Practice patterns of occupational medicine physicians in Canada

The objectives of this survey were to identify the practice patterns of Canadian physicians working in the field of occupational medicine and to determine whether the type of certification influences the nature of the work they perform in the field. An Internet-based survey was conducted in September 2015 of members of the Occupational and Environmental Medicine Association of Canada. Eighty-six Canadian-based occupational medicine physicians completed the survey (response rate 36%). These physicians performed a wide variety of tasks (12 ± 6), with few spending most of their time doing a single task. The most frequently performed tasks were fitness-to-work (78%) and return-to-work evaluations (78%). Specialty-trained physicians were more likely to be involved in teaching and research and less likely to be involved in a variety of ability-to-work evaluations.     

Management of non-marital fertility in two South African communities

In this analysis, we draw on qualitative data to examine the management of non-marital fertility among young women in two rural, Black communities situated in different provinces of South Africa: KwaZulu–Natal and Mpumalanga. While the two communities share a history of economic and social disadvantage and limited access to the labour market, there are, nonetheless, distinctive features that are evident in the management of non-marital fertility. We show that young women in both communities aspire to an ideal ordering of events that places finishing education before getting married and having children, but this is not easily attained. However, there are important differences in the ways young women and their families respond to union formation and childbearing that often occurs outside of a recognised union. In Hlabisa, KwaZulu–Natal, formal processes for legitimising non-marital pregnancies through union recognition are still in place whereas, in Agincourt, Mpumalanga, more emphasis is placed on securing support and paternal recognition for the child rather than on cementing the union between the young woman and her partner. We also find that the older generation in Agincourt at times views education as a threat to marriage while this is not common in Hlabisa. Our findings have important implications for intervention programmes that often treat Black communities as homogeneous wholes.     

Blood manganese concentrations among first-grade schoolchildren in two South African cities

Little information exists on the environmental exposures to low levels of organometallic manganese (a principal combustion product from manganese-containing fuel additives) and public health. This study was undertaken to establish biological and environmental levels of manganese among first-grade schoolchildren in the South African cities of Johannesburg and Cape Town. The study was undertaken subsequent to partial introduction of the manganese-containing fuel additive methylcyclopentadienyl manganese tricarbonyl (MMT) to South African petrol in the Johannesburg region only, about 24 months prior to the commencement of the study, and in anticipation of possible future increases in MMT use in the rest of the country. This study involved the measurement of manganese concentrations in the blood of the total number of 814 of grade one schoolchildren (430 and 384 in Cape Town and Johannesburg, respectively), and in water supplies, soil, and classroom dust at a total number of 21 participating schools. The results indicated higher concentrations of manganese in school soil (P=0.0007) and dust (P=0.0071) samples from Johannesburg relative to Cape Town. Similarly, the mean blood manganese concentration in Johannesburg study subjects (9.80 microg/L, SD 3.59) was significantly higher than that in Cape Town study subjects (6.74 microg/L, SD 3.47), after allowing for the clustering effect within schools and adjusting for the confounding effect of population group (P<0.0001). The blood manganese levels of 4.2% and 12.5% of children in Cape Town and Johannesburg, respectively, equaled or exceeded 14 microg/L, the upper normal reference value specified by the Agency for Toxic Substances Disease Registry (ATSDR, 2000). Importantly, levels of manganese in blood were found to be significantly associated with concentrations of manganese in classroom dust at schools.     

Rewards for teaching excellence: practice in South African medical schools

Excellence in teaching through recruitment of good teachers, rewarding good teaching and the creation of staff development programmes are priorities in the mission statement of most universities. Often, reality belies intention. At many universities serious attempts to ensure maximum teacher effectiveness, overt recognition of teaching excellence, and specific development funding are lacking. This study examines the extrinsic (i.e. financial) reward systems which operate at the eight medical schools attached to South African universities and reports on the current situation. Replies indicated that a reward system of some type operates within the university at seven South African universities which have faculties of medicine and embraces all faculties. One university rewards medical school teachers specifically but, at another, no reward system exists at all. The monetary value of rewards varies greatly. Significant criticism of all systems was the inability to meet their design aims. There was criticism of the criteria, such as they are and where they exist, used to identify teaching excellence and to reward recipients. All replies indicated support for an impartial and equitable system of reward for effectiveness and excellence in teaching.     

Re-examining 'professionalism' in pharmacy: a South African perspective

Although defining itself as a patient-centred profession, private sector (community and private hospital) pharmacy often appears to be that of a product-for-profit centred occupation. This perception has been at the core of the medical profession's attempts to reduce the professional autonomy of pharmacy, and has appeared at the forefront of the South African Department of Health's positioning of private sector pharmacy. Using as a starting point the debate surrounding attempts by the South African Minister of Health to regulate the price of medicines, I propose that the present negative positioning of private sector pharmacy in South Africa could be ameliorated by pharmacy practice that evidences a redefined understanding of professionalism.     

