Relevance of food‐based dietary guidelines to food and nutrition security: A South African perspective

Food‐based dietary guidelines are often developed at country level to assist in bringing dietary intakes closer to nutrient intake goals and, ultimately, to prevent nutrition‐related diseases. However, high food prices, alongside growing inflation, increasingly restrict food choices. This can leave those who are already vulnerable and less well off more exposed to the associated health implications of a nutrient deficient diet. With food and nutrition security being a high priority on the global nutrition agenda, this paper explores the feasibility of food‐based dietary guidelines to assist in improving food and nutrition security, focusing on nutritionally vulnerable groups in South Africa. It is argued that increased food prices, together with population growth, urbanisation and inflation, constrain everyday healthy food choices of a large proportion of South Africans. The South African food‐based dietary guidelines released in 2012 advocate the consumption of a daily diet containing a variety of foods. Unfortunately, even when the most basic and low‐cost food items are selected to make up a recommended daily diet, the associated costs are well out of reach of poor individuals residing in South Africa. The average household income of the poor in South Africa equips many households to procure mainly low‐cost staple foods such as maize meal porridge, with limited added variety. Although the ability to procure enough food to maintain satiety of all family members might categorise them as being food secure, the nutritional limitations of such monotonous diets may have severe implications in terms of their health, development and quality of life. Food‐based dietary guidelines alone have little relevance in such circumstances where financial means limit food choice. Alternative interventions are therefore required to equip the poor to follow recommended healthy diets and to improve individual food intake and nutrition security.     

Experiences of African American Mothers Following the Death of Their Infants

ObjectiveTo explore the lived experiences of African American mothers after the death of their infants.DesignQualitative, interpretive phenomenologic study.SettingNortheast Louisiana.ParticipantsSeven self-identified African American women whose infants died during the first year of life; the women’s ages ranged from 18 to 38 years at the time of the infant’s death.MethodsHeidegger’s interpretive phenomenologic approach guided the data collection and analysis. The women were interviewed using in-depth questioning to determine the meaning of the infant loss experience and their subsequent efforts to cope.ResultsSix themes represented the experiences of loss for the mothers: Shattered Dreams, Questioning God, Dissociation, Paralyzing Fear, Left in the Dark, and Uniqueness of Grieving. Three themes affected the women’s efforts to cope after their loss: Authentic Presence, Spiritual Empowerment, and Disconnectedness.ConclusionAfrican American women who experienced infant death described intense feelings of loss, guilt, and isolation. These negative emotions can potentially affect their physical and psychological health. These findings may help health care providers develop culturally sensitive understanding of African American mothers’ experiences of loss and equip providers to provide holistic assessment, appropriate support, and treatment for these vulnerable women.     

Recent Evidence of Hantavirus Circulation in the American Tropic

Hantaan virus was discovered in Korea during the 1970s while other similar viruses were later reported in Asia and Europe. There was no information about hantavirus human infection in the Americas until 1993 when an outbreak was described in the United States. This event promoted new studies to find hantaviruses in the Americas. At first, many studies were conducted in Brazil, Argentina, Chile, Uruguay and Paraguay, while other Latin American countries began to report the presence of these agents towards the end of the 20th century. More than 30 hantaviruses have been reported in the Western Hemisphere with more frequent cases registered in the southern cone (Argentina, Chile, Uruguay, Paraguay, Bolivia and Brazil). However there was an important outbreak in 2000 in Panama and some rare events have been described in Peru, Venezuela and French Guiana. Since hantaviruses have only recently emerged as a potential threat in the tropical zones of the Americas, this review compiles recent hantavirus reports in Central America, the Caribbean islands and the northern region of South America. These studies have generated the discovery of new hantaviruses and could help to anticipate the presentation of possible future outbreaks in the region.     

Splenic Artery Embolization after Delayed Splenic Rupture Following Blunt Trauma: Is Nonoperative Management Still an Option in This Cohort?

