗
PubMed1977

Measurement errors in pneumotachography due to pressure transducer design.

When pneumotachography is used during intermittent positive pressure ventilation (IPPV), the design of some differential pressure transducers can cause measurement errors. These errors may be avoided by using differential pressure transducers which have small, equal chambers free from temperature sensitive electrical elements. Few of the transducers which are sensitive enough for clinical use fulfil these requirements.

Diagnostic Errors↗
PubMed1975

Evaluation of infant ventilators.

A method of evaluating the performance of paediatric ventilators under simulated clinical conditions is described, together with the results of this evaluation of the prototypes of two ventilators designed specifically for use with infants and small children.

Airway Resistance↗