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SDG 3

A global analysis of molecular markers and phenotypic traits in local chicken breeds in Taiwan
20 February 2013
Stellenbosch University

Chang, C.S.;Chen, C.F.;Berthouly-Salazar, C.;Chazara, O.;Lee, Y.P.;Chang, C.M.;Chang, K.H.;Bed'Hom, B.;Tixier-Boichard, M.

Molecular and phenotypic data have been combined to characterize the genetic diversity of six local chicken breeds maintained with a long-term conservation programme. Hua-Tung, Hsin-Yi, Ju-Chi and Quemoy originated from Taiwan, Shek-Ki is from South China, and Nagoya is from Japan. Molecular tools included 24 microsatellite markers, melanocortin 1 receptor (alpha melanocyte stimulating hormone receptor) (MC1R), the LEI0258 marker located within the major histocompatibility complex (MHC), and mitochondrial DNA. Performance was recorded on the same individuals for body weight, panting rate in summer and antibody response (antigens: Newcastle disease virus and sheep red blood cells). A multivariate method previously proposed for taxonomy was used to combine the different data sets. Melanocortin 1 receptor (alpha melanocyte stimulating hormone receptor) and the MCW330 marker contributed the most to the first axis of the multiple coinertia analysis of molecular markers. Melanocortin 1 receptor (alpha melanocyte stimulating hormone receptor) showed evidence of selection, probably related to its effect on feather colour. The MHC exhibited a large diversity, with 16 alleles of the LEI0258 marker. Immune response traits contributed the most to the principal component analysis of phenotypic data. Eight mitochondrial DNA haplotypes related to clades A, B, C and E were distributed across breeds and revealed an important contribution of Indian and European breeds to Ju-Chi, Quemoy and Hsin-Yi. Phenotypic data contributed less than molecular data to the combined analysis, and two markers, LEI0258 and LEI0228, contributed the most. The combined analysis could clearly discriminate all breeds, except Ju- Chi, which was similar to Quemoy for many criteria, except immune response.
Stable and fluctuating temperature effects on the development rate and survival of two malaria vectors, Anopheles arabiensis and Anopheles funestus
04 June 2014
Stellenbosch University

Lyons, C.L.;Coetzee, M.;Chown, S.L.

Background: Understanding the biology of malaria vector mosquitoes is crucial to understanding many aspects of the disease, including control and future outcomes. The development rates and survival of two Afrotropical malaria vectors, Anopheles arabiensis and Anopheles funestus, are investigated here under conditions of constant and fluctuating temperatures. These data can provide a good starting point for modelling population level consequences of temperature change associated with climate change. For comparative purposes, these data were considered explicitly in the context of those available for the third African malaria vector, Anopheles gambiae. Methods: Twenty five replicates of 20–30 eggs were placed at nine constant and two fluctuating temperatures for development rate experiments and survival estimates. Various developmental parameters were estimated from the data, using standard approaches. Results: Lower development threshold (LDT) for both species was estimated at 13-14°C. Anopheles arabiensis developed consistently faster than An. funestus. Optimum temperature (Topt) and development rate at this temperature (μmax) differed significantly between species for overall development and larval development. However, Topt and μmax for pupal development did not differ significantly between species. Development rate and survival of An. funestus was negatively influenced by fluctuating temperatures. By contrast, development rate of An. arabiensis at fluctuating temperatures either did not differ from constant temperatures or was significantly faster. Survival of this species declined by c. 10% at the 15°C to 35°C fluctuating temperature regime, but was not significantly different between the constant 25°C and the fluctuating 20°C to 30°C treatment. By comparison, previous data for An. gambiae indicated fastest development at a constant temperature of 28°C and highest survival at 24°C. Conclusions: The three most important African malaria vectors all differ significantly in development rates and survival under different temperature treatments, in keeping with known distribution data, though differences among M and S molecular forms of An. gambiae likely complicate the picture. Increasing temperatures associated with climate change favour all three species, but fluctuations in temperatures are detrimental to An. funestus and may also be for An. gambiae. This may have significant implications for disease burden in areas where each species is the main malaria vector.
Continuously stable strategy of pathogen evolution in a classic epidemiological SIR model
07 March 2019
Stellenbosch University

Han, X.-Z.;Hui, C.;Li, F.;Lin, M.-X.

Using the framework of adaptive dynamics, here a classic susceptible-infected-recovery (SIR) host- pathogen model was considered to explore the evolutionary dynamics of pathogen virulence. Both transmission rate and recovery rate were assumed to be constrained by trade-offs with the pathogenic virulence, and the trade-offs crucially determined the behavior of the evolutionary dynamics. No additional increase in mortality due to infection was assumed and the invasion fitness and evolutionary trajectories of pathogen virulence were explored using pairwise invadability plots. The results showed that initial strains of viruses with different levels of virulence converged to one continuously stable singular point, prohibiting any other complex evolutionary outcomes to occur on the strain diversity. The insufficient nonlinearity in the population dynamics and the lack of additional increase of mortality due to infection could have led to the lack of evolutionary diversity, which could, nonetheless, serve as the base for developing potential mechanisms for reducing the diversity of virus strains in public health management.
Malaria patterns across altitudinal zones of Mount Elgon following intensified control and prevention programs in Uganda
10 July 2020
Stellenbosch University

Siya, A.;Kalule, B.J.;Ssentongo, B.;Lukwa, A.T.;Egeru, A.

Background Malaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30 years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda. Methods Times-series data on malaria cases (2011-2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period. Results Malaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases. Conclusions Despite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones.
COVID-19 length of hospital stay: a systematic review and data synthesis
07 September 2020
Stellenbosch University

Rees, Eleanor M;Nightingale, Emily S;Jafari, Yalda;Waterlow, Naomi R;Clifford, Samuel;B. Pearson, Carl A;Group, CMMID W;Jombart, Thibaut;Procter, Simon R;Knight, Gwenan M

Abstract Background The COVID-19 pandemic has placed an unprecedented strain on health systems, with rapidly increasing demand for healthcare in hospitals and intensive care units (ICUs) worldwide. As the pandemic escalates, determining the resulting needs for healthcare resources (beds, staff, equipment) has become a key priority for many countries. Projecting future demand requires estimates of how long patients with COVID-19 need different levels of hospital care. Methods We performed a systematic review of early evidence on length of stay (LoS) of patients with COVID-19 in hospital and in ICU. We subsequently developed a method to generate LoS distributions which combines summary statistics reported in multiple studies, accounting for differences in sample sizes. Applying this approach, we provide distributions for total hospital and ICU LoS from studies in China and elsewhere, for use by the community. Results We identified 52 studies, the majority from China (46/52). Median hospital LoS ranged from 4 to 53 days within China, and 4 to 21 days outside of China, across 45 studies. ICU LoS was reported by eight studies—four each within and outside China—with median values ranging from 6 to 12 and 4 to 19 days, respectively. Our summary distributions have a median hospital LoS of 14 (IQR 10–19) days for China, compared with 5 (IQR 3–9) days outside of China. For ICU, the summary distributions are more similar (median (IQR) of 8 (5–13) days for China and 7 (4–11) days outside of China). There was a visible difference by discharge status, with patients who were discharged alive having longer LoS than those who died during their admission, but no trend associated with study date. Conclusion Patients with COVID-19 in China appeared to remain in hospital for longer than elsewhere. This may be explained by differences in criteria for admission and discharge between countries, and different timing within the pandemic. In the absence of local data, the combined summary LoS distributions provided here can be used to model bed demands for contingency planning and then updated, with the novel method presented here, as more studies with aggregated statistics emerge outside China.
A survey dataset to evaluate the changes in mobility and transportation due to COVID-19 travel restrictions in Australia, Brazil, China, Ghana, India, Iran, Italy, Norway, South Africa, United States
02 February 2021
Stellenbosch University

Barbieri, D.M.;Lou, B;Passavanti, M.;Hui, C.;Lessa, D.A.;Maharaj, B.;Banerjee, A.;Wang, F.;Chang, K.;Naik, B.;Yu, L.;Liu, Z.;Sikka, G.;Tucker, A.;Mirhosseini, A.F.;Naseri, S.;Qiao, Y.;Gupta, A.;Abbas, M.;Fang, K.;Ghasemi, N.;Peprah, P.;Goswami, S.;Hessami, A.;Agarwal, N.;Lam, L.;Adomako, S.

COVID-19 pandemic has heavily impacted the global community. To curb the viral transmission, travel restrictions have been enforced across the world. The dataset documents the mobility disruptions and the modal shifts that have occurred as a consequence of the restrictive measures implemented in ten countries: Australia, Brazil, China, Ghana, India, Iran, Italy, Norway, South Africa and the United States. An online questionnaire was distributed during the period from the 11st to the 31st of May 2020, with a total of 9 394 respondents. The first part of the survey has characterized the frequency of use of all transport modes before and during the enforcement of the restrictions, while the second part of the survey has dealt with perceived risks of contracting COVID-19 from different transport modes and perceived effectiveness of travel mitigation measures. Overall, the dataset (stored in a repository publicly available) can be conveniently used to quantify and understand the modal shifts and people's cognitive behavior towards travel due to COVID-19. The collected responses can be further analysed by considering other demographic and socioeconomic covariates.
Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis
29 April 2021
Stellenbosch University

Lailulo, Yishak;Kitenge, Marcel;Jaffer, Shahista;Aluko, Omololu;Nyasulu, Peter S

Abstract Background Despite the increase in the number of people accessing antiretroviral therapy (ART), there is limited data regarding treatment failure and its related factors among HIV-positive individuals enrolled in HIV care in resource-poor settings. This review aimed to identify factors associated with antiretroviral treatment failure among individuals living with HIV on ART in resource-poor settings. Methods We conducted a comprehensive search on MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, and Latin American and Caribbean Health Sciences Literature (LILACS). We included observational studies (cohort, case-control, and cross-sectional studies) where adolescents and adults living with HIV were on antiretroviral treatment regardless of the ART regimen. The primary outcomes of interest were immunological, virological, and clinical failure. Some of the secondary outcomes were mm3 opportunistic infections, WHO clinical stage, and socio-demographic factors. We screened titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements were resolved by consensus. We analyzed the data by doing a meta-analysis to pool the results for each outcome of interest. Results Antiretroviral failure was nearly 6 times higher among patients who had poor adherence to treatment as compared to patients with a good treatment adherence (OR = 5.90, 95% CI 3.50, 9.94, moderate strength of evidence). The likelihood of the treatment failure was almost 5 times higher among patients with CD4 < 200 cells/mm3 compared to those with CD4 ≥ 200 CD4 cells/mm3 (OR = 4.82, 95% CI 2.44, 9.52, low strength of evidence). This result shows that poor adherence and CD4 count below < 200 cells/mm3 are significantly associated with treatment failure among HIV-positive patients on ART in a resource-limited setting. Conclusion This review highlights that low CD4 counts and poor adherence to ART were associated to ART treatment failure. There is a need for healthcare workers and HIV program implementers to focus on patients who have these characteristics in order to prevent ART treatment failure. Systematic review registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: 2019 CRD42019136538.
Incident tuberculosis disease in patients receiving biologic therapies in the Western Cape, South Africa from 2007 to 2018
29 April 2021
Stellenbosch University

du Toit, Tessa;Esterhuizen, Tonya M;Tiffin, Nicki;Abulfathi, Ahmed A;Reuter, Helmuth;Decloedt, Eric H

Abstract Background South Africa has one of the highest tuberculosis incidence rates. Biologic disease-modifying anti-rheumatic drugs are associated with an increased risk of tuberculosis. The objective of this study was to describe the tuberculosis disease incidence rate among public sector patients receiving biologic therapies in the Western Cape Province. Methods A retrospective, descriptive analysis was undertaken using routine health data collated by the Provincial Health Data Centre from January 2007 (first use of biologic therapy in the Western Cape) to September 2018. Results We identified 609 patients treated with tumour necrosis factor-alpha (TNF-α) or non-TNF-α biologic therapies. Thirty-seven (37) patients developed tuberculosis after biologic therapy exposure, of whom the majority (78%) had an immune mediated inflammatory disease and the remainder (22%) a haematologic malignancy. The incidence rate of tuberculosis per 100,000 person-years was 2227 overall [95% confidence interval (CI): 1591, 3037]. Patients treated with TNF-α inhibitors and non-TNF-α inhibitors had estimated incidence rates of 2819 [95% CI: 1669, 4480] and 1825 [95% CI: 1131, 2797], respectively (p = 0.10). Conclusion Patients exposed to both TNF-α and non-TNF-α biologic therapies may have a higher incidence of tuberculosis disease compared to the background risk of 681 cases per 100,000 per year in the Western Cape.
Clinical Ethics Committees in Africa: lost in the shadow of RECs/IRBs?
29 April 2021
Stellenbosch University

Moodley, Keymanthri;Kabanda, Siti M;Soldaat, Leza;Kleinsmidt, Anita;Obasa, Adetayo E;Kling, Sharon

Abstract Background Clinical Ethics Committees (CECs) are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services (CESs) on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics (p = 0.005). All participants were familiar with Research Ethics Committees (RECs), and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants (81.7%) were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed.
Spiritual care practices in hospices in the Western cape, South Africa: the challenge of diversity
29 April 2021
Stellenbosch University

Mahilall, Ronita;Swartz, Leslie

Abstract Background South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust. Discussion Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.
Increased acquired protease inhibitor drug resistance mutations in minor HIV-1 quasispecies from infected patients suspected of failing on national second-line therapy in South Africa
29 April 2021
Stellenbosch University

Obasa, Adetayo E.;Ambikan, Anoop T.;Gupta, Soham;Neogi, Ujjwal;Jacobs, Graeme B.

