Human papillomavirus in normal cervical smears from Cape Town

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) types in South African women with normal cervical cytology and to determine whether our results are comparable to what has been found elsewhere in the world. DESIGN: Cervical smears were collected from 262 women. SETTING: The Cape Town metropolitan area. PARTICIPANTS: A total of 262 women, aged 19-85 years. Eighty-five women attended the family planning clinic of the Gynaecology Department at Groote Schuur Hospital and 177 women consulted private gynaecological practices. MAIN OUTCOME MEASURES: The prevalence and types of HPV in 192 women with normal cervical cytology. RESULTS: The incidence of HPV DNA in cervical smears from Cape Town women with normal cytology was found to be 13% (25/192) using Southern blot hybridisation. The types of HPV found in normal cervical tissue from Cape Town did not differ significantly from those found elsewhere in the world. Nine per cent (17/192) were positive for "high-risk' HPV types which are associated with premalignant and malignant cervical lesions. In the age group 20-39 years, 15 of 92 (16%) were positive for HPV DNA, while in the age group above 39 years, 3 of 53 (6%) women were positive for HPV DNA. CONCLUSIONS: In this study, 25 of 192 (13%) women with normal cytology were positive for HPV.     

Underrecognition and undertreatment of asthma in Cape Town primary school children

BACKGROUND: In view of the high local prevalence of asthma, the extent of recognition and appropriate management of childhood asthma was studied in a large suburban area of Cape Town. DESIGN: Cross-sectional study based on random community sample of schools. METHOD: 1,955 parents of sub B pupils from 16 schools completed a questionnaire, followed by: (i) an interview of the parents of 348 symptomatic children; and (ii) bronchial responsiveness testing on 254 children. The final case group consisted of 242 children with reported asthma or multiple asthma symptoms on both questionnaires. Children in whom asthma was acknowledged were compared with those in whom it was not. RESULTS: Overall, any past or current ('ever') asthma was acknowledged by respondents in only 53% of the children, and current asthma in only 37.1%. While most children had received treatment in the previous 12 months, 66.1% of the recognised group were on current treatment (23.2% on daily treatment), compared with 37% of the unrecognised group (3% daily). Salbutamol and theophylline syrups were the most common types of medication, while inhalers and anti-inflammatory medications were underused. Only a minority of parents reported the child ever having used a peak flow meter, or volunteered knowledge of preventive measures. Current treatment, and to a lesser degree recognition of asthma by parents, were more common among children on medical aid and of higher socio-economic status. CONCLUSIONS: These findings suggest that ways need to be found: (i) to increase the use of current asthma treatment guidelines by practitioners; (ii) to provide access to comprehensive care by children not on medical aid; and (iii) to improve education of parents in home management measures such as severity assessment and avoidance of smoking, allergen and dietary triggers.     

An assessment of care provided by a public sector STD clinic in Cape Town

A study was undertaken in a Cape Town public sector STD clinic to evaluate the content and quality of care provided since it has been recognized that appropriate improvements in the management of conventional sexually transmitted diseases (STDs), including provision of correct therapy, health education, condom promotion and partner notification, could result in a reduced incidence of HIV infection. Our objectives were to assess patients' needs for health education and to assess the quality of STD management in terms of health education, condom promotion, partner notification, the validity of the clinical diagnoses and the adequacy of the treatments prescribed. The study subjects were sampled systematically, according to their gender. Patients included in the study were given a standardized interview and their clinical records reviewed. Specimens were collected for laboratory investigations. For each STD detected, the treatment was defined as adequate if drugs currently known to be active against that infection were prescribed. One hundred and seventy men and 161 women were included in the study (median age: females 22 years, males 26 years). While almost all patients believed their STD may have been caused by unprotected sexual intercourse, many also believed it may have been caused by other factors, such as bewitchment with traditional medicine. Only 21% of male and 37% of female patients received any education about STD transmission during the clinic visit, and only 25% of male and 36% of female patients received education about condom use. As a result of the low sensitivity of the clinicians' diagnoses, 16% of men and 61% of women left the clinic with at least one infection inadequately treated. The majority of patients were not receiving education for the prevention of STDs including HIV. Many were not receiving adequate treatment for their infections. The introduction of a syndromic management protocol in this setting would substantially reduce the proportion of inadequately-treated patients. However, syndromic protocols, and the means by which they are implemented, need to take into account problems with the clinical detection of genital ulcerative disease and candidiasis in women.     

