COPC analysis of intersectoral HIV AIDS work in Okhahlamba

No Abstract. South African Family Practice Vol. 47(6) 2005: 35-3

Advocacy: Are we teaching it?

Background. Health advocacy has been identified as a key outcome competency in the undergraduate curriculum for a number of health professions by the Health Professions Council of South Africa (HPCSA) and the University of KwaZulu-Natal (UKZN), Durban, SA. Despite health advocacy and activism playing a strong role in the student body and civil society, there has been only limited engagement with the manner in which to teach health advocacy in the health professions literature.Objectives. To assess how the faculty in health professions programmes at UKZN understood health advocacy and how it was covered in the curriculum.Methods. Focus group discussions were held with faculty from undergraduate health professions programmes at the university regarding how health advocacy was understood and how it was being integrated into the current curriculum. A thematic analysis was performed on the transcripts of the focus groups.Results. A range of ways in which health advocacy was understood became apparent in the focus groups, with a few disciplines indicating that they do not cover health advocacy explicitly in the curriculum. Three main focus areas of health advocacy training were identified: for the profession (particularly in the smaller health professions groups); for services within the health system; and for patients or communities. The main points of departure for health advocacy were ethics and human rights and to a much lesser degree social justice. There was generally limited experience of how health advocacy could be taught as a skill and little consensus between the participating disciplines regarding the scope and content of health advocacy training. Advocacy itself was also seen as potentially risky, which could undermine the relationship between the university and the service platform. Similarly, the potential risk to whistle-blowers and the institutional culture in universities and public sector services were also seen as limitations.Conclusions. Ample opportunities were identified for the potential teaching of health advocacy in complex professional and public sector interactions. Dual loyalty was seen to be a key dilemma for how to approach advocacy as part of work-based learning, and linked to considerable risk to the institution, educators and students. The current review offers an exciting opportunity to define more clearly what the outcome competencies of health advocacy are, particularly in the context of transformative health professions education – and how these can be operationalised in the overall curriculum

The value of internal medicine outreach in rural KwaZulu-Natal, South Africa

Background. Sustainable multifaceted outreach is crucial when equity between specialist services available to different sections of South Africa (SA)’s population is addressed. The healthcare disadvantage for rural compared with urban populations is exemplified in KwaZulu-Natal (KZN). Outreach to rural hospitals has reduced the need for patients to undergo journeys to regional or tertiary hospitals for specialist care.Objectives. Multifaceted outreach visits to seven district hospitals in western KZN by a specialist in the Pietermaritzburg Department of Internal Medicine were analysed for the period 2013 - 2014.Methods. Church of Scotland, Vryheid, Dundee, Charles Johnson Memorial, Rietvlei, Estcourt and Greytown hospitals were visited. During each visit, data were collected on data collection forms, including patient numbers, gender and age, whether out- or inpatient, whether referred, and diagnostic categories.Results. During 113 visits, of 1 377 contacts made, 631 were outpatients and 746 were inpatients. Females formed the majority overall, but for inpatients males outnumbered females. The majority of patients were aged >40 years, but over half of inpatients seen were aged ≤40 years. A modest 15% of patients seen were referred to hospitals with specialist services. Overall, cardiovascular disease, predominantly among outpatients, was the biggest diagnostic category. Infectious diseases followed, primarily among inpatients, and then general medicine. No other category reached 10%.Conclusions. The analysis showed differences between diagnostic categories, especially when outpatients and inpatients were separated out. Referral patterns, age-distribution and gender distinctions were made. The value of a good database was confirmed. The multifaceted outreach may have suggested useful outcomes as well as output. The vulnerability v. sustainability of outreach programmes was emphasised

Differential (2+1) Jet Event Rates and Determination of alpha_s in Deep Inelastic Scattering at HERA

Events with a (2+1) jet topology in deep-inelastic scattering at HERA are studied in the kinematic range 200 < Q^2< 10,000 GeV^2. The rate of (2+1) jet events has been determined with the modified JADE jet algorithm as a function of the jet resolution parameter and is compared with the predictions of Monte Carlo models. In addition, the event rate is corrected for both hadronization and detector effects and is compared with next-to-leading order QCD calculations. A value of the strong coupling constant of alpha_s(M_Z^2)= 0.118+- 0.002 (stat.)^(+0.007)_(-0.008) (syst.)^(+0.007)_(-0.006) (theory) is extracted. The systematic error includes uncertainties in the calorimeter energy calibration, in the description of the data by current Monte Carlo models, and in the knowledge of the parton densities. The theoretical error is dominated by the renormalization scale ambiguity.Comment: 25 pages, 6 figures, 3 tables, submitted to Eur. Phys.

