By identifying the most influential kids in small social media circles, researchers can create positive peer pressure that persuades young people to live healthier lives. Generation Z, or those born after 1995, are digital natives who grew up in a world of constant connectivity. They often see their online and offline lives as one and the same, and may spend as much time, or more, interacting with friends on social media as they do face-to-face. Important habits are also being formed within these groups, ones around eating, drinking and physical activity. This raises the question: what if we could harness the power of this peer pressure to influence adolescents to lead healthier lives? That’s the goal of researchers in the EU-funded SNIHCY project at Radboud University in Nijmegen, the Netherlands. They have developed the Wearable Lab – a bracelet that can track the activities and social networking of adolescent in small groups – and combine it with a mobile phone app, which includes a game and personalised avatar…..more
Extremely thin printable solar panels could power your phone and are amongst a range of new ways nanotechnology is opening the door to a clean energy and waste-free future. Nanotechnology, a science that focuses on understanding materials on an atomic scale, is helping researchers and businesses introduce new technologies that could transform our economy into a greener, less wasteful one. ‘Nanotechnology as a field has an enormous role to play in moving our planet to sustainable and intelligent living,’ said Professor Martin Curley from Maynooth University in Ireland, speaking on 21 June at the EuroNanoForum conference, in Malta, organised by the Maltese Presidency of the Council of the European Union and co-funded by the EU. He explained to an audience of businesspeople and researchers that nanotechnology holds the potential to spark ‘an explosion of innovation’…..more
Medical scheme members are likely to lose their tax credits to help pay for the first set of benefits to be rolled out under National Health Insurance (NHI), Health Minister Aaron Motsolaedi said on Thursday.
Briefing reporters on the government’s latest policy position on NHI, which will be published as a revised White Paper in the government gazette tomorrow, Motsolaedi said the first package of benefits would target women, children and the elderly: “The central philosophy is that we are going to start pooling funds for people who are not on medical aid, starting from the bottom.”….more
The documents released ahead of the upcoming policy conference of the governing ANC expose a panicking party that sees enemies everywhere. While previous policy conferences addressed real policy issues, all energies are now focused on retaining state power as the leadership faces damning claims of capture by a kleptocratic elite.
The discussion documents show a party that professes a desire for self-correction and renewal. But, it seems to have neither the guts, nor the necessary internal balance of forces to do so.
At the same time the documents point to deepening paranoia and an increasingly authoritarian tendency. In combination, they seem to emanate from a parallel universe where the party’s interests have become elevated above those of the South African society at large…..more
The SA Cabinet has approved the Department of Health’s latest iteration of the White Paper on National Health Insurance (NHI), paving the way for it to be published as a policy document in the government gazette.
Business Day reports that the timing is significant, as it comes less than two weeks before the ANC policy conference in early July.
NHI is an ambitious set of health financing reforms that aims to provide healthcare to everyone that is free at the point of care, the report says. “The White Paper takes the country closer to ensuring all South Africans have access to healthcare, irrespective of their socioeconomic status. This is consistent with the National Development Plan’s (NDP’s) objective that seeks to ensure everyone has access to healthcare, regardless of their income,” the Cabinet said.
The report says some of the key issues that will be scrutinised in the new policy are the details of package of benefits provided under NHI, how they will be paid for, and where the private sector will fit in…..more
When the World Health Organisation develops guidelines on the use of health care interventions, it turns to the Cochrane Library. This is a collection of databases containing high quality systemic reviews and other evidence to inform decisions about health care.
The problem is that access to these important databases costs money. In South Africa, universities and the South African Medical Research Council could access the Cochrane Library through institutional subscriptions with the library’s publishers.
But most of the country’s health care workers aren’t affiliated to universities. So the library has been inaccessible where it’s most needed – in clinical settings. Technical teams within the government and those responsible for creating policies were also left out……more
A Soweto couple has accused Chiawelo Clinic nurses of causing the death of their newly born baby after the mother gave birth in a toilet.
