Maternal mental health and caregiver competence of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa.

BACKGROUND: Maternal mental health during the perinatal period has been of interest to many researchers, with antenatal depression and postnatal depression (PND) being a leading cause of morbidity. The adverse effects of maternal depression on the offspring throughout infancy, childhood and adolescence are well documented. Studies on the mental health of persons living with HIV have also reported a high prevalence of depression. OBJECTIVES: To describe the prevalence of PND in a sample of HIV-positive and HIV-negative mothers delivering healthy singleton infants at one obstetric unit in KwaZulu-Natal (KZN) Province, South Africa, and the subsequent factors influencing neonatal behaviour and perceptions of caregiver competence. Correlations between the presence of PND and perceptions of caregiver competence (with the mother as caregiver), and between infant behaviour, the mother's confidence in her competence as caregiver, and demographic and medical variables, were also examined. METHODS: Demographic and clinical data were collected from 132 mothers at initial contact and from 32 mothers at the 6-week follow-up appointment. Mothers independently completed the Edinburgh Postnatal Depression Scale at each time point, and the Mother and Baby Scales (MABS) at the 6-week follow-up appointment. RESULTS: The prevalence of depression among all mothers at initial contact was 72.0%, remaining high (68.8%) among the mothers who returned for follow-up. There was a statistically significant correlation between depression and employment at follow-up (p=0.013), and between depression and delivery method (p=0.030). The majority of mothers reported being 'able to laugh and see the funny side of things' and 'looking forward with enjoyment to things' at initial contact and follow-up. Thoughts of self-harm were reported by 44.7% of mothers at baseline, and by 53.1% at follow-up. Although most infants scored in the average clinical band for neonatal behavioural factors in the MABS, mothers reported lack of confidence, globally and in caring for their infant. CONCLUSION: This study of maternal mental health of a sample of HIV-positive and HIV-negative mothers of infants in KZN revealed a higher prevalence of PND than reported in other studies. This population of mothers and infants is at risk of adverse outcomes of maternal depression, in addition to other possible risk factors.

Blood product utilisation for coronary artery bypass graft surgery at a public and a private hospital in Western Cape Province, South Africa.

BACKGROUND: Numerous studies have documented variation in transfusion practice for coronary artery bypass graft (CABG) surgery, despite the widespread availability of clinical guidelines. Blood management systems seek to streamline utilisation, with key indicators being patient care and outcome as well as reduction of waste and cost. OBJECTIVES: To facilitate this view, this study sought to audit blood product utilisation for CABG surgery at a private and a public sector hospital in Western Cape Province, South Africa. METHODS: A retrospective audit of 100 consecutive patients undergoing CABG surgery at a private and a public hospital during 2017 was performed. Blood product use was compared between the two hospitals, and the influence of confounding factors such as gender, weight, age, pre- and intraoperative medications, type and complexity of the procedure, and patient comorbidities was analysed. RESULTS: The proportion of patients receiving red cell concentrates (RCCs) at the public hospital was significantly higher than at the private hospital (92% v. 56%; p<0.001), which resulted in significantly higher postoperative haemoglobin concentrations (p<0.001). Although the increased proportion of RCC transfusion observed at the public hospital may have been influenced by decreased body mass (p<0.001), the patient population at the private hospital was older (p<0.05) and had higher rates of ischaemia (p<0.001), increased numbers of grafts (p<0.001) and higher preoperative use of aspirin (p<0.05). CONCLUSIONS: This study demonstrated increased use of blood products at the public hospital, despite performing fewer grafts. Although this study had limitations, which included low patient numbers and the inclusion of only two hospitals, we concluded that there is a significant variation in the use of blood products despite the risks associated with blood transfusion. These findings could be used to employ systems that will lead to improved blood usage practices.

The Effect of a Non-Powered, Self-Initiated Mobility Program on the Engagement of Young Children with Severe Mobility Limitations in the South African Context.