Patients treated with splenic artery embolization (SAE) >48 hours after a blunt injury for a delayed splenic rupture (DSR) were assessed for the need for a subsequent splenectomy. Thirty-four patients underwent SAE for DSR over 10 years at our level 1 trauma center, performed at a median of 4.5 days after the injury (interquartile range = 5.5), and the patients were followed up for a median of 11 months (interquartile range = 31). There were 3 occurrences of rebleeds, and 2 patients required splenectomy (5.9%). This study showed that treatment with SAE after DSR results in splenic salvage in 94.1% of patients.     

Preoperative Management of Endocrine,Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplinary membership to improve evidence-based perioperative care. SPAQI seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this Consensus Statement is to provide practical guidance on the preoperative management of endocrine, hormonal, and urologic medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then utilized a modified Delphi approach to critically review the literature and generate consensus recommendations.     

The introduction of umbilical cord lactate measurement and associated neonatal outcomes in a South African tertiary hospital labor ward

Purpose: To investigate the utility of umbilical artery (UA) lactate measurements in a South African hospital for assessing intrapartum care and predicting neonatal outcomes.

Materials and methods: From 3 March–12 November 2014, we conducted a prospective cohort study of UA lactate levels at Kalafong Hospital, Pretoria, South Africa. Following birth, a UA blood sample (<0.5uL) was taken from a double-clamped segment of cord and the lactate measured. Maternal and neonatal characteristics and outcomes were recorded.

Results: During the study, there were 4668 deliveries; including 1091 emergency cesarean and 154 instrumental deliveries. A lactate was recorded for 946 deliveries (20.3%). 190 babies required neonatal resuscitation, with an optimal cutoff for lactate of 5.45?mmol/L (sensitivity 68%, specificity 72%). 124 babies required nursery admission with the optimal cutoff for lactate 4.95?mmol/L (sensitivity 61%, specificity 59%). 55 babies had an Apgar score <7 at 5?min and the optimal lactate for this outcome was 5.65?mmol/L (sensitivity 64%, specificity of 69%).

Conclusions: Umbilical lactate can be used in a middle-low resource setting as a measurement of intrapartum hypoxia, with reasonable sensitivity and specificity for the prediction of, or need for, resuscitation, admission to the nursery, and low Apgar scores.     

Frailty and health service use in rural South Australia

BackgroundFrailty is a common geriatric condition, well known to contribute to morbidity and mortality. What is not yet well articulated in the literature is the health service use of frail older people in rural areas. This study investigated the impact of frailty on health service use in rural South Australia.MethodsThis secondary cross-sectional analysis included people aged ≥65 years from the LINKIN health census in Port Lincoln. Frailty was classified using a Frailty Index (FI) score ≥0.25. Health service use was determined by patient questionnaire. All regression analyses controlled for age, gender and education level.Results1501 people [mean (SD) age = 75.9 (7.9)] years were included. Frailty prevalence was 25%, with this prevalence higher in females (29%) than in males (21%). Compared with their non-frail peers, frail adults were more likely to have consulted health providers, including: general practitioners (GPs) (odds ratio (OR), 95% confidence interval (CI = 2.09, 1.24–3.53); physiotherapists (OR, CI = 2.42, 1.80–3.25); mental health providers (OR, CI = 2.88, 1.42–5.85); community nurses (OR, CI = 2.57, 1.73–3.82); and dieticians (OR, CI = 2.77, 1.77–4.48). They were also more likely to have visited a health professional prior to a problem occurring (OR, CI = 1.51, 1.08–2.11), travelled to the city for a specialist appointment (OR, CI = 1.53, 1.11–2.11), and to have been hospitalised in the previous 12 months (OR, CI = 2.39, 1.74–3.29).ConclusionFrail older adults were more likely to use several health services, yet often had unmet needs in their health care.     

Strategies to destigmatize mental illness in South Africa: Social work perspective

Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers’ perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.