Agatha Ngubane (36) and Israel Mudau (37) are looking for looking for answers from the Gauteng Department of Health following the death of little Orifha Siphesihle Mudau. Ngubane she said she had gone into labour on February 9 and when she arrived at the clinic nurses at the reception told her to wait. “I arrived at the clinic at 6.30am and I was only attended to by 7.30am. “After waiting for more than an hour, a nurse came to me and asked me to lay down on the bed. She started examining me by assessing my blood pressure and listening for a heartbeat,” said Ngubane. “We both could not hear any heartbeat.” The nurse left the room, she said. While she was gone, Ngubane said she had gone to the toilet a number of times. …more
If the beverage industry reduces the sugar content of 37% of its products, the proposed sugary drinks tax could result in around 1,475 job losses. Treasury official Warren Harris reported this to parliament yesterday while giving Treasury’s response to the many submissions made on the tax. The beverage industry has warned of tens of thousands of job losses should the tax be introduced. Treasury has proposed a 2,1 cent tax per gram of sugar on all sweetened drinks, but the first 4g per 100ml will be exempted as an incentive for producers to reformulate their drinks with less sugar. It plans for the tax – which it calls a health promotion levy – to come into effect as soon as the Rates Bill becomes law, Treasury Chief Director Mpho Legote said….more
Mid-Upper Arm Circumference (MUAC)
Mid-Upper Arm Circumference (MUAC) is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow (olecranon process and the acromium).
MUAC is used for the assessment of nutritional status. It is a good predictor of mortality and in many studies, MUAC predicted death in children better than any other anthropometric indicator. This advantage of MUAC was greatest when the period of follow-up was short.
The MUAC measurement requires little equipment and is easy to perform even on the most debilitated individuals. Although it is important to give workers training in how to take the measurement, the correct technique can be readily taught to minimally trained health workers and community-based volunteers. It is thus suited to screening admissions to feeding programs during emergencies.
MUAC is recommended for use with children between six and fifty-nine months of age and for assessing acute energy deficiency in adults during famine.
The major determinants of MUAC, arm muscle and sub-cutaneous fat, are both important determinants of survival in starvation. MUAC is less affected than weight and height based indices (e.g. WHZ, WHM, BMI) by the localised accumulation of fluid (i.e. bipedal or nutritional oedema, periorbital oedema, and ascites) common in famine and is a more sensitive index of tissue atrophy than low body weight. It is also relatively independent of height and body-shape…..more
This exciting 3 year degree will provide you with the necessary knowledge, attitudes and skills to work in a district hospital as a Clinical Associate, under the supervision of a doctor. The qualified Clinical Associates are registered with the Health Professions Council of South Africa with a defined scope of practice. Apply at Wits.
Friday 9th June 2017
WONCA News – June 2017
The latest WONCA News (June 2017) is accessible via the WONCA website, with lots of WONCA news, views and events. Activities held to celebrate World Family Doctor Day (19th May) feature prominently this month.
From the President
This month Professor Amanda Howe looks back at her time in Australia, at the WONCA Rural Health conference in Cairns. As well as a really excellent conference, highlights for her included visiting colleagues in two different clinics – one on Horn Island off the North East coast of Australia, and an Aboriginal Community and Health Clinic at Yarrabah near Cairns. Both emphasised the need to prioritise community engagement as a way of redressing the impacts of social disadvantage and improving public health: and showed her (again) the importance of family doctors who can work in a setting where they are both part of the community and may be surgeon, obstetrician and emergency care providers – as well as the community’s family doctor.
World Family Doctor Day (FDD)
Many of WONCA’s Member Organizations celebrated World Family Doctor Day on 19th May, and we were inundated with reports and photos of various events held throughout the world. We’ll be featuring some in more detail in the coming weeks, but WONCA News has all the photos and the reports on line athttp://www.globalfamilydoctor.com/News/WorldFamilyDoctorDay2017celebratedworldwide.aspx .
