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Biomedical subjects

P Barron

Publications and source records attributed to P Barron.

At least 19 recordsLinked to original sources
PubMed1997

Why wait so long for child care? An analysis of waits, queues and work in a South African urban health centre.

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

Appointments and Schedules↗
PubMed1996

Infant mortality rate inequalities in the Western Cape Province of South Africa.

BACKGROUND: Cape Town is undergoing rapid urbanization. South African vital statistics have routinely been stratified by racial categories but intra-urban and peri-urban geographical variations have been neglected. METHODS: To examine variations in infant mortality rates (IMR) and proportional infant mortality between urban, rural and informally settled areas, stratified by racial category, birth notifications and infant death certifications recorded by a large health authority were analysed. RESULTS: The IMR per 1000 livebirths was as high for coloureds on rural farms (34, 95% confidence interval 29-40) as for blacks in informal settlements (35, 95% CI: 32-37) and an exceptionally high IMR (60, 95% CI: 43-82) was found for coloureds in informal settlements. Inequalities between racial categories (11 (95% CI: 9-14) for whites, 19 (95% CI: 18-21) for coloureds and 33 (95% CI: 31-35) for blacks) were as expected from other South African studies. Of rural farm deaths, 22% were ascribed to ill-defined causes. Low birthweight was the most common defined cause of death in all areas except rural farm areas (14% ascribed to pneumonia), and gastro-enteritis was important in informally settled areas (18%). CONCLUSIONS: Routine mortality data are more informative if stratified by robust and readily available indicators of socio-economic status such as residential area and racial category. Place of residence may distinguish risk strata as well as racial category, but the latter is helpful within socioeconomically heterogeneous residential areas.

Black or African American↗
PubMed1996

The effect of Edmonston-Zagreb and Schwarz measles vaccines on immune response in infants.

The effects of measles immunization on immune responses in infants and the roles of vaccine strain and age of immunization are not known. Eighty-eight children were immunized at 6 or 9 months of age with the Edmonston-Zagreb (EZ) or Schwarz (SW6, SW9) strain of measles vaccine. Children were studied before and 2 weeks and 3 months after immunization. Seroconversion was similar, but geometric mean neutralizing titers at 3 months differed by vaccine group: SW9, 1367 mIU/mL; SW6, 982; and EZ, 303 (P = .003). Mitogen-induced lymphoproliferation was decreased at 2 weeks in the SW9 group and at 3 months in all groups and was negatively correlated with measles antibody level at 3 months (r = -.387, P = .003). CD8 T cells, soluble CD8, neopterin, and beta2-microglobulin were increased at 2 weeks in the SW9 group, and soluble CD8 and beta2-microglobulin remained elevated at 3 months. Therefore, measles immunization resulted in suppression of lymphoproliferation, which was most evident in infants with the highest antibody responses and most immune activation.

Age Factors↗
PubMed1996

Missed opportunities for immunisation in curative and preventive services in a community health centre. A follow-up survey.

OBJECTIVES: To compare prevalences of missed opportunities for immunisation between preventative and curative clinic patients and to evaluate changes 13 months later. DESIGN: Repeat cross-sectional survey of patients' Road to Health cards. SETTING: A large community health centre in Khayelitsha, South Africa. PARTICIPANTS: Patients under 6 years of age. MAIN OUTCOME MEASURES: Proportion of children needing immunisation who were not vaccinated during the visit. RESULTS: At baseline, prevalences (95% confidence intervals) of missed opportunities or immunisation were 15.7% (9.2 - 22.2%) among preventative clinic patients and 92.0% (85.9 - 98.1%) among curative clinic patients. Thirteen months later the respective prevalences were 12.0% (5.0 - 19.0%) and 90.5% (84.6 - 96.4%). CONCLUSIONS: Separate provision of curative and preventive paediatric care results in many missed opportunities for immunisation in the former service. Fewer opportunities are missed if immunisation services are available all day every day, rather than for limited periods of the week.

Child, Preschool↗
PubMed1995

Sex differences in patients admitted to a regional secure unit.

