Epinephrine and dexamethasone in children with bronchiolitis

BACKGROUND

Although numerous studies have explored the benefit of using nebulized epinephrine or corticosteroids alone to treat infants with bronchiolitis, the effectiveness of combining these medications is not well established.

METHODS

We conducted a multicenter, double-blind, placebo-controlled trial in which 800 infants (6 weeks to 12 months of age) with bronchiolitis who were seen in the pediatric emergency department were randomly assigned to one of four study groups. One group received two treatments of nebulized epinephrine (3 ml of epinephrine in a 1:1000 solution per treatment) and a total of six oral doses of dexamethasone (1.0 mg per kilogram of body weight in the emergency department and 0.6 mg per kilogram for an additional 5 days) (the epinephrine-dexamethasone group), the second group received nebulized epinephrine and oral placebo (the epinephrine group), the third received nebulized placebo and oral dexamethasone (the dexamethasone group), and the fourth received nebulized placebo and oral placebo (the placebo group). The primary outcome was hospital admission within 7 days after the day of enrollment (the initial visit to the emergency department).

RESULTS

Baseline clinical characteristics were similar among the four groups. By the seventh day, 34 infants (17.1%) in the epinephrine-dexamethasone group, 47 (23.7%) in the epinephrine group, 51 (25.6%) in the dexamethasone group, and 53 (26.4%) in the placebo group had been admitted to the hospital. In the unadjusted analysis, only the infants in the epinephrine-dexamethasone group were significantly less likely than those in the placebo group to be admitted by day 7 (relative risk, 0.65; 95% confidence interval, 0.45 to 0.95, P=0.02). However, with adjustment for multiple comparisons, this result was rendered insignificant (P=0.07). There were no serious adverse events.

CONCLUSIONS

Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions. (Current Controlled Trials number, ISRCTN56745572.)

Étude de la résistance aux β-lactamines et des marqueurs moléculaires chez 157 souches d’Haemophilus influenzae isolées chez l’enfant à Tunis

The aim of this study was to precise the capsular type of Haemophilus influenzae , to determine its susceptibility to β-lactam agents, and to search for an eventual clonality between the clinical strains of the pathogen. Polymerase chain reaction was carried out to confirm the capsular type and to determine the β-lactamase type. Minimum inhibitory concentrations (MICs) of β-lactam agents for H. influenzae were determined by the agar dilution method on Haemophilus test medium, and the strains were analyzed by pulsed-field gel electrophoresis after SmaI restriction. Among 157 strains of H. influenzae studied, 12.1% was of serotype b. Sixty-seven strains (42.7%) were resistant to amoxicillin, among which 51 were resistant through production of TEM-type β-lactamase while 16 showed high MICs for amoxicillin, amoxicillin + clavulanic acid, and cefuroxim, which suggested a resistance by modification of penicillin-binding proteins. Among the latter strains, five were producing TEM-type β-lactamase. Cefotaxim, cefixim, and cefpodoxim had low MICs in all cases. The pulsed-field gel electrophoresis revealed 110 pulsotypes. All H. influenzae strains, including noncapsulated strains and serotype-b encapsulated strains, had a high level of heterogeneity, with diversity indices of respectively 0.67 and 0.94.

Incidence of injuries among male soccer players in the first team of the University of the Free State in the Coca Cola League – 2007/2008 season

No Abstract.

University of the Free State medical students' view of at-risk drinking behaviour and psychoactive substance use