Multi-Jet Event Rates in Deep Inelastic Scattering and Determination of the Strong Coupling Constant

Jet event rates in deep inelastic ep scattering at HERA are investigated applying the modified JADE jet algorithm. The analysis uses data taken with the H1 detector in 1994 and 1995. The data are corrected for detector and hadronization effects and then compared with perturbative QCD predictions using next-to-leading order calculations. The strong coupling constant alpha_S(M_Z^2) is determined evaluating the jet event rates. Values of alpha_S(Q^2) are extracted in four different bins of the negative squared momentum transfer~\qq in the range from 40 GeV2 to 4000 GeV2. A combined fit of the renormalization group equation to these several alpha_S(Q^2) values results in alpha_S(M_Z^2) = 0.117+-0.003(stat)+0.009-0.013(syst)+0.006(jet algorithm).Comment: 17 pages, 4 figures, 3 tables, this version to appear in Eur. Phys. J.; it replaces first posted hep-ex/9807019 which had incorrect figure 4

Multiplicity Structure of the Hadronic Final State in Diffractive Deep-Inelastic Scattering at HERA

The multiplicity structure of the hadronic system X produced in deep-inelastic processes at HERA of the type ep -> eXY, where Y is a hadronic system with mass M_Y< 1.6 GeV and where the squared momentum transfer at the pY vertex, t, is limited to |t|<1 GeV^2, is studied as a function of the invariant mass M_X of the system X. Results are presented on multiplicity distributions and multiplicity moments, rapidity spectra and forward-backward correlations in the centre-of-mass system of X. The data are compared to results in e+e- annihilation, fixed-target lepton-nucleon collisions, hadro-produced diffractive final states and to non-diffractive hadron-hadron collisions. The comparison suggests a production mechanism of virtual photon dissociation which involves a mixture of partonic states and a significant gluon content. The data are well described by a model, based on a QCD-Regge analysis of the diffractive structure function, which assumes a large hard gluonic component of the colourless exchange at low Q^2. A model with soft colour interactions is also successful.Comment: 22 pages, 4 figures, submitted to Eur. Phys. J., error in first submission - omitted bibliograph

Cross-cultural medical education: Using narratives to reflect on experience

Introduction. Educating students in a multi-cultural society is a challenge as teachers, students and the community they serve all tend to representvarious social groups. Skills alone are not adequate for competency in understanding cultural aspects of consultations. A combination of knowledge, skills and attitude is the most widely accepted current approach to teaching culturally competent communication to medical students. Collaborative reflection on narratives of experienced clinicians’ cultural encounters served to construct an understanding of how to develop these attributes.Process. An interest group of medical teachers met to address the specific needs of teaching a relevant cross-cultural curriculum. Participants offerednarratives from their professional life and reflected on these encounters to understand how to improve the current curriculum to better address theneeds of the students and patients they serve.Results. Through narratives, participants were able to reflect on how their experience had allowed them to develop cultural awareness. All storiesrepresented how attitudes of respect, curiosity and unconditional positive regard were held above all else. The process of collaborative reflection withpeers unpacked the complexity and potential in the stories and different learning opportunities were discovered. Learning was personalised becausethe stories were based on real experiences.Conclusion. The use of collaborative reflection on narratives of clinical encounters could facilitate insights about cultural aspects of medical practice. Elements such as curiosity, respect and unconditional positive regard are illustrated in a unique way that allows students to appreciate the real-life aspects of cross-cultural clinical encounters

The social and clinical characteristics of patients on antiretroviral therapy who are ‘lost to follow-up’ in KwaZulu-Natal, South Africa: a prospective study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms, quality of life, depression, herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-na&#239;ve patients recruited from three (one urban, one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months&#8217; follow-up. At 12-months follow-up 557 (75.9%) individuals continued active ART, 177 (24.1%)were all cause attrition, there were 82 deaths (13.8%), 58 (7.9%) transfers, 7 (1.0%) refused participation, 8 (1.1%) were not yet on ARTand 22 (3.0%) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio, RR=2.05, confidence intervals, CI=1.20 - 3.49) and higher depression levels (RR=1.05, CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme, such as delays in health care access (delayed health care seeking), health system delays, or inappropriate treatment criteria, need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome

Bridging the gap: exploring the attitudes and beliefs of nurses and patients about coexisting traditional and biomedical healthcare systems in a rural setting in KwaZulu-Natal

Objectives: Health care in South Africa takes place within a diverse cultural context and includes perceptions about health that strongly link to cultural beliefs and values. Biomedical healthcare professionals, particularly nurses, are exposed to and expected to cope with cultural challenges on a daily basis, with little or no training on how to do so. In this paper, we explore nurse and patient attitudes to and beliefs about how the systems of health care coexist, what issues this raises and how nurses and patients address these issues in their daily practice.Design: The study employed an exploratory, qualitative research design.Setting and subjects: Four in-depth focus group discussions were conducted with nurses and patients at a deep rural, district hospital in northern KwaZulu-Natal. Participants were selected based on their availability and willingness to contribute to the discussion.Results: Traditional and biomedical healthcare systems coexist and are used simultaneously with the healthcare- seeking pattern of patients traversing multiple systems of care. Currently, patients and nurses have developed strategies to address this by steering a pragmatic course to minimise risks, and by doing so, bridging the gap between the two healthcare mediums.Conclusion: Further research is required to understand which illnesses are primarily seen as traditional, how this gap can be effectively addressed, and how different healthcare co-delivery models can best be utilised and evaluated.Keywords: health worker, traditional health care, biomedical health care, cultur

A Search for Selectrons and Squarks at HERA

Data from electron-proton collisions at a center-of-mass energy of 300 GeV are used for a search for selectrons and squarks within the framework of the minimal supersymmetric model. The decays of selectrons and squarks into the lightest supersymmetric particle lead to final states with an electron and hadrons accompanied by large missing energy and transverse momentum. No signal is found and new bounds on the existence of these particles are derived. At 95% confidence level the excluded region extends to 65 GeV for selectron and squark masses, and to 40 GeV for the mass of the lightest supersymmetric particle.Comment: 13 pages, latex, 6 Figure