The sensitivity of a syndromic management approach in detecting sexually transmitted diseases in patients at a public health clinic in Cape Town

OBJECTIVES: To evaluate the sensitivity of a syndromic diagnostic procedure in detecting and treating sexually transmitted diseases (STDs) and genital tract infections (GTIs). METHODS: All new patients presenting at an STD clinic were sampled systematically by gender over a 6-week period. After the patient's clinical consultation, the clinical records were reviewed. Thereafter all patients were given a thorough genital examination by the research physician, and specimens were collected for laboratory investigations. In a retrospective simulation clinicians' syndromic diagnoses were validated against the laboratory findings, or for genital ulcer syndrome against the findings of the research physician. RESULTS: 170 men and 161 women were included in the sample. Ninety-five per cent of patients were black and the median age was 22 years for women and 26 years for men. In this setting, the Western Cape syndromic diagnostic procedure achieved reasonable levels of sensitivity in detecting Neisseria gonorrhoeae and Chlamydia trachomatis in men and women, and in detecting Trichomonas vaginalis and bacterial vaginosis in women. However, it was estimated to be only 36.4% sensitive in detecting genital ulcers in women, and between 0% and 12.3% sensitive in detecting Candida albicans. With syndromic management 8.2% of men and 32.9% of women would leave the clinic with at least one infection inadequately treated. CONCLUSIONS: Despite the introduction of syndromic protocols, it is likely that a proportion of STDs and GTIs are not being detected and treated owing to the high prevalence of multiple syndromes and mixed infections, both symptomatic and asymptomatic.     

Typhoid fever: A report on a point-source outbreak of 69 cases in Cape Town

In 1978, after a party in a Cape Town suburb attended by several hundred people, 69 persons were treated for typhoid fever. The precise source of the infection could not be traced, although it is reasonable to suppose that food eaten at the party had been contaminated by the main caterer. All 57 cultures of Salmonella typhi phage-typed were of phage type 46, including that obtained from the stool of the main caterer, who was asymptomatic. An epidemiological profile of the cases and an account of the management of the outbreak is given. There were no deaths and no patient became a carrier. Although the outbreak was contained, certain problems relating thereto are aired, including in particular the potential hazard of food-borne disease wherever housing and environmental standards are low.     

Psychologists' membership on the medical staff of university teaching hospitals.

Senior psychologists on the faculties of the 115 US schools of medicine were surveyed to ascertain whether or not they were full voting members of the medical staff of their university hospital. Results indicate that despite the fact that some of these teaching hospitals had dropped psychologists from full membership on the medical staff following the recent rounds of hospital reaccreditation site visits by the Joint Commission on Accreditation of Hospitals (JCAH), 6 of these hospitals had recently amended their bylaws to include qualified psychologists as full voting members. A review of the JCAH accreditation policies reveals that the medical staff of a hospital had more discretion in this area than previously may have been apparent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurosurgery at the University of Virginia

Although recently developed drugs have brought significant improvement, the treatment of psychotic disorders still presents serious drawbacks. Because inherent complexity and lack of satisfactory understanding of the underlying pathophysiology impose limits for rational drug design, resourceful approaches in the search for antipsychotics are pertinent. This article reports pharmacological properties of alstonine, a heteroyohimbine-type alkaloid, which exhibited an antipsychotic-like profile, inhibiting amphetamine-induced lethality, apomorphine-induced stereotypy, and potentiating barbiturate-induced sleeping time. Atypical features of alstonine were the prevention of haloperidol-induced catalepsy and lack of direct interaction with D1, D2 and 5-HT2A receptors, classically linked to antipsychotic mechanism of action.     

Load Testing of Historic Cast Iron Stairs at Cape Hatteras Lighthouse

The Cape Hatteras Lighthouse is the tallest brick structure of its kind in the United States. The national icon was closed to visitors after several pieces of the cast iron stairs, original to the structure, dislodged and fell inside the lighthouse. This finding led to the investigative efforts outlined in this paper, on the load carrying capacity of the stairs. This article summarizes the engineering effort in the condition assessment of the stairs, the review of visitor statistical data for likely load exposures during peak times, and the development of a unique load test program for the stairs of the historic structure. The load testing program was unique because of the physical constraints of the lighthouse shaft as well as the dimensions of the stair treads. In addition, the engineering team had the added objective of protecting the integrity of the national icon and performing the load test without exposing the historic stairs to an unnecessary risk of failure.     

