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Biomedical subjects

S Tollman

Publications and source records attributed to S Tollman.

13 recordsLinked to original sources
PubMed2004

Secondary prevention of stroke--results from the Southern Africa Stroke Prevention Initiative (SASPI) study.

OBJECTIVE: To describe the prevalence of risk factors and experience of preventive interventions in stroke survivors, and identilfy barriers to secondary prevention in rural South Africa. METHODS: A clinician visited individuals in the Agincourt field site (in South Africa's rural north east) who were identified in a census as possible stroke victims to confirm the diagnosis of stroke. We explored the impact of stroke on the individual's family, and health-seeking behaviour following stroke by conducting in-depth interviews in the households of 35 stroke survivors. We held two workshops to understand the knowledge, experience, and views of primary care nurses, who provide the bulk of professional health care. FINDINGS: We identified 103 stroke survivors (37 men), 73 (71%) of whom had hypertension, but only 8 (8%) were taking anti-hypertensive treatment. Smoking was uncommon; 8 men and 1 woman smoked a maximum of ten cigarettes daily. 94 (91%) stroke survivors had sought help, which involved allopathic health care for most of them (81; 79%). 42 had also sought help from traditional healers and churches, while another 13 people had sought help only from those sources. Of the 35 survivors who were interviewed, 29 reported having been prescribed anti-hypertensive pills after their stroke. Barriers to secondary prevention included cost of treatment, reluctance to use pills, difficulties with access to drugs, and lack of equipment to measure blood pressure. A negative attitude to allopathic care was not an important factor. CONCLUSION: In this rural area hypertension is the most important modifiable risk factor in stroke survivors. Effective secondary prevention may reduce the incidence of recurrent strokes, but there is no system to deliver such care. New strategies for care are needed involving both allopathic and non-allopathic-health care providers.

Community Health Centers↗
PubMed2000

Causes of death in a rural area of South Africa: an international perspective.

The study compares the cause of death profile in a rural area of South Africa (Agincourt), with that in a rural area of West Africa (Niakhar), and in a developed country with the same life expectancy (France, 1951) in order to determine causes with high and low mortality and priorities for future health interventions. In the two African sites, causes of death were assessed by verbal autopsies, whereas they were derived from regular cause of death registration in France. Age-standardized death rates were used to compare cause-specific mortality in the three studies. Life expectancy in Agincourt was estimated at 66 years, similar to that of France in 1951, and much higher than that of Niakhar. Causes of death with outstandingly high mortality in Agincourt were violent deaths (homicide and suicide), accidents (road traffic accidents and household accidents), certain infectious diseases (HIV/AIDS, tuberculosis, diarrhea and dysentery), certain chronic diseases (cancer of genital organs, liver cirrhosis, gastrointestinal hemorrhage, maternal mortality, epilepsy, acute rheumatic fever, and pneumoconiosis) and malnutrition of young children (kwashiorkor). Causes of death with lower mortality than expected were primarily respiratory diseases (pneumonia, bronchitis, influenza, lung cancer), other cancers, vaccine preventable diseases (measles, whooping cough, tetanus), and marasmus. Verbal autopsies could be used in a rural area of a developing country without formal cause of death registration to identify the most salient health problems of the population, and could be compared with a formal cause of death registration system of a developed country.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Premarital fertility in rural South Africa: a challenge to existing population policy.

The age pattern of fertility in a rural area of South Africa under demographic surveillance (Agincourt subdistrict) was investigated over the 1992-97 period. The total fertility rate (TFR) averaged 3.3 births per woman of reproductive age over the period, a major drop from earlier estimates in the same area (6.0 births in 1970-74). Age-specific fertility rates showed an atypical bimodal pattern. They were decomposed into two components of similar magnitude: premarital fertility (among women aged 12-26) and marital fertility (among women aged 15-49). The decomposition revealed the two underlying modes: a mode of premarital fertility (among women aged 18-20) and a mode of marital fertility (among women aged 28-30). Premarital fertility accounted for 21 percent of all births and for 47 percent of births among women aged 12-26. This pattern of high premarital fertility appears to reflect a low incidence of contraceptive use before the first birth, especially among adolescents, a low prevalence of abortion, and a high contraceptive prevalence thereafter. This finding calls for a reorientation of the family planning policy, which until now has targeted married women and women who have been pregnant once, but has failed to address the contraceptive needs of young women before their first pregnancy, especially adolescents.