Abstract Background HIV-1C has been shown to have a greater risk of virological failure and reduced susceptibility towards boosted protease inhibitors (bPIs), a component of second-line combination antiretroviral therapy (cART) in South Africa. This study entailed an evaluation of HIV-1 drug resistance-associated mutations (RAMs) among minor viral populations through high-throughput sequencing genotypic resistance testing (HTS-GRT) in patients on the South African national second-line cART regimen receiving bPIs. Methods During 2017 and 2018, 67 patient samples were sequenced using high-throughput sequencing (HTS), of which 56 samples were included in the final analysis because the patient’s treatment regimen was available at the time of sampling. All patients were receiving bPIs as part of their cART. Viral RNA was extracted, and complete pol genes were amplified and sequenced using Illumina HiSeq2500, followed by bioinformatics analysis to quantify the RAMs according to the Stanford HIV Drug Resistance Database. Results Statistically significantly higher PI RAMs were observed in minor viral quasispecies (25%; 14/56) compared to non-nucleoside reverse transcriptase inhibitors (9%; 5/56; p = 0.042) and integrase inhibitor RAM (4%; 2/56; p = 0.002). The majority of the drug resistance mutations in the minor viral quasispecies were observed in the V82A mutation (n = 13) in protease and K65R (n = 5), K103N (n = 7) and M184V (n = 5) in reverse transcriptase. Conclusions HTS-GRT improved the identification of PI and reverse transcriptase inhibitor (RTI) RAMs in second-line cART patients from South Africa compared to the conventional GRT with ≥20% used in Sanger-based sequencing. Several RTI RAMs, such as K65R, M184V or K103N and PI RAM V82A, were identified in < 20% of the population. Deep sequencing could be of greater value in detecting acquired resistance mutations early.
Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis
29 April 2021
Stellenbosch University

Kabongo, Eveline M.;Mukumbang, Ferdinand C.;Delobelle, Peter;Nicol, Edward

Abstract Background Despite the growing global application of mobile health (mHealth) technology in maternal and child health, contextual factors, and mechanisms by which interventional outcomes are generated, have not been subjected to a systematic examination. In this study, we sought to uncover context, mechanisms, and outcome elements of various mHealth interventions based on implementation and evaluation studies to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and mothers. Method We undertook a realist synthesis. An electronic search of five online databases (PubMed/Medline, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate Boolean phrases terms and selection procedures, 32 articles were identified. A theory-driven approach, narrative synthesis, was applied to synthesize the data. Thematic content analysis was used to delineate elements of the intervention, including its context, actors, mechanisms, and outcomes. Abduction and retroduction were applied using a realist evaluation heuristic tool to formulate generative theories. Results We formulated two configurational models illustrating how and why mHealth impacts implementation and uptake of maternal and child health care. Implementation-related mechanisms include buy-in from health care providers, perceived support of health care providers’ motivation and perceived ease of use and usefulness. These mechanisms are influenced by adaptive health system conditions including organization, resource availability, policy implementation dynamics, experience with technology, network infrastructure and connectivity. For pregnant women and mothers, mechanisms that trigger mHealth use and consequently uptake of maternal and child health care include perceived satisfaction, motivation and positive psychological support. Information overload was identified as a potential negative mechanism impacting the uptake of maternal and child health care. These mechanisms are influenced by health system conditions, socio-cultural characteristics, socio-economic and demographics characteristics, network infrastructure and connectivity and awareness. Conclusion Models developed in this study provide a detailed understanding of implementation and uptake of mHealth interventions and how and why they impact maternal and child health care in low- and middle-income countries. These models provide a foundation for the ‘white box’ of theory-driven evaluation of mHealth interventions and can improve rollout and implementation where required.
Random drug-testing: the duty to act against learners who use drugs
27 May 2009
North West University

De Waal, Elda

This article explores educators’ duty in terms of running their own schools. It weighs the importance of a drug-using learner’s right to privacy against that of the school community’s security on the issue of random drug-testing. A comparison is drawn between the American and the South African situation. The point of departure is a pro-active stance on the sportsfield, leading to assistance in resistance training, the identification of the need for professional help, and the creation of a drug-free school environment. The ultimate issue is the random drug-testing of all learners.
Parental access to minors' health records in the South African health care context: concerns and recommendations
08 October 2009
North West University

Slabbert, M N

Privacy and confidentiality have long been recognized as essential elements of the doctor-patient relationship. Patients should feel free to disclose the most intimate and private medical facts about themselves to their physicians in order to facilitate optimal patient care. Medical records, whether hand-written or electronic, also play an important role in other contexts, such as medical research, health care management and financial audit. In South Africa there is little consistency in approaches to patient confidentiality. There are also no national standards or policies on patient confidentiality, apart from specific ethical rules, some ad hoc statutory provisions and general constitutional provisions not directly related to the intricacies of the doctor-patient relationship. A closer look at the relevant statutory provisions reveal the existence of conflicting standards, most notably in respect of parental access to a minors' health records. The purpose of this paper is to examine the discrepancies and contradictory provisions relating to the access to and disclosure of health information, in particular parental access to health records of minors. In the final instance, some recommendations will be suggested.
Job insecurity , work-based support, job satisfaction, organisational commitment and general health of human resources professionals in a chemical industry
09 November 2009
North West University

Rani, Nomhlangano Florence

The work environment in which South African employees have to function is highly demanding, offering them little in terms of job security, but simultaneously expecting them to give more in terms of inter alia flexibility, competency, and effort. Tracking and addressing chemical industry employees' functioning in areas that could affect their general health and consequent standard of service is essential. Job insecurity, work-based support, job satisfaction, organisational commitment and general health are specific focus areas in this research. It is important to use reliable and valid measuring instruments to measure these constructs. It appears that job insecurity results in reduced organisational commitment as well as reduced job satisfaction. In the long run all this may have a negative impact on the psychological well-being of employees. Therefore, the right kind of support h m the right kind of people can be of significant value in reducing occupational stress, improving health, and buffering the impact of stress on health. A lack of South African research exists regarding job insecurity, work-based support, job satisfaction, organisational commitment and general health - hence the importance of this research. The primary objective of this research was to investigate the relationship between job insecurity, work-based support, job satisfaction, organisational commitment and general health of Human Resources Professionals (N = 114) in a chemical industry. A cross-sectional survey design was used to collect data. It was found that affective and cognitive job insecurity demonstrated a statistically significant negative correlation with emotional social support (supervisor and other), but practically and statistically negative correlation with intrinsic and extrinsic job satisfaction. With regard to affective and cognitive job insecurity and general health, a statistically significant positive correlation was obtained for somatic symptoms, social dysfunction and severe depression, and a practically and statistically significant correlation with anxiety and insomnia. Affective commitment demonstrated a statistically significant negative relationship with cognitive job insecurity. The regression analysis indicated that job insecurity has some predictive value with regard to the intrinsic and extrinsic job satisfaction and general health subscales, namely somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. With regard to the two components of job satisfaction, intrinsic and extrinsic, job insecurity predicted 14% and 5% respectively of the variance. No predictions were found between affective commitment and job insecurity. With regard to general health, job insecurity predicted 5% (somatic symptoms), 11% (anxiety and insomnia), 1 % (social dysfunction) and 8% (severe depression). Conclusions were made, limitations of the cumin research were discussed and recommendations for future research were put forward.
Die invloed van fisieke-aktiwiteitsdeelname op die verband tussen die koronêrerisiko-indeks en enkele demografiese konstrukte by NG-predikante in Suid-Afrika
02 February 2010
North West University

Wilders, Cilas;Strydom, Gert;Kriel, J.S.

The objective of this study was to determine the interaction of physical activity on the relationship between coronary risk index and years of service, congregation size, co-ministership and congregation type of Dutch Reformed ministers in South Africa. The respondents were 340 ministers of the Dutch Reformed Church who volunteered to participate in the study. The quality of participation in physical activity was determined by using Sharkey's (1997:432) physical activity index, while the risk of developing coronary heart disease was determined by Bjürnstrom and Alexiou's (1978:524) coronary risk index assessment. The mean index of physical activity participation was 33.81 ± 32.30, which could be classified as fair, although 32,2% of the subjects fell in the low activity group. The coronary risk index showed that 19,9% of the population indicated a high risk of developing coronary artery disease. Significant differences (p≥0.05) were found among the high activity and low activity groups regarding the coronary risk index. Physical activity participation indicated a significant interaction on the relationship between coronary risk index and years in the ministry, size of congregation, coministership and congregation type. Physical activity also indicated a positive effect on the coronary risk index independent of years in the ministry, size of congregation, coministership and con-gregation type. Physical activity participation can be regarded as a curative modality on the interaction of coronary risk index and years in the ministry, size of congregation, co-ministership and congregation type. It can be concluded that physical activity participation can be regarded as a salutogenic modality in the physical wellness of South African ministers of religion
Stereotypic behaviour in the deer mouse: pharmacological validation and relevance for obsessive compulsive disorder
25 February 2010
North West University

Korff, Schaun;Harvey, Brian H.;Stein, Dan J.

Stereotypy is an important manifestation of obsessive compulsive disorder (OCD). OCD involves disturbed serotonin and dopamine pathways, and demonstrates a selective response to serotonin reuptake inhibitors (SRI), with limited to no response to noradrenaline reuptake inhibitors (NRI). Deer mice (Peromyscus maniculatus bairdii) engage in various spontaneous stereotypic behaviours, including somersaulting, jumping and pattern running, and has to date not been explored for possible relevance for OCD. We studied the population diversity of spontaneous stereotypy in these animals, followed by assessing behavioural response to chronic high and low dose SRI (viz. fluoxetine) and NRI (viz. desipramine) treatment (both 10 mg/kg; 20 mg/kg × 21 days). We also studied behavioural responses to the 5-HT2A/C agonist, meta-chlorophenylpiperazine (mCPP) and the D2 agonist, quinpirole (2 mg/kg and 5 mg/kg respectively × 4 days). Deer mice showed a distinct separation into high and low stereotypic behaviour populations, with high and low dose fluoxetine, but not desipramine, significantly reducing stereotypic behaviour in both populations. A significant attenuation of stereotypy was also observed in both groups following quinpirole or mCPP challenge. In its response to drug treatment, spontaneous stereotypic behaviour in deer mice demonstrates predictive validity for OCD. States of spontaneous stereotypy are attenuated by 5-HT2A/C and dopamine D2 receptor agonists
Prevalence of drug-drug interactions of antiretroviral agents in the private health care sector in South Africa
20 April 2010
North West University

Katende-Kyenda, Norah Lucky;Lubbe, M.S.;Serfontein, J.H.P.;Truter, I.

Objectives. Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART), requiring concomitant administration of three to four different agents, often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book, “Drug Interactions – Facts and comparisons.” Results. A total of 5305882 medicine items were prescribed, of these, 1.92% (N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions, 1.68% (N=43 482), were ARVs. A total number of 18035 DDIs (81 different types) were identified, of these, 83.89%, (n=15130) were DDIs between ARVs and other drugs, while 16.11% (n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, n=17) and 2 (moderate, n=1436) represented 8.06% (n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing, there is a great need of understanding and anticipating these DDIs, overcoming them by dose adjustments and patient education by pharmacists, so that they are not life threatening to HIV/AIDS patients
Humour and the locus of control in The Gruffalo (Julia Donaldson & Axel Scheffler)
13 May 2010
North West University

Van der Westhuizen, Elizabeth Susanna

The purpose of this article is firstly to distinguish between the notions “external locus of control” and “internal locus of control”, secondly to indicate ways in which the locus of control in humour in “The Gruffalo” by Julia Donaldson and Axel Scheffler can be identified and thirdly to indicate possible ways in which emphasis on the internal locus of control in the young reader can assist him/her in the development of a general mental/- psychological well-being. Different kinds of literary humour contribute to the ways in which young listeners/readers can identify with stories, poems, dramas and films. The young listener/reader can recognise him/herself in humorous situations, in the humorous use of imagery, wordplay and illustrations/visuals. He/she can also identify with or distance him-/herself from or reject the characters, the values represented and the author who created the text. When in interaction with the works of authors who use negative as well as positive kinds of humour to point out the dos and don’ts, the rights and the wrongs in life, the horizon of a young listener’s/reader’s experience can be expanded. Such a reading would contribute to the development of the young reader’s cognitive, emotional, social and moral values as it links up with an unconscious or conscious decision about the locus of control in his/her life.
HIV/AIDS Perceptions, attitudes and awareness of undergraduate students
07 January 2011
North West University

Van Wyk, Christo

The central question to be examined revolves around the perceptions, attitudes and awareness regarding HIV/AIDS among undergraduate students at the North-West University (Vaal Triangle Campus). Therefore, the objective of this research was to assess these perceptions, attitudes and awareness regarding HIV/AIDS. A convenience sample of undergraduate students was used in a cross-sectional design (N = 290). A semi-standardised questionnaire as well as a biographical questionnaire was administered. The semi-standardised questionnaire was proven to be reliable. Cronbach’s alpha coefficient of between 0.65 and 0.71 was obtained. Descriptive statistics were used to analyse the data. Results indicated that students experienced and perceived differences with regards to their biographical variables in terms of their perceptions, attitudes and awareness regarding HIV/AIDS. Differences were also found between students in different study modules and study years. The findings revealed that the majority of the students were quite knowledgeable regarding HIV/AIDS. While some students had detailed knowledge of the disease and its prevention, others (the minority) were either completely ignorant about it or deny its existence. Recommendations were made for future research in the area of HIV/AIDS within the context of tertiary education.
Psychological debriefing (PD) of trauma: a proposed model for Africa
07 January 2011
North West University

Van Dyk, E L;Van Dyk, G A J

Africa is a continent with severe trauma. Traumatic events include experiences of child soldiers, people living in war and conflict zones, and people struggling with the HIV/AIDS pandemic. These events cause high levels of trauma. The trauma causes psychological disorders like post traumatic stress disorder, acute stress disorder and combat stress reaction, specific in the military environment. This article focuses on a better understanding of the implications of trauma for military people and civilians. It discusses the different theories and models of psychological debriefing. Lastly the article discusses psychological debriefing models for military forces and the civilian population to prevent severe psychopathology after traumatic incidents in Africa.
HIV/AIDS awareness among first year pharmacy students and the role of the university
12 January 2011
North West University

Bezuidenhout, S;Summers, R S

As HIV/AIDS continues to spread and affect the lives of millions of people, a sense of urgency has developed about the imperative need to stop the epidemic. Education is the key to change knowledge, attitudes and behaviour. There is currently a gap in education programmes targeting youths of ages 18-24 years, for example, those enrolled in tertiary institutions. The aim of the study was therefore to establish the level of HIV/AIDS awareness among undergraduate pharmacy students at the University of Limpopo (Medunsa Campus)/Tshwane University of Technology Schools of Pharmacy. A structured questionnaire was administered to pharmacy students on entry to the programme. Although the students of 2003, 2004 and 2005 obtained mean percentage HIV/AIDS awareness scores in the range of 70%-80%, they had inadequate knowledge of some transmission routes, events that occur when HIV invades the body, the “window period” and some symptoms. These knowledge gaps should be addressed by universities by integrating HIV/AIDS policies and education fully into all aspects of their planning, operations and teaching.
Black workers, typhoid fever and the construction of the Berg River – Saldanha military water pipeline, 1942 – 1943
14 January 2011
North West University

Visser, G E;Monama, F L

War creates a huge need for labour to support the war efforts of the belligerent parties. In South Africa tens of thousands of ‘non-white’ workers were mobilised during the Second World War to satisfy the Union Defence Force’s (UDF’s) labour needs at home and abroad. This article, firstly, outlines the role of ‘non-white people’, particularly black Africans, in the UDF with special reference to those employed within the Union of South Africa. Secondly, it briefly delineates typhoid fever as an historical thorn in the flesh of military forces up to the early 20th century. It then looks briefly into the incidence of and perceptions on typhoid fever as a killer disease in South Africa on the eve of the Second World War. Against that background, the article investigates the employment of black workers on the construction of the Berg River-Saldanha Bay military water pipeline and the UDF’s response to the threat and subsequent outbreak of typhoid fever amongst the workers at the Berg River intake site in 1943. The article concludes that the public health authorities and UDF were aware of the threat of typhoid fever with regard to the Berg River water scheme, but did not take sufficient precautionary measures, which could have had serious repercussions for the Allied war effort. This incident should serve as a warning to the South African National Defence Force when deploying on peace support operations on the African continent where typhoid fever remains a serious threat next to Hiv/Aids.
Can the application of the human rights of the child in a criminal case result in a therapeutic outcome?
30 March 2011
North West University

Coetzee, Enid

Prior to the change brought about by S v M,1 the interests of children were only considered as a circumstance or mitigating factor of the offender during the sentencing process. The article will discuss case law in order to determine the impact that the inclusion of the human rights of the child had on the sentencing process if the offender was the primary caregiver of the child. Specific reference is made to Sections 28(2) and 28(1)(b) of the Constitution of the Republic of South Africa, 1996. The article will then consider whether this inclusion might improve therapeutic outcomes without the apprehension that the interests of justice would be forfeited. A therapeutic outcome is brought about when the attention is placed on the human, emotional and psychological side of the law. It is concluded that the Zinn triad remains the basic measure to be used by sentencing courts to determine an appropriate sentence. Should the sentence be direct imprisonment, the court has to ensure that the children receive appropriate care as prescribed by Section 28(1)(b). Should a range of sentences be considered, even though the court has a wide discretion to decide which factors should be allowed to influence the measure of punishment, when the offender is a primary caregiver, Section 28(2) must be included as an independent factor. It is also concluded from the case law discussion that the inclusion of the human rights of the child in the sentencing process did not automatically give rise to a therapeutic outcome, although in some judgments it did result in a therapeutic outcome. Thus, the consideration of the human rights of the children during the sentencing process creates the opportunity for a therapeutic outcome.
The constitutionality of biological father's recognition as a parent
30 March 2011
North West University