<p><strong>Objectives:</strong> To investigate undergraduate medical students' knowledge of at-risk drinking behaviour and their own patterns of alcohol intake. The use of non-alcoholic psychoactive substances was also investigated.</p><p><strong>Design:</strong> A cross-sectional study design was used. A self-administered anonymous questionnaire was completed by participants. Questionnaires were designed using the U.S. Department of Health and Human Services guidelines for identifying at-risk drinking.</p><p><strong>Setting:</strong> The School of Medicine, University of the Free State, Bloemfontein.</p><p><strong>Subjects:</strong> Participants included first-, fourth- and fifth-year medical students enrolled in 2006. <strong></strong></p><p><strong>Results:</strong> 371/408 (90.9%) questionnaires were returned. 10% of students who repeated an academic year ascribed it to substance use. The majority of students conservatively estimated the maximum daily and weekly safe levels of alcohol consumption for both men and women as notably lower than recommended by the guidelines. Nevertheless, 32% of students admitted to alcohol intake exceeding these limits, and 55.3% were identified as at-risk drinkers. Marijuana was the most common non-alcoholic substance used by medical students (14.6%) in the preceding three years. Alcohol or other substances was most frequently used during social activities with friends.</p><p><strong>Conclusions:</strong> Medical students' knowledge of levels of alcohol intake associated with increased risks and their own drinking patterns might influence their approach to patients with alcohol-related problems. Therefore, education regarding at-risk drinking behaviour requires to be addressed.</p>

Opinions of private medical practitioners in Bloemfontein, South Africa, regarding euthanasia of terminally ill patients

The aim of this study was to determine the opinions of private medical practitioners in Bloemfontein, South Africa, regarding euthanasia of terminally ill patients. This descriptive study was performed amongst a simple random sample of 100 of 230 private medical practitioners in Bloemfontein. Information was obtained through anonymous self-administered questionnaires. Written informed consent was obtained. 68 of the doctors selected completed the questionnaire. Only three refused participation because they were opposed to euthanasia. Respondents were mainly male (74.2%), married (91.9%) and Afrikaans-speaking (91.9%). More were specialists (53.2%) than general practitioners (46.8%). A smaller percentage (35.5%) would never consider euthanasia for themselves compared to for their patients (46.8%). The decision should be made by the patient (50%), the patient's doctor with two colleagues (46.8%), close family (45.2%) or a special committee of specialists in ethics and medicine (37.1%). The majority (46.9%) indicated that euthanasia should be performed by an independent doctor trained in euthanasia, followed by the patient's doctor (30.7%). Notification should mainly be given to a special committee (49.9%). Only 9.8% felt that no notification was necessary. There was strong opposition to prescribing of medication to let the patient die. Withdrawal of essential medical treatment to speed up death was the most acceptable method. Although the responding group was fairly homogeneous, responses varied widely, indicating the complexity of opinions.

The profile analysis of attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment from 1 May 2005 to 30 April 2006