Adolescent↗
PubMed1997

A support group for mentally ill people.

The Sizanani Club is an outpatient psychiatry support group in rural South Africa whose activities appear to have reduced the number and duration of hospitalizations of mentally ill patients. Against a background trend towards decentralization and home-based health care the findings suggest the desirability of expanding the role of such groups.

Adult↗
PubMed1994

The introverted medical school--time to rethink medical education.

Curricular reform in the education of medical students is highlighted within the context of changing patterns of provision of health care. A number of industrialised countries' medical schools have accepted that they have a 'social contract' to respond to the health needs of the populations they serve. Such a contract, and the commitment to populations which it would necessitate, is also relevant in the South African context.

Curriculum↗
PubMed1991

Community oriented primary care: origins, evolution, applications.

Community oriented primary care is a commonly used term applied to a variety of situations and programs. Its use frequently extends beyond an understanding of its specific elements or an appreciation of its history and development. This article discusses the origins and evolution of the ideas, theory and practice of community oriented primary care. In South Africa in the 1940s a team headed by Sidney Kark embarked on work in the Pholela region of Natal that became the forerunner of ideas that were later formalized and systematized under the rubric of community oriented primary care. Widespread implementation took place in South Africa but was prematurely curtailed following the accession to power of the National Party. By the early 1960s many in the team had moved to Jerusalem where the theoretical basis of the concept was strengthened and came to describe a form of practice in which aspects of primary medical care and community health are integrated and systematically applied to a defined community. Experience with community oriented primary care in the United States and elsewhere is growing. This experience is reviewed and an assessment and critique offered.

Community Health Services↗
PubMed1990

Health maintenance organizations in developing countries: what can we expect?

Health maintenance organizations (HMOs) are a relatively new and alternative means of providing health care, combining a risk-sharing (insurance) function with health service provision. Their potential for lowering costs has attracted great interest in the USA and elsewhere, and has raised questions regarding their applicability to other settings. Little attention, however, has been given to critically reviewing the experience with HMOs in other countries, particularly concerning their introduction to settings other than the USA. This paper first reviews the current experience of HMOs in low- and middle-income countries, including Argentina, Bolivia, Brazil, Colombia, Ecuador, Uruguay, Chile and Indonesia. Secondly, the paper reviews the USA experience with HMOs: prerequisites for the establishment of HMOs in the USA are identified and discussed, followed by a review of the performance of HMOs in terms of cost containment, integration of care and quality of care for the elderly and poor. The analysis concludes that difficulties may arise when implementing HMOs in developing countries, and that potential adverse effects on the overall health care delivery system may occur. These should be avoided by careful analyses of a nation's health care system.

Developing Countries↗
PubMed1988

An assessment of internship at the teaching hospitals of the University of the Witwatersrand.

Medical internship can be a physically exhausting and emotionally traumatic experience. This study assesses various aspects of internship, including continuing medical education, workload and stress, at the five Johannesburg teaching hospitals during 1985 and 1986. Data were analysed from a confidential questionnaire. Eighty-two interns completed the questionnaire at the end of 1985 and 120 at the end of 1986. Problem areas defined were excessive patient load, sleep deprivation and severe stress. The commonest symptoms of stress were fatigue, irritability and weight loss. In 1985, 53% of interns stated that they could not cope, and in 1986 this increased to 65%. Forty-eight per cent of 1985 and 69% of 1986 interns lost interest in medicine during their intern year. The implications of these results are discussed and the importance and impact on the medical profession and hospital services analysed.

Attitude of Health Personnel↗