Louw, A

Despite the increased recognition afforded to biological fathers as legal parents, the Children's Act1 still does not treat fathers on the same basis as mothers as far as the automatic allocation of parental responsibilities and rights is concerned. This article investigates the constitutionality of the differential treatment of fathers in this respect, given South Africa's international obligations, especially in terms of the United Nations Convention on the Rights of the Child, to ensure that both parents have common responsibilities for the upbringing of their child. After a brief consideration of the constitutionality of the mother's position as parent, the constitutionality of the father's position is investigated, firstly, with reference to Section 9 of the Constitution and the question of whether the differentiation between mothers and fathers as far as the allocation of parental responsibilities and rights is concerned, amounts to unfair discrimination. The inquiry also considers whether the differentiation between committed fathers (that is, those who have shown the necessary commitment in terms of Sections 20 and 21 of the Children's Act to acquire parental responsibilities and rights) and uncommitted fathers may amount to discrimination on an unspecified ground. Since the limitation of the father's rights to equality may be justifiable, the outcomes of both inquiries are shown to be inconclusive. Finally, the legal position of the father is considered in relation to the child's constitutional rights – the rights to parental care and the right of the child to the paramountcy of its interests embodied in Section 28 of the Constitution. While there appears to be some justification for the limitation of the child's right to committed paternal care, it is submitted that an equalisation of the legal position of mothers and fathers as far as the automatic acquisition of parental responsibilities and rights is concerned, is not only justified but imperative if the constitutional rights of children are to be advanced and protected.
The role of religious leaders in curbing the spread of HIV/AIDS in Nigeria
31 March 2011
North West University

Oluduro, Olubayo

The tragic impact of the HIV/AIDS pandemic in Nigeria and its rate of escalation despite increasing access to health services have been alarming and terrifying. Nigerian people are very religious, yet the impact of the pandemic leaves nothing untouched. The article examines the response of the Nigerian religious leaders to the challenges of the HIV/AIDS pandemic. It discusses some of the challenges facing religious leaders as they grapple with the consequences of this pandemic and explores ways in which they can make a real difference in halting its spread.
The impact of HIV/AIDS regarding informal social security: Issues and perspectives from a South African context
31 March 2011
North West University

Tshoose, Clarence Itumeleng

The purpose of the article is to examine the right to social assistance for households living with HIV/AIDS in South Africa. In particular, the article focuses on the impact of this pandemic on households' access to social assistance benefits in the wake of the HIV/AIDS pandemic, which has wrought untold sorrow and suffering to the overwhelming majority of households in South Africa. The article analyses the consequences of HIV/AIDS in relation to households' support systems, care and dependency burdens, and the extent to which the household members either acknowledge the illness (enabling them to better engage with treatment options) or alternatively, deny its existence. The article commences by reviewing the literature concerning the effects and social impact of HIV/AIDS on the livelihoods of households and their families. The social reciprocity that underpins households' livelihoods is briefly recapitulated. The article concludes that, while recent policy developments are to be welcomed, the current South African legal system of social security does not provide adequate cover for both people living with HIV/AIDS and their families. More remains to be done in order to provide a more comprehensive social security system for the excluded and marginalised people who are living with HIV/AIDS and their families.
Traditional knowledge and patent protection: Conflicting views on international patent standards
31 March 2011
North West University

Andrzejewski, Adam

As diseases continue to spread around the globe, pharmaceutical and biotech companies continue to search for new and better drugs to treat them. Most of these companies have realised that useful compounds for these purposes may be found in the natural resources that indigenous and local communities use. And yet, even though the importance of these biological resources to global health and economic livelihood is well recognised, the legal ownership and control of this traditional knowledge is still very controversial. This article undertakes a comparative analysis of American and European, as well as international legal regulations on patent law and traditional knowledge. Key questions include: What is traditional knowledge? How have the national patent laws of these countries treated the protection of plant variety and plant genetic resources? What are the existing international standards for patents, and what implications do they have for protecting traditional knowledge? And finally, what protection systems are emerging for the future?
Ethics, justice and the sale of kidneys for transplantation purposes
04 April 2011
North West University

Slabbert, M

Living kidney donor transplantations are complex; add to that financial compensation to the donor and one enters an ethical maze. Debates on whether the buying and selling of kidneys should be allowed are mainly between utilitarians, deontologists and virtue ethicists as legal transplants are more common in the Western world. The pros and cons of each theory in relation to the sale of human organs are analysed, after which the foundational principles for all bio-ethical judgments; beneficence, non-maleficence, autonomy and justice are also scrutinised in seeking to justify the sale of human kidneys for transplantation purposes in a country with a human rights culture.
The sero-conversion of the people of the Nelson Mandela metropole, 1985 - 2021.
23 January 2012
North West University

Shell, Robert C H;Rama, P

The authors draw attention to the little researched pandemic of HIV/AIDS in the Western area of the Eastern Cape, South Africa. They use population projection programs and new historical case level data which has a broader base than the national ante natal clinic (anc) data. They demonstrate the utility of the component method for projecting urban population trends as opposed to commonly used mathematical (exponential or logistic) projections. While there is much more work involved in an urban component projection because of problems of recovering reliable in-migration data, the final product of the component projection are of such value to planners that it is suggested that all South African city planners could benefit from such projections. This study also attempts to establish that if the HIV pandemic is allowed to run unchecked, the total population of the Nelson Mandela Metropole will be just under two million people by the year 2021. Without Aids it would be between 2.5 and 4 million. The authors analyze the new data with a view to understand the probable historical vectors of the pandemic and to enable policy formulation, interventions and planning. Any attempt to forecast the course of an urban HIV pandemic is fraught with difficulties and uncertainties. These relate primarily to the number of assumptions which must be made in building forecasting models, often with historical data that is not reliable. The results of any model should therefore be treated with caution and must be used responsibly. That uncertainty, however, should not deter attempts at developing realistic forecasts for the future course of the HIV/AIDS pandemic at the urban level, since these local projections are essential in attracting and recruiting the attention of the stakeholder urban planners and managers who need to understand the possible impact of this disease on their communities, and to plan appropriately.
HIV/AIDS in South Africa: a case of failed responses because of stigmatization, discrimination and morality, 1983 - 1994.
06 March 2012
North West University

Grundlingh, Louis

Die artikel ondersoek die aard van stigmatisering, diskriminasie en moraliteit in die Suid-Afrikaanse samelewing nadat MIV/VIGS ook hier sy verskyning gemaak het. Aanvanklik het godsdienstige fundamentaliste homoseksueles daarvan beskuldig dat hulle deur die virus besmet is omdat hulle homoseksueel is. Hierdie sienings is aangevul deur die middelklas waardes van die tyd wat epidemies met sedeloosheid vereenselwig het. Die regering sou feitlik niks doen om voorkoming van MIV in die homoseksuele gemeenskap te bekamp nie. Deur die "ander" (in hierdie geval die MIV/VIGS-Iyer) te stigmatiseer en ook teen die persoon te diskrimineer, kon heelwat Suid-Afrikaners die lyers en die hele vraagstuk rondom MIV/VIGS ignoreer. 'n Nuwe kategorie van onderskeiding is so geskep: "ons" (die gesonde heteroseksuele gemeenskap) en "hulle" (die besmette homoseksuele gemeenskap). Stigmatisering en diskriminasie teenoor swartmense, wat alreeds lank in die Suid-Afrikaanse konteks bestaan het, het teen 1987 'n nuwe dimensie bygekry toe die eerste swart heteroseksuele persoon as MIV+ identifiseer is. Die persepsie het nou toegeneem dat alle swartes vir die epidemie verantwoordelik gehou behoort te word. Hierdie rassistiese siening het baie daartoe bygedra dat enige anti-MIV/VIGS program van die regering, hoe goed bedoel ook al, as gevolg van 'n gebrek aan legitimiteit in die swart gemeenskappe verwerp is. Gevolglik is niks effektief in die 1980s gedoen nie. Dit wil voorkom of die hoofargument wel onderskryf kan word: dat stigmatisering van en diskriminasie teenoor gemarginaliseerde groepe, rassisme en homofobie sowel as 'n konserwatiewe moraliteit wat 'n sterk invloed uitgeoefen het, daartoe gelei het dat 'n gulde geleentheid om MIV/VIGS te bekamp, verlore gegaan het.
'But only we Black men die': the 1929 - 1933 malaria epidemics in Natal and Zululand.
22 March 2012
North West University

Brain, J B

• Opsomming: In Natal en Zoeloeland het die buitengewoon strawwe malaria-epidemies duisende swart lewens gedurende die tydperk onder bespreking geëis. Droogte en wanvoeding het veral kinders verswak, terwyl die ekonomiese depressie werkloses na die reservate laat terugkeer het. Sowel hulle as die duisende 'vreemde' arbeiders op die suikerplase het geen weerstand gehad nie teen malaria wat uitheems aan die streek was. Uit wantroue jeens die regeringe en gesondheidsowerhede het baie Zoeloes ook geweier om die teenmiddel kinien in te neem. Al die faktore saam het meegebring dat die epidemies die hewigste nog in menseheugenis was.
"In what way are gay men actually harmful to society?" Exploring the evidence on the feasibility of amendments to the Sexual Offences Act 23 of 1957.
11 June 2012
North West University

Grundlingh, Louis

Prompted by a perception that a gay sub-culture developed in the major urban areas of South Africa, and that this formed a threat to state security and to the established mores of society, the Minister of Justice, PC Pelser, appointed a Parliamentary Select Committee in 1968. The essence of the task given to the Select Committee was to provide clarity to the Department of Justice about a definition of homosexual acts as well as the causes, manifestations and extent of these practices. In addition, the Committee had to ascertain whether South African society was ready to decriminalise sodomy and “unnatural” sexual practices. A major concern was whether gay men were a danger to minors. The Committee received numerous written submissions and held regular meetings to hear oral testimonies, which covered a wide spectrum of opinions and issues. Representatives of the South African Police and the Afrikaans churches vehemently opposed homosexuality and homosexual activities. Ministers from the English churches pleaded for tolerance but with very specific preconditions. The position of the lawyers, psychiatrists and psychologists was clear: that homosexuality was not a threat, could not be “cured” and should be accepted. The investigation resulted in widespread debate, revealing facets of the moral dynamics of white South African society in the 1960s. Inter alia, issues such as the right of the state to make laws on morality and intrude on the privacy of individuals, diverse interpretations of the Bible, the level of intolerance for the “other” and the apparent difficulties to enforce any amendments to the Act - as far as homosexuality was concerned - were raised. By emphasising these issues, the intention of this article is to give an indication as to what extent gay white men were tolerated. To realize this, a discussion of the context of a very strong conservative government that underpinned the activities of Select Committee was essential. The upshot was that the deep-rooted conservatism of the state prevailed, finding expression in harsher and specific measures in the Immorality Amendment Act of 1969. The strong arguments from some church representatives, as well as the medical and legal fraternities, were discarded. Clearly the time was not yet ripe for liberalising sexuality in South Africa. Research for this article relied on the extensive testimonies before the Select Commission as published in its final report. In addition, relevant submissions in the Gay and Lesbian Archive at the University of the Witwatersrand helped to form a comprehensive picture and made qualitative analysis possible.
Assessing the past and the present role of the National Nuclear Regulator as a public protector against potential health injuries: the West and Far West Rand as case study.
12 June 2012
North West University

Liefferink, Mariette

Recent national and international news media articles and television programmes, official public domain Government and peer reviewed academic reports drew the international and national public’s attention to the health risks and hazards and impacts pertaining to uraniferous waste from the gold mining industry within the Witwatersrand goldfields and the role of the National Nuclear Regulator (NNR) in this regard. The Dutch research organizations’ Wise and Somo’s recent report, entitled “Uranium from Africa – mitigation of uranium impacts on society and environment by industry and governments” found that that the lack of knowledge within institutions and lack of proper environmental management systems, both in industry and in the government, “render South Africa a poor example of environmental and human health protection….The government is failing.” It is especially the poor, the disempowered and the vulnerable members of mining communities that bear the highest risks and impacts. These communities have low adaptive capacity because of chronic and acute malnutrition and high HIV/Aids percentages. The World Health Organization (WHO) recently estimated that 34% of all childhood illness in the world (compared to 24% of all age illness) and 36% of deaths in children under age 14 are due to modifiable environmental factors. As with many illnesses, genes may create a loaded gun, but environment pulls the trigger. However, determining how impacts from gold mining waste within the West and Far West Rand as part of the Witwatersrand goldfields influence or determine human health is a challenge. This is due to the social, cultural and economic conditions (thus their broader well-being status) which influence the vulnerability of communities, and subsequently their resilience. The focus of the discussion will relate to this area and the NNR’s role – past and present – as public health protector in this area per se.
Human rights that influence the mentally ill patient in South African medical law: a discussion of sections 9; 27; 30 and 31 of the constitution
03 September 2012
North West University

Swanepoel, M

The personalised nature of mental illness obscures from general view the intolerable burden of private and public distress that people with serious mental illness carry. Invariably the mentally ill person encounters rejection and humiliation that are in some way tantamount to a "second illness." The combination either disrupts or puts beyond reach the usual personal and social life stages of marriage, family life, raising children, sexual relationships, the choice of treatment, affordable housing, transportation, education and gainful employment. As a result of their lack of financial and social support and their experience of rejection from society, persons with mental illness tend to neglect themselves and their diet, and frequently delay seeking treatment. Against this background, this contribution critically focuses on the human rights that influence the mentally ill patient in South African medical law. Specific attention is paid to the relevance and meaning of sections 9 (the equality clause), 27 (access to health care services), 30 and 31 (language, culture and religion) of the Constitution of the Republic of South Africa, 1996.
Justice delayed is justice denied: protecting miners against occupational injuries and diseases: comments on Manyaki v Anglogold Ashanti LTD 2011 32 ILJ 545 (CC)
03 September 2012
North West University

Tshoose, Clarence Itumeleng

In the Mankayai v Anglogold Ashant Ltd 2011 32 ILJ 545 (CC) the Constitutional Court was called upon to give meaning and content by interpreting the provision of section 35 of Compensation for Occupational Injuries and Diseases Act 130 of 1993 (COIDA) and section 100(2) of the Occupational Diseases in Mines and Works Act 78 of 1973. The Court had to determine if the employee common-law right of recourse against his employer in cases where he sustained occupational diseases is extinguished by virtue of section 35(1) of COIDA. The purpose of this case note is twofold: firstly, it analyses the decision of the Constitutional Court in the Mankayi case; secondly, the case note looks at the significance of the Mankayi case for the system of occupational health and safety in South Africa. In conclusion, the contribution explores the need for the introduction of a unified system which will address issues of occupational health and safety in a coordinated and unified manner.
Realising equality in access to HIV treatment for vulnerable and marginalised groups in Africa
03 September 2012
North West University

Durojaye, E

This article examines the relevance of the concept of equality in improving access to HIV treatment for vulnerable and marginalised groups in Africa. The article argues that though modest achievements have been made in expanding access to HIV treatment for those in need in Africa, this expansion has concentrated on the general population with little focus on the needs of vulnerable and marginalised groups in society, especially children and sex workers. It further argues that applying the notion of equality to HIV treatment is crucial to alleviating the impact of the epidemic on vulnerable and disadvantaged groups. In conclusion, it is argued that if the aim of realising universal access to treatment for all by 2015 is to be achieved, it is imperative to ensure equal access to HIV treatment for disadvantaged groups such as children and sex workers.
The implications of fedralism and decentralisation in socio-economic conditions in Ethiopia
03 September 2012
North West University

Zimmermann-Steinhart, P;Bekele, Y

This paper analyses impacts of the federal system and the decentralisation of functions to the district level on Ethiopia's socio-economic development. Firstly we will highlight the principles of the Ethiopian federal system as well as those of the 2001/2002 decentralisation process. Secondly we will show how the decentralisation has impacted on two of the decentralised sectors, health and education, by comparing pre-federal, pre- and post-decentralisation data. In both cases an overall increase in allocated budgets and an increase in the scale of the services offered since decentralisation started in 2001 has been found. Studies also show that the increase in services is not homogenous across regional states. Within the four larger regions, strongly disadvantaged woredas at the outset of the decentralisation process have profited most, which shows that the constitutional imperative of equal access to services is being implemented. Some of the regions where decentralisation was started later have still not caught up with the other regions, a phenomenon which is mostly due to capacity deficits. The article concludes that decentralisation in combination with consistent development policies has led to an overall improvement in service delivery, while some challenges regarding quality and equity still need to be addressed.
The interpretation of the amended RAF act 56 of 1996 and the regulations thereto by the courts with regard to "serious injury" claims
03 September 2012
North West University

Steynberg, L.;Ahmed, R.

