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Allorto N, Rencken CA, Wall S, Pompermaier L. Factors impacting time to surgery and the effect on in-hospital mortality. Burns 2020; 47:922-929. [PMID: 33342553 DOI: 10.1016/j.burns.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. METHODS All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and χ2 test or Fisher's exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders. RESULTS During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3-35) and 12.0% (5-22) compared to 7 years (2-32) and 6.0% (3-13) in the late surgery group (p=0.45, p<0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47-7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05-1.12)], and FTB [aOR: 3.21 (95% CI: 1.43-7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76-3.98)]. CONCLUSION This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome.
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Affiliation(s)
- Nikki Allorto
- Pietermaritzburg Burn Service, University of KwaZulu-Natal, KZN, South Africa
| | | | - Shelley Wall
- Pietermaritzburg Burn Service, University of KwaZulu-Natal, KZN, South Africa; DRILL Fellow: Developing Research, Innovation, Localization and Leadership, Univeristy of KwaZulu-Natal, KZN, South Africa
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Haagsma JA, James SL, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Liu Z, Lucchesi LR, Roberts NLS, Sylte DO, Adebayo OM, Ahmadi A, Ahmed MB, Aichour MTE, Alahdab F, Alghnam SA, Aljunid SM, Al-Raddadi RM, Alsharif U, Altirkawi K, Anjomshoa M, Antonio CAT, Appiah SCY, Aremu O, Arora A, Asayesh H, Assadi R, Awasthi A, Ayala Quintanilla BP, Balalla S, Banstola A, Barker-Collo SL, Bärnighausen TW, Bazargan-Hejazi S, Bedi N, Behzadifar M, Behzadifar M, Benjet C, Bennett DA, Bensenor IM, Bhaumik S, Bhutta ZA, Bijani A, Borges G, Borschmann R, Bose D, Boufous S, Brazinova A, Campuzano Rincon JC, Cárdenas R, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Catalá-López F, Choi JYJ, Christopher DJ, Crowe CS, Dalal K, Daryani A, Davitoiu DV, Degenhardt L, De Leo D, De Neve JW, Deribe K, Dessie GA, deVeber GA, Dharmaratne SD, Doan LP, Dolan KA, Driscoll TR, Dubey M, El-Khatib Z, Ellingsen CL, El Sayed Zaki M, Endries AY, Eskandarieh S, Faro A, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Franklin RC, Fukumoto T, Gezae KE, Gill TK, Goulart AC, Grada A, Guo Y, Gupta R, Haghparast Bidgoli H, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Haro JM, Hassankhani H, Hassen HY, Havmoeller R, Hendrie D, Henok A, Híjar M, Hole MK, Homaie Rad E, Hossain N, Hostiuc S, Hu G, Igumbor EU, Ilesanmi OS, Irvani SSN, Islam SMS, Ivers RQ, Jacobsen KH, Jahanmehr N, Jakovljevic M, Jayatilleke AU, Jha RP, Jonas JB, Jorjoran Shushtari Z, Jozwiak JJ, Jürisson M, Kabir A, Kalani R, Kasaeian A, Kelbore AG, Kengne AP, Khader YS, Khafaie MA, Khalid N, Khan EA, Khoja AT, Kiadaliri AA, Kim YE, Kim D, Kisa A, Koyanagi A, Kuate Defo B, Kucuk Bicer B, Kumar M, Lalloo R, Lam H, Lami FH, Lansingh VC, Leasher JL, Li S, Linn S, Lunevicius R, Machado FR, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahotra NB, Majdan M, Majeed A, Malekzadeh R, Malik MA, Malta DC, Manda AL, Mansournia MA, Massenburg BB, Maulik PK, Meheretu HAA, Mehndiratta MM, Melese A, Mendoza W, Mengesha MM, Meretoja TJ, Meretoja A, Mestrovic T, Miazgowski T, Miller TR, Mini GK, Mirrakhimov EM, Moazen B, Mohammad Gholi Mezerji N, Mohammadibakhsh R, Mohammed S, Molokhia M, Monasta L, Mondello S, Montero-Zamora PA, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Morawska L, Velásquez IM, Morrison SD, Moschos MM, Mousavi SM, Murthy S, Musa KI, Naik G, Najafi F, Nangia V, Nascimento BR, Ndwandwe DE, Negoi I, Nguyen TH, Nguyen SH, Nguyen LH, Nguyen HLT, Ningrum DNA, Nirayo YL, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Orpana HM, Otstavnov SS, P A M, Pakhale S, Park EK, Patton GC, Pesudovs K, Phillips MR, Polinder S, Prakash S, Radfar A, Rafay A, Rafiei A, Rahimi S, Rahimi-Movaghar V, Rahman MA, Rai RK, Ramezanzadeh K, Rawaf S, Rawaf DL, Renzaho AMN, Resnikoff S, Rezaeian S, Roever L, Ronfani L, Roshandel G, Sabde YD, Saddik B, Salamati P, Salimi Y, Salz I, Samy AM, Sanabria J, Sanchez Riera L, Santric Milicevic MM, Satpathy M, Sawhney M, Sawyer SM, Saxena S, Saylan M, Schneider IJC, Schwebel DC, Seedat S, Sepanlou SG, Shaikh MA, Shams-Beyranvand M, Shamsizadeh M, Sharif-Alhoseini M, Sheikh A, Shen J, Shigematsu M, Shiri R, Shiue I, Silva JP, Singh JA, Sinha DN, Soares Filho AM, Soriano JB, Soshnikov S, Soyiri IN, Starodubov VI, Stein DJ, Stokes MA, Sufiyan MB, Sunshine JE, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Tehrani-Banihashemi A, Tessema GA, Thakur JS, Tran KB, Tran BX, Tudor Car L, Uthman OA, Uzochukwu BSC, Valdez PR, Varavikova E, Vasconcelos AMN, Venketasubramanian N, Violante FS, Vlassov V, Waheed Y, Wang YP, Wijeratne T, Winkler AS, Yadav P, Yano Y, Yenesew MA, Yip P, Yisma E, Yonemoto N, Younis MZ, Yu C, Zafar S, Zaidi Z, Zaman SB, Zamani M, Zhao Y, Zodpey S, Hay SI, Lopez AD, Mokdad AH, Vos T. Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017. Inj Prev 2020; 26:i12-i26. [PMID: 31915273 PMCID: PMC7571356 DOI: 10.1136/injuryprev-2019-043296] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
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Affiliation(s)
- Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Lydia R Lucchesi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Alireza Ahmadi
- Department of Anesthesiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota, USA
| | - Suliman A Alghnam
- Department of Population Health Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, Kuwait University, Safat, Kuwait
- International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
| | - Rajaa M Al-Raddadi
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ubai Alsharif
- Department of Oral and Maxillofacial Surgery, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | | | - Mina Anjomshoa
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Seth Christopher Yaw Appiah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Olatunde Aremu
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Amit Arora
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
- Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | | | - Reza Assadi
- Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
| | - Shivanthi Balalla
- School of Public Health, Auckland University of Technology, Auckland, New Zealand
| | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
| | | | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Neeraj Bedi
- Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Department of Epidemiology and Biostatistics, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Corina Benjet
- Department of Epidemiology and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Derrick A Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Isabela M Bensenor
- Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Guilherme Borges
- Department of Epidemiology and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dipan Bose
- Transport & Digital Development, World Bank, Washington, District of Columbia, USA
| | - Soufiane Boufous
- Transport and Road Safety (TARS) Research Department, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Julio Cesar Campuzano Rincon
- National Institute of Public Health, Cuernavaca, Mexico
- School of Medicine, University of the Valley of Cuernavaca, Cuernavaca, Mexico
| | - Rosario Cárdenas
- Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Carlos A Castañeda-Orjuela
- Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
- Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
| | - Ferrán Catalá-López
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jee-Young J Choi
- Department of Biochemistry and Biomedical Science, Seoul National University Hospital, Seoul, South Korea
| | | | | | - Koustuv Dalal
- Institute of Public Health Kalyani, Kalyani, India
- School of Health Science, Orebro University, Orebro, Sweden
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Dragos Virgil Davitoiu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Surgery, Clinical Emergency Hospital Sf. Pantelimon, Bucharest, Romania
| | - Louisa Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Queensland, Australia
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Gabrielle Aline deVeber
- Centre for Global Child Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Linh Phuong Doan
- Center of Excellence in Health Service Management, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Kate A Dolan
- University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Robert Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Manisha Dubey
- United Nations World Food Programme, New Delhi, India
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | | | | | - Aman Yesuf Endries
- Public Health Department, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Andre Faro
- Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, California, USA
- School of Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Florian Fischer
- Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
| | - Richard Charles Franklin
- College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, Queensland, Australia
| | - Takeshi Fukumoto
- Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
- Department of Dermatology, Kobe University, Kobe, Japan
| | | | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University of São Paulo, Sao Paulo, Brazil
- Internal Medicine Department, University Hospital, University of São Paulo, Sao Paulo, Brazil
| | - Ayman Grada
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
| | - Rahul Gupta
- March of Dimes, Arlington, Virginia, USA
- School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | | | - Arvin Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arya Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Randah R Hamadeh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Josep Maria Haro
- Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
- Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
| | - Hadi Hassankhani
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Hamid Yimam Hassen
- Department of Public Health, Mizan-Tepi University, Teppi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
| | - Rasmus Havmoeller
- Clinical Sciences, Karolinska University Hospital, Stockholm, Sweden
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andualem Henok
- Department of Public Health, Mizan-Tepi University, Teppi, Ethiopia
| | - Martha Híjar
- Research Coordination, AC Environments Foundation, Cuernavaca, Mexico
- CISS, National Institute of Public Health, Cuernavaca, Mexico
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, Texas, USA
| | - Enayatollah Homaie Rad
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Naznin Hossain
- Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka University, Dhaka, Bangladesh
- Department of Pharmacology, Bangladesh Industrial Gases Limited, Tangail, Bangladesh
| | - Sorin Hostiuc
- Faculty of Dentistry, Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Central South University, Changsha, China
| | - Ehimario U Igumbor
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
- Department of Public Health, Walter Sisulu University, Mthatha, South Africa
| | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Q Ivers
- Injury Division, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Nader Jahanmehr
- School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihajlo Jakovljevic
- Department for Health Care and Public Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Ravi Prakash Jha
- Department of Community Medicine, Banaras Hindu University, Varanasi, India
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rizwan Kalani
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Andre Pascal Kengne
- Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nauman Khalid
- School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Abdullah T Khoja
- Department of Public Health, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Young-Eun Kim
- Department of Preventive Medicine, Korea University, Seoul, South Korea
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Ai Koyanagi
- CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Barthelemy Kuate Defo
- Department of Demography, University of Montreal, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Burcu Kucuk Bicer
- Department of Public Health, Yuksek Ihtisas University, Ankara, Turkey
- Department of Public Health, Hacettepe University, Ankara, Turkey
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Hilton Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
| | - Faris Hasan Lami
- Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq
| | - Van C Lansingh
- HelpMeSee, New York City, New York, USA
- International Relations Department, Mexican Institute of Ophthalmology, Queretaro, Mexico
| | - Janet L Leasher
- College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shai Linn
- School of Public Health, University of Haifa, Haifa, Israel
| | - Raimundas Lunevicius
- Department of General Surgery, Aintree University Hospital National Health Service (NHS) Foundation Trust, Liverpool, UK
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - Flavia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Sao Paulo, Brazil
| | | | | | | | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manzoor Ahmad Malik
- Department of Humanities and Social Sciences, Indian Institute of Technology, Roorkee, Haridwar, India
- Department of Development Studies, International Institute for Population Sciences, Mumbai, India
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pallab K Maulik
- Research Department, The George Institute for Global Health, New Delhi, India
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Hailemariam Abiy Alemu Meheretu
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Man Mohan Mehndiratta
- Neurology Department, Janakpuri Super Specialty Hospital Society, New Delhi, India
- Neurology Department, Govind Ballabh Institute of Medical Education and Research, New Delhi, India
| | - Addisu Melese
- Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Walter Mendoza
- Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
| | | | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Tomasz Miazgowski
- Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland
| | - Ted R Miller
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
| | - G K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India
| | - Erkin M Mirrakhimov
- Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | - Babak Moazen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
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- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | - Mariam Molokhia
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Department of Neurology, Oasi Research Institute, Troina, Italy
| | - Pablo A Montero-Zamora
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Yoshan Moodley
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | - Marilita M Moschos
- 1st Department of Ophthalmology, University of Athens, Athens, Greece
- Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Seyyed Meysam Mousavi
- Health Management Reserach Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamarul Imran Musa
- School of Medical Sciences, Science University of Malaysia, Kubang Kerian, Malaysia
| | - Gurudatta Naik
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Farid Najafi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Bruno Ramos Nascimento
- Hospital of the Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ionut Negoi
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Trang Huyen Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Son Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | | | - Dina Nur Anggraini Ningrum