The migration decisions of physicians in Canada: The roles of immigrant status and spousal characteristics

Around 25% of practicing physicians in Canada are graduates of medical schools outside of Canada. These physicians are more likely to be working in rural communities, and in particular account for more than half of new physicians starting practice in rural regions. The extent to which particular health regions and provinces are able to retain their physicians is crucial if shortages in the delivery of physician and surgeon services in both the short and longer terms are to be avoided. In this paper, we use data from the confidential master files of the Canadian Census over the years 1991-2006 to study the geographic mobility of immigrant and non-immigrant physicians who are already resident in Canada. We consider both inter- and intra-provincial migration, with a particular focus on migration to and from rural areas of Canada. We exploit the fact that it is possible to link individuals within families in the Census files in order to investigate the impact on the migration decision of the characteristics of a married physician's spouse. Our results indicate that the magnitude of outflows is substantial and that the retention of immigrant physicians in rural areas and in some provinces will continue to be difficult. We find strong evidence that migration is a family decision, and spousal characteristics (education, age, years in Canada for immigrants) are important. As well, we find that large Canadian cities (mainly in Ontario) are the likely destination for the types of immigrant physicians typically able to be recruited to other areas, implying recruitment efforts of smaller provinces may have significant implications for the size of health care costs in larger provinces.     

Attitudes toward tobacco cessation and lung cancer screening in two South African communities

ABSTRACT

Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa.     

A Culture in Transition: Poor Reading and Writing Ability Among Children in South African Townships

Recent international studies shows that South African pupils compare most unfavourable with other countries with regard to literacy and numeracy development. In the present study our aim was to determine the presence of early childhood developmental factors that might play a role in the subsequent poor performance of these children. Children between the ages of five and a half and seven years from six daycare facilities in the informal settlement of Temba (South Africa) were randomly chosen. From each daycare facility, five children were chosen by means of the lottery method. The home language of all of the children was Tswana, one of the 11 official languages in South Africa. The reading and writing readiness checklist was used to gain insight into the reading and writing readiness of the sample group. The test was developed to determine the literacy level of prospective school beginners. Results indicate that these children are ill-prepared for formal education. They reveal inadequate literacy skill, poor sentence construction, poor sense of syntax, and inadequate sound development, and knowledge of the alphabet. They also reveal poor knowledge of sounds especially pertaining to prefixes and suffixes, transposition of sounds within words, and replacement of a sound within a word by another. These results point to a conglomerate pf factors, namely inadequate visual-motor integrative skills, poor visual analysis and synthesis, and poor fine motor development found in children who have been carried on their mothers' backs for excessively long periods (Pretorius et al. In Press). Additionally, they have also been inadequately exposured to mediated reading and writing experiences due to parental non-involvement. Cultural strengths of these black disadvantaged children include adequate gestalt formation, enjoyment of and ability in visual arts, responsiveness to the concrete, expressiveness of gestures and body language, enjoyment of and ability to learn at hand of pictorial and symbolic representations. They also excel in storytelling and singing, and enjoyment of and ability in creative movement, dance, music, and rhythm should therefore be implemented as medium of instruction in the foundational phase.     

Why equity in health and in access to health care are elusive: Insights from Canada and South Africa

Health and access to health care vary strikingly across the globe, and debates about this have been pervasive and controversial. Some comparative data in Canada and South Africa illustrate the complexity of achieving greater equity anywhere, even in a wealthy country like Canada. Potential bi-directional lessons relevant both to local and global public health are identified. Both countries should consider the implications of lost opportunity costs associated with lack of explicit resource allocation policies. While National Health Insurance is attractive politically, Canada's example cannot be fully emulated in South Africa. Short- and medium-term attempts to improve equity in middle-income countries should focus on equitable access to insurance to cover primary health care and on making more use of nurse practitioners and community health workers. In the longer-term, attention is needed to the economic and political power structures that influence health and health care and that ignore the social and societal determinants of sustainable good health locally and globally. This long-term vision of health is needed globally to achieve improvements in individual and population health in a century characterised by limits to economic growth, widening disparities, continuing conflict and migration on a large scale and multiple adverse impacts of climate change.     

A Culture in Transition: Poor Reading and Writing Ability Among Children in South African Townships

Recent international studies shows that South African pupils compare most unfavourable with other countries with regard to literacy and numeracy development. In the present study our aim was to determine the presence of early childhood developmental factors that might play a role in the subsequent poor performance of these children. Children between the ages of five and a half and seven years from six daycare facilities in the informal settlement of Temba (South Africa) were randomly chosen. From each daycare facility, five children were chosen by means of the lottery method. The home language of all of the children was Tswana, one of the 11 official languages in South Africa. The reading and writing readiness checklist was used to gain insight into the reading and writing readiness of the sample group. The test was developed to determine the literacy level of prospective school beginners.

