Monovalent neonatal polio immunization--a strategy for the developing world.
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Age Factors↗
Biomedical subjects
S G Reinach
Publications and source records attributed to S G Reinach.
A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery.
In this study, 417 patients undergoing "clean" elective neurosurgical operative procedures were randomized to receive a broad-spectrum antibiotic (piperacillin) or placebo given as three perioperative doses, each 6 hours apart. Randomization was carried out by hospital pharmacists, and the investigators remained blinded until the end of the study. Twenty cases were excluded from analysis because either an unforeseen second operation was performed or antibiotic therapy was initiated within 30 days after surgery to treat infection or the risk of infection. Twelve of the 205 patients treated with placebo developed postoperative wound sepsis, and four of the 192 piperacillin-treated patients developed wound sepsis--a statistically significant difference (p less than 0.05, Fisher's exact test). Piperacillin thus appeared to reduce the incidence of neurosurgical wound infection in this study.
Anti-Bacterial Agents↗
Magnesium, calcium, sodium and potassium status in normotensive and hypertensive Johannesburg residents.
Serum magnesium, calcium, sodium and potassium, and erythrocyte magnesium, sodium and potassium levels were measured in a selected group of 296 urbanised black male labourers in Johannesburg. Of these, 214 subjects were normotensive and 82 were hypertensive. The aim of the study was to examine the relationship between serum and erythrocyte electrolytes, specifically magnesium and calcium, and blood pressure in this population sample. The results showed a significant decrease in serum magnesium, calcium and potassium in the hypertensive subjects. Red blood cell magnesium was significantly lowered and red blood cell sodium was significantly raised in this group. A significant inverse correlation was found between serum magnesium and blood pressure, erythrocyte magnesium and blood pressure, serum calcium and blood pressure, and serum potassium and blood pressure. A positive correlation was observed between erythrocyte sodium and blood pressure. Of all the electrolytes assessed, magnesium (serum and erythrocyte) correlated most closely with blood pressure. The data reported here suggest that body magnesium and its interactions with calcium, sodium and potassium may, in certain groups of individuals, play an important role in the development and maintenance of high blood pressure.
Black People↗
Some aspects of vaccination coverage in the Gelukspan health ward.
In 1985 and 1986, 210 mothers of children aged 1-2 years were selected from the total population of the Gelukspan health ward. Sampling followed a multistage random procedure. The women and their children were studied in relation to several aspects of primary health care. In this article we report on the vaccination component of the study. The response rate was 100%. By the age of 9 months 30% of the children had completed the basic vaccination schedule and by the age of 12 months this had increased to 65%. Only 4% of the children had all the required immunisations within the time schedule defined by official policy. Completion of the vaccination schedule on time depends mostly on the frequency of contact between children and health workers in under-5 clinics. It is concluded that the main thrust of any vaccination policy should be directed at increasing the frequency of contact between the health services and children during their first 9 months of life.
BCG Vaccine↗
Adenosine triphosphate levels in human spermatozoa.
ATP levels in human spermatozoa have been positively correlated with good motility. This has given rise to the impression that good ATP levels per se are related to good motility, i.e., the higher the ATP level, the better the motility and fertilizing potential. There was no direct correlation between motility percentage, forward progression, viability percentage, and ATP levels (when expressed per 1 million spermatozoa) in the general population. This finding was not unexpected since other factors, such as defects of the microtubules and viscosity of the semen, could affect the motility in some patients. However, when semen from individual patients was assessed, the motility percent, viability, and ATP concentration decreased by comparable levels over a 4-h period postejaculation. Semen samples with normal counts of spermatozoa (greater than 20 X 10(6)/ml) had higher levels of ATP than samples from patients with oligozoospermia. Spermatozoa from patients whose semen contained less than 0.60 X 10(-2) nmol ATP/1 million spermatozoa showed a rapid drop in motility over a 4-h period compared with semen samples where the motility remained above 10% motile over this period, the latter samples having ATP levels averaging 3.30 X 10(-2) nmol/1 million spermatozoa.
Adenosine Triphosphate↗
Anthropometrically determined nutritional status and the school performance of black urban primary school children.