The RAF Amendment Act 19 of 2005 came into effect on 1 August 2008 and sections 17(1) and 17(1A) introduced the concept of “serious injury”. This entails that a third-party claimant who wishes to claim compensation for non-patrimonial loss suffered after a motor-vehicle accident has to prove that his or her injury is “serious”. If the claimant’s injury is not considered “serious” no compensation will be awarded for the non-patrimonial loss suffered and, furthermore, the claimant will also not be entitled to claim any compensation from the wrongdoer in terms of common law (s 21 of the RAF Act). In a sequence of unreported cases the courts have provided guidelines on the procedure to be followed in serious-injury claims. Firstly, a claimant must submit himself or herself to an assessment by a medical practitioner registered under the Health Professions Act. Secondly, the medical practitioner must assess if the injuries sustained by the claimant fall within the list of “non-serious injuries”, and if so, compensation for non-patrimonial loss will not be awarded. If the injury is not on the list of non-serious injuries, the medical practitioner may assess the injuries and if they result in 30 per cent or more of whole-person impairment (“WPI”) compensation for non-patrimonial loss may be awarded. If the evaluation is that the 30 per cent of WPI cannot be reached, non-patrimonial loss may still be claimed if the injuries fall within the “narrative test”, namely (a) resulting in a serious long-term impairment or loss of a body function; (b) constituting permanent serious disfigurement; (c) resulting in severe long-term mental or severe long-term behavioural disturbance or disorder; or (d) resulting in the loss of a foetus. A plaintiff may use either of the two tests to establish serious injury and in such a manner qualify for compensation for non-patrimonial loss. A medical practitioner must complete and submit a serious-injury assessment report on the RAF 4. If the RAF is not satisfied that the injury has been correctly assessed they must (a) reject the serious-injury assessment report within 60 days and furnish reasons for the rejection; or (b) direct that the third party submit himself or herself, at the cost of the Fund, to a further assessment. Thereafter the RAF must either accept the further assessment or dispute the further assessment within 90 days. An Appeal Tribunal, consisting of three independent medical practitioners, has been created to hear these disputes.
The Road Accident Fund and serious injuries: the narrative test
04 September 2012
North West University

Slabbert, M;Edeling, H J

The Road Accident Fund Amendment Act 19 of 2005 came into effect on 1 August 2008. This Act limits the Road Accident Fund’s liability for compensation in respect of claims for non-pecuniary loss to instances where a “serious injury” has been sustained. A medical practitioner has to determine whether or not the claimant has suffered a serious injury by undertaking an assessment prescribed in the Regulations to the Act. The practitioner has to complete a RAF 4 report. In doing so the practitioner must assess the injury in terms of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (6th ed). If the injury is considered to have resulted in less than 30 per cent of the whole person impairment the medical practitioner should apply the narrative test. The article focuses on the narrative test but also discusses reasons why the regulations do not fulfil the requirements of the Act; reasons why the Guides is not adequate to the task; the impact of the circumstances of an injured person on disability; problems with the existing wording of the narrative test; shortcomings on the RAf 4 form; the administrative process as well as the appeal tribunals.
Challenges confronting health care workers in government's ARV rollout: rights and responsibilities
05 September 2012
North West University

Vawda, Y A;Variawa, F

South Africa is renowned for having a progressive Constitution with strong protection of human rights, including protection for persons using the public health system. While significant recent discourse and jurisprudence have focused on the rights of patients, the situation and rights of providers of health care services have not been adequately ventilated. This paper attempts to foreground the position of the human resources personnel located at the centre of the roll-out of the government's ambitious programme of anti-retroviral (ARV) therapy. The HIV/AIDS epidemic represents a major public health crisis in our country and, inasmuch as various critical policies and programmes have been devised in response, the key to a successful outcome lies in the hands of the health care professionals tasked with implementing such strategies. Often pilloried by the public, our health care workers (HCWs) face an almost Herculean task of turning the tide on the epidemic. Unless the rights of HCWs are recognised and their needs adequately addressed, the best laid plans of government will be at risk. This contribution attempts to identify and analyse the critical challenges confronting HCWs at the coalface of the HIV/AIDS treatment programme, in particular the extent to which their own rights are under threat, and offers recommendations to remedy the situation in order to ensure the successful realisation of the ARV rollout.
Comparative analysis of access to patented HIV/AIDS pharmaceutical medicines through the Canadian and EU trips flexibilities measures: are they efficacious or overly burdensome and ineffective measures?
05 September 2012
North West University

Sibanda, O S

This paper evaluates the Canadian and the European Union's (EU) implementation of the World Trade Organisation (WTO) General Council Decision of 2003, which resolved that developed nations could export patented pharmaceutical drugs to member states in order to address public health challenges such as Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), tuberculosis, malaria and other epidemics, such states including Sub-Saharan Africa (SSA). The author makes a primarily textual appraisal of how and to what extent the Canada Access to Medicine Regime (CAMR) and European Union (EU) Regulations benefit, for instance, SSA countries in the WTO in their quest to make essential medicine more accessible. The author argues that although there are identifiable complexities inherent in the Canadian and the EU's access to pharmaceutical product regimes, there are far more important incentives and benefits that can be reaped in taking advantage of the respective systems. The author recommends that countries facing public health crises/emergencies, such as SSA countries, and nongovernmental organisations (NGOs) take advantage of the regulatory flexibilities of Canada and the EU in their efforts to provide their communities with essential HIV/AIDS treatment, and treatment for other diseases such as malaria. The author dismisses the arguments against TRIPS (Trade-Related Aspects of Intellectual Property) flexibilities-inspired legislation and similar measures as mostly mere rhetoric and hair-splitting, because they sometimes unwarrantedly dismiss a workable solution to public-health problems.
Stages of change:a qualitative study on the implementation of a perinatal audit programme in South Africa
12 September 2012
North West University

Voce, Anna;Bergh, Anne-Marie;22573143 - Cilliers, Carolé;Pattinson, Robert C.;Belizán, Maria

Background: Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme. Methods: Clinicians’ experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices). Results: Four essential factors emerged as important for the successful implementation and sustainability of an audit system throughout the different stages of change: 1) drivers (agents of change) and team work, 2) clinical outreach visits and supervisory activities, 3) institutional perinatal review and feedback meetings, and 4) communication and networking between health system levels, health care facilities and different role-players. During the pre-implementation phase high perinatal mortality rates highlighted the problem and indicated the need to implement an audit programme (stage 1). Commitment to implementing the programme was achieved by obtaining buy-in from management, administration and health care practitioners (stage 2). Preparations in the implementation phase included the procurement and installation of software and training in its use (stage 3). Implementation began with the collection of data, followed by feedback at perinatal review meetings (stage 4). The institutionalisation phase was reached when the results of the audit were integrated into routine practice (stage 5) and when data collection had been sustained for a longer period (stage 6). Conclusion: Insights into the factors necessary for the successful implementation and maintenance of an audit programme and the process of change involved may also be transferable to similar low- and middle-income public health settings where the reduction of the neonatal mortality rate is a key objective in reaching Millennium Development Goal 4. A tool for reflecting on the implementation and maintenance of an audit programme is also proposed.
The design and development of a stented tissue mitral and aortic heart valve replacement for human implantation
18 September 2012
North West University

Legg, Murray;Mathews, Edward;Pelzer, Ruaan

A study was conducted into the development of a mitral and aortic heart valve replacement that caters for patients having suffered valve damage due to stenosis or rheumatic fever. The appeal of the valve is that it is constituted from a solid frame housing pericardial tissue leaflets, and allows the patient freedom from post-operative blood-thinning medication. The valve is designed to appeal to patients in developing areas of the world, as it features a clip-in mechanism to secure the valve assembly into the sewing ring, which is stitched in independently of the frame and leaflets. Re-operative valve replacement would then be made possible when the pericardial leaflets began to calcify. Novel aspects of the design added value to the science of heart valve replacements, through the use of sintered chrome cobalt in the valve components, the insights gained into mechanical testing of pericardium, and the patient benefits offered by the complete design. Further work is planned to fatigue test the assembly, undergo animal trials and make the valve available for commercial use.
Prelimanary application of a new Bolus Insulin model for Type 1 Diabetes
02 October 2012
North West University

Liebenberg, Leon;Mathews, Edward Henry;Pelzer, Ruaan

Previous work derived a theoretically rigorous bolus insulin model. It was shown that the new model predicts insulin response of subjects without diabetes substantially better than the carbohydrate counting method (CHOcm). As most individuals with type 1 diabetes use the CHOcm, this article investigates if the new model can be applied to them.
DDT and malaria prevention: addressing the paradox
03 October 2012
North West University

Bouwman, Hindrik;Van den Berg, Henk;Kylin, Henrik

Background The debate regarding dichlorodiphenyltrichloroethane (DDT) in malaria prevention and human health is polarized and can be classified into three positions: anti-DDT, centrist-DDT, pro-DDT. Objective We attempted to arrive at a synthesis by matching a series of questions on the use of DDT for indoor residual spraying (IRS) with literature and insights, and to identify options and opportunities. Discussion Overall, community health is significantly improved through all available malaria control measures, which include IRS with DDT. Is DDT “good”? Yes, because it has saved many lives. Is DDT safe as used in IRS? Recent publications have increasingly raised concerns about the health implications of DDT. Therefore, an unqualified statement that DDT used in IRS is safe is untenable. Are inhabitants and applicators exposed? Yes, and to high levels. Should DDT be used? The fact that DDT is “good” because it saves lives, and “not safe” because it has health and environmental consequences, raises ethical issues. The evidence of adverse human health effects due to DDT is mounting. However, under certain circumstances, malaria control using DDT cannot yet be halted. Therefore, the continued use of DDT poses a paradox recognized by a centrist-DDT position. At the very least, it is now time to invoke precaution. Precautionary actions could include use and exposure reduction. Conclusions There are situations where DDT will provide the best achievable health benefit, but maintaining that DDT is safe ignores the cumulative indications of many studies. In such situations, addressing the paradox from a centrist-DDT position and invoking precaution will help design choices for healthier lives.
Cohabitation and premarital sex amongst Christian youth in South Africa today: a missional reflection
11 October 2012
North West University

Mashau, Thinandavha Derrick

This article explored the rising trends of cohabitation and premarital sex amongst Christian and non-Christian youth in South Africa that is becoming more socially acceptable. Moving from a premise of engaging in these practices, which is not biblically justified, to what a missional Christian church can do, this article sought to bring the numbers of those who cohabit and engage in premarital sex down. The thesis of this article was that a missional church should view cohabitation and premarital sex as frontiers that need to be crossed to save the lives of our youth by minimising premarital pregnancies and the spread of sexually transmitted diseases (the Human immunodeficiency virus [HIV] and Acquired immune deficiency syndrome [AIDS] pandemic included). This will also go a long way in saving the sinking image of marriage. It is the presupposition of this article that cohabitation and premarital sex are great threats to the institution of marriage.
Institutionalisation of African traditional medicine in South Africa: healing powers of the law?
25 October 2012
North West University

Rautenbach, Christa

In line with global trends in law and domestic realities the South African government has been one of the few “new” nations to make significant progress in including traditional health practice in the mainstream healthcare system by using the law as a tool for formal integration. The integration process gained momentum with the enactment of the Traditional Health Practitioners Act 22 of 2007, which provides a legal framework for traditional health practitioners (also known as traditional healers). The Act gives formal recognition to traditional practitioners and establishes an interim Traditional Health Practitioners’ Council of South Africa with wide powers to ensure that health care services provided by traditional practitioners are efficient, safe and of a high quality. Logically the next step for the South African government, and also the main focus of this contribution, is the creation of a legal framework for traditional medicine. Currently traditional medicine is not regulated although it is used by traditional practitioners on a daily basis. This contribution deals with two themes, namely law and medicine, and more specifically the interaction between law and medicine in the circumstances where the law is used to provide for the formal regulation of traditional medicine. Three matters are dealt with in this context – and it is by no means implied that these are the only issues involved. Firstly, the meaning of the concept “African traditional medicine” in a South African context is discussed. Secondly, the reasons as to why the South African government is considering institutionalising African traditional medicine are dealt with and, lastly, a few comments regarding the government’s plan of action for the effective integration of traditional medicine into the South African health care system receive attention. The contribution concludes with some thoughts on what the author perceives to be the symbolic link between law and medicine to be, a link which she calls the “healing powers of the law and medicine”.
Childhood general mental ability and midlife psychosocial work characteristics as related to mental distress, neck/shoulder pain and self-rated health in working women and men
29 October 2012
North West University

Lindfors, Petra;Sverke, Magnus;Wulff, Cornelia

Psychosocial work characteristics including high demands, lack of control and poor social support have consistently been linked to poor health as has poor general mental ability (GMA). However, less is known about the relationships between stable individual factors such as GMA, psychosocial work characteristics and health. Objective: The present study investigated how childhood mental ability and psychosocial work characteristics relate to health in terms of mental distress, neck/shoulder pain (NSP) and self-rated health (SRH). Methods: Data on childhood GMA, occupational level, self-reports of demands, control and social support and health (mental distress, NSP and SRH) in midlife came from working women (n=271) and men (n=291) included in a Swedish school cohort. Hierarchical regression analyses, controlling for occupational level, were used to examine associations between childhood GMA, self-reports of high demands, low control and poor social support and the three health indicators. Taking into consideration the gendered labor market and variations in health patterns between women and men, gender specific analyses were performed. Results: There were no significant associations between childhood GMA and health indicators. Further, there were no significant interactions between GMA and psychosocial work factors. As regards the strength of the associations between GMA, psychosocial work factors and health, no consistent differences emerged between women and men. Conclusions: In a cohort of healthy and working middle-aged women and men, self-reports of current psychosocial work characteristics seem to be more strongly linked to health, than are stable childhood factors such as GMA.
A profile of South African public relations practitioners in top performing organisations
31 October 2012
North West University

Le Roux, Tanya;Naudé, Anna Maria Elizabeth (Annelie)

The public relations practitioner is expected to have the skills and knowledge to be able to operationalise the description and definition of public relations within their specific environment. Although various studies describing South African public relations practitioners had been performed, these studies are limited in terms of size and scope and do not offer a clear profile of the practitioner and whether they are equipped to perform the necessary tasks. This article is based on a study that obtained data from practitioners in top performing organisations. It profiles South African practitioners and confirms that they need support in order to play a strategic role.
Revival of unsuccessful chemotherapeutics for highly glycolytic cancers?
08 November 2012
North West University

Liebenberg, Leon;Mathews, Edward Henry

Around 90% of cancer deaths can be ascribed to metastases , usually highly glycolytic. Rodent models are used when developing drugs to attack these cancers
High-glycolytic cancers and their interplay with the body's glucose demand and supply cycle
08 November 2012
North West University

Mathews, Edward Henry;Liebenberg, Leon;Pelzer, Ruaan

Many difficult-to-treat solid cancer tumours and metastases have high-glucose uptake, usually under hypoxic conditions. Hypoxic tumours suppress the immune system and are insensitive to traditional chemoradiotherapies. The only therapy usually available is surgical resection. However, with widespread metastases, surgery often becomes unviable. Surgery in itself can also result in metastasis. The need for investigating adjuvant treatments is obvious. Here we investigate whether the high-glucose uptake of hypoxic tumours could lead to such a treatment. Before any treatment can be hypothesised, it is crucial to understand how this glycolytic cancer phenotype fits in with the normal body’s blood glucose cycle. The brain creates the healthy body’s largest demand for blood glucose (BG) and ensures a very high level of control on in vivo supply. It is hypothesised that, through somatic evolution, high-glycolytic cancer cells opportunistically tap into this very stable energy environment. It is shown that therapies which target the glycolytic cancers’ high BG needs cannot be developed without addressing the brain’s energy needs. Based on this knowledge, and to initiate thinking on potential BG therapies, a first attempt is made at hypotheses for potential control of the in vivo brain demand as well as the available in vivo BG. The aim is to adversely affect primary as well as metastatic tumours without damaging brain and innocent bystander cells.
Sampling variation in the quantification of fumonisins in maize samples
22 January 2013
North West University