AIM: To determine the effect of a non-powered, self-initiated mobility program on the engagement of young children with severe mobility limitations, in the South African context. METHODS: A multiple-probe-across-participant design was used. Four children (aged 2-6 years) with severe mobility limitations underwent an intervention that targeted non-powered, self-initiated mobility. The intervention comprised eight sessions over a 2-week period. Engagement was measured during each baseline, intervention and postintervention session using the Individual Child Engagement Record-Revised (ICER-R). The data were presented graphically and analyzed using statistical procedures appropriate for single-subject designs. RESULTS: Participants demonstrated an improvement in engagement during the time in which non-powered, self-initiated mobility program was introduced. A reciprocal deterioration in nonengagement was also demonstrated. The results of the study are discussed in terms of various intrinsic and extrinsic factors. CONCLUSIONS: The use of a non-powered, self-initiated mobility program may be effective in improving engagement in some young children with severe mobility limitations.

The management of infant developmental needs by community nurses. Part 1: description of the responsibilities of community nurses with regard to the management of infant developmental needs.

This article is one of two that describes the responsibilities of community nurses, according to their legal scope of practice, with regard to the management of developmental needs of infants in primary health care clinics in South Africa. A subsequent article describes the development of guidelines for the support of community nurses to address the developmental needs of infants 0-2 years. While evidence confirms that developmental surveillance should be incorporated into the ongoing health care of the infant, such services are not consistently provided in health care settings and, if provided, the delivery thereof suffers from significant inadequacies. A case study strategy was used to investigate the phenomenon and content analysis utilised to analyze the data. The Transactional Model of Development was selected to interpret the data obtained in the study. Findings of the study show that infant developmental care is not included to its fullest potential in the health care delivered to infants and their families, thereby indicating that community nurses do not meet the standards of the profession with regard to the management of infant developmental needs. Health service managers need to review their commitment and type of support to community nurses, if infant developmental care, as part of community nurses' responsibilities, is to be effective and of high quality. Furthermore, community nurses and other health care professionals must recognize the nature and potential of inter-professional collaboration to ensure positive outcomes for infants with developmental delays and disabilities.

The management of infant developmental needs by community nurses. Part 2: the development of guidelines for the support of community nurses in the management of infant developmental needs.

In the previous article, the author described, according to the scope of practice of registered nurses, the responsibilities of community nurses with regard to the management of infant developmental needs in primary health care clinics in South Africa. In this article, the focus is on the development of guidelines for the support of community nurses in fulfilling these responsibilities. Before the development of the guidelines is addressed, a brief overview of the background of the study, assumptions of the researcher and the methodology of the study is given. The development of the set of guidelines (DEFINE HOPE) is set against the background of the drive to improve the quality of developmental care for infants and their families. As guidelines help to translate scientific information into statements, it could be valuable to community nurses to improve their delivery of developmental care. To gather evidence for the formulation of the guidelines, the researcher utilised the themes identified during the analysis process in phase one of the research; investigated research articles; and compared findings and recommendations of the articles with the research findings obtained in phase one. In addition to the research findings and literature review, a focus group (health care professionals represented in the case study), was utilised to assist with the final development and validation of the guidelines. The researcher adapted a number of desirable attributes for guidelines, which are indicated in the literature, to compile the criteria for validation of the guidelines. In conclusion, guidelines are necessary to support community nurses in finding "best practice" within their scope of practice to ensure higher quality of developmental care to families with infants 0-2 years.

Maternal self-efficacy and maternal perception of child language competence in pre-school children with a communication disability.

BACKGROUND: The aim of this study was to describe maternal self-efficacy beliefs within the parenting domain and maternal ratings of pre-school children's language abilities, where the child has a communication disability. The association between these two constructs was also investigated. METHOD: Twenty-five mothers completed a questionnaire consisting of two subsections: parental self-efficacy and maternal rating of child language ability. Convenience sampling was used, and mothers with children attending four special-education schools in the Pretoria area consented to participate in the study. RESULTS: The results revealed that mothers generally had high self-efficacy beliefs within certain parenting roles, in spite of the fact that their child has a communication disability. The lowest competence was reported in discipline and teaching roles. In addition, mothers' reports of patterns of child ability correlated with what has been written in the literature. Correlation statistics generally revealed weak association between the constructs, with the strongest association between the parental domain of discipline and maternal reports of their child's receptive language abilities. CONCLUSIONS: Possible reasons for the weak correlation values are proposed. These include factors that may alter the way parents of children with disabilities construct and maintain self-efficacy beliefs; as well as the fact that the two sections of the questionnaire measure maternal appraisals at two very different levels (objective observations and evaluative self-regulatory processes).