Anthropometric parameters (height and weight) were used to assess the nutritional status of 1407 black children in a Soweto lower primary school. Cross-sectional profiles were obtained in 1981 and 1983 as well as a longitudinal study of 362 pre-adolescent children who remained in the school over the 2-year period. The major proportion of the distribution of percentage weight-for-age and percentage height-for-age was less than 100 per cent of NCHS reference median. There was a small but significant increase in mean percentage weight-for-height between 1981 and 1983. Children who were stunted and those whose growth rate over a 2-year period was known to be reduced failed more frequently. Apart from these the general range of anthropometric findings did not clearly correlate with classroom achievement as assessed by end-of-year marks. The age ranges of children in the different grades exceeded 5 years. The highest failure rate occurred in the school entry grade (Substandard A). Only in this grade were the older boys found to be less adequately nourished than their age peers in higher standards. Untested adverse social, family and environmental effects may mask the real consequences of suboptimal growth. Without anthropometry the latter would frequently not be apparent because of the generally proportional reductions in weight and height for age.
Adolescent↗
Ascorbic acid and cholesterol levels in patients with diabetes mellitus and coronary artery disease.
Indian and black patients admitted to King Edward VIII and R. K. Khan Hospitals with a diagnosis of cardiac infarction and diabetes mellitus were studied. The mean serum cholesterol levels were higher in the indian group. This preliminary study suggests a negative correlation between leucocyte ascorbic acid and serum cholesterol levels in Indians, especially in patients with infarction. This, however, does not preclude an effect of latent ascorbic acid deficiency on the vessel wall. The possible relevance of the findings to the development of atherosclerosis is discussed.
Adult↗
Facilities for children in state and provincial hospitals.
A limited survey of provincial and state hospital facilities for children in the RSA was carried out through a questionnaire. Replies were received from 195 hospitals from the provinces of the Cape, Transvaal and Natal as well as from the independent homeland of Ciskei. These hospitals represented 90.3% of the beds in these areas. It was found that there were many more black children per available bed than white (632 v. 416) and that beds for black children had a much higher occupation rate than those for whites (+/- 85% v. +/- 50%). Rural black children were considerably worse off than their urban counterparts. Many hospitals did not have full-time medical officers to look after their paediatric patients. It is recommended that future resources be directed at improving facilities for rural black children and opening lines of communication between existing rural hospitals and the large academic hospitals.
Adolescent↗
Breast cancer prognosis in three different racial groups in relation to steroid hormone receptor status.
Follow-up studies on 466 patients over a 5-year period showed Whites to have an overall significantly longer disease-free interval and survival than Blacks and Asians. No racial differences in prognosis were seen in patients with Stage II disease (p greater than 0.2) but in Stage III, White patients had significantly longer disease-free periods than Blacks or Asians; the same was not true of survival. Whites had a 67% incidence of cytoplasmic estrogen receptor (CER) positive tumors compared with only 49% in Blacks and 41% in Asians. When tumors were assayed for CER, nuclear estrogen receptor (NER), and cytoplasmic progesterone receptor (CPR), there were no racial differences in the proportions of tumors containing all 3 receptors, but significant variations were found in neoplasms with no receptors and in those with apparently defective receptors. In White patients receptor status had no influence on prognosis (p greater than 0.3). Black patients whose tumors contained both CER and NER had a significantly better time to recurrence than those whose tumors lacked these receptors, while in Asian women the presence of CER alone, or CER together with NER, or CER, NER, and CPR, was indicative of a significantly longer disease-free period.
Breast Neoplasms↗
Experience with Althesin in the management of persistently raised ICP following severe head injury.
Of 243 patients who underwent intracranial pressure (ICP) monitoring after severe head injury, 42 (17%) were found to have severe persistently raised ICP, in spite of hyperventilation, mannitol, and surgical decompression. Althesin was infused to reduce ICP in these patients. This agent was shown to be effective and safe in reducing ICP, and a significant improvement in cerebral perfusion pressure was demonstrated. In this respect, Althesin may be more effective than barbiturates. However, no improvement in patient outcome was demonstrated in this series.
Adolescent↗
Protein-energy malnutrition: the role of nutrition education in rehabilitation.
A randomized trial was carried out to test the effectiveness of nutrition education as a rehabilitation measure for childhood protein-energy malnutrition. The intervention comprised a series of home-based nutrition counselling sessions for the mothers/caretakers of 65 children (hospital outpatients) aged 7-36 months, who were suffering from mild to moderate protein-energy malnutrition. Both the intervention and control groups of children and their caretakers were assessed over a 12-month period: the children on admission and at 3-monthly intervals for weight-for-age, weight-for-height, height-for-age, triceps skinfold-for-age and clinical features; the caretakers on admission and at the final follow-up for nutrition knowledge. Although the nutrition knowledge score of the caretakers in the intervention group improved significantly, no significant differences developed between the two groups of children regarding any of the nutritional status measures assessed. Thus, nutrition education per se was not found to be a major factor in promoting recovery from malnutrition. Nevertheless, both groups of children showed highly significant improvements in all age-adjusted anthropometric assessments except height-for-age.