- Public Health Department, Universitas Negeri Semarang, Kota Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | | | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- Independent Consultant, Accra, Ghana
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
| | - Olanrewaju Oladimeji
- HAST, Human Sciences Research Council, Durban, South Africa
- School of Public Health, Faculty of Health Sciences, University of Namibia, Osakhati, Namibia
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pedro R Olivares
- Institute of Physical Activity and Health, Autonomous University of Chile, Talca, Chile
| | - Heather M Orpana
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Stanislav S Otstavnov
- Analytical Center, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Committee for the Comprehensive Assessment of Medical Devices and Information Technology, Health Technology Assessment Association, Moscow, Russia
| | - Mahesh P A
- Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
| | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Population Health Department, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Konrad Pesudovs
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
- Department of Psychiatry, Department of Epidemiology, Columbia University, New York City, New York, USA
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Swayam Prakash
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando, Florida, USA
- College of Graduate Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Anwar Rafay
- Department of Epidemiology & Biostatistics, Contech School of Public Health, Lahore, Pakistan
| | - Alireza Rafiei
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavash Rahimi
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Aziz Rahman
- School of Nursing and Healthcare Professions, Federation University, Heidelberg, Victoria, Australia
- National Centre for Farmer Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, India
- Department of Economics, University of Göttingen, Göttingen, Germany
| | - Kiana Ramezanzadeh
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Academic Public Health Department, Public Health England, London, UK
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, UK
- University College London Hospitals, London, UK
| | - Andre M N Renzaho
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- Organization for the Prevention of Blindness, Paris, France
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- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Gholamreza Roshandel
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Yogesh Damodar Sabde
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Basema Saddik
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yahya Salimi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Inbal Salz
- Health and Disability Intelligence Group, Ministry of Health, Wellington, New Zealand
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Juan Sanabria
- Department of Surgery, Marshall University, Huntington, West Virginia, USA
- Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lidia Sanchez Riera
- Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Institute of Bone and Joint Research, University of Sydney, Syndey, New South Wales, Australia
| | - Milena M Santric Milicevic
- Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
- Centre-School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
| | - Maheswar Satpathy
- UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
- Udyam-Global Association for Sustainable Development, Bhubaneswar, India
| | - Monika Sawhney
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Susan M Sawyer
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Mete Saylan
- Market Access Department, Bayer, Istanbul, Turkey
| | - Ione J C Schneider
- School of Health Sciences, Federal University of Santa Catarina, Ararangua, Brazil
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehran Shams-Beyranvand
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Morteza Shamsizadeh
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aziz Sheikh
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Division of General Internal Medicine and Primary Care, Harvard University, Boston, Massachusetts, USA
| | - Jiabin Shen
- Center for Pediatric Trauma Research, Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ivy Shiue
- Institute of Medical Epidemiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Medicine Service, US Department of Veteran Affairs, Birmingham, Alabama, USA
| | - Dhirendra Narain Sinha
- Department of Epidemiology, School of Preventive Oncology, Patna, India
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Adauto Martins Soares Filho
- Department of Diseases and Noncommunicable Diseases and Health Promotion, Federal Ministry of Health, Brasilia, Brazil
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Sergey Soshnikov
- Department of Research Development, Federal Research Institute for Health Organization and Informatics of the Ministry of Health (FRIHOI), Moscow, Russia
| | - Ireneous N Soyiri
- Hull York Medical School, University of Hull, Hull City, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Vladimir I Starodubov
- Federal Research Institute for Health Organization and Informatics of the Ministry of Health (FRIHOI), Moscow, Russia
| | - Dan J Stein
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark A Stokes
- Department of Psychology, Deakin University, Burwood, Victoria, Australia
| | | | - Jacob E Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Bryan L Sykes
- Department of Criminology, Law and Society, University of California Irvine, Irvine, California, USA
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia, Valencia, Spain
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
| | - Karen M Tabb
- School of Social Work, University of Illinois, Urbana, Illinois, USA
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gizachew Assefa Tessema
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jarnail Singh Thakur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Khanh Bao Tran
- Molecular Medicine and Pathology Department, University of Auckland, Auckland, New Zealand
- Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
| | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Elena Varavikova
- Central Research Institute of Cytology and Genetics, Federal Research Institute for Health Organization and Informatics of the Ministry of Health (FRIHOI), Moscow, Russia
| | - Ana Maria Nogales Vasconcelos
- Department of Statistics, University of Brasília, Brasília, Brazil
- Directorate of Social Studies and Policies, Federal District Planning Company, Brasília, Brazil
| | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Occupational Health Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Vasily Vlassov
- Department of Health Care Administration and Economics, National Research University Higher School of Economics, Moscow, Russia
| | - Yasir Waheed
- Foundation University Medical College, Foundation University, Islamabad, Pakistan
| | - Yuan-Pang Wang
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Tissa Wijeratne
- Department of Psychology and Counselling, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
| | - Andrea Sylvia Winkler
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Priyanka Yadav
- Centre for the Study of Regional Development, Jawahar Lal Nehru University, New Delhi, India
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Paul Yip
- Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Engida Yisma
- School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mustafa Z Younis
- Health Economics & Finance, Jackson State University, Jackson, Mississippi, USA
- School of Medicine, Tsinghua University, Beijing, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Shamsa Zafar
- Department of Obstetrics & Gynaecology, A.C.S. Medical College and Hospital, Islamabad, Pakistan
| | - Zoubida Zaidi
- Department of Epidemiology, University Hospital of Setif, Setif, Algeria
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Sanjay Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- University of Melbourne, Melbourne, Queensland, Australia
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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Tau T, Kelly A, lekgwara P. Predicting outcome in patients with traumatic brain injury who undergo a decompressive craniectomy at a single academic center in Pretoria, South Africa. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Schie KE, Spies E, Hyams LB, Singh S, Bell NC, Vallabhjee AL, Hazle M, Chatzkelowitz K, Maposa I. Paediatric dysphagia within the context of South Africa's quadruple burden of disease, seen at a tertiary level hospital. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:466-474. [PMID: 31672066 DOI: 10.1080/17549507.2019.1669710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: To inform service provision, this study explored feeding and swallowing difficulties in children within the context of South Africa's quadruple burden of disease (BOD) (i.e. conditions characterised as communicable, non-communicable, maternal and/or perinatal and trauma).Method: A retrospective chart review of 1432 paediatric inpatients (under 12 years of age) who met the inclusion criteria of presenting with dysphagia and being referred for speech-language pathology services was conducted.Result: Participants with diagnoses within the maternal and/or perinatal BOD category were noted most frequently (61.2%), followed by non-communicable (59.7%), communicable (43.4%) and trauma (4.2%). The majority of participants were under 1 year of age (82.2%) and 56.2% presented with comorbidities in multiple BOD categories. Mortality was 5.9%, with a higher rate (67.7%) in more complex cases. Mortality was associated with non-communicable BOD (p = 0.001), and maternal and/or perinatal BOD (p = 0.003). Pharyngeal phase swallowing difficulties were a significant risk for mortality (OR = 2.96; 95% CI: 1.01-8.65, p = 0.047).Conclusion: The majority of children with dysphagia presented with multiple comorbidities and were at high risk for mortality. Education and service delivery models should be designed to improve health outcomes and reduce mortality rates.
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Affiliation(s)
- Kathryn E Schie
- Speech Therapy & Audiology Department, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elizca Spies
- Speech Therapy & Audiology Department, Chris Hani Baragwanath Academic Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Leanne B Hyams
- Speech Therapy & Audiology Department, Chris Hani Baragwanath Academic Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Shajila Singh
- Division of Communication Sciences and Disorders, University of Cape Town, Cape Town, Western Cape, South Africa
- Northwestern University, Evanston, IL, USA
| | - Nicoll C Bell
- Speech Therapy & Audiology Department, Chris Hani Baragwanath Academic Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Annika L Vallabhjee
- Speech Therapy & Audiology Department, Chris Hani Baragwanath Academic Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Melissa Hazle
- Speech Therapy & Audiology Department, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Kelly Chatzkelowitz
- Speech Therapy & Audiology Department, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Innocent Maposa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Adeniji AA, Mabuza LH, Titus E. Magnitude, trends and prevention of road traffic accidents in the Republic of South Africa. S Afr Fam Pract (2004) 2020; 62:e1-e4. [PMID: 32501040 PMCID: PMC8378122 DOI: 10.4102/safp.v62i1.5032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/04/2022] Open
Abstract
Road traffic injuries (RTIs) constitute one of the five major disease burdens in South Africa with high mortality and morbidity. Thus far, the scientific enquiry into this burden has not been accompanied by successful government efforts to meet the challenge. Currently, more than 1.2 million people die and 20–50 million are with disabilities annually country-wide from RTIs. While there is a progressive reduction in mortality related to human immunodeficiency virus (HIV) conditions as a result of interventions, the mortality from RTI is seen to be progressively worsening as a result of increasing motorisation. There are disparities in the burden of RTI across different countries, with low- and middle-income countries bearing the highest burden. In Africa, 24.1 per 100 000 people die annually from RTI compared to 10.3 per 100 000 people in European countries. This opinion article investigates the magnitude, trends and prevention of RTI in South Africa.
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Affiliation(s)
- Adeloye A Adeniji
- Department of Family Medicine, Stellenbosch University, Cape Town, South Africa; and, Ceres Hospital, Ceres, Cape Winelands District, Ceres, Western Cape.
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Lourens A, Parker R, Hodkinson P. Prehospital acute traumatic pain assessment and management practices in the Western Cape, South Africa: a retrospective review. Int J Emerg Med 2020; 13:21. [PMID: 32370807 PMCID: PMC7201999 DOI: 10.1186/s12245-020-00278-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/07/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Trauma is a common aetiology of acute pain in the emergency setting, and traumatic injuries have been recognised as a global public health crisis leading to numerous deaths and disabilities. This study aimed to identify the prevalence of acute pain among high acuity trauma patients presenting to a public sector emergency medical service and to describe prehospital acute traumatic pain assessment and management practices amongst emergency care providers in the Western Cape Province, South Africa. METHODS A retrospective review of electronic patient care reports of trauma patients treated by the South African Western Cape Emergency Medical Services between January 1 and December 31, 2017 was conducted. Stratified random sampling was utilised to select 2401 trauma patients out of 24,575 that met the inclusion criteria. RESULTS Of the 2401 patients reviewed, 435 (18.1%) had a pain score recorded, of which 423 (97.2%) were experiencing pain. An additional 8.1% (n = 194) of patients had pain or tenderness mentioned in the working diagnosis but no pain score noted. Eighty-one (18.6%) patients experienced mild pain, 175 (40.2%) moderate pain and 167 (38.2%) severe pain. No association was found between a pain score recorded and age group (≤ 14 versus > 14 years) (p = 0.649) or gender (p = 0.139). Only 7.6% of patients with moderate-to-severe pain and 2.8% of all trauma patients received any form of analgesic medication. No association was found between the administration of analgesia and age group (≤ 14 versus > 14 years) (p = 0.151) or gender (p = 0.054). Patients were more likely to receive analgesia if they had a pain score recorded (p < 0.001), were managed by advanced life support practitioners (p < 0.001) or had severe pain (p = 0.001). CONCLUSION Acute trauma pain assessment and management practices in this prehospital cohort are less well established than reported elsewhere and whether this reflects emergency care training, institutional culture, scopes of practice or analgesic resources, requires further research. Emergency medical services need to monitor and promote quality pain care, enhance pain education and ensure that all levels of emergency care providers have access to analgesic medication approved for prehospital use. Clear and rational guidelines would enable better pain management by all cadres of providers, for all levels of pain.