Reproducibility of a histogenetic classification of thymic epithelial tumours.

A histogenetic classification of thymic epithelial neoplasms proposed by Müller-Hermelink and co-workers has been shown by a number of recent studies to be of clinical and prognostic value. Reproducibility is an important criterion for the acceptance of any new classification for general diagnostic use. The reproducibility of this classification was tested on 51 cases of thymic epithelial neoplasia, by comparing results obtained by pathologists working from published criteria only with those results obtained by the pathologists who developed the classification. In 78% of cases there was complete concordance of results. Analysis of the 22% discordant cases showed that this discordance was due to a degree of subjectivity in determining cut-off points between categories adjacent to each other in the morphological spectrum of thymic epithelial neoplasia (medullary v. mixed, cortical v. well-differentiated thymic carcinoma). In terms of the important clinical distinction between benign (medullary and mixed) thymomas and those with more aggressive biological behaviour (cortical types and well-differentiated thymic carcinoma), the degree of reproducibility was 96%. The high degree of reproducibility of this histogenetic classification of thymic epithelial neoplasms should facilitate its acceptance and use in routine diagnostic pathology.

Coronary artery plaque rapidly induced by local electromagnetic stimulation in the baboon.

A reliable method has been developed to produce stenosis of the right coronary artery of baboons as a consequence of electrostimulation of the vessel at a chosen position. At that site a pair of electrodes were implanted and activated with a train of 9-volt pulses (length: 10 ms, separation: 100 ms) for 30 min, 5 days/week, up to 6 weeks. 13 animals were included in the experiment, 2 of those served as controls. Pathohistologically the structure of the artificially produced constrictions is similar to atherosclerotic lesions. On average the stenoses occupied 55% of the available lumen; total occlusion and no stenosis were observed in 1 case each.

Congenital hemangiopericytomas of skin.

A case of multiple congenital hemangiopericytomas of skin treated by surgical excision is presented. No recurrence of the lesions has occurred after a period of 2 years.

Sinus histiocytosis with massive lymphadenopathy. Report of a case associated with necrosis.

We describe a case of a 21-year-old man who had a generalized lymphadenopathy and arthritis. Inguinal and cervical lymph nodes showed changes typical of sinus histiocytosis with massive lymphadenopathy. Extensive coagulative necrosis of the intrasinusal histiocytes is described, a feature which, to our knowledge, is unreported previously.

The significance of left ventricular volume measurement after heart transplantation using radionuclide techniques.

Multigated equilibrium blood pool scanning using Technetium 99m labeled red blood cells was used to measure left ventricular volumes in three heterotopic and one orthotopic heart transplant recipient(s). Simultaneously, an endomyocardial biopsy was performed and the degree of acute rejection was assessed by a histological scoring system. The scores were correlated to changes in ejection fraction and heart rate. Technetium 99m scanning data were pooled according to the endomyocardial biopsy score: no rejection; mild rejection; moderate rejection, and severe rejection. In each group, the median of the left ventricular volume parameters was calculated and correlated with the endomyocardial biopsy score, using a non-parametric one-way analysis of variance. A decrease in stroke volume correlated best with the endomyocardial biopsy score during acute rejection. A decrease in end-diastolic left ventricular volumes did not correlate as well. Changes in the end-systolic left ventricular volumes were not statistically significant, but using a simple correlation between end-systolic left ventricular volumes and endomyocardial biopsy the correlation reached significance. Changes in left ventricular volumes measured by Technetium 99m scanning may be useful to confirm the presence or absence of acute rejection in patients with heart grafts.

Pathologic findings in long-term cardiac transplants.

Since the introduction of cardiac transplantation at our institution 15 years ago, major advances have occurred in the monitoring and treatment of these patients, resulting in many long-term survivors. We defined the pathologic features in 14 cardiac transplants with survival times longer than one year. Only one heart showed no evidence of rejection, while the remaining 13 hearts showed advanced chronic rejection, which was the main cause of death or of graft failure in 11 patients. One patient died of gastric carcinoma, one of Kaposi's sarcoma, and one of cerebral embolus. The most obtrusive change in the donor hearts was an obliterative arteritis, which in the epicardial coronary arteries mimicked atherosclerosis. Superadded thrombosis often resulted in myocardial infarction. These severe vascular lesions bore no constant relationship to survival time and took from 1.1 to 12.5 years to evolve.