Janse van Rensburg, B.;Flett, B.C.;McLarren, N.W.;McDonald, Alexander Henrique

Fumonisins produced by F. verticillioides and F. proliferatum cause mycotoxicoses in horses, swine and rats and have been associated with oesophageal cancer in humans. Accurate measurement of mycotoxins is essential for determining the safety of grain and their products for consumption. Four sources of variation were studied, namely sub-sample size, variation within a single maize sub-sample, number of replicates and toxin detection techniques used by independent laboratories. Variation in detected fumonisin levels within a single maize sample was high using the 25 g sub-samples proposed in the Neogen Veratox protocols. A 250 g subsample significantly reduced variation in fumonisin levels of samples. An incremental increase in sample size also improved the number of positive samples recorded. Increasing the number of replicates using the recommended sub-sample size (25 g) did notreduce variation except when the sample had high fumonisin levels. Improved accuracy was recorded when a 250 g sub-sample was used in conjunction with increased replicates. Data from laboratory analyses indicated that ELISA reactions (Agricultural Research Council - Grain Crops Institute) correlated significantly with HPLC results of the Medical Research Council (MRC), but neither of these correlated with results from an independent laboratory. Concentrations determined using ELISA were consistently higher than those from the HPLC (MRC) technique. Quantification technique, sample size, replicate number and laboratory where analyses are conducted, appear to be important sources of variation for quantification of fumonisins.
Redesigning the South African unemployment insurance fund: selected key policy and legal perspectives
25 January 2013
North West University

Dupper, Ockert;Govindjee, Avinash;Olivier, Marius Paul

This contribution examines selected issues from a policy and legal perspective. Against the background of the broader social security reform agenda in South Africa and the vision of a comprehensive social security system, the contribution covers five key areas, namely alignment with international standards; the need to develop synergies with the rest of the social security system and for institutional reform and alignment; addressing certain material deficiencies and inconsistencies in the UIF legislation (with reference to removing the restriction on certain contributors to benefit and redefining the range of dependants); re-aligning the current UIF benefit regime to focus on loss of employment; and improving the UIF benefit regime through the introduction of standardised measures and other reforms (with reference to the indexation of benefits, utilising a minimum wage arrangement as a basis for benefit enhancement, adjusting the contribution rate and developing a streamlined adjudication framework). It is argued that complying with relevant international standards will move South Africa closer to be in a position to ratify these instruments, in particular ILO Convention 102 of 1952 on minimum standards in social security. Ample opportunity exists to introduce streamlined approaches in among others the collection of contributions and shared benefit payment facilities and arrangements, and the harmonisation of benefits. However, particular considerations and substantive constraints define and circumscribe the extent and content of the alignment of the UIF that is currently considered. These relate in particular to the compensation function of the UIF; its role as a labour market instrument; and the need to recognise unemployment insurance as a separate risk category with a ringfenced contribution and benefit regime framework. It should also be considered to separate unemployment insurance benefits in the strict sense of the word (ie benefits accruing to a beneficiary as a result of loss of employment) from unemployment-related benefits such as sickness, maternity and adoption benefits.
A practical quantification of blood glucose production due to high-level chronic stress
28 January 2013
North West University

Liebenberg, Leon;Mathews, Edward Henry

Blood glucose (BG) is the primary metabolic fuel for, among others, cancer cell progression, cardiovascular disease and inflammation. Stress is an important contributor to the amount of BG produced especially by the liver. In this paper, we attempt to quantify the BG production due to chronic (in the order of weeks) high-level psychological stress in a manner that a lay person will understand. Three independent approaches were used. The first approach was based on a literature survey of stress hormone data from healthy individuals and its subsequent mathematical manipulation. The next approach was a deductive process where BG levels could be deduced from published stress data of large cardiovascular clinical trials. The third approach used empirical BG data and a BG simulation model. The three different methods produced an average BG increase of 2.2-fold above basal for high levels of stress over a period of more than a day. The standard deviation normalized to the average value was 4.5%.
HIV/AIDS, to disclose or not to disclose: that is the question
20 May 2013
North West University

Le Roux-Kemp, Andra

The systemic consequences of the HIV/AIDS pandemic in South Africa are evident not only in demographic, economic and social trends, but also on a micro- and personal level, where they are devastating. Those infected with HIV are often the target of intense discrimination and discriminatory behaviour including rejection, isolation and violence. It is especially because of these macro- and micro effects associated with HIV/AIDS that the highest regard should be placed on the fundamental rights of infected individuals - specifically the rights to privacy and bodily and psychological integrity - when determining if the disclosure of such persons’ status is necessary and justified. The primary aim of this article is to critically consider and describe the different contexts in which the disclosure of a person’s HIV/AIDS status will be relevant. The position of various role players in the economy, in the criminal justice system and in the healthcare arena will be considered with reference to relevant legislation, case law, guidelines and ethical codes. It will be clear from the discussion that no simple or single right answer exists. A patient-oriented approach sensitive to public health goals and objectives and based on human rights principles is advocated in this article.
A selection of constitutional perspectives on human kidney sales
23 May 2013
North West University

Venter, Bonnie

There are thousands of desperate people globally who need a kidney for transplantation. The number of people who require a kidney transplant continues to escalate faster than the number of kidneys available for a transplant. The specific focus of this article is to determine whether the payment of kidney donors could be regarded as constitutionally acceptable or not. To establish the constitutional acceptability of the reimbursement of kidney donors the following rights are analysed: the right to life, the right to human dignity, the right to self-determination, the right to privacy, and the right of access to healthcare services. Case law regarding the above is also included. After careful consideration of all of the above it is concluded that it should be regarded as constitutionally acceptable to remunerate a kidney donor for his kidney.
The silent victims of humanitarian crises and livelihood (in)security: a case study among migrants in two Chadian towns
16 August 2013
North West University

Djindil, Syntyche Nakar;De Bruijn, Mirjam

Once a humanitarian disaster receives coverage in the global media, the international community usually mobilises to reduce the most severe consequences. However people in Chad are experiencing endemic crises that are detached from speci!c triggers, and they are not receiving any international assistance to help relieve the hardships they face. "is study involves 111 migrant households from central Chad that, as a result of war and drought, have lost everything and now have to live in squatter areas of N’Djamena and Mongo, facing uncertainty and threats while negotiating their livelihoods. Qualitative and quantitative methods have been combined in this study to reveal the intriguing story of their daily lives in the face of complex and endemic crises. Anthropometric and health data were generated to determine the nutritional status of mothers and their children under !ve. Life histories, in-depth interviews and participatory observation allowed the researchers to capture the negotiation strategies they use to access food and shelter, their experiences of food insecurity and sanitary vulnerability, and the consequences these have on daily life. Results indicate that 62% of households were female headed, there were high rates of acute (40-50%) and chronic (35-40%) malnutrition and 46% of the mothers were underweight and anaemic. Infant mortality rates were also high at 30%-42% and 97% of the children had had incomplete or no vaccinations. No households had access to clean water, sanitation or public-health services. Endemic corruption and abuse by the authorities were identi!ed as major sources of day-to-day insecurity. Theese migrants were not expecting any improvement in their livelihoods in the foreseeable future and saw these miserable conditions as normal.
Pastorale begeleiding aan die persoon met dissosiatiewe identiteitsversteuring
19 September 2013
North West University

Du Plessis, A.L.

A person with Dissociative Identity Disorder (DID) is someone who was exposed to intense trauma impacting that person’s life negatively at various levels. Although dissociative identity disorder is described as a mental disorder in the DSM-IV, there are still unresolved issues regarding the phenomenon. Assistance should take place with care and sensitivity in order to guide the person with dissociative identity disorder taking into consideration integral dimensions of personal humanity. It is submitted that guidance in this respect can therefore not be unilaterally psychological or pastoral by nature. Effective assistance to the person implies an approach where different disciplines are part of a multidisciplinary support team. The question this article explores is how pastoral counselling may contribute to this approach in guidance of the person with dissociative identity disorder. A case study is discussed in which the conclusion is made that pastoral care has an effective role in the healing process of the person with dissociative identity disorder.
A human rights-based approach to poverty reduction: the role of the right of access to medicine as an element of the right of access to health care
16 October 2013
North West University

Strauss, Zannelize;Horsten, Debbie

The prevention and treatment of infectious diseases remain among the greatest challenges faced by today's developing countries. The World Health Organisation estimates that about one-third of the world's population lacks access to essential medicine, a fact which, according to the United Nations, directly contradicts the fundamental principle of health as a human right. According to the World Summit for Social Development, poor health and illness are factors that contribute to poverty, while the adverse effects of illness ensure that the poor become poorer. A lack of access to health care, amongst other rights, (including access to medicines as an element thereof) aggravates poverty. The most important provision in international law relating to the right to health is article 12 of the United Nations International Covenant on Economic, Social and Cultural Rights. Article 12(1) of this Covenant provides a broad formulation of the right to health in international law, while article 12(2) prescribes a non-exhaustive list of steps to be taken in pursuit of the highest attainable standard of health. Article 12(2), in particular, illustrates the role that adequate access to medication plays in the right of access to health care. The United Nations Committee on Economic, Social and Cultural Rights has explicitly included the provision of essential drugs as a component of the right to health care, thereby emphasising the causal link between the lack of access to essential medicines and the non-fulfilment of the right of access to health care. As with all socio-economic rights, the resource implications of the realisation of the right to health has the result that states cannot be expected to immediately comply with its obligations in respect thereof. Instead, article 2(1) of the International Covenant on Economic, Social and Cultural Rights and the General Comments of the Committee on Economic, Social and Cultural Rights place obligations on states to take deliberate, concrete and targeted steps towards expeditious and effective full realisation of the right to health, including access to medication. The measures taken to do so must, according to General Comment 3, embrace the concept of the minimum core obligation (the minimum core in relation to medicines being access to essential medicines, at the very least). In this article it is argued that adequate access to essential medicines, as an element of the right of access to health care, could contribute to the reduction of poverty. This is done by firstly discussing the human rights-based approach to poverty reduction, whereafter attention is turned to access to medicines as an element of the right to health, with specific focus on obligations in terms of the International Covenant on Economic, Social and Cultural Rights. Finally, the role of access to medicines in reducing poverty is considered. The article concludes that poverty constitutes an infringement on human rights and will not be eradicated without the fulfilment of human rights, including the right to health. The adequate fulfilment of peoples' rights of adequate access to essential medicines will enable them to achieve a higher level of well-being, thereby reducing the level of poverty which they experience. Both the right of access to health care and to essential medicines – a crucial component thereof – thus have a significant role to play in a state's poverty reduction strategies.
Disaster event: Window of opportunity to implement global disaster policies?
26 November 2013
North West University

Manyena, Siambabala B

Disasters have been predominantly construed as destructive events causing loss of lives, livelihoods and hard-won development. Much less attention has been paid to the constructive nature of disasters as creating potential windows of opportunities to address the overlooked and neglected aspects of disaster risk reduction. Using material from Zimbabwe, this article examines whether the humanitarian crisis, as manifested in the cholera disaster of 2008–2009, created a window of opportunity to accelerate the implementation of the Hyogo Framework for Action. The findings suggest that the humanitarian crisis did not necessarily create a window of opportunity to accelerate the implementation of the framework, owing to (1) inadequate authority and power of the agency responsible for disaster risk reduction, (2) an inadequate legal and institutional framework that outlines clear coordination, accountability mechanisms, resource mobilisation, community participation, and integration of development with regard to disaster risk reduction and (3) a lack of an integrated evidence-based approach to advocate disaster risk reduction in Zimbabwe.
High levels of DDT in breast milk: intake, risk, lactation duration, and involvement of gender
21 January 2014
North West University

Bornman, Riana;Bouwman, Hindrik;Kylin, H.;Sereda, Barbara

We investigated presence and levels of DDT in 163 breast milk samples from four South African villages where, in three of them, malaria is controlled with DDT-sprayed indoors. Mean ΣDDT levels in breast milk were 18, 11, and 9.5 mg/kg mf (milk fat) from the three DDT-sprayed villages, respectively, including the highest ΣDDT level ever reported for breast milk from South Africa (140 mg/kg mf). Understanding the causes for these differences would be informative for exposure reduction intervention. The Provisional Tolerable Daily Intake (PTDI) for DDT by infants, and the Maximum Residue Limit (MRL) were significantly exceeded. DDT had no effect on duration of lactation. There were indications (not significant) from DDT-sprayed villages that first-born female infants drink milk with more ΣDDT than first-born male infants, and vice versa for multipara male and female infants, suggesting gender involvement on levels of DDT in breast milk – requiring further investigation.
Estimation of human body concentrations of DDT from indoor residual spraying for malaria control
21 January 2014
North West University

Bornman, Riana;Bouwman, Hindrik;Fritsche, Lukas;Gyalpo, Tenzing;Scheringer, Martin

Inhabitants of dwellings treated with DDT for indoor residual spraying show high DDT levels in blood and breast milk. This is of concern since mothers transfer lipid-soluble contaminants such as DDT via breastfeeding to their children. Focusing on DDT use in South Africa, we employ a pharmacokinetic model to estimate DDT levels in human lipid tissue over the lifetime of an individual to determine the amount of DDT transferred to children during breastfeeding, and to identify the dominant DDT uptake routes. In particular, the effects of breastfeeding duration, parity, and mother's age on DDT concentrations of mother and infant are investigated. Model results show that primiparous mothers have greater DDT concentrations than multiparous mothers, which causes higher DDT exposure of first-born children. DDT in the body mainly originates from diet. Generally, our modeled DDT levels reproduce levels found in South African biomonitoring data within a factor of 3.
Using a locum tenens in a private practice
29 January 2014
North West University

Slabbert, Magda;Pienaar, B H (Hendrik)

Many medical practitioners in private practice use a locum tenens when they themselves are not available to practice. The locums are often appointed without consideration of the legal consequences or requirements. Legislation distinguishes between an employee and an independent contractor. If the locum is appointed as an employee the doctrine of vicarious liability comes into play which is not the case with an independent contractor. Contracts currently available to appoint a locum give the contracting parties a choice between being appointed as an employee or an independent contractor; this should be changed in that all locums should be appointed as independent contractors especially if the working of the Consumer Protection Act is also taken into consideration. Furthermore, according to the rules of the Health Professions Council of South Africa (HPCSA) the onus to ensure that the locum tenens is registered and fit to practice, rests with the principal.
Dealing with bioethical dilemmas: a survey and analysis of responses from ministers in the Reformed Churches in South Africa
05 February 2014
North West University

De Lange, Magdalena Catharina

Recent technological advancements in Bioethics have been rapid and incremental, leaving little time for Christian ethicists to reflect or develop a coherent methodological approach. To assess the situation in the Reformed Churches in South Africa (RCSA), a bioethical questionnaire was developed and administered during the synod in 2009. Three practical questions served as point of departure, viz. which bioethical issues confronted ministers in their work environment, which value judgement trends are evident when counselling members of their congregations and what theoretical frameworks or resources do they call upon when reflecting on these difficult situations? The survey consisted of 19 questions with several subquestions that sought demographic information to determine the population and information about bioethical issues confronting them, methodological strategies they apply and how they think they can contribute to the resolution of any such bioethical dilemmas. The results were tabulated and it was concluded that recent advancements in biotechnology cannot be ignored or dealt with in a piecemeal fashion any longer, either by the RCSA or its ministers. The need for clarity and analysis of the principles underlying those theories that guide or should guide their decision-making and pastoral care in dealing with bioethical dilemmas was emphasised. The findings highlighted the need for appropriate courses in Bioethics to be taught during initial theological training, as well as the need to keep the debate alive by offering workshops, seminars and short courses for practicing ministers to enhance awareness and allay fears and uncertainties in this very dynamic and morally challenging field of human and scientific endeavour.
From periphery to the centre: towards repositioning churches for a meaningful contribution to public health care
05 February 2014
North West University