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Affiliation(s)
- Andrit Lourens
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa.
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa
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Lourens A, Hodkinson P, Parker R. Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: a knowledge, attitudes and practices survey. BMC Emerg Med 2020; 20:31. [PMID: 32345230 PMCID: PMC7187518 DOI: 10.1186/s12873-020-00315-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between healthcare providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results Responses of 100 participants were included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD 8.13) years and the mean years’ experience 10.02 (SD 6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last 2 years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD 15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.
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Affiliation(s)
- Andrit Lourens
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa.
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town (UCT), Cape Town, South Africa
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El-Gabri D, Toomey N, Gil NM, de Oliveira AC, Calvo PRS, Tchuisseu YP, Williams S, Andrade L, Vissoci JRN, Staton C. Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil. Front Public Health 2020; 8:66. [PMID: 32269983 PMCID: PMC7109310 DOI: 10.3389/fpubh.2020.00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Previous research has corroborated a high burden of alcohol-related injury in Brazil and the presence of socioeconomic disparities among the injured. Yet, individual-level data is scarce. To fill this gap, we examined the association between demographic and socioeconomic characteristics with non-fatal alcohol-related injury in Maringá, Brazil. Methods: We used household survey data collected during a 2015 cross-sectional study. We conducted univariate and multivariate analyses to evaluate associations of demographic (age, gender, race) and socioeconomic characteristics (employment, education, income) with non-fatal alcohol-related injury. Results: Of the 995 participants who reported injuries, 62 (6.26%) were alcohol-related. Fifty-three (85%) alcohol-related injuries were reported by males. Multivariate analysis indicated being male (OR = 5.98 95% CI = 3.02, 13.28), 15–29 years of age (OR = 3.62 95% CI = 1.72, 7.71), and identifying as Black (OR = 2.38 95% CI = 1.09, 4.95) were all significantly associated with increased likelihood of reporting an alcohol-related injury, whereas unemployment was significantly associated with decreased likelihood of reporting an alcohol-related injury (OR = 0.41 95% CI = 0.18, 0.88). Conclusion: Our findings suggest that in Maringá, being male, between the ages of 15 and 29, employed, or identifying as Black were characteristics associated with a higher risk for non-fatal alcohol-related injury. Individual level data, such as ours, should be considered in combination with area-level and country-level data when developing evidence-based public-health policies.
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Affiliation(s)
- Deena El-Gabri
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Nelly Moraes Gil
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | | | | | | | - Sarah Williams
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Luciano Andrade
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
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59
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Klingberg S, van Sluijs EMF, Draper CE. "The thing is, kids don't grow the same": Parent perspectives on preschoolers' weight and size in Soweto, South Africa. PLoS One 2020; 15:e0231094. [PMID: 32251449 PMCID: PMC7135213 DOI: 10.1371/journal.pone.0231094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/16/2020] [Indexed: 12/01/2022] Open
Abstract
The prevalence of overweight and obesity is high among preschool age (3-5 years) children in South Africa, and children in urban low-income settings are particularly at risk. A better understanding of how parents or caregivers of young children perceive children's weight and size, as well as contextual factors influencing perceptions, is needed to inform interventions. The aim of this study was to examine how parents of preschool children in Soweto, South Africa, view childhood obesity, and to situate these perspectives in the context of the home environment in which preschool age children in Soweto live. Semi-structured in-depth interviews were conducted with 16 parents in four neighbourhoods of Soweto. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following a contextualist approach. Three themes were developed: growing differently, the 'right' way to be, and weight is not health. These themes capture parents' views on complex and reportedly inevitable causes of obesity, ideas about acceptable and preferred body sizes, and the low priority of weight per se compared to health. The findings suggest that childhood obesity prevention in South Africa needs to be done in a non-stigmatising way that recognises environmental and contextual factors, such as parents' limited sense of agency in relation to their children's health and weight, and concrete resource constraints. Environmental barriers to healthy behaviours need to be addressed in order to overcome the coexisting challenges of childhood undernutrition and obesity in urban low-income South African settings.
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Affiliation(s)
- Sonja Klingberg
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Esther M. F. van Sluijs
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E. Draper
- SAMRC Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Excess Mortality Due to External Causes in Women in the South African Mining Industry: 2013-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061875. [PMID: 32183181 PMCID: PMC7143399 DOI: 10.3390/ijerph17061875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/28/2022]
Abstract
Mining is a recognized high-risk industry with a relatively high occurrence of occupational injuries and disease. In this study, we looked at the differences in mortality between male and female miners in South Africa. Data from Statistics South Africa regarding occupation and cause of death in the combined years 2013–2015 were analyzed. Proportional mortality ratios (PMRs) were calculated to investigate excess mortality due to external causes of death by sex in miners and in manufacturing laborers. Results: Women miners died at a significantly younger age on average (44 years) than all women (60 years), women manufacturers (53 years), and male miners (55 yrs). There was a significantly increased proportion of deaths due to external causes in women miners (12.4%) compared to all women (4.8%) and women manufacturers (4.6%). Significantly increased PMRs were seen in car occupant accidents (467, 95% confidence interval (CI) 151–1447), firearm discharge (464, 95% CI 220–974), and contact with blunt objects (2220 95% CI 833–5915). Conclusion: This descriptive study showed excess deaths in women miners due to external causes. Road accidents, firearm discharge, and contact with blunt objects PMRs were significantly increased. Further research is required to confirm the underlying reasons for external causes of death and to develop recommendations to protect women miners.
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61
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Mould-Millman NK, Dixon J, Lamp A, de Vries S, Beaty B, Finck L, Colborn K, Moodley K, Skenadore A, Glasgow RE, Havranek EP, Bebarta VS, Ginde AA. A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting. Pilot Feasibility Stud 2019; 5:143. [PMID: 31844551 PMCID: PMC6896719 DOI: 10.1186/s40814-019-0536-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background Prehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. High-Efficiency EMS Training (HEET) is an innovative training and sensitization program conducted during clinical shifts in ambulances. We assess the feasibility of implementing EMS-TruShoC using the HEET strategy, and feasibility of assessing implementation and clinical outcomes. Findings will inform a main trial. Methods We conducted a single-site, prospective cohort, multi-methods pilot implementation study in Western Cape EMS system of South Africa. Of the 120 providers at the study site, 12 were trainers and the remaining were eligible learners. Feasibility of implementation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Feasibility of assessing clinical outcomes was assessed using shock indices and clinical quality of care scores, collected via abstraction of patients' prehospital trauma charts. Thresholds for progression to a main trial were developed a priori. Results The average of all implementation indices was 83% (standard deviation = 10.3). Reach of the HEET program was high, with 84% learners completing at least 75% of training modules. Comparing the proportion of learners attaining perfect scores in post- versus pre-implementation assessments, there was an 8-fold (52% vs. 6%) improvement in knowledge, 3-fold (39% vs. 12%) improvement in skills, and 2-fold (42% vs. 21%) increase in self-efficacy. Clinical outcomes data were successfully calculated-there were clinically significant improvements in shock indices and quality of prehospital trauma care in the post- versus pre-implementation phases. Adoption of HEET was good, evidenced by 83% of facilitator participation in trainings, and 100% of surveyed stakeholders indicating good programmatic fit for their organization. Stakeholders responded that HEET was a sustainable educational solution that aligned well with their organization. Implementation fidelity was very high; 90% of the HEET intervention and 77% of the implementation strategy were delivered as originally planned. Participants provided very positive feedback, and explained that on-the-job timing enhanced their participation. Maintenance was not relevant to assess in this pilot study. Conclusions We successfully implemented the EMS-TruShoC educational intervention using the HEET training strategy in a single-site pilot study conducted in a low-resource international setting. All clinical outcomes were successfully calculated. Overall, this pilot study suggests high feasibility of our future, planned experimental trial.
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Affiliation(s)
- Nee-Kofi Mould-Millman
- 1University of Colorado, School of Medicine, Aurora, CO USA.,2Department of Emergency Medicine, University of Colorado, School of Medicine, 12401 E. 17th Ave, B215, Aurora, CO 80045 USA
| | - Julia Dixon
- 1University of Colorado, School of Medicine, Aurora, CO USA.,2Department of Emergency Medicine, University of Colorado, School of Medicine, 12401 E. 17th Ave, B215, Aurora, CO 80045 USA
| | - Andrew Lamp
- 1University of Colorado, School of Medicine, Aurora, CO USA
| | - Shaheem de Vries
- Western Cape Government Health, Emergency Medical Services, Bellville, Cape Town, South Africa
| | - Brenda Beaty
- 4Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO USA
| | - Lani Finck
- 1University of Colorado, School of Medicine, Aurora, CO USA.,2Department of Emergency Medicine, University of Colorado, School of Medicine, 12401 E. 17th Ave, B215, Aurora, CO 80045 USA
| | - Kathryn Colborn
- 5Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO USA
| | - Kubendhren Moodley
- College of Emergency Care, Western Cape Government, Bellville, Western Cape South Africa
| | - Amanda Skenadore
- 4Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO USA
| | - Russell E Glasgow
- 4Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO USA
| | - Edward P Havranek
- 1University of Colorado, School of Medicine, Aurora, CO USA.,4Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO USA.,7Department of Medicine, Denver Health Medical Center, Denver, CO USA
| | - Vikhyat S Bebarta
- 1University of Colorado, School of Medicine, Aurora, CO USA.,2Department of Emergency Medicine, University of Colorado, School of Medicine, 12401 E. 17th Ave, B215, Aurora, CO 80045 USA.,8Office of the Chief Scientist, 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX USA
| | - Adit A Ginde
- 1University of Colorado, School of Medicine, Aurora, CO USA.,2Department of Emergency Medicine, University of Colorado, School of Medicine, 12401 E. 17th Ave, B215, Aurora, CO 80045 USA
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Mokwena K. Social and public health implications of the legalisation of recreational cannabis: A literature review. Afr J Prim Health Care Fam Med 2019; 11:e1-e6. [PMID: 31793317 PMCID: PMC6890535 DOI: 10.4102/phcfm.v11i1.2136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/23/2019] [Accepted: 08/09/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND After many years of legal struggles for the legalisation of recreational use of cannabis, the Constitutional Court of South Africa ruled in favour of the applicants in September 2018. Although the ruling issued caution regarding the social challenges accompanying this legalisation, it did not address how the country would deal with the societal consequences of this ruling. AIM The aim of this article was to discuss the social and public health implications of the legalisation of recreational cannabis on South Africa. METHODS Literature review on the social, health and legal impacts of legalisation of cannabis, considering experiences of other countries that have legalised cannabis. RESULTS The legalisation brings a range of significant negative consequences, which include an expected increase in the number of users and the subsequent undesirable effects on the physical, mental and social health of communities. CONCLUSION In terms of financial, infrastructural and human resources, South Africa cannot afford the consequences of the legalisation of recreational cannabis. Poor communities, children and the youth will carry the brunt of the scourge of cannabis use.