Prediction of acute cardiac rejection using radionuclide techniques.

Radionuclide scanning of the donor left ventricle using technetium-99m-labelled red cells was used to monitor acute rejection after heterotopic heart transplantation and compared with histopathological evidence of rejection obtained at examination of an endomyocardial biopsy specimen. The ejection fraction and end-diastolic, end-systolic and stroke volumes were calculated at each examination; an equation was derived from these data to predict the degree of acute rejection, using histopathological examination of endomyocardial biopsy specimens as criteria of the presence and severity of rejection. A highly significant multiple correlation between radionuclide scanning parameters and endomyocardial biopsy was found. The advantages of non-invasive radionuclide scanning over the invasive procedure of endomyocardial biopsy are discussed.

Infectious complications after heart transplantation.

Infection has been the major cause of death and morbidity in patients undergoing cardiac transplantation at Groote Schuur Hospital. Twenty-two (55%) patients suffered at least one major episode of infection, which accounted for 10 (59%) of the deaths in the first year. The major site of origin of infection was the lung, though dissemination was not infrequent. Bacteria accounted for 22 (59%) infections; but viral, fungal and protozoal infections were not uncommon and in fact accounted for seven (64%) of the fatal infections. Several unusual causative microorganisms have been isolated in this group of immunocompromised subjects. There is a higher incidence of infection in patients over the age of 35 years and in patients who did not comply with instructions and advice.

Angiosarcoma of the superior vena cava.

The first reported case of an angiosarcoma apparently arising from the superior vena cava is presented. The patient, a 20-year-old white man, was treated by surgical excision and reconstruction with dacron grafts from the left and right brachiocephalic veins to the right atrium. This was followed by a course of mediastinal irradiation. The patient remained clinically disease-free at 24 months post-treatment. The patient had occasional occupational exposure to polyvinyl chloride.

Toxoplasmosis of donor and recipient hearts after heterotopic cardiac transplantation.

Toxoplasmosis of both donor and recipient hearts was diagnosed by means of endomyocardial biopsy specimens after heterotopic cardiac transplantation for dilated cardiomyopathy. Before transplantation, the donor had raised antibody titers to Toxoplasma, and the recipient was negative. When toxoplasmosis was diagnosed on the basis of endomyocardial biopsy specimen, the recipient had a greatly elevated antibody titer of 1:1,027. This suggests that the infection could have been transferred with the donor heart. The mononuclear cell response elicited by disrupted toxoplasmic cysts interferes with the diagnosis of rejection in graft biopsy specimens. Electron microscopy is valuable in confirming a light microscopic diagnosis of toxoplasmosis. Drug therapy eradicated the toxoplasmosis, but the patient died later of tuberculous meningitis.

Technique, complications, and clinical value of endomyocardial biopsy in patients with heterotopic heart transplants.

A review of 157 consecutive biopsies of donor endomyocardium in patients with heterotopic heart transplants is reported. The technique of percutaneous transvenous endomyocardial biopsy after this operation is described; manipulation of the catheter and bioptome into the junction of the donor superior vena cava and right atrium can be difficult when this anastomotic junction is small, as a result either of operative surgical technique or of subsequent contraction. The complication rate was 4%, but one patient may have died from infection resulting from biopsy when the bioptome had to be introduced at the groin. The histopathological changes seen in the biopsy specimens have been graded according to a scoring system to give the clinician a guide to the severity of rejection. Histopathological assessment was of clinical value in 96% of cases, but was inaccurate on two occasions, once because an opinion was given on what was in retrospect an inadequate sample. In patients undergoing persistent low-grade acute or chronic rejection there was difficulty in detecting or appreciating the true extent of myocardial fibrosis; this led to inadequate immunosuppressive treatment in two patients. Attention is drawn to the fact that ischaemic fibrosis resulting from the vascular changes of chronic rejection may spare the endomyocardium, which is kept viable by intracavitary blood, and that this may lead to a misleading histopathological report.