The case notes of all admissions to a Regional Secure Unit over a 12-year period were examined. A higher proportion of females had a diagnosis of personality disorder. Women were less likely to have a prosecuted offence associated with admission but were more likely to be charged with fire-setting. Patients with personality disorder were more likely to be transferred to special hospitals. Women were nearly three times as likely as men to be transferred to maximum security and this was not accounted for by the excess of females with personality disorder. There was net movement of men out of special hospitals whereas the opposite was true for women. Possible explanations for this are discussed.

Adolescent↗
PubMed1995

Towards a rational cervical cytology screening strategy. Case study of a peri-urban settlement.

OBJECTIVES: To assess cervical cytology screening activity in a peri-urban settlement near Cape Town, with a view to informing rational policy development. METHOD: Total and age-specific prevalence rates of women who had been screened, relative prevalence by age group of women who had not been screened, and yield of screening were estimated from cytopathology laboratory records and available demographic data. Age-specific prevalence rates among women who had been screened were compared with age at presentation with cervical cancer at the referral hospital. Attendance for colposcopy follow-up was assessed from colposcopy clinic records. RESULTS: The number of smears taken and the prevalence of women who had been screened peaked in the 20 - 24-year age group, and declined to low levels in those over the age of 40 years. The relative prevalence of those who had not had a smear exceeded 9 in all age groups over 39 years, compared with women of 20 - 24 years. Smears which showed signs of CIN III, malignancy or possible malignancy comprised 0.13%. Thirty-six per cent of women booked for colposcopy did not attend. CONCLUSIONS: Efficiency of screening could be improved by emphasising coverage of higher-risk age groups, e.g. women over the age of 30 years, and better follow-up.

Adolescent↗
PubMed1995

Hemipancreatectomy, peripheral diversion of pancreatic venous drainage, and insulin sensitivity.

It has been previously noted that a mild insulin deficiency could increase insulin sensitivity in rats. The data shown here are consistent with such an observation in that the insulin resistance, which was induced by diversion of pancreatic venous drainage to the peripheral circulation, was corrected by the insulin deficiency which was secondary to the hemipancreatectomy performed. These results also help to explain some of the apparent inconsistencies that appear to be present in the comparison often made of insulin sensitivity following various transplantation procedures. Both the site of pancreatic venous drainage and any decrease in beta-cell mass which may accompany pancreas or islet transplantation appear to have independent and opposite effects on insulin sensitivity.

Animals↗
PubMed1994

The 1992 measles epidemic in Cape Town--a changing epidemiological pattern.

Over the last 6 years there has been a decline in the incidence of measles in Cape Town. However, during August 1992 an outbreak occurred, with cases reported at many schools in children presumably immunised. The objectives of this study were to characterise the epidemic in Cape Town and to determine possible reasons for the outbreak. The investigation consisted of two components--a description of the epidemic and an investigation of an outbreak at one primary school. Results indicate that during the last 4 months of the year, 757 cases were notified in Cape Town, compared with 144 in the first 8 months. The epidemic affected mainly white and coloured children over 5 years of age (P < 0.001). In contrast, during the period before the epidemic most cases occurred in black children and in those aged less than 1 year (P < 0.001). There was no significant increase in hospitalised cases. Investigation of the outbreak at one school revealed that the attack rate was 7.6% (25/329 children). Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% CI 55-90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%). The epidemiology of measles in Cape Town has thus changed as evinced in this epidemic, with an increase in the number of cases occurring in older, previously vaccinated children. The possible reasons for this include both primary and secondary vaccine failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

A shotgun marriage--community health workers and government health services. Qualitative evaluation of a community health worker project in Khayelitsha.

In 1988 the Western Cape Regional Services Council (RSC) initiated a community health worker (CHW) project in Khayelitsha in order to extend its preventive services to people in the community and promote 'community upliftment'. An evaluation of this project was undertaken in 1991 and 1992 in order to examine the potential of this local health authority-run CHW project to be an appropriate primary health care model. Qualitative research methods were used to explore the nature of the work done by the CHWs, whether they were accepted in their communities, and whether the project functioned as part of an integrated health service infrastructure in Khayelitsha. The CHWs were found to provide the basis for a potentially effective, community-responsive service. However, several structural problems mitigated against this service. Relations between the CHWs and nurses in all the formal public health services in the area were superficial and fraught with problems. There were significant differences and conflicting policies between the RSC's CHW project and other neighbouring non-government CHW projects, and these posed various threats to both the RSC and the non-government projects. One of the most serious of these differences was that the RSC project had no structures or plans for community involvement in the running of the project. Before a CHW project is initiated, several critical issues need to be carefully considered and discussed with all the relevant stakeholders. Furthermore, CHWs need to be flexible, and accountable to the communities in which they work. Before employing CHWs, formal public health authorities need to consider carefully whether they are able to meet these criteria.