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Affiliation(s)
- Kebogile Mokwena
- Department of Social and Behavioural Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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63
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Soeker MS, Darries Z. The experiences of women with traumatic brain injury about the barriers and facilitators experienced after vocational rehabilitation in the Western Cape Metropole, South Africa. Work 2019; 64:477-486. [PMID: 31658081 DOI: 10.3233/wor-193009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Traumatic Brain Injury (TBI) is a serious global public health problem. Globally and annually, at least 10 million individuals live with TBI that is serious enough to result in death or hospitalisationOBJECTIVE:This study aimed to explore and describe the experiences of women with traumatic brain injury, in their work environments utilising the Model of Occupational Self-efficacy as a vocational rehabilitation approachMETHOD:Ten females with mild to moderate traumatic brain injury participated in the study. Semi-structured interviews were conducted and data were analysed utilising a qualitative approach to elucidate themes. Semi-structured interviews were also conducted with two occupational therapists who served as key informants. RESULTS Two themes emerged depicting the participants' experiences and perceptions of barriers and facilitators which influenced their return to work: (1) Barriers to work participation for women with TBI, 2) Re-establishing a worker identity by means of vocational rehabilitation. CONCLUSION Both personal and environmental factors emerged as hindrances to returning to work for women with traumatic brain injury. Vocational rehabilitation proved successful in establishing a worker identity amongst participants; however, particular focus should be placed on the function-dysfunction continuum of the process of work place integration to further develop and enhance sustainable return to work programmes for women with traumatic brain injury.
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Affiliation(s)
| | - Zareena Darries
- Occupational Therapy Department, University of the Western Cape, South Africa
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64
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Mathews S, Abrahams N, Martin LJ, Lombard C, Jewkes R. Homicide pattern among adolescents: A national epidemiological study of child homicide in South Africa. PLoS One 2019; 14:e0221415. [PMID: 31465464 PMCID: PMC6715279 DOI: 10.1371/journal.pone.0221415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background Large numbers of young people die yearly due to homicide, but little is known about homicide during adolescence. Research primarily focuses on youth violence among young men and masks important gender-related factors inherent in the adolescent age group. Although young women are less likely to be victims of homicide, violence against women is an important form of violence experienced during adolescence. In this paper, we describe the prevalence of and gender difference in adolescent homicide in South Africa in 2009. Methods We conducted a retrospective national mortuary-based study to identify all child homicides (boys and girls < 18 years) in 2009 in a proportionate sample of mortuaries. Victim, perpetrator and crime data were collected in three phases: cases were identified from the mortuary register, the autopsy report and from police interviews. In this paper we focus on the adolescent group, aged 10 to 17 years. Findings We identified 674 (95% CI: 520–823) adolescent homicides for 2009, with more male (520) than female (154) homicides. This gender disparity increased as children aged, with the male homicide rate 27.9/100 000 population (95% CI: 20.3–35.5), nearly 5 times the female rate (4.5:1) of 6.5/ 100 000 population (95% CI: 4.7–8.2) in older adolescents (15–17 year old). Adolescent males were significantly more likely (61.2%) to die in a public space compared to female adolescents (39.3%) but more adolescent females (48.4%) died at home compared to adolescent males (32.9%). Adolescent females (42.1%) were mainly killed by a family member or intimate partner while adolescent males were predominantly (58%) killed by an acquaintance. Conclusion We found a distinct gender pattern for adolescent homicide in South Africa. This pattern appears to be driven by gender norms that support violence. South Africa requires an investment in developing evidence informed interventions to reduce violence.
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Affiliation(s)
- Shanaaz Mathews
- Children’s Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Naeemah Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- The Division of Social and Behavioural Sciences: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lorna J. Martin
- Forensic Pathology Services, Western Cape and Forensic Medicine & Toxicology, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
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Machine learning without borders? An adaptable tool to optimize mortality prediction in diverse clinical settings. J Trauma Acute Care Surg 2019; 85:921-927. [PMID: 30059457 DOI: 10.1097/ta.0000000000002044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mortality prediction aids clinical decision making and is necessary for quality improvement initiatives. Validated metrics rely on prespecified variables and often require advanced diagnostics, which are unfeasible in resource-constrained contexts. We hypothesize that machine learning will generate superior mortality prediction in both high-income and low- and middle-income country cohorts. METHODS SuperLearner, an ensemble machine-learning algorithm, was applied to data from three prospective trauma cohorts: a highest-activation cohort in the United States, a high-volume center cohort in South Africa (SA), and a multicenter registry in Cameroon. Cross-validation was used to assess model discrimination of discharge mortality by site using receiver operating characteristic curves. SuperLearner discrimination was compared with standard scoring methods. Clinical variables driving SuperLearner prediction at each site were evaluated. RESULTS Data from 28,212 injured patients were used to generate prediction. Discharge mortality was 17%, 1.3%, and 1.7% among US, SA, and Cameroonian cohorts. SuperLearner delivered superior prediction of discharge mortality in the United States (area under the curve [AUC], 94-97%) and vastly superior prediction in Cameroon (AUC, 90-94%) compared with conventional scoring algorithms. It provided similar prediction to standard scores in the SA cohort (AUC, 90-95%). Context-specific variables (partial thromboplastin time in the United States and hospital distance in Cameroon) were prime drivers of predicted mortality in their respective cohorts, whereas severe brain injury predicted mortality across sites. CONCLUSIONS Machine learning provides excellent discrimination of injury mortality in diverse settings. Unlike traditional scores, data-adaptive methods are well suited to optimizing precise site-specific prediction regardless of diagnostic capabilities or data set inclusion allowing for individualized decision making and expanded access to quality improvement programming. LEVEL OF EVIDENCE Prognostic and therapeutic, level II and III.
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Maart S, Amosun S, Jelsma J. Disability prevalence-context matters: A descriptive community-based survey. Afr J Disabil 2019; 8:512. [PMID: 31534919 PMCID: PMC6739523 DOI: 10.4102/ajod.v8i0.512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 02/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is increasing interest in the collection of globally comparable disability data. Context may influence not only the rates but also the nature of disability, thus locally collected data may be of greater use in service delivery planning than national surveys. OBJECTIVES The objective of this article was to explore the extent to which two areas, both under-resourced but geographically and socially distinct, differed in terms of the prevalence and patterns of disability. METHOD A cross-sectional descriptive survey design was utilised, using stratified cluster sampling in two under-resourced communities in the Western Cape, South Africa. Nyanga is an informal urban settlement in Cape Town and Oudtshoorn is a semi-rural town. The Washington Group Short Set of questions was used to identify persons with disabilities (PWD), and a self-developed questionnaire obtained socio-demographic information. RESULTS The overall prevalence of disability was 9.7% (confidence intervals [CIs] 9.7-9.8) and the proportion of PWD was significantly different between the two sites (Chi-Sq = 129.5, p < 0.001). In the urban area, the prevalence rate of any disability was 13.1% (CIs 12.0-14.3) with 0.3% (CIs 0.1-0.6) reporting inability to perform any function at all. In contrast, the semi-rural community had a lower overall prevalence rate of 6.8% (CIs 6.0% - 7.8%) but a higher rate of those unable to perform any function: 1% (CIs 0.07-1.4). Disability was associated with gender, age, unemployment and lower income status in both areas. CONCLUSION Deprived areas tend to show higher disability prevalence rates than the National Census estimates. However, the discrepancy in prevalence and patterns of disability between the two under-resourced areas indicates the need for locally specific data when planning health interventions.
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Affiliation(s)
- Soraya Maart
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Seyi Amosun
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jelsma
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
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Sui X, Massar K, Kessels LTE, Reddy PS, Ruiter RAC, Sanders-Phillips K. Exposure to violence across multiple contexts and health risk behaviours in South African adolescents: the moderating role of emotion dysregulation. Psychol Health 2019; 35:144-162. [PMID: 31273997 DOI: 10.1080/08870446.2019.1637521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The association between violence exposure and health risk behaviours in South African adolescents, and the moderating role of emotion dysregulation were investigated. Design: A multi-ethnic sample of adolescents (N = 925: boy: 47.3%, girl: 52.7%, M age = 16 years, SD = 1.54) completed a survey. Main outcome measures: Violence exposure across different contexts (home-, school-, community-, political victimisation), emotion dysregulation (inability to regulate sadness and anger) and a composite measure of health risk behaviours (smoking, substance use, risky sexual behaviour) were examined. Results: Boys reported more risk behaviours than girls, t (844) = 5.25, p < 0.001. Direct community victimisation was a predictor for boys' risk behaviours, B = 0.22, p < 0.001. Indirect school victimisation and direct community victimisation were predictors for girls' risk behaviours, B's = 0.19, p's < 0.01. Girls reported higher emotion dysregulation than boys, t (748) = -2.95, p < 0.01. Only for girls, emotion dysregulation moderated the associations of indirect home victimisation, B = 16, p < 0.01, and direct community victimisation, B = 15, p < 0.05, with risk behaviours. Conclusion: Interventions may target emotion regulation skills, particularly for girls, to enhance resilience to the negative effects of violence on behaviours.
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Affiliation(s)
- Xincheng Sui
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Karlijn Massar
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Loes T E Kessels
- Education office, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Priscilla S Reddy
- Population Health, Health Systems and Innovations, Human Sciences Research Council, Cape Town, South Africa
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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Adeloye D, Bowman K, Chan KY, Patel S, Campbell H, Rudan I. Global and regional child deaths due to injuries: an assessment of the evidence. J Glob Health 2019; 8:021104. [PMID: 30675338 PMCID: PMC6317703 DOI: 10.7189/jogh.08.021104] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Injuries result in substantial number of deaths among children globally. The
burden across many settings is largely unknown. We estimated global and
regional child deaths due to injuries from publicly available evidence. Methods We searched for community-based studies and nationally representative data
reporting on child injury deaths published after year 1990 from CINAHL,
EMBASE, IndMed, LILACS, Global Health, MEDLINE, SCOPUS, and Web of Science.