Magezi, Vhumani

The role of communities in health care has gained prominence in the last few years. Churches as community structures have been identified as instrumental in health-care delivery. Whilst it is widely acknowledged that churches provide important health services, particularly in countries where there are poorly-developed health sectors, the role of churches in health care is poorly understood and often overlooked. This article discusses some causes of this lacuna and makes suggestions for repositioning churches for a meaningful contribution to health care. Firstly, the article provides a context by reviewing literature on the church and health care. Secondly, it clarifies the nature of interventions and the competencies of churches. Thirdly, it discusses the operational meaning of church and churches for assessing health-care contributions. Fourthly, it explores the health-care models that are discerned in church and health-care literature. Fifthly, it discusses the contribution of churches within a multidisciplinary health team. Sixthly, it proposes an appropriate motivation that should drive churches to be involved in health care and the ecclesiological design that underpins such health care interventions.
Understanding gender, sexuality and HIV risk in HEIs: narratives of international post-graduate students
26 February 2014
North West University

Khau, Mathabo

Thirty years into the HIV&AIDS pandemic, the world is still striving to reduce new HIV infections and halve AIDS related deaths by 2015. However, sub-Saharan Africa still faces the burden of HIV infections as governments and private institutions try out different prevention strategies (UNAIDS 2011). Several scholars have argued that multiple concurrent sexual partnerships (MCSP) pose the greatest risk for new HIV infections. Furthermore, research has also linked MCSPs to mobility and migration. This paper draws from the project ‘Sexual identities and HIV&AIDS: an exploration of international university students’ experiences” which employed memory work, photo-voice, drawings and focus group discussions with ten (5male and 5female) Post Graduate international students at a South African university. Focussing on the data produced through memory work, I present university students’ lived-experience narratives of mobility and migration in relation to how they perceive MCSPs and HIV risk. The findings show how students construct their gendered and sexual identities in a foreign context and how these constructions intersect with their choices of sexual relationships and HIV risk. I argue from the findings that Higher Education Institutions should be treated as high risk ‘spaces of vulnerability’ and hence health support services and HIV intervention programming policies should be geared towards addressing such vulnerabilities in order to create sustainable teaching and learning environments that allow for all students to explore their full capabilities.
The regulations relating to foodstuffs for infants and young children (R 991) : a formula for the promotion of breastfeeding or censorship of commercial speech?
14 April 2014
North West University

Mills, Lize

The regulation of commercial speech in the interests of public health is an issue which recently has become the topic of numerous debates. Two examples of such governmental regulation are the subjects of discussion in this article, namely the prohibition on the advertising and promotion of tobacco products, as well as the proposed prohibition on the advertising and promotion of infant formulae and other foods and products marketed as being suitable for infants or young children. The article seek to evaluate the recently proposed regulations published in terms of the Foodstuffs, Cosmetics and Disinfectants Act in the light of the reasoning by the Supreme Court of Appeal in the British American Tobacco South Africa (Pty) Limited v Minister of Health 463/2011) [2012] ZASCA 107 (20 June 2012) decision, and in particular in terms of the section 36 test of reasonableness and proportionality found in the Constitution of the Republic of South Africa, 1996. It argues that, although the South African Department of Health must be applauded for its attempt at improving public health in the country, some of the provisions of the proposed regulations are not constitutionally sound. It will be contended that, despite the fact that the promotion of breastfeeding is a laudable goal, the introduction only of measures which restrict the right to advertise these types of products will not necessarily achieve this objective.
Restoring the generations? – A preliminary literature review exploring the educational potential of the “Zeugen der Shoah” DVDs.
19 May 2014
North West University

Morgan, Katalin E

This article is a preliminary literature review undertaken for a proposed research project, surveying the field of research concerning the use of digitised videotestimonies with Shoah survivors in German history classrooms. It is set against the argument that up to now, the perpetration of Nazi atrocities has largely been treated with silence at the family level, and that this has negative psychosocial consequences. The literature review investigates to what extent educational DVDs with Shoah survivors could present an opportunity to break this silence and thus to restore generational relationships at the social level. These educational media allow learners to not only receive first-hand audio-visual accounts of what the Shoah witnesses experienced and thus to be emotionally and empathetically engaged with history learning. Learners are also made aware of the constructed nature of historical knowledge. As a result, they may begin to question how they know what they know, and what validity and consequences this knowing has. Existing pilot studies based on social-psychological analyses of learners’ responses to the topic of Nazism, as well as a study about learners’ interaction with the DVD series in Germany has shown that learners are interested in this topic, including the question of responsibility, but that they defy external pressure to feel guilty. They tend to develop sophisticated analytical competencies when their empathy is involved. The article could help teachers in other contexts, where sensitive topics need to be taught, to gain fresh perspectives on what to consider when teaching “difficult” content.
Association of waist circumference with perception of own health in urban African males and females: the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study
05 August 2014
North West University

Botha, J.;Malan, L.;Potgieter, J.C.;Steyn, H.S.;De Ridder, J.H.

Background: Current waist circumference (WC) cut-points of the Joint Statement Consensus (JSC) (male ≥ 94 cm, female ≥ 80 cm) were compared with a recently proposed WC cut-point (RPWC) (male ≥ 90 cm, female ≥ 98 cm). In this study, we aimed to compare the two cut-points to assess the association between central obesity and perception of own health. Method: We determined blood pressure and fasting bloods [glucose, high-density lipoprotein (HDL) and triglycerides] as metabolic syndrome markers for 171 urban teachers. Perception of own health was determined via the General Health Questionnaire-28 (GHQ-28) to indicate probable psychological distress or a psychiatric disorder or caseness (≥ 4). Results: The RPWC was an improved discrimination between the WC groups on perception of own health as reflected in the GHQ-28 subscales. In the male group, higher scores were found in the RPWC high WC group (≥ 90 cm) with regard to somatic symptoms, social dysfunction and GHQ-28 caseness, compared to those of the low WC groups (< 90 cm). Compared to the RPWC high WC females (≥ 98 cm), the low WC (< 98 cm) reflected significantly higher anxiety and sleeplessness subscale scores. Conclusion: Our results suggest that the RPWC (men 90 cm, women 98 cm), (determined in this African cohort when adding GHQ-28 caseness as a discriminatory variable between WC cut-point), distinguished better between WC groups based on their perception of own health than the JSC cut-point.
An evaluation of a helping skills training program for intern psychometrists
23 September 2014
North West University

Du Preez, Jani;Jorgensen, Lené I.

This study reports on the effectiveness of a helping skills training program for intern psychometrists. A randomised pretest–posttest comparison group design was used to evaluate the training program. Participants (N = 22; 82% = female, and Afrikaans-speaking = 95%) were selected from the psychometrist-in-training program from a tertiary institution. Three helping skills development measuring instruments were administered before and after the training program. Data were quantitatively analysed to examine training effects on empathy, respect and genuineness, as well as the participants’ ability to respond to content and personalise meaning. At the conclusion of the training, participants appeared to have evidently developed a heightened sense of purpose in life.
Black Generation Y students attitudes towards the demarketing of tobacco and alcohol consumption
23 September 2014
North West University

Roets, C.R.Q.;Bevan-Dye, A.L.;Viljoen, W.P.

This article reports on a study undertaken to determine Black Generation Y students' attitudes towards the demarketing of tobacco and consequent attitudes towards the demarketing of alcohol consumption in South Africa. As governments around the world, including South Africa, seek to tackle growing health care costs, so unhealthy consumption behaviours are increasingly coming under the spotlight. Tobacco smoking and, more recently excessive alcohol consumption, are two of such consumption behaviours that have received particular attention in recent years, with different demarketing strategies being implemented in an effort to dissuade the consumption thereof. While the effectiveness of these demarketing strategies may be measured directly by looking at changes in demand levels, little is known concerning consumer attitudes towards these strategies, even though an essential prerequisite for achieving their beneficial effects may depend on consumers having a positive attitude towards these strategies. A self-administered questionnaire was distributed to a sample of 400 Black Generation Y students registered at two South African higher education institutions situated in the Gauteng province. The captured data were analysed using z-tests, Pearson's Product-Moment Correlation and regression analysis. The findings indicate that Black Generation Y students have a statistically significant positive attitude towards both the demarketing of tobacco and alcohol consumption, and their attitudes towards the demarketing of tobacco serve as an important predictor to their attitudes towards the more recently proposed demarketing of alcohol consumption in South Africa.
Home characteristics, nonwork-work role demands effects on the well-being of dual-earner parents
23 September 2014
North West University

Nel, Jolene;Koekemoer, Eileen;Nel, Jan Alewyn

This study investigated home demands, home resources, nonwork roles interference with-work roles and the welfare of dual-earner parents. A cross-sectional survey design was used in this research, where a convenience sample of dual-earner parents (N=207) were taken from a metropolitan district in South Africa. A booklet consisting of various questionnaires measuring home characteristics, nonwork-work interference, life satisfaction, ill-health, cognitive weariness and exhaustion were distributed to the participants. Product-moment correlations were conducted in order to establish the relationships between variables and multiple regressions were used to establish which home characteristics and nonwork-work interference dimensions predicted which health outcomes (physical health, anxiety, depression, and exhaustion). Gender and age were employed as control variables. Emotional home demands and lack of autonomy significantly predicted physical ill health. Emotional home demands and spouse-work interference significantly predicted anxiety and depression. Gender, home pressure, developmental possibilities and parent-work interference were significant predictors of exhaustion.
Organisational commitment, work engagement and meaning of work of nursing staff in hospitals
26 September 2014
North West University

Beukes, Ilka;Botha, Elrie

Orientation: Nursing is a noble profession but not always an easy job. Work overload, few resources, limited promotion and development opportunities have a negative impact on the sustainability of the profession. Research purpose: The primary objective of this research was to investigate the relationship between organisational commitment, work engagement and meaning of work amongst nursing staff at various hospitals. Motivation for study: It is important to understand how to optimise the work experience of nursing staff in order to ensure a committed and engaged workforce. Research design, approach and method: A survey design with a cluster sample (n = 199) was used. The Organisational Commitment Questionnaire, Utrecht Work Engagement Scale, Work-Life Questionnaire and a biographical questionnaire were administered. Main findings: The majority of the scales showed acceptable reliability. Results indicated that the majority of nursing staff view their work as either a job or a calling. This impacts the organisation in the sense that viewing work as a calling predicts 19% of the variance in organisational commitment and 30% of the variance in work engagement. Practical/managerial implications: Viewing work as a calling will accompany higher levels of engagement and commitment to the organisation. Nurses who feel that they make a meaningful contribution to the hospital are more inclined to stay in the organisation. Contribution/value-add: Strategies can be put in place to focus on experiencing work as a calling, rather than a job. Enhancing this experience and creating awareness could lead to higher levels of organisational commitment and work engagement.
Gender differences related to the health and lifestyle patterns of university students
07 October 2014
North West University

Christine Janse van Rensburg;Jhalukpreya Surujlal

One of the transitions from adolescence to adulthood is the admission of students to a university setting. Accompanying this transition is a new-found independence which results in university students having more autonomy over their lifestyles and behaviours. The assumption in this setting is that many students are likely to engage in unhealthy and risky lifestyle behaviours which include alcohol abuse, tobacco use, physical inactivity and unhealthy dietary practices which may adversely affect their health in the long-term. In South Africa, research with regard to health and lifestyle patterns amongst both male and female young adults remains limited. The purpose of this study was, therefore, to investigate whether male and female students differed in relation to their health and lifestyles, as well as the related consequences thereof. A convenience sampling technique was used, where questionnaires were administered to 400 students at three university campuses in the Gauteng province of South Africa. An exploratory data analysis for health factors was used in order to retrieve relevant factors from a factor and regression analysis. Differences in gender were tested by using cross-tabulation for descriptive statistics and Chi-square analysis. The study found no statistically-significant differences between genders relating to the three emerging health factors, namely Gastrointestinal, Upper Respiratory Infections and Total Health Problems. However, descriptive statistics of lifestyle habits revealed that more female students exercised, smoked and binged on food than their male counterparts. It was also found that female students reported a higher incidence of stress than male students. It was concluded that university students do indeed engage in behaviours and lifestyles that place them at risk for serious health problems.
The motivation and limits of compassion
08 October 2014
North West University

Cornelius, Elma

What motivates people to serve others? Why do we help those in need, the poor, the sick, the lonely, orphans and widows? Is compassion for humans a natural instinct or is it a learnt response? In the biblical tradition, it is a clear imperative to show one’s faith in God in one’s behaviour by reaching out to others. Luke 10:25−37 seems to be a key passage in the Bible that teaches and exhorts Christians to be compassionate. Psychology teaches us that compassion is a natural instinct in humans although choice is involved too, and it turns out that religion plays a role in reinforcing compassion. This article is an attempt to understand the motivation and limits of compassion as reinforced by the Christian religion by (1) interpreting Luke 10:25−37 in the New Testament and by (2) using modern psychological insights. It often happens that people reach out to others for self-interested reasons, as serving others psychologically gives them a sense of meaning and fulfilment as well as a positive public image. Compassion, however, is also motivated by a love for God and a love and concern for people in general. As caring for others also affects one emotionally and might cause burnout, it is important to set some limits and boundaries on compassion. As God’s love for us leads us to reach out to others, we need to be sure about how and when we should fulfil people’s needs, help them to cope with their own needs, help them to understand the reason for their needs, guide them to fulfilling their own needs or help them to find a place where help is available.
Psychological well-being of families in a South African context: a prospective multifactorial model
29 October 2014
North West University

Vicki, Koen;Chrizanne, Van Eeden;Sebastiaan, Rothmann

This study investigated the psychosocial well-being of a group of South African families by determining the prevalence of psychosocial well-being indicators. A cross-sectional survey design and a purposive, voluntary sampling technique were used. Data on family well-being were collected from 772 youths attending five secondary schools located in the Northern province of South Africa (females = 64%, majority ethnicity = African: 67%). Data were captured and statistically analysed utilising the PASW 18.0 program (PASW, 2010). Structural equation modelling (SEM) methods implemented in AMOS (Arbuckle, 2009), were used to test the measurement models. The results supported a two-factor model of family psychosocial well-being consisting of family functioning and family feelings. Family functioning included family relational patterns, family functioning style and family hardiness, while the second factor, family feelings, included family satisfaction and attachment.
Shaken baby syndrome: a South African medico-legal perspective
22 January 2015
North West University

Le Roux-Kemp, Andra;Burger, Elsie

Shaken Baby Syndrome refers to the violent and repetitive shaking of an infant, and is a form of abusive head trauma. It was first described in 1974, and has since been the topic of intensive study and discussion. The syndrome has classically been diagnosed with a triad of injuries, namely subdural haemorrhage, retinal haemorrhage and encephalopathy (brain abnormalities). However, recent publications have led to some doubt regarding the causation and diagnostic significance of the triad. It is now generally accepted that other conditions, even natural diseases, may cause the findings listed in the so-called "triad". To date, no reported case law is available on Shaken Baby Syndrome in South Africa; therefore this article focuses on cases in the United States and United Kingdom to delineate some of the issues associated with litigating the condition. This includes the obligation of expert witnesses to give independent, factual evidence about their areas of expertise. It is recommended that medical and legal professionals involved in cases of alleged child abuse should collect as much information as possible about the context of the case. Confessions by parents or caregivers should be treated with circumspection. Awareness campaigns should be aimed at informing the public of the dangers of shaking an infant. And with regards to Shaken Baby Syndrome an increased focus on evidence-based medicine is necessary to dissipate the uncertainty around the condition.
Internet-based early intervention to prevent posttraumatic stress disorder in injury patients: randomized controlled trial
03 February 2015
North West University