Results indicate that these children are ill-prepared for formal education. They reveal inadequate literacy skill, poor sentence construction, poor sense of syntax, and inadequate sound development, and knowledge of the alphabet. They also reveal poor knowledge of sounds especially pertaining to prefixes and suffixes, transposition of sounds within words, and replacement of a sound within a word by another. These results point to a conglomerate pf factors, namely inadequate visual-motor integrative skills, poor visual analysis and synthesis, and poor fine motor development found in children who have been carried on their mothers' backs for excessively long periods (Pretorius et al. In Press). Additionally, they have also been inadequately exposured to mediated reading and writing experiences due to parental non-involvement.

Cultural strengths of these black disadvantaged children include adequate gestalt formation, enjoyment of and ability in visual arts, responsiveness to the concrete, expressiveness of gestures and body language, enjoyment of and ability to learn at hand of pictorial and symbolic representations. They also excel in storytelling and singing, and enjoyment of and ability in creative movement, dance, music, and rhythm should therefore be implemented as medium of instruction in the foundational phase.     

Gender norms in South Africa: implications for HIV and pregnancy prevention among African and Indian women students at a South African tertiary institution

In post‐Apartheid South Africa, women are constitutionally guaranteed protections and freedoms that were previously unknown to them. These freedoms may have positive implications for women's ability to negotiate sexual protection with partners and hence prevent unintended pregnancy and decrease their risk of HIV. Among tertiary institution students, who are a relatively ‘privileged’ group, there is little information on gender norms that might shape responses to HIV‐prevention programmes. To elicit gender norms regarding women's and men's roles, condom and contraceptive use, sexual communication and sexual pleasure, we conducted 10 semi‐structured focus group discussions with African and Indian female tertiary institution students in order to understand how norms might be used to buttress HIV‐ and pregnancy‐prevention. Participants reported dramatic changes in the structure of gender norms and relations with the formal recognition of women's rights in the post‐Apartheid context. These generational shifts in norms are supported by other research in South Africa. At the same time, women recognized the co‐existence of traditional constructions of gender that operate to constrain women's freedom. The perceived changes that have taken place provide an entry point for intervention, particularly for reinforcing emerging gender norms that promote women's protection against unintended pregnancy and HIV/STIs.     

Revisiting the dynamics of early childbearing in South African townships

In South Africa over the last two decades, births to girls under the age of 20 years of age have steadily declined. The reason for the decline has been attributed to progressive social and educational policies and more accommodating reactions from families. This paper uses ethnographic data collected in 2001–2002 and again in 2013 in order to compare young women's perceptions and experiences of early childbearing at the turn of the twenty-first century with those of young women a decade later. It makes two main contributions to the literature on early childbearing in South Africa. First, it provides insight into the changes that have occurred regarding how young women experience pregnancy and motherhood over the last decade. Second, it considers changes not only in relation to time but also in relation to the significant social and ideological changes.     

Specialist training of family physicians in non-UEMO countries: An Estonian experience

ABSTRACT

Background: Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress.

Objective: Physicians have an active role in home healthcare services. The present study was performed to examine physicians’ attitudes toward this service in detail.

Methods: Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed.

Results: Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important.

Conclusion: The current study underlines physicians’ interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.     

南非国家药物政策分析及对我国的启示

分析南非国家药物政策(National Drug Policy,NDP)制定的背景、过程、目标、内容、措施,并结合我国当前药品领域存在的问题,从健全法律法规、建立目标责任明确的组织机构、加强教育培训促进合理用药、重视发展本国制药业、完善基本药物制度等5个方面,提出制定我国国家药物政策的建议。     

Symptoms of distress and posttraumatic stress among South African former political detainees

Considerable debate has centred on the question of traumatisation among individuals who have survived human rights violations in societies that have undergone political conflict. In order to gain an estimate of the extent of long-term traumatisation among political activists who experienced torture and abuse in detention during the apartheid era in South Africa, a sample of 148 survivors of such experiences were recruited in a cross-sectional study and asked to complete the Hopkins Symptom Checklist (HSCL), the Impact of Event Scale (IES), and the Trauma Symptoms section of the Harvard Trauma Questionnaire (HTQ). The proportions of the sample that scored above the clinical cut-points on these measures were calculated. On the HSCL, 14.19% of the sample scored above the cut-point for clinical significance of 44; on the IES, 17.57% scored above the clinical cut-point of 44; and on the HTQ, 37.83% scored above the cut-point of 75. Moreover, the sample's mean scores were significantly higher than the cut-point for clinically significant distress on the HSCL (p < 0.001); significantly lower than the cut-point for severe traumatisation on the IES (p < 0.001); and non-significantly lower than the cut-point for clinically significant traumatisation on the HTQ (p = 0.074). These results are considered in terms of current theoretical debates on the relevance and applicability of posttraumatic stress disorder as a circumscribed nosological entity in developing countries that are in the process of coming to terms with a history of political conflict.