<div style="left: 85.1657px; top: 691.884px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04288);" data-canvas-width="85.51575"><strong>Background.</strong></div><div style="left: 171.176px; top: 691.884px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0317);" data-canvas-width="300.2243999999999">Suicide is an increasing phenomenon</div><div style="left: 85.1657px; top: 715.224px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03619);" data-canvas-width="386.49719999999996">worldwide. A suicide occurs every 40 seconds, and there</div><div style="left: 85.1657px; top: 738.564px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02775);" data-canvas-width="386.43539999999996">is 1 attempt every 1 to 3 seconds. By 2020, these figures</div><div style="left: 85.1657px; top: 761.904px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.996047);" data-canvas-width="386.4663">may have doubled. No accurate statistics regarding the</div><div style="left: 85.1657px; top: 785.244px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03893);" data-canvas-width="386.4817499999999">occurrence of attempted suicide (or non-fatal suicidal</div><div style="left: 85.1657px; top: 808.584px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04742);" data-canvas-width="386.49719999999996">behaviour) in South Africa exist, because there has been</div><div style="left: 85.1657px; top: 831.924px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01198);" data-canvas-width="194.2991999999999">no systematic data collection.</div><div style="left: 85.1657px; top: 831.924px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01198);" data-canvas-width="194.2991999999999"> </div><div style="left: 85.1657px; top: 869.424px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00734);" data-canvas-width="25.1835"><strong>Aim</strong></div><div style="left: 110.581px; top: 869.424px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05263);" data-canvas-width="361.05105000000003">. The aim of the study was to determine the profile of</div><div style="left: 85.1657px; top: 892.764px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01698);" data-canvas-width="386.4508499999998">patients who had attempted suicide and were referred</div><div style="left: 85.1657px; top: 916.104px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.053);" data-canvas-width="386.45084999999995">to Pelonomi Hospital, Bloemfontein, for psychological</div><div style="left: 85.1657px; top: 939.444px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.09463);" data-canvas-width="386.4045000000001">evaluation and treatment during the period 1 May 2005</div><div style="left: 85.1657px; top: 962.784px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.16187);" data-canvas-width="120.83444999999996">to 30 April 2006.</div><div style="left: 85.1657px; top: 1000.28px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.09453);" data-canvas-width="55.82085">Method.</div><div style="left: 141.218px; top: 1000.28px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00434);" data-canvas-width="330.4291499999999">A descriptive, retrospective study was conducted.</div><div style="left: 85.1657px; top: 1023.62px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0197);" data-canvas-width="386.4663">The study population comprised 258 attempted-suicide</div><div style="left: 85.1657px; top: 1046.96px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0063);" data-canvas-width="386.41994999999986">patients referred to Pelonomi Hospital for psychological</div><div style="left: 85.1657px; top: 1070.3px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.995928);" data-canvas-width="386.41995000000003">evaluation and treatment. A data form was compiled to</div><div style="left: 85.1657px; top: 1093.64px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03619);" data-canvas-width="386.49719999999996">transfer the relevant information from patients’ clinical</div><div style="left: 85.1657px; top: 1116.98px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00065);" data-canvas-width="30.019349999999992">files.</div><div style="left: 85.1657px; top: 1116.98px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00065);" data-canvas-width="30.019349999999992"> </div><div style="left: 85.1657px; top: 1154.48px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.839862);" data-canvas-width="41.9931"><strong>Results</strong></div><div style="left: 127.391px; top: 1154.48px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0274);" data-canvas-width="344.17965000000004">. The majority of patients were female (68.9%). The</div><div style="left: 85.1657px; top: 1177.82px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.995888);" data-canvas-width="386.4045000000001">median age was 22 years. The most common method</div><div style="left: 85.1657px; top: 1201.16px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.985726);" data-canvas-width="386.40449999999987">used in suicide attempts was drug overdose (66%) – mostly</div><div style="left: 85.1657px; top: 1224.5px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00373);" data-canvas-width="386.43539999999985">antidepressants (19.7%)) and analgesics (8.2%). More</div><div style="left: 85.1657px; top: 1247.84px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02012);" data-canvas-width="299.91539999999986">females than males overdosed on drugs (</div><div style="left: 385.328px; top: 1247.84px; font-size: 15px; font-family: sans-serif;">p</div><div style="left: 394.212px; top: 1247.84px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.10578);" data-canvas-width="77.4045">=0.0103).</div><div style="left: 85.1657px; top: 1271.18px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03329);" data-canvas-width="386.4508499999999">The main precipitating factors included problematic</div><div style="left: 85.1657px; top: 1294.52px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.07956);" data-canvas-width="386.4817500000003">relationships (55.4%), financial problems (22.9%),<div style="left: 533.984px; top: 382.042px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03058);" data-canvas-width="386.4662999999999">psychiatric problems (22.1%), arguments (19.8%), abuse</div><div style="left: 533.984px; top: 405.382px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00441);" data-canvas-width="381.6767999999998">(emotional, sexual, physical – 18.2%), low self-esteem/</div><div style="left: 533.984px; top: 428.721px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04346);" data-canvas-width="386.0800499999998">worthlessness/hopelessness/humiliation (16.7%), and</div><div style="left: 533.984px; top: 452.061px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02182);" data-canvas-width="185.97164999999993">recent life changes (13.2%).</div><div style="left: 533.984px; top: 452.061px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02182);" data-canvas-width="185.97164999999993"> </div><div style="left: 533.984px; top: 489.561px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00927);" data-canvas-width="77.71349999999998"><strong>Conclusion.</strong></div><div style="left: 611.93px; top: 489.561px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.976479);" data-canvas-width="308.56739999999996">The aim of the study was to determine the</div><div style="left: 533.984px; top: 512.901px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00638);" data-canvas-width="386.45084999999995">profile of patients who had attempted suicide. Possible</div><div style="left: 533.984px; top: 536.242px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00381);" data-canvas-width="386.4663">factors associated with suicide attempts in our sample</div><div style="left: 533.984px; top: 559.581px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01706);" data-canvas-width="386.48174999999986">were identified and summarised in the form of a screening</div><div style="left: 533.984px; top: 582.922px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04169);" data-canvas-width="386.46630000000005">checklist. The value of the checklist is that it can be used</div><div style="left: 533.984px; top: 606.261px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05018);" data-canvas-width="386.46629999999993">as a screening method to identify possible suicide risk in</div><div style="left: 533.984px; top: 629.602px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00481);" data-canvas-width="55.26465">patients.</div></div>