Education for Primary Care
Professor Val Wass, Chair of WONCA’s Working Party on Education, has advised us of an announcement from “Education for Primary Care”. As it becomes increasingly apparent that learning in the context of family medicine and the community can impact positively on career choice for primary care, they are pleased to offer free access for a limited period of time to an article from Elizabeth Newbronner and her colleagues in the North of England offering further evidence of how this can be achieved
Creating better doctors: exploring the value of learning medicine in primary care
Elizabeth Newbronner, Rachel Borthwick, Gabrielle Finn, Michael Scales & David Pearson
Education for Primary Care Published Online: 24 Jan 2017
New Chair for the Spice Route Movement
The Spice Route Movement – the young doctor movement for South Asia – has a new Chair. Dr Santosh Kumar Dhungana from Nepal has recently taken over from Dr Bhavna Matta of India, and he is one of this month’s featured doctors in WONCA News. He is currently working in Bayalpata Hospital, Achham, Nepal, where he is the medical director. This hospital is located in a very remote area of far west Nepal, where the government health care structure is almost non-existent.
When it comes to patient engagement design, how do we know where to begin? Stacey Chang compares the task to zebras in the African savanna, whose stripes have a distinct utility. When in a herd, the overlap of stripes creates a confusing pattern, making it difficult for predators to distinguish between one zebra and another. When that herd moves, the pattern becomes even more confusing, and establishing a singular starting point for a predator becomes practically impossible…..more
In 2008, we explored the emergence of private heart hospitals in India whose outcomes rivaled those of top U.S. hospitals (low infection and readmission rates for coronary artery bypass grafting [CABG], angioplasties, and other cutting-edge procedures) at between 1/10 and 1/20 of the cost. We described how Indian hospital leaders exhibited a near-obsessive drive to offer the highest quality services at the lowest possible price. We concluded that even though India is far from a model of social justice in health care, American hospitals could learn a great deal from the organizational focus and structure of their Indian counterparts. We additionally wanted to challenge the preconceived notion in policy discussions that high health care costs were a consequence of high quality and that patients and providers could not economize without diminishing the clinical quality of care…..more
Areas of Agreement and Difference
A direct comparison of recommendations presented in the above guidelines for wound management of diabetic foot ulcers (DFUs) is provided.
IWGDF and SVS/APMA/SVM make strong recommendations for the use of dressing products that maintain a moist wound bed, control exudate and avoid maceration of surrounding intact skin. The guideline developers agree that available evidence does not support the use of any single dressing type (e.g., hydrogels, hydrocolloids, foam dressings, alginates, honey) over another. Dressing selection should therefore be guided by the characteristics of the individual wound, acquisition cost, and ease of use. IWGDF adds comfort to this list. IWGDF recommends against the use of antimicrobial dressings with the goal of improving wound healing or preventing secondary infection. The UHMS guideline does not address wound dressings.
IWGDF and SVS/APMA/SVM agree that sharp debridement of slough, devitalized/necrotic tissue and surrounding callus material should be performed at regular intervals. According to SVS/APMA/SVM, considering the lack of evidence for superiority of any given debridement technique, initial sharp debridement is suggested, with subsequent choice of method based on clinical context, availability of expertise and supplies, patient tolerance and preference, and cost-effectiveness. IWGDF similarly notes that, even though professional opinion is united in support of the use of debridement, the experimental evidence to justify debridement in general and of any particular method of debridement is not strong. Nevertheless, IWGDF makes a strong recommendation on the basis of low-quality evidence for the use of sharp debridement, taking relative contraindications such as severe ischemia into account. The UHMS guideline does not address debridement.
Hyperbaric Oxygen (HBO2) Therapy
There is general agreement among the three guideline developers that HBO2 therapy may be an appropriate adjuvant intervention for selected patients. IWGDF makes a weak recommendation on the basis of moderate-quality evidence for the consideration of systemic HBO2 therapy in order to accelerate healing of DFUs. Further blinded and randomized trials are required to confirm its cost-effectiveness, as well as to identify the population most likely to benefit from its use, notes the guideline developer. SVS/APMA/SVM suggests the use of HBO2 therapy in patients with DFUs who have adequate perfusion that fails to respond to 4 to 6 weeks of conservative management. Considering the cost and the burden of prolonged daily treatment, the developer encourages careful patient selection and suggests the use of transcutaneous oximetry to help stratify patients and predict those most likely to benefit.