Specific and all-cause mortality due to injuries were extracted for three
age groups (0-11 months, 1-4 years, and 0-4 years). We conducted
random-effects meta-analysis on extracted crude estimates, and developed a
meta-regression model to determine the number of deaths due to injuries
among children aged 0-4 years globally and across the World Health
Organization (WHO) regions. Results Twenty-nine studies from 16 countries met the selection criteria. A total of
230 data-points on 15 causes of injury deaths were retrieved from all
studies. Eighteen studies were rated as high quality, although heterogeneity
was high (I2 = 99.7%,
P < 0.001) reflecting variable data
sources and study designs. For children aged 0-11 months, the pooled crude
injury mortality rate was 29.6 (95% confidence interval
(CI) = 21.1-38.1) per 100 000 child population, with
asphyxiation being the leading cause of death (neonatal) at 189.1 (95%
CI = 142.7-235.4) per 100 000 followed by suffocation
(post-neonatal) at 18.7 (95% CI = 11.8-25.7) per
100 000. Among children aged 1-4 years, the pooled crude injury
mortality rate was 32.7 (95% CI = 27.3-38.1) per
100 000, with traffic injuries and drowning the leading causes of
deaths at 10.8 (95% CI = 8.9-12.8) and 8.8 (95%
CI = 7.5-10.2) per 100 000, respectively. Among
children under five years, the pooled injury mortality rate was 37.7 (95%
CI = 32.7-42.7) per 100 000, with traffic injuries and
drowning also the leading causes of deaths at 10.3 (95%
CI = 8.8-11.8) and 8.9 (95% CI = 7.8-9.9) per
100 000 respectively. When crude mortality changes over age, WHO
regions, and study period were accounted for in our model, we estimated that
in 2015 there were 522 167 (95%
CI = 395 823-648 630) deaths among children aged
0-4 years, with South East Asia (SEARO) recording the highest number of
deaths at 195 084 (95% CI = 159476-230502), closely
followed by the Africa region (AFRO) with 176523 (95%
CI = 115 040-237 831) deaths. Globally, traffic
injuries and drowning were the leading causes of under-five injury
fatalities in 2015 with 142 661 (22.0/100 000) and
123 270 (19.0/100 000) child deaths, respectively. The
exception being burns in AFRO with 57 784 deaths
(38.6/100 000). Conclusions Varying study designs, case definitions, and particularly limited country
representation from Africa and South-East Asia (where we reported higher
estimates), imply a need for more studies for better population
representative estimates. This study may have however provided improved
understanding on child injury death profiles needed to guide further
research, policy reforms and relevant strategies globally.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research, University of Edinburgh, Medical School, Edinburgh, Scotland, UK
| | - Kirsty Bowman
- Centre for Global Health Research, University of Edinburgh, Medical School, Edinburgh, Scotland, UK
| | - Kit Yee Chan
- Centre for Global Health Research, University of Edinburgh, Medical School, Edinburgh, Scotland, UK
| | - Smruti Patel
- Centre for Global Health Research, University of Edinburgh, Medical School, Edinburgh, Scotland, UK
| | - Harry Campbell
- Centre for Global Health Research, University of Edinburgh, Medical School, Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Global Health Research, University of Edinburgh, Medical School, Edinburgh, Scotland, UK
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Zaidi AA, Dixon J, Lupez K, De Vries S, Wallis LA, Ginde A, Mould-Millman NK. The burden of trauma at a district hospital in the Western Cape Province of South Africa. Afr J Emerg Med 2019; 9:S14-S20. [PMID: 31073509 PMCID: PMC6497867 DOI: 10.1016/j.afjem.2019.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/19/2018] [Accepted: 01/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa bears a disproportionate burden of mortality from trauma. District hospitals, although not trauma centres, play a critical role in the trauma care system by serving as frontline hospitals. However, the clinical characteristics of patients receiving trauma care in African district hospitals remains under-described and is a barrier to trauma care system development. We aim to describe the burden of trauma at district hospitals by analysing trauma patients at a prototypical district hospital emergency centre. METHODS An observational study was conducted in August, 2014 at Wesfleur Hospital, a district facility in the Western Cape Province of South Africa. Data were manually collected from a paper registry for all patients visiting the emergency centre. Patients with trauma were selected for further analysis. RESULTS Of 3299 total cases, 565 (17.1%) presented with trauma, of which 348 (61.6%) were male. Of the trauma patients, 256 (47.6%) were ages 18-34 and 298 (52.7%) presented on the weekend. Intentional injuries (assault, stab wounds, and gunshot wounds) represented 251 (44.4%) cases of trauma. There were 314 (55.6%) cases of injuries that were unintentional, including road traffic injuries. There were 144 (60%) intentionally injured patients that arrived overnight (7pm-7am). Patients with intentional injuries were three times more likely to be transferred (to higher levels of care) or admitted than patients with unintentional injuries. CONCLUSION This district hospital emergency centre, with a small complement of non-EM trained physicians and no trauma surgical services, cared for a high volume of trauma with over half presenting on weekends and overnight when personnel are limited. The high volume and rate of admission/ transfer of intentional injuries suggests the need for improving prehospital trauma triage and trauma referrals. The results suggest strengthening trauma care systems at and around this resource-limited district hospital in South Africa may help alleviate the high burden of post-trauma morbidity and mortality.
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Affiliation(s)
- Ali A. Zaidi
- Indiana University, School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States
| | - Julia Dixon
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
| | - Kathryn Lupez
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States
| | - Shaheem De Vries
- Western Cape Government EMS, Bellville, Western Cape Province, South Africa
| | - Lee A. Wallis
- University of Cape Town, Division of Emergency Medicine, Cape Town, Western Cape Province, South Africa
- Western Cape Government EMS, Bellville, Western Cape Province, South Africa
| | - Adit Ginde
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
| | - Nee-Kofi Mould-Millman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
- University of Cape Town, Division of Emergency Medicine, Cape Town, Western Cape Province, South Africa
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70
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Huang JY, Majid F, Daku M. Estimating effects of Uber ride-sharing service on road traffic-related deaths in South Africa: a quasi-experimental study. J Epidemiol Community Health 2019; 73:263-271. [DOI: 10.1136/jech-2018-211006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/22/2018] [Accepted: 12/09/2018] [Indexed: 11/04/2022]
Abstract
BackgroundRoad traffic deaths are a substantial barrier to population health improvement in low-income and middle-income countries (LMICs). In South Africa, the road-traffic injury mortality (RTM) rate of 27 per 100 000 population is twice the global average, over 60% of which are alcohol-related. Recent US studies suggest the Uber ride-sharing service may reduce alcohol-related RTM, however RTM burden in the USA is relatively low and transport behaviours differ from LMICs.MethodsUsing certification data from all deaths occurring in South Africa in the years 2010–2014 (n=2 498 216), we investigated the relative change in weekly road traffic-related death counts between provinces which received Uber services (beginning in 2013) against those that did not using a difference-in-differences approach.ResultsWeekly road traffic-related deaths in provinces with Uber were lower following Uber introduction than in comparison provinces without Uber. The effect size was larger in the province which had Uber the longest (Gauteng) and among young adult males (aged 17–39 years). However, the absolute effects were very small (<2 deaths per year) and may coincide with seasonal variation.ConclusionsOverall, findings did not support either an increase or large decrease in province-level road traffic-related deaths associated with Uber introduction to South Africa. More localised investigations in South Africa and other LMICs are needed.
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71
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Sadiki MC, Radzilani-Makatu M, Zikhali MP. Acquired physical disability: Personal meanings in a rural South African setting. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2018.1547865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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72
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Chu KM, Karjiker P, Naidu P, Kruger D, Taylor A, Trelles M, Dominguez L, Rayne S. South African General Surgeon Preparedness for Humanitarian Disasters. World J Surg 2018; 43:973-977. [DOI: 10.1007/s00268-018-04881-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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73
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Aghamohamadi S, Jahangiri K, Kavousi A, Sayah Mofazali A. Analysis and Forecasting the Accident Mortality Trends in the Islamic Republic of Iran Applying Lee-Carter Model During the Years 2006 to 2035. Bull Emerg Trauma 2018; 6:341-348. [PMID: 30402524 PMCID: PMC6215062 DOI: 10.29252/beat-060412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To predict the accident mortality trend in next two decades in Iran. Methods: The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education of Iran during the years 2006 to 2015. The information was collected via death certificate, burial permit, and reporting forms. To forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1. Results: Based on the results, the highest percentage of all causes of death from accidents (in unintentional accidents) goes to transport accidents, and most top intentional accidents belonged to intentional self-harm. The trends of unintentional accidents in the whole population and both sexes have reduced from 2006 to 2035, such that the rate has reduced from 62.2 in 2006 to 12.1 per 100 thousand populations in 2035. It is anticipated that the causes of death due to intentional accidents with the rate of 8.86 in 2006, will be 1.89 (per 100,000 population) in the year 2035. Conclusion: Accident mortalities have a significant role in the deaths of Iranian population; therefore, to reduce the impact of accident mortality on society, a precise approach is needed to monitor the trends as well as preventing measures and increasing the safety standards.
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Affiliation(s)
| | - Katayoun Jahangiri
- Department of Health in Disasters and Emergency, School of Health, Safety, Environment (HSE), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Kavousi
- Department of Health in Disasters and Emergency, School of Health, Safety, Environment (HSE), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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74
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Maass P, Friedling LJ. Morphometric Analysis of the Neurocranium in an Adult South African Cadaveric Sample. J Forensic Sci 2018; 64:367-374. [PMID: 30129084 DOI: 10.1111/1556-4029.13878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
Abstract
Craniometric studies of South Africans yield high accuracies of sex and ancestry classification, but most assess only inter-group variation of Black and White individuals, excluding the highly heterogeneous Colored group, which constitute a significant proportion of the population. This study applied a geometric morphometric approach to the neurocrania of 774 Black, Colored, and White individuals to assess sex and ancestry estimation accuracy based on the detected morphological variation. Accuracies of 70% and 83% were achieved for sex and ancestry, respectively, with ancestry-related variation contributing the largest proportion of overall observed variation. Even when comparing the closely related Black and Colored groups, relatively high accuracies were obtained. It is thus recommended that a similar approach be used to develop a contemporary three-dimensional database, which can be used to objectively, reliably, and accurately classify unknown remains in the South African forensic context.
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Affiliation(s)
- Petra Maass
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State, 205 Nelson Mandela Drive, Park West, Bloemfontein, 9300, South Africa
| | - Louise Jacqui Friedling
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Morphometric analysis of the humerus in an adult South African cadaveric sample. Forensic Sci Int 2018; 289:451.e1-451.e9. [PMID: 29895429 DOI: 10.1016/j.forsciint.2018.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/15/2018] [Accepted: 04/20/2018] [Indexed: 11/23/2022]
Abstract
Recent studies using geometric morphometrics have shown that estimations of demographic parameters can be made using skeletal elements previously not thought useful for such purposes. This study used geometric morphometrics to assess humeral morphological variation in an adult South African sample, and evaluated the accuracy of sex and ancestry estimations based on this variation. Humeri of 1046 adult South African individuals (464 females, 582 males) were digitized. Data sets were rotated and scaled to a common centroid using Generalized Procrustes Analysis. Mean centroid sizes between groups were compared using parametric tests, while morphological variation was evaluated using multivariate analyses. Discriminant Function Analysis coupled with leave-one-out cross-validation tests were used to assess the reliability of sex and ancestry classifications based on this variation. Male humeri were relatively larger and presented with morphological features indicative of larger muscle mass and smaller carrying angles than females. White individuals had relatively larger but morphologically less robust humeri than Black or Coloured individuals, likely a reflection of both genetic and socio-economic differences between the groups as enforced under Apartheid law. When sex and ancestry were assessed together, similar variations were detected than when either parameter was individually assessed. Classification accuracy was relatively low when sex was independently assessed (73.3%), but increased when considered in conjunction with ancestry, indicating greater variation between-groups (ancestry) than within-groups. Ancestry estimation accuracies exceeded 80%, even for the highly diverse Coloured group. Classification accuracies of sex-ancestry groups all exceeded 76%. These results show that humerus morphological variation is present and may be used to estimate parameters, such as sex and ancestry, even in complex groups such as the Coloured sample of this study.
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76
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RANABHAT CL, PARK MB, KIM CB, KIM CS, JEONG HS, KOH SB, CHANG SJ. Influence of Key Health Related Indicators on Adult Mortality: Result from UN Member Countries. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:794-802. [PMID: 30087864 PMCID: PMC6077630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Adult mortality is associated with different demographic and behavioral risk factors including approaches to health care financing. Adult mortality rate significantly reflects the effectiveness of public health-related program and intervention. The aim of this study was to find strength of association between key health's related indicators and adult mortality rate. METHODS This cross-sectional study used 5 sets of data combined into one from different organizations of 193 countries using record linkage theory. Eleven key health-related indicators were taken as independent variables and adult mortality of male and female were dependent variables from 2010 to 2013. Average mortality for male and female was shown by means and standard deviations, raw association by Pearson correlation and strength of association by hierarchical linear regression. RESULTS The average adult mortality rate (AMR) of male was 0.209±0.106 and of female, 0.146 ±0.105 in years. In raw correlation, almost all health indicators were associated with AMR of male and female. In regression analysis, Universal Health Coverage (UHC) significantly reduced (male ∼0.43, female ∼0.30) adult mortality, in contrast, population growth significantly increased (male ∼ 0.37, female ∼0.43). Alcohol consumption per year increased AMR in male by 0.41 (P<0.01) and vaccination coverage (DPT 3) significantly reduced the AMR (0.26) in female. CONCLUSION It is necessary to extend the UHC in remaining countries and still a need to control the population where there is high population growth. Effectively control of alcoholic drink in male and full coverage of vaccination in childhood mitigates adult mortality. The UHC is ambitious goal for SDG and special attention should be provided nationally and globally.