The general profile of children and adolescents with major depression referred to the Free State Psychiatric complex

<div style="left: 155.087px; top: 577.926px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.856878);" data-canvas-width="318.63"><strong>Background:</strong> Depression can have far-reaching effects on the</div><div style="left: 80.9418px; top: 601.256px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.92316);" data-canvas-width="392.82000000000005">functioning and adjustment of young people. Among both</div><div style="left: 80.9418px; top: 624.585px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910571);" data-canvas-width="392.775">children and adolescents depression confers an increased risk</div><div style="left: 80.9418px; top: 647.915px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.898096);" data-canvas-width="325.38">for illness, interpersonal and psychosocial difficulties.</div><div style="left: 80.9418px; top: 647.915px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.898096);" data-canvas-width="325.38"> </div><div style="left: 141.257px; top: 685.427px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.906132);" data-canvas-width="332.50499999999994"><strong>Objective:</strong>The aim of this study was to determine the profile of</div><div style="left: 80.9418px; top: 708.757px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.914105);" data-canvas-width="392.7450000000001">children (birth - 12 years) and adolescents (13 - 18 years) with</div><div style="left: 80.9418px; top: 732.086px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.896099);" data-canvas-width="392.76000000000005">major depression referred to the Child Mental Health Unit at the</div><div style="left: 80.9418px; top: 755.416px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.893043);" data-canvas-width="392.77500000000015">Free State Psychiatric Complex (FSPC) from 1 January 2004 to</div><div style="left: 80.9418px; top: 778.745px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.976556);" data-canvas-width="132.6">31 December 2004.</div><div style="left: 80.9418px; top: 778.745px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.976556);" data-canvas-width="132.6"> </div><div style="left: 129.137px; top: 816.258px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.917412);" data-canvas-width="344.5799999999999"><strong>Method:</strong> A total of 904 children and adolescents were referred</div><div style="left: 80.9418px; top: 839.587px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.919419);" data-canvas-width="392.745">to the Unit during 2004. From these referrals 100 children and</div><div style="left: 80.9418px; top: 862.917px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.933475);" data-canvas-width="392.775">adolescents (11.06%) were diagnosed with major depression</div><div style="left: 80.9418px; top: 886.246px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910612);" data-canvas-width="193.06499999999997">and were included in the study.</div><div style="left: 80.9418px; top: 886.246px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910612);" data-canvas-width="193.06499999999997"> </div><div style="left: 180.887px; top: 923.759px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.870766);" data-canvas-width="312.75000000000006"><strong>Data analysis:</strong> The data were summarised using frequencies</div><div style="left: 80.9418px; top: 947.088px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.925438);" data-canvas-width="392.91000000000014">and percentages (categorical variables) and means of</div><div style="left: 80.9418px; top: 970.418px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.885185);" data-canvas-width="200.76000000000002">percentiles (numerical variables).</div><div style="left: 80.9418px; top: 970.418px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.885185);" data-canvas-width="200.76000000000002"> </div><div style="left: 120.362px; top: 1007.93px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.905652);" data-canvas-width="353.31000000000006"><strong>Results:</strong> The majority (74%) of the cases were in the adolescent</div><div style="left: 80.9418px; top: 1031.26px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.904977);" data-canvas-width="392.74499999999995">age group and 61% were girls. The main complaints presented</div><div style="left: 80.9418px; top: 1054.59px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.882313);" data-canvas-width="392.8350000000001">by the parents or in the referral letter by the general practitioners</div><div style="left: 80.9418px; top: 1077.92px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.903519);" data-canvas-width="392.83500000000004">were behavioural problems (37%) such as stealing, aggression</div><div style="left: 80.9418px; top: 1101.25px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.936476);" data-canvas-width="392.80500000000006">and attention-seeking behaviour, followed by decrease in</div><div style="left: 80.9418px; top: 1124.58px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.898045);" data-canvas-width="392.7899999999999">school performance (25%), suspected depression (21%),</div><div style="left: 80.9418px; top: 1147.91px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.8945);" data-canvas-width="392.74499999999983">suicidal tendencies (17%), and school refusal (8%). Twelve per</div><div style="left: 80.9418px; top: 1171.24px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.880596);" data-canvas-width="392.775">cent of the group had lost a family member. The main presenting</div><div style="left: 80.9418px; top: 1194.57px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.912615);" data-canvas-width="392.81999999999994">clinical symptoms of major depression in the study group were</div><div style="left: 80.9418px; top: 1217.9px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.870739);" data-canvas-width="392.805">sleep disturbance (59%), dysphoric (depressed) mood (57%),</div><div style="left: 80.9418px; top: 1241.23px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.92694);" data-canvas-width="392.7599999999999">disturbance in appetite (49%), constant fatigue/loss of energy</div><div style="left: 80.9418px; top: 1264.56px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.908711);" data-canvas-width="392.76">(43%), inability to enjoy activities that would normally give</div><div style="left: 80.9418px; top: 1287.88px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.892772);" data-canvas-width="392.80500000000006">pleasure (37%), and impaired concentration (36%). Somatic</div><div style="left: 80.9418px; top: 1311.21px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.909585);" data-canvas-width="325.965">complaints occurred in 42% of the study population.</div>