HBO2 therapy for the treatment of DFUs is the focus of the UHMS guideline. The developer makes recommendations for its use according to the grade of the DFU in the Wagner wound classification system. UHMS explains that, despite consensus between foot and ankle surgeons and hyperbaric physicians that the Wagner grade is archaic and inadequate, most of the historical and contemporary studies and most reimbursement determinations with regard to the use of HBO2 for DFUs are based on the Wagner DFU wound appearances. In order to reduce the risk of major amputation and incomplete healing, UHMS suggests adding HBO2 to the standard of care in patients with Wagner Grade 3 (deep tissue involvement and abscess, osteomyelitis, or tendonitis) or greater DFUs who have just undergone surgical debridement of the infected foot as well as in patients with Wagner Grade 3 or greater DFUs that have shown no significant improvement after 30 or more days of treatment. The developer suggests against using HBO2 in patients with Wagner Grade 2 or lower DFUs.
BACKGROUND Community health workers (CHWs) can play important roles in primary health care delivery, particularly in settings of health workforce shortages. However, little is known about CHWs’ perceptions of barriers and motivations, as well as those of the beneficiaries of CHWs. In Rwanda, which faces a significant gap in human resources for health, the Ministry of Health expanded its community health programme beginning in 2007, eventually placing 4 trained CHWs in every village in the country by 2009. The aim of this study was to assess the capacity of CHWs and the factors affecting the efficiency and effectiveness of the CHW programme, as perceived by the CHWs and their beneficiaries.
METHODS As part of a larger report assessing CHWs in Rwanda, a cross-sectional descriptive study was conducted using focus group discussions (FGDs) to collect qualitative information regarding educational background, knowledge and practices of CHWs, and the benefits of community-based care as perceived by CHWs and household beneficiaries. A random sample of 108 CHWs and 36 beneficiaries was selected in 3 districts according to their food security level (low, middle and high). Qualitative and demographic data were analyzed.
RESULTS CHWs were found to be closely involved in the community, and widely respected by the beneficiaries. Rwanda’s community performance-based financing (cPBF) was an important incentive, but CHWs were also strongly motivated by community respect. The key challenges identified were an overwhelming workload, irregular trainings, and lack of sufficient supervision.
CONCLUSIONS This study highlights the challenges and areas in need of improvement as perceived by CHWs and beneficiaries, in regards to a nationwide scale-up of CHW interventions in a resource-challenged country. Identifying and understanding these barriers, and addressing them accordingly, particularly within the context of performance-based financing, will serve to strengthen the current CHW system and provide key guidance for the continuing evolution of the CHW system in Rwanda.
BACKGROUND: There is a dire need to expand the capacity of institutions in Africa to educate health care professionals. Family physicians, as skilled all-rounders at district level, are potentially well placed to contribute to an extended training platform in this context. To play this role, they need to both have an understanding of their specialist role that incorporates teaching and be equipped for their role as trainers of current and future health workers and specialists. A teaching and learning capacity-building module was introduced into a new master’s programme in family medicine at Stellenbosch University, South Africa. We report on the influence of this module on graduates after the first six years.
METHODS: A qualitative study was undertaken, interviewing thirteen graduates of the programme. Thematic analysis of data was done by a team comprising tutors and graduates of the programme and an independent researcher. Ethical clearance was obtained.
RESULTS: The module influenced knowledge, skills and attitudes of respondents. Perceptions and evidence of changes in behaviour, changes in practice beyond the individual respondent and benefits to students and patients were apparent. Factors underlying these changes included the role of context and the role of personal factors. Contextual factors included clinical workload and opportunity pressure i.e., the pressure and responsibility to undertake teaching. Personal factors comprised self-confidence, modified attitudes and perceptions towards the roles of a family physician and towards learning and teaching, in addition to the acquisition of knowledge and skills in teaching and learning. The interaction between opportunity pressure and self-confidence influenced the application of what was learned about teaching.
CONCLUSIONS: A module on teaching and learning influenced graduates’ perceptions of, and self-reported behaviour relating to, teaching as practicing family physicians. This has important implications for educating family physicians in and for Africa and indirectly on expanding capacity to educate health care professionals in Africa.
Sicily statement on evidence-based practice. BMC Medical Education, 5(1), 1. Available from: https://www.researchgate.net/publication/8097574_Sicily_statement_on_evidence-based_practice_BMC_Medical_Education_51_1 [accessed Jun 3, 2017].