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Affiliation(s)
- Chhabi Lal RANABHAT
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Gangwon-do, Korea, Health Science Foundations and Study Center, GPO–44600, Kathmandu, Nepal, Manmohan Institute of Health Science, Kathmandu, Nepal,Corresponding Authors: Emails: ,
| | - Myung-Bae PARK
- Dept. of Gerontal Health and Welfare, Pai Chai University, College of Howard, Daejeon, Korea
| | - Chun-Bae KIM
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Gangwon-do, Korea, Dept. of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Gangwon-do, Korea,Corresponding Authors: Emails: ,
| | - Chang-Soo KIM
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Gangwon-do, Korea, Dept. of Business Administration, College of Government and Business, Yonsei University, Wonju, Gangwon-do, Korea
| | - Hyoung-Sun JEONG
- Dept. of Health Administration, Yonsei University, Wonju, Gangwon-do, Korea
| | - Sang Baek KOH
- Dept. of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Gangwon-do, Korea
| | - Sei-Jin CHANG
- Dept. of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Gangwon-do, Korea
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77
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Weeber H, Hunter LD, van Hoving DJ, Lategan H, Bruijns SR. Estimated injury-associated blood loss versus availability of emergency blood products at a district-level public hospital in Cape Town, South Africa. Afr J Emerg Med 2018; 8:69-74. [PMID: 30456151 PMCID: PMC6223604 DOI: 10.1016/j.afjem.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/08/2017] [Accepted: 01/21/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION International guidance suggests that injury-associated haemorrhagic shock should be resuscitated using blood products. However, in low- and middle-income countries resuscitation emphasises the use of crystalloids - mainly due to poor access to blood products. This study aimed to estimate the amount of blood loss from serious injury in relation to available emergency blood products at a secondary-level, public Cape Town hospital. METHODS This retrospective, cross-sectional study included all injured patients cared for in the resuscitation area of Khayelitsha Hospital's emergency centre over a fourteen-week period. Injuries were coded using the Abbreviated Injury Scale, which was then used to estimate blood loss for each patient using an algorithm from the Trauma Audit Research Network. Descriptive statistics were used to describe blood volume lost and blood units required to replace losses greater than 15% circulating blood volume. Four units of emergency blood are stored in a dedicated blood fridge in the emergency centre. Platelets and fresh plasma are not available. RESULTS A total of 389 injury events were enrolled of which 93 were excluded due to absent clinic data. The mean age was 29 (±10) years. We estimated a median of one unit of blood requirement per week or weekend, up to a maximum of eight or six units, respectively. Most patients (n = 275, 94%) did not have sufficient injury to warrant transfusion. Overall, one person would require a transfusion for every 15 persons with a moderate to serious injury. CONCLUSION The volume of available emergency blood appears inadequate for injury care, and doesn't consider the need for other causes of acute haemorrhage (e.g. gastric, gynaecological, etc.). Furthermore, lack of other blood components (i.e. plasma and platelets) presents a challenge in this low-resourced setting. Further research is required to determine the appropriate management of injury-associated haemorrhage from a resource and budget perspective.
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Affiliation(s)
| | | | - Daniël J. van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | | | - Stevan R. Bruijns
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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78
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Matiwane BP, Mahomed O. Cost analysis of road traffic crashes in a tertiary hospital in Mpumalanga Province, South Africa. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1549800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Busisiwe Precious Matiwane
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of Kwa-Zulu Natal, Howard College Campus, Durban, South Africa
| | - Ozayr Mahomed
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of Kwa-Zulu Natal, Howard College Campus, Durban, South Africa
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79
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Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein. Health SA 2017. [DOI: 10.1016/j.hsag.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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80
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Reniers G, Blom S, Lieber J, Herbst AJ, Calvert C, Bor J, Barnighausen T, Zaba B, Li ZR, Clark SJ, Grant AD, Lessells R, Eaton JW, Hosegood V. Tuberculosis mortality and the male survival deficit in rural South Africa: An observational community cohort study. PLoS One 2017; 12:e0185692. [PMID: 29016619 PMCID: PMC5634548 DOI: 10.1371/journal.pone.0185692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 09/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Women live on average five years longer than men, and the sex difference in longevity is typically lower in populations with high mortality. South Africa-a high mortality population with a large sex disparity-is an exception, but the causes of death that contribute to this difference are not well understood. METHODS Using data from a demographic surveillance system in rural KwaZulu-Natal (2000-2014), we estimate differences between male and female adult life expectancy by HIV status. The contribution of causes of death to these life expectancy differences are computed with demographic decomposition techniques. Cause of death information comes from verbal autopsy interviews that are interpreted with the InSilicoVA tool. RESULTS Adult women lived an average of 10.4 years (95% confidence Interval 9.0-11.6) longer than men. Sex differences in adult life expectancy were even larger when disaggregated by HIV status: 13.1 (95% confidence interval 10.7-15.3) and 11.2 (95% confidence interval 7.5-14.8) years among known HIV negatives and positives, respectively. Elevated male mortality from pulmonary tuberculosis (TB) and external injuries were responsible for 43% and 31% of the sex difference in life expectancy among the HIV negative population, and 81% and 16% of the difference among people living with HIV. CONCLUSIONS The sex differences in adult life expectancy in rural KwaZulu-Natal are exceptionally large, atypical for an African population, and largely driven by high male mortality from pulmonary TB and injuries. This is the case for both HIV positive and HIV negative men and women, signalling a need to improve the engagement of men with health services, irrespective of their HIV status.
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Affiliation(s)
- Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sylvia Blom
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York, United States of America
| | - Judith Lieber
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abraham J. Herbst
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Clara Calvert
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacob Bor
- Department of Global Health, Boston University, Boston, Massachusetts, United States of America
| | - Till Barnighausen
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States of America
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Basia Zaba
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zehang R. Li
- Department of Statistics, University of Washington, Seattle, United States of America
| | - Samuel J. Clark
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, The Ohio State University, Columbus, Ohio
| | - Alison D. Grant
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Lessells
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeffrey W. Eaton
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, United Kingdom
| | - Victoria Hosegood
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
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Abstract
OBJECTIVE Inadequate immunoregulation and elevated inflammation may be risk factors for posttraumatic stress disorder (PTSD), and microbial inputs are important determinants of immunoregulation; however, the association between the gut microbiota and PTSD is unknown. This study investigated the gut microbiome in a South African sample of PTSD-affected individuals and trauma-exposed (TE) controls to identify potential differences in microbial diversity or microbial community structure. METHODS The Clinician-Administered PTSD Scale for DSM-5 was used to diagnose PTSD according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Microbial DNA was extracted from stool samples obtained from 18 individuals with PTSD and 12 TE control participants. Bacterial 16S ribosomal RNA gene V3/V4 amplicons were generated and sequenced. Microbial community structure, α-diversity, and β-diversity were analyzed; random forest analysis was used to identify associations between bacterial taxa and PTSD. RESULTS There were no differences between PTSD and TE control groups in α- or β-diversity measures (e.g., α-diversity: Shannon index, t = 0.386, p = .70; β-diversity, on the basis of analysis of similarities: Bray-Curtis test statistic = -0.033, p = .70); however, random forest analysis highlighted three phyla as important to distinguish PTSD status: Actinobacteria, Lentisphaerae, and Verrucomicrobia. Decreased total abundance of these taxa was associated with higher Clinician-Administered PTSD Scale scores (r = -0.387, p = .035). CONCLUSIONS In this exploratory study, measures of overall microbial diversity were similar among individuals with PTSD and TE controls; however, decreased total abundance of Actinobacteria, Lentisphaerae, and Verrucomicrobia was associated with PTSD status.
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Carney T, Myers B, Kline TL, Johnson K, Wechsberg WM. Aggressive behaviour among drug-using women from Cape Town, South Africa: ethnicity, heavy alcohol use, methamphetamine and intimate partner violence. BMC WOMENS HEALTH 2017; 17:93. [PMID: 28964269 PMCID: PMC5622560 DOI: 10.1186/s12905-017-0447-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/20/2017] [Indexed: 11/10/2022]
Abstract
Background Women have generally been found to be the victims of violence, but scant attention has been paid to the characteristics of women who perpetrate aggression and violence. In South Africa, violence is a prevalent societal issue, especially in the Western Cape. Method This study aimed at identifying factors that were associated with aggression among a sample of 720 substance-using women. We conducted multivariate logistic regression to identify factors that are significantly associated with these behaviours. Results Ethnicity (Wald Χ2 = 17.07(2), p < 0.01) and heavy drinking (Wald Χ2 = 6.60 (2), p = 0.01) were significantly related to verbal aggression, methamphetamine use was significantly related to physical (Wald Χ2 = 2.73 (2), p = 0.01) and weapon aggression (Wald Χ2 = 7.94 (2), p < 0.01) and intimate partner violence was significantly related to verbal (Wald Χ2 = 12.43 (2), p < 0.01) and physical aggression (Wald Χ2 = 25.92 (2), p < 0.01). Conclusions The findings show high levels of aggression among this sample, and highlight the need for interventions that address methamphetamine, heavy drinking and intimate partner violence among vulnerable substance-using women.
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Affiliation(s)
- Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa. .,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tracy L Kline
- Substance Use Gender, and Applied Research Program, Research Triangle Park, RTI, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa
| | - Wendee M Wechsberg
- Substance Use Gender, and Applied Research Program, Research Triangle Park, RTI, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA.,RTI Gender Global Gender Center, Research Triangle Park, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA.,Health, Policy and Administration, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, USA.,Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA.,Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
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83
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Figueiredo TA, Schramm JMDA, Pepe VLE. The public production of medicines compared to the National Policy of Medicines and the burden of disease in Brazil. CAD SAUDE PUBLICA 2017; 33:e00179815. [PMID: 28977283 DOI: 10.1590/0102-311x00179815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 09/08/2016] [Indexed: 11/22/2022] Open
Abstract
: The public production of medicines in Brazil by Government Pharmaceutical Laboratories has once again become the object of incentives, and Industrial Development Partnerships are one of the mechanisms adopted for the production of strategic medicines for the Brazilian Unified National Health System (SUS). Considering that burden-of-disease studies have been used as a tool to define priority and essential medicines, the article compares the product portfolios of the country's Official Pharmaceutical Laboratories (OPL) and the list of strategic medicines for the SUS and burden of disease in Brazil in 2008. Of the 205 strategic medicines for the SUS and 111 from the portfolios, 73% and 89%, respectively, are on the National List of Essential Medicines (RENAME 2014). Some strategic medicines for the SUS are already produced by OPL and feature the selection of cancer drugs and biologicals. The current study contributes to the discussion on the public production of medicines in light of the country's current industrial policy and highlights the need to define priority drugs and the role of OPL in guaranteeing access to them.
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Affiliation(s)
| | | | - Vera Lúcia Edais Pepe
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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84
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Dayananda K, Kong VY, Bruce JL, Oosthuizen GV, Laing GL, Clarke DL. Selective non-operative management of abdominal stab wounds is a safe and cost effective strategy: A South African experience. Ann R Coll Surg Engl 2017; 99:490-496. [PMID: 28660819 DOI: 10.1308/rcsann.2017.0075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Selective non-operative management (SNOM) of abdominal stab wounds is well established in South Africa. SNOM reduces the morbidity associated with negative laparotomies while being safe. Despite steady advances in technology (including laparoscopy, computed tomography [CT] and point-of-care sonography), our approach has remained clinically driven. Assessments of financial implications are limited in the literature. The aim of this study was to review isolated penetrating abdominal trauma and analyse associated incurred expenses. METHODS Patients data across the Pietermaritzburg Metropolitan Trauma Service (PMTS) are captured prospectively into the regional electronic trauma registry. A bottom-up microcosting technique produced estimated average costs for our defined clinical protocols. RESULTS Between January 2012 and April 2015, 501 patients were treated for an isolated abdominal stab wound. Over one third (38%) were managed successfully with SNOM, 5% underwent a negative laparotomy and over half (57%) required a therapeutic laparotomy. Over five years, the PMTS can expect to spend a minimum of ZAR 20,479,800 (GBP 1,246,840) for isolated penetrating abdominal stab wounds alone. CONCLUSIONS Provided a stringent policy is followed, in carefully selected patients, SNOM is effective in detecting those who require further intervention. It minimises the risks associated with unnecessary surgical interventions. SNOM will continue to be clinically driven and promulgated in our environment.