Psychiatric evaluation of intellectually disabled offenders referred to the Free State Psychiatric Complex, 1993-2003

<div style="left: 80.9418px; top: 681.852px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00583);" data-canvas-width="78.45509999999997"><strong>Background</strong></div><div style="left: 159.629px; top: 681.852px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03081);" data-canvas-width="308.21204999999986">. Increased crime is a problem in South Africa</div><div style="left: 80.9418px; top: 705.192px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02338);" data-canvas-width="386.8370999999999">and complications arise when the accused is intellectually</div><div style="left: 80.9418px; top: 728.532px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.99448);" data-canvas-width="386.85255000000006">disabled. The accountability and fitness to stand trial of</div><div style="left: 80.9418px; top: 751.872px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.999579);" data-canvas-width="386.83709999999996">such individuals is an important facet that needs to be</div><div style="left: 80.9418px; top: 775.212px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02131);" data-canvas-width="293.11739999999986">managed by the judicial and health systems.</div><div style="left: 80.9418px; top: 803.277px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04883);" data-canvas-width="63.978449999999995"><strong>Objective</strong></div><div style="left: 145.152px; top: 803.277px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00521);" data-canvas-width="322.67325">. To analyse the accountability and triability of</div><div style="left: 80.9418px; top: 826.617px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05689);" data-canvas-width="386.8216499999998">intellectually disabled people awaiting trial referred to</div><div style="left: 80.9418px; top: 849.957px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.952801);" data-canvas-width="386.83709999999985">the Free State Psychiatric Complex (FSPC) from 1993 to</div><div style="left: 80.9418px; top: 873.297px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01014);" data-canvas-width="386.8834500000001">2003 according to Sections 77 and 78 of the Criminal</div><div style="left: 80.9418px; top: 896.637px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04688);" data-canvas-width="221.9392499999999">Procedures Act (Act 51 of 1977).</div><div style="left: 80.9418px; top: 924.702px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.08084);" data-canvas-width="50.79959999999999"><strong>Method</strong></div><div style="left: 131.973px; top: 924.702px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.956668);" data-canvas-width="335.7902999999999">. A retrospective study was conducted. The study</div><div style="left: 80.9418px; top: 948.042px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00735);" data-canvas-width="386.8216499999999">population consisted of 80 intellectually disabled people</div><div style="left: 80.9418px; top: 971.382px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04281);" data-canvas-width="386.8834499999999">awaiting trial in the Free State, referred to the FSPC. The</div><div style="left: 80.9418px; top: 994.722px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.974401);" data-canvas-width="386.83709999999996">reason for referral was the possibility that they were not</div><div style="left: 80.9418px; top: 1018.06px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05115);" data-canvas-width="386.8216499999999">triable or accountable. A data form was compiled to</div><div style="left: 80.9418px; top: 1041.4px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0371);" data-canvas-width="386.8371">transfer the relevant information from the patients’ clinical</div><div style="left: 80.9418px; top: 1092.81px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.839862);" data-canvas-width="41.9931">files.