Mouthaan, Joanne;Sijbrandij, Marit;De Vries, Giel-Jan;Reitsma, Johannes B.;Van de Schoot, Rens

BACKGROUND: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. OBJECTIVE: To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients. METHODS: Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale-Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented. RESULTS: The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001). CONCLUSIONS: Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).
Transboundary movements of genetically modified organisms and the Cartagena protocol: key issues and concerns
04 February 2015
North West University

Lim Tung, Odile J

Biotechnology or the engineering of the genetic material of species can give way to avenues of possibilities for the benefit of people, fauna and flora but also has the potential of posing untold and undiscovered threats to human beings and other living organisms. One of the first attempts to legislate on international rules on biotechnology can be traced back to article 19 of the Convention on Biological Diversity (CBD) in 1992. The CBD is indeed the first international legal instrument apart from the then European Community’s relevant directives to suggest that biotechnology is a matter of concern for the international community while providing a basis upon which more detailed procedures would be elaborated in the field of biosafety. While the CBD includes international rules on access to genetic resources, access to and the transfer of technology, the handling of biotechnology and the distribution of its benefits, it does not include a detailed regulation on genetically modified organisms (GMOs) and their possible adverse effects on the environment, human and animal health. It was only with the coming into existence of the Cartagena Protocol on Biosafety (Cartagena Protocol) to the CBD in 2000 that the safe transfer, handling and use of living modified organisms (LMOs) such as genetically engineered plants, animals, and microbes were at last being catered for, albeit leaving aside the broader categories of GMOs. Due to the need for the negotiators of this protocol to make compromises, there were still key issues on the international biosafety framework pertaining mainly to the scope of the GMOs to be covered by this protocol and by the Advanced Informed Agreement procedure; identification and traceability issues; and liability and redress issues. Nine years after the entry into force of the Cartagena Protocol the transboundary movements of GMOs have clearly increased with new categories of GMOs and genetically modified products to regulate. The debate on the safety of GMOs used for food and feed as well as the effects of GMOs on the receiving environment is still very lively throughout the world, amidst a lack of traceability of GMOs or epidemiological studies in the GMO-producing countries. However, there has been some progress on liability and redress with regard to damage resulting from the transboundary movement of LMOs with the adoption of rules and procedures for liability and redress in 2010 with the Nagoya-Kuala Lumpur Supplementary Protocol "(hereafter the Nagoya SP)" to the Cartagena Protocol, which is yet to enter into force. There are also concerns on the harmonisation of national biosafety regulation, risk assessment and risk management standards, the interpretation of socio-economic considerations, and the monitoring of compliance with the provisions of the Cartagena The scope of the GMOs covered by the Cartagena Protocol is discussed first, which discussion is followed by the discussion of identification and traceability issues, the harmonisation of national biosafety regulation, the harmonisation of risk assessment and risk management standards, the scope of the relevant socio-economic considerations, implementation, and concerns about the settlement of disputes.
Redefining child sexual abuse: from a legal to a psychosocial perspective
16 February 2015
North West University

Aucamp, Louise;Steyn, Marie;Van Rensburg, Esmé

In order to effectively help traumatised children to achieve positive outcomes, one must have a clearly defined methodology, underpinned by theory and based on an integrated approach. The first step towards this is clearly to redefine the phenomenon of the sexual abuse of children. As sexual abuse is both a legal and a psychosocial phenomenon, the authors are of the opinion that the South African context necessitates a more integrative definition. The information in this article is therefore aimed at providing health care professionals with an integrative definition that takes into account both the South African legal definition of sexual abuse and the underlying psychosocial factors with which it is associated.
Leisure-time physical activity and some psychological parameters among some executive employees in selected African countries
25 February 2015
North West University

Thendo, Thangavhuelelo;Monyeki, Andries M.;Strydom, Gert L.;Amusa, Lateef O.;Temane, Michael O.

Participation in leisure-time physical activity (LTPA) is vital to ensure adequate physical work capacity for the demands of daily living and job performance. Due to work demand, most top and middle level (executive) managerial employees become physically inactive and experience psychological and other health problems which may lead to hypokinetic diseases and even premature death. The purpose of this study was twofold: to determine leisure-time physical activity and psychological well-being of executive employees; and to determine the relationship between leisure-time physical activity and psychological well-being of executive employees in selected African countries. A cross-sectional study design was carried out on a group of 156 (mean age; 41.22±10.17 years) available executive employees from selected African countries. Participants were grouped according to ages (≤35 years; 36–46 years and ≥ 45 years). Standardized questionnaires were used to collect the data. Subsequently, total scores were calculated for all variables. Out of 156 participants in the study, 42.9% occupied top level management and 57.1% middle level management positions. Age groups analysis indicated that, 31% and 68.6% in the less than 35 years age group were in the top and the middle levels management positions respectively. In the age group 36 to 46 years, 47% occupied the top level management position and 52.8% occupied the middle level management position. With regard to LTPA, top level managers (71.6%) scored low LTPA compared to the middle level managers (62.9%). In addition, both the top and middle level managers reported bad emotional (49.3%; 56.2%) and happiness indexes (41.8%; 37.1%) respectively. Though not significant, LTPA was positively associated with psychological well-being parameters amongst top level managers. The study concluded that both top and middle levels managers exhibited low LTPA, and with no participation in high physical activity among top level managers. In addition, more middle level managers reported bad emotional stage than the top level managers, while the top level managers were less happy than the middle level managers. It is recommended that urgent strategic intervention programmes for leisure-time physical activity and psychological wellness are needed to promote physical health and well-being of the executive employees.
Determining potential drug-drug interactions between lopinavir/ritonavir and other antiretrovirals and prescribed daily doses in a section of the private health care sector in South Africa
11 March 2015
North West University

Katende-Kyenda, Norah L.;Lubbe, Martie S.;Serfontein, Jan H.P.;Truter, Ilse

Lopinavir/ritonavir forms part of the antiretroviral therapy for the treatment of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The aim of this non-experimental, quantitative drug-utilization study was to determine and identify potential drug-drug interactions between lopinavir/ritonavir and other antiretrovirals in general practitioners and specialists prescriptions with inappropriate prescribed daily doses. The study was performed on 49,995 (2005), 81,096 (2006) and 88,988 (2007) anti-retroviral (ARV) prescriptions claimed through a pharmacy benefit management company. Of the total 2,638 ARV general practitioners prescriptions and 472 specialist’s prescriptions claimed with potential drug-drug interactions (DDIs), 505 (19.1%) were for general practitioners and 143 (30.3%) for specialists. Potential drug-drug interactions identified between lopinavir/ritonavir and other anti-retrovirals with inappropriate prescribed daily doses accounted for 88.9% (n = 449) for general practitioners and 98.6% (n = 141) for specialist’s prescriptions. The highest percentage of anti-retroviral prescriptions with potential drug-drug interactions were between lopinavir/ritonavir at 1066.4 mg/264 mg and efavirenz at 600 mg average of prescribed daily doses with 61.4% (n = 276) for general practitioners and 38.3% (n = 54) for specialists, prescribed to patients between 19 and 45 years. The recommended standard adult dose for lopivavir/ritonavir is 400 mg/100 mg twice daily or 800 mg/200 mg once daily. The dose prescribed to HIV/AIDS patients in this section of the private health care sector of South Africa was therefore high. It is therefore recommended that more education be given to prescribers and dosage adjustments be done where indicated
Existential attitudes and Eastern European adolescents' problem and health behaviors: highlighting the role of the search for meaning in life
17 March 2015
North West University

Brassai, Laszlo;Piko, Bettina F.;Steger, Michael F.

Although the role of existential attitudes in adolescent health-related behavior has received increased attention recently, historically it has been under investigated in the field. The present study focuses on existential attitudes related to meaning in life and hopelessness. Relations of presence of meaning, search for meaning, and hopelessness with past and anticipated future involvement in problem- and health-enhancing behaviors were examined in a cross-sectional study of Eastern European (Transylvania, Romania) adolescents (N = 426, 42.1% males; M age = 16.5 year, range 15-18 years). Results indicated that these existential variables were significantly related to higher levels of healthy behaviors and lower levels of problem behaviors (hopelessness inversely). Among these existential factors, the search for meaning in life was the most significant contributor factor for adolescent behavior. As an overall conclusion, results point to the significant role that the search for meaning in life may play in the relation with adolescents' problem and health behaviors. (Contains 5 tables.)
Prospective Urban Rural Epidemiology (PURE) study: baseline characteristics of the household sample and comparative analyses with national data in 17 countries
18 March 2015
North West University

Corsi, Daniel J.;Subramanian, S.V.;Chow, Clara K.;McKee, Martin;Kruger, Annamarie

Background: The PURE study was established to investigate associations between social, behavioural, genetic, and environmental factors and cardiovascular diseases in 17 countries. In this analysis we compare the age, sex, urban/rural, mortality, and educational profiles of the PURE participants to national statistics. Methods: PURE employed a community-based sampling and recruitment strategy where urban and rural communities were selected within countries. Within communities, representative samples of adults aged 35 to 70 years and their household members (n = 424,921) were invited for participation. Results: The PURE household population compared to national statistics had more women (sex ratio 95.1 men per 100 women vs 100.3) and was older (33.1 years vs 27.3), although age had a positive linear relationship between the two data sources (Pearson's r = 0.92). PURE was 59.3% urban compared to an average of 63.1% in participating countries. The distribution of education was less than 7% different for each category, although PURE households typically had higher levels of education. For example, 37.8% of PURE household members had completed secondary education compared to 31.3% in the national data. Age-adjusted annual mortality rates showed positive correlation for men (r = 0.91) and women (r = 0.92) but were lower in PURE compared to national statistics (7.9 per 1000 vs 8.7 for men; 6.7 vs 8.1 for women). Conclusions: These findings indicate that modest differences exist between the PURE household population and national data for the indicators studied. These differences, however, are unlikely to have much influence on exposure-disease associations derived in PURE. Further, incidence estimates from PURE, stratified according to sex and/or urban/rural location will enable valid comparisons of the relative rates of various cardiovascular outcomes across countries.
Double product reflects the predictive power of systolic pressure in the general population: evidence from 9,937 participants
18 March 2015
North West University

Schutte, Rudolph;Thijs, Lutgarde;Asayama, Kei;Boggia, José;Li, Yan

BACKGROUND The double product (DP), consisting of the systolic blood pressure (SBP) multiplied by the pulse rate (PR), is an index of myocardial oxygen consumption, but its prognostic value in the general population remains unknown. METHODS We recorded health outcomes in 9,937 subjects (median age, 53.2 years; 47.3% women) randomly recruited from 11 populations and enrolled in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) study. We obtained the SBP, PR, and DP for these subjects as determined through 24-hour ambulatory monitoring. RESULTS Over a median period of 11.0 years, 1,388 of the 9,937 study subjects died, of whom 536 and 794, respectively, died of cardiovascular (CV) and non-CV causes, and a further 1,161, 658, 494, and 465 subjects, respectively, experienced a CV, cardiac, coronary, or cerebrovascular event. In multivariate-adjusted Cox models, not including SBP and PR, DP predicted total, CV, and non-CV mortality (standardized hazard ratio [HR], ≥ 1.10; P ≤ 0.02), and all CV, cardiac, coronary, and stroke events (HR, ≥ 1.21; P < 0.0001). For CV mortality (HR, 1.34 vs. 1.30; P = 0.71) and coronary events (1.28 vs. 1.21; P = 0.26), SBP and the DP were equally predictive. As compared with DP, SBP was a stronger predictor of all CV events (1.39 vs. 1.27; P = 0.002) and stroke (1.61 vs. 1.36; P < 0.0001), and a slightly stronger predictor of cardiac events (1.32 vs. 1.22; P = 0.06). In fully adjusted models, including both SBP and PR, the predictive value of DP disappeared for fatal endpoints (P ≥ 0.07), coronary events (P = 0.06), and stroke (P = 0.12), or DP was even inversely associated with the risk of all CV and cardiac events (both P ≤ 0.01). CONCLUSION In the general population, we did not observe DP to add to risk stratification over and beyond SBP and PR.
Exploring the link between cardiovascular reactivity and end–organ damage in African and Caucasian men: the SABPA study
18 March 2015
North West University

Huisman, Hugo W.;Schutte, Aletta E.;Schutte, Rudolph;Van Rooyen, Johannes M.;Fourie, Carla M. T.

BACKGROUND Heart failure in the African population is reaching alarming levels. Increased afterload as a result of increased vasoconstriction during stress may lead to impaired ventricular function and stroke volume (SV) as well as vascular hypertrophy. In this study, we challenged the cardiovascular system in order to evaluate the possible contribution of indicators of α-adrenergic vasoconstriction (i.e., vascular resistance and SV reactivity) on left ventricular mass and carotid intima-media thickness (CIMT) in African and Caucasian men. METHODS We evaluated 101 African and 101 Caucasian male schoolteachers. Ambulatory blood pressure measurements were taken. Total peripheral resistance, Windkessel compliance and SV, and resting and reactivity values were obtained using a Finometer device while the Stroop color word conflict test was being applied. The electrocardiogram was recorded to obtain the Cornell product as indication of left ventricular mass. The CIMT was measured and the cross-sectional wall area (CSWA) calculated. RESULTS African men showed higher total vascular resistance resting values as well as higher positive reactivity values compared with Caucasian men. The SV decreased significantly during stress in African men while resting blood pressure and the Cornell product value increased. SV showed a consistent association with left ventricular mass (β = –0.21; P = 0.04) and CSWA (β = –0.24; P = 0.01) in single and multiple regression analyses. No such associations were evident in the Caucasian men. CONCLUSIONS African men showed a suppressed SV, possibly as a result of an increased ventricular afterload leading to end-organ damage.
Contributions of internationalization to psychology: toward a global and inclusive discipline
18 March 2015
North West University

Van de Vijver, Fons J.R.

In this article I define and describe the current state of internationalization in psychology. Internationalization refers here to the approach in which existing or new psychological theories, methods, procedures, or data across cultures are synthesized so as to create a more culture-informed, inclusive, and globally applicable science and profession. This approach is essential to advance psychology beyond its Euro-American context of development and to achieve a more global applicability of its theories and professional procedures. Internationalization already has led to a better integration of cultural aspects in various psychological theories, to more insight into how to deal with methodological aspects of intact group comparisons (such as bias and equivalence), and to the development of guidelines in areas such as test development, test adaptations, ethics codes, and Internet testing. I review systemic and scientific climate factors in psychology that thwart the progress of internationalization, and conclude by suggesting methods of enhancing internationalization, which is essential for developing a truly universal psychology
The link between vascular deterioration and branched chain amino acids in a population with high glycated haemoglobin: the SABPA study
19 March 2015
North West University

Mels, C.M.;Schutte, A.E.;Schutte, R.;Huisman, H.W.;Smith, W.