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Affiliation(s)
- Kss Dayananda
- University of Kwa-Zulu Natal , Durban , South Africa
| | - V Y Kong
- University of Kwa-Zulu Natal , Durban , South Africa
| | - J L Bruce
- University of Kwa-Zulu Natal , Durban , South Africa
| | | | - G L Laing
- University of Kwa-Zulu Natal , Durban , South Africa
| | - D L Clarke
- University of Kwa-Zulu Natal , Durban , South Africa.,University of the Witwatersr and, Johannesburg, , South Africa
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85
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The incidence and epidemiology of eldercide in the city of Johannesburg, South Africa. J Forensic Leg Med 2017; 52:82-88. [PMID: 28869850 DOI: 10.1016/j.jflm.2017.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/28/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
The current study describes the incidence and epidemiological characteristics of eldercide (homicides among victims aged 60 years and older) in Johannesburg for the period 2001 to 2010. A retrospective population-based study was conducted on cases drawn from the National Injury Mortality Surveillance System. A total of 557 eldercides were recorded by NIMSS for the study period with an average annual rate of 23.1 per 100 000. The average annual rate for males was 42.4 per 100 000 and 8.9 per 100 000 for females. There was little variation in the rates by race. Eldercide victims were predominantly male (77.4%), black (48.3%) or white (43.2%), and were mainly killed by firearms (44.8%) or the use of blunt force (27.8%), in a private residence (66.0%), on a week day (53.8%) and during the day (56.1%). The study also found that the characteristics of eldercide varied across males and females, and across black and white race groups. The high incidence of eldercides points to the need for interventions that give special attention to the risk configurations and circumstances associated with these violent deaths.
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86
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Patel N, Khofi-Phiri I, Mathiva LR, Grieve A, Loveland J, Nethathe GD. Trauma related admissions to the PICU at Chris Hani Baragwanath Academic Hospital, Johannesburg. Pediatr Surg Int 2017; 33:1013-1018. [PMID: 28668993 DOI: 10.1007/s00383-017-4125-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Paediatric trauma is a major cause of morbidity and mortality in low and middle income countries. Data from these regions are scant. We aimed to describe the demographic and injury profile, treatment modality and outcome of trauma admissions to the paediatric intensive care unit at Chris Hani Baragwanath Academic Hospital (CHBAH). METHODS A retrospective record review of trauma cases admitted to the PICU at CHBAH from 2011 to 2013 was performed. RESULTS One-fifth of admissions were due to trauma. 58% of admissions were male. Weekends accounted for 49% of admissions. Road traffic injuries (RTI) (66%) and toxin ingestion (TI) (17%) contributed the majority of admissions. Children aged 0-4 years accounted for 45%, 5-9 years 39%, and 10-15 years 16% of admissions. The mortality rate was 9.0% with RTI accounting for 64%. 64% of mortalities occurred in the 0-4 year cohort. Mean age of survivors (5.8 years) was significantly higher than non-survivors (3.4 years) (p < 0.05). 89% of all children required invasive ventilation on PICU admission. Mean length of ventilation in non-survivors (10.2 days) was significantly longer than survivors (4.5 days) (p < 0.05). CONCLUSIONS RTI accounted for the majority of trauma admissions to our PICU. RTI, female gender and age less than 4 years were all associated with an increased risk for mortality in our study.
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Affiliation(s)
- Nirav Patel
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa.
| | - I Khofi-Phiri
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Division of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L R Mathiva
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Division of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Grieve
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa
| | - J Loveland
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa
| | - G D Nethathe
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Division of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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87
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Neille J, Penn C. The Interface Between Violence, Disability, and Poverty: Stories From a Developing Country. JOURNAL OF INTERPERSONAL VIOLENCE 2017; 32:2837-2861. [PMID: 26228916 DOI: 10.1177/0886260515596332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
People with disabilities are vulnerable to multiple forms of violence in their everyday lives, including structural violence, deprivation, and physical, emotional, and sexual exploitation. Despite increasing reports of violence against people with disabilities, little is known about this phenomenon, especially in the context of poverty. Furthermore, the various types of violence have traditionally been studied in isolation, which has led to a limited understanding of the nature and persistence of violence in society, and has affected our understanding of the relationship between different forms of violence. In this article, we explore the relationship between violence, disability, and poverty among people living in a rural area of South Africa. Thirty adults with a variety of disabilities living in 12 rural villages in the Mpumalanga Province of South Africa participated in the study. Each of the participants was provided with an opportunity to tell their life story. Narrative inquiry and participant observation were used to explore the ways in which violence pervades the participants' everyday experiences. Results were analyzed using thematic analysis and suggest that in the context of poverty, it is impossible to separate the experience of disability from the experience of violence. Structural violence was shown to underpin all other forms of interpersonal violence, making persons with disabilities vulnerable to additional forms of exploitation, and serve to further isolate people with disabilities from society, compromising both health and human rights. The findings suggest that an understanding of contextual factors is fundamental to understanding the relationship between violence and disability.
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Affiliation(s)
- Joanne Neille
- 1 University of the Witwatersrand, Johannesburg, South Africa
| | - Claire Penn
- 1 University of the Witwatersrand, Johannesburg, South Africa
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88
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Ranabhat CL, Kim CB, Park MB, Acharaya S. Multiple disparities in adult mortality in relation to social and health care perspective: results from different data sources. Global Health 2017; 13:57. [PMID: 28789698 PMCID: PMC5549395 DOI: 10.1186/s12992-017-0283-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/28/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Disparity in adult mortality (AM) with reference to social dynamics and health care has not been sufficiently examined. This study aimed to identify the gap in the understanding of AM in relation to religion, political stability, economic level, and universal health coverage (UHC). METHODS A cross-national study was performed with different sources of data, using the administrative record linkage theory. Data was created from the 2013 World Bank data catalogue by region, The Economist (Political instability index 2013), Stuckler David et al. (Universal health coverage, 2010), and religious categories of all UN country members. Descriptive statistics, a t-test, an ANOVA followed by a post hoc test, and a linear regression were used where applicable. RESULT The average AM rate for males and females was 0.20 ± 0.10 and 0.14 ± 0.10, respectively. There was high disparity of AM between countries with and without UHC and between groups with low and high income. UHC and political stability would significantly reduce AMR by >0.41 in both sexes and high economic status would reduce male AMR by 0.44, and female AMR by 0.70. CONCLUSIONS It can be concluded that effective health care; UHC and political stability significantly reduce AM.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
- Health Science Foundations and Study Center, Kathmandu, Nepal
| | - Chun-Bae Kim
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
| | - Myung-Bae Park
- Department of Gerontal Health and Welfare, Pai Chai University, Seo-gu, Daejeon, Republic of Korea
| | - Sambhu Acharaya
- Department of Country Cooperation and Collaboration with the UN System Office of the Director-General, World Health Organization, Geneva, Switzerland
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89
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Sex and gender differences in HIV-1 infection. Clin Sci (Lond) 2017; 130:1435-51. [PMID: 27389589 DOI: 10.1042/cs20160112] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/06/2016] [Indexed: 01/03/2023]
Abstract
The major burden of the human immunodeficiency (HIV) type 1 pandemic is nowadays carried by women from sub-Saharan Africa. Differences in the manifestations of HIV-1 infection between women and men have been long reported, and might be due to both socio-economic (gender) and biological (sex) factors. Several studies have shown that women are more susceptible to HIV-1 acquisition than men. Following HIV-1 infection, women have lower viral loads during acute infection and exhibit stronger antiviral responses than men, which may contribute to differences in the size of viral reservoirs. Oestrogen receptor signalling could represent an important mediator of sex differences in HIV-1 reservoir size and may represent a potential therapeutic target. Furthermore, immune activation, a hallmark of HIV-1 infection, is generally higher in women than in men and could be a central mechanism in the sex difference observed in the speed of HIV-1 disease progression. Here, we review the literature regarding sex-based differences in HIV-1 infection and discuss how a better understanding of the underlying mechanisms could improve preventive and therapeutic strategies.
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90
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Waterhouse P, van der Wielen N, Banda PC, Channon AA. The impact of multi-morbidity on disability among older adults in South Africa: do hypertension and socio-demographic characteristics matter? Int J Equity Health 2017; 16:62. [PMID: 28388911 PMCID: PMC5385014 DOI: 10.1186/s12939-017-0537-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/14/2017] [Indexed: 01/19/2023] Open
Abstract
Background Alongside the global population ageing phenomenon, there has been a rise in the number of individuals who suffer from multiple chronic conditions. Taking the case of South Africa, this study aims, first, to investigate the association between multi-morbidity and disability among older adults; and second, to examine whether hypertension (both diagnosed and undiagnosed) mediates this relationship. Lastly, we consider whether the impact of the multi-morbidity on disability varies by socio-demographic characteristics. Methods Data were drawn from Wave 1 (2007–08) of the South African Study on Global Ageing and Adult Health. Disability was measured using the 12-item World Health Organisation Disability Assessment Schedule (WHODAS) 2.0. Scores were transformed into a binary variable whereby those over the 90th percentile were classified as having a severe disability. The measure of multi-morbidity was based on a simple count of self-reported diagnosis of selected chronic conditions. Self-reports of diagnosed hypertension, in addition to blood pressure measurements at the time of interview, were used to create a three category hypertension variable: no hypertension (diagnosed or measured), diagnosed hypertension, hypertension not diagnosed but hypertensive measured blood pressure. Interactions between the number of chronic diseases with sex, ethnicity and wealth were tested. Logistic regression was used to analyze the relationships. Results 25.4% of the final sample had one and 13.2% two or more chronic diseases. Nearly half of the respondents had a hypertensive blood pressure when measured during the interview, but had not been previously diagnosed. A further third self-reported they had been told by a health professional they had hypertension. The logistic regression showed in comparison to those with no chronic conditions, those with one or two or more had significantly higher odds of severe disability. Hypertension was insignificant and did not change the direction or size of the effect of the multi-morbidity measure substantially. The interactions between number of chronic conditions with wealth were significant at the 5% level. Conclusions The diagnosis of multiple chronic conditions, can be used to identify those most at risk of severe disability. Limited resources should be prioritized for such individuals in terms of preventative, rehabilitative and palliative care.
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Affiliation(s)
- Philippa Waterhouse
- Faculty of Wellbeing, Education and Language Studies, Open University, Milton Keynes, UK.
| | | | - Pamela Chirwa Banda
- Department of Demography and Population Studies Programme, University of the Witwatersrand, Johannesburg, South Africa.,Ministry of Education, Provincial Education Office, Lusaka, Zambia
| | - Andrew Amos Channon
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
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91
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Swain KD, Pillay BJ, Kliewer W. Traumatic stress and psychological functioning in a South African adolescent community sample. S Afr J Psychiatr 2017; 23:1008. [PMID: 30263182 PMCID: PMC6138196 DOI: 10.4102/sajpsychiatry.v23i0.1008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 12/01/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Traumatic stress may arise from various incidents often leading to posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD is estimated at 1% - 2% in Western Europe, 6% - 9% in North America and at just over 10% in countries exposed to long-term violence. In South Africa, the lifetime prevalence for PTSD in the general population is estimated at 2.3%. AIM To examine the prevalence of posttraumatic stress symptomatology and related psychological functioning in a community sample of adolescents. SETTING Low-socioeconomic communities in KwaZulu-Natal. METHODS Home interviews with adolescents and their maternal caregivers were used to collect the data using standardised instruments. Adolescents completed the Trauma Symptom Checklist for Children; Children's Depression Inventory; Children's Somatization Inventory; and Revised Children's Manifest Anxiety Scale. The Child Behaviour Checklist was completed by the caregivers. The sample comprised Grade 7 (n = 256) and Grade 10 (n = 68) learners. Sixty-five percent of the sample was female, and ages ranged from 9 to 18 (M = 13.11, s.d. = 1.54). RESULTS Almost 6% of the sample endorsed PTSD and an additional 4% of the participants had clinically significant traumatic stress symptomatology. There was a significant, large, positive correlation between posttraumatic stress and anxiety, and medium positive correlations between posttraumatic stress and depression and somatic symptoms. CONCLUSION Posttraumatic stress symptomatology can be debilitating, often co-occurring with symptoms of depression, anxiety and somatic complications. This may lead to long-term academic, social and emotional consequences in this vulnerable group.