Age Factors↗
Anaemia among the inhabitants of a rural area in northern Natal.
Haematological and parasitological investigations were carried out on apparently healthy subjects in a rural area of Natal. Anaemia was highly prevalent and of a moderate to severe degree (haemoglobin value less than 11,0 g/dl) in 42% of males and 52,5% of females. In 50% of subjects the anaemia was hypochromic and iron deficiency appeared to be the major contributing factor. However, failure to utilize iron, giving rise to hypochromia, was not excluded as a complicating factor. Subnormal serum vitamin B12 levels were found in some subjects, and this frequently coexisted with iron deficiency. The presence of parasites was not considered to have contributed to the production of anaemia. It was concluded that the anaemia was to a large extent nutritional in origin.
Adolescent↗
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↗
Reflex heart rate control in asthma. Evidence of parasympathetic overactivity.
The bronchial hyperreactivity characteristic of asthma may be related to enhanced parasympathetic nervous activity. We postulated that an abnormality in the autonomic control of airway caliber might be reflected by a parallel change in the reflex control of heart rate. We examined the heart-rate variations induced by deep breathing (respiratory sinus arrhythmia), the Valsalva maneuver, and standing up from the recumbent position in asthmatic subjects and nonasthmatic control subjects. The asthmatic patients had evidence of enhanced parasympathetic neural drive to the sinoatrial node, as manifested by a significantly greater magnitude of respiratory sinus arrhythmia, than the controls (p less than 0.0005). We were unable to induce a similar change in normal subjects by resistance breathing. A statistical analysis suggested the presence of a relationship between the magnitude of respiratory sinus arrhythmia and the degree of bronchial hyperreactivity in a group of asthmatic patients. Our results support the hypothesis that enhanced parasympathetic activity is an important factor in the pathogenesis of bronchial asthma.
Adult↗
Pharyngeal carriage of group A beta-haemolytic streptococci in coloured and Indian schoolchildren.
Throat swabs for group A beta-haemolytic streptococci were taken from 120 Coloured children and 126 Indian children at approximately 3-monthly intervals during 1980. The prevalence of positive throat swabs was related to crowding at home as measured by the number of people per bedroom. Coloured homes were much more crowded than Indian homes, but no statistical relationship was found between the number of persons per bedroom and the positivity rates. Both groups of children had high positivity rates in summer (24,4% and 21,3% for Coloureds and Indians respectively) but low rates in spring (4,3% and 3,4% respectively). These positivity rates do not support the provision of primary prophylaxis against acute rheumatic fever for these children.
Black or African American↗
HLA antigens and Graves' disease in Black South Africans.
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Adult↗
Primary health care nurse training in Kwazulu. An evaluation of diagnostic flow charts versus a conventional training method.
Diagnostic flow charts have been adapted for the training of primary health care (PHC) nurses in a rural area of South Africa. We designed a randomized controlled trial to assess whether nurses' clinical competence differed if they were trained using flow charts or using conventional patient-centered teaching. Although clinical competence improved during the training programme, this improvement did not differ significantly according to which of the two training methods was used. The nurses in this trial had considerable earlier experience and some training in primary care. Before the trial they had a high level of clinical competence and may already have developed their own diagnostic strategies. We therefore cannot make inferences from our study about whether or not flow charts will be a valuable addition in PHC. Flow charts need to be adapted to take into account where, by whom, and for what purpose they will be used. They must then be tested to ensure that they only rarely result in incorrect diagnosis and treatment. A decision on the use of flow charts in the training of PHC nurses should be based on further educational trials and long-term follow-up of trained health workers. Nurses should participate in educational trials at the start of their careers in PHC. The additional value of flow charts in the auditing of competence and assessment of educational needs should also be explored.
Ambulatory Care Facilities↗
An analysis of indeterminate western blot patterns of black African subjects.
The significance of indeterminate Western blotting results was assessed by determining their distribution in attenders of sexually transmitted diseases (STD) and family planning (FP) clinics. As expected, it was found that the former had a highly significantly greater prevalence of HIV infection. Indeterminate results were not found more frequently in STD attenders refuting any association with sexual promiscuity. They were, however, found significantly more frequently amongst black compared to white subjects, but no difference was found between males and females. Indeterminate results appear to be a feature of black African sera and what the significance is, still remains to be elucidated.
Black People↗