Globally the prevalence of non-communicable diseases, such as hypertension and type 2 diabetes, are escalating. Metabolomic studies indicated that circulating branched chain amino acids (BCAAs) are associated with insulin resistance, coronary artery disease and increased risk for cardiovascular events. We aimed to extend the current understanding of the cardiovascular risk associated with BCAAs. We explored whether BCAAs are related to markers of cardiovascular disease in a bi-ethnic population and whether this relationship was influenced by chronic hyperglycaemia. We included 200 African and 209 Caucasian participants, and determined their ambulatory blood pressure and carotid intima-media thickness (cIMT). We analysed blood samples for glycated haemoglobin (HbA1c) and BCAAs. Participants were stratified into two groups according to their HbA1c value using the median cut-off value of 5.6 %. Ambulatory BP, cIMT and BCAAs were significantly higher (all p < 0.001) in the high HbA1c group. Single regression analyses indicated significant positive associations of ambulatory blood pressure and cIMT with BCAAs (all p < 0.05) in both the groups. These associations between ambulatory systolic blood pressure (SBP) (r = 0.16, p = 0.035) and cIMT (r = 0.22, p = 0.004) with BCAAs remained in the high HbA1c group after adjusting for age, gender, ethnicity and body mass index (BMI) and were confirmed in multiple regression analyses (ambulatory SBP: R 2 = 0.17, β = 0.21, p = 0.005 and cIMT: R 2 = 0.30, β = 0.19, p = 0.003). Our results demonstrate that BCAAs are independently related to ambulatory BP and cIMT in individuals with high HbA1c levels and suggest that potential cardiovascular deterioration accompany the rise in BCAAs in conditions of hyperglycaemia.
A critical reflection on the participatory action process involved in the develoment of a congnitive–behavioural based Counselling Intervention Programme for youth living with HIV/AIDS in a rural South African town
01 April 2015
North West University

L’Etang, Shlaine;Theron, Linda

South Africa currently lacks HIV counselling interventions that are youth-specific and that meet the psychosocial needs of young people living with HIV/AIDS. Indigenous strategies and interventions need to be developed that cater for the psychosocial needs of South African youth living with HIV/AIDS. By using Participatory Action Research (PAR) a Cognitive-behavioural-based Counselling Intervention Programme (CBCIP) was developed for use in a rural South African town. This article discusses the participatory action process involved in the development of the CBCIP. It shows how PAR theory relates to practice by highlighting the benefits, challenges and caveats in applying PAR within a rural setting. The lessons that were learned in the development of the CBCIP may provide future researchers with useful insight and foresight in the development of HIV counselling interventions for young people living with HIV/AIDS in South Africa.
Defensive coping facilitates higher blood pressure and early sub–clinical structural vascular disease via alterations in heart rate variability: the SABPA study
13 April 2015
North West University

Malan, L.;Hamer, M.;Schutte, R.;Van Rooyen, J.M.;Mels, C.M.;Fourie, C.M.T.;Uys, A.S.;Malan, N.T.

Objectives: Defensive coping (AC) responses in urban African males have been associated with vascular responsiveness, partly explaining autonomic nervous system dysfunction. We therefore aimed to assess whether AC responses facilitate higher blood pressure and early sub-clinical structural vascular disease via alterations in frequency- and time-domain heart rate variability (HRV) responses. Methods:We included 355 African and Caucasian men and women without pre-existing atrial fibrillation, aged 45 9 years. Significant interaction on main effects (coping ethnicity gender) for left carotid intima media thickness far wall (L-CIMTf) and cross sectional wall area values necessitated selection of AC responders above mean via the Coping Strategy Indicator. We collected B-mode ultrasound L-CIMTf, ambulatory BP andeHRV data. Overnight fasting blood was obtained. Results: Overall, Africans and AC Africans, mostly men, revealed a poorer lifestyle profile, higher prevalence of hypertensive status, disturbed sympathovagal balance and depressed HRV temporal and geometric patterns compared to the Caucasians (P 0.05). Moderately depressed non-linear and timedomain HRV (SDNN <100 ms) was prevalent in 28% of Africans compared to 11% of Caucasians. A similar trend was shown for the AC African participants (32%) compared to Caucasians (16%). Only depressed HRV time-domain (SDNN: adj. R2 ¼ 0.34; b ¼ 0.24; p ¼ 0.08) and vagal-impaired heart rate responses (RMSSD: adj. R2 ¼ 0.28; b ¼ 0.28; p < 0.05) were associated with higher blood pressure and early structural vascular changes in AC African men. Conclusion: Defensive coping facilitated autonomic nervous system dysfunction, which was associated with higher blood pressure and sub-clinical structural vascular disease in an African male cohort.
Reappraisal of spontaneous stereotypy in the deer mouse as an animal model of obsessive-compulsive disorder (OCD): response to chronic escitalopram treatment and basal serotonin transporter (SERT) density
14 April 2015
North West University

Wolmarans, De Wet;Brand, Linda;Harvey, Brian H.;Stein, Dan J.

Obsessive-compulsive disorder (OCD) is characterized by recurrent thoughts and repetitive motor actions. Hyposerotonergic signalling in the cortico-striatal circuitry is believed to be central to the pathology of OCD, while many patients only respond to chronic treatment with high dose selective serotonin (5HT) reuptake inhibitors (SSRIs). Confined deer mice spontaneously develop two forms of stereotypy, namely vertical jumping and pattern running. The purpose of this investigation was to reappraise these behaviours and strengthen the validity of deer mouse stereotypy as an animal model of OCD within a framework of three study questions: (1) can the time spent executing stereotypical behaviours be employed as a measure of extent of stereotypy, (2) does deer mouse stereotypy only respond to chronic, but not sub-chronic treatment with a high-dose SSRI, and (3) is deer mouse stereotypy associated with altered cortico-striatal 5HT transporter (SERT) binding? The current study demonstrates that treatment naïve high stereotypical (HS) deer mice spend significantly more time executing stereotypical behaviours while significantly less time is spent indulging in stereotypy following chronic, but not sub-chronic, treatment with escitalopram. Furthermore, HS deer mice present with a significant decrease in striatal SERT density compared to non-stereotypical (NS) controls. Building on previous validation studies, we conclude that deer mouse stereotypy is a valid naturalistic animal model of OCD with robust face, construct and predictive validity.
Inhibition of monoamine oxidase by phthalide analogues
15 April 2015
North West University

Strydom, Belinda;Bergh, Jacobus J.;Petzer, Jacobus P.

Based on recent reports that the small molecules, isatin and phthalimide, are suitable scaffolds for the design of high potency monoamine oxidase (MAO) inhibitors, the present study examines the MAO inhibitory properties of a series of phthalide [2-benzofuran-1(3H)-one] analogues. Phthalide is structurally related to isatin and phthalimide and it is demonstrated here that substitution at C6 of the phthalide moiety yields compounds endowed with high binding affinities to both human MAO isoforms. Among the nineteen homologues evaluated, the lowest IC50 values recorded for the inhibition of MAO-A and -B were 0.096 and 0.0014 lM, respectively. In most instances, C6-substituted phthalides exhibit MAO-B specific inhibition. Among a series of 6-benzyloxyphthalides bearing substituents on the para position of the phenyl ring the general order of potency was CF3 > I > Br > Cl > F > CH3 > H. The results also show that the binding modes of representative phthalides are reversible and competitive at both MAO isoforms. Based on these data, C6-substituted phthalides may serve as leads for the development of therapies for neurodegenerative disorders such as Parkinson’s disease.
Inhibition of monoamine oxidase by 3,4-dihydro-2(1H)-quinolinone derivatives
15 April 2015
North West University

Meiring, Letitia;Petzer, Jacobus P.;Petzer, Anél

In the present study, a series of 3,4-dihydro-2(1H)-quinolinone derivatives were synthesized and evaluated as inhibitors of recombinant human monoamine oxidase (MAO) A and B. The 3,4-dihydro-2(1H)- quinolinone derivatives are structurally related to a series of coumarin (1-benzopyran-2-one) derivatives which have been reported to act as MAO-B inhibitors. The results document that the quinolinones are highly potent and selective MAO-B inhibitors with most homologues exhibiting IC50 values in the nanomolar range. The most potent MAO-B inhibitor, 7-(3-bromobenzyloxy)-3,4-dihydro-2(1H)-quinolinone, exhibits an IC50 value of 2.9 nM with a 2750-fold selectivity for MAO-B over the MAO-A isoform. An analysis of the structure–activity relationships for MAO-B inhibition shows that substitution on the C7 position of the 3,4-dihydro-2(1H)-quinolinone scaffold leads to significantly more potent inhibition compared to substitution on C6. In this regard, a benzyloxy substituent on C7 is more favourable than phenylethoxy and phenylpropoxy substitution on this position. It may be concluded that C7-substituted 3,4-dihydro-2(1H)-quinolinones are promising leads for the therapy of Parkinson’s disease.
Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations
20 April 2015
North West University

Gaziano, Thomas A.;Pandya, Ankur;Steyn, Krisela;Levitt, Naomi;Kruger, Annamarie;Schutte, Aletta E.

Background: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods: We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results: Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions: We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.
The nature of relapse in schizophrenia
20 April 2015
North West University

Emsley, Robin;Harvey, Brian H.;Chiliza, Bonginkosi;Asmal, Laila

Background: Multiple relapses characterise the course of illness in most patients with schizophrenia, yet the nature of these episodes has not been extensively researched and clinicians may not always be aware of important implications. Methods: We critically review selected literature regarding the nature and underlying neurobiology of relapse. Results: Relapse rates are very high when treatment is discontinued, even after a single psychotic episode; a longer treatment period prior to discontinuation does not reduce the risk of relapse; many patients relapse soon after treatment reduction and discontinuation; transition from remission to relapse may be abrupt and with few or no early warning signs; once illness recurrence occurs symptoms rapidly return to levels similar to the initial psychotic episode; while most patients respond promptly to re-introduction of antipsychotic treatment after relapse, the response time is variable and notably, treatment failure appears to emerge in about 1 in 6 patients. These observations are consistent with contemporary thinking on the dopamine hypothesis, including the aberrant salience hypothesis. Conclusions: Given the difficulties in identifying those at risk of relapse, the ineffectiveness of rescue medications in preventing full-blown psychotic recurrence and the potentially serious consequences, adherence and other factors predisposing to relapse should be a major focus of attention in managing schizophrenia. The place of antipsychotic treatment discontinuation in clinical practice and in placebo-controlled clinical trials needs to be carefully reconsidered.
Complicated grief in the South African context: a social work perspective
20 April 2015
North West University

Drenth, Cornelia M.;Herbst, Alida G.;Strydom, Herman

Social work in South Africa in the last decade has been shaped by the White Paper for SocialWelfare (Ministry forWelfare and Population Development, 1997) which promotes developmental social services and constitutes both traditional social work and social developmental practices. Little consideration is given in social work literature and within the developmental welfare approach on the bereaved person whose social functioning is impaired by the death experience. South Africa has a generalised HIV epidemic and currently ranks the third highest in the world in terms of the tuberculosis burden. Fatal motor vehicle accidents are a common phenomenon and crime-related deaths are reported daily. Although loss and bereavement may be included in graduate social work education in South Africa, social workers in practice are often not familiar with grief-related intervention. Social work is concerned with loss and therefore also with death and aims to bring a system approach to dying. Grief is regarded as a normal process after the death of a significant person. There is, however, evidence that 10–20 per cent of the bereaved persons may experience prolonged, traumatic or complicated grief. This article explores complicated grief from a South African social work perspective. The discussion starts off with conceptualising complicated grief in South Africa and clarification of the concepts of loss, normal and complicated grief. This is followed by an overview of some risk factors for developing complicated grief. Lastly, the focus is on the role of social work when grief becomes complicated. More research is needed on social work intervention with reference to complicated grief in South Africa.
Depression, cardiometabolic function and left ventricular hypertrophy in African men and women: the SABPA study
05 May 2015
North West University

Mashele, Nyiko;Malan, Leoné;Van Rooyen, Johannes M.;Harvey, Brian H.;Potgieter, Johan C.;Hamer, Mark

Depressive symptoms are associated with an increased risk for developing cardiovascular diseases, driven by its link to the metabolic syndrome (MetS). This phenomenon, however, still needs to be investigated in the African population. The aim of this study is to investigate the association between left ventricular hypertrophy (LVH) and MetS risk markers in a determined sample. The researchers stratified Black African men and women into with depressive symptoms (D) or without depressive symptoms (ND) group, based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria score. Fasting MetS, chronic hyperglycemia (HbA1c), ambulatory blood pressure (BP) and Cornell product-LVH (CP-LVH) in ECG measures were obtained. Depressive symptoms were reported in 45.3% of the sample. Independent of depression status, African men and women revealed a pre-diabetic state (glycated hemoglobin >5.7%). CP-LVH was associated with decreased low high-density lipoprotein cholesterol in D African women. In D African men, systolic BP (P = .001) and HbA1c (P = .08) explained 64% and 31% of the variation in LVH, respectively. In conclusion, depressive symptoms in Black African women were associated with a measure of target end organ damage, CP-LVH, and this association was driven by a metabolic factor. In Black African men, independent of depressive symptoms, LVH, was driven by cardiometabolic factors, namely SBP and HbA1c.
Halogenated pollutants in terrestrial and aquatic bird eggs: converging patterns of pollutant profiles, and impacts and risks from high levels
20 May 2015
North West University

Bouwman, Hindrik;Viljoen, Ignatius M.;Quinn, Laura P.;Polder, Anuschka

We investigated the presence, levels, relationships, and risks of HCHs, DDTs, chlordanes, mirex, PCBs, and brominated flame retardants (BFRs) in terrestrial and aquatic bird eggs from an area in South Africa where DDT is used for malaria control. We found one of the highest ΣDDT levels reported this century; 13 000 ng/g wm (wet mass) in Grey Heron eggs which exceeds critical levels for reproductive success (3000 ng/g wm) calculated for Brown Pelicans, with a no-effect level estimated at 500 ng/g wm. Even higher ΣDDT levels at 16 000 ng/g wm were found in House Sparrow eggs (possibly the highest ever recorded for sparrows), with a maximum of 24 400 ng/g wm. Significant eggshell thinning in Cattle Egrets (33% between thickest and thinnest) was associated with increased levels of p,p′-DDT and p,p′-DDE. There were indications of unknown use of DDT and lindane. Relative to DDT, PCBs and BFRs levels were quite low. Ordinated data showed that different terrestrial pollutant profiles converged to a homogenised aquatic profile. Converging profiles, high levels of DDT in heron and sparrow eggs, and thinning eggs shells, indicate risk and impacts at release, in the aquatic environment, and in between. If characteristic life-strategies of birds in warm areas (e.g. longer-lived and fewer eggs per clutch) increases the risk compared with similar birds living in colder regions when both experience the same environmental pollutant levels, then malaria control using DDT probably has more significant impacts on biota than previously realised. Therefore, risk assessment and modelling without hard data may miss crucial impacts and risks, as the chemical use patterns and ecologies in Africa and elsewhere may differ from the conditions and assumptions of existing risk assessment and modelling parameters. Consideration of other findings associated with DDT from the same area (intersex in fish and urogental birth defects in baby boys), together with the findings of this study (high levels of DDT in bird eggs, eggshell thinning in the Cattle Egrets, and the apparent absence of breeding piscivore birds in the sprayed area) are strongly suggestive of negative impacts from DDT spraying for Malaria control. Our data presents strong arguments for an expedited process of replacing DDT with sustainable methods.
Dietitians in South Africa require more competencies in public health nutrition and management to address the nutritional needs of South Africans
20 May 2015
North West University

Parker, Whadiah;Steyn, Nelia P.;Mchiza, Zandile;Nthangeni, Gladys;Mbhenyane, Xikombiso;Dannhauser, Andre;Moeng, Lynn;Wentzel-Viljoen, Edelweiss

The aim of this study was to determine whether dietitians in South Africa are competent to meet the requirements of working in a health care setting during a compulsory oneyear community service (CS) program immediately after receiving their degree. A national survey was conducted using questionnaires to illicit information from dietitians on their training and competencies. In 2009, data were collected from both community service dietitians (CSDs) participating in community service programs in primary, secondary and tertiary health care centers in all provinces of South Africa, as well as from their provincial managers (nutrition coordinators). Sixteen (100% response) nutrition coordinators and 134 (80% response) dietitians participated in the quantitative survey. The majority of the CSDs reported that, overall, their academic training had prepared them for most aspects of nutrition service delivery. However, some recommended that academic programs include more training on community-based nutrition programs and in delivering optimal services to under-resourced communities as they believed that their competencies in these two areas were weakest. Furthermore, many CSDs were required to establish dietetics departments where none had previously existed; consequently, their capacity in management and administration needed improvement. In conclusion, academic training institutions should align their programs to the transformation of the health sector in South Africa by ensuring that dietitians are empowered to provide optimal public health nutrition services in under-resourced communities.

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