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Affiliation(s)
- Karl D Swain
- Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa
| | - Basil J Pillay
- Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa
| | - Wendy Kliewer
- Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa
- Department of Psychology, Virginia Commonwealth University, United States
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92
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Dowdall N, Cooper PJ, Tomlinson M, Skeen S, Gardner F, Murray L. The Benefits of Early Book Sharing (BEBS) for child cognitive and socio-emotional development in South Africa: study protocol for a randomised controlled trial. Trials 2017; 18:118. [PMID: 28279200 PMCID: PMC5345192 DOI: 10.1186/s13063-017-1790-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children in low and middle-income countries (LMICs) are at risk for problems in their cognitive, social and behavioural development. Factors such as a lack of cognitive stimulation, harsh parenting practices, and severe and persistent aggression in early childhood are central to the genesis of these problems. Interventions that target the intersection between early childhood development, parenting, and early violence prevention are required in order to meaningfully address these problems. METHODS We are conducting a randomised controlled trial to evaluate a parenting intervention for caregivers of children aged between 23 and 27 months, designed to promote child cognitive and socioemotional development in Khayelitsha, a low-income peri-urban township in South Africa. Families are randomly allocated to a book-sharing intervention group or to a wait-list control group. In the intervention, we train caregivers in supportive book-sharing with young children. Training is carried out in small groups over a period of 8 weeks. Data are collected at baseline, post intervention and at 6 months post intervention. In addition to targeting child cognitive development, the intervention aims to improve child socioemotional functioning. DISCUSSION The Benefits of Early Book Sharing (BEBS) trial aims to evaluate the impact of an early parenting intervention on several key risk factors for the development of violence, including aspects of parenting and child cognition, prosocial behaviour, aggression, and socioemotional functioning. The study is being carried out in a LMIC where violence constitutes a major social and health burden. Since the intervention is brief and, with modest levels of training, readily deliverable in LMIC contexts, a demonstration that it is of benefit to both child cognitive and socioemotional development would be of significance. TRIAL REGISTRATION The BEBS trial is registered on the International Standard Randomised Controlled Trial Number database, registration number ISRCTN71109104 . Registered on 9 February 2016. This is version 1 of the protocol for the BEBS trial.
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Affiliation(s)
- Nicholas Dowdall
- Department of Social Policy and Intervention, Oxford University, Oxford, UK
| | - Peter J. Cooper
- University of Reading, Reading, UK
- University of Cape Town, Cape Town, South Africa
- Stellenbosch University, Stellenbosch, South Africa
| | | | - Sarah Skeen
- Stellenbosch University, Stellenbosch, South Africa
| | - Frances Gardner
- Department of Social Policy and Intervention, Oxford University, Oxford, UK
| | - Lynne Murray
- University of Reading, Reading, UK
- University of Cape Town, Cape Town, South Africa
- Stellenbosch University, Stellenbosch, South Africa
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93
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Lewandowski LB, Watt MH, Schanberg LE, Thielman NM, Scott C. Missed opportunities for timely diagnosis of pediatric lupus in South Africa: a qualitative study. Pediatr Rheumatol Online J 2017; 15:14. [PMID: 28231857 PMCID: PMC5322669 DOI: 10.1186/s12969-017-0144-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/29/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a serious multisystem autoimmune disease, which is more aggressive in children and people of African descent. In South Africa, pediatric SLE (pSLE) patients are at high risk for severe disease. Similar to pSLE worldwide, South African children and adolescents with SLE require subspecialized medical care. The aim of this study is to describe the care-seeking experiences of families and examine factors that contribute to delays in the diagnosis of pSLE. Specifically, we sought to identify factors to inform interventions that support the timely referral and diagnosis of pediatric SLE patients in South Africa. METHODS In-depth, semi-structured interviews were conducted with 22 caregivers of pSLE patients recruited from two government hospitals in Cape Town, South Africa in 2014. Interviews were audio-recorded, transcribed, and analyzed for themes related to barriers to diagnosis. RESULTS Six themes were identified and classified as either caregiver or health system barriers to diagnosis. Caregiver barriers included lack of knowledge regarding SLE, financial difficulties, and the social stigma of SLE. Health system barriers were lack of trained staff, a complex medical system, and misdiagnosis. CONCLUSION Caregivers reported missed opportunities for diagnosing pSLE in their children. Raising public awareness may improve caregiver awareness and reduce stigma of pSLE. Improving family education at diagnosis holds potential to increase patient-physician trust and mitigate fear. Education modules for primary care providers at initial point of contact with the health care system may improve recognition of early pSLE and facilitate expedited referral to a specialist.
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Affiliation(s)
- Laura B. Lewandowski
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12 N248 Room 28, Bethesda, MD 20892-1102 USA ,0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA ,0000000100241216grid.189509.cPediatric Rheumatology, Duke University Medical Center, 2301 Erwin Road, Durham, NC USA ,0000 0004 1937 1151grid.7836.aRed Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape South Africa
| | - Melissa H. Watt
- 0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Laura E. Schanberg
- 0000000100241216grid.189509.cPediatric Rheumatology, Duke University Medical Center, 2301 Erwin Road, Durham, NC USA
| | - Nathan M. Thielman
- 0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Christiaan Scott
- 0000 0004 1937 1151grid.7836.aRed Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape South Africa
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94
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Ntsiea MV, Mudzi W, Comley-White N, Van Aswegen H, Olivier B, Roos R, Pilusa S, Potterton J, Myezwa H, Benjamin N, Naidoo V. University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:362. [PMID: 30135907 PMCID: PMC6093094 DOI: 10.4102/sajp.v73i1.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals. Objective To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum. Methods This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition–related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum. Results Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours. Conclusion The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.
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Affiliation(s)
- Mokgobadibe V Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Witness Mudzi
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Nicolette Comley-White
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Heleen Van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Benita Olivier
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ronel Roos
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sonti Pilusa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Natalie Benjamin
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Vaneshveri Naidoo
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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95
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Azami-Aghdash S, Sadeghi-Bazargani H, Shabaninejad H, Abolghasem Gorji H. Injury epidemiology in Iran: a systematic review. J Inj Violence Res 2017; 9:852. [PMID: 28039683 PMCID: PMC5279990 DOI: 10.5249/jivr.v9i1.852] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background: Injuries are the second greatest cause of mortality in Iran. Information about the epidemiological pattern of injuries is effective in decision-making. In this regard, the aim of the current study is to elaborate on the epidemiology of injuries in Iran through a systematic review. Methods: Required data were collected searching the following key words and their Persian equivalents; trauma, injury, accident, epidemiology, prevalence, pattern, etiology, risk factors and Iran. The following databases were searched: Google Scholar, PubMed, Scopus, MagIran, Iranian scientific information database (SID) and Iran Medex. Some of the relevant journals and web sites were searched manually. The lists of references from the selected articles were also investigated. We have also searched the gray literature and consulted some experts. Results: Out of 2747 retrieved articles, 25 articles were finally included in the review. A total of 3234481 cases have been investigated. Mean (SD) age among these cases was 30 (17.4) years. The males comprised 75.7% of all the patients. Only 31.1% of patients were transferred to hospital by ambulance. The most common mechanism of injuries was road traffic accidents (50.1%) followed by falls (22.3%). In road traffic accidents, motorcyclists have accounted for the majority of victims (45%). Roads were the most common accident scene for the injuries (57.5%). The most common injuries were to the head and neck. (47.3%). The mean (SD) Injury Severity Score (ISS) was 8.1(8.6%). The overall case-fatality proportion was 3.8% and 75% of all the mortalities related to road traffic accidents. Conclusions: The main priorities in reducing the burden of injuries include: the young, male target group, improving pre-hospital and ambulance services, preventing road traffic accidents, improving road safety and the safety of motorcyclists (compulsory helmet use, safer vehicles, dedicated motorcycle lanes).
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Affiliation(s)
| | | | | | - Hassan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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96
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Quitian-Reyes H, Gómez-Restrepo C, Gómez MJ, Naranjo S, Heredia P, Villegas J. Latin American Clinical Epidemiology Network Series - Paper 5: Years of life lost due to premature death in traffic accidents in Bogota, Colombia. J Clin Epidemiol 2016; 86:101-105. [PMID: 27771358 DOI: 10.1016/j.jclinepi.2016.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/19/2016] [Accepted: 04/11/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to quantify the number of years of life lost in traffic accidents in Bogota, Colombia. STUDY DESIGN AND SETTING The years of life lost were calculated using the 'age-standardized expected years of life lost' method, the table of Japanese adjusted life expectancy and the database of the Institute of Legal Medicine and Forensic Science between September 2012 and August 2013. RESULTS During a period of 1 year, 430 people died and 10,056.3 years of life were lost in Bogota due to traffic accidents. CONCLUSION The mortality burden of traffic accidents in Bogota is high. Further studies are required in order to characterize the accidents and develop effective policy decisions.
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Affiliation(s)
- Hoover Quitian-Reyes
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Cra. 7, No 40-62, Bogotá 110231, Colombia.
| | - Carlos Gómez-Restrepo
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Cra. 7, No 40-62, Bogotá 110231, Colombia
| | - Maria Juliana Gómez
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Cra. 7, No 40-62, Bogotá 110231, Colombia
| | | | - Patricia Heredia
- National Institute of Legal Medicine and Forensic Sciences, Cll 7A, No 12A-51, Bogotá 110321, Colombia
| | - John Villegas
- National Institute of Legal Medicine and Forensic Sciences, Cll 7A, No 12A-51, Bogotá 110321, Colombia
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98
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Urry RJ, Clarke DL, Bruce JL, Laing GL. The incidence, spectrum and outcomes of traumatic bladder injuries within the Pietermaritzburg Metropolitan Trauma Service. Injury 2016; 47:1057-63. [PMID: 26854075 DOI: 10.1016/j.injury.2016.01.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/02/2016] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study is to provide a comprehensive overview of the incidence, spectrum and outcomes of traumatic bladder injury in Pietermaritzburg, South Africa, and to identify the current optimal investigation and management of patients with traumatic bladder injuries. METHODS The Pietermaritzburg Metropolitan Trauma Service (PMTS) trauma registry was interrogated retrospectively for all traumatic bladder injuries between 1 January 2012 and 31 October 2014. RESULTS Of 8129 patients treated by the PMTS over the study period, 58 patients (0.7% or 6.5 cases per 1,000,000 population per year) had bladder injuries, 65% caused by penetrating trauma and 35% by blunt trauma. The majority (60%) were intraperitoneal bladder ruptures (IBRs), followed by 22% extraperitoneal bladder ruptures (EBRs). There was a high rate of associated injury, with blunt trauma being associated with pelvic fracture and penetrating trauma being associated with rectum and small intestine injuries. The mortality rate was 5%. Most bladder injuries were diagnosed at surgery or by computed tomography (CT) scan. All IBRs were managed operatively, as well as 38% of EBRs; the remaining EBRs were managed by catheter drainage and observation. In the majority of operative repairs, the bladder was closed in two layers, and was drained with only a urethral catheter. Most patients (91%) were managed definitively by the surgeons on the trauma service. CONCLUSION Traumatic bladder rupture caused by blunt or penetrating trauma is rare and mortality is due to associated injuries. CT scan is the investigative modality of choice. In our environment IBR is more common than EBR and requires operative management. Most EBRs can be managed non-operatively, and then require routine follow-up cystography. Simple traumatic bladder injuries can be managed definitively by trauma surgeons. A dedicated urological surgeon should be consulted for complex injuries.
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Affiliation(s)
- R J Urry
- Department of Urology, Greys Hospital, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa.
| | - D L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa
| | - J L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa
| | - G L Laing
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa
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Amashnee S, Guinevere G, Indiran G. Non-fatal injuries of interpersonal violence at the Leratong Provincial Hospital, South Africa. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2016.1167311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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