Ownership and governance of university teaching hospitals: let form follow function

Under the best of circumstances, the complex decision-making and resource-allocation processes of a state university (and often of a variety of state agencies important to the university) significantly hinder the ability of the university-owned hospital to make changes critical to its financial and, hence, its programmatic success. At worst, as was the case for the University of Maryland Hospital a decade ago, the hospital can become capital-starved and operationally deficient under the bureaucratic mantle of the state and university and find itself unable to respond to the fast-changing market, placing its viability in jeopardy. To remedy this situation at the University of Maryland Hospital, in 1984 the state created a separate not-for-profit corporation, the University of Maryland Medical System ("the Medical system"), governed by its own board of directors, with a mandate to assure sound business practices, outstanding patient care, access to patients from across the state for tertiary care, access for the local disadvantaged community for comprehensive care, and attention to the academic mission of the university and its school of medicine. The results include strong financial performance, the ability to recapitalize outmoded facilities and technology, growth of strong programs, and the recruitment of excellent chairs and faculty. The Medical System's success suggests that university teaching hospitals, which necessarily depend on patient care revenues, may best be served by (1) removing them from university governance, thus allowing them to give primacy to their mission of patient care, and (2) removing them from state ownership, thus allowing them to use sound business practices in the competitive health care environment. The challenge under this arrangement is to ensure that the teaching hospitals can still support the educational and research programs that distinguish them. By establishing its independent, actively involved board of directors, the Medical System has successfully responded to this challenge.     

Quality of care for two common illnesses in teaching and nonteaching hospitals

Teaching hospitals are recognized for treating rare diseases, but their value in caring for common illnesses is less clear. To assess quality of care for congestive heart failure and pneumonia, we reviewed the medical records of Medicare beneficiaries in major teaching, other teaching, and nonteaching hospitals in four states. Overall quality was rated better in major and other teaching hospitals than in nonteaching hospitals by physician reviewers and explicit process criteria, but the results varied for different subsets of explicit measures. Future studies should assess whether outcomes differ between teaching and nonteaching hospitals.     

School psychology at the University of Texas at Austin.

Describes the development of a university school psychology (SP) program, which began in 1962 as a component of a counseling psychology program. In 1965, the author became director of the SP program. Objectives were to have a leadership role in the field of SP, facilitate both school- and non-school-based career opportunities for nontraditionally educated and trained school psychologists, contribute to the upgrading of doctoral SP, and push for more extensive institutionalization of doctoral SP in public schools. The curriculum has come to encompass more eclectic theoretical foundations. Three reasons are noted for why the program has been successful: its attraction of outstanding students and preparation of graduates for leadership roles, departmental support and breadth, and financial support from the National Institute of Mental Health. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurosurgery at the State University of New York at Buffalo

We treated five patients with auricular deformities (microtia in microform and group IIB or III constricted ears) using the following procedure: nearly all of the contralateral conchal cartilage was resected, grafted, and sutured to supplement a cartilaginous deficit and to keep the supporting frame of conchal cartilage expanded by the double banner flap method. After this, a soft tissue deficit was reconstructed by our newly developed method of covering the defect with a triangular flap superior to the auricle by making a skin incision and a rhomboid flap anterior to the auricle. So far, we have obtained satisfactory results using this one-stage procedure.     

Missed opportunities for immunisation at hospitals in the western Cape--a reappraisal

Immunisation practices were examined at 6 hospitals in the western Cape during the latter half of 1992 to determine whether these practices had improved subsequent to the February 1991 resolution of the Health Matters Committee (HMC) on immunisation in hospitals, and since a similar study was undertaken in 1990. Exit interviews were conducted with the escorts of all children aged 3-59 months who attended the study hospitals on the days designated for the study. In the second study, 88 of the 311 children studied (28.3%) were in need of immunisation on arrival, but only 12 of the 88 (13.6%) were immunised during the hospital visit. There was no evidence of an increase in requests to see children's Road-to-Health cards (37.1% compared with 35.2% previously). The incidence of missed opportunities for measles immunisation in children aged 6-59 months remained unacceptably high (51.4% compared with 63.7% previously, when a strict definition was used; and 15.7% compared with 18.1% previously, when a lenient definition was used). Health authorities at all levels need to take urgent action to address the problem of missed opportunities for immunisation at hospitals.     

Computer-aided veterinary learning at the University of Cambridge

An approach of computer-assisted learning in veterinary education at the University of Cambridge, involving the development of four types of learning module, is outlined. A tutorial on regional perineural anaesthesia in the horse, based on the familiar tape-slide format but with significant improvements, is described. A question and answer self-assessment package and a computer-based 'digital lecture' are also discussed, together with a case simulation involving the investigation of a polydipsic dog. All the tutorials were developed using standard software packages and image digitising processes. The philosophy behind the development of these computer-assisted learning packages is discussed.