<strong></strong></div><div style="left: 80.9418px; top: 1092.81px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.839862);" data-canvas-width="41.9931"><strong>Results</strong></div><div style="left: 123.167px; top: 1092.81px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04442);" data-canvas-width="344.65859999999986">. The study found that the majority of subjects</div><div style="left: 80.9418px; top: 1116.15px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05405);" data-canvas-width="386.83709999999985">were male (96.3%), unmarried (76.3%) and unemployed</div><div style="left: 80.9418px; top: 1139.49px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05127);" data-canvas-width="386.8679999999999">(63.8%). The median age was 27 years. A relatively</div><div style="left: 80.9418px; top: 1162.83px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0483);" data-canvas-width="386.8216499999999">high percentage (49%) had received some schooling</div><div style="left: 80.9418px; top: 1186.17px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04005);" data-canvas-width="386.8988999999999">and 16% had attended a special school. Most (32%)</div><div style="left: 80.9418px; top: 1209.51px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05131);" data-canvas-width="386.88345000000004">were referred from the Bloemfontein area and 68% were</div><div style="left: 80.9418px; top: 1232.85px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.976783);" data-canvas-width="386.80620000000005">referred from the remainder of the Free State and other</div><div style="left: 80.9418px; top: 1256.19px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.98424);" data-canvas-width="386.8062000000001">areas. The majority were referred according to Sections</div><div style="left: 80.9418px; top: 1279.53px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.972108);" data-canvas-width="386.89889999999986">77 and 78. The highest number of the offences were of<div style="left: 529.761px; top: 369.865px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05429);" data-canvas-width="387.9803999999998">a sexual nature (78%). Of the subjects, 62 (62.5%) were</div><div style="left: 529.761px; top: 393.204px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.06894);" data-canvas-width="388.02674999999994">diagnosed as having mild mental retardation, while 16%</div><div style="left: 529.761px; top: 416.544px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00007);" data-canvas-width="388.02674999999994">were diagnosed as having moderate mental retardation.</div><div style="left: 529.761px; top: 439.884px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0157);" data-canvas-width="387.9958500000001">A total of 71 (71.25%) were found to be untriable and</div><div style="left: 529.761px; top: 463.224px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01876);" data-canvas-width="100.85759999999996">unaccountable.</div><div style="left: 529.761px; top: 491.289px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.995784);" data-canvas-width="72.69224999999999"><strong>Conclusion</strong></div><div style="left: 602.685px; top: 491.289px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.09803);" data-canvas-width="315.13365">. Triability and accountability are not only</div><div style="left: 529.761px; top: 514.63px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04024);" data-canvas-width="388.01129999999995">reflected by IQ score, but also involve the accused’s</div><div style="left: 529.761px; top: 537.969px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05438);" data-canvas-width="388.0112999999999">understanding of his/her environment, his/her speech</div><div style="left: 529.761px; top: 561.31px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02108);" data-canvas-width="388.01129999999995">and language proficiency, level of education, reasoning</div><div style="left: 529.761px; top: 584.649px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03211);" data-canvas-width="388.07309999999995">ability and the manner in which the crime was committed.</div><div style="left: 529.761px; top: 607.99px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.043);" data-canvas-width="387.99585">It is important to note that having an IQ of 70 or less does</div><div style="left: 529.761px; top: 631.33px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.960348);" data-canvas-width="387.9803999999999">not automatically mean that the accused is unfit to stand</div><div style="left: 529.761px; top: 654.669px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02908);" data-canvas-width="387.9649499999999">trial or is not accountable. It is possible for an intellectually</div><div style="left: 529.761px; top: 678.01px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.06613);" data-canvas-width="388.07309999999995">disabled person to be triable, accountable or diminished</div><div style="left: 529.761px; top: 701.349px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0305);" data-canvas-width="85.53119999999998">accountable.</div></div>

