South African Family Practice最新文献

Background:  Evidence on circulating magnesium and hypertensive disorders of pregnancy in African populations is limited. We assessed between-group differences in serum magnesium and examined associations with early-onset pre-eclampsia and late-onset pre-eclampsia.

Methods:  We conducted an analytic cross-sectional study of 252 pregnant women sampled as four clinical groups: normotensive at a first antenatal visit, normotensive at term, early-onset pre-eclampsia, and late-onset pre-eclampsia. Serum magnesium was measured. Between-group differences were tested using one-way analysis of variance with contrasts. Associations with early-onset or late-onset pre-eclampsia versus normotensive groups were estimated using logistic regression adjusted for gestational age, body mass index, and human immunodeficiency virus status. We report effect sizes and 95 percent confidence intervals.

Results:  Serum magnesium was lower in normotensive women at term compared with those sampled at the first antenatal visit, consistent with physiological change across gestation. No comparable decrease was observed in early-onset or late-onset pre-eclampsia. The prevalence of hypomagnesaemia differed by group and was lowest at the first antenatal visit among normotensive women, while pre-eclampsia groups showed a divergent pattern. In adjusted models, obesity was positively associated with early-onset and late-onset pre-eclampsia, whereas human immunodeficiency virus status showed no significant association.

Conclusions:  In this South African cohort, cross-sectional comparisons demonstrate lower serum magnesium at term in normotensive pregnancies and a divergent profile in pre-eclampsia, supporting the hypothesis of altered magnesium regulation in hypertensive disorders of pregnancy. Results represent associations rather than causal effects and motivate future longitudinal research with repeated and intracellular magnesium measurements to clarify temporality and clinical relevance.Contribution: This article adds to the limited literature on Mg dynamics in pregnancy and highlights the need for population-specific strategies to reduce maternal mortality.

Background:  The quality of the leadership shown by operational managers was tested during coronavirus disease 2019 (COVID-19). They were expected to demonstrate positive leadership attitudes while being stretched by the demands of the pandemic.

Methods:  A qualitative, descriptive, phenomenological approach was used in this study to explore and describe strategies that can enhance and sustain a positive leadership attitude among operational managers after the COVID-19 pandemic. Ten operational managers were purposively sampled from primary health care (PHC) clinics in different regions of the City of Johannesburg. Data were collected using semi-structured individual interviews. Colaizzi's seven-step descriptive phenomenological analysis method was used to analyse and summarise the data to the point of data saturation.

Results:  Three themes emerged on ways to enhance and sustain positive leadership attitudes among operational managers in this study: (1) debriefing and counselling services, (2) teamwork, team-building and senior management support and (3) continuous staff development.

Conclusion:  The study suggests strategies to enhance and sustain positive leadership attitudes after COVID-19. This will prepare operational managers for future pandemics or crisis situations.Contribution: This is the first study in the City of Johannesburg that focuses on strategies to enhance and sustain positive leadership attitudes among operational managers at PHC clinics in the City of Johannesburg. The findings will provide leadership with direction on the requirements for support, equipment and transparency for subordinates should a pandemic or crisis occur in future.

Background:  Problematic Smartphone Use (PSU) is a growing concern, particularly among university students, due to its potential negative impacts on mental health, academic performance, and daily functioning. Characterized by compulsive smartphone use, PSU is linked to anxiety, depression, and sleep disturbances. Understanding PSU in university settings is essential for creating effective interventions. Additionally, primary care settings can play a key role in identifying and managing PSU to support overall well-being.

Methods:  This cross-sectional study involved 867 students from Nelson Mandela University, South Africa. Participants completed the Smartphone Addiction Scale - Short Version (SAS-SV) to assess PSU levels. The study explored associations between PSU, daily smartphone usage time, and gender using descriptive statistics and correlation analyses.

Results:  The findings revealed that 55% of the students exhibited PSU. A significant correlation was observed between increased daily smartphone usage and higher PSU levels. However, no significant gender differences were found. These results highlight the widespread nature of PSU among university students and its strong association with smartphone usage patterns.

Conclusion:  The study underscores the importance of addressing PSU in primary healthcare settings, where early detection and intervention can prevent further psychological and social consequences. Primary care providers can offer counselling, screen for PSU, and guide students towards healthier smartphone habits.Contribution: This study provides valuable insights into the prevalence and impact of PSU among university students. It emphasizes the vital role of primary care in addressing this emerging health issue to improve students' mental health and overall quality of life.

The emergence of large language models such as ChatGPT is already influencing health care delivery, research and training for the next cohort of health care professionals. In a consumer-driven market, their capabilities to generate new forms of knowing and doing for experts and novices present both promises and threats to the livelihood of patients. This article explores burdens imposed by the use of generative artificial intelligence tools in reflective essays submitted by a fifth of first-year health sciences students. In a curriculum centred around Vision 2030 at a South African university, deviations from prescribed guidelines in an essay requiring students to demonstrate an understanding of the models of disability are presented as moral injuries and epistemic injustices. Considering our obligations as educators to contribute to a humanising praxis, the author evaluates an eroded trust between educators and students and offers an interim solution for attaining skills in academic literacy in a developing country.Contribution: This article provides health sciences educators with an opportunity to pause and reflect on how they would like to integrate generative AI tools into their assessments.