Community Health Services↗
PubMed1994

Insulin sensitivity and glucose tolerance following transposition of pancreatic venous drainage to the systemic circulation.

In these studies it has been demonstrated that the diversion of pancreatic venous drainage to the systemic circulation (1) increases the peripheral insulinemia and metabolic clearance of glucose under basal conditions; (2) decreases insulin sensitivity, as measured by the hyperinsulinemic euglycemic clamp, more than 2-fold; and (3) decreases peripheral insulin sensitivity and the suppression of endogenous glucose production during exogenous glucose infusion. In spite of these changes, tolerance to the intravenously infused glucose improves. This is accounted for by higher insulin concentrations following diversion, more than compensating for decreases in insulin sensitivity and the suppression of endogenous glucose production. Data on insulin sensitivity and glucose tolerance after pancreas transplantation are not completely consistent, as discussed above. When the site of venous drainage of the pancreas was the only factor altered in the experimental model, unequivocal insulin resistance resulted. This occurred in a relatively short period (ie, 2 weeks). The results here are consistent with a number of studies that have demonstrated normal glucose tolerance coupled with hyperinsulinemia in a partially pancreatectomized dog model as well as in human pancreas transplants. Data presented here imply that the hyperinsulinemia which results after surgical diversion of the pancreatic venous drainage from the portal to the systemic circulation causes an important degree of insulin resistance. Physiological insulin delivery and therefore portal drainage during transplantation may therefore be relevant for the complete normalization of glucoregulation in diabetes. The reduction of hyperinsulinemia may also be important in light of the recent emphasis on the role that this and insulin resistance may play in the development of complications such as cardiovascular disease or hypertension.

Animals↗
PubMed1993

The effect of systemic venous drainage of the pancreas on insulin sensitivity in dogs.

To assess the metabolic consequences of the diversion of the pancreatic venous drainage to the systemic circulation, the pancreaticoduodenal and gastrosplenic veins were anastomosed to the inferior vena cava in nine normal dogs. This procedure maintained the integrity of the entire pancreas while shunting the hormonal output of the pancreas to the periphery. The metabolic effects were assessed from the sensitivity to insulin during a euglycemic hyperinsulinemic glucose clamp using an insulin infusion of 800 microU/kg per min. The studies were controlled by their duplication in seven dogs identically treated but with the pancreatic veins reanastomosed to the portal vein. No differences in systemic insulin levels or insulin sensitivity before and after surgery were seen under these circumstances. After diversion, however, basal insulin levels rose from 4.5 +/- 1.0 to 11.5 +/- 2.5 microU/ml. Basal glucose metabolic clearance rate (MCR) rose to 3.0 +/- 0.4 from 2.0 +/- 0.3 ml/kg per min. On insulin infusion, maximal stimulation of MCR within the 2-h infusion period was to 15.2 +/- 2.5 ml/kg per min preoperatively and to 7.2 +/- 0.8 ml/kg per min after diversion. Using ratios of MCR-to-insulin concentration as an index of insulin sensitivity, it was demonstrated that this index decreased by at least 50% after diversion. These data imply that portal venous drainage of the pancreas is an important factor in the determination of peripheral insulin sensitivity.

Anastomosis, Surgical↗
PubMed1993

Far fewer missed opportunities for immunisation in an integrated child health service.

The mobile nature of the population of Khayelitsha makes it imperative that opportunities for immunisation of children are exploited at every visit to health services. Previous studies have demonstrated a high incidence of missed opportunities for immunisation at curative health services. The occurrence of undetected opportunities for immunisation are compared at two primary care institutions: one in which curative and preventive services are provided separately, and one in which these functions are integrated. Far fewer opportunities for immunisation were missed at the integrated service, underscoring the urgency of integrating child health services throughout the country.

Child Health Services↗