Profile of mentally ill offenders referred to the Free State Psychiatric Complex

NO ABSTRACT AVALIBLE

Evaluation of attempted-suicide management in a rural district of KwaZulu-Natal

<p><strong>Objectives.</strong> Critical aspects in the management of attempted-suicide patients have been identified in the literature. The aim of this study was to determine which of these aspects were included in the management of patients who attempted suicide in a rural district of KwaZulu-Natal.<strong> </strong></p><p><strong>Design.</strong> Descriptive study. Setting. The two hospitals in a rural district of KwaZulu-Natal.<strong> </strong></p><p><strong>Subjects.</strong> Attempted-suicide patients admitted to the above two hospitals between 1 June 2001 and 31 March 2002.Outcome measures. Patients were interviewed regarding how they were managed and were followed up until 3 months after the attempted suicide.<strong> </strong></p><p><strong>Results.</strong> Medicine was given to 41% of participants on admission and 64% were counselled by a doctor. A no-suicide contract was entered into in 42% of counselled cases. Family therapy, social worker involvement and psychiatric referral were very low and there was no involvement of friends, teachers or priests.<strong> </strong></p><p><strong>Conclusion.</strong> Management of patients who attempted suicide in this district is inadequate as there are no proper policy guidelines. It is important that health caregivers be trained in psychiatry.</p>

Psychiatric evaluation of offenders referred to the Free State Psychiatric Complex according to sections 77 and/ or 78 of the Criminal Procedures Act

<p><strong>Background.</strong> The increase in crime is a problem of great concern in South Africa and complications arise when the accused is mentally ill.</p><p><strong>Objective.</strong> Analysis of the offenders referred to the Free State Psychiatric Complex from 1995 to 2001 according to section 77 (triability) and/or section 78 (accountability) of the Criminal Procedures Act (Act 51 of 1977).</p><p><strong>Method.</strong> The study population consisted of 514 persons awaiting trial in the Free State. They were referred to the Free State Psychiatric Complex for 30 days’ observation from 1995 to 2001. A data form was created and used to transfer the relevant information from the accused’s clinical files.</p><p><strong>Data analysis.</strong> The data collected were analysed by the Department of Biostatistics at the University of the Free State.</p><p><strong>Results.</strong> The majority of the offenders were male (94.6%) and unmarried (66.3%). The median age of the group was 30 years. The unemployment rate was 60%. Most of the referrals (84.2%) were in terms of sections 77 and 78. The accused were found to have mainly average intelligence (75.3%). The main offences were theft (27.8%), murder (18.9%), assault (18.1%) and rape (16.2%). The most common mental disorder diagnosed was schizophrenia (23.0%), with 54.3% having no mental disorder. Nearly half the offenders (48.6%) were found to be triable and accountable.</p><p><strong>Conclusion.</strong> The majority of the offenders referred for psychiatric observation were found to have no mental illness and were referred back to the courts. This results in high costs for the Department of Health. To reduce the high rate of unnecessary referrals it is recommended that courts give clear reasons for the referrals according to each section (77 and 78).</p>