Background:  Non-adherence to treatment remains a major contributing factor to uncontrolled hypertension and its complications. In South Africa, an estimated 50% of adults are living with hypertension and between 41.9% and 45.5% adhere to their treatment. Knowing reasons for non-adherence, therefore, is important in the treatment of hypertension.

Methods:  A cross-sectional study involving 243 hypertensive patients was conducted from May to July 2022 at Voortrekker Hospital, Mokopane, Limpopo province. The questionnaire included socio-demographic and hypertension-related medical information and adherence was assessed using the previously validated Therapeutic Adherence Scale for Hypertensive Patients (TASHP).

Results:  Forty-two per cent of participants adhered to their antihypertensive treatment, whereas 56% controlled their blood pressure. Variables such as employment (p = 0.0076), secondary and tertiary education (p = 0.0048), duration of hypertension of less than a year (p = 0.019) and level of income (more than R3000/month) (p = 0.033) were significantly associated with better adherence.

Conclusion:  Adherence to treatment and blood pressure control among hypertensive patients in the Mokopane area is still inadequate, although within the same range as reported in the literature. Effective strategies must be developed to address adherence, especially for vulnerable patients. Contribution: The study identified that only 42% of patients in a rural district hospital setting adhere to their hypertension management. Furthermore, it was found that patients less educated, unemployed, having an income of less than R3000/month or living with hypertension for more than 15 years are significantly more vulnerable to poor adherence.

Background:  Retention in care is vital for the successful management of human immunodeficiency virus (HIV). About 20% of clients interrupt their HIV therapy within 6 months of starting it. Lay healthcare workers complement the healthcare professionals to provide services across the HIV care continuum. However, there is limited support for lay healthcare workers as compared to healthcare professionals. Therefore, this study was conducted at a primary healthcare centre in South Africa to develop a support model for lay healthcare workers to improve clients' retention in HIV care.

Methods:  Interviews were conducted with the lay healthcare workers, their supervisors, nurses and clients on antiretroviral therapy. The support model was then developed by following Dickoff's survey list of a theoretical framework and the theory development processes of Chinn et al. Results: The context, agent, recipient, dynamics, procedure and outcomes of support were described in the support model. To nurture lay healthcare workers, the nurses, supervisors and department of health must provide a good environment, recognise each person's needs, offer both practical and emotional support, encourage mutual reliance and provide feedback.

Conclusion:  Support is an ongoing, mutually beneficial action that is essential to the efficient operation of lay healthcare workers. Contribution: Improved motivation, job satisfaction, competence and thriving are possible outcomes of the support for lay healthcare workers. This would increase the number of clients retained in HIV care, improve viral suppression and reduce transmission.

  Background: Immediate umbilical cord clamping has been part of the active management of the third stage of labour for centuries. Despite the benefits of delayed cord clamping, immediate cord clamping remains the routine practice in many countries, including South Africa. The aim of this study was to determine South African midwives' knowledge of the benefits of delayed umbilical cord clamping.

Methods:  Employing a quantitative, descriptive, cross-sectional design, 150 midwives from three Midwifery Obstetric Units (MOUs) in a district in one South African province were sampled through a stratified sampling method to complete the survey with an adapted self-administered questionnaire.

Results:  The majority of midwives lacked knowledge of the benefits of delayed umbilical cord clamping or were unsure of their knowledge.

Conclusion:  There is documented evidence on the benefits of delayed umbilical cord clamping for both mother and newborn. Midwives who participated in the research lacked knowledge of these benefits. Identification of the knowledge deficits of midwives regarding the benefits of delayed umbilical cord clamping may inform future midwifery education pertaining to delayed umbilical cord clamping and its benefits and may improve the practice thereof. Contribution: This is the first study in South Africa to report on midwives' knowledge of the benefits of delayed umbilical cord clamping.

Background:  Point-of-care ultrasound (PoCUS) is a core competency in emergency medicine, and its use in other primary healthcare settings is growing. The study investigates the PoCUS competency, training and qualifications of doctors working in public emergency departments.

Methods:  An online survey was distributed to doctors at five public Cape Town emergency departments, followed by a practical assessment of an Extended Focused Assessment with Sonography in Trauma (eFAST) and a basic cardiac ultrasound examination. Descriptive and inferential statistics are presented.

Results:  All participants had attended an in-person PoCUS course before, and 45 (83.3%) were trained by supervisors at work. Eleven participants (20.4%) were credentialled. In the practical assessment, 73.5% were rated as competent in eFAST and 55.9% in basic cardiac ultrasound. The median scores were 80.4% (eFAST) and 76.9% (cardiac ultrasound). Credentialled participants were more likely to achieve a pass mark ( 60%) in eFAST (p  0.001) and cardiac ultrasound (p  0.001).

Conclusion:  All the emergency department doctors who use PoCUS had received formal PoCUS training, and the majority of PoCUS providers had an adequate skill level in the applications tested. The credentialled providers performed better overall. There is a need for further research to investigate the persistently low credentialling rate and potential solutions, not only among practitioners in emergency departments but also generalists and primary care practitioners.Contribution: Our study provides a unique snapshot of the PoCUS skills of junior doctors and trainees in public Cape Town emergency departments.